Paperless?

I came into adulthood in the era when utilities, companies that provided services, and those that extended credit used the U.S. Mail to send an invoice. In most cases the invoices came at the end of the month and it was expected that you paid them within ten days or so. The method of payment was to write a check and use the enclosed envelope to return the payment by mail. I don’t remember the postage rate exactly, but it was probably somewhere between ten and fifteen cents when we began our married life. Large companies had access to lower postage rates by presorting the invoices.

I’m not unhappy that business is making a transition from that system. It is very convenient for me to pay bills electronically by using the computer and the Internet to transfer money from my checking account to the businesses with whom I do business. I like the convenience of automatic payments that are set up in advance and allow for important bills such as our mortgage, insurance and utilities to be paid on time without every experiencing a delay. Having things like that set up also makes it much easier to travel. I don’t have to worry about checking the mail in order to keep up with payments that need to be made.

More and more businesses are getting into electronic and paperless billing systems. Usually it works fairly flawlessly, but occasionally there are small glitches. I’ve been paying attention to the glitches in the area of medical bills lately. We’ve been more aware of medical expenses since my wife’s hospitalization this fall.

We are covered by medicare and we have a very good supplementary insurance to cover other medical expenses. Although we don’t fully understand the system, we are aware that the process begins with the health care provider sending bills to Medicare and to our supplementary carrier. Medicare is the primary insurance, so they respond first. They send the provider a check, but they don’t just pay the bill. They discount the amount billed to another figure. This not only decreases the medicare portion of the payment, but also the amount remaining to be paid by the other carrier. The bill is then processed by the supplementary insurance company which also applies discounts. We receive explanation of benefits statements from Medicare and from the insurance company which, if carefully studied, eventually tell us what portion of the bill we are supposed to pay. A bill that starts out at $1,500, for example may result in a total payment to the provider of perhaps $800, with the portion that we pay being $20. It takes a couple of months or more for all of the paperwork exchanges to be made before we finally know what we are supposed to pay. Although we have signed up for “paperless” billing, we will receive multiple invoices, explanation of benefits sheets, and other pieces of paper in the mail from the insurance company and from the health care providers.

A week ago, I received notice from a health care provider that the process on one bill had been completed and it was time for me to make a payment. The amount was small, less than $30. I immediately used the provider’s online payment method to make a transfer from my checking account and pay my portion of the bill. I was pleased with how well the process went and how easy it was to make a payment. The amount I paid was exactly the amount the explanation of benefits report from the insurance company said I should pay. Then, yesterday, I received a paper statement from the provider in the mail for the amount that I paid electronically. Since I have already paid the bill, I filed the statement together with the explanation of benefits and a hand-written note to myself with the date of the electronic payment. I know that the provider will catch up with the payment eventually.

I’m a bit annoyed with the simple fact that “paperless” doesn’t mean “without paper.” There is still a lot of paper involved in the process. With many providers it doesn’t even mean less paper. But I am more deeply troubled by the huge inefficiency of the system. I know that with the costs of paper, envelopes, mail and especially the costs of people to operate the computers, it cost the provider way more than $30 to collect the fee from me. I don’t know what portion of medical costs is wrapped up in the inefficiencies of the billing and payment system, but I know it is a lot. Our local hospital, for example, sends statements from Denver, which means that they have contracted with an independent business just for the process of billing and collections. Those services are not inexpensive.

It is virtually impossible to determine how much this inefficiency costs consumers in part because there is no one in the system who can explain the amounts that are billed. It appears that initial statements are simply huge numbers created in order to make income from receiving a partial payment. As valuable as my wife’s trip to the hospital was, it probably never had a fair market value of over $100,000 which was the number for just the hospitalization that appeared on the first statement. The process doesn’t begin with real numbers, just fantasy numbers. No one can say why that number was chosen, as opposed to one that might vary as much as 50 or 60 percent. I’m guessing that the hospital spends more than 10% of its operating budget on the costs of negotiation and billing. That would be more than $10,000 on a single hospitalization. It is, of course, only a guess because there is no one who actually knows the real numbers. Hospitals don’t operate in the arena of real numbers.

So we have a very thick file of paper to document our encounters with the medical providers. Thank goodness we’ve gone paperless. I can’t imagine what it would be like if we weren’t using their “paperless” electronic billing system. We’d need a separate filing cabinet just for two weeks over the end of September.

Copyright (c) 2019 by Ted E. Huffman. I wrote this. If you would like to share it, please direct your friends to my web site. If you'd like permission to copy, please send me an email. Thanks!

Too many deaths

At a board meeting yesterday, we were discussing the statistics for our community for the preceding month. Four deaths by suicide isn’t high enough to make us think it is unusual any more. In fact, our average is slightly higher than that number. After our conversation, as I was driving home, I felt increasingly alarmed at our attitude during our discussion. We may be becoming callous about the deaths of our neighbors. Death by suicide is so common that those of us who pay attention to our statistics have lost our sense of outrage. I don’t want to get to the point where I am no longer shocked by unnecessary death. I’m not saying that every death by suicide is preventable. I don’t think we possess the knowledge and resources to prevent every suicide death. But we ought to be able to make a difference and decrease the number of deaths.

I still run into people who believe that the United States has the world’s longest life expectancy. For those who haven’t looked at the data, it is easy to assume that our country is Number 1 on everything. But that simply isn’t true. For decades U.S. life expectancy has been below that of other advanced countries. And that gap is increasing dramatically. The widening “death gap” is the result in increased mortality among working-age American, largely due to what has been deemed “deaths of despair”: drug overdoses, suicides and alcohol. As the number of deaths from these causes rises, overall life expectancy for Americans has fallen every year for decades.

These deaths are not evenly distributed throughout the United States, however. A 2018 article in the Journal of the American Medical Association provided information on state by state changes in health and life expectancy. The divergence among states is striking. In 1990, Texas and Florida had higher life expectancy than New York and about the same as California. Today those two states are far behind. Life expectancy in New York and California continues to rise while it is falling in Texas and Florida. Our state, South Dakota, parallels Texas and Florida. Our health statistics were behind more populated regions of the country already and we have continued to see dramatic increases in deaths of working-age adults.

It is difficult to explain the divergence in the various states. Public policy is part of the picture. States that have expanded Medicaid and have taken action to decrease the number of uninsured people have seen increases in overall health. Our state has not taken any action to address those without insurance and remains near the top of states when it comes to the percentage of our population who are without insurance.

Being without insurance is not simply a matter of having less contact with health care providers, which is definitely true. It also means that we lead the nation in bankruptcies as a result of unpaid medical bills. The financial devastation of families due to the inability to pay for health care could be a factor in the increase in despair and a subsequent increase in death by addiction and suicide. Those connections, however, are largely speculative. Little or no solid research has been conducted into the reasons behind the disparity in states when it comes to increasing mortality.

Conservative leaders have argued that the rise in mortality is caused by the lack of traditional values. Attorney General William Barr has blamed what he calls “militant secularists.” He says that secularists attack traditional values and that is what lies behind soaring suicide rates, rising violence and a deadly drug epidemic. The statistics, however, don’t back him up, however. European nations, which are far more secularist than the United States have not see a comparable rise in deaths of despair and a decrease in life expectancy that the United States has experienced. And within the United States, the states that appear to be more urban and secular have better statistics than those with more traditional values. South Dakota is a conservative state. We are about as conservative politically as a state can get. Our legislature and our people have resisted attempts to increase secularism. Last year our state legislature mandated that every public school in the state display the national motto, “In God We Trust.” The law specifies the size of the letters and the locations where the motto is to be displayed. It is too soon to have comprehensive statistics, but so far there is no evidence that the displays have had any effect on rising teen suicide and drug-related deaths. South Dakota leads the nation in methamphetamine addiction among youth 12 to 17 years of age. We remain near the top when it comes to teen suicide.

Much attention has been given to South Dakota over state spending on an advertising campaign aimed at raising awareness of meth addiction. I’ve already focused on the campaign in a previous journal entry. Despite the lack of educational theory behind the slogan, “Meth. We’re on it.” and despite the lack of evidence that advertising has any impact on addition rates or treatment options, there is a grain of truth in the intended double meaning of the slogan. Addiction affects all of the citizens of our state, not just those who are using the drugs.

What frightens me about the spending of so much money on the advertising campaign is that I believe it is based in an inaccurate analysis of the case of the problem. It encourages people to continue in the belief that addiction, mental illness and suicide are somehow the result of a lack of moral education. These evils are rampant in our society and deeply seated in our state. They are not, however, signs of moral weakness or of a lack of religious training.

Our legislature has consistently taken actions that have not had any impact on the life expectancy of our people. They may be aware that we have a problem, but their analysis and response to that problem has been misguided at the least.

At the worst, it has been dead wrong.

Unfortunately, we’ve gotten all too used to the deaths.

Copyright (c) 2019 by Ted E. Huffman. I wrote this. If you would like to share it, please direct your friends to my web site. If you'd like permission to copy, please send me an email. Thanks!

In defense of wordiness

In a month I will be writing my annual report to the congregation. It will be the 42nd annual report to a congregation that I have written in my career. Not long ago I read an article on the design of annual reports for the corporate world and the article suggested that a report should consist of about 150 words. The rationale was that people rarely will stay focused and read a report that is longer than 150 words. I was dismayed at that thought. I don’t know for sure but I guess that my average report to the congregation I serve is in the neighborhood of a thousand words. I have a good feel for what 1000 words feels like because that is the rough length of my journal essays. I came up with the idea of writing a 1000 word personal essay every day a dozen years ago. I wanted to teach myself more about writing, feeling that I was at a point in my life where making a transition from being a contract writer to writing my own material was in order. Previously, I had done quite a bit of professional writing on contract. Publishers hire writers to produce material and specify the length of the content. I wrote educational resources to contract for years The idea of a 1000 word goal for my personal essays came from the proverb, “A picture is worth a thousand words.” When I started my journal, I would post a single picture and a 1,000 word essay each day. I enjoy photography, but haven’t been as disciplined about my photography as I have about my writing. As a result, I often do not publish a picture with my essay.

A customer service representative of the company that hosts my web site was amazed at the amount of data in my journal. A dozen years of 1,000 word essays every day adds up to quite a bit of data. That representative said that most people make blog posts in the 100-word range. I decided to stop calling my journal a blog and have been referring to it as a journal since that conversation. I don’t want to mislead people who aren’t interested in reading that much.

I do, however, want to defend my use of words.

I think that one of the problems with the lack of civility in our society these days is that we don’t take time to really understand other people. We want short identifiers that will quickly allow us to categorize others. Is this person with us or against us, friend or foe? Of course there are lots of other options. The world does not consist of only two categories. We can have allies with whom we disagree on many subjects. Human beings are complex. When we reduce others to simple categories, we fail to understand them. Conversation looses nuance and subtlety. I think we need to teach people to use language more fully.

When I was a student, the common assignment was a 10-page paper. A ten page paper contains around 5,000 words. Of course you can get by with fewer words by using longer words and more than a few college students expanded their vocabulary in order to fill the assigned pages. Ten pages gives enough space to explore a topic. It allows for consideration of opposing viewpoints and discussion of small differences. A ten page paper allows enough room to demonstrate that research has been conducted and the field of literature on a topic has been explored.

Ten page papers may still exist, but they are nowhere near as common in college work as once was the case. I recently spoke to a professor in a college of education who said, “I’m lucky to get two or three pages out of my students. If I assign more, it will just be a jumble of things cut and pasted from the Internet. I don’t have students who are capable of writing 10 pages of original content.” The students to whom he was referring are the future teachers in our public schools. It is a depressing thought.

Social media seems to be redefining not only the way we speak to one another, but the way that we think. Most famous is twitter, which began its service by allowing only 140 characters. The character limit was based on the limit for a text message at that time. It isn’t possible to communicate a complex thought in 140 characters. The limit produced a strange adaptation of language. According to the company, when the limit was 140 characters, the average tweet was only 34 characters. People developed abbreviations, known as “text speak.” “u r” replaced you are; “b4” replaced before; “sry” replaced sorry. Of course the last one wasn’t used very much because manners and politeness went out the window with the lack of characters. People didn’t use tweets to apologize. They didn’t waste characters on please or thank you, either.

When the limit on the number of characters in a text message, Twitter doubled the allowable number of characters in a tweet. The current limit is 280 characters. Most messages sent, however, are much shorter than the limit. In fact, the company says that the average character count has gone down to 33 characters since the new limit was announced.

Very little communication can be accomplished in 33 characters. (That sentence would read: “Very little communication can be ac” in 33 characters).

If we are to maintain civil society and civil conversations, we need more than aphorisms and tweets. Human beings are complex and we are capable of complex thought. We can make subtle distinctions, given the opportunity. So far, I have only used my Twitter account to point towards more substantive ideas. I will continue to defend longer and more complex modes of writing. I will continue to read books and other long forms of writing. And you can count on my annual report to be even a bit longer than usual this year.

Copyright (c) 2019 by Ted E. Huffman. I wrote this. If you would like to share it, please direct your friends to my web site. If you'd like permission to copy, please send me an email. Thanks!

My wanderlust

“Blessed are the curious, for they shall have adventures.” (Lovelle Drachman)

Our language has a lot of words borrowed and adapted from other languages. That’s how we got the word, “wanderlust.” In its original German it means a love of hiking. In its contemporary usage in our language it is the desire to travel far and wide. I seem to be affected by it. From as early as I can remember, I loved going on trips. With pilots for parents, there were frequent opportunities. Whether it was a routine check of Yellowstone National Park or a charter to Oregon, my father kept the airplanes ready and when the weather cooperated we took some really grand adventures. Our whole family flew from our home in Montana to Indianapolis, Washington DC, Chicago, Salt Lake City, San Francisco and Seattle among other destinations closer to home. When we graduated from seminary, we spent six weeks traveling with my parents and sister and her husband in Europe, driving around in a rented van and visiting friends, many of whom had visited our home.

I come by the wanderlust naturally. My parents loved to travel. They visited Japan and Taiwan and New Zealand and Australia. They took trips to the Bahamas and Bermuda. They wandered around Hong Kong. After my father died, my mother toured China, the Philippines and Sri Lanka on her bicycle. She also took cycling trips around Montana and did a New England tour as well. Later she went on several cruises and traveled with her brass choir to Germany. She had a list of possible future destinations that she kept with her and talked about for all of her life. Had her health permitted, she would have traveled even more.

I am constantly thinking of and planning trips. Some of them are only dreams. They involve destinations and modes of travel that I cannot afford and are trips that I probably will never take. All the same, we have been fortunate enough to travel to Costa Rica several times and we had a wonderful trip to Australia with our adult children in 2006. We’ve been to England and made two trips to Japan. And we enjoy hitching up our trailer and exploring the northwest. One of the kayaks I built has been in the Atlantic, the Pacific, the Bay of Fundy and the Salish Sea. It has been paddled in Lake Superior, Lake Michigan and Lake Huron as well as the Yellowstone and the Missouri and countless little lakes and ponds one the way.

Not long ago I read a piece published on the BBC website that reminded me that this desire to explore and travel is not universal. While some of us find travel and adventure to be a huge part of our lives, there are others who focus their energy and attention on staying at home. They may travel, but their true joy is in remaining where they are rooted.

Scientific research has discovered a variant of the DRD4 gene, the gene that affects sensitivity to the near sensor dopamine, a chemical that is involved in the perception of pleasure. Dopamine research has produced significant progress in treating illnesses as varied as Parkinson’s and bipolar disorder. It isn’t as simple as having the 7R variation of the DRD4 gene means that one has a craving for travel. People with that variation, however, are less sensitive to some of the simple pleasures that give others satisfaction. While one person might feel intense pleasure with a taste of chocolate, a walk in the park, lingering with the newspaper or a favorite coffee, another person might be able to recognize the value of those things, but not feel the deep pleasure experienced by the first person. Those with the 7R variation seem to need more dramatic stimulation in order to experience the same level of pleasure. Those with the 7R variation are more likely to be risk taker and thrill seekers. Those people will go farther than others in order to get those increased dopamine levels.

I have never had genetic testing. I don’t know whether or not I have the 7R variation. I don’t seem to be attracted to the most extreme forms of risk taking. I’ve never had the desire to parachute, an experience both my son and my brother have had. I’ve never been attracted to bungie jumping. I got great pleasure from staying home with our children. I enjoy paddling in the same lake over and over again. I never tire of the sunrise view from my home.

We know that genes don’t determine one’s personality. All sorts of different factors play into the personalities we have. Relationships can affect the amount of travel and the amount of staying at home one experiences. One’s career can have a big impact on the opportunities for travel. Furthermore, the 7R variation has been linked to addiction, a short temper, and delinquent behavior. I don’t think I’m especially prone to any of those things. Of course all humans have addictions, but my primary addiction is to my family and perhaps to some of the gadgets in my life. I drink perhaps a half dozen glasses of wine a year. I gave up caffeine without a big problem. I did have a rather short temper when I was younger, but I’ve learned to control that without problems and I don’t think people would describe me as having a short fuse these days. I haven’t been one to get in trouble with authority, where inside of the church or in my life in the community.

If I do have the 7R variation, the desire to travel and explore seems like a much better expression of that variation than struggling with addiction or destroying relationships with a violent temper.

I suspect that my urge to travel may be more psychological than genetic, however. With the Internet and other forms of instant communication, I am constantly aware of what others are doing. Most of our recent travel adventures have been to visit family who are in distant places. I am inspired by the lives of my colleagues, who live in many different places around the globe. The church is a world-wide fellowship and I am continually aware of ministries and missions taking place in countries and on continents I have never visited. I only have to open up YouTube to view another camping trip or canoe trip or a trek to a very remote part of the globe. My mind wanders even when I am at home.

Jack Kerouac wrote, “Because in the end, you won’t remember the time you spent in the office or mowing your lawn. Climb that damn mountain.”

I think I may have a few more mountains in my system before I really settle down for good.

Copyright (c) 2019 by Ted E. Huffman. I wrote this. If you would like to share it, please direct your friends to my web site. If you'd like permission to copy, please send me an email. Thanks!

Snow go or no go

About 30 years ago we were in Portland, Oregon. My sister lived there at the time and her home was on a hill. Portland experienced an ice storm. The freezing rain stuck to everything and coated the roads. I put tire chains on our family van and pulled it out of my sister’s driveway. I could get some momentum, but I couldn’t steer the van. I got it stopped without hitting anything and got out some cable chains and put on the front tires. So-equipped I loaded my family into the van and headed out for the 400+ mile drive home. Within 30 miles we had the chains off of the van and encountered no further problems.

As we drove I told our children the story of another time, years before, when we were living in Chicago and a blizzard shut down the city. I had tire chains, put them on my car and was able to get to a motel where my sister was staying. The next morning we proceeded to show her the city. It was amazing the way people had abandoned cars in the middle of the highways. There were plenty of drifts, but we were able to get around without big problems.

I’ve always had pretty good equipment for getting around when inclement weather occurs and I haven’t been held back much. However, there is a need for a bit of common sense to go with the equipment we have.

Perhaps as a result of my experiences, I am very reluctant to cancel events when the weather turns harsh. Today is another morning when I’m facing a decision. I could have made the decision last night. A lot of churches in our community did. There are plenty of cancellation notices already posted. But I knew that the winds would go down overnight. I was right. It isn’t as bad this morning as it was last night. I have the snow cleared from my driveway except for a bit that blew in overnight. I have chains on all four wheels of my pickup, which has pretty high clearance and four wheel drive. We could get to the church.

The snow plow has just made its first run up Sheridan Lake Road and it will be cleared soon.

On the other hand, there is a Whispering Pines rescue truck stuck in the ditch across the road from our home. The car they were trying to pull out of the ditch when they slid in is also still there. It is going to take several hours for our city to dig out after a full day of snow and blowing. The drifts in our yard are the biggest I can remember in 25 years of living here.

I used to say that we trust people to make their own decisions. If I can get to the church, I’ll go there and we’ll have worship for whoever shows up. This morning as I contemplate the right thing to do, I am questioning that approach. Technically, there is still a “no travel advised” order for the city. It is likely that will be lifted before the 9:30 start time for worship. On the other hand, when I think of who might come to worship, I wonder if I want to take responsibility for those who might not have the right equipment to venture out.

We’ve already made the decision to cancel our bus service. The driver doesn’t think he will be able to get the bus out in time. Our choir director lives out in the country and his equipment probably isn’t heavy enough to conquer the drifts. It is unlikely that he can make it. We aren’t likely to have enough people to have a choir anyway.

Yet, when I think of it, I know that the church parking lot is likely to have been plowed well before worship. The plowing bill will be big. It seems a bit of a shame to go to all of that work for a cancellation.

It is easy for me to argue both sides of the issue.

This is likely to be the last winter that I’m the one calling the shots on this type of decision. On the other hand, it is early for us to be contemplating closings to winter storms. There could be a lot more decisions that need to be made before summer comes. We have had to cancel worship in May due to a spring blizzard once before.

Within an hour or so, I will suck it up, make a decision and we’ll get busy getting the word out. I can change the outgoing message on the church phone. I can send an email “blast” to church members who have subscribed. We can post on social media. We can call the various church leaders who have responsibilities. We have already been in touch with the family who have a baptism scheduled for this morning and know what the alternate dates are if we cancel.

If we do cancel, I know that by 9:30, I’ll be a bit antsy. The weather is supposed to be sunny. We’ll be dug out. The snow plow will have made a trip up our street. There will be nothing that really prevents me from getting out.

If we do decide to go forward, I know that attendance at church will be light. 9:30 is just too early to get dug out if you don’t start digging until 8 or so. We probably won’t have a choir. We might not have an organist. I have a clear memory of a day when we proceeded with worship because of a scheduled baptism. The family of the baptized were almost the only ones who showed up. I picked up the organist and give her a ride to church and back home afterward. We didn’t have a choir. It was not one of our grander or most glorious worship experiences. On the other hand the family of the baptized will never forget it.

Either way, I’ll be second guessing the decision that I make. Making decisions is part of my job. It goes with the territory. But it is one area of my work life where experience doesn’t seem to help. These decisions don’t get any easier.

Copyright (c) 2019 by Ted E. Huffman. I wrote this. If you would like to share it, please direct your friends to my web site. If you'd like permission to copy, please send me an email. Thanks!