Actually, so far such costs are indeed passed on to the providers. Charges for services isn't something providers generally get to choose themselves -- simplistically, a specific diagnosis or complexity of a patient encounter is billed at a fixed cost determined by medicare, and by discounted contracts between provider groups and insurers (eg, "in this market we agree to get reimbursed 70% of the usual rate to have access to your patients"). So far, such costs for retooling with technology have been passed on to the providers.
Providers have been very reluctant to put money and effort into large scale technologies because so far this has been essentially out of pocket, requires several years to implement, and is not subject to a standard. Our physicians group over the past few years has migrated to a fully electronic record and prescription system. It cost 10s of millions of dollars out of our practice. It slows us down compared to the old system so we can see fewer patients a day. It's limited in the sense that it forces you into certain "boxes" in terms of documentation that make the old flexibility of dictated charts go away. The upside is much more consistent access to data, simpler provision of records to other providers, etc. It still costs us several million dollars yearly to maintain, and still can't interact with other medical record or data systems, because there isn't a clear standard.
In a nutshell, we paid for it, it's made us more efficient in some areas, less so in others, and it's not clear on balance if it was worth it for us.
In another example, CMS (medicare) has implemented a "pay for performance" system, where providers identify several measure they'll get graded on and reimbursed higher if they meet those targets. Think grocery store shoppers club. So far providers are at best lukewarm -- after making substantial up-front investments (which again, we can't directly pass on to patients ourselves, but the system overall does in one way or another) we now have a byzantine system of reporting that nobody seems quite clear on how it works, and very limited reimbursement for our efforts that are making people think it would be cheaper overall just to take a loss on medicare reimbursement.
So, standards and better information systems are an absolute must in many people's minds as doctors really do hate the tremendous inefficiency we currently have, but it's vastly more complicated and expensive than it seems...
If I drive from Tucson to San Diego on I-8,besides the AZ/CA border at Yuma, I typically pass through about 3 of such checkpoints. There it is not uncommon to be asked for ID, and if you have an accent (as my parents do) for a passport/green-card. If I drive to Sierra Vista from Tucson (nearer the border) I sometimes get stopped at a "mobile" checkpoint and get asked for ID, what I'm doing, etc. The point is, none of that activity has anything to do with crossing borders, but occurs near the border, and I would argue does not qualify as "something for which papers should be required", beyond presumably a driver's license.
You know, I appreciate a good discussion about as much as the next guy, whether or not I agree. Sitting on a handful of mod points though, I would like to be able to mod you down as -1, "appreciate your argument, but not the all-caps lunix fag part". Flamebait probably, but +0.5 informative maybe?
Sorry, but while you're correct, I can't resist either:
effect can be a transitive verb too, as in "to cause to come into being" (eg, "to effect change"). Of course the fact that affect can also be a noun (eg, "he seemed depressed, his affect was blunted") makes it even more confusing.
In case this sparks someone's interest, a good book on HM is "Memory's ghost", by Philip Hilts. It's a fascinating read that does of good job of explaining the backgound of why this was done at the time, and what HM's day to day experience may be like.
I think you'll find that teachers unions have some major beefs with the DOE lately, eg as pertains to NCLB. A few years ago the secretary of education even called the NEA terrorists for not being more supportive of federal policy. I'll totally give you 2 out of 3 though...
Cigarette smoking is the single most preventable cause of premature death in the United States. Each year, more than 400,000 Americans die from cigarette smoking. In fact, one in every five deaths in the United States is smoking related. Every year, smoking kills more than 276,000 men and 142,000 women.
I agree with you 99%, except I have to nitpick your toothache -- you could argue that teeth are pretty important (because excluding the evolutionarily relatively recent development of dentistry, you need them to eat and survive), and need to be protected with a sensitive pain system. Your tooth decay can lead to infection, abscess, sepsis, and death if you don't take care of it (say, with a good rock). If you manage to survive long enough to develop lung cancer, you won't be doing much about that, again, discluding the recent advent of modern medicine, which hasn't had an effect on evolution (well, for the most part, probably).
I see, so what you're saying is that Arnold is "normal people" and has no special interest ties. Right. I'd agree with you if he were a teacher, a construction worker, a small business owner. But Arnold?
Uhm, if you're looking for a more expensive model of camera as a measure of quality as it seems, then you might want to look for the Canon EOS 1DS Mk-II, a 16.7 Mp digital SLR that goes for around $7500. How that compares to Nikon's top of the line camera body is (and always was and will be) really a matter of apples, oranges, patented features, preference and evangelism...
I use parts of Kontact directly in OSX (under the OSX X11 server which runs seemlessly parallel to other apps). Just like on my linux box. Works great. Downside is you essentially have to build it with fink, which is not completely trivial, and takes a while.
Fair enough in general, but cadmium is one of the most toxic things you can pollute with, in tiny quantities. Becoming less of an issue as nicads gradually go away, but that logic may not really hold looking at the larger picture.
Actually, competing on the basis of price can be construed by the government (ie medicare) as fraud. If I see you for disease x, with complexity y, I'm allowed to charge you z dollars. I can charge you more, but will still get z. (In practice though, generally something less than z).
If I try to bill you less, I will likely either not be able to stay in business, because these days what medicare dictates for reimbursement makes it very difficult to have much of a margin, or might be construed as fraud unless I can justify it and charge everyone the same. What is reimbursed depends on how well things are documented, and doctors are so afraid of overcharging (and medicare fraud has enourmous fines and potential jail time) that ~80% will undercode, ie actually charge a bit less than they probably could.
Besides, when you see your doctor, you probably just pay a small co-pay (psychology to make you realize it's not free). The insurance company actually pays the bill (hopefully). Perhaps insurance companies ought to compete on price -- doctors fees for insured patients are essentially dictated by what insurers decide that they'll reimburse.
Add to that the age-old notion that on some level you have a philosophically innate right to some sort of at least basic healthcare, and it should start to sink in that we're not just talking about simple economics.
You could argue that doctors do compete to some degree on quality, as word gets out and patients avoid bad ones. (Did I just feed a troll?)
Hey, worst is that they don't work and they will have to see a real doctor.
No...the worst thing that can happen is that you may mis-self-diagnose a serious illness, or have an interaction between your internet drug and something else, an allergy, or maybe (as has happened before) the unenforcable quality standards of the supplement industry may result in a harmful impurity or contaminant. ie, you may suffer serious harm if you decide you want to trust the internet to tell you what to put in your body.
Slashdot Mirror
Actually, so far such costs are indeed passed on to the providers. Charges for services isn't something providers generally get to choose themselves -- simplistically, a specific diagnosis or complexity of a patient encounter is billed at a fixed cost determined by medicare, and by discounted contracts between provider groups and insurers (eg, "in this market we agree to get reimbursed 70% of the usual rate to have access to your patients"). So far, such costs for retooling with technology have been passed on to the providers.
Providers have been very reluctant to put money and effort into large scale technologies because so far this has been essentially out of pocket, requires several years to implement, and is not subject to a standard. Our physicians group over the past few years has migrated to a fully electronic record and prescription system. It cost 10s of millions of dollars out of our practice. It slows us down compared to the old system so we can see fewer patients a day. It's limited in the sense that it forces you into certain "boxes" in terms of documentation that make the old flexibility of dictated charts go away. The upside is much more consistent access to data, simpler provision of records to other providers, etc. It still costs us several million dollars yearly to maintain, and still can't interact with other medical record or data systems, because there isn't a clear standard.
In a nutshell, we paid for it, it's made us more efficient in some areas, less so in others, and it's not clear on balance if it was worth it for us.
In another example, CMS (medicare) has implemented a "pay for performance" system, where providers identify several measure they'll get graded on and reimbursed higher if they meet those targets. Think grocery store shoppers club. So far providers are at best lukewarm -- after making substantial up-front investments (which again, we can't directly pass on to patients ourselves, but the system overall does in one way or another) we now have a byzantine system of reporting that nobody seems quite clear on how it works, and very limited reimbursement for our efforts that are making people think it would be cheaper overall just to take a loss on medicare reimbursement. So, standards and better information systems are an absolute must in many people's minds as doctors really do hate the tremendous inefficiency we currently have, but it's vastly more complicated and expensive than it seems...
If I drive from Tucson to San Diego on I-8,besides the AZ/CA border at Yuma, I typically pass through about 3 of such checkpoints. There it is not uncommon to be asked for ID, and if you have an accent (as my parents do) for a passport/green-card. If I drive to Sierra Vista from Tucson (nearer the border) I sometimes get stopped at a "mobile" checkpoint and get asked for ID, what I'm doing, etc. The point is, none of that activity has anything to do with crossing borders, but occurs near the border, and I would argue does not qualify as "something for which papers should be required", beyond presumably a driver's license.
On OSX, the best one I've found is Desktop Manager.
You know, I appreciate a good discussion about as much as the next guy, whether or not I agree. Sitting on a handful of mod points though, I would like to be able to mod you down as -1, "appreciate your argument, but not the all-caps lunix fag part". Flamebait probably, but +0.5 informative maybe?
Please explain what you mean by "when you aren't on Slashdot"...
Sorry, but while you're correct, I can't resist either:
effect can be a transitive verb too, as in "to cause to come into being" (eg, "to effect change"). Of course the fact that affect can also be a noun (eg, "he seemed depressed, his affect was blunted") makes it even more confusing.
In case this sparks someone's interest, a good book on HM is "Memory's ghost", by Philip Hilts. It's a fascinating read that does of good job of explaining the backgound of why this was done at the time, and what HM's day to day experience may be like.
I think you'll find that teachers unions have some major beefs with the DOE lately, eg as pertains to NCLB. A few years ago the secretary of education even called the NEA terrorists for not being more supportive of federal policy. I'll totally give you 2 out of 3 though...
I agree with you 99%, except I have to nitpick your toothache -- you could argue that teeth are pretty important (because excluding the evolutionarily relatively recent development of dentistry, you need them to eat and survive), and need to be protected with a sensitive pain system. Your tooth decay can lead to infection, abscess, sepsis, and death if you don't take care of it (say, with a good rock). If you manage to survive long enough to develop lung cancer, you won't be doing much about that, again, discluding the recent advent of modern medicine, which hasn't had an effect on evolution (well, for the most part, probably).
I see, so what you're saying is that Arnold is "normal people" and has no special interest ties. Right. I'd agree with you if he were a teacher, a construction worker, a small business owner. But Arnold?
Uhm, if you're looking for a more expensive model of camera as a measure of quality as it seems, then you might want to look for the Canon EOS 1DS Mk-II, a 16.7 Mp digital SLR that goes for around $7500. How that compares to Nikon's top of the line camera body is (and always was and will be) really a matter of apples, oranges, patented features, preference and evangelism...
I use parts of Kontact directly in OSX (under the OSX X11 server which runs seemlessly parallel to other apps). Just like on my linux box. Works great. Downside is you essentially have to build it with fink, which is not completely trivial, and takes a while.
Fair enough in general, but cadmium is one of the most toxic things you can pollute with, in tiny quantities. Becoming less of an issue as nicads gradually go away, but that logic may not really hold looking at the larger picture.
Actually, competing on the basis of price can be construed by the government (ie medicare) as fraud. If I see you for disease x, with complexity y, I'm allowed to charge you z dollars. I can charge you more, but will still get z. (In practice though, generally something less than z).
If I try to bill you less, I will likely either not be able to stay in business, because these days what medicare dictates for reimbursement makes it very difficult to have much of a margin, or might be construed as fraud unless I can justify it and charge everyone the same. What is reimbursed depends on how well things are documented, and doctors are so afraid of overcharging (and medicare fraud has enourmous fines and potential jail time) that ~80% will undercode, ie actually charge a bit less than they probably could.
Besides, when you see your doctor, you probably just pay a small co-pay (psychology to make you realize it's not free). The insurance company actually pays the bill (hopefully). Perhaps insurance companies ought to compete on price -- doctors fees for insured patients are essentially dictated by what insurers decide that they'll reimburse.
Add to that the age-old notion that on some level you have a philosophically innate right to some sort of at least basic healthcare, and it should start to sink in that we're not just talking about simple economics.
You could argue that doctors do compete to some degree on quality, as word gets out and patients avoid bad ones. (Did I just feed a troll?)
Hey, worst is that they don't work and they will have to see a real doctor.
No...the worst thing that can happen is that you may mis-self-diagnose a serious illness, or have an interaction between your internet drug and something else, an allergy, or maybe (as has happened before) the unenforcable quality standards of the supplement industry may result in a harmful impurity or contaminant. ie, you may suffer serious harm if you decide you want to trust the internet to tell you what to put in your body.