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Check it out at blog.karlbecker.com, which is a much better domain name than here… since URL should be about my Car Care app, after all!
A workday inside a China Airlines 777-ER200
I just spent the majority of a 24 hour period on an airplane. Sound hellish?
Consider this: I was in business class on the 777-ER200, and more or less had my own little cubicle, which had a chair that folder out to 180 degrees flat.
I slept – and worked – well.
I have been in the business class lounge most of the time since I arrived in the Taipei airport. The airport is very clean, very quiet, and everyone is quite orderly. It feels less stressful than an American airport.
I’ve seen a few things here I’ve never seen in any other airport, though I’d love to learn about other airports that might have these things:
- a sit-down calligraphy desk, where someone helped teach me how to draw a couple names in Chinese characters. At the end, I drew her name in roman characters.
- a library – a completely non-commercial space in the airport. They were not selling anything, but instead just had this space for people to quietly work on a computer or read, complete with walls full of various types of books.
- a workout area, with a shower – I don’t know who could use the shower, but I assume anyone. The workout area was very spacious, although it had only 6 pieces of equipment: 3 bikes, a treadmill, and two weight machines. It was connected to a small Adidas store, but there was zero sales pressure… though perhaps the language barrier had something to do with that.
I’ve spent a long time in the Turkish airport, and this time is flying by in comparison, because:
- a quiet space is much more calm, and the hours go by smoother there… at least, when you’re my age, apparently
- lots of good food and drinks – I’m sipping on some single malt scotch right now before bed, and I had Bailey’s and some red wine since arriving here
- there was a shower, complete with towels, toothbrush and toothpaste, cologne, and soap, shampoo, and conditioner… all for free, within the business lounge. Considering I will be spending over 12 hours here, it’s not too far off from a hotel experience.
Wifi is solid, food is delicious, and there’s issues of Time, The Economist, and Bloomberg to read if I get bored… which, trust me, I’m not, with all the work I’ve got to get done.
China Airlines wifi
I asked online whether wifi on an airplane crossing the Pacific Ocean would be reliable or any good. People said it was bad. I disagree. I worked for about 7 hours on the flight, from 9am central time until touchdown around 4pm central time, and the wifi – although too slow to, say, stream videos – was perfectly fine with the text chat, file downloads, and web browsing I was doing. I was committing just like I was sitting on the earth. I’m sure your results may vary depending on weather and other unexpected technical difficulties, but I had zero problems.
China Airlines Business Class
It was a great experience! Everyone was nice, the food was good, and the TV screen was huge (I drifted off to bed to Ted 2, after leaving LAX at 11:45pm). The noise-canceling headset wasn’t branded Bose, and it didn’t seem as good as some other ones I’ve used, but at least they had one, which came in useful early in the flight.
Overall, it’s been a great first day of adventure … spent mostly in an airplane and in an airport lounge.
An adventure across continents and years
I am going to fly around the world.
I just took off from Boston on an American Airlines flight. We have power outlets so I can charge my laptop and phone, although they are both full of charge and don’t really need it. However, I want to make sure I have all the power I can, because my livelihood depends on a few key things:
- my laptop
- electricity, whether in my laptop’s battery or at a wall plugin
- internet
- my fingers
These things are important to me in many ways, because I really enjoy:
- making software
- making websites
- playing video games, although I do it very infrequently these days
- playing piano
- keeping in touch with family and friends
- learning
All of those 3 or 4 of the things above, except that last one.
That’s what this trip is all about. Learning about the world.
Why am I going on this trip?
My girlfriend Diveena asked me on the way to the airport this morning, “Why are you going on this trip?”
I have thought about this question a few times since I first thought of redeeming 275,000 frequent flier miles on Delta to get a Round the World (RTW) ticket.
Diveena didn’t ask it accusingly, nor because she has no clue why I’d go or want to go; on the contrary, she encouraged me to go on the trip, since I had talked to her about this crazy RTW ticket long before I knew Delta was eliminating the ability to redeem miles in exchange for one at the end of 2014.
Before the end of 2014, I thought I’d save up my miles for an indetermine time in the future when I would have enough vacation to simply take off a few weeks, maybe even a month or two, and see the world. I had a vague notion that I would do this in one of the following scenarios:
- I quit a job, and take a few months before starting on my next job
- I retire, then go see the world
That’s about it.
I’m not sure why I limited myself to just these two scenarios, but I think it’s a variety of reasons:
- Most companies rarely give any ability to take more than 2 – 4 weeks of vacation off at one time.
- I’ve been very busy with Third Iron, the company I co-founded in 2011, and there’s still so many things to do with the company, taking a full week off is a fairly big luxury, let alone multiple weeks in a row
- Almost nobody I know has ever done anything like that
Without someone paving the way to do something, it can seem very difficult to do. However, I did have a role model for this: Dima, a friend I met in Iowa who has done the very thing I’m about to do. More about him in another post, though.
Seriously, why am I going on this trip?
Although I thought about why I was going close to deciding to go, and after I got the ticket, I did not ponder this question when I started saving up for this ticket. Since 2007, when I first heard about this round the world ticket things from my good travel buddy and friend Jessica Sander, I have been saving all my frequent flier miles in hopes of earning enough for this ticket. Three things helped me with this:
- getting a bunch of miles for signing up for the Delta WorldPerks Gold American Express card
- 30 or 50 thousand, I believe
- preferring Delta over other airlines
- if a flight cost less than about $50 more, I’d typically go with Delta… and because I would frequently fly out of Minneapolis or Iowa, Delta was typically the lowest priced option
- using that Amex fairly frequently, especially for large purchases (computers, car repair, recurring bills, flights (with double points when flying Delta), etc)
- flying
- I really like to travel, so I certainly did fly and earn up miles that way, too!
So I just started slowly earning points, and after a couple years, I had enough for the economy-class Delta RTW ticket: 185,000 miles.
So earning the miles wasn’t too big of a deal to me, because I knew I was in no rush to go on this trip. Instead, I wanted to have them banked, so in case I lost a job or quit, I could take advantage of it.
But I never questioned why I wanted to do it when Jessica first told me about it.
Instead, my inherent thought was, “why would anyone NOT want to do that?”
I suppose I can think of a few reasons:
- health problems
- children
- can be difficult to travel with them
- taking them out of school for an extended period would be rough
- fear of traveling alone
- I’m lucky to be born a guy – we generally don’t have too much troubles traveling alone, but the same cannot be said for women
- no desire to travel alone
That last one is a big one for me. I traveled alone around Germany and Austria during a two week period in 2008. I spent three weeks in Europe during that trip. The first week was spent with my work teammates, doing a multi-day presentation about the software my team was building for a helicopter upgrade we were selling to our German government customer. The next two weeks I spent most of the time alone, with a few breaks to meet my friend Amanda King, who was au pairing in Austria, and some family I never before met.
At the end of two weeks traveling largely alone, I was ready to be home and see friends. I was happy to get the opportunity to do it, but I thought I wouldn’t travel alone again for awhile.
Why, then, am I doing it now? Especially now that I have a great girlfriend?
One reason is because I have a great girlfriend. That may seem counter-intuitive to most people; why would you want to not be around your partner? In this case, though, Diveena saw that this was something I really wanted to do, since:
- I had been saving for a long time
- talked about it, even though I had zero plans to do it anytime soon
- was quite unhappy when I found out Delta was discontinuing the ability to redeem miles for the RTW ticket
- I love to travel, as does she
Diveena pointed out that I am in probably the 1% of people in the world who both want to and can do a trip like this, because:
- I’m not married
- I don’t have children
- I have a job that allows me to work anywhere I have my laptop, internet, and a little electricity
Not everyone’s partner would be understanding enough to let someone live out a trip like this, let alone encourage it. I wasn’t early thinking of going, since I thought even though I can work remotely, some of my free time would be taken finding lodging, ensuring I had good internet, and I wouldn’t be able to travel with anyone else. My company, Third Iron, just seemed to have too many things going on for this to be a good idea.
Then I thought about the example my friends with children point out: there never is a right time to have kids. There is always a reason or excuse to not have them: we’re too young, our career is too overwhelming, we want to do too many other things, and eventually, we’re too old.
I thought about it some more, and since I started Third Iron in 2011, I have worked while visiting:
- Bismarck
- Seattle
- San Francisco
- Minneapolis
- Rochester, MN
- Boston
- Connecticut
- New York
- Denver
- Las Vegas
…and I’m sure a few more I’m not recalling.
I’m no stranger to working on the road. In fact, getting focused time to work on one single thing while I’m on an airplane is – however perverse this may sound – a joy to me. Throughout my working life, whether working for KB Productions, Rockwell Collins, or Third Iron, I’ve relished the time on an airplane as an environment where, free of anything else to do, it’s just me and the screen in front of me. I enjoy chatting up a friendly person in the seat next to me, but since a comfortably chatty person can be somewhat rare on airplanes, I generally look forward to them as a time to get something done… such as writing this very piece you are now reading. I believe I’m somewhere over Pennsylvania at the moment.
Seriously, you still haven’t said why you’re going on this trip
Well, I kind of did:
- I have a girlfriend who encourages me to do the big things I’ve always thought about, but perhaps I never thought I could do
- I have a job that lets me work where I want, and I’ve proven in the past that I’m able to handle traveling and working
- because the world
I want to see more of the world up close.
I feel every place has many lessons to teach.
Every person you meet has a unique story, and can help you learn something new.
Putting yourself into an unfamiliar environment challenges you to reconsider what’s right, what’s pragmatic, and what’s possible.
What better way to put yourself into an unfamiliar environment than literally leaving the country in which you’ve grown up, and placing yourself into a place where people have spent generations growing up and living differently?
Some of the lessons I’ve learned in the past from traveling:
- * If you don’t understand the local language, life gets difficult, and you rejoice when something is written in your language, or a picture, number, or symbol you understand is visible
- After coming back from Europe the first time, I localized my Car Care iOS app into multiple different languages… it’s just so much easier when things are in your native language!
- Plans are temporary – flexibility, and being open to change, is a cornerstone of being happy in life
- We can’t predict what will happen – 99.999% of the world is outside of our control, so if change from something other than us causes you stress, you’re going to live a pretty stressful life
- Don’t get too stressed out about being late – do your best to be on time, but if something happens and you don’t make it, apologize, and proceed to watch life go on
- Corollary to the corollary: Being late for an airplane really sucks, so… try to be on time for that
- Good people are everywhere
- Creepy people are everywhere, too, but they’re vastly outnumbered by good people
So there’s another, and perhaps the most important, reason for going on this trip: to add to my list of life lessons.
One hospital visit, two bills
I went to dinner the other night, ordered a nice steak and salad, and a glass of fine wine. Once the bill arrived, my eyes grew slightly and my eyebrows creeped up and away from the table. The price was not the shocker; the two individual bills, one labeled “food prep,” another labeled “food service,” confused me.
I don’t see my waiter, so I grab the attention of another waiter, asking, “Excuse me, but I think you brought out someone else’s check with mine.”
“Sorry about that, sir. Which item didn’t you receive – the steak, salad, or wine?”
“I received them all – they were delicious.”
“Great. Glad we cleared up the confusion then. Shall I take your credit card?” the waiter replied, with no confusion over the two bills each with different amounts of money on them.
“Well, hold on… I think I got someone else’s bill. I only ordered the meal for myself, so I should have one bill.”
My waiter gave me the expression of a patient grade school teacher, explaining, “The restaurant bills you for the ingredients for your meal, storage of the ingredients and tools to cook your meal, and the time it took to cook your food and prepare your meal. Your waiter, however, is an independent contractor, and bills you separately.”
I sat there, fairly confused.
“So… I have to pay each of you separately? You can’t just combine it and split it yourself?”
“No sir.”
“Huh… can I speak with a manager?”
“Certainly, sir.” A manager came over shortly, reiterated that’s how the restaurant does business, and I eventually ended the meal by paying two bills. The strangest restaurant paying system I’ve ever encountered!
Okay, confession time: the above didn’t happen.
But the below did, and it’s essentially the same scenario.
I went to the hospital earlier this year.
Later, I got the bill. I got MANY bills.
I paid the bills, but over time I kept getting more bills. And I was confused, since I paid these already.
Turns out I was indeed billed twice for one single hospital visit.
Bill 1: for the doctors and staff directly employed by the hospital.
Bill 2: for a doctor who is on contract to the hospital.
All the doctors (I saw 4 of them in one evening!) looked the same.
All of the equipment was in the same room.
Yet one of those doctors was not a regular employee of the hospital, but somehow was a contractor.
Why is this happening in health care? And will it be coming to other businesses soon?
A company is like a child
A company is like a child.
In order for a company to be successfully created, conditions have to be just right. Try making a company too early or too late, and there won’t be a conception. There’s a window to making a baby, and a window to making a company.
Even before conception, there is lots of planning to do, including:
- discussion about how the company should be guided over its lifetime
- the company’s religion – not talking about deity worship, but what are the important values that will form the company’s core beliefs
- will you push the company into doing certain things, or will you let your company find its own way depending on what its strengths are (hint: it’s probably wise both for people and companies to do the latter)
The company can be conceived in all kinds of ways, too:
- Company conception can be the result of a number of bad decisions.
- It can be done under duress. You didn’t want to make this company, but you think somehow it will hold your relationship with the other person together, even though you secretly think it may not be wise.
- It can be a thoughtful creation with the best of intentions
Whatever the family situation is like for a company or a child, it grow up to be happy and successful, or end up broke and penniless. But conditions among the parent(s) are important in determining the odds of a child being the next Lebron James, Karl Rove, Barack Obama, or Whitey Bulger; your opinions of these (in)famous people will likely determine how you’ll raise your child or company.
Strunk said “Omit Needless Words:” this vaccine-related press release omits important facts
A friend sent me a link to a press release (specifically, this copy of it) claiming “Public Health Officials Know: Recently Vaccinated Individuals Spread Disease.” My friend asked my opinion on it.
The meat of this press release says documentation from Johns Hopkins and St. Jude’s Hospital says to be careful around cancer patients. This is not surprising to me, so I do not find this article interesting. There’s also numbers about measles deaths at the top of it, but below I’ll show that’s a small part of the story, and the writer of this press release is omitting important information.
I also see one major problem with this press release: it cites its sources incorrectly.
Inaccurately citing sources is the bedrock for bad journalism and bad science.
It specifically says “Johns Hopkins Patient Guide”. That language implies it’s for all Johns Hopkins patients, but it’s not. The guide is instead for the “Johns Hopkins Kimmel Cancer Center,” and is within the context of providing guidance for cancer patients to be careful around loved ones, especially young children.
Seem like a small point? It’s not. Leaving out small but important pieces of information and context is important.
Here’s an example of omitting important information to completely change a graph: http://www.software3d.com/Home/Vax/Graphs.php
The graph in that link shows deaths by measles. It confirms the two data points from the linked press release: “measles deaths declined from 7575 in 1920 (10,000 per year in many years in the 1910s) to an average of 432 each year from 1958-1962.”
However, that link’s graphs also clearly show it doesn’t give the whole story. Take a look and you’ll see for yourself how deaths and infections of measles dropped like a rock once the vaccine was introduced.
Also, I noticed this other paragraph in this press release:
Scientific evidence demonstrates that individuals vaccinated with live virus vaccines such as MMR (measles, mumps and rubella), rotavirus, chicken pox, shingles and influenza can shed the virus for many weeks or months afterwards and infect the vaccinated and unvaccinated alike.
What effective writing to scare people! I could write a similar sentence and be completely accurate. Here I go:
Scientific evidence demonstrates that individuals who fly on airplanes, ride motorcycles, or drive in cars die while in transit.
Correct? Yes.
Sort of implies that if I avoid these types of transportation, I have a better chance of not dying? Yeah, it kind of does.
Tells the whole story? Of course not. There are huge differences between those methods of transportation.
In The Elements of Style, William Strunk encourages us to “Omit needless words” to more effectively communicate. The author of this press releases heeded this; no words were omitted that would go against the clear thesis statement of this press release, which is to downplay the importance of vaccines and frighten people of vaccines, which are proven to be great in countless scientific papers.
The press release’s author omits very important information, though, leaving us with a slanted view of the story.
Should health care be profitable?
In the USA, health care results in massive profits.
Should it?
According to this Washington Post article, health care in the USA is “very much something people make money out of. There isn’t too much embarrassment about that [in the USA] compared to Europe and elsewhere.”
Profits have enabled us to look past the embarrassment of benefitting from others’ suffering.
This attitude pervades not only the health care establishment, but the military-industrial complex… but today let’s focus on the world of health care.
Non-Profit and For-Profit can coexist peacefully
I want income for health care companies. I want enough to make sure they are there when me and my loved ones need them. Every company, whether a non-profit or profit, needs income. And the people providing the extremely worthwhile service of healing people, and easing people’s pain, should be paid well.
And maybe some health care companies should have some profits. Look at the world of higher education: there are profit and non-profit institutions. Putting aside the questionableness of profit-based colleges (some of which are owned by the Washington Post!), they are legal and they serve… some kind of role.
So let’s say we allow for-profit health care providers, just like we allow for-profit educational institutions.
*shudder*
That means they will be profitable. But the ability to screw people over is so… there. Especially when we consider our existing for-profit health care system.
Profitable… but obscenely profitable?
A fantastic recent Time article by Steven Brill mentions how, on the bill of sale from a hospital stay, a single Tylenol pill cost $1.50… even though we can buy 100 of them for $1.49 on Amazon.com.
And the Washington Post article showed an MRI costs about 4X more in the US than in France.
Why are hospitals charging so much?
Well, think about what you do for a living.
What if your customers did not know how much they should expect to pay? And what if you got paid the majority of the time, no matter what you charged? And say you did not need to even tell people how much your product costs until after the person has already purchased the product?
America’s Stockholm Syndrome to health care costs
One of the first phrases you learn as a tourist traveling in a non-English-speaking country is, “How much does that cost?”
Italian: Quonto costa?
Arabic: beh-KEM-deh?
German: Wieviel kostet das?
When you ask this question in the native language of a country, you will get a smile from the local salesperson. You have taken the time to learn a little bit of the local language, after all.
But say the same question – in English! – after you step inside a hospital in the USA, and prepare for gnashing of teeth.
The sentence “how much will that cost?” is unheard of in US hospitals.
I asked it recently when, after getting pretty routine blood work done, was told I should get an ultrasound, too.
An ultrasound… for symptoms that sure just seemed like a nasty cold or flu? I was confused, and with my high-deductible health care plan (maybe $2500 deductible over a year?), I didn’t really feel like paying loads of cash for something whose root cause could probably be unveiled by lower-tech methods… especially since I knew not all the possible blood tests had been run yet.
So as I stood in the hospital, still sleepy, early on a Saturday morning, I asked the question I’ve asked on three different continents to shopkeepers (always with positive results): “How much does this cost?”
The looks I got from the administrative assistants in the radiology department were a mix of:
- shock (“Who asks that? Seriously??”)
- fear (“Wait… can he pay? Will he just leave without paying??”)
- disbelief (“Why in the world would he want to know the price? The doctor wants this test for him, why would he care what it costs? You need to get this done!”)
If the question “How much does this cost?” is not applicable to an entire industry, I give a HUGE tip of my hat to the marketers behind that industry: they have somehow made taboo the mere IDEA of ASKING to see a price list! To merely ask the most basic of questions of my captors is not culturally allowed.
Even though I can afford anything in a McDonald’s, I still like knowing how much the cheeseburger is compared to the chicken sandwich.
But in addition to getting my kudos, an industry that gets out of that question needs to be treated differently than other industries.
Health care: A unique industry
Health care is unlike any other industry. So we should be dealing with it differently, especially if our country is paying much more than other countries for the same service.
How much more? That’s a problem right there – hospitals don’t know. The ladies behind the counter that Saturday morning, after staring at me trying to parse my foreign question, and quickly paging through a thick 3-ring binder in a cupboard, said they truly do not know. And had no way for me to find out until Monday.
So before we can determine what’s a good price and what’s not, we better see and compare what everybody is charging.
The Affordable Care Act – known as Obamacare to both haters and supporters alike (what better way to steal your adversary’s thunder than to embrace the denigrating word they call you – classic grade school trickery use on both sides!) – has a provision in section 2718(e):
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
Source: govtrack.us
After a quick call to my senator’s office (on a Friday afternoon, no less!), I was informed that the format for these reports are not determined yet, nor are the reports’ specifics yet scheduled to be discussed by the oversight committee. Also, this ACA provision doesn’t kick in until 2014.
But thankfully, by 2014, we will at least have a little more transparency on how much different hospitals are charging.
I am going to do my best to have some influence over what goes into these reports.
I want the output to come out as nicely-formatted tabular data that I can easily process in a spreadsheet or a user-friendly website. Think of the nice websites that could pop up to help us understand how much different items cost, comparing one hospital to another… we deserve this comparison shopping opportunity in the health care world. And it will make more jobs!
I also want hospitals to have to report down to the smallest items, things like how much a single Tylenol costs, or an alcohol wipe. Too much detail? No. This is reasonable because, well, after decades of not asking how much these things cost, we have arrived at an industry that is charging us 100X markup.
And since health care is different than every other industry, I argue huge markup is not just personally unacceptable, but should be criminal. The government sets limits on how much loan companies – even the shady payday loan companies – can charge. Why don’t we limit the markup on incredibly important, essential health care related items?
A restaurant marks up liquor by a lot – I can buy a reasonably delicious bottle of wine for $10, but a single glass will often cost $9 at a restaurant. But this is a luxury that is easy to turn down.
Can I turn down that ultrasound? Not necessarily… but at least tell me how much it will cost!
When everything costs the same, everything is worth the same
What if health insurance’s pricing model applied to other things we buy, such as… food?
My cousin Adam Emter made a great comparison:
Just think if other aspects of our lives were paid for by some other entity, requiring very little outlay from us. My employer starts purchasing all of my family’s food, and only requires a $20/month co-pay. You think I’m going to still clip coupons, shop for good deals, buy items based on the nutritional and economical value, or control my calorie intake? Hell no – I’m eating steak 5 nights a week…
It’s no wonder that pricing has gone out of whack – we feel it when the price of milk, or the price of gas, goes up. The vast majority of us never directly feel when health care prices go up.
The health care industry is addicted to its own personal all-you-can-eat buffet of money, provided to them by health insurance companies (which, interestingly enough, don’t have too much markup).
When a person (and corporations are people, right, Supreme Court?) is caught abusing a substance, and his friends want to help him straighten out his life, friends need to know everything about his life, so they can see where to make adjustments to this person’s life decisions to help him back onto the road to well-being. The health care industry is that friend who needs an intervention, and ACA section 2718(e) is hopefully the tool that lets us see all his income and expenses to see how in the world he got so much money to begin with.
Ask “How much?” next time you’re at the clinic
We need to start educating ourselves on how overpriced our health care is. Let’s stop allowing a hospital to charge us $1.50 for a single pill that costs less than $0.02.
And let’s start that process by asking how much things cost.
By asking, we make the health care employees realize that at least one patient seems to care what these things cost… and this person wants to know *before* it’s done.
By asking, we make health care employees think about it a little more, and therefore the price may stick in their head a little more.
Ask how much. It’s a step we can all do.
Karl’s first blog
It only took until 2013, but now I’ve got a place to put my random thoughts. Stay tuned for everything from thoughts on health care to software development practices, mobile apps, and everything inbetween.
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