Thursday, February 26, 2009

Medical Miracle: Cheaper prescriptions — for free?

Published in the Portland Phoenix

It started out normally: I was filling a 90-day prescription at Hannaford, and my insurance co-pay was $20. But wait! said the woman behind the counter. Was I a Hannaford Healthy Saver?

A what? I asked.

A Hannaford Healthy Saver. If I signed up for this program, my co-pay would drop to $9.99.

How much does the program cost? I asked.

Seven bucks. All I had to do was fill out a form — name, address, birth date, phone number, all stuff Hannaford already had on file — and Hannaford would basically give me $10. I'd make three bucks this time (plus get a coupon book that could help me save another $100), and — since the up-front fee was an annual one — I'd save even more down the road.

The next time my wife or I needed a prescription, it was almost a sure thing that Hannaford would give me more money. Nearly 500 drugs for humans (and even some for pets) are covered in this strange new program, under which 30-day prescriptions for covered drugs cost only $4. Many generic antibiotics are — get this — free. Wal-Mart offers a similar program; so do other supermarkets and pharmacy chains around the country.

But these companies are doing more than saving us money in the short term. They are teaching us how to fix our healthcare system — how to sell at rock-bottom prices and still make a profit.

Competition can be not just on service or product, but price as well. Most supermarkets offer similar — even the same — products and services. Medical professionals do, too, but they don't compete on price — try to think of the last time you saw a medical ad, even for liposuction or corrective eye surgery, that told you how much the procedure would cost.

If doctors posted their prices, competition would drive down costs — and doctors who charged more than average would have to justify their higher price by claiming a better technique, an advanced degree, or more experience. Would quality of care suffer in the name of economy? Only if the government, which regulates the quality of the groceries we buy at competitive prices, dropped its standards for medical care. Consumer protection is necessary at any price point.

It's time to apply this market common sense to the entire healthcare system. Right now, there's no way for a layperson to determine the actual cost of a prescription. The companies involved — manufacturers, insurers, distributors, suppliers, pharmacies — treat their costs as trade secrets.

The closest anyone comes to disclosure is found in the lists of "usual and customary" (U&C) costs. But no drug price is really usual or customary — partly because no two companies agree except by coincidence, but mainly because almost nobody ever actually pays it. Nobody with insurance does, because their insurance plans have negotiated a reduction. Nobody who signs up for $7-a-year discount programs does either, because that's the point of the discount.

And, in fact, the "U&C" charge is not anything close to an actual cost — the prescription I got for $10 had a U&C cost of $175!

That's the killer — and, for people who struggle to afford healthcare, it's a literal killer — the purported cost is not the actual price of providing a service (or its value to others), but rather a negotiating tool to fool others into handing over more money.

Companies like Hannaford can upend this system, not by taking losses or writing checks they can't cash, but by telling customers the truth — how much they really need to charge to make a bit of a profit.

Naturally, Matt Paul, a very friendly and helpful spokesman for the Scarborough-based Hannaford Bros. company, was reluctant to give any details on how much profit the company actually makes. But he would say that instead of the insurance company setting the profit margin for its prescription plan, Hannaford was calling the shots on the costs in the Healthy Saver plan.

It's not enough to make healthcare affordable on its own, but it's a big start.

Wednesday, February 18, 2009

Stuff you really should know (From a guy who learned it the hard way)

Published in the Portland Phoenix

The biggest - and hardest-to-follow - rule in homebuying is that friendly real-estate agents and mortgage brokers don't actually work for you, no matter how much they act like they do. They work for themselves, and they earn money based on the prices (and interest rates, for brokers) at which the deals close.

This means the real-estate agent wants you to buy a house for the highest price she can talk you into accepting, and the mortgage guy will give you the highest interest rate he thinks you'll agree to.

But if you spend all your cash on the down payment, and lock up all your monthly income in a mortgage payment that's too high, you'll become "house-poor" — you'll have a house, but no money to improve it or fix anything that might break, and you'll risk being unable to make the payments if unforeseen expenses crop up.

So, buyer, beware - and be patient. Don't let other people pressure you into something you don't want, and when you find something you do want, bargain with them to get the best deal for yourself.

Your real-estate agent will ask what your price range is. And then she'll try to show you houses with asking prices "just a little more" than that. That's her upsell trick - if you fall in love with a house that costs more, your emotions might take over, and she'll make a bigger commission - for ignoring your initial request.

Once you've found the right house, your agent will start negotiating for you. She'll probably ask "How high are you willing to go?" But your answer is not just giving her information that can help her make a deal on your behalf; it's giving her tacit permission to set your highest price as the final amount (which makes her a better commission). Just tell her what your offer is at that moment.

If a counteroffer comes back, consider it - on your own. Multiple rounds of offers and counteroffers are quite normal - though your agent may push you to make big concessions to close the deal (so she gets paid sooner, and for less work).

Mortgage brokers will pull similar tricks, trying to get you to take a higher rate - which gets them better pay. If you want something lower, keep pushing, and keep waiting.

Above all, remember that right now, houses aren't moving. Agents and mortgage brokers are sitting idle, hoping to close deals to get some income for themselves. So drive a hard bargain - even with the people who are "on your side." If you make it clear that your offer is your offer, and you're not moving, your agent will work really hard to close the deal. If you are unambiguous about wanting a lower interest rate or better terms, your mortgage broker will step up to the plate for you. But you must make it plain that you know the market favors you, and you're willing to wait.

Friday, February 13, 2009

Media discussion on MPBN's MaineWatch

Aired on Maine Public Broadcasting Network's MaineWatch

Wednesday, February 11, 2009

Press releases: Confusion and upset

Published in the Portland Phoenix

The big Maine media news is that Central Maine Morning Sentinel executive editor Eric Conrad fired reporter Joel Elliott on January 26. (Disclosure: Elliott is a friend and a fellow member of the Maine Pro chapter of the Society of Professional Journalists.)

Since then, Elliott (who had been at the paper since June 2005) and several Maine-media watchers have criticized Conrad's action.

There appears to have been longstanding trouble between Conrad, a former managing editor at the Portland Press Herald who left briefly in 2006 and then returned to take the helm at the PPH's sister papers, the Morning Sentinel and the Kennebec Journal, and the career-minded Elliott, who used a personal "vacation" last year to report from Pakistan for the New York Times and the San Francisco Chronicle.

The dispute ultimately comes down to whether Conrad is too milquetoast or Elliott too aggressive. Elliott says Conrad used complaints from sources to justify disciplinary action, suspending him repeatedly over the past year and ultimately firing him.

The three main complaints relate to a May story in which Elliott quoted the Waterville police chief disparaging Colby College's student-discipline practices, which the chief denied saying; an August story in which he quoted a special assistant attorney general saying something she later claimed was off-the-record; and a September story in which he quoted a Colby College guest speaker saying something a Colby public-relations official suggested could have been interpreted as disparaging the people she was talking about — who had no connection to Colby.

Elliott, who is challenging his termination through his union, says the stories were accurate, and the paper has so far taken no action to suggest otherwise; the stories in question have not been retracted or corrected, online or in print.

He says Conrad should have supported his reporter, but instead sided with powerful local interests — the Waterville police chief, a state official, and the college.

In the Colby situation, unnamed college officials asked Conrad not to assign Elliott to write any stories at all relating to the college. While that in itself is a remarkable request — and even more remarkable for Conrad's mention of it in Elliott's termination letter — Elliott makes two noteworthy accusations.

First, he observes that Conrad's wife works for Colby, which could suggest a conflict of interest — pitting Conrad's obligation to serve his readers against accommodating his wife's employer. (Not to mention, of course, the standard pressure to "play nice" a heavyweight non-profit institution can put on its local newspaper.)

Second, and most powerful for non-conspiracy-theorists, Elliott notes the bizarre timing of the request. The last piece he wrote about Colby was in mid-October, a full three months before Colby asked Conrad to bar Elliott from covering the college. As it turned out, there wasn't much danger of that: a week later, Elliott was fired.

Conrad declined to comment on any aspect of the situation, citing privacy concerns (even though Elliott has repeatedly waived confidentiality — including once allowing several newsroom staffers into a disciplinary meeting with Conrad).

Conrad's reluctance to talk about Elliott is reasonable; but his failure even to directly refute the charges laid against him only serves as fodder for further questions. By failing to explain his actions, Conrad, whose newspaper promotes transparency and accountability in those it covers, appears to be putting himself in a situation that — if not compromising — is certainly uncomfortable. And as most in the media realize, impressions often assume a reality all their own.

Wednesday, February 4, 2009

Judge dismisses RNC protest case

Published in the Portland Phoenix and the Boston Phoenix

Portlander Paul McCarrier, an activist with the Black Bird Collective and the North East Anarchist Network, Bostonians Molly Adelstein and Kate Bonner-Jackson, Drew Wilson of Worcester, and three others were among roughly 20 people arrested September 1, 2008, at the intersection of 6th and Wall Streets in St. Paul, Minnesota during the Republican National Convention. Police alleged that they had participated in a roadblock four blocks away, and charged them with unlawful assembly, impeding traffic, disorderly conduct, and obstruction of a legal process.

The defendants — who became known as the "Wall 7" — were in St. Paul during the RNC because, as Wilson puts it, "we think that our government should be held accountable for the crimes it has committed." They weren't released from jail until the last day of the convention.

Along with many of 800 others arrested (including journalists, a convention delegate, and a convention security guard), faced misdemeanor charges, 40 percent of which have since been dropped. More than 20 people — including the "RNC 8" activists who coordinated protests and protest support — face felony charges.

The Wall 7 were offered plea deals — the chance, says Bonner-Jackson, to "plead guilty to something you didn't do" — but, unlike many others, didn't take them. With legal advice and support from the National Lawyers Guild, Minnesota activists Community RNC Arrestee Support Structure (CRASS) the Seven, relative strangers, demanded a collective jury trial, which was scheduled for January 20, inauguration day.

But the case was doomed because the Wall 7 and other RNC protestors had demonstrated wearing masks, helmets, and padding for both protection and anonymity — the familiar "black bloc" protest tactic. As a result, witnesses couldn't identify who had done what in the streets of St. Paul, and the judge dismissed all the charges.

"Police had no basis for the vast majority of arrests made during the RNC," said defense attorney Jordan Kushner said in a press release after the trial ended. "The judge in this case decided there wasn't even enough evidence to require the defendants to put on any evidence and allow the case to go to a jury."

Bonner-Jackson (who works with Boston's Food Not Bombs group) is "kind of disappointed" their day in court didn't include the chance to explain what they were doing, but she's "not arguing" with the ruling.

"We did nothing wrong. We went there for good reasons. We did something right," says Worcester community activist Wilson.

The Wall 7's victory is significant in that it opens the courtroom doors for other protestors who've declined plea bargains. CRASS, meanwhile, is now organizing arrestees to sue authorities for wrongful arrest and use of excessive force.

What the Wall 7 learned in Minnesota

The Wall 7 learned a few things for their next protests, too:

During protests, they should pass out flyers and talk to passers-by about what the protest is about, and why the demonstrators are dressed in protective clothing.

Creating positive community-support structures works: activists set up health clinics, hot-meal services, Internet access, legal observers, street medics, bicycle sharing, and shared housing during the RNC, and community support for those on trial afterwards.

Sticking together really helps, while being arrested, when in jail, upon release, and during the trial.

Hugging irritates jail guards, who say it's not allowed, and call it "stupid."

The public at large is willing to accept a startlingly high level of police brutality toward citizens.

Being arrested, even when it includes being pepper-sprayed, isn't as bad as they thought it was.