1st Place – Bobby the Ferret; Demi Mozian, HRPS/CRIS/ISP
2nd – Gwendolyn the Roach; Anonymous
3rd – JoJo the Yorkie; Lisa Baker, MSD/CHCMS/TMG
4th – Spencer & Kodi the Dogs; Jennifer Vassallo, MSD/CHCMS
5th – Kona the Pembroke Welsh Corgi; Joel Aufrecht, HRPS/CTS/ASMG
6th – Tucco the Wheaten Terrier; Yanira Rosado, OCFO/PICG
7th – Maddie the Boxer; Lucy M. Polk, SHRP/CEFSP/WFG
8th – Leica the Dog; Sharon Glick, HRPS/CRIS/MIB
9th – Maia and Electra the Bengals; Kim Bauhs, HRPS/USAJOBS
10th – Chance and Leo the Dogs; Willette Kinsler, HRPS/CRIS/RESG/RBB

I think fifth is respectable, especially given the evidence of ballot stuffing. Nothing like Afghanistan or the US, but I did see a fat wad of singles in Bobby's cup on the second day of voting. Rumor has it the cockroach was submitted by the accounting department. I'm providing you two different jokes from that starting point and you can read the one you like better. A: given how our new accounting system is going in FY'10, the roach is a pretty good mascot for that department; or, B: so where exactly did Accounting get the cash to buy second place for a cockroach?

In terms of actual dollars, I think first place went for something like $60, and I was told Kona got around $40, which means other people voted at least 27 times for her. I have the fifth-cutest pet at OPM.

Here is the story of how I changed insurance companies as part of changing jobs, and how that affected my ongoing quest for medical car for my broken clavicle, and what it is like to get health care from Kaiser Mid-Atlantic.

As an independent contractor in California, I didn't have very many choices for health insurance; I went with Anthem Blue Cross high-deductible and paid about $100/month including dental. This is for coverage with a $3500 deductible, meaning that I pay the first $3,500 in medical expenses per year. There's a strong economic argument that you shouldn't get insurance for anything where the worst-case scenario wouldn't bankrupt you, because the insurance companies, like the casinos, know the odds much better than you do, and over the course of your lifetime you'll come out behind paying monthly premiums instead of a few multi-thousand-dollar payments. Like most economic arguments, it gets very complicated in health care.

I followed that logic to get the high-deductible plan that essentially only protects me from getting bankrupted if I'm in a major medical emergency. But even if you could afford to pay a million out of pocket, you should still have health insurance, because it gets you access to the negotiated rate, which is often half of the list price. Not that you can find the list price for anything medical before you buy, but that's another digression.

After six months they increased my premium from about $90 to about $160 per month, and I think also upped the dental rates. I called to ask why they increased my rates, and the lady said that my six-month introductory period was over and they were allowed to raise the rate.

"Okay, you're allowed to raise the rate, but why did you?"

"Your introductory period was over."

"I understand that you were no longer prevented from raising the rate, but why ... did I age into a new bracket, or otherwise change categories, or become a bigger risk?"

"No, nothing changed, but your introductory period was over."

Two things I regret failing to ask: was there a law preventing them from raising rates in the first six months, or was it just a trick to get new customers? And was there anything preventing them from raising my new rate right away, and if not, why hadn't they raised it to, say, $300 or $1000?

Anyway. In the end I got the last laugh because I paid less than a year of premiums and got tens of thousands of dollars of care, thanks to getting hit by a car, but I'm going to write about the medical/financial side of that incident separately. Today I want to talk about Kaiser.

Oh, and the other piece of background you should know is that, by the last visit with my surgeon, I was pretty sure I wanted to get some physical therapy because my shoulder, while much improved compared to "broken", was not quite right yet. This is no doubt to be expected with a surgically repaired clavicle, but I wanted to see what I could do, with help, to get those last few percent of function back. But the wait to see a therapist was several weeks, and my moving date to DC was several weeks in the future, so I put it off.

Federal employees get a choice of health insurance provider, from a list of maybe as many as ten. Blue Cross is on the list; I decided to go with Kaiser. I've always had a PPO before, not an HMO, so I thought it would be interesting to see the difference. Kaiser on the West Coast is generally well-regarded and is often cited as a model for how to both contain costs and provide good service. I heard less flattering things about Kaiser Mid-Atlantic, but figured what the heck, I can change it later.

I filled out my health insurance form during my first pay period, since I was told that it wouldn't be effective until partway into the first pay period after the one in which I submitted the form, carefully walking it over to the person on the second floor who actually processes the forms. Then nothing happened for almost a month. Then I got email telling me my login information for eOPF, the electronic access to my personal personnel file. One of the recent documents in that file said something about Kaiser, so I called Kaiser directly. They said I had been covered since my third week, and had had a Kaiser account since my fifth week, and would be getting something in my mail, and yes, they could give me my Kaiser account number over the phone so I could start booking appointments.

So I made an appointment to see my Primary Care Physician (PCP), conveniently located almost directly on a line between work and office, and 39 days after starting my new job, saw a doctor. He agreed that I should see a physical therapist, so I got a referral and then made an appointment for that. Two weeks later, 53 days after starting my new job and ten weeks after being cleared by my surgeon for resuming general activities, I finally saw a physical therapist.

Who told me that the only thing my PCP had written was "joint pain", and that she couldn't take my word for what my surgeon had said, and that without a note in the system from the PCP saying that I was okay for therapy and what the limits where, she couldn't do anything other than a preliminary evaluation; she couldn't do any therapy with me or recommend any exercises. We spent about an hour going, not in circles, but in perhaps a spiral, and she did ultimately listen to my description of what had happened and what the surgeon had said, and suggested that I try swimming as probably the best possible immediately therapy for the shoulder.

I also have been having some problems with my finger, the left index finger. At first I thought it had to do with the knuckle, which along with several others was scraped bloody—always wear gloves that cover the complete hand, not cool, comfortable ones that leave the last joint uncovered, that's another lesson I've learned from this— but was the only one to permanently scar. The scar hurts if I bend the joint all the way, but it turns out that the muscles or ligaments anchoring the finger are also damaged in their own right. I found this out when I tried to open the door of a 1993 Miata. The door handle of this model is a canonical style of the triumph of style over function; the modern term for this is FAIL.

The opening (affordance, in usability lingo) is so small that you have to pull it open with one finger. But the force required is the same as for any car door, and do you make a habit of opening your car door with one finger? I made the mistake of opening this door with my left index finger, and it briefly felt like I'd torn the finger off. This is when I learned that all was not right with that finger. The door, by the way, can be safely opened with one finger if you are slow and careful and use a healthy finger. But Miata eventually figured out that "barely possible to do without injury" is not the same as "fun", and this is the newer Miata door handle:

So I raised the issue of the finger, along with a few other aches and pains that seemed related to the crash, and the therapist said that each appointment could only deal with one body area.

So. Now what? She suggested I transfer my records from Stanford Hospital into Kaiser, and also that I see an orthopedic surgeon within the Kaiser network. So I did all of that—of course, I couldn't just make an appointment with the surgeon, and she couldn't give me a referral, she could just suggest to my primary care physician that he give me a referral. A mere ten days later (six working days, and let me just mention that most Kaiser services are only available during regular nine to five hours, which means I was taking time off work for each and every visit) the doctor agreed and provided the referral, and two days later, I was seeing the orthopedist. Which was a very cursory visit during which I learned nothing, but did get the x-rays taken which you see in this post. My clavicle looks the same as in August, which I guess is good since in August it looked joined.

Once the bone grows together, there is still a multi-month process of recalcification or crystalization or one kind of bone replacing another etc etc, so it's not done, but it's basically together and fully, if gingerly, weight-bearing. And it's still at an angle compared to the normal side, sticking up a bit and stretching the skin at the top of my shoulder. But the best news was that I could go see the physical therapist again and get some actual therapy. (I did try to go to the public pool near my apartment; more on that later.)

Long story short, I had a very productive first real visit with the physical therapist. A different one, since mine is vacationing in Thailand. We did a number of exercises that amount to strengthening and stretching the shoulder muscles, and I got some giant blue and red rubber bands to use, and a recommendation to find a gym with a hand-cycle.

So, all done, just had to stop by the medical records department to pick up the inch-thick stack of Stanford paperwork I'd dropped off the previous week, and then to Radiology to get copies of those new X-rays, about which I'd heard nothing and therefore assumed, and as of this writing continue to assume, indicate no special problems.

Those records I'd dropped off the week before, when the woman at the counter had looked at me like a crazy person when I said I wanted the papers back, and then I said, okay, fine, I'll go make copies, and she said, no, it's okay, leave them here and you can pick them up tomorrow, and I said, okay? Today's lady behind the counter said they were all at central processing and I couldn't have them back.

"So are they going to be destroyed?"

"They're at central processing. They'll be added to your records."

"I understand that. What will happen to that inch-thick stack of paper once it's added to my records?"

"Oh, I guess it'll be destroyed. But it'll be in our records."

... So I can then either fill out your form and get your printouts of your scans of my copies of my lawyer's copies, or I can get fresh copies from my lawyer, or I can fill out Stanford's form and get those copies again. Whatever.

So off to Radiology.

"Yes, we have your X-rays in our system."

"Great, so can you burn me a cd or something?"

"We have them in the system. You don't need a CD because your doctor is in the system and he can see them."

"Great, but I would like a copy for myself."

"Are you going out of system? We can make you a copy if you are going to see a doctor out of system, but you can't just have copies for your *personal use*." (said disdainfully)

At this point the locus of the conversation shifts from the lady behind the counter to the somewhat more smiley guy who's been listening in behind her.

"So if you were going to Georgetown University hospital you could get a copy," he says, helpfully.

"So if I tell you right now that I'm going to go to Georgetown, you'll give me a copy, but not if I say that I just want a copy myself."

"That's right."

"I'm going to Georgetown tomorrow. Could I please have a copy?"

"Sure. It'll just take a minute; have a seat."

He and I are grinning at each other; the lady has a disgusted expression. And that's how I got the pictures that you see in this post.

So, from the time I thought I might want physical therapy to the time I had my first real appointment was about three months, because I was moving and changing jobs, and because of delays built into the HMO system, and because of capacity limitations. I moved all of my records between systems myself, in some cases physically carrying copies of papers to the records desks; it's possible I could have done the same thing by mailing some forms around, but the last time I waited for Stanford to respond to requests for records it took about four weeks. I had to lie to get copies of my own medical images. And I had a $30 co-pay for each and every visit, so I had to pay for the three pointless meetings whose only purpose was to prevent me from stealing physical therapy services that I might not have actually needed (and prevent me from suing Kaiser for prescribing therapy that I wasn't physically ready for). In other words I paid an extra $90 in addition to my regular payments and my employer's contributions to do things that were only in Kaiser's interest, not my own.

Explain to me again how having the government run health care will result in a burdensome system with rationing of care and some bureaucrats coming between me and my doctor? 'Cause I'm afraid that particular scare isn't very powerful any more.

We have an "Open Season" in a few weeks, when we can change our insurance. I am of course leaning strongly towards leaving Kaiser, held back only by the headaches involved in starting over and interrupting what might turn into useful physical therapy, and by a sense of duty to you, my dear readers, that if I go to a better system, I might have fewer stories to tell you.

So I'm a fed now.

I work in the Automated Systems Management Group (ASMG) of the Center for Talent Services (CTS) in the Human Resources Products and Services (HRPS) division of the Office of Personnel Management (OPM), which is an independent agency in the Executive Branch of the US government; our Director reports to President Obama, although I have the impression that he has to be very nice to Peter Orszag, the Director of the Office of Management and Budget (OMB). I started on August 31, 2009, after coming through the Presidential Management Fellowship selection process. I talked to many agencies during the job fair and followup process, and ASMG seemed to present the best chance to do what I wanted to do in government: find some little corner of the machine in which I could make things better and have fun doing so.

The Automated Systems Management Group manages one automated system, USA Staffing. USA Staffing is an automated hiring system that other agencies in the Federal government (and some state and local) pay for to help them post job vacancies, receive applications, administer online questionnaires, and make selections. It has roughly a quarter share of its market, competing with companies such as Monster Government Solutions and Avue, among others. USAS, or any of its competitors, provides half of an automated hiring system. The other half is USAJOBS, which is a website with almost all of the civilian job postings for the Federal government. USAJOBS was the other Automated System in ASMG's name, I think, but it got outsourced to Monster a few years ago.

So ASMG, together with its partner group Technical Services Group in Macon, Georgia, is essentially a small software company within the government. Because it sells its services to the rest of the government (a form of transfer pricing) via a "revolving fund", it has more budgetary flexibility than other agencies or other parts of OPM. And so that's where I've landed: an unexpected little corner of the Office of Personnel Management, which I doubt I'd ever heard of before starting my Fellowship application. (The OPM administers the PMF; in fact, ASMG shares an office with the people who run PMF.)

And, two months in, I have to say I'm pretty happy. I found exactly what I was looking for and what I was led to expect. I like my co-workers, and things are functioning well enough that I'm part of a success, but not so well that I can't help make things better. Within our own group, we have plenty of expertise in federal hiring but not much in professional software development and product management. And in OPM and the federal government hiring process, things are not all roses.

Some thinly researched institutional History

OPM used to be the Civil Service Commission. The Civil Service Commission in turn draws its roots from the 1881 assassination of President Garfield by disgruntled job-seeker Charles J. Guiteau. In consequence, the entire federal hiring process was reformed, replacing the spoils system with merit hiring.

For most of its history (I think; I don't really know how it worked in the early 20th century), the Civil Service Commission performed the essential HR functions of the federal government. In the '80s and '90s, most of the hiring was delegated to the various agencies, but without funding, knowledge, or institutional support to do hiring well. OPM, which shrank roughly in half from its peak size, now serves primarily to support the rest of the government in doing hiring, rather than to actually do the hiring. There are a lot of problems with the current federal hiring process; here are two reports:

MSPB Report: What's wrong with federal hiring?

• The hiring process is too long and complicated (average 102 days between making request to fill a position and filling it)
• The assessment methods used are poor predictors of performance.
• There are too many bad exceptions to the merit-based system.
• Background investigations block hiring and take forever

• get better qualification standards: multiple hurdle approach (use progressively more expensive tests to shrink the applicant pool)
• spend more time and money on better assessment tools
• several recommendations that amount to "do better"
• train HR staff better
• simplify the laws and rules

Factoid:

[I]n 2002, 1.8 million people applied for 55,000 screener positions at the Transportation Security Administration. Only about 340,000 met the minimum qualifications for the position and only 100,000 were rated as fully qualified.

Most jobs have a one-year probationary period during which it's much easier to fire people. Less than 2% of probationary employees are fired in their first year.

[A] study found that selecting officials often feel they know who would be the best person for an internal job promotion before they announce the vacancy. And they select that person 80 percent of the time.... The cost of applying this competitive process—when selecting officials already have a good idea of whom they will promote—was about $102 million in 2000, just in supervisory expenditures. This does not include the costs of administrative tasks performed by the HR staff.

PACE: good predictor, ruled illegally discriminatory in 1979 by Luevano judgement. Written ACWA test: introduced in 1990 as replacement for PACE. Pretty good, and better than the post-Luevano hacks. But the Form C, derived from ACWA, leaves out too much and is not good. Other authorities created so address Luevano, including Outstanding Scholar and Bilingual/Bicultural Hiring Authorities, are lousy at predictive performance and lousy at increasing dirversity.

Many agencies have used technology to automate poorly designed processes, so that they are slightly faster and cheaper at hiring bad candidates.

MSPB Report: A Review of Federal Vacancy Announcements

The conclusion is that federal vacancy announcements are not very good. Too long, written to fulfill requirements and rules rather than to attract and inform applicants. Why? The HR staff writing them aren't sufficiently trained, experienced, supported, or competent. Every job application has to have two pages of explanation of veterans preference and other narrowly targeted programs. And USAJOBS has similar problems, in that it's not designed for the user.

I was born in Los Angeles, grew up in Alaska, and spent most of my adult life either on the West Coast or in other countries. I don't have much experience with the South. My understanding is that some parts are very nice. I saw an extremely lovely Gorge in Tennessee.

I've had occasion to spend some time in Macon, Georgia, lately, because it hosts the technical counterpart to my office here in DC. I think that has some historical roots in the nearby Air Force Base, Warner Robbins. Which, in turn, might have something to do with this:

Or not. In any event, while many parts of the south may be extremely charming, I regret that the parts of Macon that I have been exposed to have not fully demonstrated said charm.

Although, even this human landscape has its moments:

I'm going to Macon roughly once a month for the foreseeable future; that currently comprises a trip to Reagan airport, a flight to Atlanta, a rental car, and a bit of a drive. One of these days I might rent a car here in DC and take Kona with me, stopping once or twice along the way to see something beautiful, maybe on the coast. Meanwhile, if you have recommendations for Macon or its surroundings, please share.