Healthcare in a Backward Country

The backward country being the United States of America.  My own healthcare experiences, though not exactly crippling, have helped me realize how much our healthcare system is a big detriment to those of us living in "The Greatest Country in the World."

I am in a better position than a lot of people. I am working intermittently as a contractor for now, but I worked full-time for 25 years as an accountant and made a wage that put me in the top 20% or so of Americans. I have health insurance as a result of early retirement, although it is expensive and has a really high deductible ($3,000 just for me.)

Still, right now I find myself trying to balance my health needs versus the costs in a couple of important ways.  For my diabetes, I am trying to take as little insulin as possible, allowing my blood sugar readings to drift a little higher than my doctor would like (though still within American Diabetes Association guidelines), because insulin alone was costing me $20 per day.  I have it down to $10 per day, but I am taking some risk to do so.  I hope the risk is pretty small, but I cannot really be sure.  My mother died from diabetes, and I saw what it does to people; I really don't want to go down that road.

My father died from colon cancer, and that is the second risk.  Colon cancer is very treatable if it is caught early, and due to my family history, I have colonoscopies every few years -- a little more often than most people -- but I am a couple of months overdue for my latest one, because I know it will be expensive, and I don't want to spend that much money right now.  Not a huge deal for the moment, but still, I am balancing my medical needs against cost.

And it all seems just crazy to me.  Other countries -- almost all other relatively wealthy countries -- have found better solutions to the healthcare problem.  If I lived in Japan, Great Britain, France, Switzerland, Germany, Canada, or any number of other countries, I would just get the treatment I need without having to worry about cost.  Instead, I am trying to weigh treatment and prevention of the two diseases that killed each of my parents versus what I can afford.

It is easy enough to blame Republicans, and people who reflexively hate Obamacare but agree with its individual provisions, and certainly they deserve blame.  But I think the biggest obstacle to a better healthcare system in the US is American arrogance.  The smart thing to do would be to study the solutions other countries have tried, evaluate what works and what doesn't, and then build on their experiences to re-engineer our whole system.  But of course, The Greatest Country in the World doesn't have anything to learn from Canada or Germany.  God forbid we copy the French.  Better to just put the blinders on and pretend we're doing great, because hey, we're America.  We're the best.

The Long Commute

My current job is a little north of downtown Seattle, so I am taking the bus to work again.  In fact, I am taking the same bus I used to take, but now I take it two more stops, then get off and walk 10-15 minutes, so my total commute is about an hour and twenty minutes, one way.

I decided a while back that I would not commute any more than one hour each way, but I am finding that I have to keep lowering my expectations.  It's part of the life of a contractor that you have to be flexible, and I have not exactly been overwhelmed with opportunities closer to home, so my options are limited.

I have decided that I can live with this as long as I am doing something constructive while I am travelling.  I'm stretching the word "constructive," but anyway.  I drive about 25 minutes each way, and during that time I listen to books on CD.  Right now I'm listening to War and Peace, believe it or not, and if my CD player holds out (it's acting badly, but not dead yet), that will keep me busy for a long time.  I am on disc 18 of 25 of part one.  Rumor has it that part two contains 35 discs.  It's not bad, by the way.

During the bus ride, I read.  I am reading the last book of The Belgariad now, and I have an Elmore Leonard and a random Sci-Fi/Fantasy cued up behind that.  I will probably finish all three of them before War and Peace.  After the bus ride, I walk, and it's good for me to get some exercise each day, so that's not really lost time.

I agreed to a couple of other jobs that maybe had better commutes but did not pay well at all, but fortunately did not get them.  If I have to choose one or the other, the long commute is better than crappy pay.

The job is for an indeterminate length and could result in something permanent, although I don't think the employer (City University) really has its ducks in a row to hire me.  Meanwhile, I am going to great lengths, literally, to stay employed, and getting used to the idea that that's the deal.  You do what you have to do.

A Job

I got one.

It is at City University in Seattle, starts tomorrow.  I should be more than well-qualified, just need to get up to speed quickly in order to make an impact.

As of last week, I had three possibilities going.  I had a phone interview last Friday for a Cost Accounting position.  Yesterday I heard back that they liked me, but they chose someone else.  A recruiter submitted my resume for an inventory accountant position at Starbucks, but they decided I was overqualified.  I'm sort of past getting annoyed about being too well-qualified for jobs, as it just is something I have to live with, but still, they don't want me because I could easily do the job?  OK, maybe still a little annoyed.

Then the job with City University came through.  I'm delighted.  Jackie is more delighted.  My unemployment is running out, and I could use the income.  The pay is good, and I'll actually be an independent contractor receiving a 1099 instead of a W2 for the first time.  This works well since I already have medical insurance.

The Director of Finance indicated that this might lead to a permanent position, although that sounds pretty shaky.  However, what she is really missing is having a go-to senior accountant she can rely on to deal with whatever comes up.  She had one, but that person quit.  I understand the need; as a manager, I felt that my top senior accountant was the key to my success.

I could potentially fill that type of role.  Certainly, it is what I saw myself doing at Farmers if I could have made it happen.

For now, it's money coming in.

The Interview

This post is another in my series of things that corporations do that could be done better.  Today we look at the interview process.

I recently went through a set of interviews with Symetra, and after a phone interview with HR, an interview with the hiring manager (a VP), and a second round of interviews with three VPs (I think there are a lot of VPs at Symetra) and a Director, they decided after each spending 45 minutes with me that I did not have the right personality for the particular job they had in mind.  The HR recruiter sent me an email saying that they were looking for a strong leader to take the group through upcoming changes, leaving it implied that I was not a strong leader, and she asked if she could save my resume and consider me for future opportunities.

I told her no.

That was crazy of course; anyone would tell you so.  Nuts.  And yet...

Let's think for a minute what they were asking me.  I was totally qualified for that position, had already held a very similar job for years, met every single qualification they asked for, including the ones they said were not required but would be a plus.  I spent time filling out their application, applying for the job, and arranging the interviews with HR.  I researched the company and the people I would talk to before each interview, spent hours preparing for questions.  Then I got dressed up and spent about six hours total driving to Bellevue and actually interviewing.  All to be told that, sorry, your twenty years of work history are nice, but after spending a very short time with you, we decided it's not a good "fit", meaning you can't be in our club because, based on purely subjective criteria, we think you have the wrong personality.  But if you want, maybe you can come back later and try again.

Well, sorry, but screw you.

Now, don't get me wrong -- I'm not questioning the decision.  Probably they ultimately chose someone who will do about as well as I would have, or maybe better.  My point is more that they put me, and several other people, through a lengthy process that, in the end, is about equivalent to rolling dice.  I have been on the other end, and I always thought that choosing someone based on an interview was a crapshoot.  I used behavior-based interview questions provided by HR, like you are supposed to.  Didn't matter.  Also, when I have interviewed in the past and gotten the job, it usually seemed just as random.

So let me propose an alternative:  unless you are interviewing for a really high-level position, like a CFO (in which case I really have no idea what to do), pick about three people based on their resumes.  (You need a couple of extra in case one or two turn you down.)  As a courtesy to them (a foreign concept to most companies), interview them on one day, but get a few opinions if you want.  You are looking for two things: First, do they seem OK?  Most people are fine, especially in an interview, but occasionally you will get one that comes off as hard to get along with, or seems stoned, or whatever.  It isn't very common.  Second, do they know the stuff their resume says they should?  It's not terribly unusual to find someone who is a fake; somehow they have held jobs in the past, but they don't really know anything.  Hard to spot in an interview, but worth a try.

Then, hire the one with the best experience.  And here is the important part:  Now you have 90 days to interview them.  At most companies, you can let someone go in the first 90 days without giving them a warning or producing a bunch of documentation.  After that, it's a lot of work to fire someone, but in the first 90 days, it's pretty easy.  Companies under-utilize this free-look period; at Farmers, I can remember two people in the eleven years I worked there who were let go during their probationary periods, and neither was for incompetence.  On the other hand, I saw some woefully incompetent people who sailed through their 90 days long before someone realized something was wrong.  So companies reject perfectly good candidates based on a short, scripted discussion, then can't be bothered to evaluate new employees during their first three months.

Will this method get you the best person?  No, but neither will your long interview process.  Will it get you better people?  Yes, actually it will, because instead of using the interview process as the gatekeeper to decide who works for you, you will be using the work the person does over a few months.  That's pretty much guaranteed to improve the process, and as a bonus, you won't waste as much time and effort trying to make uneducated guesses based on an hour asking canned questions.