Wednesday, May 02, 2018

The ambiguity of discrimination

Last week I stopped briefly at the supermarket to pick up a few items. When I was done, I approached the checkout counters from the far end of the supermarket, passing stations 17, 16, and 15 that were closed. In most American supermarkets, each checkout counter is really in a lane, flanked on both sides by "impulse purchases" like candy and tabloid newspapers and scandal magazines. The checkout lanes have tunnels of about 5 meters before the conveyor belt actually begins. I saw that stations 14 and 13 both had their lights on, meaning they were open, and as I came up to 14, I looked down the tunnel and saw the cashier handing the customer the receipt, so I knew I could enter and immediately get checked out. As I turned down the lane for counter 14 and got ready to put my few items from my cart onto the conveyor belt, I heard a voice from the other side of the tunnel (in lane 13) say, "I can also take you over here." I looked up and saw the head of a blond woman speaking to me; she was the cashier from lane 13, walking in her "tunnel", perhaps re-arranging the candy on the shelves. Since there was no one in front of me, and especially since my cashier in lane 14 was African-American, I was not about to switch lanes. That would have required backing up and going around the candy and magazine racks to enter her lane. My daughter had just emailed me two days earlier with a story in the NY Times about the rules readers "of color" follow to avoid being harassed by security or store attendants, rules like "don't throw away your receipt before you leave a shopping center," "put your American Express Platinum Card next to your driver's license so a police officer will see it when they ask for an ID" and "do not wear a large purse or many layers of clothes when you walk into a store." So I was not about to switch lanes. I just started putting my items on the conveyor belt. After I had put my items on the conveyor belt and walked up to the cashier, the cashier from lane 13 said to my cashier, "They never see you when you're old."

I was stunned. She thought I was discriminating against her for being "old." I had barely seen her face, did not know her age or think of her as "old," and was not thinking about that at all. I was concerned about not appearing to discriminate against an African American, but more importantly, I just took the first empty lane! I was mostly trying to save time. The cashier in lane 13 apparently did not realize that I could not actually see that her lane was empty as I approached the checkout counters; because of the "tunnels" of impulse items, I could only see each lane as I came up to it. I had taken the first empty lane.
In this photo, I returned to the scene days later. Lane 14 is not open this day, but you can see that one cannot see the cashier over the displays.
From my point of view, it is clear I was not discriminating against an old person, but maybe other people do discriminate. And this is what makes claims of discrimination so difficult to prove. I can easily dismiss this instance, but I cannot say that it never happens. Indeed, I suspect that the cashier in lane 13 has probably experienced some discrimination, which led her to impute discrimination in me. It would be easy for me to accuse her of being oversensitive, or of imagining things. But that would be missing the point. People who do not experience discriminatory treatment can easily dismiss it, and not admit even when it really does happen.

I sheepishly told my cashier, "I just took the first empty line." She just smiled.

Tuesday, May 01, 2018

Insurance Magic and Medical Mess

We received a statement from our insurance company today that is astonishing. For a regular diagnostic test (don't remember what it was, but it is part of an annual physical), the company doing the diagnostics charged $1,149.22. Seems kind of expensive.

The crazy part is below:


Somehow, Blue Cross Blue Shield was able to "negotiate" a $1,067.80 discount! The insurance company only had to pay $81.42, and we did not need to pay anything.  I wish I had that kind of power; that is a 93% discount, meaning I could buy a $75K Alfa Romeo for just $5,313.

How is this type of "discount" even possible? It should be criminal to charge the full price, given the steep discount possible.

Note also that the services were provided on January 22nd, but the insurance company did not pay until April 10th, roughly 80 days later. The delay in payment raises costs for the provider. And it suggests this case had to go through a lot of people's hands before it was decided, and all that effort costs money too. The overhead is all cost that is not working on health. And the "negotiation" of the discount is also an additional cost.

When my mother fell and broke her hip in Sicily ten years ago, she had a hip replacement in a small hospital. We were lucky that the surgeon there was a professor at the University of Catania, so she received excellent care. But what was most notable was that the hospital did not have an accounting department. We did not have to pay anything! We could say that the hospital reduced costs by eliminating the accountants. Unfortunately, that is probably not a sustainable solution either, but it certainly seems like a lot of human effort is being wasted in bill tracking and negotiating "discounts." Without all these accountants, the prices could probably be lower for everyone.