My Musings

Originally published at Flametoad. You can comment here or there.

I just wanted to point out a new, neat little RPG supplements called Instant Antagonists. In short, they are villain profiles designed to be dropped into any modern horror campaign. Character stats are left to the GM since this is supposed to be system-agnostic, but it provides a worthwhile foe with multiple variations on background and purpose. It’s great as an idea generator, a villain for a side trek, or as stand-in for when the players overcome your “big bad” two games into the campaign. The first in the series, Selfish Succubus, is available as a PDF.

Oh yeah. Full disclosure: while it’s not a 12 to Midnight product, I did help out with layout.

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Originally published at Flametoad. You can comment here or there.

I’m thankful for terrible holiday-themed movies. I’m also thankful for Netflix’s on-demand service that me stream movies through my Xbox 360 to the TV. I’m thankful that Netflix offers a RSS feed of movies newly added to their on-demand list so I’m always aware of new releases. I’m thankful that all of these things have come together in a perfect storm of awesomeness called ThanksKilling. From their description:

While on their way home for Thanksgiving break, five college kids run afoul of a homicidal turkey that wants them dead. As the cursed bird hunts them down one by one, the survivors scramble to find a way to defeat the possessed creature. Will the bloodthirsty turkey make this their last Thanksgiving feast ever? Writer-director Jordan Downey’s holiday-themed horror spoof features an appearance by adult-film star Wanda Lust.

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Originally published at Flametoad. You can comment here or there.

I was 9 years old when my parents took me to the movie theater in Gonzales (yes, the one and only theater) to see Clash of the Titans. I thought it was a pretty awesome movie at the time, but as an adult I never would have picked it for a remake. In fact, the mere thought that they would try merely underscored the whole problem with Hollywood’s lack of creativity. However, now that I’ve seen this teaser trailer, I may have to eat crow. This movie looks awesome!

It’s still possible that the plot will fall apart like wet paper and the acting be a form of remote torture, but it looks fantastic and I can hope that the plot and acting are just as good.

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Originally published at Flametoad. You can comment here or there.

I am so renting this movie when it comes out. Who’s with me?

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Originally published at Flametoad. You can comment here or there.

Got this e-mail this morning and it was too delicious not to share.

Dear Facebook user,

Due to Facebook policy changes, all Facebook users must submit a new, updated account agreement, regardless of their original account start date.
Accounts that do not submit the updated account agreement by the deadline will have restricted.

Please unzip the attached file and run “agreement.exe” by double-clicking it.

Thanks,
The Facebook Team

The mail appears to come from Facebook <update+ogqlkohachj@facebookmail.com>. Facebookbmail.com? really? And you want me to execute an EXE file?

I thought we were past this, guys. We live in an age of drive-by malware infections from legitimate websites and botnets 10,000+ strong. And you’re sending executables in zip files?

Originally published at Flametoad. You can comment here or there.

For the whole time the Flametoad blog was on hiatus, I kept squirreling away links use as blog fodder. The theme for this week’s linkdump is publishing and e-books.

Profit & Loss – If you’ve ever wondered why books cost as much as they do, you’ll want to check out this post on Marion Gropen’s Publishing for Profit blog. Marion takes the reader step-by-step through all the factors that make up a non-fiction book’s cost. It’s an eye-opening exercise if you’re not already familiar with the business side of publishing.

International Rights – Publishing rights are traditionally sold on a country-by-country basis. This made sense 100 years ago for print books, but in today’s ebook market it just hurts the customer. In this case, the customer is a solider serving overseas who is being blocked from buying American books because his base’s IP address isn’t registering as in-country. It’s just another sign that it’s time to rethink how publishing works.

E-book DRM – Nobody likes it, but in an industry where profit is slim, the threat of loss through illegal duplication is terrifying. Booksquare tries to move the conversation forward with minimal drama.

Comparison Shopping – The price of e-books varies a lot more widely than one would expect. The MetaEbooks site lets you search for a book by title or author and find the cheapest price across several online retailers. You can even narrow your selection by ebook format.

Save your Money – A friend recently advised me to consider TVs to be just like computers. The technology is changing so rapidly that there will always be a better model on the market just a few months after you buy one, and for the same price. Should we now add ‘books’ to that category as well? The venerable Teleread.org has an essay titled “Why you probably should NOT buy an ereader this year”. I’m not sure I entirely agree, but read it for yourself.

Lessons from History – The excellent O’Reilly Tools of Change for Publishing companion website has a short post called Lessons from Digital Disruption in the Music Business. I’ll admit that I didn’t listen to the linked hour-long podcast, but the quote and other links were certainly good food for thought.

Books Aren’t Baked Beans – That’s the title of the first in an excellent series of articles by Martyn Daniels, republished by permission at Litopia.com. If you’re interested in publishing or even simply interested in a case study in how digital technology is disrupting an entire industry, I highly encourage you read the whole series.

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Originally published at Flametoad. You can comment here or there.

Dear Parent,

In reference to your request for the return of your childcare deposit, I am afraid we must decline. I know that this comes at a particularly difficult time, in light of your tragedy, and we genuinely do not wish to add to your pain. I must regretfully remind you that your letter of intent is a binding agreement, and it clearly states that the deposit is 100% non-refundable. I know this may come across as a heartless policy, but unfortunately if we returned the deposit or childcare tuition of every child stolen from its cradle by a witch, lured into the land of Faerie by traveling musicians, or turned into animals for naughty behavior–well, you can imagine how quickly we would be left near-destitute. As difficult as this may seem, I hope you will take this rejection as a sign to strengthen your resolve and reaffirm your hope. Surely if your precious child is as clever as you led us to believe during the interview, he will find a way to trick the witch into pouring a circle of salt around herself or perhaps push her into an oven. If this is the case, then rest assured that your unrefunded deposit continues to guarantee him a spot here in daycare.

Regards,

MG

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Originally published at Flametoad. You can comment here or there.

It’s hard to believe, but we began working on ETU: Degrees of Horror back in 2007. Sometimes the words flowed easily, and other times we made absolutely no new progress for months at a time. With the first draft complete and work begun on revisions and refinement, Ed and I wanted to reward our loyal fans for their patience. So, I put together a sneak peek at a some of the content. The layout is in no way representative of the final book, but it’s fun and evocative of college life.

This sneak peek is only 32 pages, which is a drop in the bucket compared to the book as a whole. It covers all of chapter one, much of the character creation chapter, character sheets, a new mechanic for creating inventions, and a pair of adventures you can play. We’re calling this a “beta” because we’re seeking your input on the rules, so please head on over to the 12 to Midnight website and download it.

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Originally published at Flametoad. You can comment here or there.

Well, Halloween 2009 was a big weekend at Flametoad Manor. Starting with our family tradition of Saturday morning BBQ breakfast tacos, we quickly moved on to errands, home for a play date with one of Tadpole 1’s friends, and a low-key afternoon punctuated with pumpking carving and of course trick-or-treating. We had more than 100 kids come to our door, based on the amount of candy I handed out. This year I wanted to hand out something a little more unique, so I ordered a bunch of grape-flavored wax mustaches and gummie candy shaped like roadkill, sure to appeal to any 7 year-old’s funny bone. Mrs. Flametoad and I finished the night by watching Dusk Till Dawn, although I’ll admit we skipped to the part where the group showed up at the “biker bar”.

The next morning, I loaded up the kids and we drove to the Houston Zoo. Mrs. Flametoad regretfully skipped on this trip because the walk up and down the street did bad things for her broken toe. Walking all over a zoo just wasn’t in the cards. Despite the lack of Mommy, the tadpoles and I managed to have a great time. If you can’t see the photos below, you’re probably reading this on some third party site like Facebook. Just jump over to Flametoad.

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Originally published at Flametoad. You can comment here or there.

And now, for the opposing viewpoint.

What made it all seem worthwhile was the book, the physical item, a kind of sacred and appropriate temple for the text contained within. Had I been told from youth that my literary destination would be some 7 inch plastic gizmo containing my texts shuffling alongside thousands of other “texts” I would have spit in the face of such a profession and become instead a hit man or a rabbi.

What do you think? Are e-books an abomination to all that is right with humanity?

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Originally published at Flametoad. You can comment here or there.

I and a lot of other people were caught off guard by the recent changes to how Facebook is showing us our news. What’s the difference between the News Feed and the Live feed. It would have been nice if there had been some sort of news update or instructions or something. Instead, it just appeared and we had to figure it out on our own. A few days later word started traveling through the grapevine that you could rearrange the list on the left, putting Status Updates at the top, and things would go back to the way they were.

Only, that’s not really true. Moving Status Updates to the top of the list does (sometimes) change your default view, but as the name suggests, you only see status updates. You don’t get the photos of your nieces and nephews or all the other miscellaneous stuff that is posted on Facebook. It just seemed wrong that there would be a change like this with no explanation, so I started looking for one. It took me all of about 30 seconds. This public service announcement is for all of you who have been complaining about Facebook but haven’t bothered to look into why it’s doing what it’s doing.

For starters, you can go to Settings->Help and read most of what I’m about to tell you.

Now, there are two views of News Feed: a summary view of the most interesting activity that’s happened in the last day and a real-time view that shows you what is happening right now. Learn more about News Feed and how to edit the views here.

That is followed with a link that takes you to an FAQ. The money quote is the very first question and answer.

What is the difference between News Feed and Live Feed?
News Feed aggregates the most interesting content that your friends are posting, while Live Feed shows you all the actions your friends are making in real-time.

I don’t know about you, but I have a ridiculous number of “friends” on Facebook. I put friends in quote because it’s really a mixture of friends, acquaintances, colleagues, people whom I’ve never met in person but nevertheless are fans of 12 to Midnight and seem great. I’ve got less than 200 Facebook friends, and I know quite a few people who have in excess of 500. Every time I log in, it’s with the knowledge that I’m missing dozen of posts because of all the noise. I’ve even created some custom friends lists to use to narrow down groups and try to catch everything, but honestly it’s more trouble than it’s worth.

I think the Facebook team has recognized this trend and is trying to do something about it. Thus we’ve got the News view, which tries to summarize the most interesting stuff, and the Live view, which is every post from every friend in date order.

How does News Feed determine which content is most interesting?
The News Feed algorithm bases this on a few factors: how many friends are commenting on a certain piece of content, who posted the content, and what type of content it is (e.g. photo, video, or status update).

This is pretty cool, in my opinion, because if I were designing it that’s exactly how I would do it. I’d look at the number of views and comments on a post, content type (ranking user generated higher than app-generated), and how frequently I’ve interacted with the poster in the past.

Where are my Highlights?

Highlights and News Feed have been merged into one single stream in order to provide you with more control over what you see on your home page. Now when you load Facebook for the first time in a while, you’ll land on your News Feed, which contains a summary of the best content that you missed. After you’ve caught up on what you’ve missed, you can switch to the Live Feed. The Live Feed is a real-time stream that allows you to connect and share with friends’ updates immediately as they are occurring.

Once I realized what the two pages were for, I saw that they did their jobs pretty well. Where Facebook fell down was in not explaining all of this to us as an item in our news streams. I’m sure there’s an essay about the sad irony in Facebook’s communication failure. In the meantime, give the two news views a fresh chance. You may come to like them.

Originally published at Flametoad. You can comment here or there.

In the Halloween-themed episode of Castle that just aired, the script writers floated the theory that people who showed a deep fascination with death usually had a triggering, traumatizing event in their past. Since the tv show is about a murder mystery writer, the obvious question was what caused him to be drawn to death. We viewers may not know that answer for a while, but fortunately we can look for answers elsewhere.

A friend just sent me a link to an article in the Chronicle of Higher Eduction, titled Monsters and the Moral Imagination. For me, the money-quote follows.

In a significant sense, monsters are a part of our attempt to envision the good life or at least the secure life. Our ethical convictions do not spring fully grown from our heads but must be developed in the context of real and imagined challenges. In order to discover our values, we have to face trials and tribulation, and monsters help us imaginatively rehearse. Imagining how we will face an unstoppable, powerful, and inhuman threat is an illuminating exercise in hypothetical reasoning and hypothetical feeling.

This gets to the heart of not only horror, but the fun in roleplaying games as well. From the outside, there’s a vague notion that RPGs are for loners to play elves and dwarfs in their parent’s basement. In reality, it’s a highly social activity that posits a series of challenges and allows players to collectively overcome them (or not). Unlike traditional board games, the players usually don’t compete against one another, but cooperate against an external threat. RPGs come in all styles and flavors, but horror RPGs have a special place in my heart. The Chronicle article “gets it”. Enjoying horror isn’t about reveling in the macabre, it’s about imagining external adversity* and then overcoming it– all from the safety of one’s dining room table.

*As opposed to sitting around pretending to overcome internal adversity, like breast cancer. That’s just morbid.

Originally published at Flametoad. You can comment here or there.

Officially the blog is still on hiatus, but I just wanted to let everyone know that 12 to Midnight is having our annual halloween sale. Almost all our modern horror e-books are 50% off. Even better, our horror anthology Buried Tales of Pinebox, Texas is only $0.99! If you haven’t picked up a copy of this book, there will be no better time. If you enjoy it (and I know you will), I hope you’ll take the time to write a short review on Facebook, GoodReads, Amazon, LibraryThing, or whever you hang out.

You can read more about the sale on Flames Rising, or you can start buying from DriveThruHorror.com, Midnight Cellar (the official 12 to Midnight store), or RPGNow.

Originally published at Flametoad. You can comment here or there.

Oh yes!

Originally published at Flametoad. You can comment here or there.

Yes, I know I said that Flametoad was going on hiatus, but this morning in my Flametoad inbox I found an e-mail from a guy named Alex Poutiainen. I almost deleted it, because the subject was “New Vid”, which has “spam” written all over it. However, the first few lines of the message related to Flametoad content, so I took a chance and opened it.

That’s when I was reminded that Alex was the guy who created Nazi Dinosaurs and Zoo of the Dead. It was very cool of him to write me personally to let me know that he’s back with a new YouTube movie – Robowaitress Fury. Enjoy!

Originally published at Flametoad. You can comment here or there.

Yes, I’m still here. I still have more to say about the whole health care reform thing. However, I also renewed my focus on finishing the writing/editing of a big project– ETU: Degrees of Horror. I have very little time for writing these days, so I have to make tough decisions about how I use it. That means Flametoad will be going on a planned hiatus for a few more weeks while I continue work on ETU. I will be back. In fact, when I return I’ll probably be devoting even more time to Flametoad than I had previously. I’ve got some ideas for short fiction in addition to my usual random essays and links to cool stuff. I hope you’ll hang in there with me. There’s still quite a bit of fire left in this old toad.

Originally published at Flametoad. You can comment here or there.

In Flametoad’s continuing series on health care, today I’d like to take a closer look at some of the costs that affect what we (or insurance companies) pay for health-care. Before I we get into those costs though, I did want to mention something that I meant to bring up in my first post. Has anyone else noticed that eighties are the new sixties? The average lifespan in America is now between 77.5 – 80 years old [PDF from the CDC]. Long term disability insurance is more important than ever because, as Mrs. Flametoad has said “We’re really pretty good about keeping you going. We just can’t guarantee that we can put you back to the way you were before.” This ties in directly with what I said in that first post about people who are regularly admitted to the ICU today are the patients who simply would have been dead 30 years ago. We’re better at extending life, but not necessarily because we’re living more healthy.

Anyway, this post is about expenses. What drives the costs behind health-care? Why, when you go to a hospital, does aspirin cost $10? That goes back to one of the idiosyncrasies of medial billing. If you’re really persistent, you can get a nice, itemized bill for your hospital services. What that bill doesn’t show you are items like ”nursing care”, or “administrative costs”, or “floor waxing”. When we buy a shirt from a store, we all understand that the price of that shirt includes the overhead involved in running that store–from utilities to rent to the cashier’s hourly wage. But when we see $10 aspirin on a hospital bill, the very first thing we all think is “I can buy a whole bottle for $3! I’m getting robbed.” In a way, it would be better if they did add on a line item called “hospital overhead”.

Another driving cost behind health-care is what we’ll broadly call “bad debt”. A 1986 federal law, the Emergency Medical Treatment and Active Labor Act, requires emergency rooms to screen and stabilize all patients, before even asking if they can pay. I have heard that both hospitals in my city are stuck with hundreds of thousands of dollars in unpaid emergency room visits every year. Incidentally, this law has been interpreted to apply to all persons, regardless of immigration status. That means that on boarder states like mine, hospitals get quite a few poor, illegal immigrants who go to the emergency room with no intention of paying. One source report linked from this Wikipedia article on EMTALA estimates that non-citizens make up more than 20% of uninsured (although I’m skeptical of their methodology).

On the subject of bad debt, the California Supreme Court has ruled that patients cannot be billed for services if their HMO fails to pay.

At issue in the case is a practice known as balance billing, a practice that typically occurs when a patient is treated for an emergency at a hospital that does not have a fee contract with the patient’s HMO.

In such cases, HMOs say, physicians and hospitals often submit inflated charges. But hospitals and physicians say that without minimum fee requirements, HMOs routinely underpay them.

Disputing such underpayments is impractical and costly, physicians say, so they bill patients for the balance, hoping the patients’ complaints will prompt the HMO to pay in full. 

Now let’s talk malpractice. Conventional wisdom points to growing abuse of the legal system that began in the 1980s. Patients racked up large jury awards, which bankrupted some physician groups and drove insurance premiums higher. That would account for high health care costs, right? Well, there’s an interesting new study out by Americans for Insurance Reform that paints a different picture. Their report indicates that malpractice premiums and claims make up less than 1% of the total cost of health-care, that premiums and claims have been fairly steady for well more than a decade when factored for inflation, and that premiums are roughly the same in states that have enacted tort reform over ones that haven’t. Now, this is a relatively new report, and I would have liked a little more time for someone with more intimate knowledge of the situation to check it for accuracy. You also have to be careful because sometimes these innocuous-sounding groups are really mouthpieces for a particular political party. In this case, we’ve got what we’ve got so we’ll make the best of it.

To be honest, I was pretty surprised when I came across this report. It does certainly seem to fly in the face of conventional wisdom. More than that, it flies in the face of anecdotes by Mrs. Flametoad. However, upon further study and reflection, I found a pattern. The report quotes a New Yorker article about McAllen, Texas “the most expensive town in the country for health care” with regard to Medicare claims. The article quotes local doctors who claim that aggressive lawyers seeking malpractice suits are to blame. Yet, at the same time  they admit that state tort reform has dramatically reduced the actual number of malpractice cases. So what gives? I think to reconcile what’s happening, we should imagine a cornered gunfighter facing a dozen grisled henchmen.

 ”You only got six bullets in that side-iron! You can’t shoot us all!”

“You’re right,” the gunfighter replied. So you six who want to get shot, just step forward.”

The direct impact of malpractice suits on “the health-care industry” may be small, but to the guy getting shot, it’s deadly. Nobody wants to be the target of a malpractice suit. Even if awards are capped, there are still the legal fees for the doctor’s defense. Consequently, doctors run more tests than their patients’ immediate symptoms would indicate, just as a CYA. Our bodies are all different, and despite all the medical advances we’ve made a lot of medicine is still trial and error. When it comes to our health, it’s nice to know that every avenue is being pursued, right? Yet, when it comes to assessing the cost of health-care though, how would you feel about being told that half the tests on your statement were unnecessary? And if that happens over and over again, what does that do to the cost of health-care?

In an interesting bit of timing, this hit the news.

It seems like the biggest winner in the health care system is the insurance industry. They make money from health care providers in the form of malpractice premiums. They make money from consumers in the form of health-care premiums. They even find ways to drop those bad bets to which I referred in my post on insurance.

So where do we go from here? That’ll be the next post. Stay tuned.

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Originally published at Flametoad. You can comment here or there.

Worked on ETU tonight instead of my series of posts on health care reform. However, I believe this news report article on medicare fraud is relevant to the discussion. Stay tuned!

Originally published at Flametoad. You can comment here or there.

Today marks the second part in my series examining “health care reform”. If you couldn’t tell from the title, today’s post focuses on how insurance works.

The best way to understand insurance is to think of it as institutionalized gambling. When you buy health insurance, you’re saying “I bet that I’m going to get sick or need health care this month,” and a company says “I’ll bet you won’t.” Based on what may as well be Vegas odds and the payout, the company determines a monthly premium, which is your bet. If you’re wrong, the company keeps the money. If you’re right, you get the payout in terms of health care spending. Depending on your policy, it probably still doesn’t pay 100%, but something closer to 80/20. Regardless, that’s insurance in a nutshell. The company needs to make sure that it wins its bets more often than the consumer, or it’ll go bust.

Health insurance companies have various strategies for making sure they don’t go bust. For starters, they like safe bets. A young non-smoker in his 20s or 30s is a much safer bet than a smoker in his 50s or 60s. Based on the odds, the companies can afford to offer lower rates for young, healthy people. It takes a lot of young, healthy people (safe bets) to cover the people almost guaranteed to lose the insurance company money.

We’ve all heard stories of insurance companies that drop a policy as soon as they have to pay out for the first major illness. For a consumer who has already suffered a costly (and likely serious) health problem, it definitely feels like being kicked while you’re down. It’s hardly fair, and various legislation has been tried over the years to prevent it, but it seems to happen anyway. Remember, the insurance carrier is a gambler. Why would a gambler make a bet he knows he’s going to lose?

Another strategy of insurance companies is to minimize their loss when they do actually lose a bet. They do this by using the strength of their numbers to leverage better rates from health care providers. Basically they say “If you want access to our network of 1,000,000 customers, we want a reduced rate on your services. You say that test costs $60? We’ll give you $40.” The problem is that sometimes that test really costs $50. That gets into medical billing, which is almost a post in and of itself.

I should also note that Medicare and Medicaid works the same way. Medicare is government insurance for the elderly. (Incidentally, in FY 2007 Medicare was 16% of all federal spending.)  Medicaid is government insurance for the poor. There’s a standard table of what each insurance company will pay for a medical “incident”. This is a flat rate that is supposed to discourage health care providers from prolonging hospital stays or heaping on unnecessary treatment. If you get the same money whether you keep a patient for 10 days or 2, there is a certain incentive to get your patients in and out. This is another one of those changes in medicine compared to 30 years ago. Stays are shorter because there is financial incentive to have high turnover. Five patients staying one day are more profitable than one patient staying 5 days.

Now that we’ve looked at health care (Part 1) and insurance, the next part will take a closer look at the costs of providing health care. Stay tuned!

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Originally published at Flametoad. You can comment here or there.

In the grand Flametoad tradition of eschewing any sort of predictable theme, today’s post marks the first in a weeklong series of essays on health care and health care reform in the US. What can I say? Sometimes you get Duke Nuk’em Disease, sometimes you get health care reform. For this series I’ll be drawing heavily upon Mrs. Flametoad’s knowledge of the health care system. Mrs. Flametoad is employed in a hospital lab. As you’ll read, I’ll also draw upon other sources that have engaged in the national conversation on health care, which I’ll try to cite with links as much as possible. Be warned that I’ll be breaking it down in a way that plain folks (like me) can understand, which in some cases will mean simplifying very complex processes and systems.

Today’s post focuses on the health care as it stands today.

First, even as we talk about health care “reform”, I want to point out that most people aren’t really talking about reforming health care itself. Our advances in medicine are nothing short of miraculous and the envy of much of the world. What people want to reform is how we access that health care. That’s an important distinction, because as we work on improving the system we don’t want the science of medicine or health care to suffer.

In the interest of helping demystify health care and the hospital system in particular, I’ll share an interesting bit of trivia with you. Hospitals don’t employ doctors. (Okay, some hospitals employ a very few, but it’s not all that common.) Doctors employed by a doctor’s group and keep their own offices. Hospitals are merely places that provide facilities, staff, equipment, and support services such as laboratories. It’s like renting office space to work. THAT is why when you have to go to a hospital you get one bill from the hospital and another from each doctor. You’ll get one from your doctor, one from an anesthesiologist, the specialist, and so on. From the outside, it might look like all these people are working together like clockwork, but from the inside it’s like random cogs mashed into a watch casing with the expectation that they all work together to tell time. The amazing thing is that they usually do.

A week or two ago I was fortunate enough to catch part of a one-hour radio show in which two nurses were being interviewed. These particular nurses were instructors in a nursing school and had been in the nursing profession since the 1970s. This provided them, and we listeners, with a very interesting perspective on how the medical profession has changed. One comment that really grabbed my attention was the assertion that patients who were in the ICU 30 years ago are just regular admitted patients these days. The types of patients who are admitted to the ICU today would simply have been dead 30 years ago. So generally speaking, people who end up in a hospital stay today are more sick and need more care than ones 30 years ago.

As a corollary, people who would have been admitted for a two or three day hospital stay 30 years ago are instead treated to outpatient care today. This is actually win-win for both hospitals and patients. From the hospital side, they can bill for procedures without the overhead* associated a room stay. (More on that in a bit.) From the patient side, it’s usually safer to get home as soon as possible. With the rise of hospital “super-bugs” that are immune to all but the most aggressive (and expensive) of antibiotics, if you’re in a position where your immune system is already low or you have a wound that could serve as an entry point you really don’t want to hang out in a hospital any longer than necessary.

Patient expectations have also changed over the last 30 years. In the 1970s, people questioned their doctors much less. Generally speaking, they were less educated about medical procedures and had much less access to information. Today, patients are more proactive about getting treatment. Here’s an example.

Joe: Hey doc. I hurt my knee playing football in my back yard with my brother and our kids. Now it’s all swollen and I can barely stand on it.
Doc: Let’s see… yeah, that looks swollen alright. Hmm, I don’t see any indication of a break. I’d say it’s just sprained. Keep ice on it to reduce the swelling and keep weight off it for a few days. If you’re not better in three days, com back and we’ll take another look at it.
Joe: But if something really is wrong, wouldn’t it be better to get a MRI now?
Doc: …Well… it could. But if it’s just sprained then it’s a waste.
Joe: That’s alright. I’ve got pretty good insurance. This thing hurts like hell. I don’t think it’s just a sprain. Let’s do the MRI.

So those are just a few data points on health care today. There could certainly be more. Much more. A blog’s entire purpose could be devoted to demystifying the health care system. However, we have more important things to do. Tuesday, we talk about insurance.