• Blinded by Choice

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    April 25, 2010 /  Musings After Midnight

    I experienced one of the problems with American health care tonight: 94 eye care providers. While this may seem like a marvelous example of Kapitalism at work, I am worse off than if I had fewer options. Let’s delve into this.

    It’s not that my eyesight has degraded, I think, but my last eye exam was 2 years ago. I have no spare contacts, and my glasses are scratched, so it’s time for a new exam, glasses, and contacts. My insurance year ends May 31, so that plays a role, too. Unhappy with my last eye doctor in Louisville, who took 6 weeks to schedule me and didn’t handle my insurance paperwork, I decided to search on my provider’s website. I entered my zip code, selected a 20 mile radius, and got over 200 possibilities. Well, Louisville is a fairly big city, and that’s basically the entire city, so that’s too much. Reducing the distance, within 5 miles of my zip code there remain 94 providers!

    My insurance provides a PDF listing. On this list, I can see each provider’s name, gender, degree (OD, OPT, MD), associated company, address, and phone number. The symbol listings at the bottom have entries for “accepting new patients” and “not accepting new patients”, but none of the entries have either mark. A couple people list a second language, which would be useful if I would be more comfortable in French, Spanish, or Hebrew. That’s the best part, but I want English so it doesn’t decide things.

    Overall, there is almost nothing here. There’s not even a description of the degrees. Which do I need? I have to head off to eHow to get a description. OPTs don’t do exams. ODs do general exams. MDs can handle more difficult cases and surgery. An OD should be fine for me. (This OD isn’t the OD Latin for Right Eye, by the way. Fortunately, in an example of good sense, OD and OS are supposed to be replaced with Right and Left. No more sinister Lefties!)

    Another factor, I guess, is that I’m not looking at 94 providers, but rather a smaller number of centers. Most doctors, though not all, are associated with a clinic structure, like Kentucky Eye Care PSC, Vision First, or Dr. Bizers Vision World. I count 14 centers within 5 miles. This would help me somewhat, except there’s no general information about the centers. Google search sends me to healthgrades.com, which only has 77 listings for the entire city. That’s not much help. There are also ratemds.com and vitals.com, each with a few reviews. Most people, and even most groups, have none. I have no filter.

    There’s not even a list of specialities, or areas, or programs. As a comparison, when searching for colleges there are a lot of providers organized into groups, like me. It can be overwhelming, and the USA might be better off with fewer larger schools. Yet there are listings, guides, and data. No such information exists for eye doctors. Continuing the analogy, one can make college visits and see sample classes. I don’t think there are sample eye exams.

    Putting it all together, I have no idea who to select. I would do much better if Bellarmine’s human resources department had handed me 3 preferred choices, with commentary they had prepared. I might even do better if the plan had ONE choice that they, as more knowledgeable people, had chosen to be best. From their perspective, the transaction costs in dealing with 1 or 3 providers would be less than the dozens around Louisville. In the quest for “freedom”, we all have to pay greater transaction costs. And I, like other consumers, are asked to make choices without information or background.

    I just don’t know. I’m in analysis paralysis, the the The Paradox of Choice. More is less, because I must spend much more time on the decision, plus I have a much greater likelihood of suboptimality, and thus am more likely to be unhappy. Author Barry Schwartz explained the problem in a TED talk. Mr. Schwartz mentions health care in his talk. As he notes, it’s not patient autonomy, it’s a shift of responsibility from an expert to a less able decision-maker.

    There’s another good solution beyond my choice reduction, of course. In the comments on the talk, a Chris Grayson makes a good point: “Our problem is not too much choice but too poor filters. As choice multiplies, informed recommendation becomes increasingly valuable.” But until that happens for eye doctors, or Bellarmine frees us from the false benefits of Kapitalistic “freedom”, I still have to stare at those 94 choices with my old glasses, and not be totally blinded by choice.

  • Thank you, Butler.

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    April 6, 2010 /  Mass Media

    I went to the NCAA basketball championship in Indianapolis last night. My trip home from Chicago to Louisville literally passes within sight of the stadium, so it was an easy diversion. After Butler won Saturday night, Stubhub provided a seat. I have pictures and commentary from the game, and TiVo to review what actually occurred versus what I thought I saw from the nosebleed seats. I’m a little hurt from the 61-59 defeat, so it will take me a few days.

    As I drove home, though, I wasn’t that dismayed, because there’s a lot of joy in my heart. I almost saw a fairytale. Earlier, one of the radio tunes approaching Indianapolis was from Omar Samhan’s crush Taylor Swift, Today was a Fairytale. Could Monday night become one?

    The student-athletes of Butler played hard and played well. Butler’s motto is The Butler Way: The Butler Way demands commitment, denies selfishness, accepts reality, yet seeks improvement everyday while putting the team above self.

    You could do much, much worse. They represented young men valiently, from going to class on Friday, to church on Sunday, to dealing with poor officiating on Monday. With 5 minutes left, their best player got shoved into the basket support on a breakaway, a play so dangerous that doing that in a pickup game would typically lead to a fight. As the officials gathered, those of us in the stands knew. “It’s D–e. That’s not going to be a flagrant foul.” Of course. Despite many things, Butler held close. Close enough for belief.

    When I used online dating, I started my profile with “A friend once said that in my world, fairy tales still exist.” Why not? We read those stories to children because they have the values we want them to learn. Yes, we fail in them. Yes, I fail in them. That doesn’t make them wrong principles.

    Watching Butler fight tonight, the crowd believed, even the worried D–e supporters. We tried to help, cheering Butler and being noisy when the opponent had the ball. Things looked bleak after the knockdown thuggery, but Butler recovered. Then, after a scrappy rebound with 33 seconds to go, Butler had a chance. During the timeouts with 13 seconds left, the crowd believed in fairy tales. And as the last shot went into the air, even from halfcourt, for a few seconds there was a rare, special hope.

    Coach Stevens spoke very well in the ESPN interview outside the locker room. (For contrast, listen to the Michigan State coach’s comments from Saturday night.) The players were hurt, not disappointed. Several of them later answered questions. The effort, the journey, still meant a great deal. On the way out, the fans understood that as well. I saw sadness, but no sense of failure. It was always an uphill battle, monetary and otherwise, for anyone outside the BCS Circle. While 50,000 people inside the stadium, millions of people watching on TV, and I wanted the fairy tale, I can still be satisfied with what I received. As Coach Stevens said, “This one, obviously, got a lot of people dreaming.” Eventually, it will happen. Until then, thank you, Butler Bulldogs, for pleasant dreams.

  • Horatio Alger Returns: Butler vs Michigan State

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    April 4, 2010 /  Mass Media

    I’m in my second home, a Hyatt, with a 14th floor view of Interstate 88. Tonight it’s the Hyatt Lisle out in the Chicago suburbs. Right now, God is dead, though according to my favorite news channel Russia Today, the Holy Fire has traveled from Jerusalem to the Orthodox Cathedral of Christ the Savior.

    Tonight, in the way that the grand Orthodox Cathedral represents part of Russia, there’s a basketball game that represents part of America. One of the teams, Butler University, normally plays at Indiana’s Basketball Cathedral. They are student-athletes, with all the contradictions that entails. The star Butler player went to Game Theory class yesterday. On one side, we have the home team even though they are 259 miles away, the athletes of Michigan State. Nobody talked about their classes.

    I don’t have a TiVo, so these comments will be with less review, particularly on fouls. If you’re reviewing this later, the NCAA rulebook is available so you can see what I reference.

    16:28: The first call is against Butler, when the Michigan State player pushes into him and falls down. I didn’t have the TV on when the referees appeared. I hope the music wasn’t No Chance in Hell.

    12:41: The players at Sports Bubble Stadium have to sit below the floor, which means they can’t study the play as well. To understand this, you need to remember the NCAA motto. Who cares about proper benches when there’s money to be made?

    10:15: Butler is not Cornell; they have five non-white players in the game right now. The whole Hoosiers thing is overdone.

    9:45: Michigan State makes a three point shot, and the TV has the sound of cheers. Either CBS put microphones in the Michigan State section, or that’s not good news for Butler. Given that I can also hear cheerleader calls, I’ll go with the microphones.

    8:47: With less than 5 seconds on the shot clock, the MSU player wildly drives into the Butler defender and gets a call. Right now, Michigan State understands officiating better than Butler.

    4:50: Butler is rushing three point shots a little bit, here at 22-20. Their feet are not fully set. There haven’t been any points in 3 or 4 minutes. Michigan State ends the drought with a very nice interior pass for a layup.

    3:32: An uncalled foot shuffle travel by Michigan State, countered by a push away from the ball. The Butler push was a foul. I point out all these traveling calls because the officials seem to consistently miss them.
    Hitting the one-and-one free throws, fouls 7, 8, and 9 each half, is very important. There are lots of zeroes on them. Michigan State gets two here.

    2:48: Great back door cut by Michigan State. Butler’s coach is justifiably annoyed. He calls a timeout. Thanks to an explicit exception for media timeouts, what should be 30 seconds becomes 150. There are plenty of commercials. Who cares about game flow when there’s money to be made?

    2:00: Has the foot shuffle travel disappeared from the rulebook? There were two more on this Michigan State possession. No, it’s still there in Rule 4, Section 70. There’s another one later, all by the same player.

    2.5 seconds: Butler uses a timeout at 28-28 for a last shot attempt. One of the Butler players, now #20, has done it before. He doesn’t catch it, though.

    Halftime: The score is tied at 28. Each team has had 31 possessions, by my count, so the points-per-possession is 0.90. That’s not very good, though it’s a lot better than minutes 21-35 of Kentucky-Cornell. There’s been some good defense: Michigan State has 3 clean blocks, and Butler has made several clean steals. But there’s also been mediocre shooting. That’s part of the Sports Bubble, I suspect. Placing a court in a gridiron stadium makes terrible shooting backgrounds.

    Michigan State is getting baskets from their three best players, with 8, 7, and 7 points. Butler is being carried by its two stars who played for the USA Under-19 Team last summer. Remember that the talent level is close to even here. No other Bulldog has a field goal.

    Now is a good time to talk about how this represents America. The fundamental American contradiction involves Horatio Alger and General Electric. (By the way, I want a basketball with the Presidental Seal, though I doubt I will adopt the President’s shirt and tie workout wear.) The Horatio Alger Myth is that by leading a valient life, a protagonist gains wealth and honor. It’s rags to riches. Interestingly, Alger’s characters rarely became superbly wealthy, generally just acquiring the earlier version of Levittown, the suburban dream.

    The Alger myth is part of America, that through hard work and luck, anyone can advance. This is Cornell, or Butler. It’s to our nature that we routinely help this type of person, we cheer for them, we like this type of victory.

    At the same time, America is also home to the Carnegie Steels, General Electrics, and Microsofts, who use size, connections, and power to crush opposition. Many of us support them, as well. That’s what’s strange.

    18:20: Butler takes a one-point lead on an opportunistic second chance layup. Michigan State makes a good play to regain the lead.

    17:16: Shocking me, the officials manage to not believe that a jersey just wound up in an opponent’s hand.

    16:41: The temporary rims at a Sports Bubble installation have a hard metallic bounce. It doesn’t help the shooters, as the Michigan State player misses two free throws.

    15:24: Wow, Butler runs a Globetrotter weave. In a world of isolation sets, that’s very unusual. Michigan State doesn’t have that play.

    14:19: Butler has figured out that the hard drive gets foul calls, even the reckless drive. It’s worth 1 made free throw. Michigan State gets an #omgdunx. Then Butler gets a tough layup, misses it, gets tackled on the rebound with no call. Momentum might have changed, but Michigan State misses the transition jumper.

    12:38: Brilliant Butler defensive switching leads to a turnover and a frustration foul. The commentator is correct, that having lost one ballhandler to injury has hurt the Spartans against a good defensive team. Butler is already in the one-and-one. They only score one, though.

    12:15: A Butler steal, a dunk, and momentum almost changed. But the Michigan State player made a good post move to recover, though the ESPN play by play incorrectly called it a layup.

    11:32: Worry for Butler, as Butler’s #2 player has muscle spasms and is out. Also, the rebounding is starting to get more brutal.

    10:09: The key one-and-one by Butler’s big man is missed. So the one-and-one is a disadvantage. This is relatively common in college. The NBA rule of going from nothing to two shots is better.

    9:24: The Michigan State player makes a sliding block, the correct call. The final one-and-one gets two free throws. Now, it’s two shots for Butler the rest of the way, so they have the advantage again. Michigan State still has to go through the three one-and-ones, and they are 0 from 4 this half from the foul line. Did you know that in 1953, fouls until the final 3 minutes resulted in a single free throw? Under that rule, I’d foul on every possession.

    7:46: Michigan State has found a good matchup in the low post, but the last two possessions have led to a missed off hand layup, and a missed baby hook. A secret I’ve discovered in recent pickup play is not to be overly concerned with post up play. Spinning layups and contested 6 foot hook shots are middle-of-the-road shots. An open 3 point field goal is much better for the opponent. I once found a shot chart that showed this.

    Here it is. Note the blue line, shooting percentage. It’s basically flat from 5 feet through 24. Actually, the shooting percentage is maximized around the three point line. That doesn’t mean a three pointer is easier than a 10 foot shot, of course. It’s not. It means that players are much more likely to take closer contested shots. From NBA figures, a contested shot subtracts about 20 points from success percentage – 60% to 40%, for instance.

    6:04: The Butler player makes a great move and draws a foul. The Michigan State player wasn’t angry at the call, rather the lack of help defense.

    5:00: An absolute thug rebound goes to Michigan State, and Butler misses a left hand half hook. Despite great defense, they’re only up four.

    4:25: Butler rushes two put-backs, which would have been a big help. They haven’t had a field goal in 8 minutes.

    2:23: Butler makes a steal and an attack. It’s only worth free throws, though, and only one is made. It would have been better to pull up for a eight foot block jumper.

    1:34: Finally, Butler makes a field goal, on a missed open 3, great clean rebound and save by a guard, then a pass for a layup.

    1:18: Fouls 7 and 8 for Michigan State have been shooting fouls, ruining the advantage of the one-and-one. They’ve been worth two points and a clean offensive rebound. off a metallic long bounce.

    56.3 seconds: Foul 9 is a key one-and-one. Michigan State gets the first. The coach puts in their best rebounders, but Butler’s coach does not. It’s made, though. Butler 50-49.

    23.0: An eight footer rattles out for Butler. Thanks, temporary supports. Michigan State has the ball with a chance to win. Butler made a mistake here by not shooting quickly, so they could see another possession. We’ll see if it hurts them. Will Michigan State run the clock down? Likely not, as they want multiple options, and they can crash the rebounds with impunity. It’s exciting.

    6.5: There’s no foul on the Michigan State attempt, though lots of unofficial commentators believe so in the ESPN chat. The Michigan State player leaned forward to try to make contact. The play starts with about 10.5 seconds in the game, inside the highlight. It starts around 1:08 in. As Rule 4, Section 74, Article 1, part d states, “The defender shall not be penalized for leaving the playing court vertically or having his or her hands and arms extended within the vertical plane.” If anything, it’s closer to an offensive foul for Charging. As Rule 4, Section 10 states, “Charging is illegal personal contact by pushing or moving into an opponent’s torso.” And Rule 10, Section 1, Article 7 reminds us “contact caused by the momentum of the player who has tried for goal is charging.” I’m impressed that the referees made the correct call there.

    6.1: A Butler guard gets the rebound and two key free throws. Make! Make! Leaders, like freshmen class presidents, do that.

    5.8: The Michigan State coach is yelling, and has to be restrained by HIS PLAYER. He claims the clock started early. It didn’t. That should be a technical foul.

    2.0: Butler plays smart! They attempted to foul and almost made a strip. They then got the semi-intentional two shot foul. The first is made to go to 52-50. Now the second is a natural miss, but Butler’s star grabs the rebound, even though a Michigan State player commits a blatant violation of Rule 9, Section 1, Article 2 g by coming inside the three-point line before the ball strikes the backboard. Bulldogs WIN! Horatio Alger cheers!

    That was a very quick game; it took less than 90 real time minutes. It wasn’t an offensive clinic. By my physical count, there were 29 possessions in the second half, a total of 60 for the game. (The formula is slightly off.) Michigan State had 0.83 points per possession, and Butler won with 0.87. The overall college average is about 1.01. What happened? I also see 8 missed Michigan State free throws. Butler missed 7, though, so that’s close. Rebounds are close, too. Michigan State had 6 offensive of 26 (23%), while Butler had 10 of 38 (26%). The major factor was turnovers. Butler had 8. Michigan State had 16, 12 of which were Butler steals.

    Anyway, since I’m headed through Indianapolis Monday evening, back to work, I dropped a little cash for a nosebleed seat. There’s more to come, and it may not end in a loss.