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Archive for February, 2011

Bouchon Street Food

Posted by eemilla on February 27, 2011

I enjoy eating at Bouchon, and much to my delight they opened a fast food option, Bouchon Street Food, a while ago.  We’ve stopped there to cure my craving for french fries and aioli, and now that they’ve moved into an enclosed space in the courtyard adjacent to Bouchon, I stopped in for lunch last week after a long shopping spree for maternity clothes.

I generally abhor soda, but I love Orangina because it isn’t so saccharine sweet so I savored my Orangina while I waited for my farm to table crepe with of course my beloved herbed frites and aioli.  I sat at the counter which was empty while the banquette that occupies almost the entire wall opposite the bar had a few couples.  A relatively steady flow of customers came in while I had lunch in the late afternoon, and one couple even ate on the patio (although the high was less than sixty that day).  My crepe was hearty much like the crepes served at dinner at Bouchon, and the frites were savory and crisp and hot.  I’d love some additional vegetarian options, but my farm to table was a good value for $6.  After smelling another patron’s fleur (simply delicious nutella) crepe, I also ordered one, which was again the same hefty size as my savory crepe, and served with a dollop of whipped cream.

Bouchon Street Food is open for lunch, but they also do early dinner during the week with a bit later dinner on the weekend; as Bouchon doesn’t take reservations (and they are frequently packed due to all you can eat mussel nights Monday through Wednesday), their sister restaurant might be available to cure your crepe craving.

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Boca

Posted by eemilla on February 19, 2011

Before I was hit with this wretched cold, my honey and I had a night on the town with food and music.  We’re trying to get in as much fun and going out as possible before we have to also find a babysitter.  For dinner my husband chose Boca, a new addition to Lexington Avenue, and I couldn’t resist a menu with two of my favorite Spanish words: jicama and Oaxacan.

We arrived sometime between 7:30 and 8, so they were relatively busy for a Thursday night.  I saw one other empty table, which was a four top miserably situated to be shot with an arctic blast every time the front door opened.  Although we were sat behind a protective planter, we were acutely aware each and every time the door was opened, especially if a few people were trying to squeeze into the tiny foyer to talk with the hostess.  Boca leaves no space unused, and with a prime spot who can blame them for trying to maximize every square inch.  However, we were nestled into an alcove with another two top and a six top; this is no restaurant for large people, because if I had been anymore pregnant I’m not certain I could have managed to sit close enough to the table to avoid touching the seat behind me.  As a foil the ladies’ rest room was huge.  In the warmer months, they have a garage door that looks like it will open to provide patio access, and I look forward to dining on the patio enclosed by their large water feature.

Our service was prompt and professional by both the server and the hostess; although our server did not mention any specials, and from our seat the specials board wasn’t readily visible in the dimly lit atmosphere.  I opted to stick to the appetizers menu for my dinner; I tried the chickpea salad and the mushroom empanadas, while he chose the ceviche of the day, jicama salad, and the entree he tried to push me into ordering, black Oaxacan mole enchiladas.  Everything we ordered was served in hearty portions well worth the price, but the executions of a few items fell short of our expectations.  My chickpea salad which promised almonds, pomegranate seeds, and a vinaigrette came sans; the greens, goat cheese, and fried chickpeas, however, were served in abundance (there was actually too much goat cheese).  The jicama and chile lime dish would have been better if it had actually been jicama and chile lime rather than the sweet chile sauce we received.  As it was the biggest dish, the enchiladas were also the biggest disappointment.  I definitely dodged a bullet by not ordering this dish; the sauce was so searingly spicy that even my smoker husband who adores more heat that I can stand was taken aback.  He ordered it with tofu, and he reported the tofu was bland and probably cooked by someone who doesn’t actually eat tofu.  On the bright side the rice was perfectly cooked and delightfully fresh with the taste of cilantro.

My mushroom empanadas were smoky, and unlike the mole on the enchiladas, their smoky spice was perfectly balanced with the blandness of the corn pastry; I have been craving those things all week long, but I think pairing them with a nice cold beer will make them even better so I’m abstaining for now.  My husband enjoyed his mahi- mahi ceviche.

Our meal was mostly pleasant, and hopefully Boca will iron out the kinks in their execution of the menu items without reducing their portion sizes; again, I am looking forward to sitting on the patio with sound of their water feature and enjoying a cold beer and some mushroom empanadas.

Boca

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Why I Despise my HSA – Part Five

Posted by eemilla on February 13, 2011

(Continued from Parts One, Two, Three, and Four)

After over eighteen hundred words complaining about my current health insurance coverage, I would like to clearly and unequivocally express my gratitude that I have an employer that pays a large portion of my premiums in addition to providing a moderate yearly contribution to my HSA; I would also like to show my gratitude that my husband’s employer provides a small reimbursement for his coverage too, and that we can still afford to pay for the remaining premiums.  I have many family members and friends that are uninsured because they either work for an employer that doesn’t provide coverage, they cannot afford coverage on the individual market, or they are looking for employment after losing the jobs which provided their coverage.

Although I haven’t read the Patient Care and Affordable Care Act, I have listened to numerous podcasts and read ample articles discussing the law.  Like most Americans, I like that health insurance companies can no longer non-renew policies after subscribers get sick.  I’ve never thought making people wait for their pre-existing conditions to have coverage is overly unfair because this is generally a twelve to eighteen month waiting period only if there was a lapse in coverage, but now this will eventually be eliminated; however, I recently discovered that even if one maintained continuous coverage with an individual policy but didn’t carry maternity coverage that the maternity coverage could neither be added nor could one purchase a new policy to provide maternity coverage without a waiting period.  I’ve always had a problem with the discrepancies between group and individual coverage, and after 2014 individual policies will be treated more like group policies in that age, gender, and location are considered when calculating the premium not whether someone has ever taken medication to treat anxiety or depression.  Another favorite provision is that all health plans will eventually pay for preventive care without any co-pay or deductible (this is already in effect for plans purchased after September 2010, but won’t begin for current plans until 2014), although whether the global billing package will come into play or not isn’t clear (in fact the section on pregnancy at healthcare.gov sounds suspiciously like my current health insurance policy).  Finally my favorite provision is that all those elected officials who are trying to repeal healthcare reform and who proclaim that American healthcare is the best in world will no longer have government provided healthcare after 2014.

Insurance only works when the risk is spread over a large pool of people, and without a strong incentive to purchase coverage young and healthy people would continue to not carry insurance (this is why I don’t think waiting periods for pre-existing conditions is entirely wrong).  It is inappropriate to call the provision an individual mandate, as it is one’s option to either purchase insurance or pay a tax, which frankly will probably be less than obtaining insurance coverage in most instances.  Numerous studies have shown that the uninsured do not obtain preventive care, receive less treatment after diagnosis, and have a higher mortality rate than the insured.  They often receive their care at free or low cost clinics or emergency rooms or urgent care centers, and while these places provide valuable services, they are not a substitute for regular check-ups and treatment.

However, I do not like the fact that the law doesn’t firm price controls while pushing large numbers of people into the private market or even establish a state by state standard of usual and reasonable cost index for care (my greatest difficulty with my HSA has been to find out the cost of care prior to obtaining care).  In North Carolina, if you wish to obtain a driver’s license you must first obtain automobile liability insurance, and no insurance company can refuse to write a liability policy for any driver that can provide proof of North Carolina residency regardless of their driving record.  This works because the state has a reinsurance facility, which is funded by a surcharge to every single auto policy written in North Carolina; the insurance companies then send all the high risk policies to this pool.  If you are a high risk driver and need to have collision, no company is required to provide the coverage, but most companies will provide the coverage because again they can send the policy to the high risk pool.  The state sets the maximum auto rates as well as approving what discounts and rate reductions each company can provide; a high risk driver must agree to pay higher than the state rates to obtain collision coverage.

This model seems to work fairly well for all parties in the state, and I wish the healthcare law had enacted something similar.  A basic policy would be required to be issued, and a maximum rate for this coverage would be set.  The basic policy would cover preventive care along with a few sick visits and generic prescription drug coverage with some out of pocket costs, and it would be the same basic policy with every insurer (like the North Carolina auto policy).  Each company could offer enhancements and of course charge for those, but again there would be a maximum rate any company could charge for any policy.

Although the health insurance exchanges are purported to be the best way to control cost, I fear that the sick will be pushed to exchanges exclusively with the young and healthy primarily insured outside of the exchanges.  This is sure to bring about failure of the exchanges if they are heavily loaded with those that are more expensive to insure.  I also don’t like that even though the insurance companies are about to get an influx of customers the federal government is going to be subsidizing the high risk; why can’t the health insurance companies use their increased profits with their broader customer base to fund the high risk pools?

I also like that an excise tax will be levied against drug companies to help pay for the healthcare bill, but I really want to see an end to prescription drug commercials in all media.  As doctors have the power to prescribe, the advertising should be limited to that population.  If a patient wants to explore treatment options access to medical journals is open and available.  I loathe how much money is spent on those incessant commercials when public funds contributed to their research and development only to have private companies then hold patents for years to ostensibly recoup their development costs.

Even after all this thought, I am still undecided as to whether I will continue with the HSA or not;  if I move back to the traditional plan I will no longer get my little bonus from my employer, and we’ll still have some fairly large out of pocket expenses if I get sick.  I have quoted policies for the little one, and if we do an HSA with a $5,000 deductible the premiums will be less than $100 a month, but a traditional plan without huge out of pocket expenses it will be over $200 a month for a newborn that doesn’t smoke or drink or engage in other destructive behaviors.  However, if we decide on a plan for the little one and my honey we can have a $10,000 deductible with no co-insurance for about the same monthly premiums we are paying now, and as we will be purchasing this policy later this year, thanks to the Patient Protection and Affordable Care Act, preventive care is fully covered even in a traditional health policy.

I am interested to see how all of this plays out between now and 2018 when the final provisions of the bill become effective, and I will strenuously protest anyone who dares to repeal this law without codifying virtually all of its patient protections and adding a cost ceiling.  If it survives beyond 2014, I will be rather interested to see how those who praise American healthcare as the best in the world are dealing with being on the private market rather than on the free government provided care they currently have.

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Why I Despise my HSA – Part Four

Posted by eemilla on February 6, 2011

(Continued from Parts One, Two, and Three)

Dealing with the global billing package is working against us again because we decided to change providers.  I initially went to the obstetrician because when I called the midwife last year to see if they contracted with my health insurance company they didn’t, and out of network benefits have a higher deductible and coinsurance.  However after three visits with the obstetrician, I decided to at least explore the increased cost of out of network care only to find out the midwifery practice had begun working with my health insurance company.  The first visit at both the OB and the midwife left us with a payment schedule, so we have already paid the OB practice a few hundred dollars towards our estimated share of the global package, and they have yet (after about two months of being aware of our transferring our care and a phone call requesting it) sent a statement of our account.  I called back with my health insurance statement in hand, and after two more phone calls they issued a refund check, which includes treatment they billed for that I never received.

As previously stated I have a real problem with the uninsured subsidizing the health insurance companies.  I understand statistically the insured are healthier than the uninsured (due to obtaining preventative care and getting early diagnosis and treatment), and I understand the benefits of buying in bulk; in most cases I support it (we’re members of the French Broad Food Co-op, and I used to belong to Sam’s Club).  However, it is morally devoid that people trying to take care of themselves should subsidize companies that basically have monopolies; over 70% of health policies in North Carolina are with Blue Cross Blue Shield, and they even promote themselves as having the largest market share in the state.  According the NC Department of Insurance, in 2008 United Health Care ranked second for NC policies with less than 13% of the market.  In 2009, the CEO of BCBSNC earned almost $4 million all the while raising premiums for policy holders in a down economy, and BCBSNC is a non-profit (although thankfully not tax exempt).  Both my husband’s and my premiums increased from 2009 to 2010 and again in 2011 (I sincerely appreciate my employer not increasing my portion of my health insurance), and we can only expect another increase next year plus what we will have to pay for a third policy for our little one (as it is prohibitively expensive to add anyone to my plan, and we are probably not going to do an HSA with the kid).  In 2004 the Kaiser Family Foundation found that the uninsured paid about a one-third of the cost of their medical care, leaving the rest to be paid by charity, federal, state, or local governments, or the providers, and in 2008 Families USA found little had changed.  However, the uninsured is billed double (in most cases based on numerous personal experiences) what most insurance companies are billed.

Before this year,  I would have thought an HSA/HDHP would have been fine for a child too since most of the visits would be for wellness check-ups and vaccinations (although we might be struck with the new parent urge to rush to the doctor at every little “symptom”).  However, in reviewing my policy there is no mention about the global billing package so what surprise might be waiting for us for the little one’s care?  My policy does state that “all maternity-related medical services for prenatal, postnatal, delivery, and any related complications” are covered, and when I refer to the Schedule of Benefits I find that in network services are the same “as those stated under each Covered Health Service category in this Schedule of Benefits except that an Annual Deductible will not apply for a newborn child whose length of stay in the Hospital is the same as the mother’s length of stay.”  The term “global billing package” is absent from the definitions section of my policy, too.

In shopping for health insurance it is impossible to know what you are truly purchasing because even though the marketing material might imply or explicitly state one thing the policy will always supercede, and until the policy is purchase I don’t know of a single insurance company that will provide a copy of the policy for perusal.

To be continued.

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