Saturday, January 19, 2019

Gigs Up!

I predict that as the new ## du jour as we wind down the kerfluffle of the women's movement, the irony not lost that it perhaps is happening on the worst day of weather across the country is a symbol that cannot be lost. Remember the Climate Change marches?  Me either.

Again could we find a coalition and somehow find issues that we agree are priority and in turn eliminate individual mandates for the collective whole?  Funding for schools, raising the minimum wage, affordable housing, equal rights that include gender/sexuality/religion, Immigration and climate change.  Start there, it is a big list and given the people currently serving in office those seem to be 7 - 13 on matters of import.  Wow lucky 13 right there!   One through six seem to be more money for the rich via tax cuts, deregulation, Russia, walls, China and suffocating free press.

The reality is that America's greatest economic generator is the tech sector and their relationship with China is fraught with complex issues that make any seen on the Bachelor kiddie play.  Part of the Valley's innate problem is they are exactly like the Oligarchs were of yesteryear, protecting their own class and securing their economic place in society.  They have a better vocabulary that professes doing good but so far I have seen or heard little that actually demonstrates this.    Sure I can freely Google but the costs are my personal privacy and a violation of my own personal civil rights for privacy. 

We used to feed the Gods that were Wall Street and in turn all hearts and minds fell to them to ensure that the prosperity of America was under the dubious belief that all Americans could grow wealthy and find economic security through the concept of investments in public funds.  Sure that was then this is now and if anything we learned from 2008 that regardless of the crime we pay the costs and do the time.

I have been using Lyft of late as I travel across the city to get to appointments, pick up goods and try to manage at times a commute that I prefer to rely upon buses frankly as there is less conversation and less confusion as how to go three city blocks.  Seriously Google your maps with all your tech are junk.  Weird how that works out and as if I would get into a driverless car knowing that.

Millennial's you are so used to people aka "Mommy"  driving you as you shuttled to school, to practice, to homes and to play dates you are pretty sure everyone loves that and as Chauffeurs are related to Green Books and the rich you came up with the idea of ride sharing.  Really it is a taxi but without that pesky regulation and licensing.  Good plan.   Then you have the same person shop for your Groceries and bring them home and if you cannot manage actually doing real meal preparation then the same person who drove you home, shopped for you and brought it to you will go out and get takeout for you.   I used to call that a Parent, then a Husband and then I got independent and shit and managed to do it myself.  Wow and I car shared my own car via Car2Go and drove myself, parked it, found it later and used it again.  Saving money and bother of owning a vehicle when this thing called public transit was not convenient.  You know like grown ups do and shit.

But Silicon Valley is the valley of the dolls, they have one shared brain and don't do fun ones like those in the book by Jacqueline Susan.  They would be better off.  I am still trying to figure out how Lyft and Uber have valuations in the billions when all they are are taxi and food delivery services and they actually don't even own the taxis, so they have no tangible assets in which to inventory and assess value.  And they don't produce any product that is sold and can be in turn valued for gross income versus net profit after labor and manufacturing costs are tallied.  So they get individuals to use their cars, pay their insurance to drive strangers all over town for a cut of the costs they bill the passenger.  Like Taxi and Limo Services only the cost of upkeep for the vehicle and insurance is covered by the company.  I used to love that show Taxi!  So anyway if the driver gets into an accident or is hurt by a car or a passenger that falls to them to repair said vehicle, pay any costs and are ultimately responsible. Same with the passenger.  Good luck with that if anyone has ever dealt with insurance you will find yourself lost in a quagmire of hell and I have a suspicion that they don't look kindly on these kind of drivers so I suspect that is one hell of a premium.

One thing I have learned is that I ask all my drivers what they do and where they live.  Few if any live in Nashville proper, hence the reliance on the tool (in every sense of the word in a negative manner) on Google maps.  They also commute themselves as a result to drive around the city finding gigs and one driver I had informed that she worked all day and made $6.00.  She lived an hour commute outside Nashville and has been doing this for two years and frankly given her lack of knowledge knowing the area I was shocked as she was nice but okay. Then we had the "Hotelier" who seemed to know nothing about commercial development or anything about Hotels but was building one that he could not share with me as it would disrupt the hotel industry.  This is from someone who came here 10 years ago to be a Musician and worked waiting tables while failing at that career and now was driving Lyft. But I felt like I was trapped with an aspiring Donald Trump the way he informed me about real estate investments. Funny that I had to tell him about current hotels and land for sale but okay then.  Sure this is the Nashville Way - stupid.

I would rather walk than use Lyft and I rarely tip and did with the woman as I felt bad as when I am directing them and having to deal with all this to get from point A to B it just isn't worth it.  I have watched cars drive by as they are confused by where I am standing and in turn gotten into some vehicles that the driver was so bizarre that I ended the trip earlier feigning I forgot something.

I urge you to read this and understand that the Valley is about green and by green they mean money that is how green the valley is.

Silicon Valley’s grand experiment in jobs means employees are the guinea pigs

By Katherine Boyle
The Washington Post
January 18 2019

Katherine Boyle is a venture capitalist at General Catalyst in San Francisco.

For roughly 2,300 years, Aristotle’s edict “We work in order that we may have leisure” has explained a lot of why humans do what they do. Philosophers in every age have upheld the virtue of work, providing that, at some point, we could kick back a little bit.

But Silicon Valley is busy fiddling with that ancient contract. Among technologists building our task-based gig economy, there have emerged two factions holding opposing theories of the future of work and what it means. In one, we each will need to have many jobs. In the other, we will not work at all. It’s unclear in which direction we’re headed.

The first group — the UBERians, let’s call them — believe the gig economy will give workers more money, more time and more flexibility. In a perfect UBERian world, we will all be gig workers, working for a variety of platforms, enjoying the benefits of life as independent contractors. As Uber and Lyft — the current victors of the gig economy — go public this year, it’s also clear that Silicon Valley’s grand experiment with gig employment is not so much freedom from labor but gamifying it so that workers will do more of it. The next time you climb into the Prius you just summoned, ask your driver if he or she is on track to hit their Quest bonus today and see what happens.

The second group — the UBIans, let’s call them — believe machine intelligence will soon replace much of work as we know it. The UBIan mantra is: “We work on algorithms in order that . . . oh no, humans may never need to work again.” As human labor increasingly becomes the most expensive input in the “technical stack,” this faction believes much of work will become obsolete and the government will need to give everyone some form of Universal Basic Income (UBI) to live.

Universal Basic Income has become intellectually so trendy in Silicon Valley that it’s a little like last season’s Juicero — faddish and frivolously accepted as something society really needs. When UBIans gather in their cryptocurrency WhatsApp groups — UBIans aren’t fans of dinner parties, as they tend to fast “to enhance cognitive function” during the week — they’ll cite the success of UBI in Kenya and Uganda, where GiveDirectly, a nonprofit, offers unconditional cash to small groups. Or the Alaska Permanent Fund, which has been supplying Alaskans with a yearly cash dividend since 1982. “On a limited scope,” they’ll say, “this works!”

As everyone knows, when Silicon Valley investors assess start-ups, their primary question is, “Will it scale?” When it comes to solving the riddle of an economy where work is dramatically changing, many who work with me in the digital economy are eager to foist the problem on Washington. Perhaps they know full well that our gridlocked Congress will not enact the greatest change to welfare since the New Deal. For many technologists, UBI is an intellectual get-out-of-jail-free card that makes it easier to stomach the long-term effects of our preferred business models.

On the flip side, many advocates for the gig economy genuinely believe their new business model is better for workers’ lives. And for many workers, it is: Uber and Lyft and many of their like are strong platforms for part-time workers who make gig work a supplement to a full-time job.

But the reality of who benefits seems to relate directly to the type of gig work one does and how much of it one performs: According to a JPMorgan Chase Institute study, from 2013 to 2017, gig-worker earnings fell by 53 percent in the transportation sector but grew by 69 percent in the leasing sector. Thus, if you’re driving, you’re likely worse off than you were five years ago. But if you’re renting an apartment, you’re faring much better.

Meanwhile, it’s somewhat unclear how many people the gig economy really serves. Government agencies can’t even agree on “who” a gig worker is: The Bureau of Labor Statistics recently declared a slight decline over 12 years in gig economy workers to 10 percent of the workforce, while the Federal Reserve says contractors compose closer to 30 percent, the difference being whether gig work is primary or supplemental income, which again, isn’t easy to measure. Even Alan Krueger and Lawrence Katz, the two economists who published a widely cited study in 2016 on the gig economy, recently walked back their conclusions that the gig economy was growing rapidly.

Growing or not, it’s clear though that politicians are not keen to fund the social costs of these new business models; more likely, they will force tech companies to unravel the problems themselves. In December, New York officials enacted a guaranteed minimum wage for ride-hailing drivers of $17.22 per hour. Neither the UBERians nor the UBIans applauded. That may be because it’s increasingly clear what most people want: a traditional relationship with their employer. Silicon Valley would be wise to heed the signs — as well as the literal signage — now popping up on streets. Last year, when striking workers picketed outside many Marriott hotels in San Francisco, they held up signs that said, “One job should be enough.”

While the future may mean choosing no job or many, many of us are still with Aristotle, craving that weekend nap.

Friday, January 18, 2019


That is the new way hospitals are listing comparative pricing to meet the new law that the Trump team devised to reduce medical/insurance costs.  Much like his mind this new system is full of bullshit.

I can add little to this but as one who walks into the Dental and Hospital Clinic of Vanderbilt on a regular basis I can assure that pricing, billing and insurance coverage varies day to day.  I rarely get a bill in advance with the treatment plan, the pricing and the insurance coverage clearly spelled out in which to budget.   So when I get a bill I wait for a long time to pay it as half the time the payments made are not deducted from the balance so in turn that figure is often incorrect.   I still cannot forget that when I walked in for surgery last year and was asked three times by three different people had I paid the outstanding bill.  Yes I had to another person a week before as requested and required by the bill I had received for the procedure the week before.  It was wrong but I paid it as I instead had more treatments and changes to that bill that my surgeon elected to do upon opening up my gums and seeing the tissue and jaw damage.  But too late, I paid so thanks!  For what its worth I felt I deserved it and made no effort to contact them nor they me regarding this and in turn I still wrote a complaint about the process as they had put me under anesthesia too long and had overbooked the surgical rooms leaving me to dress in the hall with people walking by.  And the day after I came home to a Washington Post article describing what I had just experienced and my Nurse that I hired heard as she waited for me to complete the procedure.  So again, I paid. Thanks!

And these prices are not accurate and in turn are based on numerous factors so as you are getting wheeled in after being picked up by an Ambulance on the way to ER I doubt this information will help you.  So again the point is what exactly?

Hospitals Must Now Post Prices. But It May Take a Brain Surgeon to Decipher Them.

By Robert Pear
The New York Times
Jan. 13, 2019

WASHINGTON — Vanderbilt University Medical Center, responding to a new Trump administration order to begin posting all hospital prices, listed a charge of $42,569 for a cardiology procedure described as “HC PTC CLOS PAT DUCT ART.”

Baptist Health in Miami helpfully told consumers that an “Embolza Protect 5.5” would cost them $9,818 while a “Visceral selective angio rad” runs a mere $5,538.

On Jan. 1, hospitals began complying with a Trump administration order to post list prices for all their services, theoretically offering consumers transparency and choice and forcing health care providers into price competition.

It’s turning into a fiasco.

“This policy is a tiny step forward, but falls far short of what’s needed,” said Jeanne Pinder, the founder and chief executive of Clear Health Costs, a consumer health research organization. “The posted prices are fanciful, inflated, difficult to decode and inconsistent, so it’s hard to see how an average person would find them useful.”

The data, posted online in spreadsheets for thousands of procedures, is incomprehensible and unusable by patients — a hodgepodge of numbers and technical medical terms, displayed in formats that vary from hospital to hospital. It is nearly impossible for consumers to compare prices for the same service at different hospitals because no two hospitals seem to describe services in the same way. Nor can consumers divine how much they will have to pay out of pocket.

“To 99 percent of the consuming public, these data will be of limited utility — meaningless,” said Kenneth E. Raske, the president of the Greater New York Hospital Association.

The list price for a hospital service is like the sticker price for a car. But as it is playing out, it is as if the car dealers were disclosing the price for each auto part, without revealing the charge for the vehicle as a whole.

The result has baffled consumers.

“This is gibberish, totally meaningless, a foreign language to me,” said Sara Stovall, 41, of Charlottesville, Va., after looking at price lists for hospitals in her area.

She reviewed the price lists for Sentara Martha Jefferson Hospital and for University Hospital, each of which has more than 16,000 items.

“I can’t imagine how I would go about making this useful,” Ms. Stovall said on Sunday. “I wouldn’t know how to find my procedure. I wouldn’t know what services might be rolled up with my procedure. And I would not know the price to me after health insurance.”

By most accounts, the Trump administration is pursuing a worthy goal, but the execution of its plans leaves much to be desired.

After the administration proposed the price-disclosure requirement in April 2018, many hospitals warned of the shortcomings that are now evident.

But federal health officials, accustomed to debating issues inside the Washington policy bubble, have still been surprised at the reaction around the country as consumers and local news media try to decipher the data. The administration says it is open to suggestions for 2020 and beyond.

The price-disclosure requirement, issued by the Department of Health and Human Services, grows out of one sentence in the Affordable Care Act, which says, “Each hospital operating within the United States shall for each year establish (and update) and make public (in accordance with guidelines developed by the secretary) a list of the hospital’s standard charges for items and services provided by the hospital.”

The idea languished for eight years. Under prior guidance from the government, hospitals could meet their obligations by providing charges to patients on request. But the Trump administration wanted to go further.

“We’ve updated our guidelines to specifically require hospitals to post price information on the internet in a machine-readable format,” Seema Verma, the administrator of the Centers for Medicare and Medicaid Services, said last week. “This is a historic change from what’s been required in the past.”

“This is about empowering patients,” Ms. Verma said.

It has not worked out that way, at least so far. Martin Gaynor, a professor of economics and health policy at Carnegie Mellon University in Pittsburgh, described list prices as “somewhat fictitious.”

“If this is an initial step leading to real transparency with actionable, usable information, that would be fantastic,” Mr. Gaynor said.

But in its current form, he added, the price information is “not very useful and could even be misleading” because a hospital with high list prices could be the cheaper alternative for some consumers, depending on their insurance.

“For patients to know up front how much their care will cost, that’s incredibly valuable,” said Brenda L. Reetz, the chief executive of Greene County General Hospital in rural southwest Indiana. “We’ve posted our prices, as required. But I really don’t think the information is what the consumer is actually wanting to see.”

Spending on hospital care last year totaled $1.1 trillion, or nearly one-third of all health spending, according to the Department of Health and Human Services. So even small improvements in the market could yield big savings.

The Trump administration adopted the new requirement as part of its agenda to promote “transparency” in health care, in the belief that health markets would work better if consumers had more information. In another example, federal officials want to require pharmaceutical companies to disclose the list price of prescription drugs in television advertisements.

“Providers and insurers have to become more transparent about their pricing,” Alex M. Azar II, the secretary of health and human services, said last year. “There is no more powerful force than an informed consumer.”

The Trump administration told hospitals that they had to post their standard charges for all services and items, including drugs, by Jan. 1, but did not define “standard charges.” In later guidance, it said the format was “the hospital’s choice.”

“Without a standard definition, patients cannot make accurate comparisons between hospitals,” said Herb B. Kuhn, the president of the Missouri Hospital Association.

No hospitals operating in the United States are exempt from the new requirement, but the Trump administration has not said how it plans to enforce it. Federal officials have asked the public to suggest “enforcement mechanisms.”

Each hospital has a list — known as a “chargemaster” — of prices for thousands of goods and services, including medical procedures, laboratory tests, supplies and medications. But the price information is often difficult and sometimes impossible to find on hospital websites.

List prices may be relevant for some consumers. People with high-deductible plans may have to pay some or all of the list price until they meet the deductible, and people with insurance who go outside their health plan’s network may also have to pay a substantial share of the list price.

But to others, the prices listed on the “chargemaster” may have no bearing on the cost of their care. Health plans and insurance companies usually negotiate much lower prices, and uninsured patients often qualify for substantial discounts.

“Many hospitals still see the chargemaster price as an important way to enhance revenue,” said Ge Bai, an expert on health care finance and accounting at Johns Hopkins University. “Having a high list price means they have more leverage in negotiating prices for people covered by private insurance.”