My experience with American health care

Right now*, I stand among several dozen patients at Health Center #3, operated by the Philadelphia city government to provide clinical care to residents in a way that is available even to those without insurance or wealth. I’ve nearly been waiting for two hours for a quick skin test.

My alternative is Student Health Service, on another edge of campus, where there is a comfortable environment, shorter waiting times, and probably better trained personnel.

Instead of taking advantage of the benefits afforded to me by my student health insurance plan, a consequence of my attendance at the University of Pennsylvania, I chose this clinic because I could get the test done on an earlier date. I imagined it wouldn’t be as great of a place as SHS, or the expansive, top-tier hospitals of Penn Medicine, but what I am experiencing has convinced me, even more so than I thought before, of the epic failures of the American health care system.

* This post has since been revised and reformatted, although it was initiated during my time in the clinic.

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A comparison

Those who are fortunate enough to have employer- or school-sponsored health insurance may have access to HMO hospitals, clinics, and doctors.

Those who attend a comprehensive university like mine may have access to the combined resources of a student health clinic and a set of university hospitals merely a block away.

Those who are in the lower strata of income and status, or whose recent unemployment leaves them uninsured, are relegated to public institutions such as these health centers, left to understaffed clinics, long wait times, and expensive, unaffordable medications. Some of these people are also caught outside the eligibility criteria of governmental programs like Medicare and Medicaid.

I’m from Canada

If timing weren’t an issue, I would just do this skin test back at home in Ontario, Canada. Sure, the skin test itself might not be covered by the provincial OHIP program, but at least every resident (after a certain number of months of residence) has access to physicians and walk in clinics at no basic charge beyond their taxes; those who are below the low-income cutoff might even pay $0 in federal and/or provincial taxes.

There is no such thing as a general practitioner who will turn you away because you “belong” to another unaffiliated insurance company. Low income citizens do not have to go to a crowded government “health center” for basic medical care; any privately-operated walk-in clinic, or a family doctor who is accepting new patients, will do. The UK also demonstrates how access to prescription medicine can be broadened.

Even those who are insured in the US are shocked when they find the cost of health care to be much higher than budgeted.

  • Students on our private university-organized insurance plan still must pay a $100 co-pay to go to the emergency room, although the co-pay is waived under restrictive conditions
  • There’s a co-pay of $35 for an X-ray diagnostic test. I had a chest X-ray done as a matter of an annual physical examination over the summer in Canada, and it was covered by OHIP.
  • Flu vaccinations are $24 (at least) in the vicinity of this university. While private health insurance may cover the cost, it’s surprising that this basic tool of public health isn’t free; municipal governments in Ontario almost universally administer them at no charge, and they are available through doctors’ offices, public health clinics, walk-in clinics, and even some pharmacies.

Even if we forget entirely about how much this sucks compared to medical care in Canada—which admittedly has its own issues—the disparities in access to, and quality of, health care between classes here in the United States should be appalling.

Dr. David Himmelstein of The Cambridge Hospital and Harvard Medical School, and his colleagues, authored a paper in the International Journal of Health Services in 2004 on the inefficiencies in the American health care system. One of the most potent conclusions is summarized in the abstract:

The United States wastes more on health care bureaucracy than it would cost to provide health care to all its uninsured … Only a single-payer national health insurance system could garner these massive administrative savings, allowing universal coverage without any increase in total health spending.

He also concludes that, in the US in 1999, “administrative spending consumed at least 31.0 percent of health spending… [i]n contrast, administrative costs in Canada… are about 16.7 percent of health spending.” I imagine some people are profiting from this spending.

Closing

I am a student, who, as a matter of circumstance (i.e. parents’ hard work) and fortune, have access to one of the top hospital systems in America. Not everyone is as fortunate. And it takes a bit of altruism to be able to stand up in a position like this and advocate on behalf of those who can’t.

Experience has shown that a weak populace is easier to rule over. One wonders if the goal of weakening the populace, especially the poor, is the reason that America continues to fail at reforming health care.

How I organize my books

Barcode stickers as book tags

I keep all of my books organized in Librarian Pro by Koingo Software. Admittedly, the Windows port is a sort-of-slow version of the Mac software, but it’s usable and rather pretty.

Librarian Pro interface
The Librarian Pro software I use to catalogue books

Along with this, I use a USB barcode scanner to import items by their EAN/UPC barcodes. Librarian Pro connects to Amazon’s APIs and loads book metadata based on that barcode.

Laser barcode scanner
The operative end of a laser barcode scanner

After importing a book, I make sure to tag it with a code of my own, specific to my collection. For that, I have these stickers:

Barcode stickers as book tags
Barcode stickers as book tags

And voila, an electronically-catalogued library of books awaits. It’s pretty easy to add location information to the metadata to help look for books, as well as generate HTML pages to show off or sell used books.

Windows Live Hotmail is now authenticating DKIM

Hotmail inbox screenshot

I haven’t seen anything published about this yet, but I noticed today that Windows Live Hotmail seems to be authenticating incoming e-mail using DKIM in addition to Sender ID.

Background

In the past, Hotmail has verified the authenticity of incoming e-mail through Microsoft’s proprietary version of Sender Policy Framework called Sender ID. Both of these projects were designed to verify that the computer sending the message, as identified by the originating IP address, is authorized to send e-mail on behalf of the named sender.

A typical SPF policy, specified through a TXT record in DNS, might say

v=spf1 ip4:208.97.132.0/24 -all

This means that only IP addresses in the 208.97.132.1–208.97.132.254 range are allowed to send e-mail on behalf of this domain. (The Sender ID policy would look similar, but starting with spf2.0/pra.)

Hotmail’s policy has been to verify all incoming e-mail using the Sender ID framework. This theoretically reassures users that authenticated e-mail definitely comes from the named sender, reducing the likelihood of header forgery. If an e-mail does not pass Sender ID verification (softfail) and has other signs of being forged, it will likely be classified as junk.

A valid e-mail is marked with these headers:

X-SID-Result: Pass
X-AUTH-Result: PASS

If the organization’s policy uses the strictest policy (-all), and the message does not pass Sender ID validation, and the organization has submitted its Sender ID records to Microsoft, invalid e-mail sent to @live.ca and @live.com domains are rejected. As far as I am aware, this protection is not applied to @hotmail.com accounts.

From SPF to DKIM

The problem with SPF is that it doesn’t verify much. All it tells us is that an e-mail comes from the right computer—not that an intermediate server hasn’t tampered with it. In addition, SPF only really validates the From: or Sender: headers.

Besides, many large service providers cannot implement a strict SPF/Sender ID policy because users may be sending e-mail through other servers. (For example, I might use my ISP’s SMTP servers to send e-mail from my Windows Live Hotmail address; a strict SPF/Sender ID policy would mark those e-mails as junk.)

DKIM, however, encompasses the contents of the message body, in addition to the headers. It does not necessarily require the e-mail to come from a certain IP address. Using public key cryptography, it allows organizations to take responsibility for sent e-mails by verifying that the e-mail came from an authorized source, similar to the way secure servers connect over TLS/SSL.

Implementing DKIM means that all outgoing e-mails are signed using a private key; the signatures are then checked by compatible software against the public keys published in DNS. Each domain can have multiple DKIM keys, allowing multiple sending systems to sign outgoing e-mails independently.

A sample DKIM signature looks like this:

DKIM-Signature: v=1; a=rsa-sha256; c=relaxed/relaxed;
        d=frederickding.com; s=google;
        h=domainkey-signature:mime-version:from:date:message-id:subject:to
         :content-type;
        bh=b3wR4p4G21l92tc0ahioopi7atMwDp2wkaQb/uOL65E=;
        b=YJ6nD3Nx5hgwRhYppb/n2g5lQxA5jzFvYEJ0dR4dtkRFv14GVJWStQXwwZryGuujC/
         v4ve5ZE3ZAEAtv5hCj99ZLAfR52rskpbitso+106M8uQvryLyuLSnX1mrk6JaDFLMr8V
         qHmCEZUF5+cnWEYSwlLo1T8hntgN28hj8OyJY=

DKIM actually requires a lot more work for organizations to implement, as it requires additional DNS lookups and (perhaps) expensive cryptographic calculations. A decade ago, it would have been unfeasible to implement this on an organization as large as Windows Live Hotmail.

Hotmail today

Today, the inexpensive cost of processing power makes it possible for Hotmail to validate DKIM. Yahoo! has been doing this since the beginning, as it was the source of this technology. Gmail, too, has been validating DKIM for some time. (Both Yahoo! and Gmail sign outgoing e-mail with DKIM signatures, and Google has made this possible through its Google Apps service for companies as well.)

While Windows Live Hotmail has always validated Sender ID, today I noticed the addition of a new e-mail header:

X-DKIM-Result: Pass

This is good news.

Conclusion

To summarize a post’s worth of babbling, this means that Windows Live Hotmail is taking additional steps to combat e-mail forgery, phishing and spam. A step forward for everybody.

CRTC: never-ending madness

Easing of standards proposed

'In the wake of the Arizona shootings, it seems especially insensitive to suggest that we should lower the bar on media obligations as long as no one is directly threatened or killed:' NDP MP Charlie Angus.

Earlier, Angus told reporters the public has just three days to comment on a proposed regulatory change at the CRTC that would ease standards for radio and TV networks in terms of broadcasting false or misleading news.

A motion by Angus to have the Commons committee on Canadian heritage call witnesses and study the proposed changes passed late Monday. Witnesses may be called as early as next week.

Under the proposed changes, licence-holders would have more latitude in their reporting as long as comments do not directly put human life in danger.

Broadcasters would face penalties if it could be proved the licence-holder had prior knowledge that information was inaccurate.

Angus said the proposed changes directly contradict section 3.1 of the Broadcast Act obligating Canadian media to maintain high standards of objectivity.

“It seems astounding that the CRTC would consider such a move at a time when we see the growing backlash in the United States to the poisoned levels of political discord in the American media,” he said, referring to the debate over what might have influenced someone to shoot U.S. Congresswoman Gabrielle Giffords and 18 others in Tucson last month.

“In the wake of the Arizona shootings, it seems especially insensitive to suggest that we should lower the bar on media obligations as long as no one is directly threatened or killed.”

Read more of this article at cbc.ca

Pretty much, they’re changing

5. (1) A licensee shall not broadcast
(d) any false or misleading news.

to

5. (1) A licensee shall not broadcast
(d) any news that the licensee knows is false or misleading and that endangers or is likely to endanger the lives, health or safety of the public.

Posted via email from Frederick’s posterous

How would you shorten your name?

Happy New Year!

We’re now in the year 2011 — which I propose is “twenty-eleven” as opposed to “two thousand eleven”. It’s time to answer some serious questions.

I’ve been bothered recently (very recently, perhaps a few minutes ago) by a daunting challenge. Why do I abbreviate my name to “Frederick D.” instead of “F. Ding”?

I don’t know. What do you do, and why?