Rubbish. You can own a TV that can be used to watch TV and so long as it is never switched on, you don't have to pay. I know, because this describes my situation a few years ago.
I think you're right to say that there will be interesting new revenue streams opening up -- the refresh cycle for a phone vs a laptop is one obvious way that at least some of the loss can be recouped. I agree that the lack of a keyboard isn't fatal, and portable kit will obviously help, as will new technology (maybe this is the driver for speech-to-text software to go mainstream?).
This is fantastic insight into the future of the iPhone. It makes absolute sense that in due course, the iPhone *becomes* the computer. There's a huge challenge for Apple to manage -- how to monetise this future, as it clearly erodes the value of their current computer lineup, but you're spot on. The key technical challenge is finding a way to provide a mobile user with a keyboard, trackpad and laptop while they are out of the office and needing to do the kind of work (spreadsheets, powerpoint) that can't easily be done on an iPhone. I guess technically the solutions might incorporate OLED screens that can be rolled up, but how to make the setup non-clunky is challenging (although the kind of challenge that Apple has prowess in solving)
Mate, this is just horseshit. Asserting that "if it's worth spending $200k to save your life, you can afford it" doesn't make it so. There are tens of millions of people in your country and mine who could never even dream of persuading anyone to lend them that much money, nor of paying it back if by some weird chance some kindly bank manager made them the loan. In 2006, the bottom 20% of US households earned less than $19,178. Do you really believe that the vast majority of these households could ever get or pay back a loan of $200k (no matter how dire the consequences of not obtaining the money)? And if you don't consider $200k expensive, then have in mind that care can be much, much more expensive than that: well in excess of £1m for a single intervention. And of course, you don't always get to be conscious or competent at the point at which treatment decisions need to be made. For example, a young man was caught in a bomb blast in London in 2005. His care involved rescue by paramedics and firefighters, a complete resus team who restarted his heart twice, a full CT scan, a major trauma op involving six doctors, ten nurses and many more support staff, a microbiology team to identify and resolve fungal infections, another bout of surgery to remove a damaged eye and replace with a prosthesis, more surgery to resolve a pulmonary embolism, extensive stays in intensive care and rehab involving dozens more doctors, nurses, physical therapists, occupational therapists, psychologists and pyschiatrists, etc, plus prosthetic legs, vast amounts of pharmaceuticals, etc etc. The costs for this must easily have exceeded £500k. Lifetime costs will be much higher. He had no opportunity to make the kind of sovereign decisions about his care that you so fondly imagine, and at the most crucial point, nor did anyone who could be regarded as a guardian (parent, significant other).
This kind of story sits beautifully alongside your glorious statement that "if you have the earnings potential after being saved, you can afford it". So presumably, if you don't have the earnings potential after being saved, you can't afford the treatment. In which case, if someone's say, 80 years old and has a stroke, they should get the treatment only if they commit to going back to work. What happens if the stroke renders them unable to work, by the way?
You originally said: "Either people in the US blow out their joints way more frequently than Europeans with socialized health care (unlikely), or their system isn't providing them with that option [joint replacement surgery]. So our 'inferior' privatized system is providing more people with life-improving treatments..."
So you've provided two possible explanations for your observation that 50% of joint replacements globally happen on just 5% of the global population: 1. People in the US blow out their joints way more frequently than Europeans 2. Socialized health care systems are not providing them with the option for joint replacement surgery
I caricatured 2 as "pennypinching bureaucrats are cruelly denying Europeans of the care they need". Your "socialized health care / system" = my "pennypinching bureaucrats". Your "not providing" = my "cruelly denying". Your "that option / life-improving treatment" = my "the care they need". My caricature is thus firmly rooted in each part of your original explanation. And it's not much of a caricature, either -- your original statement was clearly implying that you thought the American system was better than European systems because it provided more access to joint replacements.
You then rephrased your original explanation as follows: "from a bureaucratic perspective, a $600 wheelchair or $200 walker is just as much a solution to the problem as a $25,000 joint replacement"
It's still all in there: your "from a bureaucratic perspective" directly equals my "pennypinching bureaucrats". It also clearly implies "cruelly denying" (after all, who could read your sentence and not be moved to compare "a bureaucratic perspective" with "a humane perspective"?). And the only reading of the phrase "a $600 wheelchair or $200 walker is just as much a solution to the problem as a $25,000 joint replacement" that rings true is that you are saying "Europeans are being given wheelchairs instead of joint replacements as a cost-saving, ie pennypinching, measure"
Finally, you rephrased your original explanation from: 'Socialized health care systems aren't providing Europeans with the option of [joint replacement surgery]...so our 'inferior' privatized system is providing more people with life-improving treatments' to: "elective procedures are neglected if there is a cheaper option that covers the need" By writing in the third person, and removing words such as "socialized", "privatized", 'inferior', "life-improving", you created a more dispassionate argument, but the core contention remains the same: the reason there are fewer joint replacements in Europe is that to save money, cheaper options are used instead.
Your position has thus not shifted at all throughout, which is good. And my description of your explanation holds as true for your third restatement of your position as your first. And I repeat, there is at least one other explanation for why Americans have joint replacement surgery more frequently than Europeans, and I think it's obvious: American doctors and insurance companies recommend earlier and more aggressive intervention than European doctors. And I went on to cite one example of where the jury is out on whether earlier and more aggressive intervention is worthwhile (breast cancer), and I'll now cite another example of where higher operating rates are undoubtedly because of earlier and more aggressive intervention: c-section rates.
Studies show that the best outcomes for mothers and babies appear to occur with cesarean section rates of 5% to 10%. Rates above 15% seem to do more harm than good (Althabe and Belizan 2006). And the rate in the US is about 33% (up ~50% in about a decade). And in the UK it's about 20%, and somewhat lower in many other European countries. I raise this to make clear that you cannot assume that a lower rate of intervention (eg fewer joint replacements) demonstrates worse levels of care or outcomes (eg more pain and less mobility).
You're nowhere near the clear-sighted rationalist you believe yourself to be, and I'm not the dewy-eyed, woolly-minded liberal you're imagining me to be either.
I am thinking. I'm thinking, "I think it's worth spending $200k to save my life, but oh shit, I don't have the $200k needed for this operation. Oh well, I'm economically non-viable. This feller thinks I should therefore just be left to die." I'm also thinking, "this feller either does not know or does not care that his proposal would create yet more inequities in health, to join a crowded field: a rich person and a poor person with the same disease and the same desire to treat it, but the poor person dies because they don't have the money to pay for treatment, while the rich person lives". Tell me, are you the kind of moralising snit that blames poor people for being poor, so they get what they deserve, or do you have some other form of motivation, such as "the market will sort it all out"?
In any event, in answer to your question, health economists long ago needed to develop a method to compare the relative benefits and costs of different interventions and non-interventions. It's called the QALY, and in the UK, the cutoff for funding ("range of acceptable cost effectiveness") is set at about £30k (oh my god, a number! and set by the state and not a freeborn individual making sovereign decisions for their own selves. What cruel and stupid calculus is this!!). Given the UK median household income was ~£25k in 2004, it's clear that the UK health system provides a safety net for families against illnesses whose treatments would otherwise be catastrophically expensive or simply unaffordable.
I agree that confounding factors make it challenging to understand what statistics about health are telling us, but I don't think that we should simply throw our hands up and say "such figures cannot be compared from one country to another" or that "infant mortality cannot be shown to be affected by health systems as opposed to the social and environmental determinants of health".
Um. The explanation you've laid out here is just a repeat of your previous explanation, which is that pennypinching bureaucrats are cruelly denying Europeans of the care they so desperately need.
You may disagree that my explanation is obvious, but I think it's pretty fuckin obvious myself. Especially given that there's plenty of evidence of aggressive early intervention for lots and lots of diseases in all branches of healthcare, and not all of it is helpful, and lots of it happens in the US. Breast cancer screening is just one such area.
OK, you got me. I almost believed you were serious. And then I thought, no-one could be that much of a dumb prick to think that "if I can't afford a 300K operation, then I'm not worth keeping alive. But if I can, I am". So you must be a troll. Right?
You've set up a false dichotomy with your either-or. The other obvious explanation for the high rates of joint replacement in the US compared to everywhere else is that doctors and insurers are trigger happy and recommend earlier and more aggressive intervention. This may or may not be the right thing to do, but it's not *obviously* the right thing to do. There are always risks and downsides to each course of action (or inaction) in healthcare.
As for your final comment, it's very nice that you'd rather pay more and pay for yourself. Let's hope your disease isn't one that's too expensive for you to afford to treat out of your own resources.
You didn't read the Wikipedia article properly. It said that countries used to use different standards but that most developed countries have been using the same WHO definition of infant mortality since the late 1980s or early 1990s. It strikes me that this is mostly squirming around trying to find reasons why infant mortality is higher in the US than other developed countries other than the obvious one: because for a large fraction of the US population, health and healthcare is worse than in other countries.
You have the causative chain the wrong way round: why do black Americans suffer greater infant mortality than white Americans? Two reasons: they're poor (and poverty is a risk factor for morbidity and mortality), and the healthcare they receive is of a lower standard.
The choices are not: 1) Get whatever care you need in the wonderful US 2) Stand in line in commie Britain
The choices are: 1) Get whatever care you individually can afford in the US (rationing by cost) 2) Get whatever care you as a country decide via the government you can collectively afford in the UK, potentially waiting up to 18 weeks for it (rationing by waiting list)
The former method tends to ensure that rich people live even longer and healthier lives than poor people than would otherwise be the case. The latter method leads to endless grumbling about cruel governments denying people access to treatments that cost more than £30k/QALY.
I agree. To be honest, I think this is perfect example of Avon and Somerset Police demonstrating that public sector organisations fail to understand the needs of the people they serve, and then "punish" them if they exhibit the "wrong" behaviour. You couldn't imagine Tesco behaving in this way. It's clear from watching the clips that many of these calls are made simply because people trust the police to solve every problem (who said authority figures were dead in modern society?) and know of only one way to get hold of them: 999. The fixes would work rather better if they focused on ensuring everyone knows that another number besides 999 and knows that it's the best number to call to get stuff sorted -- and then for that number to be staffed by people empowered to connect callers with the services they need (animal health, social services, the health service etc etc).
I think they'd be far better off calling Val Curtis and asking her how she went to consumer goods companies for advice on how to persuade people in developing countries to change their habits. By respecting the undeniable truth about how people behaved in response to the messages they received, she helped craft the right kinds of messages to encourage soap-washing and is on track to save millions of lives. http://www.iht.com/articles/2008/07/13/business/13habit.php
(None of this is to deny that a few callers were idiotic, but others were simply confused or scared. )
I love macs and loathe my work laptop, a PC, but I think this is a bit silly. Lots and lots of us work for extended periods on a single application -- whether reading emails, surfing the web, or drafting a presentation. In those circumstances, it's helpful to be able to focus exclusively on the matter at hand, and a maximise-to-full-screen option is a good way of doing it.
There may be dross, but there's plenty of super-useful and well-designed apps too. In about 30seconds browsing, I found Babelingo -- I'd have appreciated having that last week in Spain.
I saw your "partially attributable". I also saw that you preceded it with the phrase "I guess". That doesn't sound like a statement of fact to me, and as such is particularly open to counter-assertions. I also recall reading Robert Heinlein bemoaning the fact that populations were *not* well spread out during the Cold War and that planners and builders were not taking the issue seriously.
I doubt a 75yro 280lb man could *complete* a 10 mile bike ride, which makes survival a bit of a moot point. Anyway, that's a strawman. Just because some people can't cycle safely (you forgot to mention deafblind babies, by the way), doesn't mean no-one can. And of course, for most people and thus for the population as a whole, cycling will be a net benefit for health.
Sure. But the risks that cyclists will give themselves heat stress etc must be balanced against the risks to heart health of not cycling. Heart disease has been the leading cause of death in the US for 80 years -- about 27% of all deaths. I'm not sure what the rate is for deaths from heat stress while cycling, but I should imagine it's quite a bit smaller, even among the susceptible population (ie idiots who ride hard in the hot sun when they're out of practice).
Slashdot Mirror
Rubbish. You can own a TV that can be used to watch TV and so long as it is never switched on, you don't have to pay. I know, because this describes my situation a few years ago.
I think you're right to say that there will be interesting new revenue streams opening up -- the refresh cycle for a phone vs a laptop is one obvious way that at least some of the loss can be recouped. I agree that the lack of a keyboard isn't fatal, and portable kit will obviously help, as will new technology (maybe this is the driver for speech-to-text software to go mainstream?).
For the fairly obvious reason that you then need at least two pieces of kit (laptop, phone / earset) to answer a call. Not very convenient.
This is fantastic insight into the future of the iPhone. It makes absolute sense that in due course, the iPhone *becomes* the computer. There's a huge challenge for Apple to manage -- how to monetise this future, as it clearly erodes the value of their current computer lineup, but you're spot on. The key technical challenge is finding a way to provide a mobile user with a keyboard, trackpad and laptop while they are out of the office and needing to do the kind of work (spreadsheets, powerpoint) that can't easily be done on an iPhone. I guess technically the solutions might incorporate OLED screens that can be rolled up, but how to make the setup non-clunky is challenging (although the kind of challenge that Apple has prowess in solving)
You might give credit where credit is due:
http://www.cl.cam.ac.uk/techreports/UCAM-CL-TR-500.pdf
Mate, this is just horseshit. Asserting that "if it's worth spending $200k to save your life, you can afford it" doesn't make it so. There are tens of millions of people in your country and mine who could never even dream of persuading anyone to lend them that much money, nor of paying it back if by some weird chance some kindly bank manager made them the loan. In 2006, the bottom 20% of US households earned less than $19,178. Do you really believe that the vast majority of these households could ever get or pay back a loan of $200k (no matter how dire the consequences of not obtaining the money)? And if you don't consider $200k expensive, then have in mind that care can be much, much more expensive than that: well in excess of £1m for a single intervention. And of course, you don't always get to be conscious or competent at the point at which treatment decisions need to be made. For example, a young man was caught in a bomb blast in London in 2005. His care involved rescue by paramedics and firefighters, a complete resus team who restarted his heart twice, a full CT scan, a major trauma op involving six doctors, ten nurses and many more support staff, a microbiology team to identify and resolve fungal infections, another bout of surgery to remove a damaged eye and replace with a prosthesis, more surgery to resolve a pulmonary embolism, extensive stays in intensive care and rehab involving dozens more doctors, nurses, physical therapists, occupational therapists, psychologists and pyschiatrists, etc, plus prosthetic legs, vast amounts of pharmaceuticals, etc etc. The costs for this must easily have exceeded £500k. Lifetime costs will be much higher. He had no opportunity to make the kind of sovereign decisions about his care that you so fondly imagine, and at the most crucial point, nor did anyone who could be regarded as a guardian (parent, significant other).
This kind of story sits beautifully alongside your glorious statement that "if you have the earnings potential after being saved, you can afford it". So presumably, if you don't have the earnings potential after being saved, you can't afford the treatment. In which case, if someone's say, 80 years old and has a stroke, they should get the treatment only if they commit to going back to work. What happens if the stroke renders them unable to work, by the way?
[Sigh]
I'll lay it out for you:
You originally said:
"Either people in the US blow out their joints way more frequently than Europeans with socialized health care (unlikely), or their system isn't providing them with that option [joint replacement surgery].
So our 'inferior' privatized system is providing more people with life-improving treatments..."
So you've provided two possible explanations for your observation that 50% of joint replacements globally happen on just 5% of the global population:
1. People in the US blow out their joints way more frequently than Europeans
2. Socialized health care systems are not providing them with the option for joint replacement surgery
I caricatured 2 as "pennypinching bureaucrats are cruelly denying Europeans of the care they need". Your "socialized health care / system" = my "pennypinching bureaucrats". Your "not providing" = my "cruelly denying". Your "that option / life-improving treatment" = my "the care they need". My caricature is thus firmly rooted in each part of your original explanation. And it's not much of a caricature, either -- your original statement was clearly implying that you thought the American system was better than European systems because it provided more access to joint replacements.
You then rephrased your original explanation as follows: "from a bureaucratic perspective, a $600 wheelchair or $200 walker is just as much a solution to the problem as a $25,000 joint replacement"
It's still all in there: your "from a bureaucratic perspective" directly equals my "pennypinching bureaucrats". It also clearly implies "cruelly denying" (after all, who could read your sentence and not be moved to compare "a bureaucratic perspective" with "a humane perspective"?). And the only reading of the phrase "a $600 wheelchair or $200 walker is just as much a solution to the problem as a $25,000 joint replacement" that rings true is that you are saying "Europeans are being given wheelchairs instead of joint replacements as a cost-saving, ie pennypinching, measure"
Finally, you rephrased your original explanation from:
'Socialized health care systems aren't providing Europeans with the option of [joint replacement surgery]...so our 'inferior' privatized system is providing more people with life-improving treatments'
to:
"elective procedures are neglected if there is a cheaper option that covers the need"
By writing in the third person, and removing words such as "socialized", "privatized", 'inferior', "life-improving", you created a more dispassionate argument, but the core contention remains the same: the reason there are fewer joint replacements in Europe is that to save money, cheaper options are used instead.
Your position has thus not shifted at all throughout, which is good. And my description of your explanation holds as true for your third restatement of your position as your first. And I repeat, there is at least one other explanation for why Americans have joint replacement surgery more frequently than Europeans, and I think it's obvious: American doctors and insurance companies recommend earlier and more aggressive intervention than European doctors. And I went on to cite one example of where the jury is out on whether earlier and more aggressive intervention is worthwhile (breast cancer), and I'll now cite another example of where higher operating rates are undoubtedly because of earlier and more aggressive intervention: c-section rates.
Studies show that the best outcomes for mothers and babies appear to occur with cesarean section rates of 5% to 10%. Rates above 15% seem to do more harm than good (Althabe and Belizan 2006). And the rate in the US is about 33% (up ~50% in about a decade). And in the UK it's about 20%, and somewhat lower in many other European countries. I raise this to make clear that you cannot assume that a lower rate of intervention (eg fewer joint replacements) demonstrates worse levels of care or outcomes (eg more pain and less mobility).
You're nowhere near the clear-sighted rationalist you believe yourself to be, and I'm not the dewy-eyed, woolly-minded liberal you're imagining me to be either.
I am thinking. I'm thinking, "I think it's worth spending $200k to save my life, but oh shit, I don't have the $200k needed for this operation. Oh well, I'm economically non-viable. This feller thinks I should therefore just be left to die." I'm also thinking, "this feller either does not know or does not care that his proposal would create yet more inequities in health, to join a crowded field: a rich person and a poor person with the same disease and the same desire to treat it, but the poor person dies because they don't have the money to pay for treatment, while the rich person lives". Tell me, are you the kind of moralising snit that blames poor people for being poor, so they get what they deserve, or do you have some other form of motivation, such as "the market will sort it all out"?
In any event, in answer to your question, health economists long ago needed to develop a method to compare the relative benefits and costs of different interventions and non-interventions. It's called the QALY, and in the UK, the cutoff for funding ("range of acceptable cost effectiveness") is set at about £30k (oh my god, a number! and set by the state and not a freeborn individual making sovereign decisions for their own selves. What cruel and stupid calculus is this!!). Given the UK median household income was ~£25k in 2004, it's clear that the UK health system provides a safety net for families against illnesses whose treatments would otherwise be catastrophically expensive or simply unaffordable.
I agree that confounding factors make it challenging to understand what statistics about health are telling us, but I don't think that we should simply throw our hands up and say "such figures cannot be compared from one country to another" or that "infant mortality cannot be shown to be affected by health systems as opposed to the social and environmental determinants of health".
Um. The explanation you've laid out here is just a repeat of your previous explanation, which is that pennypinching bureaucrats are cruelly denying Europeans of the care they so desperately need.
You may disagree that my explanation is obvious, but I think it's pretty fuckin obvious myself. Especially given that there's plenty of evidence of aggressive early intervention for lots and lots of diseases in all branches of healthcare, and not all of it is helpful, and lots of it happens in the US. Breast cancer screening is just one such area.
OK, you got me. I almost believed you were serious. And then I thought, no-one could be that much of a dumb prick to think that "if I can't afford a 300K operation, then I'm not worth keeping alive. But if I can, I am". So you must be a troll. Right?
You've set up a false dichotomy with your either-or. The other obvious explanation for the high rates of joint replacement in the US compared to everywhere else is that doctors and insurers are trigger happy and recommend earlier and more aggressive intervention. This may or may not be the right thing to do, but it's not *obviously* the right thing to do. There are always risks and downsides to each course of action (or inaction) in healthcare.
As for your final comment, it's very nice that you'd rather pay more and pay for yourself. Let's hope your disease isn't one that's too expensive for you to afford to treat out of your own resources.
You didn't read the Wikipedia article properly. It said that countries used to use different standards but that most developed countries have been using the same WHO definition of infant mortality since the late 1980s or early 1990s. It strikes me that this is mostly squirming around trying to find reasons why infant mortality is higher in the US than other developed countries other than the obvious one: because for a large fraction of the US population, health and healthcare is worse than in other countries.
You have the causative chain the wrong way round: why do black Americans suffer greater infant mortality than white Americans? Two reasons: they're poor (and poverty is a risk factor for morbidity and mortality), and the healthcare they receive is of a lower standard.
Listen to this podcast for more:
http://deimos3.apple.com/WebObjects/Core.woa/Browse/yale.edu.1320598949.01320598958.1583568871?i=2073945130
Are you being deliberately dumb?
The choices are not:
1) Get whatever care you need in the wonderful US
2) Stand in line in commie Britain
The choices are:
1) Get whatever care you individually can afford in the US (rationing by cost)
2) Get whatever care you as a country decide via the government you can collectively afford in the UK, potentially waiting up to 18 weeks for it (rationing by waiting list)
The former method tends to ensure that rich people live even longer and healthier lives than poor people than would otherwise be the case. The latter method leads to endless grumbling about cruel governments denying people access to treatments that cost more than £30k/QALY.
I agree. To be honest, I think this is perfect example of Avon and Somerset Police demonstrating that public sector organisations fail to understand the needs of the people they serve, and then "punish" them if they exhibit the "wrong" behaviour. You couldn't imagine Tesco behaving in this way. It's clear from watching the clips that many of these calls are made simply because people trust the police to solve every problem (who said authority figures were dead in modern society?) and know of only one way to get hold of them: 999. The fixes would work rather better if they focused on ensuring everyone knows that another number besides 999 and knows that it's the best number to call to get stuff sorted -- and then for that number to be staffed by people empowered to connect callers with the services they need (animal health, social services, the health service etc etc).
I think they'd be far better off calling Val Curtis and asking her how she went to consumer goods companies for advice on how to persuade people in developing countries to change their habits. By respecting the undeniable truth about how people behaved in response to the messages they received, she helped craft the right kinds of messages to encourage soap-washing and is on track to save millions of lives.
http://www.iht.com/articles/2008/07/13/business/13habit.php
(None of this is to deny that a few callers were idiotic, but others were simply confused or scared. )
A bus transaction takes on the order of a tenth of a second -- you pass the card in front of the reader and hear a beep.
I love macs and loathe my work laptop, a PC, but I think this is a bit silly. Lots and lots of us work for extended periods on a single application -- whether reading emails, surfing the web, or drafting a presentation. In those circumstances, it's helpful to be able to focus exclusively on the matter at hand, and a maximise-to-full-screen option is a good way of doing it.
There may be dross, but there's plenty of super-useful and well-designed apps too. In about 30seconds browsing, I found Babelingo -- I'd have appreciated having that last week in Spain.
I saw your "partially attributable". I also saw that you preceded it with the phrase "I guess". That doesn't sound like a statement of fact to me, and as such is particularly open to counter-assertions. I also recall reading Robert Heinlein bemoaning the fact that populations were *not* well spread out during the Cold War and that planners and builders were not taking the issue seriously.
I doubt a 75yro 280lb man could *complete* a 10 mile bike ride, which makes survival a bit of a moot point. Anyway, that's a strawman. Just because some people can't cycle safely (you forgot to mention deafblind babies, by the way), doesn't mean no-one can. And of course, for most people and thus for the population as a whole, cycling will be a net benefit for health.
Sure. But the risks that cyclists will give themselves heat stress etc must be balanced against the risks to heart health of not cycling. Heart disease has been the leading cause of death in the US for 80 years -- about 27% of all deaths. I'm not sure what the rate is for deaths from heat stress while cycling, but I should imagine it's quite a bit smaller, even among the susceptible population (ie idiots who ride hard in the hot sun when they're out of practice).
Quite:
http://www.guardian.co.uk/environment/2008/jul/06/travelandtransport.usa
No, the main reason for urban sprawl in the US is that there was lots of cheap land available when the suburbs were built.
Are you honestly suggesting that the net impact of an increased use of bicycles will be to *increase* heart-related morbidity and mortality?