No, they just make it impossible to ever live a normal life ever again.
How is that any different than going to jail and having a criminal record follow you around?
They ruin your career and alienate your friends and family. They force you to live through humiliation and shaming every day, often for weeks or months at a time.
Welcome to the life of any ex-convict. While the mob way was definitely the incorrect way to do this, all the people mentioned in the story got exactly what they deserved. Killing kittens, cheating on your spouse, etc should be cause for you to have to get humiliation and shame from others.
Leaving aside whether that is appropriate punishment or not...
I hope most people see the difference between a conviction in a court of law and Internet mob justice. While *these* people may be unequivocally guilty, there are no rules, no checks and balances in place to ensure that the next person is. There's no innocent until proven guilty, burden of proof, right to representation, or rules of evidence. There is what people believe to be true, and the actions they take based on it. If their belief is misguided, or doesn't happen to be in line with law (for example, if an Internet group decided to ruin a woman's life because she had a perfectly legal abortion), then you've got a big problem on your hands.
The rules are there to protect everyone... especially the innocent who are accused anyway. It happens every day. Circumventing the rules may provide a certain visceral satisfaction, but it doesn't serve the greater good at all.
The site chosen for a data center can greatly affect its value to a hospital. Because on-campus real estate is probably tight, a remote data center is highly recommended.
And a senior sysadmin type costs $60-80k a year, plus 25% for bennies. That's pretty damned expensive for a small practice.
She had the money. She paid it all in cash. But most people aren't in that situation, and if you're not, you'll be totally screwed if you have no insurance. That's all I'm saying... your method only works if you've got six or seven figures in the bank ready for disaster to strike.
Also, she bought two cars in my entire lifetime. She drove the first one for 25 years (gotta love Toyotas), the second for 7. The second one was still in great shape when she died.
And then you have to consider what proportion that is of the total expenditure on healthcare.
I love that link. Here's what I found:
The per capita government expenditure on healthcare in 2006 (in USD) for: Canada $2754 UK $2939 US $3074
So the US government is not just spending a greater percentage of its total budget, but also spending more per person. This likely includes military health care, which is in many ways excellent (and in many ways atrocious... let's not fight about it; in any event, it's expensive), not just Medicare and Medicaid. But that's still a small percentage of our population receiving care given the per-capita expense.
Then when you look at TOTAL spending:
Canada $3912 UK $3361 US $6714
wow. We're spending about double per person compared to the UK. For that, we're probably a lot healthier, right?
So I picked some random indicators. Some are better for the US, some not:
Adult mortality rate (probability that a 15-year-old will die before reaching age 60):
Canada 72 UK 80 US 109
Ok, not even sure HOW the US is above 100 on that. But there ya go.
Infant mortality is 5.0 for each of Canada and the UK, and is 7.0 for the US. The incidence of tuberculosis is similarly low between the US and Canada, but is about three times higher in the UK; that surprised me. Deaths due to tuberculosis are pretty negligible; there was 1 in the UK, none in Canada and the US.
But, given that we're spending as much as 2x what they are, shouldn't we be... I dunno... twice as healthy? Clearly the market for health care in the US has raised prices, but it doesn't seem to have improved outcomes all that much. For a given individual, it might make a difference... but for the population as a whole, it's hurting us.
Hospitals managed without computers before the '60s/'70s, so why can't they get by with a paper-based backup process today?
I'm sure that they could provide the same level of care they provided in the 1960s and 1970s without computers. But then your formulary is a whole lot smaller; you've got no Cipro, no antiretrovirals, nothing to be done about MRSA, no imaging besides x-rays (and even those aren't that great, being dependent on film with no computer enhancement), no HIPAA compliance, no arthroscopic surgery, a much narrower selection of anesthesia options... plus, the largest segment of your patient population (the baby boomers) are most likely coming to you for routine exams or prenatal care, rather than having heart disease and type II diabetes and prostate cancer.
Health care has changed. In large part, the changes have been possible because of computers, and associated technology. If you want the old-fashioned level of care, maybe you can find someone to give it to you... but don't come crying to me if you get cancer or pop your ACL.
Most EHRs are hosted systems. The costs involved in putting your own data center into your care setting are enormous. Not only that, but having your data restricted to your site eliminates some of the benefit of EHRs; if your personal physician has privileges at the hospital, and has a logon to the EHR that they can use from their practice, you can follow up with them after an ER visit and they don't have to request your records. If they have to be on the hospital's LAN to access them, then the records have to be printed out and carried or mailed to the office, which will probably delay their availability (unless you have the presence of mind to request a copy before you leave the ER... which you always should, anyway, but most of us aren't thinking that clearly when we're in that state).
More and more ambulatory care providers are organizing into Health Center Coordinated Networks, to lower licensing costs, improve support, and pitch in on connectivity solutions, too. That requires them to be hosted systems.
They could certainly use standard word processor documents to keep track of patient information. Or copy off some of the old paper forms. How hard is that?
Well, if the power's out, pretty hard.
But they *did* start using the paper forms. Every care setting with an EMR has a disaster recovery "drop to paper" plan in place. The issue wasn't that the power went out and they said "Oh noes! Now we can't make peepuls bettur!" It's that after about 30 hours of doing everything on paper, the backlog was SO huge that their ability to keep track of patient's information was compromised. They needed to stop adding to that backlog so they could catch up, for the safety of the patients currently in the hospital.
They probably have a form cycle system. That's probably what they implemented when the system went down and they had to "drop to paper."
Being able to scan the forms in is useful for looking up later what happened during the outage, but it's of no use WHILE the system is down. Your form cycle system may rely on temp workers to come in and scan all those forms after an outage. The system in TFA had been down more than 24 hours when they went on diversion; by that time, the amount of papers waiting to be scanned was probably staggering.
We don't know what causes autism. It's not "vaccines," it's not "genetics," it's not "diet," it's not "bacteria," it's not "heavy metal toxicity," it's not "too much television," it's not "birth trauma." But ALL of these items have been shown to correlate to SOME kinds of autism. What is likely is that there is a genetic predisposition to autistic traits, which is then expressed in various ways (or not at all) depending on environmental factors, including substances that the body is exposed to (food, heavy metals, medicines) and experiences (birth trauma, television exposure), as well as the overall status of the state machine that is the human body (levels of beneficial or harmful gut flora, for example), which again is influenced by environmental factors and inherited factors.
For the vast majority of children, vaccines do not cause autism. For a tiny number of children, autistic symptoms emerged shortly following vaccination. Note that there are multiple ways that autism expresses itself; some children exhibit symptoms practically from birth (babies that don't make eye contact, that engage in play in atypical manners, etc.), while some have sudden onset after relatively normal infancy/toddlerhood. There are plenty of kids who had no vaccines and are still autistic. There's also plenty of kids who were developing perfectly normally until a particular vaccine, and now they're autistic.
We don't really know very much about how the immune system works, especially when it comes to autoimmune disorders; we need to recognize that vaccines are an intervention, and like ANY OTHER medical procedure, should follow a process of informed consent. I live in one of the biggest port cities in the world; you bet my kids will be vaccinated against polio (the older one is; the younger just started his vaccinations). but Prevnar? It's a scam. They told the CDC it would reduce ear infections by about 5 million a year, so the CDC put it on the schedule... but a prior and ex post facto study have both shown that it only impacts vulnerability to a particular type of bacterial meningitis that hits about 7,000 kids a year. And it's by far the most expensive vaccine on the schedule, plus it has a much higher rate of adverse reaction than other vaccines.
While there's no conclusive evidence that X vaccine causes "autism," there's also no research at ALL showing that the current vaccination schedule used in the US is better than some other schedule. Right now, the CDC instructs doctors and parents to expose two-month-old babies to 13 separate strains of disease in a single office visit, then go away for two months and repeat the process. There is NO evidence that this results in better outcomes than starting at six months, or a year. There's some evidence that it does not, when US outcomes are compared to those in other developed nations with different vaccination schedules.
Bottom line... EVERY parent should read the "package insert" info for each vaccine, and the CDC data on the diseases they're protecting against, and make an informed decision about whether the vaccine is appropriate for their child. No one should accept or reject the entire panel out of hand with no consideration. There are a whole lot of adverse health outcomes emerging in our population (increased rates of autism, allergies, asthma, obesity, diabetes), and we don't know the exact causes; our aggressive vaccination schedule is a likely suspect, along with many other changes, such as overuse of antibiotics and topical antibacterials, changes in perinatal procedure, new medications, pollution, lifestyle changes, changes to our food supply, and so on.
No one's right, no one's wrong. Parents with autistic children often exercise extreme caution in what they expose their children to, because they frankly don't know (nobody does) what caused the condition or might make it worse (or better). From a sociological standpoint, vaccines offer us "herd immunity," and are desirable. There, can we all hug and make up now?
In some cases that's true, but not usually. It's only true if they already have records for the patient, and if they have identified the patient, and if they have bothered to look it up.
Whenever I've sought medical care, regardless of whether it was a scheduled visit, urgent care, or hospital admission, the experience usually includes two questions early on:
"Are you allergic to any medication?" "Are you currently taking any prescription or over-the-counter medication?"
I get asked these questions even in situations where I know they're staring at my previous answers on the screen in front of them. They want to see if anything's changed.
Now... they can, do, and did still ask these questions without the EMR. The problem becomes where the ANSWERS go. Someone asks the question, writes the answer down on the paper form they fell back to, and....
If this was a hospital still using paper for their primary charting, it would get routed into the paper chart. That chart would be put in a pocket made for it on the exam room door, or would be given to the chart runner to take where it needs to go, etc. There would be PEOPLE whose job it is to get that chart where it's going.
One of the advantages of an EMR/EHR is that you don't need all these people to file, pull, and run charts around your office/hospital. It's a cost savings, and an efficiency gain. But it also means that, when you fall back to paper, you don't have those people you used to to do all that paper-routing. For an hour or two, this isn't such a horrible problem... but when it goes on, and the paper stacks up, you start to have trouble keeping the pieces of paper in the right place, so that you have access to information that YOUR FACILITY generated just half an hour ago.
I can totally understand why this happened. I'm glad they handled it, instead of just ignoring the problem.
Well, we'd still have to document everything pretty much the same -- you can (and do) still have payment/service disputes with self-pays, too.
Mind you, I do agree that Health Care would be better suited if it were allowed to be a (cash) business like any other,
It is. Every doctor, hospital, lab, and pharmacy is perfectly happy to accept cash payments.
but as long as you have lousy, mooching, wealth-bashing ingrates who think that health care is something to which they're entitled (they're not.),
Yeah, that's true. By "Life, liberty, and the pursuit of happiness" our founding fathers didn't actually intend for people to *live*, I'm sure.
Were the Health Care market (more) free (as in speech, not as in beer), you wouldn't have the problem with Health Care that you now do -- that is, that Health Care has effectively priced most of its consumers (customers) out of the market. Health Care has no incentive to innovate and develop low-cost products and services.
Your final statement is true, but you're wrong about how we got there.
There is no limit on what people are *willing* to pay for a longer life or better health. Sure, at some point, a small incremental change won't be worth a relatively large cost; no one's going to pay $100 for another minute of life. But $10,000 for another month? $100,000 for another year? A lot of people would be willing, if they had the money.
It doesn't work like that, though. You don't know how much life you're buying; all you're buying is the ability to cheat death. And the demand curve for that isn't very curved. Practically everyone is willing to pay practically anything for that. The demand is as inelastic as it gets.
This throws the normal equilibrium pricing completely out of whack. You've got a demand curve that almost immediately asymptotically approaches infinity, so your supply curve is almost irrelevant.
Then you get into what people *can* pay... and this gets all screwed up again. Because while we balance food and shelter and other important expenses, people routinely trade off between feeding themselves and paying doctor bills. They sell their homes to pay the hospital. When the alternative is "You could die," people don't sit there and rationally decide how much their own or their child's life is to them. They sign now, and deal with the consequences. They may go into bankruptcy, move the entire family into a relative's spare bedroom, get a second job... at the moment they're agreeing to pay the (unknown until the bill arrives) cost, they DON'T CARE how much it is.
So the most profitable health care is that which postpones death with ongoing maintenance, that has the widest applicability, that deals with the most dramatic of situations. The technology gets better, and everyone wants the best. Do you look at your ten-year-old with leukemia and decide they don't *need* the really good hospital? They can get by with the previous generation of chemo drugs?
Health care cannot be efficiently allocated by a free-market system. It's a total market failure.
Just imagine how much easier it would be if we simply paid cash, you know like our ancestors did prior to World War 2. Walk in; get your service; and hand-over the cash, check, or credit card. That's what I do today. I even get a 10% discount from my doctor since he says my approach makes his life much simpler.
Yes, it does. The hospital will even give you a discounted rate if you ever need a major procedure. My uninsured cousin, for example, was able to negotiate a rate of only $10,000 for the first 10 days of her hospital stay after having her uterus and part of her colon removed due to cancer. (If she'd taken care of the pain in her abdomen sooner, she wouldn't have lost her colon and might have recovered... but, without insurance, she was hoping that the pain would just go away without her having to shell out $150 for a doctor's visit, plus whatever tests they needed to run.)
Of course, that $10,000 just paid for the bed, the nurses, and the food. Then there's the cost of every bag they hook up to your IV, all the meds, and the $75,000 she paid for surgery and the doctor's care. The anesthesiologist bills separately, too.
If you have $100,000 in the bank waiting in case of catastrophe, your system works. If you don't, though, you can lose EVERYTHING... your car, your house, not to mention your credit rating... due to one bad illness or accident. Say someone hits you and speeds off while you're crossing the street. Even the healthiest people have catastrophic health problems sometimes.
me i wish you could get a standardized flash key with a dump of your records (can't access the main server just use the local copy) (not counting the pay us a couple hundred a year and we will include this neat flash key type services)
And when the power's out, how do they read your flash key? Do you dump the data to paper at home before hopping in the ambulance?
Actually how about eliminating the problem itself ? If the paperwork is overwhelming, with a reasonable minimum workforce present in the hospital, the government (the recipient of said paperwork),
I work for a non-profit healthcare provider, where 94% of our patients are below 200% of the Federal Poverty Level. Most of *our* paperwork does go to the government... the County as part of the Public-Private Partnership fund, the State as part of OAPP, the Feds as part of our FQHC billing, etc. (Only about 17% of our patients even have Medicaid or Medicare). A lot of that paperwork also goes to our private funders; foundations and corporations that donate to specific programs and then expect us to report on our results.
But for most hospitals and doctor's offices, most of that paperwork is for billing private insurance companies. A fraction is for billing public insurance for those without private. Some is sent straight to the patient. A lot is for accreditation and patient records, too (and The Joint Commission is a private, non-profit entity... they are who is usually accrediting hospitals and ambulatory care).
needs to accept the fact that there isn't any paperwork, and foot the bill anyway.
As mentioned above, they're not generally footing the bill.
Obviously this will present docters with patients without medical records. But better to be treated a bit worse than not at all.
It's not "a bit worse." Incomplete or inaccurate medical records kill thousands of people every year, and many more suffer permanent or temporary injury as a result. Giving me or my son certain common antibiotics via IV can kill me. Medical records are EXTREMELY important, because people are very different from each other.
Obviously any sort of national healthcare system will preclude having this common-sense approach, as any system that does not make it the responsibility of the patient to ensure medical bills are paid will ration health care ("total health care resources" are limited. Either you let people pay for them, or you ration them). Rationed health care means "no government approval, no healthcare" both in theory and in practice.
I really don't know where this keeps coming from. Obviously, just like every private insurance company in creation, a government-run health plan would also decide what was worth the money and what wasn't. This does not currently and could not in the future prevent people from paying out of pocket if they think it's worth it. I'm not sure how people get from "government provides health care" to "government prohibits the purchase of health care by private entities."
It is very true that, when confronted with the incredible costs of certain treatments and medications that are declined for coverage, people find themselves unable or unwilling to pay. It's therefore unlikely that people will just pay out-of-pocket for those services which are not covered. This does not mean they are prevented from doing so by legislation; it simply means that the person footing the bill is likely to weigh the situation differently.
[wtf is up with/. formatting today? I've tried everything to put line breaks in the right places, but it keeps running paragraphs together anyway. Bah.]
A monopoly, of any kind, is a bad idea. Imagine the DMV or Amtrak running your hospitals - no thanks. I prefer the freedom of choice where if I don't like Country General I can go visit St. Josephs instead. If they are crap I can to to John Hopkins or Mt. Sinai or any other place within driving difference.
Unless the pain in your abdomen is so intense, you ARE GOING to the closest hospital no matter who runs them, because you don't know what's going on and whether you have time to go to the next one.
We were in that situation about a year and a half ago. There's a Catholic Healthcare West hospital just a mile from our house. CHW played a large role in my cousin's death, and given all the lawsuits pending against them for their billing practices, I had vowed never to darken their door. But when my husband had a kidney stone (and we had no idea what was going on), and the next hospital was several more miles away, I took him to the closest ER anyway.
That's why healthcare is a market failure. There is not perfect access, or anything even approaching it. You cannot make informed decisions based on quality of service and cost and all that when you think you might be dying. You'll go wherever's closest, no matter HOW badly they do their job, if you think that they're at least basically competent WRT lifesaving.
BTW, JC Penney has much better quality than Macy's. You might try "Nordstrom" in that last slot.
It's not like the JRE shipped by default with the OS, and the original version didn't include the firefox extension while subsequent updates bring this new functionality.
is misleading. Of course JRE doesn't ship with the OS. It doesn't ship with any OS. It's a product made by a company seperate from the OS's manufacturer. It's like bitching about a.pdf reader not coming with the OS, and when you go get it, it plugs in to your browser to read.pdfs in the browser window, but the.jpg viewer that came with the OS gains.pdf support through a later update, and causes.pdf links in your browser to open in it instead after you install the update.
I think that was his point. Comparing Java JRE to this Firefox add-on isn't accurate, BECAUSE Java is a totally separate program you go out and deliberately get, and then install, and it happens to install an add-on to your browser (and IIRC tells you so in the install wizard). OTOH, the.NET add-on is being installed by a security update to the OS, without notifying you that they're changing functionality in a separate program.
I think the real question is, whose Internet is it? Does it belong to the corporations, the marketers, the governments, and other monied interests? Or does it belong to the people who use and enjoy it?
At best, you're creating a false dichotomy here. "The Internet" doesn't belong to anyone. The hardware, data lines, servers, client machines, and content belong to a whole lot of different entities around the world; no one category of them "owns" the Internet. We're all in this together.
Insofar as laws identify who is the "owner" of a particular piece of content, and what that ownership means in terms of their rights, we're all subject to that (unless we're in a different jurisdiction that says we don't have to pay attention). But an awful lot of the internet would be too expensive to maintain without a revenue stream, and that revenue stream has two ends: the producers, and the consumers. Neither one has "ownership" of the internet in any meaningful way; each is a necessary part of the whole.
Except for a bit of expansion in DHTML and Flash, you could do everything then that you could do now. The only differences is bandwidth and processing power.
I don't think the issue is what kind of functionality you can potentially implement, but what kinds of functionality *are* implemented and available. Back then, I couldn't order pizza or make a restaurant reservation on the web. I couldn't find out the value of my car or house, or how my salary compares to others in my field. Et cetera, ad infinitum. No discipline is an island; back when it was just geeks on the Internet, geeks still had to interact with the rest of the world on a regular basis. Now we can do that without leaving the Internet. And for that, I'm grateful.;-)
Yes, in WoW, you *can* solo. But if you are playing an MMOG, chances are, you enjoy the social aspect at least a little bit, so it's more FUN to group. Hence, you frequently see duos and larger groups just out questing and leveling together, because *gasp* it's FUN.
So maybe the game doesn't *have* to force grouping on you to be "good." And maybe a game that my husband and I can play together for an hour after the kids are asleep is more in demand than something that you need 30-45 minutes to set up and pack up at the beginning and end of each play session. It doesn't mean someone might not prefer something different, but it means, probably, that games that require a large investment, where the risks of going AFK (because the baby started crying, or someone came to the door, or you needed to go to the bathroom) are big enough to wipe out your entire play session, will be niche products.
And yea, SWG wins with custimazation again...how many different styles of just jacket were there? Even the standard composite armor most people wore at least came in array of colors.
But everyone wanted the cloak, and the cloak palette sucked. There were what, 26 colors? I know I made display models of them all and had them arranged in my house.
There were a few overpopulated servers that had waits at peak periods. This was seen as preferable to having SO many people playing on the server that it slowed down the game for everyone, but clearly, the servers had adequate capacity; the problem was traffic management. Everyone wanted to play on the same server as Gabe and Tycho, or Thott, or wanted the RPPVP experience, or whatever... and it took a while for free transfers to thin out the herd and balance the population.
MOST games have had overpopulation problems on certain servers or in certain zones, at least at launch (and the peak-time queues have returned for a week or two following the release of each expansion to WoW as well). But WoW implemented a system to handle population caps and queue players at launch. Yet another example of "polish."
The servers are stable in that they very rarely crash or get taken down for emergency maintenance.
Let's be sensible: You cannot create an MMO at the same "polished" level as WoW. No MMO, ever, will have the polished feel of an MMO that has been in existance for about 5 years.
How many years had EQ been around when WoW launched?
And in public beta, WoW was more "polished." It ran better, it had more content, more world area, a better UI... there was a huge sense of "Oh, *this* is what Verant was trying to do all that time!"
Now, I think a lot of this probably has to do with differences in management practices and such between the companies. Verant/SOE had some serious issues in how they related to their player base, how they planned expansions, and I suspect they also had never heard of source control;-). This meant that anyone who was halfway professional about developing an MMORPG had a big advantage over them. Blizzard, not being at such a disadvantage, won't be as easy to "beat."
But it doesn't mean it can't be done. Yes, you'd have to have a whole lot of money to sink into development, but there are some big game companies out there without a solid MMO offering who might decide the time is ripe to spend millions on developing the Next Big Thing. And the bar is higher now, clearly. But it's entirely possible that someone could look at WoW, and say "It's great, but what if we..." and come out with something even better from the get-go. Maybe it doesn't have to be "more" polished, but if it's *as* polished, with some good innovations and sufficient content from launch, as well as a well-structured dev cycle to ensure new content is added fast enough to keep up with 85% of the playerbase (while not feeling rushed or letting issues slide in released content), it could happen.
The "Jedi are supposed to be rare" argument always seemed a bit strange to me. The game could expect what, half a million players at most? Of which maybe 50k would ever be online at the same time. Compared to the number of NPCs in the universe the players would be tiny.
Um, did you play SWG? There weren't very darned many NPCs. There were a few trainers, the guy you caught shuttles from, and a few vendors, plus random people standing around for flavor. Quests came from a vending machine, though. Like most MMOGs, the players vastly outnumbered the NPCs.
Slashdot Mirror
No, they just make it impossible to ever live a normal life ever again.
How is that any different than going to jail and having a criminal record follow you around?
They ruin your career and alienate your friends and family. They force you to live through humiliation and shaming every day, often for weeks or months at a time.
Welcome to the life of any ex-convict. While the mob way was definitely the incorrect way to do this, all the people mentioned in the story got exactly what they deserved. Killing kittens, cheating on your spouse, etc should be cause for you to have to get humiliation and shame from others.
Leaving aside whether that is appropriate punishment or not...
I hope most people see the difference between a conviction in a court of law and Internet mob justice. While *these* people may be unequivocally guilty, there are no rules, no checks and balances in place to ensure that the next person is. There's no innocent until proven guilty, burden of proof, right to representation, or rules of evidence. There is what people believe to be true, and the actions they take based on it. If their belief is misguided, or doesn't happen to be in line with law (for example, if an Internet group decided to ruin a woman's life because she had a perfectly legal abortion), then you've got a big problem on your hands.
The rules are there to protect everyone... especially the innocent who are accused anyway. It happens every day. Circumventing the rules may provide a certain visceral satisfaction, but it doesn't serve the greater good at all.
But that was a written letter from one man to a family member.
No, that was a Manifesto which was directed at the entire world. The right person saw it and realized it was written by his brother.
From your link:
The site chosen for a data center can greatly affect its value to a hospital. Because on-campus real estate is probably tight, a remote data center is highly recommended.
And a senior sysadmin type costs $60-80k a year, plus 25% for bennies. That's pretty damned expensive for a small practice.
She had the money. She paid it all in cash. But most people aren't in that situation, and if you're not, you'll be totally screwed if you have no insurance. That's all I'm saying... your method only works if you've got six or seven figures in the bank ready for disaster to strike.
Also, she bought two cars in my entire lifetime. She drove the first one for 25 years (gotta love Toyotas), the second for 7. The second one was still in great shape when she died.
And then you have to consider what proportion that is of the total expenditure on healthcare.
I love that link. Here's what I found:
The per capita government expenditure on healthcare in 2006 (in USD) for:
Canada $2754
UK $2939
US $3074
So the US government is not just spending a greater percentage of its total budget, but also spending more per person. This likely includes military health care, which is in many ways excellent (and in many ways atrocious... let's not fight about it; in any event, it's expensive), not just Medicare and Medicaid. But that's still a small percentage of our population receiving care given the per-capita expense.
Then when you look at TOTAL spending:
Canada $3912
UK $3361
US $6714
wow. We're spending about double per person compared to the UK. For that, we're probably a lot healthier, right?
So I picked some random indicators. Some are better for the US, some not:
Adult mortality rate (probability that a 15-year-old will die before reaching age 60):
Canada 72
UK 80
US 109
Ok, not even sure HOW the US is above 100 on that. But there ya go.
Infant mortality is 5.0 for each of Canada and the UK, and is 7.0 for the US. The incidence of tuberculosis is similarly low between the US and Canada, but is about three times higher in the UK; that surprised me. Deaths due to tuberculosis are pretty negligible; there was 1 in the UK, none in Canada and the US.
But, given that we're spending as much as 2x what they are, shouldn't we be... I dunno... twice as healthy? Clearly the market for health care in the US has raised prices, but it doesn't seem to have improved outcomes all that much. For a given individual, it might make a difference... but for the population as a whole, it's hurting us.
Hospitals managed without computers before the '60s/'70s, so why can't they get by with a paper-based backup process today?
I'm sure that they could provide the same level of care they provided in the 1960s and 1970s without computers. But then your formulary is a whole lot smaller; you've got no Cipro, no antiretrovirals, nothing to be done about MRSA, no imaging besides x-rays (and even those aren't that great, being dependent on film with no computer enhancement), no HIPAA compliance, no arthroscopic surgery, a much narrower selection of anesthesia options... plus, the largest segment of your patient population (the baby boomers) are most likely coming to you for routine exams or prenatal care, rather than having heart disease and type II diabetes and prostate cancer.
Health care has changed. In large part, the changes have been possible because of computers, and associated technology. If you want the old-fashioned level of care, maybe you can find someone to give it to you... but don't come crying to me if you get cancer or pop your ACL.
Most EHRs are hosted systems. The costs involved in putting your own data center into your care setting are enormous. Not only that, but having your data restricted to your site eliminates some of the benefit of EHRs; if your personal physician has privileges at the hospital, and has a logon to the EHR that they can use from their practice, you can follow up with them after an ER visit and they don't have to request your records. If they have to be on the hospital's LAN to access them, then the records have to be printed out and carried or mailed to the office, which will probably delay their availability (unless you have the presence of mind to request a copy before you leave the ER... which you always should, anyway, but most of us aren't thinking that clearly when we're in that state).
More and more ambulatory care providers are organizing into Health Center Coordinated Networks, to lower licensing costs, improve support, and pitch in on connectivity solutions, too. That requires them to be hosted systems.
They could certainly use standard word processor documents to keep track of patient information. Or copy off some of the old paper forms. How hard is that?
Well, if the power's out, pretty hard.
But they *did* start using the paper forms. Every care setting with an EMR has a disaster recovery "drop to paper" plan in place. The issue wasn't that the power went out and they said "Oh noes! Now we can't make peepuls bettur!" It's that after about 30 hours of doing everything on paper, the backlog was SO huge that their ability to keep track of patient's information was compromised. They needed to stop adding to that backlog so they could catch up, for the safety of the patients currently in the hospital.
They probably have a form cycle system. That's probably what they implemented when the system went down and they had to "drop to paper."
Being able to scan the forms in is useful for looking up later what happened during the outage, but it's of no use WHILE the system is down. Your form cycle system may rely on temp workers to come in and scan all those forms after an outage. The system in TFA had been down more than 24 hours when they went on diversion; by that time, the amount of papers waiting to be scanned was probably staggering.
Oh, brother, why am I wading into this?
We don't know what causes autism. It's not "vaccines," it's not "genetics," it's not "diet," it's not "bacteria," it's not "heavy metal toxicity," it's not "too much television," it's not "birth trauma." But ALL of these items have been shown to correlate to SOME kinds of autism. What is likely is that there is a genetic predisposition to autistic traits, which is then expressed in various ways (or not at all) depending on environmental factors, including substances that the body is exposed to (food, heavy metals, medicines) and experiences (birth trauma, television exposure), as well as the overall status of the state machine that is the human body (levels of beneficial or harmful gut flora, for example), which again is influenced by environmental factors and inherited factors.
For the vast majority of children, vaccines do not cause autism. For a tiny number of children, autistic symptoms emerged shortly following vaccination. Note that there are multiple ways that autism expresses itself; some children exhibit symptoms practically from birth (babies that don't make eye contact, that engage in play in atypical manners, etc.), while some have sudden onset after relatively normal infancy/toddlerhood. There are plenty of kids who had no vaccines and are still autistic. There's also plenty of kids who were developing perfectly normally until a particular vaccine, and now they're autistic.
We don't really know very much about how the immune system works, especially when it comes to autoimmune disorders; we need to recognize that vaccines are an intervention, and like ANY OTHER medical procedure, should follow a process of informed consent. I live in one of the biggest port cities in the world; you bet my kids will be vaccinated against polio (the older one is; the younger just started his vaccinations). but Prevnar? It's a scam. They told the CDC it would reduce ear infections by about 5 million a year, so the CDC put it on the schedule... but a prior and ex post facto study have both shown that it only impacts vulnerability to a particular type of bacterial meningitis that hits about 7,000 kids a year. And it's by far the most expensive vaccine on the schedule, plus it has a much higher rate of adverse reaction than other vaccines.
While there's no conclusive evidence that X vaccine causes "autism," there's also no research at ALL showing that the current vaccination schedule used in the US is better than some other schedule. Right now, the CDC instructs doctors and parents to expose two-month-old babies to 13 separate strains of disease in a single office visit, then go away for two months and repeat the process. There is NO evidence that this results in better outcomes than starting at six months, or a year. There's some evidence that it does not, when US outcomes are compared to those in other developed nations with different vaccination schedules.
Bottom line... EVERY parent should read the "package insert" info for each vaccine, and the CDC data on the diseases they're protecting against, and make an informed decision about whether the vaccine is appropriate for their child. No one should accept or reject the entire panel out of hand with no consideration. There are a whole lot of adverse health outcomes emerging in our population (increased rates of autism, allergies, asthma, obesity, diabetes), and we don't know the exact causes; our aggressive vaccination schedule is a likely suspect, along with many other changes, such as overuse of antibiotics and topical antibacterials, changes in perinatal procedure, new medications, pollution, lifestyle changes, changes to our food supply, and so on.
No one's right, no one's wrong. Parents with autistic children often exercise extreme caution in what they expose their children to, because they frankly don't know (nobody does) what caused the condition or might make it worse (or better). From a sociological standpoint, vaccines offer us "herd immunity," and are desirable. There, can we all hug and make up now?
In some cases that's true, but not usually. It's only true if they already have records for the patient, and if they have identified the patient, and if they have bothered to look it up.
Whenever I've sought medical care, regardless of whether it was a scheduled visit, urgent care, or hospital admission, the experience usually includes two questions early on:
"Are you allergic to any medication?"
"Are you currently taking any prescription or over-the-counter medication?"
I get asked these questions even in situations where I know they're staring at my previous answers on the screen in front of them. They want to see if anything's changed.
Now... they can, do, and did still ask these questions without the EMR. The problem becomes where the ANSWERS go. Someone asks the question, writes the answer down on the paper form they fell back to, and....
If this was a hospital still using paper for their primary charting, it would get routed into the paper chart. That chart would be put in a pocket made for it on the exam room door, or would be given to the chart runner to take where it needs to go, etc. There would be PEOPLE whose job it is to get that chart where it's going.
One of the advantages of an EMR/EHR is that you don't need all these people to file, pull, and run charts around your office/hospital. It's a cost savings, and an efficiency gain. But it also means that, when you fall back to paper, you don't have those people you used to to do all that paper-routing. For an hour or two, this isn't such a horrible problem... but when it goes on, and the paper stacks up, you start to have trouble keeping the pieces of paper in the right place, so that you have access to information that YOUR FACILITY generated just half an hour ago.
I can totally understand why this happened. I'm glad they handled it, instead of just ignoring the problem.
Well, we'd still have to document everything pretty much the same -- you can (and do) still have payment/service disputes with self-pays, too.
Mind you, I do agree that Health Care would be better suited if it were allowed to be a (cash) business like any other,
It is. Every doctor, hospital, lab, and pharmacy is perfectly happy to accept cash payments.
but as long as you have lousy, mooching, wealth-bashing ingrates who think that health care is something to which they're entitled (they're not.),
Yeah, that's true. By "Life, liberty, and the pursuit of happiness" our founding fathers didn't actually intend for people to *live*, I'm sure.
Were the Health Care market (more) free (as in speech, not as in beer), you wouldn't have the problem with Health Care that you now do -- that is, that Health Care has effectively priced most of its consumers (customers) out of the market. Health Care has no incentive to innovate and develop low-cost products and services.
Your final statement is true, but you're wrong about how we got there.
There is no limit on what people are *willing* to pay for a longer life or better health. Sure, at some point, a small incremental change won't be worth a relatively large cost; no one's going to pay $100 for another minute of life. But $10,000 for another month? $100,000 for another year? A lot of people would be willing, if they had the money.
It doesn't work like that, though. You don't know how much life you're buying; all you're buying is the ability to cheat death. And the demand curve for that isn't very curved. Practically everyone is willing to pay practically anything for that. The demand is as inelastic as it gets.
This throws the normal equilibrium pricing completely out of whack. You've got a demand curve that almost immediately asymptotically approaches infinity, so your supply curve is almost irrelevant.
Then you get into what people *can* pay... and this gets all screwed up again. Because while we balance food and shelter and other important expenses, people routinely trade off between feeding themselves and paying doctor bills. They sell their homes to pay the hospital. When the alternative is "You could die," people don't sit there and rationally decide how much their own or their child's life is to them. They sign now, and deal with the consequences. They may go into bankruptcy, move the entire family into a relative's spare bedroom, get a second job... at the moment they're agreeing to pay the (unknown until the bill arrives) cost, they DON'T CARE how much it is.
So the most profitable health care is that which postpones death with ongoing maintenance, that has the widest applicability, that deals with the most dramatic of situations. The technology gets better, and everyone wants the best. Do you look at your ten-year-old with leukemia and decide they don't *need* the really good hospital? They can get by with the previous generation of chemo drugs?
Health care cannot be efficiently allocated by a free-market system. It's a total market failure.
Just imagine how much easier it would be if we simply paid cash, you know like our ancestors did prior to World War 2. Walk in; get your service; and hand-over the cash, check, or credit card. That's what I do today. I even get a 10% discount from my doctor since he says my approach makes his life much simpler.
Yes, it does. The hospital will even give you a discounted rate if you ever need a major procedure. My uninsured cousin, for example, was able to negotiate a rate of only $10,000 for the first 10 days of her hospital stay after having her uterus and part of her colon removed due to cancer. (If she'd taken care of the pain in her abdomen sooner, she wouldn't have lost her colon and might have recovered... but, without insurance, she was hoping that the pain would just go away without her having to shell out $150 for a doctor's visit, plus whatever tests they needed to run.)
Of course, that $10,000 just paid for the bed, the nurses, and the food. Then there's the cost of every bag they hook up to your IV, all the meds, and the $75,000 she paid for surgery and the doctor's care. The anesthesiologist bills separately, too.
If you have $100,000 in the bank waiting in case of catastrophe, your system works. If you don't, though, you can lose EVERYTHING... your car, your house, not to mention your credit rating... due to one bad illness or accident. Say someone hits you and speeds off while you're crossing the street. Even the healthiest people have catastrophic health problems sometimes.
me i wish you could get a standardized flash key with a dump of your records (can't access the main server
just use the local copy) (not counting the pay us a couple hundred a year and we will include this neat flash key
type services)
And when the power's out, how do they read your flash key? Do you dump the data to paper at home before hopping in the ambulance?
Actually how about eliminating the problem itself ? If the paperwork is overwhelming, with a reasonable minimum workforce present in the hospital, the government (the recipient of said paperwork),
I work for a non-profit healthcare provider, where 94% of our patients are below 200% of the Federal Poverty Level. Most of *our* paperwork does go to the government... the County as part of the Public-Private Partnership fund, the State as part of OAPP, the Feds as part of our FQHC billing, etc. (Only about 17% of our patients even have Medicaid or Medicare). A lot of that paperwork also goes to our private funders; foundations and corporations that donate to specific programs and then expect us to report on our results.
But for most hospitals and doctor's offices, most of that paperwork is for billing private insurance companies. A fraction is for billing public insurance for those without private. Some is sent straight to the patient. A lot is for accreditation and patient records, too (and The Joint Commission is a private, non-profit entity... they are who is usually accrediting hospitals and ambulatory care).
needs to accept the fact that there isn't any paperwork, and foot the bill anyway.
As mentioned above, they're not generally footing the bill.
Obviously this will present docters with patients without medical records. But better to be treated a bit worse than not at all.
It's not "a bit worse." Incomplete or inaccurate medical records kill thousands of people every year, and many more suffer permanent or temporary injury as a result. Giving me or my son certain common antibiotics via IV can kill me. Medical records are EXTREMELY important, because people are very different from each other.
Obviously any sort of national healthcare system will preclude having this common-sense approach, as any system that does not make it the responsibility of the patient to ensure medical bills are paid will ration health care ("total health care resources" are limited. Either you let people pay for them, or you ration them). Rationed health care means "no government approval, no healthcare" both in theory and in practice.
I really don't know where this keeps coming from. Obviously, just like every private insurance company in creation, a government-run health plan would also decide what was worth the money and what wasn't. This does not currently and could not in the future prevent people from paying out of pocket if they think it's worth it. I'm not sure how people get from "government provides health care" to "government prohibits the purchase of health care by private entities."
It is very true that, when confronted with the incredible costs of certain treatments and medications that are declined for coverage, people find themselves unable or unwilling to pay. It's therefore unlikely that people will just pay out-of-pocket for those services which are not covered. This does not mean they are prevented from doing so by legislation; it simply means that the person footing the bill is likely to weigh the situation differently.
[wtf is up with /. formatting today? I've tried everything to put line breaks in the right places, but it keeps running paragraphs together anyway. Bah.]
A monopoly, of any kind, is a bad idea. Imagine the DMV or Amtrak running your hospitals - no thanks. I prefer the freedom of choice where if I don't like Country General I can go visit St. Josephs instead. If they are crap I can to to John Hopkins or Mt. Sinai or any other place within driving difference.
Unless the pain in your abdomen is so intense, you ARE GOING to the closest hospital no matter who runs them, because you don't know what's going on and whether you have time to go to the next one.
We were in that situation about a year and a half ago. There's a Catholic Healthcare West hospital just a mile from our house. CHW played a large role in my cousin's death, and given all the lawsuits pending against them for their billing practices, I had vowed never to darken their door. But when my husband had a kidney stone (and we had no idea what was going on), and the next hospital was several more miles away, I took him to the closest ER anyway.
That's why healthcare is a market failure. There is not perfect access, or anything even approaching it. You cannot make informed decisions based on quality of service and cost and all that when you think you might be dying. You'll go wherever's closest, no matter HOW badly they do their job, if you think that they're at least basically competent WRT lifesaving.
BTW, JC Penney has much better quality than Macy's. You might try "Nordstrom" in that last slot.
your bit about
It's not like the JRE shipped by default with the OS, and the original version didn't include the firefox extension while subsequent updates bring this new functionality.
is misleading. Of course JRE doesn't ship with the OS. It doesn't ship with any OS. It's a product made by a company seperate from the OS's manufacturer. It's like bitching about a .pdf reader not coming with the OS, and when you go get it, it plugs in to your browser to read .pdfs in the browser window, but the .jpg viewer that came with the OS gains .pdf support through a later update, and causes .pdf links in your browser to open in it instead after you install the update.
I think that was his point. Comparing Java JRE to this Firefox add-on isn't accurate, BECAUSE Java is a totally separate program you go out and deliberately get, and then install, and it happens to install an add-on to your browser (and IIRC tells you so in the install wizard). OTOH, the .NET add-on is being installed by a security update to the OS, without notifying you that they're changing functionality in a separate program.
I think the real question is, whose Internet is it? Does it belong to the corporations, the marketers, the governments, and other monied interests? Or does it belong to the people who use and enjoy it?
At best, you're creating a false dichotomy here. "The Internet" doesn't belong to anyone. The hardware, data lines, servers, client machines, and content belong to a whole lot of different entities around the world; no one category of them "owns" the Internet. We're all in this together.
Insofar as laws identify who is the "owner" of a particular piece of content, and what that ownership means in terms of their rights, we're all subject to that (unless we're in a different jurisdiction that says we don't have to pay attention). But an awful lot of the internet would be too expensive to maintain without a revenue stream, and that revenue stream has two ends: the producers, and the consumers. Neither one has "ownership" of the internet in any meaningful way; each is a necessary part of the whole.
Except for a bit of expansion in DHTML and Flash, you could do everything then that you could do now. The only differences is bandwidth and processing power.
I don't think the issue is what kind of functionality you can potentially implement, but what kinds of functionality *are* implemented and available. Back then, I couldn't order pizza or make a restaurant reservation on the web. I couldn't find out the value of my car or house, or how my salary compares to others in my field. Et cetera, ad infinitum. No discipline is an island; back when it was just geeks on the Internet, geeks still had to interact with the rest of the world on a regular basis. Now we can do that without leaving the Internet. And for that, I'm grateful. ;-)
Honorary +1 Insightful. ;-)
Yes, in WoW, you *can* solo. But if you are playing an MMOG, chances are, you enjoy the social aspect at least a little bit, so it's more FUN to group. Hence, you frequently see duos and larger groups just out questing and leveling together, because *gasp* it's FUN.
So maybe the game doesn't *have* to force grouping on you to be "good." And maybe a game that my husband and I can play together for an hour after the kids are asleep is more in demand than something that you need 30-45 minutes to set up and pack up at the beginning and end of each play session. It doesn't mean someone might not prefer something different, but it means, probably, that games that require a large investment, where the risks of going AFK (because the baby started crying, or someone came to the door, or you needed to go to the bathroom) are big enough to wipe out your entire play session, will be niche products.
And yea, SWG wins with custimazation again...how many different styles of just jacket were there? Even the standard composite armor most people wore at least came in array of colors.
But everyone wanted the cloak, and the cloak palette sucked. There were what, 26 colors? I know I made display models of them all and had them arranged in my house.
There were a few overpopulated servers that had waits at peak periods. This was seen as preferable to having SO many people playing on the server that it slowed down the game for everyone, but clearly, the servers had adequate capacity; the problem was traffic management. Everyone wanted to play on the same server as Gabe and Tycho, or Thott, or wanted the RPPVP experience, or whatever... and it took a while for free transfers to thin out the herd and balance the population.
MOST games have had overpopulation problems on certain servers or in certain zones, at least at launch (and the peak-time queues have returned for a week or two following the release of each expansion to WoW as well). But WoW implemented a system to handle population caps and queue players at launch. Yet another example of "polish."
The servers are stable in that they very rarely crash or get taken down for emergency maintenance.
At least if you want to "beat" WoW.
Let's be sensible: You cannot create an MMO at the same "polished" level as WoW. No MMO, ever, will have the polished feel of an MMO that has been in existance for about 5 years.
How many years had EQ been around when WoW launched?
And in public beta, WoW was more "polished." It ran better, it had more content, more world area, a better UI... there was a huge sense of "Oh, *this* is what Verant was trying to do all that time!"
Now, I think a lot of this probably has to do with differences in management practices and such between the companies. Verant/SOE had some serious issues in how they related to their player base, how they planned expansions, and I suspect they also had never heard of source control ;-). This meant that anyone who was halfway professional about developing an MMORPG had a big advantage over them. Blizzard, not being at such a disadvantage, won't be as easy to "beat."
But it doesn't mean it can't be done. Yes, you'd have to have a whole lot of money to sink into development, but there are some big game companies out there without a solid MMO offering who might decide the time is ripe to spend millions on developing the Next Big Thing. And the bar is higher now, clearly. But it's entirely possible that someone could look at WoW, and say "It's great, but what if we..." and come out with something even better from the get-go. Maybe it doesn't have to be "more" polished, but if it's *as* polished, with some good innovations and sufficient content from launch, as well as a well-structured dev cycle to ensure new content is added fast enough to keep up with 85% of the playerbase (while not feeling rushed or letting issues slide in released content), it could happen.
The "Jedi are supposed to be rare" argument always seemed a bit strange to me. The game could expect what, half a million players at most? Of which maybe 50k would ever be online at the same time. Compared to the number of NPCs in the universe the players would be tiny.
Um, did you play SWG? There weren't very darned many NPCs. There were a few trainers, the guy you caught shuttles from, and a few vendors, plus random people standing around for flavor. Quests came from a vending machine, though. Like most MMOGs, the players vastly outnumbered the NPCs.