On The Cost of Bringing a Person Into The World Via C-Section

@therealjaygatsby There are a lot of reasons, but I think the biggest one has to do with the way we view nursing as a calling and specifically a maternal-slash-spiritual calling. It makes most people really, really uncomfortable to acknowledge the professional aspects of nursing, and putting a price on nursing care more specific than "nurses with x years of experience and x credentials in x unit costs so much per hour" highlights the way in which it's skilled *work*, not just soothing brows with angelic patience. To admit that the nursing care given to a quadraplegic with c. diff diarrhea or a 700 lb COPD patient is fundamentally different and more labor-intensive than the care given a little kid who cut his foot and needs a tetanus shot and an encouraging sticker destroys a lot of the romanticized vision of nursing many people have. Nobody expects their respiratory therapist to be a ministering angel (although a lot of them are!) so it doesn't offend their sensibilities in the same way to be charged for what RTs actually *do* rather than a flat rate for unlimited access, the way we pay for nursing. The unfortunate consequence of this is that hospitals see nurses as their biggest single expense, and and also as the first choice for absorbing any new workload, since lacking the ability to bill for what we do, the only way we can be more profitable is to either work less (most nurses are hourly employees and subject to being put on call, sent home early, or called off at the discretion of the hospital) or become more productive per working hour. For instance, Vanderbilt recently decided to have their OR and floor nurses start cleaning rooms between cases/patients to reduce the number of housekeepers needed. They did not simultaneously lower their patient load- just eliminated housekeepers and added their work to nursing duties. So, college-educated, licensed professionals who literally are supposed to be making sure people don't die, mopping floors and pulling trash in order to save the cost of janitors. Madness. And of course patient care suffers when these things happen because management has no incentive to hire more staff, no matter how intensive the patient needs become- they're not making more money from each nurse being able to perform more nursing care. If outcomes suffer, they *may* hire more staff, but it sure sucks to be one of the patients whose outcome suffered while the quality control people were figuring out their staffing cuts were too severe. And of course, very sick and very demanding patients take up the majority of a nurse's time, while less sick or just less noisy patients get less attention, but pay the same bills. There are a lot of nursing tasks that are difficult or impossible to quantify in a billable sort of way, and that's okay, those will always be a part of nursing. But with insanely detailed real-time computerized charting and government-mandated patient satisfaction surveys, we're rapidly moving towards a situation where it will be possible to bill for many nursing tasks. But it might be a long time before we're comfortable actually doing so as a culture. tl;dr version: Many people subconsciously think of nurses as combination moms/angels and nobody likes the idea of getting an itemized bill from their mom.

Posted on August 28, 2014 at 3:44 pm 0

On The Cost of Bringing a Person Into The World Via C-Section

@Stina Yeah, depending on the hospital, if they have a full triage area for L&D it's may technically be considered an L&D emergency room.

Posted on August 27, 2014 at 11:06 am 0

On The Cost of Bringing a Person Into The World Via C-Section

@therealjaygatsby Yeah, "room charge" is a catchall for everything in the hospital that isn't individually billed. Including nursing care, food service, housekeeping, durable equipment depreciation, etc. And as a nurse I hate it and wish we were billed according to our actual services. The idea that each patient requires the same amount of nursing care is obviously ridiculous, the cost of nursing care should not be the same for the person who got themselves up to the bathroom and had one pill during med pass vs the person who requires hourly meds, total assist, feeding, turning, hour-long dressing changes twice a day, etc. But that's how it is presently. It's still totally insane, but it's not JUST the room.

Posted on August 27, 2014 at 11:05 am 0

On Stress-nesting During a Season of Turmoil

Oh god, yes. All of this, yes. I woke up in a similar mood last week and our house is in currently-unaddressable disarray due to tearing up the damaged floor in the living room. So when I got a text that our local shelter was full and about to start euthanizing, I drove down there and grabbed four tiny kittens. Three solid black (because they euthanize them first, because the world is just total shit) and one torte. Bathing tiny kittens in Dawn dish soap and then watching them climb all over my husband like he's Gulliver in Lilliputia does not solve any of the other horrors in the world. But at least now when I want to scream at the news, I can go in the bathroom where they're on quarantine (to the fascination of our other pets right outside the door) and say "Well, you guys didn't get killed last week, and that's something."

Posted on August 19, 2014 at 1:05 pm 0

On Only Suckers Don't Buy Generic

@clo That entire article is about testing early- it even specifies that by one week post-missed-period, "any home pregnancy test will do". Hcg levels double roughly every two days in early pregnancy, and even the least sensitive tests will measure positive at 100 mlU, while the most sensitive tests measure in the 20 range. So we're talking a matter of a few days of difference in effectiveness between available products- relevant for a few users, and if you're one of those users, definitely worth the extra money. But at a markup of 300-400% over less expensive tests, not worth it for every customer. And price is also not a clear indicator for sensitivity- some of the most sensitive tests are generic, and some of the most expensive tests aren't very sensitive. I just get exasperated at the number of people who come to the ER because they "can't afford" a pregnancy test, and when it's mentioned that you can buy a pregnancy test at Dollar General, tell us that "they don't trust a Dollar General pregnancy test". And then it turns out they're already three months along and a Dollar General test definitely would have worked *just* fine vs a $500 ER visit that they can't afford (and for which we used a pregnancy test no better in quality than commercial ones). It's frustrating that pregnancy test manufacturers play on peoples' anxiety to buy the best in that situation to jack up their prices way beyond actual costs, often without delivering any additional value to the consumer.

Posted on July 24, 2014 at 5:10 pm 0

On Expenses Relating to My Wedding That I Couldn’t Possibly Have Anticipated

I packed, but then forgot the entire bag containing, all my toiletries (including my makeup and brushes, which are all of a quality that can't be replaced at the drugstore/overnight without bankrupting myself) the night before my wedding. My amazing, amazing maid of honor drove back to my apartment from the venue, almost two hours round trip, to pick up the forgotten bag before I even woke up the morning of. Did I mention how amazing she is?

Posted on July 24, 2014 at 11:59 am 2

On Only Suckers Don't Buy Generic

@clo Pregnancy tests come in a range of sensitivities to hcg- if you're planning on testing very early, before your missed period, a very sensitive test is better, but the most expensive test available isn't always the most sensitive. The accuracy levels you cite are almost certainly referring to how likely the test is to detect pregnancy at the earliest possible testing stage, when hcg has just surpassed normal background levels, not accuracy overall- ie, the particular Target test you looked at might be only 84% accurate at detecting pregnancy 3 days before your first missed cycle because it's slightly less sensitive to hcg, while that particular name brand test is 99% accurate at that stage. But that difference disappears the later you test, so for women who are testing later, there is no difference in quality or accuracy between most tests. Also, you can find pregnancy tests in a range of sensitivities at all price points- there's a Walmart Equate brand test that's almost as sensitive as e.p.t. (25 mlU vs 20 mlU) and there are name-brand tests that cost a lot with digital displays that aren't especially sensitive at all (Clear Blue Digital springs to mind). Once you account for sensitivity, the price difference are entirely based on packaging, marketing, and things like the type of results display (two lines vs a digital smiley face, for instance). TL;DR version: If you're looking for the earliest possible result, google the tests available and buy the one with the highest sensitivity to to hcg, which may or may not be the most expensive one available. But if you're planning on testing after a missed cycle, spending more does not get you better results- just better packaging/fancier displays.

Posted on July 24, 2014 at 10:23 am 0

On Label Whoring at Thrift Town

I laughed so much reading this, and you made me miss living somewhere with good thrifting. Growing up in Chicago, I was spoiled by the crazy stuff people gave to thrift stores- my lunch money bought so many dresses I could never have afforded new, sometimes still with tags! In my little southern town now, it's all three wolf moon shirts and poly blend suits, all the time. I hope you're going to be a regular contributor.

Posted on July 11, 2014 at 11:11 pm 0

On Concerning Inflation, Pants, and Getting Old

@Gef the Talking Mongoose I always read advice like this and have a burst of "I should buy high-quality things that will rarely if ever wear out!" enthusiasm. And then I remember that I'm an absent-minded klutz with dogs, and that the majority of my purchases are not in replacement of a thing that wore out, but a thing that I lost, damaged beyond salvation, or that the dogs chewed to shreds, and I keep on buying cheap stuff. =(

Posted on July 11, 2014 at 2:41 pm 3

On Concerning Inflation, Pants, and Getting Old

@Allison We are! Or rather, the seller is getting one and passing it along to us, but we will maintain it. I lived in a house owned by family for a while in college and thankfully had a warranty. So relieved it existed when I had to call a plumber on a Saturday.

Posted on July 11, 2014 at 2:10 pm 0