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Can Technology Fix the Health Care System?
I was surfing through my usual tech sites for the latest news when I came across an article on Wired News. It turns out Steve Case is not alone in the quest to fix the health care system. I guess I don't get what the big attraction for these guys are.... I know the US's health care system is messed up, but I'm not sure technology can fix all of the aches, pains and dysfunction in our current system. I don't get why they don't just join a major company's board or start a hip/trendy start-up....
The biggest impediment to a great health care system is, and will always be, regulation. Regulation comes from one monster: the State.
The US had the greatest healthcare system in the world. Then the U.S. Federal State decided to start destroying it, piece by piece, through regulation. After the HMO Act of 1973, healthcare quickly degraded. Instead of removing the regulations, the State decided to make new ones, creating more aggressive monopoly powers (see: AMA), making costs go up (by providing tax relief for corporations and not individuals), and then tossing new entitlements into the system (medicare, medicaid, VA, etc) that made everyone's prices go up.
What's the old adage about insurance? Invite all your friends to dinner, and most will have burgers instead of steak. Agree to split the bill equally, and a few will order steak, but pay less for their share. Eventually, everyone will want steak, and they'll wonder why no one can afford dinner. It is no different with State-forced health care, and State-regulated healthcare.
To fix healthcare, start by dumping your AMA doctors. Ask your doctor if they are affiliated with the AMA, and if they are, walk. Find a great AAPS doctor, and pay them cash (they are MUCH cheaper paying cash than most deductibles with insurance). Start saving a nice nest egg, and then start increasing your deductible as high as you can -- $10,000 or more once your nest egg gets there. Insurance is for detrimental emergencies, not to check out that cough or find out why your nose is running.
Then, lose weight. Watch your carbs (starches and sugars). You'll have little need likely for doctors once you are healthy.
Finally, go the self-employment route. It works, once you have a big savings account, a high deductible, and are truly healthy because you're not another fat American. By being self employed, you can walk away from the monstrosity that is called "employer-sponsored health care." What a farce.
It isn't the market that made healthcare bad, it isn't corruption or greed -- it is your very government, trying to fix mistakes that the State of past generations has slowly caused. Don't spew garbage about the U.K. either, I have a few ex-patriate friends living there who has mentioned how terrible it is.
Links to good info:
Lowering the Cost of Health Care, Dr. Ron Paul
Free Market Medicine, Dr. Ron Paul
Subsidizing Sickness, Llewellyn Rockwell
Please mod me down.
-1, Troll
Thanks!
A Slashdot troll
But I'd suggest that proper application of game theory is key. Making a system that is hard to manipulate (i.e."game") is a very challenging problem, and frankly, I find it a lot more interesting one than the submitter seems to.
Anyone else think Stevie Case would do a good job, too?
I guess that all depends on if a robot masseuse can give you a massage with a happy ending.
HMOs are another part of a bigger issue.......everyone thinks they MUST live on forever and have EVERY miracle cure for everything. Same reason pharmaceutical companies can get away with charging insane amounts of money for the latest miracle drugs, even though they LIE THRU THEIR TEETH about the cost of R&D.
If you took the current medical system and had the government spent 10x as much on it prices would rise around 10 times. That's because doctors who want to work are all working, getting paid very well, and more money will just make them have to raise their prices or, if their prices were fixed, result in a shortage of available time slots for patients. The fix is is to make health care more efficient by not requiring someone who had to go to 8 years of college to give you a refill on your antibiotics, etc. There are serious medical cases that need expert attention but the vast majority of health care problems suck up the efforts of lots of highly trained accountants, overseers, inspectors, lawyers, claims adjusters and health professionals when the transaction could be so much simpler if they'd just trust people to have a bit more personal responsibility over their own health and not try to make sure that every single step of their treatment is authorized and approved by a limited pool of highly skilled professionals who are much better employed elsewhere.
The article contains numerous errors in regards to # of uninsured, % of Americans uninsured, and the pricetag of the US healthcare system.
It seems to me that the problem is expectations. If we set the bar lower, say providing 2001's level of capability, the costs for care would go down. Standard behavior with any product - cost of production for the original item goes down as time goes on (and patents expire, etc).
However, whenever new technology in healthcare is unveiled, everyone expects that it should be available (new treatments, drugs, etc). Healthcare costs more now because more of it is available. There has to be a balance, and right now it is tilting towards more care for more cost.
So your solution is to fix humans?
Yes, I suppose humans are greedy (although I'm not sure relative to what). You can't change that. "Technology" (which, in the general sense, includes things like laws and law enforcement, locks, etc) keeps it in check. Some places have more room for improvement than others. Healthcare, in my opinion, being one of them.
I'm sorry you are sick, but it seems like you are not helping by simply blaming human nature and suggesting it is unsolvable.
Don't be bitter, but what can we do about it? One set of legislators is just as likely to write the rules in their favor as the next set. How can we possibly opt to stop giving them money when tax collection is automated and we have no direct control over their spending?
the NPG electrode was replaced with carbon blac
... and a strong believe in suvival of the fittest. Look to Europe: Afordable, reasonable healthcare for everyone is not a dream. Many countries have it. For example in Swizerland everybody has health-insurance, you cannot be without it, whether you have money or not.
However it is not possible with a free market, since that will charge customers whatever they still can pay and will let those that cannot pay die or live with problems that could be fixed. At the same time, hugely expensive treatments will be available for those that have the money and single wealthy individuals will be saved instead of hundreds without money. Face it: Despite its lip service to christian values, the US is one of the coldest, inhumane countries on this planet, were cristian values are preached but not practised at all. Instead there is this believe that the market can fix anything. It cannot were infrastructure questions like education, public transportation, healthcare, etc. are concerned, since all of these need a really long-term perspective and the will to make thinks work well instead of turning a profit.
Most ACs are not even worth the keystrokes to insult them. Be generically insulted by this and ignored otherwise.
A collar that shocks it's wearer every time they try to stuff a Big Mac, Twinkee, Slurpee or Hoagie down their gullet.
Anything human beings can do with a bureaucracy, computers can do lots faster and more accurately. Thanks to data mining techniques pioneered in the last few years, expert systems can even find efficiencies and improve themselvs.
So to me, the answer is yes. What is wrong with our health care system is that it is a human run, for-profit bureaucracy. Replace that with a computer run, single payer system and you will realize billions of dollars in immediate resource allocation savings- dollars which can then be used to feed back into the system and used to provide health care to more people.
That, and I trust a computer more than I trust a politician any day.
SJW: a person who perceives an injustice, and while correcting it, commits a greater injustice.
If tech is the answer, the initial attempts aren't going so well:2 9244
http://it.slashdot.org/article.pl?sid=07/04/27/12
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"You are not remembered for doing what is expected of you." - Atul Chitnis
I mean, come on. People just want a pill to fix their woes. How many times have you met someone that you know have a condition that can be easily fixed through diet and exercise alone?
Besides cancers and other similar conditions, most problems facing the health care industry are caused by lack of exercise and eating the wrong kinds of food, and its a hard thing for people to change. And generally health care professionals are afraid to give definitive health advice because of the opportunity of lawsuits. How many times have doctors told patients that they should "reduce" instead of "eliminate" or "substitute" some offending substance?
There tons of evidence that most medications (some help) have horrendous side effects and yet people continue taking them as if there's no tomorrow. I think that no matter what doctors, tech, or the government does, its gonna take a sea change for Americans to wake up and smell the coffee and start taking their own health in their hands.
Newsfollow.com
Technology doesn't "fix" anything by itself.
I Heart Sorting Networks
Huh? I don't get it. How is technology going to fix anything? Sure, it's true that there are inefficiencies in the system, like being asked for your health history over and over, as described in the article, but you're not going to wring any major change out of this dysfunctional system just by digitizing people's health histories.
Technology is part of the problem. Technology costs money, and part of the problem with the US system is that it encourages people to spend inappropriately large amounts of money.
The fundamental problem is that it's a positive feedback system that's doing what positive feedback systems always do: wig out exponentially. If you really want to see something scary, look at an itemized hospital bill that includes the costs of things like bandages. The bandages cost 10 or 100 times more than they would at the drugstore. The reason they cost so much is that insurance companies are willing to pay it. Why are insurance companies willing to pay it? Because everything else is ridiculously expensive too, and anyway the insurance companies can raise their rates to cover it. Once the insurance companies raise their rates, the health-industrial complex smells money, and raises their prices.
If you like government regulation, one very simple, sensible thing to do would be for the government to penalize people who are affluent, but have a low deductible compared to their income. If my annual income is $150,000, then they should use tax incentives to browbeat me into not buying insurance that has a deductible any lower than, say, $40,000/year. That would make me treat all these expenditures like real money, not like other people's money. All of a sudden I'd be complaining bitterly about the overpriced bandages. When a nurse pulled out one of the hospital's bandages, I'd say, "No no no-- wait, don't open that! My wife went and got some bandages from CVS. Here, use one of these."
Find free books.
Technology cannot. The system is broken from the implementation. I wish I had the reference material with me, but as explained in this TTC Course on Economics the American system is set up to charge too much for services. The professor of those lectures recommends the German system over all other popular systems for being most efficient and manageable. He also suggests that the Canadian system is broken (which I use) but it is not currently as badly broken as the US system.
Technology is not a solution for all problems. In this case, the underlying system and procedures are flawed, and technology will not fix those problems.
Try to hack my 31337 firewall!
Sure it can fix healthcare! Just look what it's done for the FAA, Bureau of Indian Affairs, the Russian submarine K-141 Kursk, and the myriad of undisclosed technology related disasters to pick from.
We don't have this right yet. Perhaps somewhere else, but definately not in the US. I just left a project where IBM had their weasels walking the halls and inviting executives to the golf course in an effort to grab a sale versus a really good product that specialized in the area my client was purchasing for. We need about another 30 years in this country before anything but specialized systems are applied against healthcare.
Hell, fix the transportation system first and replace cars with PRT's and you'll eliminate a good percent of the hospital visits in the first place.
You are checking your backups, aren't you?
I was in the emergency room for a few hours because I got suddenly very sick after a tooth extraction to the point that I was going to die. They ran a bunch of tests and gave me a saline iv and then sent me home shivering with a 102 fever.
So I got the bill a few weeks later. It was astronomical. Luckily the insurance covered it but it was of course filled up with all kinds of obscure bizarre codes that only insurance billers know anything about. What I'd like to see is some auditor look very closely at how the money flows around the medical system and find the $3000 toilet seats that I'm sure are lurking somewhere in their. I wouldn't be surprised if there were a few dirty HMOs that were taking kickbacks from hospitals for over-billing. Hospital over-billing would also be a perfect way to launder money I'm sure because everybody expects the costs to be unreasonable.
I think the best course of action would be for hospitals to sell their own insurance. Having the HMO and the hospital separate creates all kinds of incentives for fraud and over-billing not to mention many different sets of books to take care of.
I've certainly heard this conspiracy theory before. The only problem is that if it were true, lifespans would have been longer 100 years ago, when medical technology barely existed and health care was certainly not big business. But of course this was not the case; people used to die young from diseases that are now easily treatable by health care professionals.
- Overhead. Doctors need to hire transcriptionists and billing clerks to do work that could be largely automated. (Our product addresses this).
- Ease-of-use. Most of the EHRs on the market require an office to switch to a very low patient load for a very long training period. This makes migration to a product intended to improve communications and efficiency into an extremely expensive and cumbersome proposition. (Our product addresses this).
- Lack of communications (or standardized records formats). There are *some* standards (HL7 is what we use for integration with 3rd-party scheduling and billing systems where possible), but nothing widely accepted and comprehensive enough to be able to give a patient a flash drive with their complete medical history in a format any doctor's EHR product will understand. Worse, a lot of systems won't integrate with anything else without requiring the customer to fork out serious $$$ for the add-on functionality. (As just one small vendor, there's not so much we can do about this right now)
There are a bunch of other benefits that EHR vendors try to sell folks on -- automatic warnings about allergies, ability to guide the physician towards checking for symptoms that could indicate a serious problem, etc etc etc; I'm coming at this from the back-office geek point of view, though, so I really have no idea how significant these are in the grander scheme of things.Is adding more expensive IT products magic fairy dust that'll make healthcare cheap? Of course not. But technology that's well-thought-out, well-implemented and sanely priced certainly can help to make healthcare less expensive -- and putting records in a portable format benefits everyone.
(That said, there's a lot of poorly-implemented technology in healthcare... but that's a topic for a different, much more anonymous forum).
My friend and I just had a conversation about this last night. The fundamental problem is that your health is my responsibility, no matter what.
Let's say we went to a world where only private doctors existed and no one accepted insurance. The rich will be able to afford most care (although they're pretty much dead if they need something big like an organ transplant). With insurance so expensive these days, this isn't too far off from reality today.
Now, pretend that you're poor, and you come down with melanoma, despite your best attempt to avoid the sun. You can't afford care, so you wait until the last minute to get care at the ER. By then, your disease is probably advanced and much more expensive to treat, and the ER can't turn your away legally.
The ER charges you some really high price that you can't pay. They repossesses your car and foreclose on your home so you can pay for it. Maybe you can find a lawyer to declare bankruptcy. Meanwhile, the ER is still waiting for their payment, and the doctors have to be paid to pay off their student loans. So what do they do? They charge the rich people more to offset the cost.
Now you're now homeless, without a car to get to work, unemployed, and you're still in debt. Where do you go? Perhaps you turn to a life of crime and end up in prison. You definitely end up on welfare and Medicaid, probably living in a homeless shelter that is likely funded by tax-payer money.
This isn't some theoretical story. It happens to people all the time.
So, all of you who are terrified of having your tax dollars pay for "socialized health care," you're really missing the point. You're paying for it already. You're paying it in your hospital bills as cost shifting. You're paying for it via Medicare and Medicaid. You're paying for it in the prison system (which is the new mental health system). You're paying for it in terms of treating STDs by county clinics and through federally-qualified health centers.
Socialized health care is inevitable because it's already here, albeit in a horribly disorganized and inefficient state. If we kept everyone healthy, the cost of health care would drop for everyone. The question is, how can we do that while balancing quality care?
The VA has an electronic health record that is winning awards from Harvard:s p
http://www.eweek.com/article2/0,1895,1988099,00.a
The US medical system is definitely sick. US citizens spend drastically more on medical care than other countries. If you are poor you cannot get decent medical help. If you are a visiting tourist and you get sick then you are in for bills that will make your eyes water.
... The list is far too long, guys - you come below Ireland in the Human Development Index. It's about time to pull your socks up America.
If you are in a job it HAS to pay medical insurance. People are terrified, not so much of losing their jobs, but losing their medical cover. (Yes, I do know that ruling a frightened people is much, much easier).
Why?
It isn't true in the UK, or Australia, or Europe. So it doesn't HAVE to be so.
But then the USA is one of the most unbalanced countries on Earth. By unbalanced, I mean the rich-poor gap is horrendous. Here we have the richest country in the world, and yet it has large numbers of poor illiterates, sick and dying. It is very, very sad.
I think it is amazing how the USA has gone from being perhaps the most admired country on the planet - say after the 2nd world war, to one of the least admired - say now - in barely a single generation. Quite an achievement.
I think it's time the USA started doing things that the world could admire, instead of steadfastly serving its own interests. In the medium to long term, being greedy and acting like a spoilt, petulant child tends to result in nobody liking you.
What could they (you) do?
* clean up your own backyard
* Institute a decent national medical system. Increase taxes to pay for it. Kill off the medical insurance companies, push back the tide of wealth in the medical profession
* Fix the schools. Put money into the system (gosh, there's tax again) especially in the poor areas. You NEED those scientists and business folk who drive you economy - and if they don't get a decent education because they were born poor, black, Hispanic, Muslim, female (or any of the other sins of America), you won't get them
* stop messing up the world. Stop starting wars (USA has started more than any other country since the 2nd world war ended). Try to do some good - but not with soldiers
* start doing thing that need to be done. How about really, really investing in sensible power generation (and stop giving tax breaks to oil and coal companies - maybe that would save you some of the tax). Do some decent research. Put some people on the moon. Make the world proud! You've done it before - do it again
Mind you, a good start would be just stop driving those horrible little trucks (called truck so they can break their own rules on fuel consumption - I mean really, guys).
Sweden is a far easier country to admire. Finland
And getting a fair and equitable medical industry would be a good start.
"Cats like plain crisps"
The money doesn't go towards $3000 toilet seats. It goes towards $3000 worth of treatment given to an uninsured person, as the hospital is required by law to do. They make up for unfunded charity care by sticking it to anyone who has good insurance.
I worked in a hospital for 9 years in the IT department. Trust me when I say that technology was NOT the impediment, but nurses and doctors who refused to use the technology. Instead of thinking about the positive uses (checking drug interactions, streamlining data collection, improved imaging times), the mere idea of "technology" was shunned by these supposedly-educated professionals.
I will never work in a hospital ever again. It was too painful the first time around. I understand that not all users are going to be computer proficient, but to have a user BRAG how little they know about computers, and they will be retiring in a few years, so they will just drag their heals...
Guh!
If ever there was a time to justify beating something with an ethernet patch cord, that was the time.
Fix the people and you fix the single largest impediment in any system.
Bearded Dragon
The insurance industry is the reason the healthcare system is so screwed up.
First, theyre greedy as all gtfo. Medical insurance rates have skyrocketed to the point even large corporations can't afford group rates, let alone individuals affording individual rates, and the boards which are supposed to be regulating them are sitting on their hands and taking kickbacks.
Second, they're greedy as all gtfo. The function of insurance (just like the lending industry), is to spread risk among many people. Except they don't actually ACCEPT anyone who has the slightest physical malfunction. I have crohn's disease, a mild case which can be remedied by periodic medication, but i can't get arrested, let alone get an individual policy.
Third, they don't have a standardized/centralized claim process, meaning extra beurocratic costs on medical offices. Some estimates are that as high as 30% of medical costs can be attributed to the beurocratic mess that is insurance red tape.
Finally, their prolonged presence has resulted in inflation of medical costs in the same way legal mandation of auto insurance has inflated auto repair costs.
Socialized healthcare would fix this problem if implemented properly, and more importantly would bring proper medical and dental care to the over 40 million and growing americans who can't get it right now.
Yes other nations have their problems with it, and that gives US better perspective to make a better system than theirs.
And for those who will cry "oh no i will not take more taxes", you won't have the monthly payments into insurance. It would balance out.
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For the US healthcare system, technology has a huge role to play in improving things. Lots of low-hanging fruit, and an important mission given the state of things:
- Efficiency. The inefficiency of paper is pretty obvious. Nuff said.
- Record portability. Again, an obvious win to anyone who has been referred to see specialists and must complete a separate history for *each one*. Truly ridiculous.
- Reduced error in prescriptions. Many people get multiple prescriptions from different doctors who aren't fully aware of everything the patient is getting. And sometimes these combinations are dangerous.
- Datamining. This is the really really big one. And it's not about marketing to patients. It's about being able to learn from all that data out there that is currently locked up in paper and kept in separate silos (not shared between organizations).
The Commonwealth Club had a recent talk given by George Halvorson, CEO of Kaiser Foundation Health Plan and Hospitals. It includes a lot on how Kaiser is trying to improve their healthcare system using technology. Here is the podcast , worth a listen if this topic interests you.
One take-away I did get from Mr. Halvorson is that healthcare in the US won't be saved by technology, but the data tells us what would save it. The majority of costs come from just a few chronic illnesses, including heart-disease and diabetes (but not cancer, which is only 5% surprisingly). These diseases are largely preventable, but it will require widespread behaviour change in America: diet and exercise, I hate to say.
I hate Europe as much as the next guy, but the fact remains that Eruoscum pay less per capita for their nationalized health care systems, and they are on average healthier and longer-lived than Americans, even when you correct for factors like lifestyle and the odd campus shooting spree.
Just suck it up, Slashbots, nationalized health care is superior.
libertarianism is nothing but a code word for selfishness, dressed up in political signals and philosphical portents. but if you dress up a cheap whore in a fine dress, she's still a cheap whore. so it is with libertarians and anyone who spouts that nonsense
i put it this way: human nature is both altruistic and selfish. any political philosophy you present to the world has to address both sides of this coin, or you have built a political philosophy which is a nonstarter in the real world, because it doesn't jive with the nature of the humans you are attempting to impose it on
we all understand why communism doesn't work: it depends upon altruism, and doesn't address human selfishness. in a communist system, selfishness still exists, in the human beings in the system, but unaddressed by the system imposed upon them, and so selfishness eats communism apart from the inside
if you will, if a whole country suddenly went libertarian, you'd have the exact same problems as a communist country, in reverse along the axis of human selfishness-altruism. it would fail. as miserably and as surely as communism did. for the same reasons, in mirror image reverse
libertarianism appeals to earnest but naive college students with too many philosophy books under their belt, but without any real life experience, who build castles in the sky in their minds about how the world should or would or could work if people just started behaving in ways people have never behaved in any culture or time period since the dawn of mankind
it also appeals to rural folk, who don't understand how they fit into the larger world, and firmly believe themselves to be islands completely owing nothing to anyone else. what they are of course is coccooned within a larger country and system upon which the relative peace and quiet of their worlds depend. but it is hard to see that from the hinterlands until madness marches across the countryside, which it does, unfortunately, in societies that have abandoned the simple common human responsibility we have to take care of each other
and it appeals to 40 something selfish assholes behind on their alimony payments, corrupt and personally bankrupt about any give and take in their lives. nothing more needs to be said of such people. we understand them, and we understand why libertarianism appeals to them on a deep level
libertarianism is a gem of modern foolishness, and you are a glorious fool if you swallow the pap called libertarianism
intellectual property law is philosophically incoherent. it is your moral duty to ignore it or sabotage it
..did this "journal" post make it to the front page of Slashdot? Looking at the day's posts, apparently there's no a damn thing interesting happening in the world of "geeks".
And yes, I agree, our national health care system (hah) is non-existent and needs addressing. And there are plenty of discussions to be had among reasonable and intelligent people. But this post isn't the prod for that kind of conversation. It's half a thought, and literally ends on an ellipsis.
I think the article states some good points. I like the idea of using technology to help the elderly maintain their medication more reliably.
However, I think one of the biggest pitfalls is the constant battle between the practitioners and insurance companies. Practitioners realize they only get paid for 10% of their procedures, so they charge 10x as much. Insurance companies refuse to pay even in cut and dry cases, causing rates to soar. All this lands on the patient's lap as a big bill.
Kaiser Permanente really has the right idea. Expensive, yes, but arguably worth it. Service is prompt and predictable, and when you need real work done, it costs next to nothing. Preventative medicine is where it's at. If they can take this to the next level and start providing proactive health advice for patients at risk for certain diseases, healthcare companies can avoid paying huge costs for big procedures.
While Mr. Grove's suggestions are not terrible, they are attacking problems that are ancillary to the efficient operation of the health care system as a whole.
The biggest problems in the US healthcare systems are of access and funding. Not everyone can afford access to basic healthcare, and those that can are - generally - paying too much for it. The first contention is sufficiently obvious that I won't bother supporting it. The second should be pretty clear if we look at the profits generated by health insurance companies. (All those profits? They come from our premiums.)
Private insurance has - oddly - a much higher administrative cost per healthcare dollar than public payors such as Medicaid. Strange but true. And the majority of US heatlhcare dollars are flowing through these inefficient private payors. Of course, when I say inefficient I mean inefficient for the patients... they are excellently efficient at enhancing shareholder value.
We spend enough to have very good healthcare for every person in the US, but the way we pay for it is not well adapted to that goal. More home care, retail healthcare outlets, and a unified EHR may be beneficial, but they will not solve this structural economic problem.
With reasonable men I will reason; with humane men I will plead; but to tyrants I will give no quarter. -- William Lloyd
(( "Iron Ships" "Wooden Men" )) is a nice Google query. Every time you want to think of yourself as say "genetically superior" to poor savages, the gut reaction is however "but the poor savages are healthy as horses, due to selection pressure". I remember reading in some Australian digression on Aborigines "Don't bother hitting a blackfella with your fist, he won't even feel it". The 45ACP was invented, because although a 38 was good enough for shooting white people, it would not reliably put a savage down. Musashi style, we must (( "research this deeply" ))
The most significant problem with modern Western health care is not the technology per se, it's the inappropriate use of it. It's all too tempting for doctors to order more and more sophisticated tests whereas, in reality, "take an aspirin and see me in the morning" would do. It's great to have access to the latest, expensive, whiz-bang technology; but it the majority of cases it isn't appropriate, nor needed. There's a similar story for antibiotics - use these prophylactically and you eliminate the odd 0.1% infection rate (until the bugs become resistant). Either our doctors need to cool it with the technology a little, or the population as a whole has to realize that it some want to stay alive for a little longer, it's going to cost everyone very dearly.
The other problem with our health care system is that there are too many costly administrators. But that's another story.
it's the inflation and beurocratic burden that is private insurance. This is the same thing that happened with auto repair.
So yeah. remove greedy insurance companies, socialize healthcare, profit.
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Seriously, if you were going to try to fix the health system, would you try to do it without use of technology?
Without I/T systems and infrastructure, obviously any new system you implement to replace the older, obviously inefficient systems would be paper based.
While paper based methods are necessary for some systems (see George W. Bush, US Elections for clarification), I cannot see that being applicable to health care.
I am government man, come from the government. The government has sent me. -- G.I.R.
I didn't see much talk of tech, but I can tell you this: The more crap there is between me and you (the sick guy) the less time I get to think about how best to care for you and then actually do it.
I once worked in a hopsital where each item used in patient care was accounted for by a large electronic cabinet. A nurse has to login, use a password, unlock the drawer, and retrieve the item. Then they have to go to a barcode scanner and scan the item, pull the barcode sticker off, and put it in a ledger book. Medications are accessd this way as well. Before these systems came out, if we needed an item, we would simply enter a room, and pull it off a shelf. If we needed a med, we'd walk up to a cabinet, and unlock it! I guess back in the good old days, someone had a *job* accounting for the supplies we used. Is this progress?
Not when you need a shot of Narcan STAT because your lungs are shutting down....
"Haste makes waste", let's not forget
You got it right. The doctors have established what amounts to a state-sponsored cartel that prevents anyone from practicing medicine who isn't a member of their cartel, even well-trained people like nurses or patients themselves who may be much better in tune with their health than they're given credit for.
Oddly enough, one part of the "health care" system that's ignored is the war on drugs. I include it since its ostensible mission is the public health goal of preventing addiction and substance abuse. The DEA alone spends $2.5 billion (up from $1 billion from 1995!); add in the total expenditures of all state and local drug enforcement efforts and you have probably something on the order of $40 billion spent on an effort that obviously doesn't work well if at all.
$40 billion in spending would go a long way towards dealing with some of the skyrocketing costs.
And Amen again... apparently people don't realize how much cheaper healthcare would be if the government would just leave healthcare professionals alone and let a free market run it's course.
If you had any idea how much money the healthcare industry had to spend on being 'compliant' with all the government's rules and regulations, you'd be bitching about how much the "government" was making you pay for your healthcare, and not the doctors.
But hey, at least it creates lots of jobs for accountants, right?
The fix is not technology - it is to extract government as the middleman and favor dispenser and put it back in the hands of the free market. Technology won't improve government health care any more than it "helped" build German census machines. It only takes you where you are going more quickly.
Why is it people acknowledge that socialism is bad as a whole but fool themselves into thinking it's OK if approached in small increments? I'll concede, I've never understood that.
Government regulations and meddling created the problem. What we need is a sliding scale system and allowing medical institutions to be tax-exempt.
Tens of millions of people in america alone suffer from depression, and while it's attributed to a certain chemical imbalance, it might just be that "imbalance" gives them greater propensity to see through bullsh*t that's spoon fed to them by their manipulators. (for a good example see the telco's net neutrality ad campaign or bill oreilly).
So they have antidepressants, which are basically soma, because if you don't choose suicide you have to medicate away the realization you live in a very real dystopia.
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Sure, there are theoretically ways that these systems could be fixed, but in practice that would be very difficult to do.
Why? The people who have the positions and power to make the changes are benefitting from how the status quo, so why would they really want a change?
Healthcare workers get huge salaries, http://swz.salary.com/salarywizard/layouthtmls/swz l_compresult_national_HC07000007.html Anesthetist Nurse:$130k+, etc etc.
There is no motivation from within the healthcare sector to fix the problem. Any moves from outside to do so will get lobbied to death pretty soon.
Engineering is the art of compromise.
ah, the peachy kean usa of a hundred years past, where racism was considered common sense, monopolistic robber barons controlled industry with pinkerton's men and bully clubs, and a war was started with spain to grab territory
clearly, the founding father's dream, right?
ever hear of a fancy word called "progress"?
libertarianism has nothing to do with what the founding fathers were getting at. the founding fathers were getting at liberty and freedom... freedom from things like disease and lives shortened by infirmary. things a little socialized medicine will fix. what will you lose? some money from your paycheck? you'd prefer to have people die in the streets? if a guy falls down and breaks his arm, do you walk by him and ignore him? no, you take care of him. here's a fancy phrase for you from the founding fathers, who you obviouslly adore, and SHOULD adore: "life, liberty, and the pursuit of happiness." hey genius. what's that first word in there?
LIFE
the fact is, i am more in tune with what the founding fathers wanted than you are
intellectual property law is philosophically incoherent. it is your moral duty to ignore it or sabotage it
Now many people reading what I just said are probably thinking, "That's inhuman." These are people's lives, not cars. Well, I'm sorry but this is exactly why health care costs are spiraling out of control. Just like the United States being a debtor nation because people cannot say, "No."
I worked in health care as an analyst and application developer for 3 years. For one: it's a nightmare to use technology to do anything because the systems are hugely complicated and entangled in an enormous amount of rules, regulations, qualifications, exceptions, and so on. For two: we have all the statistical information necessary to classify diseases and injuries by cost and come up with a budget that says, "We can treat that, but the cost is too great given the statistical occurrence of the problem, so we can not treat you."
The outcry against that would be tremendous. But I can tell you for a fact that this is exactly what happens on a battlefield. Any battlefield: a corporate takeover, war between nations, etc. People make brutal choices that have a huge negative impact on peoples' lives all the time. A company buys another because it is expedient and then they let go of 50% of the workers. We don't like that, but we accept it.
But if someone says to most people, "I'm sorry but we cannot treat 30% of these problems. We have the money on hand in the short-term, but in the long-term it will break the system for all of us." People are not altruistic. People will not accept the fact that they have cancer and are going to die because the treatment is available but too statistically expensive. People will not accept the fact that they need some expensive heart surgery because they have been pouring fat and sugar into their bodies for years and now it's time for someone to pay for that abuse.
Many people don't take responsibility for themselves, because we don't have a system that requires it. We put people in prison and relieve them of the responsibility of food and shelter and making adult ethical choices. We provide expensive treatments for people that need emergency treatment because an emergency has occurred as a result of years of abusing themselves. And so on.
We're not going to fix a damn thing until we get better at saying, "No" in the short-term when it is absolutely necessary for a sustainable long-term. And that's true in all aspects of society. Health care, the environment, economics, education, whatever. It's all the same single cause. Most people can't make personal short-term sacrifices for long-term gain. Debtor nation. The one's that can, don't spend much time talking about these things because it goes nowhere. They can't solve other people's problems. People need to take responsibility for themselves or the few that already do have to carry everyone else.
yes, it is, as long as mclarens and bentleys sell.
0.02% of the world's population hordes 70% of it's wealth. As long as people like the waltons and ted turner are able to squirrel away billions of dollars (with a friggin B) which would otherwise be useful for the rest of the population.. you know.. as actual wages rather than accounts in the cayman's, i will be defending the provision of "a few bed-ridden months at the end of life", because to deny the elderly care while others who make a much smaller fraction tie up more resources which they don't even use is about as immoral as it gets.
It's one thing to allow people to become independently wealthy, and even set their future generations up for life, but to allow the obscenity that is sitting on more assets than many nations have while denying the elderly the right to live is over the top.
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I've spoken with people who worked on large-scale projects to create IT systems that would monitor patients, gather statistics for datamining (to improve the treatments and learn new correlations), and even automatically suggest diagnoses and drugs (with references and reasons for the suggestions) to help doctors save time. I know two separate groups who tried similar projects. Both projects failed for the same reason: Doctors did not want their actions to be logged. Doctors want the freedom to skirt protocols when they feel it is appropriate, without worry of repercussions from insurance and / or drug companies. If their actions are logged, then doctors would lose all their power, and that power would be completely transferred to whoever writes the protocols. There was also quite a lot of resistance from the doctors who didn't want to deal with a PDA or whatever while working, but that was a less significant problem.
Music speeds up when you yawn, but does not change pitch.
This is /.... When you ask to be modded down, you get modded up. Maybe the mods think you need some mental health care?
If you mod me down, I *will* introduce you to my sister!
I used to tell a very conservative friend, that if you create two areas, one which is liberal and has social programs and the other that is conservative and independent, people would choose to live in the first. We'd also have all the woman, which would be a nice addition.
The problems with healthcare, IMHO, really reflect a capitalistic, market oriented economy. We have excellent healthcare in terms of keeping us alive when we're nearly dead, but little that makes the time we're here better. most of those things really do involve choice, but our choices are pretty much limited to options which are profitable. Small, incremental, sustainable choices inevitably fall into the appendix. You can bet that the prescription options have been supplied by their friendly, blond representative as well.
I'm a pragmatist. try both options, and see what works. We're spending a trillion bucks on a war, and can't supply a free college education or healthcare to everyone? These are things that benefit everybody, as a strong economy really does raise all boats. How many people, like my conservative friend, miss the Clinton years? Trickle down is for kinky sex.
Umm, you're making it sound impossible to have decent health care that covers the basics. Most industrialized countries have done that, except the US, without resorting your "inhuman" suggestions.
My cholitis reduces the nutrients i take in.. i HAVE to eat that big mac to get normal fat levels you insensitive clod!
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I didn't read clear to the end here, so it may have come up, but I would like to hear from citizens of Canada, the UK, and others about how they feel their countrys' health care systems are doing. I don't want to pre-suppose their answers, but I seem to remember that at least some Canadians and Brits aren't exactly happy with wait times and quality of care with socialized medicine.
How about a moderation of -1 pedantic.
this medical system's on a fast track to the it list, blast back kudos all around!
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With modern science and technology, there are marginally effective treatments which can cost millions of $$ in resources. In a socialistic system, of course everyone thinks that regardless of their individual situation, the cost of treatment should be irrelevant if it has any chance of working. If we're all "equal," how can the state reserve such expensive treatments to only a few? The result is either a bankrupt system (when such treatments are made available to all), or one where new treatments cannot advance to achieve economies of refinement and scale (when such treatments are witheld from all).
It's all a form of the well known quote:Where does the concept that "healthcare is a right" come from? When, except for very recent times, has a person been able to demand healthcare (walk into an emergency room) without any ability to pay for it?
"National Security is the chief cause of national insecurity." - Celine's First Law
... Eventually, technology will replace all humans with artificial intelligences.
it's not important to cower in fear of it
that seems to be a problem of yours currently
there's healthy intelligent distrust, then there is rabid pathological distrust
intellectual property law is philosophically incoherent. it is your moral duty to ignore it or sabotage it
What do you make of all the countries where health care is cheaper but there is MORE government regulation than the United States? How about those national health care plans that spend less per person than the United States?
I agree. The poor are unfortunate and I'd like to help them. But I don't want to do it with my own money if I can help it. Now, if there was some way I could force others to do something, we'd all be in great shape. They'd have clear consciences for giving the money, and I'd feel great for having helped too.
Can you be Even More Awesome?!
Yes, if you mean making the consumer more price sensitive.
Information side:
In the US health care providers should be forced to publish prices for all medical procedures 1 month in advance on a central website for each state. Right now consumers can't shop around.
Personal side:
Tax all health care benifits, and maybe put tax breaks on high deductable plans. The consumer will see the cash leaving their wallet and be more apt to look up information.
bash-2.04$
bash-2.04$yes "Don't you hate dialup connections?"| write USERNAME
were it not for the existence of a large number of people who don't want to help anyone at all
you present a false choice: force people to help the poor, or do it themselves
the real choice is to have a bureaucratic inefficient machine helping the poor, or a tiny band of good people helping the poor
the big inefficient monolith actually does more good. it's simply a matter of size, no matter how valiant the tiny band of charitable souls are
it's an unfortunate shame that so many are so selfish and unhelpful and uncharitable, but you need to take the existence of such people into account in your worldview, because they do exist
intellectual property law is philosophically incoherent. it is your moral duty to ignore it or sabotage it
The whole notion of viewing the healthcare as a market is brain dead.
Healthcare can only function in the hands of the government.
Pay high takes and get good health care. Don't let the corporations greed the cream from the healthcare system for some spurious shareholders.
This is not a case for bad management. it is certainly possible to manage hospitals efficiently and effectively using sound business principles.. Efficiency and effectiveness most certainly does not require private ownership, as many places of Western Europe will attest.
US health care is by far from the best in the world. Hate to say it, but Cuba has a lower infant mortality rate than the US.
(happy may 1 everybody!)
t goes towards $3000 worth of treatment given to an uninsured person, as the hospital is required by law to do.
Amen! Amen! I was wondering when someone was going to get around to posting the truth about how the insured pay for the services that are rendered to the uninsured. Health care organizations "give away" a certain percentage of their services to uninsured or under-insured patients every year. The fancy hospitals in the suburbs that generate a healthy profit are being used to support the hospitals that serve the inner-city population.
i would reply that the world isn't hopeless
and btw: fuck ayn rand, queen of fools
intellectual property law is philosophically incoherent. it is your moral duty to ignore it or sabotage it
I volunteer once or twice a year at my local hospitals. Many of the other volunteers are billing / admin employees from these respective hospitals. There were several times where we held a charity auction, and rich folks come by and bid $60,000 on a bottle of wine or something like that.
Windows computer terminals with a very straightforward tallying application are set up for us to record all final auction wins and purchases. It required 3 simple steps - enter the item number, the bidder's auction ID number, and the bid amount. These people who worked in the hospital - the ones who deal with data entry and accounting and whatnot on a daily basis - took 60 minutes of frustratingly painful training before _starting_ to understand the trivially simple application. I've worked in other hospitals before and have also seen a girth of not-so-bright individuals working the billing / admin sectors of health care.
I've heard that up to 20% of overhead in health care costs comes from inefficient billing methods (due to the practice of hiring the aforementioned people) and lack of data integration with insurance companies. Maybe fixing this along with hiring better people would go a long way in reducing costs.
There are a huge number of yeast infections in this county. Probably because we're downriver from the bread factory.
From the article:
Case declined to provide specifics about the health care ventures he intends to pursue. He said 90 percent of health care expenditures go to treat sick patients while only 10 percent are earmarked for keeping people well. His comments, and early investments, suggest that he will focus on the wellness business.
What the hell does this even mean?
There is no shortage of healthcare business models that involve extracting money from people who aren't sick. The problem is in transferring that money to actual health care, which gets more complicated when middlemen like Steve Case, not to mention the for-profit HMOs and for-profit pharmaceutical companies and the doctors from the AMA (world's most powerful trade union) start wanting their cut. Trust the former chairman of AOL, architect of the disastrous Time Warner/AOL merger to reform health care? Bring the same brilliant technological innovations to health care that AOL brought to the Internet? Pah!
but like most difficult problems in life, the choice is between two infringements on your liberty: taxes, or the infirmary of your community
the bite taxes take out is easy to see and quantify and immediate in effect
a community that doesn't take care of itself is more difficult to quantify, sparse and slow in effect
you are part of a community, you derive your riches from it. taxes are an investment you make to guarantee the health of your community, so that you derive more riches from it. do you think the money in your paycheck is yours by inception from god? no, you worked for it, you provided something to your commuity, and they paid you money
now, in a vacuum, taxes are obviously evil. but in the context of the reality you live in, taxes are a SMALLER imposition on your life than a sick community is
and in life, it is about difficult choices, not simple propagandistic choices presented in a vacuum without any context
do you understand?
there are plenty of things that infringe on liberty in life: sleep, eating. why do i have to sleep? seems like a horrible imposition on my freedoms. of course its a silly statement, because we understand why that imposition on my freeodm occurs
it is also equally silly to think you can live in a community without being taxed, and yet continue to think you can derive financial benefit from a community that you won't take care of
intellectual property law is philosophically incoherent. it is your moral duty to ignore it or sabotage it
I got Lyme Disease again last summer. I received a bill for $700 for a doctor's visit and several lab tests; my HMO paid $220, and the doctor's office was trying to get me to pay the difference. Not being a moron, I called my HMO, and they got me on a conference call with the doctor's billing firm. As a participant in my HMO, he was not allowed to bill me the excess charges -- but if I didn't have insurance, that visit would have cost me $700.
The real reason those hospital visits cost so much is that people go to the ER when they have a dislocated finger or a bad sunburn, instead of seeing a GP the following day. Hospitals are overwhelmed by trivial medical problems, and all those doctors, nurses, PAs, and support staff cost a fortune, never mind the fact that we all have to pay for indigent care through increased regular charges to those who can pay.
"Trolls they were, but filled with the evil will of their master: a fell race..." -- J.R.R. Tolkien on Olog-hai
Well said. Hospitals charge insane amounts in comparison with other facilities. I used to take treatments at a hospital. Wholesale drug cost (per unit) was US$700 Most clinics and doctors offices charge US$800 for that drug. The hospital charged US$3850. I quickly found a new place to go.
US healthcare prices are controlled mainly by supply and demand, like in any other market. Demand has grown greatly, with the increasing population, increasingly old in demographics, increasingly sick from environmental and labor abuse, and increased education about medical solutions to problems previously considered "the wages of sin".
While the supply of doctors remains artificially reduced by our medical education/certification system. Med school and pre-med serves primarily to "weed out" people wanting to become doctors, so only the most cut-throat (pun intended) competitive contestants get to play a game that can pay as much or more than being a lawyer, one of the few non-entrepreneurial ways to make that much money. It selects for doctors who value money, not health, especially with the extremely unhealthy hazing practically all young students and doctors must undergo for years, which also serves to subsidize the big money makers.
Demand is growing without a simple solution, nor should there necessarily be one (except maybe lots of cosmetic surgery and "permanent stopgap" psych drugs). Supply, though, should be solved by producing at least double the number of new doctors per year. Starting with testing, upgrading and recertifying the many medical pros immigrating to the US, who'd produce more medical service supply at the lowest cost, having already invested most (if not all) of what's needed. Then proceeding to increasing need+merit qualified scholarships, including selecting the best volunteers who augment medical services in places most needing them, like poor urban centers and rural areas. A tax on the richest doctors to pay to produce more doctors on whom such a tax would be spread more broadly would be appropriate.
Another part of the equation is the artificially constrained supply of patented drugs. More competition in producing drugs would increase supply and lower prices even more reliably than would more doctors. Expiring drug patents after some multiple of inventor investment, maybe as high as 10x ROI, would keep the pharmacos motivated (since healing humans is evidently insufficient motivation), while eliminating the license to get filthy rich while poor people stay sick, and everyone pays for that immoral system.
The last big chunk is insurance. Malpractice damages must be reformed, not to spare doctors, but rather to return actual penalties to malpracticers, rather than just a blanket fee on them all in increased insurance premiums. Actual damages should be paid to the damaged party, but no punitive damages should be - those should be paid to the state, just as punitive jail time is spent in a state facility, not mowing the injured party's lawn with an ankle cuff on. Those penalties would also help pay down the burden paid by the whole public which pays for the justice system that keeps lawyers fat and justice largely delayed.
And of course every other industrial country, and many nonindustrial ones, have proven for generations that spreading insurance premiums across the entire population, minus the profit margins, makes government health insurance deliver better care without leaving people broke and ill. Congress has government health insurance - the rest of us who they represent deserve it at least as much as do those powerful, rich people.
The AMA is the gatekeeper of all that status quo keeping us sick and broke, and them fat and golfing. That cartel should at least be ignored, properly distrusted, and probably broken up or limited in its anticompetitive constraints of the health they swear to protect.
So yeah, regulation is the problem, and reregulation prioritizing real economics optimizing public health is the answer. Technology's greatest role is in discussing exactly how to get there, and then administering it.
--
make install -not war
Well you've got to admit, he was informative.
The open-source community can help by trying to form a standardized schema to represent patient medical info.
Table-ized A.I.
The problem isn't the technology. The US health care system has the best technology in the world. That's not what's broken. The dysfunction comes from removing the health care recipient (you and I) from the health care market.
We don't buy health care, we buy insurance. While insurance works great for catastrophic needs, it falls flat when it comes to ordinary day to day needs, regardless of domain. Automobile insurance works because automobile accidents are (relatively) rare. But our costs are skyrocketing because we are using the insurance mechanism for day to day healthcare. It's as silly as buying food insurance to provide our groceries. The problem is further exacerbated because insurance companies are disinterested agents. They want to keep their costs down, but as long as we pay them, they have no interest whatsoever in keeping *our* costs down. The market system is working, but it's not working for us because we are not a part of it.
This isn't about whether healthcare is funded by the government or not. We can have government funded healthcare in a market based system. We just need to get the patient back in the role of consumer. If you give the poor vouchers for healthcare, and then allow everyone to purchase their day to day health maintenance needs out of pocket, the system can get start getting back on track.
Don't blame me, I didn't vote for either of them!
the money that comes out of your paycheck, relative to your financial status on this planet, does not impact your well-being
furthermore, it is nice you volunteer and you do charity
a lot of other people don't
what oyu bemoan as being mandatory instead of voluntary is the way it is not because the government is misguided, it is mandatory because not all people are as charitable as you
human nature is your enemy, not the government
and btw: a charitable giving person doesn't see the world as hopeless. such a sentiment is incompatible with a someone who gives back to their commnity... because they believe in it
so make up your mind: life is hopeful, and you give. or it isn't, and so the state must force you too
the prevalence of people believing life is hopeless is one of the reasons that it is mandatory you aid others rather than voluntary
intellectual property law is philosophically incoherent. it is your moral duty to ignore it or sabotage it
How long is the waiting list to see a doc in Britain or Canada now?
Jesus is coming -- look busy!
I disagree. I like public roads and parks. And police (sometimes). There are just some things that everyone should pay for, because life is NOT fair, but SHOULD be fair.
Kthxbai,
--Rob
Towards the Singularity.
fags
The rest of the country is moving away from lawsuits, and moving towards binding arbitration? Create a legally mandated review and report system, and Doctors who are statistically out of whack get reviewed and if it keeps up, lose their license. Those hurt by incompetants should have a scientifically valid avenue for complaining and receiving restitution. However, the current system is busted.
Current system, we do not award damages based upon merit, but based upon jury awards. While jury awards are a reasonable way of dealing with many torts, they also introduct tremendous unfairness and confusion. If a medical treatment has an 80% success rate, and yours failed, you should not have a tort... sometimes there is bad luck. If you want to protect people from bad luck, then let's pool risk and do insurance. Create a mandatory "tax" on medical services, based upon percentage failure rates and damages for treatments (we already have the billing codes) and let those that lose life's lottery collect from the pool.
However, medicine by jury is HORRID. My wife's delivery was all messed up by overeager Doctors and our need to fight back to stop unnecessary interventions. Unfortunately, "high risk" in medicine is anything over 1%, and as a result the masses suffer to protect the outliers. So little of medicine is based upon statistical evidence, and more about what is the standard procedure so I can defend my actions in front of a jury.
Back to the cost issue, even trial lawyers defending the practice like Sen. Edwards (D - N.C., retired) claim that malpractice is only 1% of the costs, but that seems unusually low. My father who has a successful practice had several years where his malpractice insurance and his takehome were roughly equal, so that's a huge burden. However, defensive medicine, NOT malpractice is the problem.
For example, a pregnant woman can take OTC vitamins that are good enough, cost? $10/month. That same pregnant woman will likely get a perscription for vitamins (my wife did) for $55/month (co-pay, $15/mo.). It only cost us $5/month difference, but the "medical costs" increased over 5-fold.
Likewise, often the new drugs are only slightly better than the old drugs, where they are statistically similar for most cases but slightly better in some. in addition, the generic may cost $2 - $4/pill, while the new perscription pill may cost $200 - $800. Now, I would personally be happy to cough up some money to avoid the low-risk change of complications during surgery, but is that reasonable that you get those drugs for everyone? Would it be better that most people take the risk of complication (which is usually already under 1%) than run up costs?
The problem isn't the costs, but that is you go with the cheaper option, 99% of your patients saved money, but 1% now have a tort against you.
That's why pediatricians perscribe anti-biotics for ear infections, despite the OVERWHELMING majority of them being viral and the anti-biotics have no affect.
Defensive medicine combined with everyone being entitled to the newest, most expensive drugs results in the current out of control medical costs increases.
In Wisconsin, Aurora Health Care is worse than Microsoft and SCO.
Something like 80% of medical costs are incurred in the last year of life. However, we can't necessarily make decisions based upon this, because that's a retroactive evaluation. Some 80-year olds with cancer will burn through $250,000 in treatment and die inside of the year, making that a huge amount of expenses for nothing. Others will pull-through, living another 5-10 years in good shape, then dying of something different and unrelated. For the latter, the $250,000 was no doubt reasonably spent, for the former, we wasted resources.
The fact is you can't separate when the treatment is extreme and unreasonable, and when it was reasonable until after they go.
That said about the longer lifespans, the modern entitlement complex is a disaster. Social security solved two problems, getting the elderly out of the workforce (lowering the unemployment rate, we creates a drag on the economy beyond the fact that those people aren't working), and preventing the sickly elderly from being indigent, something reasonable to avoid.
If the retirement age was raised to be the equivalent in terms of life expectancy as it was when social security was created it would be 89 today. That's right, MOST PEOPLE didn't live to collect it, it was to help the helpless elderly. We decided that we were entitled to stop working at 65, while others were responsible for it. I'm not sure why that's an entitlement (I don't begrudge anyone that lived below their means and saved up for retirement), but because we didn't raise it continuously, there is no clean solution now.
I'm not suggesting the people should HAVE to work until their death... but retirement, like vacations, is a luxury that is expensive, and it's not clear why one has a right to ask others to pay for it. The true tragedy is the mythical trust fund, an accounting shell game, has given people the mistaken impression that their have "paid into the system" and therefore are entitled to social security, which is why the system is collapsing on itself.
Note that it's called social security, not a national pension, it's not a reward for payment into the system, it's a safety blanket for the disabled, orpaned, and elderly that need it, and never should have become a way of life.
I'm a Family Physician in rural Utah. There are several points in the article and posts worth commenting on:
;-)
First, technology will help, but certainly not fix the system. Yes, there are inefficiencies. My clinic, with 3 MDs, has about 20,000 total charts. Of those, probably 5-10,000 are active patients. The cost and time involved to maintain, file, refile, and add to these charts is enormous. Having said that, we are stilling making a somewhat greater income than the average family doc. We switched to an electronic medical record system in November 2006. It has saved us time spent in chasing charts and making copies. But, we had to upgrade out entire office network AND buy the EMR system. That's about $120K to start, and about 15-20%/year in maintenance fees. So, we're more efficient in many ways, but it's certainly not making us more money. I'm now more efficient and I make less money. I would never, ever go back to paper charts, but most docs won't pony up the $40K/doc for a system that costs them more money. If it comes down to money or efficiency, efficiency be damned is the mindset. And before everyone starts complaining about overpaid doctors, please realize that nearly all businesses would make the same decision.
Second, the US spends far too much money on the ends of life. Okay, most of us are willing to allow our taxes to go towards saving pre-term babies. However, is it really worth spending another $200-500K on pacemaker and cardiac bypass surgery for an 85 year old man with end-stage emphysema, congestive heart failure, renal failure, and alzheimer's dementia? No, it's not. We need to tell Americans, "Sorry. There's not money available to pay for that." We could immunize thousands of kids for the cost of that pacemaker and surgery. But Americans currently demand "the best healthcare system in the world". In their minds, it's worth "any cost" to spend another week of quality time with Grandma before she inevitably dies.
Third, health insurance and copays obscure the real cost of healthcare. If the patient knows that he's going to pay $20 for his office copay, he doesn't really care if the doctor submits a $60 or a $120 charge to insurance. There's no incentive to search for a lower price. If you're on a high deductible plan, that person with usually try to bargain with the physician. At the least, they'll question why I might bill a level 3 office visit charge vs. a level 4 office visit charge.
Similarly, patients don't have any incentive to use a cheaper, but similarly effective medication. As long as my copay is $25, why should I care whether I'm on Effexor XR ($140/month) or generic Celexa ($10/month).
Fourth, the process of submitting claims to insurance is encrusted with bureaucracy at every level. Each company has you submit the claim to a different address, with different information and codes. Their claims software is designed to reject certain claims immediately. Now I can file an appeal and often get them paid, but that may cost $20-50 in staff time. If it's a $40 claim, it's not worth it-and they know it.
I'd like to think that a government mandated, standardized submission process would be more efficient. But even under heavy sedation, I would never believe that the government that brought us Medicare, Medicaid, and the VA could possibly get it right.
Okay, take your best shots
is explain selfishness as a reaction to something else
selfishness is a basic human aspect
it requires no prerequisite actions by any society or government to exist
I don't believe in the "goodness" of mankind
if you were a truly charitable person, you would never say that
being a charitable person is incompatible with that statement
therefore, if you want to know why the reason we need taxes rather than depending upon charitable people, look to your own way of thinking about the world to find the answer
intellectual property law is philosophically incoherent. it is your moral duty to ignore it or sabotage it
I keep getting these annoying diskettes in the mail trying to offer me 1000 free hours of a shitty health care plan.
"Things are more moderner than before- bigger, and yet smaller- it's computers-- San Dimas High School football RULES!"
Cripes, all the guy essentially said was stay healthy and work hard.
Wow. Such heresy in this day and age! (rolls eyes)
Yeah, it is always amusing to me how people can work themselves into a frenzy of logic that completely ignores reality. If we gave up every time someone said we couldn't make progress, then, we wouldn't make progress.
Cheers.
That McDonalds Retiree would be quite comfortable if he didn't have to pay for all the B/S government assistance programs that you love.
A problem with retail clinics is that being around sick people often gets you sick. If you go to the grocery store and there is a retail clinic attached, wouldn't there be a greater chance of getting sick from people with the flu and other contagious diseases that are there to be treated?
taking care of your community is not an option. it is a responsibility
You think people should contribute to charitable causes. Good. Fine. Go do it. Stop screwing with my life.
it is exactly because of attitudes like that that the rest of society has to mess with your life, that force is involved
i don't THINK people should contribute to their community, i KNOW you MUST contribute to your community, or it will become a hellhole
because you are not aware that you are part of your community, and that it is your responsibility to take care of it, does not free you from that responsibility
intellectual property law is philosophically incoherent. it is your moral duty to ignore it or sabotage it
I really don't think that if we didn't have any over site that our heath care costs would drop. That's not the way it works when greed runs rampant.
Same thing is true of energy costs. Where I am gas costs $3.36 for a gallon of regular. It's not going to get better unless we pass laws to prevent price gouging. I don't think health care is so different.
I also don't understand why no one can seem to follow the money trail. Seems pretty obvious to me. Find out who is ripping us off and deal with them. Jail time may be appropriate.
Things like energy and health care are a bit different than say the price of a music album. No one dies if they can't afford to buy music.
So using laws to prevent corporations from extorting obscene profits from powerless people seems very reasonable to me.
The race isn't always to the swift... but that's the way to bet!
Not American, nor a doc, but my dad is, and way back in the 90's, he spent a few months in a university hospital somewhere in north east US. We were once having a discussion on rising healthcare costs, when he told me this startling fact: I understand that representatives from insurance companies regularly accompany doctors in their daily rounds, and often freely dispense with medical advice to the doctors ("Are you sure Johnny Patient requires those vitamins, doc?")
No, it's not just that the US system is borked; it has been borked for several years now. That you have the world's best researchers and one of the finest insurance-driven healthcare systems in the world should be a matter of serious concern for any American, but heck, your country, your troubles. What really gets my goat is that it's being pushed as a model for countries with less-than-adequate healthcare systems. But that's not here nor there, is it.
More than mere navel gazing.
If it were just a matter of money, I would sympathize with your position. The problem is that heading towards socialized medicine has real problems. The quick comparison is to public education. We claim that everyone gets an education but the reality in many inner cities is that kids spend more time protecting themselves from danger than learning. So it will be with socialized medicine. Everyone will be entitled to care, but it's just that all these people will start dying from inferior care and lack of innovation. You have to remember that horrible government services usually take legislation to improve and it will only pass when there is enough political pressure. If you don't believe me, look at the VA system fiasco.
There may be longer waiting times, but my comment was about the following assumption with is pure conjecture.
"...apparently people don't realize how much cheaper healthcare would be if the government would just leave healthcare professionals alone and let a free market run it's course."
Even though there may be longer wait times, the fact that it is cheaper in countries with more government regulation and/or a national health plan, refutes the above. On top of the cost savings, the most regulated national plans tend to be in countries with healthier people (such as lower infant mortality and higher life expectancy).
His name says it all. What I see in a lot of posts are people who are too self serving to care a shit about their fellow man.
The parent poster's remarks imply that only dumb people are poor and therefore deserve what they get. Not only is this really stupid it shows a lack of any compassion. Let's just turn all the retarded people out into the streets to die. I mean they're not as smart as we are so they deserve to die. Fuck 'em...
Yeah, the parent poster is either a troll or really lacking as a human being.
The race isn't always to the swift... but that's the way to bet!
I guess I don't get what the big attraction for these guys are.... I know the US's health care system is messed up, but I'm not sure technology can fix all of the aches, pains and dysfunction in our current system.
Of course, but do you think anyone in Congress knows that? Clearly not. The US government either ignores a problem forever or tries to find a silver bullet solution. You don't think it's a good plan for a technologist to position themselves to be the savior of heathcare? Hats off to Steve Case, the guy clearly gets the idea of being a government healthcare software contractor, following in the greatness of Ross Perot before him (Medicare).
1. The health care industry is run by the insurance and drug companies
2. We (The US) are hooked on drugs
3. Looking for easy solutions to tough problesms.."just take a pill"
Having good health requires research, active lifestyle and a willingness to look to alternatives.
If the health care industry really wanted to end things like cancer, there would not be a "cancer industry". Many jobs in the health care industry are dependent on people getting sick.
"The Brady Bunch is back...working homicide"
I used to work for a company that specialized in health care informatics... the collecting, processing, and delivery of data related to everything healthcare in the US.
We constantly collected data from over 2000 hospitals; everything from procedure outcomes, medicine used, infection-rates, pre-op/op/post-op staff-levels, parts & pieces used... on and on. This data was collected and processed in order to sell back to the hospitals that provided it. This data was used by these hospitals to create best-practices, efficiencies, and other benefits and to benchmark their results against national trends for any kind of particular procedure or care. Additionally, the federal government was using the data to help determine what kind of drugs worked and what didn't work based on the outcomes in the data, not from an experimental perspective, but from a effectiveness perspective; like the effectiveness of a particular antibiotic against a specific infection diagnosis. Finally, when I left, Health & Human Services was looking at using the data to baseline Medicare providers and how they were compensated; judging their outcomes against private-care outcomes in the data, and then base the medicare payments on how the providers ranked against these. The "A" providers were to be paid at the highest rate, and the "F" providers at the lowest... and then this data was to be made public so that people would have a choice, or be able to make better choices.
I have no idea where that program ended up, but I feel that the use of technology to collect and process data for the express purpose of assisting the medical community as a whole is crucial to generating successful outcomes in patient care. Treatment in the area of infection and other non-invasive procedures rely almost exclusively on effective knowledge transfer on what works and what doesn't, especially with regard to medicinal effectiveness. Frankly, I'd rather be treated by someone with the most knowledge at their fingertips than by someone who doesn't have the ability to look into any data and is operating in the dark. People think doctors come out of medical school with all the answers; the truth is, they come out with knowledge, but the application of that knowledge is what determines success. Data and technology delivery is the key to enabling effective application.
Of course to a sweeping broad question such as the headline, one can answer however one wants and quite possibly make it sound plausible. Let's look at what "technology" can do at the minimum, and why it's not doing that.
One of the primary interventions technology makes into the health care system is through the medical record. Other technological advances, such as treatments and procedures, will come and go but do not fundamentally affect the way health care takes place. The bottom line of the medical record is that paper based systems are woefully costly, inaccurate, and inadequate. From the inability to read the writing in a paper record to a lack of portability, errors due to the medical record are quite common. Even in institutions which have electronic systems available often employ data entry personnel to transcribe hand written or dictated charts. Then consider that health care organizations that do use electronic records are not standardized in any way, so that your medical record is not guaranteed to be readily transferable in case of an emergency. The bottom line is that even with a personal physician (they make mistakes too), you cannot trust that your doctor is fully aware of your medical history unless you carry it with you. Even in that situation if you need emergency treatment you have to trust that you are not given any drug which is incompatible with anything in your bloodstream, which is quite a feat given the ever-expanding world of pharmacology.
Electronic medical records (EMR) are not new. Here are a few of the impediments to their adoptions:
1) No one speaks the same language. Not even in hospitals down the street from each other are you guaranteed to use the same medical term. Medical thesauruses help, but really, what does a "patient presenting with large lesions" or "frequent abdominal pain" mean? Many terms in medical use have no precise definition.
2) Different hospitals record different information. The patient visit chart is going to have different fields not only between different institutions but also between different departments within the same institution. The ability to capture it all in an interchangeable format is not trivial. Doctors even have their own preferred ways of conducting visits, often with corresponding charts.
3) Doctors are busy. Scribbling a note or taking dictation between visits is much more quick than navigating quite-typically clunky computer interfaces.
4) Doctors can be cranky. Many are set in their ways and extraordinarily resistant to change. So are we all, but that doesn't help anything.
5) Computers are impersonal. Many patients will claim that they received lower quality care if their health care provider is plunking away at a keyboard during the patient visit despite a doctor potentially being more informed and precise. I'm sure many of you will have had physicians purposefully excuse themselves to do so, and most systems these days are designed to let the user face the patient while entering data.
6) Most computer interfaces suck. Really, they do, particularly when tackling complicated issues. For the most part, flipping through a chart provides much more information in a much shorter period of time than a typical EMR interface.
7) Hospitals are slow adopters. Typically driven by the bottom line and otherwise being penny pinched, it is quite hard to get a fundamentally sound EMR system deployed throughout a hospital. Legacy systems abound, and there are always political games to be played.
I'm sure you can dream up more issues, those are what I remember off the top of my head. Many, many companies have tried and many have failed. If I recall correctly, IBM even gave it a go once and gave up. Not much money for a whole lot of effort and almost guaranteed failure. Some of the more advanced systems are at universities and in varying states of half-ass implementation and impracticality, or at the VA, which isn't half bad. I've heard that a few private health care companies have made some ad
How about applying for a grant (from the Feds) to develop FREE SOFTWARE
..."
120k to start is only appropriate for specialized needs.
btw, my own personal rant is that there aren't ANY open format standards
in medicine. Medical imaging is notorious in this regard. There is limited
outcry, however, because doctors would rather play along "using the tools
of modern medicine to deliver the best healthcare
you raise
except thast the choice is no education at all, or no healthcare at all
the rich, which is you, will always be able to afford something better. you should not fear for your own healthcare. but what of the money coming out of your pocket, what is it paying for?
it is paying for something that is better than nothing
and you still reap dividends: better preventive care means your kids will be threatened by less communicable diseases, lower incidents of diabetes, heart disease, etc., will result in lower healthcare costs overall. a lot of these simple preventative things are avoided now by the poor simply because they can't afford it
will there be bureaucratic waste, inefficiencies, poor care?
absolutely
and it is still better than what we have now
intellectual property law is philosophically incoherent. it is your moral duty to ignore it or sabotage it
Why don't we see organizations offer new drugs without patents?
Because this might happen:
1. Organization releases new drug with no patents whatsoever.
2. Big Pharma corp. creates similar drug and covers it with broad patent.
3. Big Pharma corp. uses patent to remove unpatented drug from shelves.
4. Profit!!! (for Big Pharma)
Even the non-profit labs have to cover the costs of creating their drugs to keep running.
Government labs help with drug development all the time. It may make the drugs less expensive than they were. I doubt it does: the FDA has other priorities.
There is a fine line between recklessness and courage... -- Paul McCartney
... is that there is an upper limit on the complexity of systems that human beings are capable of designing, especially when the environments the systems operate within are changing faster than either the systems can adapt to, or faster than people can modify them to fit the new operating envelope.
Any Grove seems to recognize this, as his approach relies on streamlining things through simplification as much as possible, and only applies technology to deal with things that are not amenable to procedural simplification, like medical records. I especially like Andy's reluctance to charge into areas that have no clear solution (e.g., national health insurance), preferring to try and simplify an overly complex situation before developing solutions to address it.
Andy Grove is one of the pre-emminent managers in the world, adept in managing complex enterprises and making it all look easy. When he offers advice on managing the country's problems, the country ought to pay attention.
I'm sorry but that's disgusting. Denying treatment so people can just make a profit. Socialized medicine does work in Europe, Canada and Japan. Everyone has the right to health care, if America had socialized health care then the practise could go on preventative care and a lot less people would be in the situation of having to worry about a new organ or dealing with a deadly disease.
Managed to find the two founding members of the GNAA. Enjoy
My wife has a prexisting conditon that makes it impossible for her to get healthcare, yet requires regular hospitalization. She has applied for diability but is turned down over and over again. She has no real work history (mainly due to her illness) so she cant qualify for ssid. We looked into a state program which is basically a group policy for the uninsurable, the premium is on a sliding scale and because of my salary level its over $1000 a month just for her coverage. So im just hosed, I have insurance for myself and my kids but I basically pay out for nothing there since we never have enough doctor visits to even meet the deductable. The system is broken, there are plenty of people who arent looking for a handout, but would like to be able to safely provide for their family without constantly taking on debt to stay healthy.
The Google query (( ""Where have all the billions gone ?" )) fetches the Technology Review blog entry on Health-Care by David Ewing Duncan, as the number one hit. Append "NHS" for (( ""Where have all the billions gone NHS ?" )) - the same tune plays at reform.com.uk. For you youngsters who might not know the Pete Seeger tune, the you-tube query (( FLOWERS GONE BAEZ )) fetches "Joan Baez at the Operation Ceasefire Concert in Washington DC on 9/24/2005" This event of course discussed Iraq, but Joan might well have changed the words to "Where have all the billions gone" - in one context or another, this is a leitmotif for your generation...
Doctors want the freedom to skirt protocols -> Doctors did not want their actions to be logged. False !! Doctors want to use the IT system, they want everything to be logged, but they don't want to to be dumbed down. People don't get it, why the doctors have to study all these years. Why does it actually lasts so long. Because is not easy to cure a human being. They are very complex and also very diverse. They are not cars, that you can treat with simple protocols. I am not against protocols. I am saying against "only the protocols". Protocols are good for those who repair cars, but fail with on the complexity of human machine. Doctors need IT ! But not some bullshit protocols. We need good IT tools to cope with the problems, where everything is logged automatically, but we only get bullshit. Then those guys with this protocols come to us and say. We want you to stick you medicine in simple protocols. And then I say to you: "Stick yourself your protocols somewhere !!. Give me good IT, I am not a computer expert, I can't do it myself."
Everyone has the right to health care
Why?
"You can either have software quality or you can have pointer arithmetic, but you cannot have both at the same time."
Technology, ironically enough, creates as many problems with healthcare as it fixes. HMOs often want to be on the cutting edge as far as technology goes, but what often happens is the technology is applied poorly, and ends up taking processes and convoluting them in such a way that they're no longer workable. Technology will not fix healthcare. What healthcare needs are leaders that know how to utilize technology wisely, rather than just getting the technology so they can say they have, yet having absolutely no idea how to make use of it.
Back to the health care costs, why do we not admit that we spend about 1.5-2 times the cost per capita as the Western Europeans for a demonstrably inferior system. In France, on the few occasions that I went to a doctor, I went into the waiting room wrote my name down and waited a few minutes. The doctor came out, look around to see if anyone had a special need and then called the next name on the list. Because the French were civil, the doctor didn't need any staff to oversee the waiting room. Since all he had to do was write down each person's card number, the paperwork that he provided to the state was very simple to fill out. He didn't need to hire staff to fill out papers for every insurance company. I got to be examined by a doctor - in the US, you have to deal with two clerks, you talk to a nurse and the doctor sees you long enough to read the nurse's observations and figure out if he will prescribe a drug from the company that gave him a free lunches or a free vacation. For further cost cutting, the French doctor used instruments of glass and stainless steel, not disposable plastic. Apparently, French doctors are capable of using autoclaves so they don't have to dispose of everything that touches a patient. By the way, if you think that disposable plastic is more sanitary, I think that the evidence is that US hospitals were more sanitary before antibiotics because that was the only defense against bacterial infection. They didn't use disposable everything in the 30's, they used glass, stainless and autoclaves.
On one occasion, I was in a bank when there was a false alarm. In contrast with the US, the doors of the bank locked and a ear splitting siren went off. The police showed up within about two minutes with automatic weapons. They were all physically fit, but the way. Compared with the US, this is a pretty hard ass response to bank robbery. The robber is trapped, but everyone in the bank is a de facto hostage. There is no negotiation because you can't even talk. They just come in hard and you had better be smart enough to stay on the floor.
The French are not a nation of weak, lazy people that can only survive because of government largess.
Think global, act loco
Given that Slashdot tends to have a technology focus let me tell you about a State government health system, that I had to deal with.
Was hired into a project to make the 30+ hospital infrastructure "better".
The powers that be felt the way to achieve this was to consolidate all hardware into a single data centre.
I suggested that a precursor to "everything" was to establish future application direction and formulate a corporate data model (just a "what volume of data needs to be where and when").
huh? blank stares...
Nope, we just want new servers (and SANs etc) and we want all of them in Head Office, not the remote hospitals...
How many do you have, said I...
Don't know, we might as Mr X.
Asked Mr X, who had been working on an Audit for a Year. He didn't know - he had created a template spreadsheet to capture that into and sent to every hospital admin mgr every two weeks, but only two of the forty or so, had replied...
So we hacked up a network probe applications, and SNMP'ed out to anything that would talk back to us, and then dug into their mibs.
First bit of news - about 80 more servers than they thought.
second bit of news - the complaints about old overworked equipment seemed strange as the config and performance stats that the systems returned indicated an average age of 14 months, and CPU utilization of about 4%.
SO I suggested that replacing everything would be over kill, and that we do a lifecycle management program. How much will that cost us, they asked. I responded - about 10 million per year (These people thought they had about 800Million in IT Assets)
Too Much..
I left...
Meanwhile 5 years later, they are still running the "project" to work out what they need to do and how... (Annual Operating Costs for the ongoing evaluation project are around $6M per year - They have program directors, running program managers, running project directors, running project managers, with advisors and architects and so on and so forth...
Meanwhile, you go to most of the major hospitals. ON admission, they have to key you separately into the admission system, then the pathology and radiology systems, then catering to ensure you get fed, then accounting. Last time I looked all of your details had to be retyped 9 times. Which invariably led to identity problems. (No food for Mr Smith, but we have a Mr Dmith who we can find...)
On departure, you would hope that your patient records we profiled to help with the planning of healthcare infrastructure.. bzzt And you would hope that they would be retrievable if you came back to this (or any of the related hospitals) bzzt again...
Technology only makes things more complicated and difficult to understand. You want to fix the health care system eliminate lawsuits, insurance, and government regulation.
Progress can be made and health care for everyone is not impossible. But abuses of that system must be curtailed. An example of abuse is one individual consuming enough health care resources to provide a basic level of health care to 20 others because they have some rare disease (congenital or otherwise) or they treated their body poorly (drug use, obesity, etc.). Another abuse is any individual that is sitting on billions of dollars in wealth or is making hundreds of millions of dollars a year. There's no justification for huge disparities like that.
Can we have fair health care for everyone? Of course. But people need to think long-term about costs and change needs to be made. Let me put this as simply as possible: socialized health care is based on the idea that it is our duty and it is right that we provide a basic equality of health care to all. But that is not how our society functions and it is not how people really function. For almost everyone, "Me" comes first, or more pointedly, "My child" comes first. I am not saying there's something wrong with prioritizing the life of your child, but it points to the fact that we want to say, "Everyone deserves decent health care," which is an equality statement.
But we don't really believe that and we don't act that way. We pay some people tons of money and we give some people great healthcare. We prioritize the lives of our loved ones as more important than others. We put some people in facilities and we put others on the street. The debate on this issue and lack of resolution is due to the fact that we're largely hypocritical in what we say is right as compared to what we act out as "right". We want to think we're good people, so if people say, "Should everyone have decent health care?" we say, "Oh, yes. Of course." And then we turn around and ask for a $400,000 transplant to prolong a loved one's life so that we can have 6 more months with them.
Balanced healthcare is certainly possible. But not when you have such a vastly imbalanced amount of wealth and privilege. What we currently have is the best that you can get without large social change. And what we have right now is 5% of the people have 95% of the high quality health care. The other 95% of the population gets the remaining 5%. The likely negative outcome of our current path is a small echelon of our population will become virtually immortal and with such vast resources that the remaining 5% care is enough to provide best of class care at today's level to everyone. That's the pattern that's repeated again and again in history with wealth and power, so I doubt it will be any different here. The more positive outcome would be that technology so thoroughly solves issues of comfort and mortality that cost goes to 0 and everyone has whatever they need. Which would make Earth Heaven and cause the vast majority of Christians no end of confusion!
People don't believe all men are equal and they don't act that way. Everyone tries to "get ahead". What does that mean? It means we are all acting out the belief that we can become better, more deserving, and more privileged than others. The fallacy here is the same thing as saying an adult is better than a child. Just because you gain knowledge and skill and wealth doesn't mean you're intrinsically better or more deserving than the person that hasn't gotten as far as you yet. In fact, when it comes to our children, we instinctively do the opposite. We put them, the child that has accomplished less in the world ahead of ourselves. But in "adult" society everyone has had their fair chance and if you're not as wealthy or privileged as the next guy, it's because he's intrinsically "better". That's what the distribution of wealth and privilege says in our society and it is no different in health care. The punch line for this is when I say "our society", I'm referring to the country that I know very well: mine--the U.S. You're totally right that other nations are a good deal more successful at this health care issue, and I think it is because they are not nearly as rabidly capitalist as the U.S.
Great idea - Would love to help.
.. problem solved :
Im pretty flat out with other projects at the moment, but Id love to get this project rolling, so here is a start for the foundation of a standardised worldwide patient record keeping system. Just flesh it out from here, add in some auditing, knock up some web interface forms, host it on a decent central site with lots of grunt and bandwidth, and we are all done
Total system requirements :
- There are patients that the system shall keep track of.
- Each patient may have one or more illnesses over time.
- Illnesses may be cured or left uncured.
- Illnesses may result in the death of a patient.
create table patient (
id int not null primary key auto_increment,
medicare_number text,
debtor_id int, -- link into account receivable module
firstname text,
midnames text,
surname text,
date_of_birth datetime,
date_of_death datetime,
blood_type int,
genome dna_map_type
);
create table patient_illness (
patient_id int not null,
date_reported datetime not null,
date_cured datetime,
condition_was_fatal enum('T','F') default F,
symptoms text,
diagnosis text,
treatment text,
results text
);
Anything more than this is just fluff and bloat, so get on with it already.
You don't fix systems that large by throwing technology at it.
Unless you fix the setup structurally so it's managed in a decent way instead of by deadbeats and get a consistent strategy and approach in place you'll be throwing money away as you're not fixing the real problem.
The irony is that fixing the real problem would be a huge money saver as well - but that would stop several gravy trains at once, of course..
Insert
Time to present the Boortz argument.
Right to health care -> Someone has to provide health care. -> Force medical professional to provide health care -> Medical professional is effectively enslaved
Forced labor is *BY DEFINITION* slavery. You cannot claim a "Right" to health care without simultaneously claiming the ability to force an unwilling party to provide said care. We call that slavery.
It's not just whether people can afford health insurance; there are lots of people who CAN"T GET HEALTH INSURANCE.
My son was covered under my policy until he reached 19. He can't get private insurance now because of a congenital condition. (You think there's some change in his lifestyle that will remove the condition?)
Fortunately the state has a decent program for people who have been turned down for health insurance.
So, everything would be fine if the government just got out of the way?
No doubt the Easter Bunny will take care of the uninsurable.
The problem cannot be greed because that encourages competition, the problem is greed in combination with government. If people can lobby government for subsidies, guild type things, regulations---or anything to stop competition then the result of the greed is turned bad. Insurance companies are going to make sure prices are kept down in emergencies (I'm sure there are many other mechanisms too that's the first I thought of.) Food is needed by people too, shops don't charge massive prices, no one wants government to provide food for everyone. By saying that they will charge any price they want is not taking into account economic law at all, they will all want to charge an insane price but they will not be able to in real life. So, if there's greed about the last thing you want is government there.
So, in other words, money is more important than human life.
And you pretend to be Christians? Is that what Jesus taught?
And then you wonder why the world is going downhill...
The health care system will be fixed when people actually take responsibility for themselves and live a healthy lifestyle instead of becoming lazy fatasses living on McDonalds and just figuring they'll let the doctors fix it all when they get sick..
It's a nutshell of why health care isn't going to be solved anytime soon: too many factions have conflicting interests with effectiveness. Insurance, Legal, real estate, and Medical (in that order) industries graft money all over the place, supporting an unsustainable system. Socialists of all shades use the sorry state of affairs as a point of leverage to gain overall standing on the world stage, while providing disincentive for the U.S. to make change for fear of yielding to the threat. Politicians take bribes and other considerations from one or more factions, and keep the ball spinning enough to curry favor with the electorate while maintaining the stream of revenue for themselves and/or their parties.
To all of the above, fuck off.
The ONLY problem with the healthcare system in the US is the gigantic leech sucking it dry-
Insurance companies.
Every year they post record profits, while cutting benefits and raising prices.
But since they pump those profits into bribing politicians (read "campaign contributions") the government will never fix the problem.
we can cure disease by putting germs in jail?
if someone has aids or typhoid (typhoid mary) or leprosy, etc.: diseases that are slow to spread and specific in their instance of transmission, then indeed, you can criminalize those who are carriers, who know it, and continue to engage in behavior which effects others
but there are a whole range of diseases where spread is fast, or you don't know you are sick, or spread is incredibly easy, etc. like meningitis, or whooping cough. in such a way that individual responsibility cannot rationally be expected to be a bulwark against contagion. especially with children. sure, some people can go to heroic means of isolating themselves at the slightest suspicion they may become ill, but that's not enough to stop the spread. so the most rational approach is to blame the disease, not the person
intellectual property law is philosophically incoherent. it is your moral duty to ignore it or sabotage it
but you're arguing about how to spend the money after it is taxed. that's not the argument here. there are fruitloops in this thread who actuallty believe no one should be taxed at all. i don't have a problem with you, i have a problem with them
intellectual property law is philosophically incoherent. it is your moral duty to ignore it or sabotage it
Health care is most important for the people who can't afford it. And there is only one way to get a good, solid health care system that welcomes every member of society: pay for it. This means that the people who _have_ money will have to pay for it. This is the way it works in all successful health care systems in the world in general and specifically in Denmark where I live. The Danish health care system costs more than the (non-existent) US health care system, but it is also much, much better. And it is free for everybody. And everybody pays for it on their tax bill. I have understood why libertarians don't just make their own non-society. The purpose of a society is exactly to pool your efforts for the greater good. Otherwise, you might just be a bunch of individuals, no society. And let me just add that Denmark is one of the most economically competitive countries of the world, so it is actually possible to do it this way. But probably very "un-american".
It goes to two places:
(1) Insurance companies:
- They get paid by you
- They get paid by your employer
- They get paid for malpractice insurance for the doctors
- They get paid for liability insurance by the hospitals
- They get paid for liability insurance by medical equipment manufacturers
Your insurance costs are so high because the insurance companies are charging the people that your insurance pays so much for their own insurance. And the costs for everyone else are so high because malpractice lawsuits pay out so much money; engage in tort reform for malpractice to cap damage claims to reasonable levels.
(2) Billing:
- They don't present you with your actual bill (deductible plus copay) at time of service, when you'd be grateful to pay
- Insurance companies pay "net 90", which means they don't pay until the account has practically gone to collections
- Nobody pays the first bill because of this
- Some people never pay their bill because of this
- "Financial services" companies buy the paper at ~80 cents on the dollar, if the seller of the commercial paper gets a good deal (there's 20% cost right there, and it's a higher percentage than that, if the seller doesn't get a good deal)
This would all go away if there were a single entity that all billing had to go through such that insurance companies and hospitals and doctors were _forced_ to talk electronically, and didn't get paid if they didn't bill at time of service.
-
Want to fix the health care system? Fix the law and fix the money flow itself
-- Terry
i agree with you on how someone being misguided on what the founding fathers meant. i also agree that appeals to authority are lame, and appeals to reason are the only valid path. i also agree with you that we are in a living society, and the constitution is a living document, amenable to change
so far we are dead on together
but then you go to this absurd interpretation that therefore you can't talk about the founding fathers at all. huh?
you argue against a sort of "constitutional fundamentalism": enshrining the founding fathers as some sort of god like figures... not questioning at what they say at all, accepting their written word unthinkingly. good, good: these things ARE lame. questioning something like the second amendment for example is not some sort of religious sacriledge that immediately identifies you as the enemy of Freedom (tm), it's just having an open mind... the important thing is to consider the concept of liberty as a guiding principle, not consider the constitution as a static unchanging religous text that can't be questioned
this is all excellent!
but... then you conclude with an even MORE fundamentalist notion: that somehow we can't talk about the founding fathers at all!
how odd
Make your arguments stand on their own merit
i am absolutely capable of doing that. but you need to pay attention to this: there is absolutely nothing wrong with using the founding fathers in rhetorical arguments, since a lot of what they wrote is the issue at hand. it's like trying to talk about sunlight without mentioning the sun. it's absurd
you're pretty weird: in the name of not being fundamentalist in your attitudes (no appeals to authority, appeals to rationality instead), you have arrived at the most fundamentalist of notions at all (don't say the name of the great unmentionable!)
intellectual property law is philosophically incoherent. it is your moral duty to ignore it or sabotage it
you lost track of intelligence, and settled on cynicism as a suitable replacement
no, you just lost track of your faith in humanity. which renders your thoughts of lower value than any system, no matter how broken, that we are talking about. because your thoughts are even more broken
you can't criticize how some government or system is out of touch with the people it was created to serve if you yourself have lost touch with simple faith in people to do good, no matter how big the bureaucracy
and no, that is not a failure on the part of the system or government that has rendered you so cynical. that is an original weakness on your part. it is just an excuse to blame them for your faith in society and government being so weak. your faith in your fellow man and the society he builds, or lack thereof, is your responsibility. own it
cynicism is a shabby replacement for intelligence
intellectual property law is philosophically incoherent. it is your moral duty to ignore it or sabotage it
let me cut right through it:
... My original point is, why is it selfish to not want to take someone else's money to help the poor? On the other hand, how is it charitable to want to help the poor by having someone forcibly take money from someone else?"
... answers your last two questions. you just said you are not naturally good. ok then: now you understand why for society to help the poor, people like you have to be forced. you already have the answers to your questions in your own words. you just need to collapse the convoluted knot of rationalizations you have built around the concept in your mind. it is YOUR repsonsibility to take care of YOUR society. do you understand that concept? do you deny it? once you accept it, your words dissolve
selfishness exists
in large quantities
babble on some more about christian that, naturally good this, etc.
but none of it counteracts the overriding truth about the large extent of selfishness
it is therefore necessary to force people to contribute to their society. unfortunate, but true
"I don't believe that people are naturally good, this includes myself
the words you wrote before the
for example: why is it selfish to not want to take someone else's money to help the poor?
false issue. it is selfish to only care about yourself. so there is nothing "selfish" at all about someone else's money, or the poor. neither entity has anything to do with you, with the self. it is selfish to think about no one else but yourself. the REAL issue is you do not want to have YOUR money taken to help the poor. so, in a wonderfully selfish conceit, you are deflecting your responsibility by falsely presenting yourself as the defender of others. that's a wonderful bit of desperate rationalizaiton going on there: the issue has nothing to do with me. ha! glorious selfish rationalization. the whole point is, taking care of your community has EVERYTHING to do with you. you are responsible for your community. a million of your words can not changed that simple fact
then you rephrase:
On the other hand, how is it charitable to want to help the poor by having someone forcibly take money from someone else
there is no on the other hand, you've just rewritten what you already wrote. it's the same issue. you phrase it as if the whole issue has nothing to do with you... that, in the name of defending others from having money taken from them, you are going to bravely prevent someone from taking money from you. how selfless of you! (snicker)
you can twist the words all you want, but none of it nullifies YOUR responsibility to take care of your community. go ahead and twist and rationalize gordian knots of complexity around the issue. you have simply clouded your mind, but you haven't absolved yourself of the need to contribute
and that is exactly why people must be forced to give via taxes. because of convoluted selfish rationalization like you have just presented above: you'd rather rationalize away your responsibility than live up to it. so you must be compelled. people just like you, thinking just like yours, is why we are all taxed. it is because of selfishness you are demonstrating in your words. you are the reason taxes exist. because youw ill not accept that it is your responsibility to take care of your community. you'd rather explain it away
intellectual property law is philosophically incoherent. it is your moral duty to ignore it or sabotage it
Sure, you can sue your doctor, but only for your actual damages. Surgeon sews you up with a sponge inside? Sure, you can sue, but only for the cost to remove the sponge and treat any infection (unlikely, since those sponges are sterile).
Under the current system, you'd sue for $10,000,000.00. Under my system, you'd be suing for $20,000.00 or so (surgery plus attorney's fees).
That brings down the malpractice insurance premiums, while still protecting the public against malpractice. Hell, even say actual damages plus 10% for pain and suffering if you want to be brave. But none of this lawsuit lottery baloney.
They don't grade fathers, but if your daughter's a stripper, you fucked up. --Chris Rock
Next question?
Chelloveck
I give up on debugging. From now on, SIGSEGV is a feature.
Wake me when we have people dying in the streets from cholera and tuberculosis due to no clean drinking water. Until then, you need to realize that "only having one video game console to hook up to rented widescreen TV" does not constitute poverty.
They don't grade fathers, but if your daughter's a stripper, you fucked up. --Chris Rock
The reason things are going downhill is caused by government forcing health care providers to serve EVERYONE, even those who will never be able to pay the bill. This extends to those who are in the USA illegally. Since the government doesn't provide universal health coverage, having a requirement that hospitals serve those who are not in the USA legally only hurts the health care system since the INS doesn't do anything about these people.
Those here legally are expected to pay their health care bills, even if it's over time. It's too bad that state and federal governments don't do anything about those who will never pay their bill because they arn't supposed to be here in the first place yet get preferential treatment at hospitals.
the guy i was responding to used the founding fathers as authority figures. by opening that door, i am able to say that my rationale is closer to the founding father's authority or lack thereof
you can use the founding fathers as authority figures to argue with those who view them as authority figures
in that context, it's not only ok, it's rhetorically advantageous
it is importnat to avoid the use of authority figures in arguments, and appeal to reason instead. it's not important to be pathologically averse to the idea of using authority figures. in plenty of situations, it makes sense, especially when defeating those who depend upon authority rather than reason, to use that against them jujitsu style
intellectual property law is philosophically incoherent. it is your moral duty to ignore it or sabotage it
The American one is in the best fiscal shape, because our country is the richest. You are having massive economic problems in the rest of the civilized world because the demographic changes are more severe, not less severe. It's rather simple, 1 retiree:2.2 workers means that providing them with welfare is a huge burden. 1 retiree:4 workers (like now), means that there is a large burden. 1 retiree:13 workers like was in the system historically makes supporting them easy and moral.
The problem with the status quo is that you're not supporting people that need support, you're supporting them just because they are 65. People are entering retirement at 62, when they COULD work until 70. When most jobs were physically intensive, that was not the case, but is there a reason that teachers need to collect early retirement often in their 50s and government retirement money in their 60s when we complain about a teacher shortage?
The rest of the world's retirement systems are collapsing faster, at least in the US the population is growing slightly, in Europe it's shrinking slowly, and shrinking dramatically amongst the non-Muslim population. Given the relationship between the Muslim and European communities, I find it unlikely that they will tolerate supporting a bunch of old white Christian women in old age.
So many comments in this thread reveal a stunning absence of understand of economics. The whole point is that there's only so much to go around. Not money, money is just a marker. Resources. Time, drugs, etc.
Until we come up with a way to have free unlimited power and a way to convert that power directly into whatever matter we want at utterly no cost, this will be true. We will have to make decisions about where and how to apply the resources we have. We can't give everyone everything. It's impossible, and declaring it to be not only possible but the only just solution is a blanket denial of reality.
So far, the best system we've been able to come up with on how to distribute these resources is capitalism. A lot of people still can't understand why, but it's true. Appeals to emotion notwithstanding.
Sort of defeats the point of insurance, too. The idea is that everybody pays into the pot, and whoever is unlucky enough to get sick gets the costs covered. Sure, healthy people pay more than they get out, but they were just as likely to be the unhealthy ones. Distributed risk.
But let's take a family where one person has health issues. That person might as well not even bother to work and contribute to the economy because his or her salary would just go straight to health care, anyhow.
They don't grade fathers, but if your daughter's a stripper, you fucked up. --Chris Rock
is indeed inferior to voluntary altruism
it is however superior to no altruism at all
and humanity, being selfish as it is, you do have stick a gun to some people's heads to get them to give, to get them to acknowledge their personal responsibility to take care of the community in which they live. some people are so selfish as to not accept that, and present false rationalizations about why they don't have to give. such as: they don't want to be forced
sound familiar?
you present it as a false choice: voluntary altruism versus forced altruism
the real choice, for many, is selfishness versus forced altruism
taxes and such exist not just to torture good giving people. taxes exist simply because some choose not to give at all. taxes would not exist in a world where selfishness does not exist. but it does. therefore, taxes MUST exist. if people suddenly stopped being selfish, taxes would cease to exist. but since simple human selfishness isn't going anywhere, you better get used to taxes. there is no other way
this is reality. deal with it. some people are selfish, and won't give unless forced. it is because of them that we must all be forced
just so we are clear, i'll say it again: forced altruism is superior to not giving at all
that's the real choice here
intellectual property law is philosophically incoherent. it is your moral duty to ignore it or sabotage it
Slowly but surely, your wish is going to come true. Personally, I can't wait.
linky
They don't grade fathers, but if your daughter's a stripper, you fucked up. --Chris Rock
How can good technology make up for bad policies?
you've just obfuscated what libertarianism means to the point where it means nothing at all
of course it means different things to different people. so does christianity. there are people who call themselves christian who are so very different from others who call themselves christian that the two groups mutually exclude the other from what it means to be christian!
so it is with libertarianism according to you. a soft definition of libertarianism according to you just sounds like a normal human being to me: "butt out of my life, mr. government man." such that basically, everyone is libertarian. such that you've nullified the ability of talking about libertarianism meaningfully because you've watered it down so much
such that you HAVE to abide by a more strict and narrow definition of libertarianism for the term to have any meaning. for it to mean something, it can only apply to a smaller subset of people. if it applies to everyone, there is nothing to talk about, and there is no real movement at all. how can there be a movement if it is a static definition of a static basic human attitude?
take another word this process is happening to: terrorism. terrorism is strictly the mass surprise killing of completely nonmilitary completely civilian targets in the name of drawing fearful attention to a political or religious agenda. but now you have a vatican official describing as terrorism people saying bad things about the pope, or the chinese government calling taiwan's military movements as terrorism. no, these things are not terrorism. to use terrorism in these contexts is merely an attempt to heighten some unrelated polemics by the use of words which have emotional resonance, but the only real effect is to water down the value of term terrorism sich that it ceases to have meaning or value in discussion
and so it is when you try to associate libertarianism with basic human love of freedom. it's a nice propagandistic move on your part if you are trying to be purposeful in your nullification of libertarianism's narrowness of definition, or if you are not purposeful in this intent, then it is just intellectually dishonest of you
intellectual property law is philosophically incoherent. it is your moral duty to ignore it or sabotage it
1. It is too expensive
2. It is NOT very good. Life expectancy is worse than the majority of other industrialized nations, even if you restrict yourself to people with full insurance.
The honest truth is that there are a LOT of expensive procedures of questionable value that are accepted and paid for. The prime one I know about is "Stents". Several studies have shown that life expectency for people that undergo expensive surgery to implant uncoated stents into their veins because the veins were blocked/collapsed is no better than people using relatively cheap pills.
Right now, a lot of health care is 'unproven' with regards to helping the patient. They find something that does X and claim that X means the patient will get better, but often that is not the case. They prove things like Y medicine lowers chlorestal, but don't check to see if it increases life expectancy. Sometimes that same medicine also raises the risk of cancer, or may increase all chlorestal, even the good one, and life expectancy does not change.
I don't have a solution to this problem, but it should be pointed out.
excitingthingstodo.blogspot.com
Because its the humane thing to do dipshit.
dude, it's kind of hard to make the case for charitable giving instead of taxes with the language of rationalizing your impulses towards selfishness. it's like looking through tissue paper, your motivations are so transparent
basically, someone who is truly charitable at heart would never utter the words you just wrote above. perhaps you do give to charity. people have a lot of motivations for giving to charity. i would suspect that if you actually gave to charity, you are motivated by something else other than a charitable heart. not that it's wrong to give to charity just because your motivations aren't absolutely pure, hardly. but it is certainly wrong to argue against charity, forced or unforced, simply because someone suggests charity is mandatory rather than voluntary
no one truly altruistic at heart thinks like that. the very thougth process you display is alien to the concept of altruism. however, the thought process on display in your words above is the beating heart of the selfish instinct. people who are truly altruistic at heart DO think it is mandatory to give... that's why they give! the selfish thinker looks for the slightest, flimsiest excuse not to give. and you've done a spanking job constructing one of those in your words above wilbur
in your words above, you want to give because you feel like it's important to give... but the moment someone suggests it isn't voluntary, that it's mandatory... nope! not giving anymore!
oh really?! that's all it takes to get you to stop giving?!
what a charitable person you are! i can see the depth of your altruism in your words! it's truly awe inspiring the deep hold it has on your heart, your aching compelling desire to give to others is on regal display in your words above (snicker)
thanks for the laugh dude, thanks for playing a little game to keep me entertained, but basically the crocodile tears really don't impress, sorry. a kindergartener could see through you
intellectual property law is philosophically incoherent. it is your moral duty to ignore it or sabotage it
CTS, My fear is this: socialized medicine will increase the demand and then drive up prices. To control rising expenses the government puts in place waiting lists, rationing, or price controls to reduce the expenses. The profit motive to school for how many years to become a doctor will erode, leaving us with less. Then you will have less doctors treating more people. A lower percentage will get the treatments they need and more will have to go without. Do you really think that the poor will be able to jump in front of the rich to get these limited procedures? (Note: Most legislators are in the upper half of the wealth spectrum.)
i'm just glad you give
;-)
but when i hear your strong reaction to the concept that you SHOULD give, it makes me wonder if you really give at all, or what your true motivations might be if you do give
see a truly altruistic person doesn't have a problem with the idea of giving, forced or unforced
an altrusitic person understands it is their reponsibility to take care of their community. this realization is that the heart of their altruism. therefore, they give freely and happily
but some altruistic people are disturbed that some don't give at all
and therefore they understand why some must be forced to do what they choose to do freely: some people aren't altruistic, they are selfish
all of which renders your tanturm at the idea of being forced to give rather suspect
shakespeare said it better than me: "methinks the lady doth protest too much"
intellectual property law is philosophically incoherent. it is your moral duty to ignore it or sabotage it
and yet, still better than the current status quo
why do you think a flimsy guarantee of health is worse than NO guarantee of health?
intellectual property law is philosophically incoherent. it is your moral duty to ignore it or sabotage it
So, spending 400 million dollars a day for the Iraq war is better than treating human beings from their illnesses or educating them?
No.
In other words, health care is a scarce resource that must be allocated in some fashion. Just like any other scarce resource allocation problem, there will always be some methodology where it is decided who gets what.
One system is to decide based on money: the people with the most money will get the most health care. The advantage to this system of allocation is that it will happen no matter what else you do - more money will always equal better health care, because there will always be someone willing to take payment for services. Various factors can affect how much more money is required to receive the best health care, but the fundamental fact will still hold true.
Another system is to decide what a basic minimum of health care is, and guarantee that minimum to all people irrespective of the money they, personally, have. This will increase the relative scarcity of health care to everyone else, thereby increasing that "how much" number from the previous paragraph. The net effect will tend to be raising the level of health care for lower incomes, maintaining it for low/middle incomes, decreasing it for upper/middle incomes, and maintaining it (at higher cost) for the high incomes.
Yet another system is to subsidize all health care, and give everyone equal access to all levels of medical attention. This shifts the burden of allocating the scarce resource away from having money, and towards having time/luck. The net effect of this will depend entirely on what system replaces money (interpersonal relationships? How long you can wait in a waiting room? A national lottery system?) as the determinant of allocation. The only thing that can be guaranteed is that it won't change the availability of health care for the high incomes (though it will increase the cost, both in money and, possibly, time - if, for example, they need to go to less-regulated countries for some procedures).
That's just the reality of the situation. There are only so many doctors, nurses, MRI machines, hospitals, clinics, ambulances, what-have-you to go around. How many childhood immunizations could each one of the people in the ER for an 18-hour heart operation perform in that 18 hours? All those immunizations go undone while the person on the bed is having his quadruple bypass.
What we have now may well be the worst of all worlds, where the customers are the least involved in determining costs of all the players, and organizations that neither receive nor provide health care are the major profit makers. You can make a good case that any sort of somewhat planned system is better than the agglomeration of interests from all sides coming to an emergent compromise that we have right now - I'd agree with that completely.
But you're never going to get past the fact that the weatlhiest will always get whatever health care they want, you're never going to be able to provide the best possible health care for everyone, and you're going to have to, in some fashion, decide who doesn't get care that they need.
Reality has a conservative bias: it conserves mass, energy, momentum...
Here's a great link that helps illustrate the "problem" with healthcare in the US by asking why is there no car insurance crisis.
Constitutionally Correct
the choice is between taking more money from you, and someone else getting well
the choice is not between taking more money from you for the heck of it, and not taking more money from you
do you understand?
or do you insist on your propagandistic way of presenting the choices before us in a vacuum, rather than as they exist in reality: in context, between two kinds of competing losses of liberty
you loose liberty every day according to various compromises so that you may gain some other type of liberty
tell me, which do you gain more liberty with: an extra $50 in your pocket? or a healthier society?
that's the real choice before you, the choice in context. not in a vacuum. you have to learn to stop thinking in simplistic half truths, and understand the larger web of cause and effect that your life is part of
you are not an island
intellectual property law is philosophically incoherent. it is your moral duty to ignore it or sabotage it
You can use Technology to create solutions, but technology by itself without intelligent application is basically a waste of money. It won't magically solve problems -- it's just a toolset like any other.
Mainframe/UNIX Bit Twiddler and long time Windows/Linux Hobbyist.
The Theorem Theorem: If If, Then Then.
I'll always take advice from a guy with a handle like "sumdumass". nuff said.
I may not be a smart man, but I know what an inode is.
The overhead due to the forms that doctors offices have to deal with amount to 1/3 the cost of health care in this country.
Ever wonder why the United States spends more on health care and gets so little in return in comparison to other capitalist industrialized nations? Because, they have nationalized health care and they don't have a for profit health insurance industry.
BTW - Why are our emergency rooms overflowing? Because people that don't have health insurance tend to put off going to the doctor till the very last gasp. What is the most common reason for people filing for bankruptcy in the United States? Answer: Catastrophic
health problems (like cancer, Diabetes, etc).
One more thing... 8 million children in the United States have no health care coverage in the United States.
I may not be a smart man, but I know what an inode is.
Can technology fix the technology that broke the healthcare system that was never correct in the first place?
I tried to think of a good sig, and this wasn't it.
You are operating on principles that are not sound. 'Humane' is a feel-good term, but does not in itself carry any weight.
Would it be nice to be able to provide health care to everyone? Yes. Would it be fair or even doable? Not at present.
The appeal of 'humane' treatment is not a good one.
"You can either have software quality or you can have pointer arithmetic, but you cannot have both at the same time."
I'm only 26 and I'm still at my first job out of college. I work for a dept. of the state of NJ and have an awesome benefits package. I recently went to the ER for stitches and I paid $25 for my visit. A few weeks later I got a summary of the billing and it was as follows...
Total bill from hospital: $1600+
My co-pay: $25
Insurance paid: $360
Now, how can that be? The insurance company, which undoubtedly is filthy stinking rich, gets a "bulk rate" of less then 1/4 of the total bill? WTF!?!?! It boggles my mind. What if I didn't have insurance? Do i owe the full $1600? I understand that if you can't pay it, you get help, but at what cost? Debt for the rest of your life? What if I can afford to pay, but don't have insurance? Do they let me off with only paying less then 1/4 of the full price?...i doubt it!...
Seems like the best way to fix this problem would be to make these scumbags(read: insurance companies) pony up the full amount billed.
... brought you some of the "best care anywhere". From the article:
Also:
People need to just drop the idea that government-provided healthcare is somehow inferior. It's not. By almost any measure - patient satisfaction, outcomes, costs - the government run VA system is significantly better than private medicine. You don't need heavy sedation to believe it.
We've heard from the libertarians, from people who work for medical software companies, and from people who work for insurance companies. I am the sys admin for a medical practice with 7 doctors. My perspective is that the doctors make plenty of money, but the insurance, software, and pharmaceutical companies are really what drive up the price of healthcare. Insurance companies are paying doctors less and less for procedures. They are charging consumers more. Where is the money going? Look at the stock prices and CEO salaries and bonuses for the top insurance companies. They are obviously making a huge profit. They also employ the largest number of lobyists in Washington. Medical software companies are charging absurd prices, bundling unnecessary hardware, and requiring exorbitant annual maintenance fees. They get away with it because doctors lack technical and business savvy. It's no secret that pharmaceutical companies spend a lot of money wooing doctors. There's a constant stream of drug reps in my building. They always have free samples. They usual bring lunch for the entire office. In fact, I'm having a "free" lunch right now. I don't know if you can fix the healthcare system in one fell swoop. I think the problems need to be addressed individually, starting with the low hanging fruit.
The fact that some Doctors and Nurses think that they can tell doesn't mean that they can. The process you are describing is not a statistical analysis of treatment, it's assigning treatment instead of on ability to pay on ability of loved ones to show up. Similarly to the general social medicine situation where the politically connected get the best treatment, it all seems less fair than the American ability to pay.
It's basically assigning woth to the life based upon how much the doctor's decide that that life is worth... that hardly seems to be the role that we want them in.
My point was that the fact that 80% of costs are in the last year is something we know in retrospect. You don't know if the $50,000 heart treatment will work or not. If it doesn't work, then that was $50,000 in the last year. You often have survival rates of 50% - 90% for major treatment, in all cases some people, statistically speaking, will have "wasted treatment."
and someone ignorant of road laws see no reason to stop for red lights. and people ignorant of common sense see no reason to not take that cell phone call in the movie theatre
point is, you live in a community, and it is your repsonsibility to take care of it, whether you like it or not
where did that $50 come from? did God himself reach down from the sky and put it in your pocket? no, you got it from giving something to the community. and wiat a seoncd... what is money anyway? money is just a symbolic expression of expression of value in a society. in other words, you don't own any money. what you own is a recognition of oyur value within society. money has no value outside of socety... but you want to thinnk about it as something different from it, when it is philosophically utterly entwined with that which you have zero respect for: your fellow men and women
in other words, think of your community like a farmer would think of a field. if you take care of it, it gives you good crops. it pays you well. it gives oyu more money. if you ignore it and just take from it, it goes to seed and rot and weeds. it gives you less money. not paying your taxes means that lateron down the road, you will get $20 instead of $50 in your paycheck. you make no investment in that which makes you money means you make less money. the taxes you pay don't disappear like a far tin the wind. they pay for things that benefit you, and everyone else. get the simple concept dear simpleton?
basically, your entire attitude boils down to: i want to benefit from my community, but i don't want to add anything back to maintain it. i drive to work on roads, but i don't want to pay to get them fixed, i want people working around me, but i don't want to help people recover from illness, i want to be free form crime, but i don't want to pay to protect citizens form banditry. got it: you're ignorant of anything outside yourself or how you are not an island
and really, it's ok that you're ignorant and selfish. ignorance is common enough of a personal failure, you got a lot of company. and it's ok because your taxes will be taken out of you anyway, no matter that you don't understand why, no matter that you don't understand that you have a responsibility to take care of your community, you WILL take care of it, whether you like to or not
it's because of people like you that we have taxes in the first place. too few people voluntarily contribute to the greater good. some ignorants, like yourself, have to be compelled to contribute to that which allows them to benefit from society. ignroants think that things like stability, education, healthcare for the poor, money, a job, security: they just magically appear. others understand what it takes to maintain these things
so you continue being your empty headed self. those who understand how the world works will tax your ignorant head and keep you happy, thinking you live in a bubble
intellectual property law is philosophically incoherent. it is your moral duty to ignore it or sabotage it
You may not have noticed, but hospitals make far more off of the uninsured than they do off those who are insured.
Look at an explanation of benefits for hospital treatment. If you have "good insurance", anywhere from 20-60% of the hospital bill is written off when insurance declares the amount charged to be higher than the industry established norm, then insurance pays their portion, and you pay whatever is left over. That "written off" portion neither you nor insurance pays for, the hospital just has to absorb the loss of income.
The uninsured can't look at their bill and declare a big portion of it as "too high", so they pay whatever rate the hospital wants to charge, or go bankrupt trying.
"Flame away, I wear asbestos underwear"
i just think you are being disingenuous. "methinks the lady doth protest too much" is pretty much my whole attitude towards you: for someone whose work is so complete, you seem rather upset at the idea of anyone being compelled to give. such a tender wound to be nursing for someone who self-identifies as robustly satisfied, no?
;-)
you are the brave champion for those unnaturally compelled to give? hmmm... what an interesting crusade for you to champion, dear confessor of altruistic contentment
and as for giving leeway to the pathologically envious, i actually was only giving leeway to the simply envious. but even though you raise the bar higher, i will still meet it: yes, i would give the pathologically envious far more leeway than i give the simply selfish. the pathologically envious are laughably pathetic, and yet they are still more deserving than the simply selfish
intellectual property law is philosophically incoherent. it is your moral duty to ignore it or sabotage it
you have crossed the threshold of an argument we are having into another argument: you have gone from point of contention #1: "i don't have responsibility to my community" to point of contention #2: "ok, i have repsonsibility, but i differ on the degree of my responsibility"
i don't have any problem with the latter and anything you said about it. yes, it is contentious and evolving and full of pitfalls. i DO however have a problem with the former, and the only people i have an argument with in this thread
intellectual property law is philosophically incoherent. it is your moral duty to ignore it or sabotage it
a wasteful, sluggish, barely responsive, bureaucratic healthcare system is better than no healthcare system at all
the worst government in the world is still better than anarchy
intellectual property law is philosophically incoherent. it is your moral duty to ignore it or sabotage it
Can I assume that you have never read Hamlet? You are continuing to misquote it, and furthermore you are misinterpreting the original quote's meaning.
On the flip side, I suppose that I the type of thing that I should expect from a person willing to argue that pathological envy is somehow preferable simply wanting more control over one's own charity or altruism. Wouldn't you agree?
They don't grade fathers, but if your daughter's a stripper, you fucked up. --Chris Rock
Gordon Guyatt et al. just published "A systematic review of studies comparing health outcomes in Canada and the United States," in volume 1, issue 1 of Open Medicine, a new Canadian journal with an editorial board composed of some of the world's top medical experts, and a staff that just quit or got fired from Canada's formerly top medical journal.http://www.openmedicine.ca/article/view/8/ 1 The review's conclusion is:
"Available studies suggest that health outcomes may be superior in patients cared for in Canada versus the United States, but differences are not consistent."
The article also says that, in 2003, Americans spent an estimated US$5,635 per capita on health care, while Canadians spent US$3,003.
The journal Open Medicine is another story. John Hoey, editor of CMAJ, the journal of the Canadian Medical Association, was fired last year by the CMA, and most of the staff resigned. http://content.nejm.org/cgi/content/full/354/19/19 82 http://www.cmaj.ca/cgi/content/full/174/1/9 http://www.cmaj.ca/cgi/content/full/173/12/1435 Hoey sent reporters to buy morning-after pills in pharmacies around Canada. They found out that pharmacists illegally asked for personal information, which was entered in their computers. The Canadian Pharmacists Association complained to the CMA, and the CMA censored the story. The CMAJ staff now founded this new journal, Open Medicine, and they have loaded the first issue with the best studies they could get.
so what is going on here is not that i am trying to exert control over you, the overriding issue at hand is taking care of our fellow human beings, to recognize that responsibility. force, if it comes into play, ONLY comes into play when someone refuses to accept their responibilities. do you deny it is your reponsibility to take care of your fellow human beings?
for a teenager, the answer would be "no, i don't have the responsibility!" SIMPLY BECAUSE the threat of force exists behind those words, and you react to the threat of force, rather than the real overriding concept. just like you said:
absolutely classic teenaged psychology going on here. you say many many people react to force this way: yes, exactly. the many people you allude to are teenagers and those adults who are still psychologically teenagers. simply because somebody is developmentally retarded though does not mean society has to for some reason respect their inflamed and pathological reaction to the phantom idea of force. force exists in any society, yes. it has to. but it's not about fascism, it's not about force purely for the sake of domination. you see it that way because force in your mind is a point of inflamed passion, a hysteria
but in reality, there is such a thing as too little force, and too much force. but in your mind, there is only one thing: way too much force. because the very concept of force as a normal and MINOR part of any normal functioning society is something your psychology has not yet developmentally come to grips with
my whole premise, my overriding concern, is an awareness of your responsibility to your fellow man. but that's not how you hear it. for your mind, the overriding premise of my words and the overriding concern is "i will control you"
that's not my thrust at all! but you hear it that way, due to your teenaged psychology
it's like some teenagers getting pulled over for drunk driving and whining about fascist police taking away their freedoms. well yeah, they are having their freedoms taken away by the police. but not because the police are some sort of mindless gang that likes to control people's lives for no reason, but because the teenagers were driving drunk. in a mind where control is preeminent issue, the "fascist police" is the dominant issue. but in reality, the dominant issue is "don't drive drunk, or you'll go to jail". get it?
you may not, you may be bordering on paranoid schizohrenia, and i may only be inflaming you more
ah well, put it this way: for an adult psychology, there is an acceptance of repsonsibilities. not because of force, but because of MATURITY. you are seeing me as presenting myself as a parental figure. hardly. i am not doing that. what is happening is your teenaged psychology is choosing to see me that way
that's really all that is going on here. no one really wants to control you simply for the sake of controlling you. really. the nanny state requires people who think in terms of parent-child relationships. the master-slave relationship requires people who accept being slaves as much as it requires masters. you are the one supplying yourself as being in the child position in this argument, i am not the one supplying myself as the parent in this argument. when i talk to you, i do n
intellectual property law is philosophically incoherent. it is your moral duty to ignore it or sabotage it
if you tell me that being envious, to any degree, is less of a concern than being selfish, to any degree
;-)
you seem to perpetually frame your words in such a way that you avoid the idea of selfishness as existing in society, and the need to counteract its negative effects. do you accept it exists or not? do you see deleterious effects because of it? or not?
why is it that the issue of selfishness never seems to register in your concerns? strange
insert your own appropriate shakespearean quote here then (snicker)
intellectual property law is philosophically incoherent. it is your moral duty to ignore it or sabotage it
> The New Deal was the single biggest disaster in the history of the US government, in my opinion. Before we had that, the national debt was actually paid off some years.
Look, if you're going to talk about the national debt, you're going to have to look WAY after the New Deal before you see it inflate. Please, at least blame the right people for the national debt.
And just because I'm betting you don't know, here's a nice graph of the national debt so you can see that it really started spiking in the 1980s, under Reagan. That's quite a long way off from the New Deal.
But who am I kidding? You even dragged the 2nd Amendment into this for no reason. You're just trolling.
Not that there really are such people above all others, on whom the unwashed masses unknowingly rely.
But it makes for a nice, mythical superman via which one can claim supposed superiority.
I was deliver a choice quote from Tommy Boy about guarantees but the bottom line is that I don't believe a guarantee from the government, especially when it's not a guarantee. (Look the huge Social Security cuts that are looming.) Socialized medicine will drive personel out of the field. Less people will be available to treat the ill. The guarantee doesn't matter when there aren't enough doctors. Don't forget all the people who will suffer in the future when research money goes elsewhere. Right now most people who need help get it one way or another.
i am fully ready to talk to you as adult human being, but it is you who presents yourself with a teenager's mentality, and so i must treat you this way
if you act like an adult, and talk about your responsibilities to your community, rather than talking about who is forcing who to do what, then i will treat you like an adult
my whole point is, i am not the one who is making the subject matter about force. you are. and so i must talk about that subject matter to show you that the world, and what i am saying about it, is not as you perceive
libertarianism has less to do with your words than simple teeenaged psychology. you're immature
intellectual property law is philosophically incoherent. it is your moral duty to ignore it or sabotage it
there is an 800 pound gorilla in the room sitting next to you, and it grows larger with every word you say, simply by your continued omission of a certain glaring point i have highlighted multiple times, and which you continue to disregard
intellectual property law is philosophically incoherent. it is your moral duty to ignore it or sabotage it
that's the biggest stretch of suspended disbelief in a twisted attempt at rationalization that i have seen in a long time
"it is better because it can become something else i don't care to describe and which nullifies my original point about anyways"
wtf?!
next, time try to be more coherent please, k thx
what you presented above is laughable stretching at best
intellectual property law is philosophically incoherent. it is your moral duty to ignore it or sabotage it
kuro5hin.org?
intellectual property law is philosophically incoherent. it is your moral duty to ignore it or sabotage it
I'm sorry, I thought I had already addressed each of your points and insights. Which one was it? Any omissions were certainly unintentional.
They don't grade fathers, but if your daughter's a stripper, you fucked up. --Chris Rock
snore...
consult any of my earlier posts, they all mention it
wake me up when you stop dancing...
intellectual property law is philosophically incoherent. it is your moral duty to ignore it or sabotage it
classic teenaged bullshit
read his original post... it's all about reverse psychology from his mom to get him to clean up his room, because if anyone tries to force him to do anything, he won't do it simply on the principle of being forced
that's not ideology right there, that's psychology
i'm sorry, but with this guy, there is no political differences going on
it is pure, 100%, immature teenaged psychology
intellectual property law is philosophically incoherent. it is your moral duty to ignore it or sabotage it
I have consulted all of your earlier posts, and I have determined that I have addressed each of your thoughtful points.
They don't grade fathers, but if your daughter's a stripper, you fucked up. --Chris Rock
snore...
intellectual property law is philosophically incoherent. it is your moral duty to ignore it or sabotage it
Well, if your concern is so minute, so minuscule that it doesn't even merit a copy and paste, I'll just assume that you never really wanted it addressed in the first place.
Good day.
They don't grade fathers, but if your daughter's a stripper, you fucked up. --Chris Rock
True. Compared to poor Chinese and poor Indians, even most poor Americans are well off.
Now, think about why "capitalistic" corporations are exporting jobs to China and India. Think about why HMOs are willing to send people to Thailand for medical care....
There is a fine line between recklessness and courage... -- Paul McCartney