08/16/2015   English German

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  Edition # 112  
San Francisco, 08-16-2015
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Figure [1]: A homeless person lies down on the chairs in the emergency room's waiting area.

Angelika Michael has always been playing soccer with a passion, ever since he was a little kid. Here in San Francisco, he's been in a pickup game every Tuesday for many years, and he religiously sticks to his routine, rain or shine. One Tuesday in June this year, however, he came home early from a game, cursing like a sailor. Als always, he had given his last in the game, but had tripped and fallen hard on his shoulder. Michael knew right away that his collar bone was fractured from experience, as many years ago he'd injured this delicate bone on the opposite side during Judo training. So we called our primary care physician the next day, who told us to get it x-rayed and that we should drive to the emergency room for that.

We usually try to avoid visits to the emergency room at all cost, because we know from experience that the waiting times there are unbearably long, and there's total chaos because you share the area with all the crazies, the wretched and the huddled masses of the City of San Francisco. It's quite interesting to hang out there for social studies, but if you're not doing so well yourself it gets old very quickly. Under Obamacare, patients are supposed to limit emergency room visits to real emergencies, which was supposed to reduce their workload significantly, because previously the ER was the only to-go place for people without health insurance as no regular doctor would see them.

Figure [2]: The hardest problem with the broken collar bone was eating ramen soup while holding the chop sticks in my left hand.

But Obamacare actually had the opposite effect. There's a severe shortage of primary care physicians in the United States, estimates run from about 20,000 additional doctors needed until the end of 2020. Now, with the increasing number of people having access to health insurance, the situation is getting worse because those newly insured need additional doctors. It's not uncommon nowadays having to wait 4-6 weeks for a doctor's appointment, which is unacceptable if you have an urgent health problem, even if it's not life-threatening. Because of this dire situation, patients are heading in droves to the emergency rooms once again. On top of that, many states have extended their "Medicaid" social medicine program under Obamacare. It provides health benefits to people in the lowest income categories. But many doctors simply refuse to see Medicaid patients, because the rates covered by the Medicaid insurance are significantly lower than the rates paid by regular insurance companies, and low-income patients have no choice but to head to the nearest emergency room once again.

Figure [3]: First part of the ER bill: 1,900 Dollars.

But back to Michael: Spread all across the city of San Francisco, there's a number of emergency rooms, and if a patient is still able to get there without an ambulance, they need to decide on which one to head for. A few of those ERs take appointments, that's helpful for patients who aren't already on their last legs. But if you think about it, the idea is quite absurd, as the concepts of "appointment" and "emergency" don't really fit well together. We picked an ER in the Castro district, because it's located in a relatively calm neighborhood and it's only 10-15 minutes driving distance by car from our place.

Since Michael didn't have a life-threatening condition, we had to wait more than an hour until finally someone took pity on us and made the x-ray. While we were waiting, two emergency patients were dropped off by ambulances, and a homeless person made herself comfortable on the chairs next to us in the waiting area. She had all of her possessions with her, and lied down to sleep, stretching out over three adjacent chairs. After a while, ER staff called security and it turned out that the woman needed a place to sleep in a homeless shelter. The security folks promised to make the necessary calls to help her out. Apparently, this kind of thing happens quite frequently.

Then the door flew open, in walked a loudly moaning woman, and another security guard started to worry and asked what was going on. The woman quickly started to chit-chat with him and all of a sudden completely forgot about the moaning. Four young girls visiting from the UK were all buzzing around the waiting area, all of them chipper and in apparently perfectly healthy condition. The ER doctor didn't seem to be amused. A nurse kept complaining loudly on the phone about a doctor who had treated him badly. This went on and on until it was finally Michael's turn, he got his x-ray taken, and minutes later the doctor released him with the hardly surprising news that his collar bone was broken. Since a fractured clavicle usually needs to heal by itself, Michael simply received an arm sling which we could have just as well bought at any pharmacy. Further, he got a referral to an orthopedic doctor for follow-up and was offered a pain killer pill, which he declined to take by mouth right away but kept just in case. Weeks later, the first bill came in the mail, followed by a second one a few days later.

Figure [4]: Second part of the ER bill: 1,400 Dollars.

Surprise: For the generic Ibuprofen pill, the ER had charged our health insurance a whopping $19.41, but of course you need to consider that they had an entire team of doctors available ready to squeeze Michael through a CT scanner in an emergency. The total ER bill turned out to $3.306,41, as you can see in Figures 3 and 4. That's the amount that an unsuspecting tourist would have had to pay. But since the ER participates in our health insurer's network, the two parties have agreed on fixed rates for medical procedures, and the health insurance "only" had to pay $1,883.35. We had to chip in $75 as ER co-pay and another $300 deductible which our health plan required. In comparison: For the follow-up visit at the orthopedic specialist, including another set of x-rays, the health insurance only had to pay $177.24, and we forked over $30 in co-pay. You can easily see that it would have been much more cost effective for the health insurance if we had gone to the orthopedic specialist first, but there were no appointments available. In fact, when Michael got the ER's referral, he called the orthopedic doctor's office and the receptionist told him that the next available appointment was in four weeks. When he asked about other doctors in the same office, the receptionist found a less popular one that had an appointment available only a week later.

Stimulated by the ailing state of the American health care system, innovators have come up with capitalist and technical solutions to alleviate the situation. Popular are so-called boutique or concierge doctors. Patients who are willing to sign up for a yearly, monthly, or three-monthly fee can enjoy improved services, like same-day appointments, even on Saturdays, a shorter wait at the doctor's office, and more time with the doctor. Doctors who switch to this model are seeing fewer patients and can focus better on individual cases.

Figure [5]: Concierge medicine: Offices of One Medical around in our neighborhood.

There's many different cost models to choose from. In some, the patient buys the aforementioned conveniences, but claims resulting from visits at doctor's office or lab tests are charged to the patient's health insurance. Another model charges a higher fee, but covers additional services, like seeing a doctor or preventive screenings. Other expenses like immunisations or x-rays are the patient's responsibility. Membership fees range from $150 to $5,000 per year.

The concierge medicine provider "One Medical Group" is currently spreading across San Francisco, with one of their offices being located just around the corner from our house. Critics of this new approach rightfully object that concierge medicine splits patients into first and second class citizens, since not everyone can afford paying the hefty yearly fees. And, what's worse, participating doctors accept fewer patients, exacerbating the effects of the current doctors shortage even further.

Lately, a new trend is making big strides. So-called telemedicine uses video conferences, available today on a wide variety of smart phones and tablets to a broad audience. With the "Doctor on Demand" app downloaded onto their device, patients can enter a video conference with a doctor who is certified to practice in the state the patient resides in. Not having to drive to a doctor's office or wait for days until the next available appointment can be quite advantageous.

Figure [6]: A patient converses with a "doctor on demand" using a video app.

Patients simply type in their symptons, along with potential allergies and regularly taken medication, after which they're connected straight with a doctor. Participating doctors are typical primary care physicians handling the usual minor illnesses like the flu, severe head colds, diarrhea, rashes). They're not allowed to treat serious diseases, for these the patient has to visit a doctor's office in person. The video doctors will write prescriptions, though. The fixed price for a virtual session with a doctor is $40. Since this is significantly less expensive than a traditional office visit, one of the major U.S. healthcare providers, United Healthcare, has added the service to their coverage plan.

Even sessions with psychologists are available on "Doctor on Demand". The advantage of this kind of interaction with a doctor is of course that the patient won't have to sit in a waiting room with other sick people, and will get an appointment right away without having to actually drive to the office location. Disadvantages are that the doctor can't examine the patient thoroughly because of the lack of physical contact, and that the personal relationship with the doctor suffers. "Doctor on Demand" is a San Francisco company, by the way. But we're still devoted to our good old primary care physician of 20 years and will dutifully drive to his office whenever we need him.

Top Product: The Foldable Cargo Box

Figure [7]: Michael discovered a collapsable cargo box at Costco.

Michael In Germany, many supermarkets carry these collapsable cargo boxes, and they usually cost about three or four Euros. Experienced shoppers carry them folded up in the trunks of their cars, and when they've pushed the shopping cart full of groceries back to their parking spot, they simply unfold the box, place the items in it, and have thus saved the environment from dealing with another plastic bag.

But these boxes are largely unknown in the United States. Angelika calls them "Curver Boxes", but those are different, as they're solid plastic and non-collapsable.

It must have been about 15 years ago, when I found a similar collapsable orange and black colored plastic box at the Daiso store, which is a Japanese dollar store in Daly City. I paid only 6 Dollars for it, first bought one, then another one, and every time I unfolded it at the register of Trader Joe's groceries, the cashiers were rubbing their eyes in disbelief and started marveling how smart the design was and if I could do it again, just for illustration purposes, fold, and unfold it, please?

This story continued, as I said before, for something like 10 or 15 years, but lately, the two boxes started to show their age and kept deteriorating slowly. I went back to Daiso, but they no longer carried the marvelous boxes. So I grudgingly glued my old broken boxes time and time again, until by sheer coincidence I saw a new, much more stable version of the box at Costco the other day. They called it "Clever Crates" and charged a whopping $12.89 for it. I immediately bought two, and hope that this new investment will pay off until year 2030 for all my groceries shopping. If you know your way around Costco, it's an open secret that everything in the store costs a certain dollar amount and 99 cents, but if you see merchandize priced at $xx.89, it means that it's an everything-must-go sale of a few remaining items. For heaven's sake, quick, go find your box at Costco, it's an opportunity that opens only once every 15 years!

New Delivery Services

Figure [8]: For restaurants without their own delivery service, there's a new way to offer delivery.

Michael Hardly any powermum has the time anymore to cook meals for dinner, and that's why new kinds of delivery services are mushrooming in the Bay Area. And it goes without saying that today's hipster families won't order profane dishes like burgers or pizza anymore, but instead they insist on produce grown by happy farmers, whole foods that are both sustainable, gluten-free, and detoxicating, if that's indeed a word. Since not every family-owned diner restaurant has the resources to get an order web site up and running, which is also compatible with the latest smartphones, or manage hoards of rabid bike messengers, a new breed of middleman entered the landscape offering exactly these kinds of services.

Take Doordash, for example, a company that delivers dishes from restaurants that don't want to run their own delivery service. Or Sprig.com, which cooks healthy meals with broccoli and less fat and delivers them to your doorstep in environmentally friendly cardboard boxes.

Figure [9]: Sprig.com cooks healthy meals and delivers them in an environmentally friendly way.

And what fascinates me personally about these companies is that their web pages and apps were apparently developed by people who actually know what they're doing. Ordering is easy and even from a security standpoint they're state of the art as well. If you compare that with, say, apps by the German news magazine "Der Spiegel", it seems as if Germany's IT sector work force consists of former shopping cart retrievers, who were retrained by the unemployment agency from complete amateurs to write smartphone apps in no more than two weeks time. Such slipshod work and couldn't-care-less-attitude would be unthinkable in the U.S., as the ubiquitous competition would simply crush companies with such bad employees.

Figure [10]: It's that easy to reserve a table in a restaurant.

Nowadays, to reserve a table in a restaurant, there's no need to call them. Instead, their web site usually directs guests to a service called Open Table. Five buttons appear, labeled 5:00 pm, 5:30 pm, 6:00 pm, and so forth, from which you simply select one and then let the smartphone auto-fill in your name and phone number. That's it! Recently, we were on a hiking trail in Point Reyes and were planning on having lunch soon after, so we booked a reservation for an hour later right there on the trail. After we had finished the hike and arrived back at the parking lot, we drove to the restaurant and were seated immeditately, even though there were other people waiting in line. Open Table is free for guests making reservations, and the restaurant pays a fixed price of $199 per month plus $0.25 per guest if they came through the restaurant's website, and $1.00 if they came via Open Table's own site.

And of course the local restaurant scene here also sports a small share of naysayer dinosaurs, complaining that allegedly, Opentable isn't worth paying for. But seriously, if you don't generate enough revenue to expense 25 Cents per Customer, you're already in a downward spiral and better prepare to shut down your restaurant soon. Which, ironically, the previously mentioned restaurant owner has done recently. Well, it's common knowledge that running a restaurant in San Francisco is a relentless dog-eat-dog competition, and what's most surprising is the sheer number of people who think they can beat the odds. Most keep flushing down their money down the toilet for a year or so before they finally realize it's not for them and give up. I hope whoever reads this will do their homework ahead of time and avoid that costly mistake.

Figure [11]: This lady can't believe her package didn't get nabbed by some package-stealing bum for a change.

Another opportunity for a newly invented service industry came about because unfortunately there's a bunch of bums scouring our neighborhood during the day, stealing packages casually "delivered" by mail carriers who simply leave them on people's doorsteps (Rundbrief 12/2014). Recently, a young entrepeneur grasped the opportunity. He previously pitched his idea in the the TV show Shark Tank and has launched Doorman, a package delivery service with more flexible operating hours than established companies like the US Postal Service, UPS, or Fedex. Instead of having online orders shipped to a private residence, people now simply ship to Doorman, receive a message when the package arrives and can then schedule delivery between 6pm and midnight. Doorman charges $3.99 per package or $19 a month for unlimited packages. Great idea, and I'd hop on it if I hadn't perfected shipping to my workplace and hauling stuff home on the bus at night.

Unusual Drought Measures

Figure [12]: Showers at the beach have been shut off by the park service, prompted by the drought.

Angelika It's been reported all over the world that California has been struggling with a severe drought for four years now, because there hasn't been enough rainfall during the winter months. We've been experiencing the effects of this lately day in and day out. Caused by the extreme dryness all around, there's no less than 17 active wild fires raging across the State of California, and even in our neighborhood in San Francisco, we can smell smoke and the air is quite hazy.

Figure [13]: "Brown is the new Green" is the motto on California's lawns.

Although San Francisco hasn't legislated compulsory measures for saving water yet, there's reminders towards conserving the precious resource all over the place. The new slogan "Brown is the new Green!" refers to the city no longer watering their public green spaces, and they're asking citizens to follow suit.

Figure [14]: This restaurant stopped filling water glasses automatically and will do so only upon request.

Many restaurants stopped automatically serving glasses filled with tap water at their tables. I hope that this stays that way, regardless of the drought. And, unfortunately, the park service has turned off all showers at the public state beaches, forcing visitors to return home with sandy feet! And many gardeners are coping with the water shortage by picking plants which get by with very little watering.

Figure [15]: The car wash is closed on Wednesdays to save water.

Figure [16]: This is what the car wash looked like in happier days.

Some hobby gardeners are watering their plants with reclaimed waste water. A few municipal wastewater recycling plants offer this turbid water product for free and people are driving to these places with giant containers on their trucks to haul them back filled with few hundred gallons. Their offerings have become so popular that they've started restricting the program to local residents.

Figure [17]: Recycled wastewater for lawn watering ...

Figure [18]: ... is given away for free and people haul it back to their yards in giant tanks on their trucks.

It never ceases to amaze me how people completely change their behaviour and mutate to environmentalists, just because they're not given a choice. Even our carwash place is now closed on Wednesdays, to conserve water. Some people cut so far back on their water usage that this led to downright absurdities, like the water supply companies raising their prices (up to 30%) because due to concerted conservation efforts, they're not selling enough water to cover their cost. Now, we all put our hopes on the forcasted El Nino winter, which is supposed to bring the desired rain.

Figure [19]: Scandal: Actor Tom Selleck allegedly stole water to irrigate his lawn.

Recently, news broke that the actor Tom Selleck, well-known for his lead role in the 80ies TV series "Magnum", had become entangled in an irrigation scandal. The Callegues Municipal Water District found it curious that a privately owned water truck had been heading to a public water hydrant several times a week, to syphon off a full tank of water and drive it the actor's property. They hired a private investigator for a whopping $20,000 and found out that Magnum used the water to irrigate his vast lot of greenery. And that while his neighbors dutyfully rationed their water to comply with state mandates, and were forced to look at their own dried brown turf in disdain! The water district sued Magnum, but both parties reached a settlement out of court, where Magnum paid the cost for the private investigator back, plus an undisclosed amount in damages.

Top Product: Rold Gold Pretzels

Figure [20]: The classic Rold Gold Pretzel snack.

Michael Agreed, a bag of salty pretzels isn't exactly a gourmet snack, which would justify paying more for a respectable brand, but what I find really fascinating about the Rold Gold pretzels is the classic 1950ies design of the bag, which almost looks like it came straight from an episode of "Mad Men". These pretzels are bigger and thinner than those manufactured by other brands and you can easily eat a whole plate of them while washing them down with a glas of beer. While doing that, I like to imagine how a middle class family man plops down on the couch after work, turns on the black-and-white TV to "I Love Lucy" and starts dropping pretzels into his open mouth. Angelika finds this behavior unacceptable, which is why I can only do it when I'm by myself.

Figure [21]: A few pretzels along with a glass of beer: Priceless.

According to the imprint on the bag, the brand has been around since 1917, but no longer belongs to the original owner "American Cone and Pretzel Company", as it got acquired by the gigantic Frito Lay corporation. And don't believe that it says "America's No. 1 Pretzel" either, because the pretzel market leader Snyder's of Hanover is selling more of them.

Back in 2010, the press was tight-lipped about which brand of pretzel George W. Bush choked on, in the incident that became known because he subsequently fell unconcious, face-planted against the wooden floor of his sun deck, to explain to astonished news people the next day where the big wound on his temple came from.

Tools made in USA

Figure [22]: A Ridgid pipe wrench, made in USA.

Michael Which hobby handyman doesn't take pride in his tool collection! Ever since I was a young kid, I've been collecting the highest quality tools, even when they could only be obtained at an exorbitant price. For example, in my toolbag, there's two pairs of piers that are about 30 years old, made by the famous German toolmaker Bernstein, which I personally purchased back in the day at the Bürklin store in the Schillerstraße in downtown Munich, and I vividly remember how I cringed because they were really expensive back then. Or take the screwdriver set made in Germany by Wiha, which I bought in Germany last year when we visited the old country again. They are really fun to work with and feel fantastic, they really make my day when I set out to repair anything that needs maintenance.

If you inspect the shelves of a typical big box home improvement store these days, regardless whether in Germany or in the United States, you'll mostly find tools manufactured in China. That's not necessarily a bad thing, as every hobby handyman can find excellent quality tools there, just remember to stay away from the 1-Dollar bins. The smaller hardware stores, however, for example "Ace Hardware", often carry more traditional tools made in the USA. I can't help it, but I'm really drawn to their opulent design. It's sometimes a bit overly sturdy and almost klutzy, but I love the retro look and feel. There's a certain clientele here in the United States who would never buy anything that's not made in the USA, and they're often leaving vitriolic comments on Amazon's product review pages, driving home the point that a certain tool that used to be manufactured in the U.S. is now being assembled in China, which allegedly led to shoddy quality that doesn't measure up to the tool they tried to replae after owning it for 30 years without problems.

Figure [23]: A traditional punch manufactured by Osborne, made in USA.

I love the bold design of these traditional made-in-the-USA tools, which seems to have been unaffected all the progress in modern toolmaking since the 1950ies. Some of them are pretty heavy-handed because the manufacturing companies are still using ancient materials like cast iron, but I like they way they look and how the feel in my hand. I spent a whopping $50 on the bodacious "Ridgid" pipe wrench (Figure 22), but I've got to admit that for practical reasons, I didn't go for the cast iron version and chose the aluminum make instead, although even the lighter version still feels like it could easily withstand a nuclear strike. Or take the revolving punch made by Osborne (Abbildung 23). The design could easily date back to Wild West times, but even nowadays, no honest shoemaker or leather craftsman would settle for anything less solid.

Figure [24]: A carpenter's hammer made by Craftsman.

Interestingly, hammers sold in the US are typically carpenter's hammers, featuring a claw on one end to help removing nails, although I don't think I've ever in my life removed a nail with a hammer claw. The "Craftsman" brand is sold at "Sears" retail stores, which is the most disastrous American chain and I'd shop there only if there was absolutely no other way, like if all other stores had been overrun by zombies and I was in desperate need of a hammer.

Let me tell you, I've ordered items at Sears' website, but when I then followed the directions in the confirmation email to pick up my stuff at the nearest store, it turned out that no one there knew where my order was. It wouldn't surprise me at all if their terrible business went bankrupt soon. Regardless, the hammer in Figure 24 with its 1950ies style walnut handle is a timeless beauty, and most likely, I bought it not from Sears, but at a completely different chain store, Ace Hardware. They feature many small franchise stores all across America, and sometimes they can be found even in remote villages. Their staff is always knowledgable and eager to help. And they even sell single screws at 10 Cents! I'm telling you, we've got to support these Ace stores, because if they're gone one day and all that's left are the "Home Depot" and "Lowes" big box hardware stores, there's going to be a rude awakening with much moaning and tearing of clothes. Make sure to frequent them for your hardware needs, and even if you need a more expensive item, give them your business even if it's a few dollars more. You'll save gas and time driving to the nearest suburban big box store anyway.

Thank you - Uh huh

Figure [25]: "Uh-Huh", an astonishingly versatile sound.

Michael How do you respond if someone is expressing gratitude by saying "Thank you"? It's probably one of the first things Germans learn in English class, that under no circumstances they may reply by using the literal translation of the German "bitte" ("please"). Instead, valid responses include "you're welcome", "sure", or "no problem".

But we're not in English class here, rather you have the pleasure of being instructed by some of the most experienced foreign language connoisseurs on the American continent, and today we're telling you what Americans say when they want to be informal in this context: "Uh huh". The phrase is most commonly used in situations where one party says "thank you" for a common courtesy like a door being held open, where "you're welcome" would be too much and sound almost silly.

Sometimes people pronounce it almost like "a-ha!" or more subtly as "mmh-hm", both variations are friendly acknowledgements. On the other hand, if the pitch goes down towards the end, and it almost sounds like "uh-oh", then it's meant sarcastically. A single "Huh?" on the other end is a rather sloppy way of telling someone that what he's saying doesn't make any sense. Without the question mark and without the corresponding rising pitch at the end, "Huh" expresses mild astonishment, as in "Who would have thought?". Strictly speaking, none of these expressions will go well if you're in a job interview with the company owner who's wearing his pants pulled up all the way to his chest. In these situations, you'd be advised to resort to traditional idioms to avoid being reprimanded.

Michael leaving Yahoo, joining Apple

Figure [26]: Now in the fruit business: Michael.

Michael And, finally, a story on internal matters: After working at Yahoo for more than ten years, I was confronted with the decision whether to wait for the golden watch and retire, but at hardly thirty-five years of age (heh heh), that seemed to be premature. So, I pulled myself together to start another breathtaking carreer, and, as a matter of fact, to make a giant dent in the universe! I struck a deal with the famous mobile phone and laptop manufacturer, and instead of taking the company shuttle to Sunnyvale every morning, my stop is now called Coppertino or something like that.

Greetings from your mystery mongers:

Angelika & Michael

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Latest update: 27-Nov-2015