... if it's so valuable and scarce, why is it so cheap? You would think that this is the kind of thing that really would get itself sorted out by the market, and I don't think there's "big helium" or government subsidies happening behind the scenes to mess things up.
I've got it! Attach a balloon filling station to every MRI in the country - as the helium boils off, just stuff it in balloons. Bonus points for charging 10x the going rate because it's now a 'medical procedure'.
I would agree that medical use trumps party use; but how difficult would it be to retool an MRI to use, say, liquid nitrogen for cooling?
All you need is a breakthrough in superconducting magnets and you're golden (and rich, did I say rich?). They often use liquid nitrogen to precool the magnets but it's just not cold enough. Liquid hydrogen would probably work, but that's rather a bitch to use.
...yea cause only 10's of thousands of lives have been saved by "unnecessary" MRI's that caught cancer early. What kind of doctor is appalled by the overuse of technology that results in a net saving of lives and an overall reduction in the cost of the technology by increasing the availability?
No, those lives haven't been saved. Quit reading advertising copy. When you start running around and doing random MRIs (or CTs) on people, you find very few cancers and save very few people. You do end up poking around inside of people and having the occasional 'surgical misadventure' that runs up costs and actually hurts patients.
Remember, images from these machines don't say 'here's a cancer' - they show a grainy, black and white image of an indistinct process. The vast majority of the time that process is benign but when the doc says 'you might have growth there, son' and suggests surgical removal, the tendency is to go along with the idea and hopefully the doctors won't take out anything really important in the process.
Cancer screening is a very, very complicated subject. The idea that you can just go randomly look for things and expect to actually help the patient (as opposed to the bank account of the hospital and providers) has been debunked quite clearly.
On the other hand, once you have a saturated market in MRI hardware, the price of scans drops dramatically, which is why doctors here "overuse" the machines.
If by 'here' you mean the US, then not exactly. Prices are essentially set by Medicare with a bit of whining from the private insurers. So when doctors overuse the machines, you just get more money going to the machine's owner / financier. If you really over saturate a market then you get some downwards price pressure for cash customers (the well heeled folks from out of town) but you don't save the system a dime.
But that's a small edge case and has little to do with the economics of healthcare delivery in the US. It is much more of a 'build it and we will bill insurance" philosophy than anything remotely sane.
They can try and dictate it, but the market always wins at the end, it's a law of nature, like gravity. You can fight it for a while, but you can't stop it.
You can't win. You can't even break even. You have to play the game.
Sound familiar? That's who wins. Not 'the market'.
Even if you factor all of that in, it probably represents something like 20-30% of the 'extra' costs in US medicine. It's a significant and important aspect of the problem, but it's not the sole nor major driver.
Briefly you have:
- The issue of 'defensive medicine' as you point out. - The issue that much of US medicine is set up as a for profit entity with expectations of increasing growth and profits. Many of the big players are heavily leveraged. - The multiple sacred cows - physicians, insurers, hospitals and, not least, patient expectations (I want that MRI and I want it NOW). - And the fact that it's a highly complex, labor intensive field.
Different problem (a real problem but a different problem).
The big issue here is how the billing codes are set up for physician encounters. You determine the code (and hence the charge) with a laundry list of things - how many issues you covered in your interview, how many parts of the body you examined, how much extra detail you went into (family history, smoking history and the like).
Then you get brownie points for medical complexity.
So, you add all of this up and you get your E&M code (Evaluation and Management). Now, in the olden days you had to manually keep track of how many 'points' you were wracking up. Amazingly enough, computers can add! So the program keeps track of all the little points and thus can maximize the code. Extra bonus points for the program 'helpfully' pointing out a few things you might have missed (did you ask about smoking? Vaccines?) - you can then go back and do them (or at least say that you did) and up code.
The other problem is cut and paste - you can take the Past Medical History of the patient and copy it from one encounter to another. Now, that seems perfectly reasonable - you WANT to know this stuff, it's important and that's why you take the time to write it down. However, you don't need to go through a 45 minute interview with the patient ever time you see them - but that's what the billing codes assumed you did. Now Medicare has decided if you copied the old data that's "fraud".
Basically, you have a clumsy, prehistoric system for coding physician encounters that has been computerized without much thought as to what happens after the fact.
One of my favorite aphorisms in this arena is "Computerizing chaos yields computerized chaos."
Thanks for that. If any Slashdot editors are sober enough to type, please consider adding that link to the summary to at least some fraction of the audience will see it.
tl;dr - they already thought of that (surprise!) - the summary really doesn't relate to the lawsuit, it's misleading and inflammatory (surprise!).
Except that no one has figured out a business case for the pentilobe other than messing with customer's heads. They could have switched out the Phillip's for Torx - that would be an improvement in a number of areas and follows an industry standard. But they had to make one of their own for some bizarre reason.
Humanity isn't doomed at all. Business As Usual is doomed. The old Chinese curse "May you live in interesting times" is likely to become an obvious phenomena. You might see half of the human population (and 90% of everything else) go extinct. But there will still be humans screwing things up (again) for a long, long time.
Except your invisible hand is just moving the deck chairs. The cheap shale gas isn't going to last very long (yes, natural gas is 'better' for the environment than oil or coal) and just encourages more growth which is the underlying cause of the problem.
Capitalism is a fine method for optimizing short term issues, long term not so much. Anything to do with external costs or problems, not so much.
I had a friend who was blind since birth - and the best mechanic I've ever seen. He could tell you WHICH CYLINDER and WHICH VALVE was leaking by listening for a few minutes and was right more often than not. This was in the days of real distributors and points (no pansy assed electronic stuff). He would adjust timing by a combination of listening and feel. Yeah, most people can get within a couple of degrees doing that - he was right on.
The human brain is an interesting device. Wish we knew something on how it works.
I always thought that 128k MP3 sounded "wrong". Couldn't tell you why though. I just perceive it well enough to be annoyed enough by it to make my own better quality rips.
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Yeah. This article struck me as particularly whiny. 30 Nuclear Power Plants! The horror.
It's almost like they want you to read a paper newspaper or something.
... if it's so valuable and scarce, why is it so cheap? You would think that this is the kind of thing that really would get itself sorted out by the market, and I don't think there's "big helium" or government subsidies happening behind the scenes to mess things up.
I've got it! Attach a balloon filling station to every MRI in the country - as the helium boils off, just stuff it in balloons. Bonus points for charging 10x the going rate because it's now a 'medical procedure'.
There, that's market forces working for everyone!
I would agree that medical use trumps party use; but how difficult would it be to retool an MRI to use, say, liquid nitrogen for cooling?
All you need is a breakthrough in superconducting magnets and you're golden (and rich, did I say rich?). They often use liquid nitrogen to precool the magnets but it's just not cold enough. Liquid hydrogen would probably work, but that's rather a bitch to use.
And thermite. Teach the little monsters how to make thermite.
Remember "Don't be dull".
...yea cause only 10's of thousands of lives have been saved by "unnecessary" MRI's that caught cancer early. What kind of doctor is appalled by the overuse of technology that results in a net saving of lives and an overall reduction in the cost of the technology by increasing the availability?
No, those lives haven't been saved. Quit reading advertising copy. When you start running around and doing random MRIs (or CTs) on people, you find very few cancers and save very few people. You do end up poking around inside of people and having the occasional 'surgical misadventure' that runs up costs and actually hurts patients.
Remember, images from these machines don't say 'here's a cancer' - they show a grainy, black and white image of an indistinct process. The vast majority of the time that process is benign but when the doc says 'you might have growth there, son' and suggests surgical removal, the tendency is to go along with the idea and hopefully the doctors won't take out anything really important in the process.
Cancer screening is a very, very complicated subject. The idea that you can just go randomly look for things and expect to actually help the patient (as opposed to the bank account of the hospital and providers) has been debunked quite clearly.
On the other hand, once you have a saturated market in MRI hardware, the price of scans drops dramatically, which is why doctors here "overuse" the machines.
If by 'here' you mean the US, then not exactly. Prices are essentially set by Medicare with a bit of whining from the private insurers. So when doctors overuse the machines, you just get more money going to the machine's owner / financier. If you really over saturate a market then you get some downwards price pressure for cash customers (the well heeled folks from out of town) but you don't save the system a dime.
But that's a small edge case and has little to do with the economics of healthcare delivery in the US. It is much more of a 'build it and we will bill insurance" philosophy than anything remotely sane.
They can try and dictate it, but the market always wins at the end, it's a law of nature, like gravity. You can fight it for a while, but you can't stop it.
You can't win.
You can't even break even.
You have to play the game.
Sound familiar? That's who wins. Not 'the market'.
Even if you factor all of that in, it probably represents something like 20-30% of the 'extra' costs in US medicine. It's a significant and important aspect of the problem, but it's not the sole nor major driver.
Briefly you have:
- The issue of 'defensive medicine' as you point out.
- The issue that much of US medicine is set up as a for profit entity with expectations of increasing growth and profits. Many of the big players are heavily leveraged.
- The multiple sacred cows - physicians, insurers, hospitals and, not least, patient expectations (I want that MRI and I want it NOW).
- And the fact that it's a highly complex, labor intensive field.
Hard to fix something that crazy.
Different problem (a real problem but a different problem).
The big issue here is how the billing codes are set up for physician encounters. You determine the code (and hence the charge) with a laundry list of things - how many issues you covered in your interview, how many parts of the body you examined, how much extra detail you went into (family history, smoking history and the like).
Then you get brownie points for medical complexity.
So, you add all of this up and you get your E&M code (Evaluation and Management). Now, in the olden days you had to manually keep track of how many 'points' you were wracking up. Amazingly enough, computers can add! So the program keeps track of all the little points and thus can maximize the code. Extra bonus points for the program 'helpfully' pointing out a few things you might have missed (did you ask about smoking? Vaccines?) - you can then go back and do them (or at least say that you did) and up code.
The other problem is cut and paste - you can take the Past Medical History of the patient and copy it from one encounter to another. Now, that seems perfectly reasonable - you WANT to know this stuff, it's important and that's why you take the time to write it down. However, you don't need to go through a 45 minute interview with the patient ever time you see them - but that's what the billing codes assumed you did. Now Medicare has decided if you copied the old data that's "fraud".
Basically, you have a clumsy, prehistoric system for coding physician encounters that has been computerized without much thought as to what happens after the fact.
One of my favorite aphorisms in this arena is "Computerizing chaos yields computerized chaos."
Elsewhere?
What, New Mexico or someplace foreign like that?
But here in the US it makes little difference. What are you going to do?
Sign up for AT&T?
Thanks for that. If any Slashdot editors are sober enough to type, please consider adding that link to the summary to at least some fraction of the audience will see it.
tl;dr - they already thought of that (surprise!) - the summary really doesn't relate to the lawsuit, it's misleading and inflammatory (surprise!).
A use for all those Windows ME disks!
(You need a DVD as a diffraction grating.)
we will see if they really do release useful documentation or if this is just smoke and mirrors to try to limit the damage from Linus comments.
Sure, they'll release some documentation. Starting with:
"This page intentionally left blank."
Recess is over, kids. Time to get back to class.
This is Slashdot. Recess is never over. Endless summer and all that.
Evil Vortex?
Evil Vortex?
Please disconnect from the Internet before you do yourself a mischief.
Except that no one has figured out a business case for the pentilobe other than messing with customer's heads. They could have switched out the Phillip's for Torx - that would be an improvement in a number of areas and follows an industry standard. But they had to make one of their own for some bizarre reason.
When in trouble,
Or in doubt,
Run in circles,
Scream and shout.
(Heinlein)
Humanity isn't doomed at all. Business As Usual is doomed. The old Chinese curse "May you live in interesting times" is likely to become an obvious phenomena. You might see half of the human population (and 90% of everything else) go extinct. But there will still be humans screwing things up (again) for a long, long time.
Except your invisible hand is just moving the deck chairs. The cheap shale gas isn't going to last very long (yes, natural gas is 'better' for the environment than oil or coal) and just encourages more growth which is the underlying cause of the problem.
Capitalism is a fine method for optimizing short term issues, long term not so much. Anything to do with external costs or problems, not so much.
Off your meds again, I see....
It's the money. All the way down.
Pretty impressive diatribe by an advertising executive. He probably eats the Wheaties box for breakfast.
I had a friend who was blind since birth - and the best mechanic I've ever seen. He could tell you WHICH CYLINDER and WHICH VALVE was leaking by listening for a few minutes and was right more often than not. This was in the days of real distributors and points (no pansy assed electronic stuff). He would adjust timing by a combination of listening and feel. Yeah, most people can get within a couple of degrees doing that - he was right on.
The human brain is an interesting device. Wish we knew something on how it works.
A Youtube video playing via my PC speakers is more than fine for me.
And you shop at WalMart and think it's the best.
You sir, are not part of this discussion. Please sit down.
I always thought that 128k MP3 sounded "wrong". Couldn't tell you why though. I just perceive it well enough to be annoyed enough by it to make my own better quality rips.
You probably reversed the polarity.