McMegan is a jackass.

This would all be solved if we taught housecats to swarm-tackle health costs.

This would all be solved if we taught housecats to swarm-tackle health costs put Grumpy Cat in charge.

Fixed.

Feral cats: Is there anything they can't do?

I don't know who "Flipanter" is but I endorse his or her comment.

The Left/Right split is interesting. On one hand there's the argument McMegan makes, "this proves that high deductibles won't lower spending" but the far more important argument lurking behind that is the debate between "medicare spending will kill us all, we need to cut entitlements now" and "we need to figure out how to lower health care costs; if we do that entitlements are fine."

Do any insurance plans or foundations pay people or rebate premiums for creating advanced directives? What about discounts on preventive and palliative care for DNR?

Yeah, I don't have any respect for or interest in MM either. But vet expenditures are in the statistical abstract of the US and those are up by 500% since 1983.

I don't have a cut-and-dried summary, but it looks to me like a portion of health care outlays in the US are voluntary and look like luxury spending. I don't know whether this is an appreciable fraction of health care expenditures, possibly it's not enough to make a difference.

I was interested to see the age breakdown.

Reading some of the back and forth about the problems of getting the two data sets to match up I wonder if there's a more important dis-analogy between spending on human and pet health care.

As the OP suggests, for any market there's going to be a mix of discretionary and required spending which will change over time. I would think that ratio would be more stable over time for human care -- with most patients feeling like they don't have much of a choice (and, if they do defer health care feel it a significant deprivation) and only a small fraction falls into the category of, "I don't really need this, but it would be nice and I can afford it." By contrast I could easily imagine that part of the increase in health care spending for pets is demand-induced supply -- people having more money they are willing to spend on pets and Vets figuring out new ways to pitch their services leading to people getting procedures that they wouldn't have gotten 15-20 years ago and shifting the composition of the basket "health care spending on pets."

That was written badly but I'm just arguing that there may be some "one-time" increases baked into the increase in pet spending which are not analogous to health care costs. Perhaps during that time frame people simply decided that they wanted to buy more pet health care.

Cat operations are luxury spending FFS. As the rich get richer you see more expenditures on that. And it creates jobs for hard-working vet techs!

it looks to me like a portion of health care outlays in the US are voluntary and look like luxury spending

What does this mean? Aside from (some, but not all) cosmetic elective surgery, "voluntary" and "luxury spending" are going to be very contested terms here. Human health is pretty much the first thing that human beings are willing to spend money on, so in that sense (as I think all health economists argue) it's not surprising that as people get richer they devote more of their income to health care. But describing this as "voluntary" or "luxury" spending is a problem: the difference between an OK treatment that lets you survive but not thrive and a more expensive treatment that permits better results is one issue. Is it a "voluntary" or "luxury" good to spend money on a cancer treatment that is much less painful than standard chemo, even if it is equally effective at treating the cancer?

The ultimate luxury good: joint replacement. How much pain can you afford to remediate? You'll still be in SOME pain.

Oh-- so human luxury spending can look a few different ways, but definitely one of them is bragging to other rich people about how excellent your specialist is and discussing relative merits of various treatments. I think that spas used to be similar, benignly so. A long hot soak can ease up arthritic knees. Gabbing about how YOUR doctor is head of a good hospital department when you're none too sick is different. Basically like cat surgery.

People who have good insurance may find they're getting overtreated, especially in a fee-for-service system. This could happen passively, it's a politicized question, but again, does happen. Getting many MDs and other caregivers off of fee-for-service is my vague idea for improvement, but I have no suggestion for practical first steps to doing that.

Lastly, people who distrust everything but see a loved one sick tend to wait before seeking medical care, because treatment is going to be expensive, and then want all possible steps taken. No idea on practical steps to mitigate that. Doesn't feel like luxury spending to those involved, maybe harsh to define it that way, but one analogy is with an elaborate funeral.

I'm not sure how separable this is, or really if it's a big factor at all, but there's some element of luxury spending in ambiance and convenience. If your hospital bills are significantly higher because the hospital has pretty paneling and a gourmet cafeteria, that'd be luxury spending.

But I doubt this sort of thing explains much of anything: American health care doesn't seem all that gilt-edged to me.

What does this mean

Yeah, that was badly written in a variety of ways. Try this: spending can go up either because we're paying more for functionally the same things or because we're buying things which we weren't buying before. In the latter category you have things which simply didn't exist before so nobody could buy them, and things which did exist but which are being consumed more widely.

In a mature market you would expect less of the latter (increasing the number of people buying something which had been available for years). I would think, by that standard the market for human health care is more mature than the market for pet health care.

Three thoughts:

1. Fear of death is strong, and spending mere cash to push death off, whether your own or your beloved companion's, is entirely predictable.

2. Modern medicine is kind of magical, and I think that makes it a much more tempting thing to spend money on. I'm tempted to link it to iDevices, but I don't want to get bogged down by the comparison. But I think the idea that we can apply this technology to our pets is in some sense intoxicating.

3. I don't think people know what the norms are. Is it outrageous to spend $1000 to save your beloved companion's life, or is it outrageous just to let your pet die and/or put it to sleep when you could save it through the application of mere cash? As you all know, we're generally cash constrained, to the point where we only just took the dog to the vet for the first time in 3 years. And sure enough, it cost a damn fortune (heart worm/flea/something else pills that cost $20/month), and part of me doesn't even want to spend it. But can you imagine the conversations? "Yeah, we had to get rid of the dog, it cost $500/year to keep alive."

How much of the increase in spending comes from the increase in health care worker salaries?

Cat operations are luxury spending FFS.

Bad technical area to use that acronym.

She says write there

But you went and wrote it here, contrarian.

The more I think about it, the more the idea of both "voluntary" and "luxury" in this context becomes nonsensical.

but definitely one of them is bragging to other rich people about how excellent your specialist is and discussing relative merits of various treatments

Why in the name of Christ is this "luxury" spending? I assume that people in the NHS in England also compare specialists and brag (or not) about how good they are. That the difference is to a greater extent based on wealth in the US than elsewhere, that's perhaps a bad thing, but it's not an indicator of frivolous expenditure.

If you'll excuse a long post, here's another way to look at it. A couple of months ago I pulled together the following links for some friends:

-------

We talked about Health Care Economics on Monday and I wanted to mention one the major questions that I have about health care reform --
how much of a free lunch is available? I had time to pull together a couple of links on the subject and wanted to pass them along.

One arguments is that there's a significant amount of savings available my reducing unnecessary treatment and making cheap early treatment/diagnostics more easily available.

Perhaps the best argument for that point of view comes in two Atul Gawande articles for the new yorker:
1) About McAllen TX, which makes the claim that the medical/hospital establishment drives a lot of spending over and above what's medically necessary

2) About "hot spot" patients and the idea that reducing the amount of health care resources consumed by a small umber of patients could reduce costs without affecting the health care available to the vast majority of people.

Two interesting counter-arguments that I've seen are both from Ezra Klein's Washington Post blog, the first by Sarah Kliff and the second
by Klein:

1) On prevention: "The idea that prevention saves money feels intuitive. "When we think of prevention, we tend to think of the individual who benefited," Russell writes. We conjure up an image of the woman who caught breast cancer early, averting expensive treatments, or the man who brought his weight down and lived a long, healthy life. That, however,
discounts all the mammograms that didn't detect cancer and didn't prevent anything and all the individuals for whom weight management
programs didn't work. All those costs add up to the point that most preventive interventions cost more than they save."

2) On comparative spending: "There are many possible explanations for why Americans pay so much
more. It could be that we're sicker. Or that we go to the doctor more frequently. But health researchers have largely discarded these theories. As Gerard Anderson, Uwe Reinhardt, Peter Hussey and Varduhi Petrosyan put it in the title of their influential 2003 study on international health-care costs, "it's the prices, stupid.""

This argument suggests that comparisons to other countries (almost all of whom have lower per-capita health care spending than the US) may
create false impression about the scale of "free lunch" opportunities.

If the cost of Health Care in the US is driven primarily by the cost of treatments, rather than the frequency and distribution of treatment it could mean that there's no way to make significant cost reductions without directly challenging current providers and asking somebody to take less money for a service they currently perform -- a different argument than getting people to be more efficient about what services they do, and likely to face much more push-back.

----------

The question is whether the the chart about spending on health care for pets helps answer that question, and I'm not sure that it does. It might push you towards a more pessimistic view if you think that the comparative lack of pet insurance reduces the opportunities for McAllen style spending and that "hot spot" pets would be a smaller portion of the total spending than is true for humans, and that prices have still gone up.

But you might also conclude, as I was trying to argue, that prices have gone up from a very different base, and that the dis-analogies might be a reason to think the two data sets aren't directly comparable, rather than thinking that it's evidence against the hoped for "free lunch" reductions in health care spending.

or is it outrageous just to let your pet die and/or put it to sleep when you could save it through the application of mere cash?

A few months ago, my friend called me in tears because she'd just had her cat put to sleep. The cat had become paralyzed and the vet couldn't figure out why, without spending a couple hundred dollars on tests. So they put the cat to sleep.

I didn't ask "What about just letting the cat spend the night at the vet and see if it gets any better?!" because she was already upset, and the cat was already euphemized. But I was amused/weirded out that they killed the cat so readily.

I mean EUTHANIZED. Jeez.

doesn't seem all that gilt-edged to me.

Maybe luxury is a slur, read volitional if a less snarky description is preferable.

For well-insured wealthy people, I don't agree. I don't know how much of the system that accounts for. Any substantive answer would include numbers, which I do not have. But overtreatment is an issue. Like everyone else, I know people who aren't getting enough care due to poor/absent insurance, and I want a better life for them. I am thinking about better care in some form different from amplifying the current often dysfunctional system.

Maybe ceasarean sections are a useful example of a marginally beneficial treatment much more frequent in the US than elsewhere. Basically, aside from thinking that the age distribution data was worthwhile and interesting, I was curious whether anyone knew of concise descriptions of tweaks to the existing US system that might make things better. Atul Gawande describes various shortcomings of fee for service, maybe he or someone similarly oriented has policy suggestions that I haven't noticed.

Atul Gawande describes various shortcomings of fee for service/i>

Pwned. (But, hopefully, that means that 20 is on-topic and not just self-indulgent).

Do any insurance plans or foundations pay people or rebate premiums for creating advanced directives? What about discounts on preventive and palliative care for DNR?

No, but there is a good chance that your doctor gets a bonus payment from the insurer based (among other things) on reaching a target percentage of patients with an advanced care directive.

20 and links look great, thanks!

"Luxury good" doesn't have to mean people feel good about getting it. A luxury good is something people consume more of as their incomes increase. In the case of health care, the mechanism is not (by and large) luxuriance, but that people desperately don't want to get sick / die, and when they're in the medical setting, they will normally undergo whatever they're advised for that reason.

Maybe luxury is a slur, read volitional if a less snarky description is preferable

I think there's a problem with both 'luxury' and 'volitional' that's not just about the negative way they sound -- it's that they're implying that there's overspending driven by a consumer choosing between buying more or less of a well-understood consumer good. While I'd buy that there's a fair amount of wasteful medical spending, I don't have the impression that much of it is driven by consumer choice, rather than by confusion and lack of understanding of alternatives.

And people realize this is the case, which is why so many uninsured manage their spending by staying away from the medical setting.

When I had surgery recently, I was awakened in the hospital by the cheery voice of my insurance company asking why I hadn't yet filled out my living will. In principle, I'm in favor of advanced directives and all that, but the timing was unfortunate.

[Redacted], can I do a pause/ play and ask an unrelated question? Whenever I'm traveling and wondering why the airlines are treating me so badly (because they don't care about my business, as has been helpfully explained). But now I have a question about the loading of the planes. It seems to me that there are many things the flight attendants could do to make boarding more efficient, from actually policing the size of the carry-ons to encouraging people to pull out the things they'll want for their trip before they put their bags in the overhead compartment, but these things are never done. Is it because, as I fear, there's no real incentive for an efficient and timely departure?

On he age thing, my first thought is deferred maintenance.

On the vet thing, it's all about demand and available cash.

IME, for a bunch of different relatively minor things that people close to me have had, the doctors give a set of choices for treatment, which have different possibilities of success, and different costs.

I told the story of having a 3 legged dog before. In treating the broken and infected leg, we came to a point where the vet said he could try a bone transplant using one of her ribs, that it had a 50% chance of working, that she'd be walking normally (if it worked) in a matter of months, at a cost of X. Or, for 1/8X, he could do an amputation today, and she'd be running around fine in 2-3 days.

31 wasn't me, but:

I hate, hate, HATE the fourteen different classes of boarding that have emerged. Elite first class passengers? You first! Elite fast quicklane passengers next! Elite Miles Plus members, you're next! After that we'll have Privilege Plus and then Upwardly Reaching, and then we'll begin boarding schmucks in groups 1-7.

Except for boarding families with small children first. That's entirely different.

(a) I hate this too because I can't hear the announcements and they never, ever put it on the screen, even if they have a screen, but

(b) this means I almost always get to pre-board. HA.

(I don't ask to preboard. I ask, "could you please let me know when it's my turn, because I won't hear you call the things". They almost always say "no, we'll pre-board you".)

Also evidence proves (I think, maybe I'll look it up later) that it doesn't improve boarding times at all.

Then they give me a card with evacuation instructions in braille.

There's also the tendency to feel (believe?) that `doing something', or using a new treatment, is better than doing nothing or doing something standard even if the predicted outcomes are the same. I've had a couple generation-older relatives with gold-plated medical coverage go so far this way (sometimes their decisions, sometimes their children) that it became damaging to their health (interactions between new drugs).

It seems to me that this is related to our moralizing over health, the belief that if you do the Right Things you'll be healthy, and anyone really ill did something avoidable. (Just World Fallacy?) Even that isn't enough to explain why we assume New! is the right thing. Come to think of it, some people instead assume that health practices of periods they consider more virtuous must be basically right -- I wonder how much of that fuels the chickenpox parties.

Boarding families first *is* entirely different, which is why it's part of my efficient boarding scheme that I'd be happy to pass on to the management consultants. (I wrote 31, forgot to sign my name, and then was too embarrassed to claim it when I remembered that Heebie doesn't like us to pause/ play so early in the thread. But here she is!)

Heebie doesn't like us to pause/ play so early in the thread.

Heebie doesn't actually care, she just doesn't want Teo to yell at her.

One airline has numbered stanchions, and everyone lines up in order, back-to-front, and gets on without passing in the aisles or using other people's overhead bins. Neat, sensible, efficient, and seemed to work for families -- I think only people who needed physical assistance moving preboarded?

I don't actually want to maximize my time sitting on the plane, me.

I never bother about the boarding priority, but people blatantly taking the piss with the carry on luggage can be annoying. Especially if you are boarding last in peon class and there's nowhere to put your small bag as assholes with 80kg of hand luggage have filled every space.

I remember flying KLM to Amsterdam and it was like sitting inside a cargo plane.

Carryon has gotten much worse since they started charging for bags.

If I've got a window seat, I'm happy to get on the plane on the early side, put on noise cancelling headphones, and zone through the rest of it. Planes suck, but it's not like they are hugely worse than airports.

I skipped most of the comments, so forgive me if this has been mentioned, but I am puzzled by all the puzzlement in the US over how to do healthcare. It's not like we don't have dozens of different, successful models to look at, and tons of empirical evidence from countries not so different from us. Finally, these other countries have all managed to create workable models which provide luxury healthcare for the rich or those willing to pay more, and basic, adequate healthcare for everyone else. European, Canadian, and Australian wealthy are getting boutique treatments, not jammed on metal cots in public wards.

Yes, Britta, the problem is that nobody has thought to look north or overseas for models. It has nothing at all to do with the nature of American politics.

Nearly everyone on this blog could design a better health-care system than we have in the U.S. The problem is making it into law.

I thought the limp was supposed to slow you down.

43: In terms of getting everyone access to an efficiently and equitably administered system, yes. In terms of reining in cost growth, not clear - the government's monopsony power helps, and it's much easier to try reforms, but it still seems to get more expensive as a percentage of GDP and has the same problem with linkage to quality and outcomes. Everywhere medicine is only half a science, and that's a problem for everyone.

I'm posting on my iPhone so this may have already been posted. Concierge medicine is a luxury. That's where a doctor drastically reduces the patient volume and charges an annual fee to belong to the practice to cover stuff they can't bill for like wellness advice or vitamin analysis. The fees range from a couple hundred to around $1000. I saw a husband and wife team who did it. He talked about a client whose rash he diagnosed remotely using an iPhone picture. It meant that the guy didn't put on hydrocortisone cream and knew he needed to go to the doctor. He was in Germany at the time.

Concierge practices have sprung up in places with public systems. In Canada you are not allowed to provide privately for anything covered by public insurance. Nonetheless, in affluent parts of Toronto these concierge practices are springing up.

||

In good news, I may be able to get the Assisted Living Facility bastards who were trying to screw me.

|>

No duh its political, and our country is being held hostage by terrorists.

But anyways, it just seems like someone, somewhere, in the MSM could point out we don't live in a void, and that we're actually debating something that is done successfully everywhere else in the developed world and half the developing world as well. Given media conversations, even at 'highbrow' places like the Atlantic, you'd think we're discussing planning a Mars colony. I'd like to think our media slightly better than just propaganda machines for corporate interests, but I guess not. I'd like to think at least the NYTimes could point this out.

I had to pick health care last week, and the options were a bit strange and surprising. There's a "consumer driven plan" and ordinarily I'd assume that's just conservative-speak for a plan that sucks, but its actually really good and generous. The key fact is that the large deductible (2.5k) is also exactly the size of the employer contribution to the HSA. So it's better than having no deductible! There was almost no situation where the regular plan is better, in particular the out of pocket maximum is small (5K) so even if you're very sick you're still ok. The only situation I could find where the traditional plan wins out is if you have large (but not so large you hit the maximum) perscription drug costs. Even then it's not much worse. Details here

Further investigation suggests that our outgoing governor basically wanted to move people to CDHC plans for ideological reasons, but somehow decided that rather than screwing people over it'd be better to make plans that are actually appealing. Supposedly the state is saving money on these plans even though they're more generous because people save money since they get to keep whatever's left of the 2.5k. I'm a little skeptical of that claim politically, but if its true it really would be a "conservative" idea implemented in way that's actually non-sucky. I mean I'd still rather have single payer, but this plan does seem like a genuine conservative alternative. (Until 10 years down the road the next republican decides to decrease the funding, of course.)

It's non sucky for you Mitch, but it does suck. That money you get to keep isn't going into the insurance pool to pay for the care of really sick people.

I don't think HSAs let you "keep" the money in the full sense of being able to buy Apple products with it. You roll it over for future medical expenses, and there's a big penalty for non-medical withdrawals unless you're turning 65.

But the plan is also better for the very sick! (Due to low out of pocket maximum and low premiums.) The state self-insures, so it's possible that the taxpayers are paying more than they would otherwise, but I think I'm not actually free riding here.

Right, it becomes a retirement account if you don't spend it, so it's not as good as actual cash.

But anyways, it just seems like someone, somewhere, in the MSM could point out we don't live in a void, and that we're actually debating something that is done successfully everywhere else in the developed world and half the developing world as well. Given media conversations, even at 'highbrow' places like the Atlantic, you'd think we're discussing planning a Mars colony.

But enough talk about gun control.

Carryon has gotten much worse since they started charging for bags.

This is so very true.

Philosophically it drives me up the wall that there is all this nice space available under the plane, and an efficient system for getting people's luggage there, and they went and priced things to sabotage the use of the nice big space in favor of the crappy, time-inefficient overhead space.

Heebie doesn't actually care, she just doesn't want Teo to yell at her.

Heebie does care, but it varies how much she cares based on how much effort she invested in the initial post, and how much she wants to talk about the topic at hand. Or the threadjack at hand.

Well, also, there is a greater tendency for checked luggage not to arrive at the same airport I do. If they fixed that, I'd think charging for all luggage by weight would help more.

[T]here is all this nice space available under the plane, and an efficient system for getting people's luggage there....

"Efficient"?

Or! Concierge aPodments in the luggage space! High-comfort, high-risk.

Not to mention, they don't charge fees for gate-checking. One has no incentive not to sneak on as big a suitcase as one can get away with and just check it at the gate if it doesn't fit.

and an efficient system for getting people's luggage there....

Sure - it's not carted through, one item at a time, by hapless travelers going through security with their shoes off. It disappears on a belt and magically reappears one thousand miles away. Efficient for me!

52: Right, but the really high income, reasonably healthy people can use all of it as a retirement account and not spend any of it on medical expenses, using current income to pay for a physical or whatever. If you make $500K or above, you can use it as an extra retirement account.

53: Your state is probably paying more than it should. If a young healthy young woman who only ever gets birth control buys a high deductible health insurance plan which costs her a lot less, then the money she is saving by not consuming healthcare is not available to finance the care of the sick. In a self-insured plan that's not really an issue. But in a way a lot of self-insured plans are sort of sucky, because they're providing care for their employees who--by virtue of the fact that they are employed and working--are likely to be somewhat healthier than the general population are not subsidizing the really sick among us.

Vets and doctors both have cartels. So maybe the supply of both vets and doctors has decreased in recent years, allowing them to raise prices? That sounds like a good standard Econ explanation to me.

All you would have to do is check to see if the number of vets and doctors has fallen or risen as compared to general population increases for both people and pets.

Then you would have to decide whether it makes sense to change the cartel rules so that we can have more vets and doctors.

Are there any additional questions for me?

If not, that's cool. I'm heading to the dog park but will check back in a bit. ttyl.

Very general question that I should probably know the answer to, but don't: when "health care spending" is referred to in, e.g. the OP, does the annual expenditure per age bracket include the annualized health insurance premium?

I tend to distinguish between health care spending and health insurance spending, but a lot of people don't -- Mitch Daniels upthread in 50 said he had to "pick health care" last week. I was prepared to read a description of treatment options for some condition.

I was prepared to read a description of treatment options for some condition.

Me too.

63.last: That's a problem with employer-based healthcare, which is orthogonal to the CDHC issue. You could have single payer CDHC with the same rough outline.

68: Meant to say "health care plan." But there's really not a clear care/insurance distinction in the health arena. A lot of provisions in health insurance plans have nothing to do with insurance.

[redacted]

I'll go ahead and clean up both 31 and 71. Email me if you'd like me to change it back.

A lot of provisions in health insurance plans have nothing to do with insurance.

I don't really understand this, but it may not be important. Given that health insurance expense and health care expense are lumped together as "health care expenses", if we're discussing a rise in the latter, it seems that we'd want to be clear on whether the insurance portion of the expense is driving any significant part of the increase.

Certainly in my own case, health insurance costs have gone up tremendously in the last half-dozen years. My premium went up 40% four years ago, and just went up another 22% this year. This is age-based: I've simply moved into a new age bracket. I'm also using the health care system more, as it happens, but not remotely to the tune of the 40% + 22% rise in insurance cost.

Our jackass HR department has sent out endless emails over the past three months about ominous health care changes now that the Supreme Court has upheld the ACA. But when you actually attend the seminars or read the fine print, the changes are not due to ACA whatsoever. (We're part of a group of self-insured small colleges, and last year more people than usual were sick. That's the explanation when you're actually at the seminar.)

This is not to say, obviously, that rising insurance costs are solely at issue.

if we're discussing a rise in the latter, it seems that we'd want to be clear on whether the insurance portion of the expense is driving any significant part of the increase.

It's not a big driver, as far as I can tell. Administrative costs as a percentage of total private health insurance consumption, per CMS's National Health Expenditure:

1970: 9.3%
1980: 11.1%
1990: 12.4%
2000: 11.4%
2010: 12.3%

The insurance companies aren't competent to stem the growth, so they don't deserve to be getting that much, but still they're mostly just passing on growth in spending on actual medical services rather than eating up more and more of the premium dollar.

Wait a minute. People on FB talking about Bama aren't talking about our president, are they.

There's a big hockey game or something.

Okay, and thanks for reminding me of that angle on the matter. I'm back now to thinking that "it's the prices, stupid" provides a better explanation for rising costs among the over-60 (or indeed, over 45 or 50) set than something to do with voluntary/luxury/discretionary health care spending.

78: Apparently, the secessionists are beating the Catholics.

The obvious solution is to set the Death Panels to euthanize at age 60. I've solved healthcare AND social security with one policy. Can I be president next?

A couple of my co-workers are really keen on the health savings account plans, because they can treat them as backdoor retirement vehicles - (a) shove money into the HSA, (b) pay cash for actual health expenses, keep track of the amount spent on (b) forever because it's the amount you can withdraw before retirement without penalty, or something like that. It's the annoying situation where I suspect they're right, but I can't make myself go to the trouble of doing it.

80: The fuckers.

I didn't see what was redacted. but I assume that's actual kim because he's not a president, so hi kim?

oh durrr, that's the evil cia one never mind. though the spirit of greeting remains, as why should it not? hi other kim, who's alla time o'erthrowing the democratically elected government of iran. you should like, lighten up, dude. that shah guy is a total asshole. I know you're thinking you'll pull some beast rabban/feyd shit here but this is a non-starter. the guy's secret police roast people over open coals! I mean--everyone has quirks, but... he has a peacock throne all covered with fucking jewels from the arabian nights! does that seem cool? no. there's actually a shit ton of fremen right over there. no, behind that rock, dumbfuck. yeah there. see? aw, shit; too late now.

I met the real Kermit's grandson at the kiddie museum in town.

82: I heard about that too recently. That approach is only worth doing if you're already at your legal maximum for all other tax deferred savings options available to you. I learned this poking around bogleheads, which appears to be the flyertalk of personal finances.

11

The ultimate luxury good: joint replacement. How much pain can you afford to remediate? You'll still be in SOME pain.

An elderly relative has had two hip replacements. If they have residual pain they haven't mentioned it. And they have improved mobility.

On the other hand the same elderly relative was scheduled for a knee replacement, had it postponed because of an unrelated problem, during which time the knee pain went away and never returned.

Yeah, actually my mom has had two hips replaced in her 60s, and she'd quite possibly be in a wheelchair otherwise. This way she is independent and very active.

And they don't cause her ongoing pain. Hip resurfacing ftw.

Also my brother had it done at age 35, but that's a whole 'nother thing.

Also, my dad. New hip two years ago, went from limping around in a lot of pain to jogging again, pain-free. He's still slow, but he was never fast.

If you pay twenty cents a character, you can get an engraving on it. Mine will say "Manufacture date: July 1545."

I just found out that I drive through a superfund site on my way to work everyday.

Contaminated ground water. Not the worst superfund site possible.

The worst Superfund site is probably Auschwitz, right?

Since this is apparently the airline thread, I'm currently confused about United's website simultaneously telling me that I was upgraded to first class on my flight tomorrow and that all first class seats are full, and I will be assigned a seat at the gate. Which is it, United? I want to know if I'm getting the first class dinner so I can decide whether to eat before going to the airport. I guess this is a first-world problem if there ever was one.

The worst Superfund site is probably Auschwitz, right?

No, it's a landfill in New Jersey. I'm not even kidding.

Speaking of airlines and travel thereby, in a few hours somebody and I leave for our first vacation together, the tenor of preparations for which can be summarized in her refusal to promise not to argue with the TSA if they attempt to confiscate her packed travel snacks.

And I'm going to get sunburned.

Ringwood Mines?

My mother died not quite 2.5 weeks ago, three days before Christmas.

In the months leading up to her death, we were willing to kick the shit out of the Canadian health care system to give her everything she needed, and then some. Me and my sisters, we signed her up for everything: we had "community resource workers" coming every morning to fix her breakfast and make her bed; we had bi-weekly visits from nurse-practitioners set up, and twice-monthly checkups by nurse/social workers. I'm sure we ran up quite a bill (all paid for by OHIP [Ontario Health Insurance Plan]: there's not really a "Canadian" health care system, btw, it is all provincial in provenance, though related to the federal govt in terms of standards and transfer payments). No apologies, no guilt: I figure there are worse ways to spend some money than in ensuring a dignified death to a citizen who had produced a number of taxpayers/ratepayers: and what's the point of inhabiting an advanced, industrial economy if you can't even ensure that?

The social workers at the hospital tried to get my mother to sign a DNR, but she was having none of it. I suspect they sounded too utilitarian in purpose. But as soon as my mum saw the writing on the wall (confined to bed; no longer able to eat; no longer able to use the bathroom on her own), she did not linger. She left the hospital voluntarily, to be with my father as she died, rather than in some crummy hospital room. But the bureaucrats/social workers did not help her with that decision, really.

Sorry to hear about your loss, Zoé. Hell of a time for it.

I'm so sorry, Zoe. I'm glad that OHIP made it possible for your mother to have dignity and autonomy until the end.

Ugh, yes, what Teo and MM said. My sympathies.

My condolences, Zoé.

Mes condoléances

So sorry to hear that, and what difficult timing.

I'm so sorry Zoé, that is awful. it sounds as if some of the health workers meant to help your mother when she needed it most failed her, but it also sounds as if you and your sisters were strong advocates for her and should feel that you did your best in that evil time. please accept my condolences on your mother's death. there is no point in making up silver linings for the stark awfulness of that, but I am glad she was able to go home and die in her own bed, with her family there. you did a great thing in helping her have that. it is what we all want for ourselves, when we consider the possibilities; only that we wish it to be infinitely far in the future.

and without being flippant in changing the subject, I hope that your trip goes well, flippanter. I don't suppose there's any hope of you having sunscreen on and hats etc.? you don't seem as pale as all of that. but then, my husband invariably gets burned once per trip in the tropics: we forget to put the sunscreen on his ears or the tops of his feet or something; he falls asleep in a hammock or reads in the illusory shade of a palm tree; we are on a boat and T-shirts really are not very useful. he's fine on martha's vineyard but considering the distances and expenses involved one is inclined to go to lombok...

also, traveling together is a crucible of sorts for relationships, backpacking across india probably more so (my best friend from 7th grade and I are still best friends!) and going to st. kitt's less, but anywhere is bound to push you in various directions and force you into trying circumstances. so I wish you and t.w.y.r.i.o.c.l. smooth sailing all the way!

So sorry, Zoe.

My condolences Zoe.

Sorry to hear that, Zoé. Hope you're holding up and have lots of support.

to sabotage the use of the nice big space in favor of the crappy, time-inefficient overhead space

When I flew home to Missouri before Christmas, the plane had somewhat smaller overhead bins than you usually see, so some rollaways wouldn't fit with the short side facing in. But a lot of them would: mine is not on the smaller side, and with a little jostling around, it did fit that way. Actually looked like it didn't, but then I tested whether the door would latch, and it was fine. But most people were just putting their suitcases up there sideways, and the flight attendants stood around and didn't seem to care at all. I boarded relatively early, and it made me insane to sit there and watch the bins get taken up but not be full.

European airlines are fairly rigorous about the size of carry on, especially the budget outfits, because they can make money out of making you check stuff. I'm surprised American carriers are so cavalier about it fot that reason.

The idea of paying for checked luggage is new enough here. Give them time.

No, it's because there's no mechanism yet for charging people to check their luggage upon discovering it won't fit in the overhead bin. Tra-la-la, we'll just gate-check it for you, for free.

I suppose the mechanism would be to enforce carry-on limits at the check-in counter, pre-security. I don't know why they don't do that, profit-wise.

And Zoe, I'm really sorry for your loss.

I suppose the mechanism would be to enforce carry-on limits at the check-in counter, pre-security.

Exactly what they do here. I imagine they'll learn.

Does everybody have to go to the check-in counter? I always check-in online.

118. No dice. They'll stop you as you walk through if they think your bag looks too big.

Walk through where?

My condolences, Zoe.

In the US, security checkpoints are not run by the airlines (one), different airlines have different overhead bin sizes (two) and most people check in without ever talking to a person (three). So it wouldn't be easy to arrange. Also, the airline of which Blume is speaking doesn't charge bag checking (it's a big marketing ploy) and is known for having smaller than usual overhead bins. So when things fill up they just gate-check people's bags (for free, but still annoying) but anyhow the incentives aren't there.

It's worth noting that for all our faults the US has not yet produced an airline as apparently horrible as RyanAir.

And I think the airlines are saving a lot of money by cutting as much staff as possible at the check-in point. So it's not obvious that they'd want to create a luggage bottle-neck there.

different airlines have different overhead bin sizes

People who fly on regional jets still expect their luggage to be considered carry-on luggage if it will fit in the overhead bin of a regular jet.

RyanAir is just a financial and tax engineering product, not actually an airline, right?

124 is right - there is a standardized "will your bag fit in this silver box?" contraption all over the place in airports, which kids like to climb into.

So when things fill up they just gate-check people's bags (for free, but still annoying)

Eliminates the "I went to Miami, my bag went to Minneapolis" problem, at least.

Mostly the post 9/11 security measures eliminated that.

I have always wondered why security checkpoints didn't incorporate a "put your carryon in this box and close it successfully" size check. You wouldn't think it would slow things down all that much.

My solution to carry-on hassles is to only carry a tiny laptop sized bag that fits under the seat. No interaction with overhead compartments at all. It's not really practical with kids, but for an adult it seems like the best solution.

||

I would like to bitch that I contacted 6-7 house owners off VRBO, back in December, in Baltimore for Unfoggedy-dodecahedron, and none of them have gotten back to me.

Re-emailing out them, or finding 6 more, is the type of task that's really hard to not procrastinate on. Goddamnit.

|>

RyanAir is just a financial and tax engineering product, not actually an airline, right?

Pretty much, although some people are desperate enough to use the fact that it moves aircraft around to ride on them. It has to be said that some of its customers fully deserve it. I once witnessed some tourists going home being charged enormous sums in overweight by the O'Leary mahine because they'd packed their beach towels soaking wet and couldn't understand why they were heavier than on the trip out.

130: Yes, it's very practical with kids. We always just pay for checked luggage, and only take what fits under the seat in front of us, because a) it's much harder to pack lightly, and b) I don't want to haul luggage and kids through the airport during a connection.

131: It'll probably work better the second time -- I bet the poor response rate is explained by amateurs being inattentive over the holidays.

I thought it was going to be Pittsburgh! Still up in the air, is it?

It could be? I don't have anything against it being in Pittsburgh, and I don't have a clear memory for the thread, but I'd thought Baltimore guaranteed the most attendees.

133: Agree. The fact that kids don't need any room under the seat in front of them for their feet is a great help in stowing carry-on bags.

I have a question for Europeans on the thread. I flew on a small airline between two regional airports on the continent, and no one wanted to see any ID--in fact, they actively waived away my passport when I tried to show them--both when I checked in and when I went through the security checkpoint, where they did check my boarding pass. Is this common? Also, I was surprised at first, but now that I think about it, is there any actual security value to make sure people are flying on tickets under their own name, or is that just one more step the US likes to do in the appearance of security?

138.1: Schengen group countries don't enforce passport controls on each other's citizens. They should have still checked you, but I guess they assumed you were a national.

138.2: no fly lists, I suppose?

I have always wondered why security checkpoints didn't incorporate a "put your carryon in this box and close it successfully" size check.

They have them at UK airports, but at checkin, not at security.

I thought it was PGH, too?!

I guess it's a good thing I haven't booked anything yet.

t's worth noting that for all our faults the US has not yet produced an airline as apparently horrible as RyanAir.

I think Satan himself would have difficulty producing an airline as horrible as Ryanair. I've heard it suggested that its ostentatious horribleness, and the all-round dickishness of its CEO, is a deliberate marketing ploy to convince people of the cheapness of its tickets. The idea goes something like: "If they're nickel-and-diming me for food and luggage and boarding and everything else, and working conditions are so terrible for their staff, then they can pass on more savings to me on the flights themselves!"

They should have still checked you

They should? I didn't think there was ever passport control when crossing borders between Schengen countries, for citizens or non-citizens; I can't recall ever having my passport checked when traveling within Europe except in non-Schengen Switzerland. (With the possible exception of Hungary, but I think I was there shortly before they started participating in Schengen.)

And anyway, travelers in Europe will always have their passports checked by the diligent hotel staff, who usually want to hold onto it for hours and sometimes overnight. I'm always mildly uncomfortable with that.

Huh. I understand the lack of passport control, but I would have assumed they'd ask for some form of ID in the general spirit of security and maintaining no-fly lists. Of course the main impact of that is to make price discrimination much easier.

The no-fly list makes price discrimination easier?

I've heard it suggested that its ostentatious horribleness, and the all-round dickishness of its CEO, is a deliberate marketing ploy to convince people of the cheapness of its tickets.

By me, possibly. If not it's certainly something I believe. Why else would they do ludicrous things like announce they will introduce strap-hanger fares that don't include a seat? Anyone in their ops side would have been able to say "no, that would be illegal". So it was a publicity stunt, aimed at creating the impression of an airline focussed on cheapness over all else (not always true; mostly when I travel in Europe BA is the cheapest way to go).

As a non-Schengen citizen, I've had my ID checked at internal Schengen borders. Sometimes it seemed like the result of profiling, as my non-whiteness is much more distinct in Europe. I've been pulled out of a line of mostly Scandinavians coming off a ferry between Denmark and Sweden (and asked questions that suggested they thought I might have drugs), the only one checked in a train compartment/seating area on a busy train, etc. But more often than not I wasn't checked, so I guess I benefited from my partial European-ness too.

140, 149

I wouldn't be surprised if ethnic profiling was involved. I am white and look stereotypically "non-threatening" and also plausibly like I am from a Schengen agreement country. I was surprised at the lack of having to show any ID at all at the airport though. Flying domestically in the US one still has to show a driver's license or some other form of state issued ID.

Oh, BTW, the only thing they did check the check-in counter was that my carry on luggage weighed less than 8 kilos.

re: 148

I've read it discussed explicitly as a strategy in the newspapers. There was a time when they were just cheap enough, and I was just skint enough, that it was worth the hassle. Now they aren't cheap. As you say, once you include all the hidden 'extras' regular BA flights are often cheaper, and other less nasty Euro budget airlines are usually much cheaper (e.g. Wizz, to the Czech Republic). And the experience has become progressively more degrading and unpleasant.

129: What happens if someone's bag doesn't fit? Do they havr to go back and check it, then wait in the security line a second time? Or does it somehow get checked and paid for at security?

I don't even think MOL denies that's what he's doing. Ryanair is a case study for the revolution's anti-business school.

I decided never to deal with them when I still thought I'd fly for a living and they invented the "self sponsored type rating" - you borrowed the money, did the 737NG course with them, and banged on the hours in the right seat on their revenue flights without getting paid, in the hope they'd give you a job. Also, they charged £50 to read your CV, and if you were fool enough to pay by credit card, you'd discover they billed you again in a month's time to "review the application". And there was the whole thing of travelling to places like Skavsta as standby crew but not being paid.

They aren't as anti-union as they were, but that's only because they lost an organising war at their Stansted base vs. the GMB and BALPA.

Flying Ryanair is basically experiencing what the Irish political elite did to the Irish in the last few years; they treat you like shit, they expect you to be grateful and think you're getting something special, and the whole thing only holds together by pretending the prices are different from what they are and bejasus the fucking Brits!* hiding in a cloud of patriotic bullshit under pressure.

the last (only) time I did travel with them (someone's PR - IBM - booked) I went down to Montpellier in one of the new 737s with the hard plastic seats and the non-English-or-French-speaking crew. I had the strong impression the point was to make you feel like a peasant.

*or these days, the Germans.

The only people I know who actually get the ultra-low fares are French PhD students - they don't seem to mind kipping on the floor of Stansted airport to make the 0615 to Brive-la-Gaillarde or Hahn, and usually someone can be tearphoned into showing up with a car at the cold war bare-base 70 miles from town at silly o'clock. Also, they have nothing to do, so the process of reloading the Ryanair website regularly but not so quickly it notices isn't a problem.