A Critical Look at Comprehensive Member Standby (CMS)

All topics about cryopreservation costs, membership dues, etc.
Aschwin.de.Wolf
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A Critical Look at Comprehensive Member Standby (CMS)

Post by Aschwin.de.Wolf » Tue Feb 28, 2012 4:22 pm

I had promised to write a separate post about Comprehensive Member Standby (CMS).

Here is Alcor's page about CMS, which includes rationale and costs:

http://www.alcor.org/BecomeMember/standby.html

As much as I can sympathize with the quality-of-care reasoning behind CMS I have a number of objections pertaining to the idea itself, and how it is structured in particular.

1. Mandatory bundling of standby and cryopreservation requires an increase of cryopreservation minimums. The result is that a lot of Alcor members were pushed into 'underfunded' status as a consequence. In this case, Alcor's underfunding problem is partly of its own making.

2. The associated annual CMS dues contribute to higher total annual dues - which has become one of the reasons some Alcor members had to terminate their membership. In fact, Alcor members who have a hard time increasing their life insurance and/or paying annual CMS dues, have the most to lose.

3. The CMS is almost completely insensitive to age, location, health status and life style. As a consequence, there is little financial incentive to bring down the costs associated with your own standby and stabilization.

For example, a person who lives around the corner of Alcor and has made meticulous plans for his/her cryopreservation is required to have the same CMS allocation and pay annual CMS dues as a person in Canada who may need extensive technical and legal interventions.

4. The kind of risk pooling that CMS does will invariably lead to determinations about what kind of standby care should be offered and withheld. You can already see an example of this here:
http://www.alcor.org/BecomeMember/stand ... imitations

Members may be allowed to complement these services but this makes the whole thing even more complicated to the average Alcor member.

5. CMS provides a disincentive for self-help standby and local capabilities. People have less of an incentive to invest in robust personal and local standby arrangements when they are already paying Alcor for this. It will be really hard for a local standby group to collect dues for developing and retaining capabilities. CMS is a threat to grassroots standby efforts.

6. The combination of mandatory standby and CMS excludes Alcor members contracting with other cryonics organizations for standby and stabilization services, or at least makes this difficult, cumbersome and expensive.

7. Although CMS is limited to the US and Canada, national standby remains an (unrealistic?) ambitious objective. There have been a number of periods in Alcor's existence where national (and even local) standby capabilities were poor, if non-existent. In fact, Alcor currently outsources most of its standby case work to Suspended Animation, Inc., which may be either an example of good judgement or necessity.

8. Unlike the PCT, there is not an (independent) committee that oversees and evaluates the quality of standby care on a regular basis. I do not see a powerful mechanism for cost control in CMS.

9. CMS eliminates the possibility of complete pre-payment for Alcor's services. Even members who are vastly over-funded (such as myself), or who have provided Alcor with a generous pre-paid amount, are not exempt from annual CMS dues.

10. CMS raises complex ethical questions. One can agree that standby and stabilization is an essential part of cryonics services without making it mandatory. This is especially important for (potential) Alcor members who can barely afford cryopreservation but not the additional costs associated with CMS.

Since I cannot be sure that the Alcor Board and Management will be persuaded by the idea of making (national) standby and stabilization services optional again I want to end with some constructive recommendations:

1. Do not terminate Alcor membership or impose underfunding dues on members who are only underfunded for standby and stabilization services and who can pay regular annual dues.

2. A realistic floor for Alcor services is cryopreservation and local standby. This service should be provided to all members and funded by regular annual dues.

3. Introduce an incentive in the program that rewards members for being pro-active about their own cryopreservation. The only thing right now that comes even remotely close is the $5,000 for relocation assistance.

4. Allow people with excess funding by a certain amount to opt out of the annual CMS dues.

5. Form an independent standby committee that monitors the collection and allocation of CMS dues and the quality of care of standby and stabilization at Alcor.

TDK
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Re: A Critical Look at Comprehensive Member Standby (CMS)

Post by TDK » Tue Feb 28, 2012 5:14 pm

Aschwin.de.Wolf wrote: 4. Allow people with excess funding by a certain amount to opt out of the annual CMS dues.
That would be a really easy way to address a variety of issues.

Alcor would know in advance, that if they cryopreserve a specific member,
utilizing standby, etc, Alcor will get an additional $100,000 or $50,000,
above and beyond the base cryopreservation cost. So there is no need
to charge that member additional membership or CMS fees, since those
fees could be rolled into the larger payment they will be providing to Alcor.

This would address my concern about older members not being able to
keep up with rising yearly fees, rising CMS costs, etc. If that person has
greatly overfunded life-insurance, they might even have that policy paid
off by the time they are elderly. But Alcor would still be assured, that if
they properly cryopreserve that member, regardless of their mental or
financial state, Alcor will still get a large amount of money for their trouble.

The other main benefit to this method, is keeping the costs simple,
and transparent. I know when I first found out about Alcor, I was
thinking that all I would be paying, was my life insurance premiums.
I wasn't initially aware Alcor had yearly dues. And then I was made
aware of the CMS costs and fees. At the time, provided by credit card.
Then the dues went up. So eventually it made me feel like the overall
cost of being an Alcor member was much higher than I initially thought
it would be.

If *everything* Alcor does, was all rolled into the cost of
the cryopreservations, then it would be one single monthly fee.
For life insurance. Monthly fees are also much lower than yearly fees,
so I think the whole package would be much more appealing,
and much more honest. Charge future members $200k for
neuro suspension. And have no Alcor dues, no CMS fees, etc.
Just one price, that includes all of those things.

paulwakfer

Re: A Critical Look at Comprehensive Member Standby (CMS)

Post by paulwakfer » Wed Feb 29, 2012 2:03 pm

Aschwin.de.Wolf wrote: As much as I can sympathize with the quality-of-care reasoning behind CMS I have a number of objections pertaining to the idea itself, and how it is structured in particular.
I and Kitty strongly support Aschwin's analysis and proposed solutions. Most particularly his following point would go a long way toward enabling us to remain Alcor members.
Aschwin.de.Wolf wrote:1. Do not terminate Alcor membership or impose underfunding dues on members who are only underfunded for standby and stabilization services and who can pay regular annual dues.
However even the remaining dues are still far too high because Alcor is not running nearly as lean and efficiently as it could - not nearly as lean and efficiently and lacking in non-essentials as I and Kitty run our own lives. We have no desire to fund the inefficiency and non-essentials of others when we cannot afford these for ourselves. We have asked for detailed breakdown of expenses by project and received almost nothing which would enable us to even make suggestions on practical cost cutting measures for Alcor operations. Until Alcor begins full divisional and project accounting for all their expenses, making all of this available to members, any analysis and rectification of these costs is impossible.

Aschwin.de.Wolf
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Location: Portland, OR
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Re: A Critical Look at Comprehensive Member Standby (CMS)

Post by Aschwin.de.Wolf » Thu Mar 01, 2012 9:37 pm

paulwakfer wrote: However even the remaining dues are still far too high because Alcor is not running nearly as lean and efficiently as it could - not nearly as lean and efficiently and lacking in non-essentials as I and Kitty run our own lives. We have no desire to fund the inefficiency and non-essentials of others when we cannot afford these for ourselves. We have asked for detailed breakdown of expenses by project and received almost nothing which would enable us to even make suggestions on practical cost cutting measures for Alcor operations. Until Alcor begins full divisional and project accounting for all their expenses, making all of this available to members, any analysis and rectification of these costs is impossible.
Yes, I agree with this (and you are not the first to point this out). Dues need to go down by further streamlining Alcor.

Eliminating waste and inefficiency is also important to recruit and retain competent employees. If there is too much inefficiency in an organization, the most capable people will leave. This produces a downward spiral from which it is difficult to recover.

One of the biggest problems I have seen in cryonics is a tendency to compare the state of affairs against points in the past or other cryonics organizations. Since cryonics generally lacks the discipline that comes with operating in a competitive market, the value of this comparison is quite limited. There is a need for independent, common sense, benchmarks.

One of the frustrating aspects of cryonics is that one of the most effective responses to (perceived) waste and incompetence - terminating membership - also hurts the person who wants cryonics arrangements. I do not have good suggestions how to resolve this issue except for better member scrutiny of Alcor's operations and for Alcor to offer as much (financial) choice and flexibility for members as possible.

BTW, I concur that it would be desirable to eliminate the 'admin' profile on the Alcor news blog so that staff members can write in person about their projects and objectives.

In the early 2000s Alcor provided weekly updates ('This Week at Alcor') from individual staff members about their projects and progress. I think that was a great feature and it also gave valuable insights in the operations and priorities of the organization. When Charles Platt started Alcor News the updates were quite timely, too:
http://www.alcor.org/Library/html/alcornewsarchive.html

southbay

Re: A Critical Look at Comprehensive Member Standby (CMS)

Post by southbay » Fri Mar 02, 2012 1:34 am

The problem with CMS can be summed up much more simply. CMS (the annual fee tack-on) is term insurance. You pay money each year, and if you need standby, it pays for it.

Now I could explain all the reasons why it's a lousy insurance buy -- all the reasons cited above, inability to choose your provider or negotiate the terms, premiums the same no matter what your circumstances -- but the basic reality is that it's insurance, and Alcor should not be selling insurance.

Let insurance companies sell insurance. Alcor can help me figure out what a standby should cost based on my circumstances. I can either increase my whole-life coverage to provide for my standby expenses, or I could buy term life insurance if I prefer that method.

If my CMS cost is low, I should not buy insurance at all. Insurance is, after all, never a good buy. Insurance is there to cover risks that you can't afford to bear, like hour house burning down, or hitting somebody with your car. For events that you can afford, and that you know the probability of them happening, that's what savings and investments are for.

You may or may not agree about the value of insurance for non-catastropic events. That's actually not the point. The point is it should be your choice.

paulwakfer

Re: A Critical Look at Comprehensive Member Standby (CMS)

Post by paulwakfer » Fri Mar 02, 2012 5:49 pm

southbay wrote:The problem with CMS can be summed up much more simply. CMS (the annual fee tack-on) is term insurance.
This would only be the correct view if there were no additional CMS fee as part of the minimum funding. As it is the CMS part of the minimum funding pays for the per patient immediate costs of CMS and the yearly fee pays for the readiness of the CMS team to do its job prior to and at the time of legal death. This is entirely similar to a portion of the dues going towards the readiness of the cryopreservation facility to do the cryoprotective perfusion and cooldown at the time of receipt of a patient.

I have always argued against all such "readiness" fees on the same justification that McDonald's does not charge you a yearly fee just so that they will be ready to serve you a hamburger when you enter one of their stores! Rather they include a prorated portion of that readiness cost in the price of each product which they sell.

Now that Alcor is doing a reasonable number of cryopreservations each year, it is time to include all readiness costs within the charges for the entire cryopreservation procedure.
southbay wrote:Now I could explain all the reasons why it's a lousy insurance buy -- all the reasons cited above, inability to choose your provider or negotiate the terms, premiums the same no matter what your circumstances -- but the basic reality is that it's insurance, and Alcor should not be selling insurance.
Except for legal reasons, I disagree that "Alcor should not be selling insurance", since the entire nature of its business is related to the statistics of mortality.
southbay wrote:Alcor can help me figure out what a standby should cost based on my circumstances.
That is simply not possible in advance.
southbay wrote:If my CMS cost is low, I should not buy insurance at all. Insurance is, after all, never a good buy. Insurance is there to cover risks that you can't afford to bear, like hour house burning down, or hitting somebody with your car. For events that you can afford, and that you know the probability of them happening, that's what savings and investments are for.

You may or may not agree about the value of insurance for non-catastropic events. That's actually not the point. The point is it should be your choice.
It is always a delight to find someone who thinks about insurance somewhat as I do (and which is why I totally reject medical insurance). But even more than only for "catastrophic" purposes, insurance is only reasonable as pooled risk for those harmful events which are highly unlikely to happen to an individual within hir lifetime! - of which clearly legal death is not one such.

bwowk
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Re: A Critical Look at Comprehensive Member Standby (CMS)

Post by bwowk » Fri Mar 02, 2012 8:07 pm

The problem with making standby optional is that almost no one will do it. We have ample precedent for that in the low standby rates of the 1990s and early 200s when most Alcor cryopreservations were performed on members who suffered cardiac arrest unattended by any cryonics personnel. Asking a dying person or their family to come up with approximately $50K cash while dealing with all the other issues that accompany serious illness or end-of-life isn't realistic, or some would say even humane.

Whether the CMS Fund that pays for all standbys needs to continue collecting CMS fees from everyone annually, or whether CMS fees could be reduced or eliminated by a larger allocation of cryopreservation minimums to CMS, is a separate question. It's a good question, and one that warrants some serious consideration. If the problem of underfunded cryopreservations can be fixed so that allocated minimums are actually what flows into the CMS Fund for each case (instead of coming up $100K short last year), there will be more room to consider this.

The point that people who take personal steps to reduce logistical difficulties in their standbys is also well-taken.

Kaminsky
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Re: A Critical Look at Comprehensive Member Standby (CMS)

Post by Kaminsky » Mon Mar 05, 2012 12:43 pm

When I signed up, the thought was that one reason to over-fund one's suspension was to pay for standby. I understand that this was changed when Alcor realized that not every standby resulted in a suspension. Then it changed to the suggestion of doing a pre-authorization on a member's credit card to be charged only in the case of these "unmatched" standbys (this didn't fly long because of numerous logistical problems). I wonder how many standbys result in suspensions, and how many are "walkaways"?

southbay

Re: A Critical Look at Comprehensive Member Standby (CMS)

Post by southbay » Mon Mar 05, 2012 2:11 pm

If a standby does not result in a suspension, and the member has ordered one, either personally, or through a standing order to do one if they are not competent to order one, then you call bill the member for the costs up to whatever cap they put on it. (If costs exceed the cap, that's because ALCOR was mistaken that death was assured enough to justify that.)

If the member won't pay for a standby they ordered (and survived) that could jeapordize their future suspension as they would go into it with a debt. Of course, family opposed to suspension might be fine with that, even work towards that.

The total cost of standby, though, seems out of control for those are are not ready to buy a gold plated service. Consider a member with 40 years of expected lifespan. At $15/month and 6% interest, that has a future value of around $30,000. In addition $25,000 of their $80K neuro would go to the standby pool. That's $55,000 (in 40 years) just for standby.

Overall, for a 40 year expected lifespan and a $66/month annual fee, the cost of suspension in 40 years is $132,000 in monthly fees and $80,000 in insurance payout.

Compare that to when I joined when it was $60,000 in monthly fees and $41,000 in insurance payout.

The problem, as indicated before, is that the high shift to fees is effectively a lock-in. Fees paid are lost. If you switch to another cryonics org, that money is gone even though your old org performed no service for you other than existing. Insurance premiums on the other hand are retained by you, and if you switch to another firm (or decide not to do Cryonics, or you get your aging reversed in a lucky world) the insurance policy moves with you.

bwowk
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Re: A Critical Look at Comprehensive Member Standby (CMS)

Post by bwowk » Mon Mar 05, 2012 4:10 pm

Some very good points have been made in this thread. The board is discussing them.

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