Thanks for providing a good example of how hard it can be to understand science.
This project has the potential to be meaningful, but it has a long way to go yet. They need a hypothesis, a rigorous way to test it, and repeatable results.
What the surfacestations project has right now is the beginnings of a hypothesis--that local changes have biased the long-term trends that weather stations have recorded. It's not really a strong one yet because they don't have good coverage yet...last time I checked there were like 15 station reports, out of well over a thousand, and that's just the NOAA stations.
Once they have good coverage they'll need to devise a quantitative way to test for bias in the readings. This might involve placing duplicate weather stations nearby but further from the alleged bias factors, and looking for long-term differences in readings. Or it might involve comparative statistical analysis to check the data trends from these terrestial stations with satellite and other terrestrial data sets. The point is, they are going to have to do some testing or comparison involving precise numerical data.
Then their conclusions have to be peer reviewed and published, where they will become public knowledge for other scientists to poke around in, look for flaws, and try to repeat.
Unfortunately you jumped right past all that stuff, straight to a belief that the mere existence of this site somehow provides support for your pet theory. It doesn't.
And cell networks are generally the worst networks out there right now--lowest bandwidth and highest latency. That may change in the future, but right now it is a big hurdle to the scenario you're describing. Particularly with a converged device like the iPhone, you're going to have to plug it into your PC at some point because not even 802.11n can move large chunks of data as fast as a USB 2.0 cable. This is probably a big reason Apple did not provide direct iTMS access from the phone. Even a 4 minute single would take significant time to pull down over EDGE, let alone a TV show or movie.
The iPhone is not a thin client. It's probably one of the thickest clients in the mobile market right now, with claims of a "full" version of OS X and Safari, plus all the media functions.
The difference between a "researcher" and a "hacker" is that a "researcher" works in a nice shiny office building or school campus, while a "hacker" works at home or his mom's basement. No, the difference is usually that researchers investigate areas of knowledge that are incomplete to humanity. Things like shell access to the iPhone don't qualify because they known to someone--after all they were designed by someone. Trying to discover what someone else designed is hacking. If they were doing original algorithm work it might qualify as research.
Seriously, if blogs mean anybody can become a journalist, if open source means anybody can write code used in mission critical systems, I think it's only fair that any random curious person can be a "researcher". Of course they can, and just like journalism and programming, modern tools are lowering the barriers to doing research. It's just that this work on the iPhone is not an example of that.
The tech behind multitouch is the same behind the iPod clickwheel and laptop trackpads--the capacitance of your finger. Thin gloves might or might not work. They make gloves specifically for iPod's clickwheel, and these might work with the multitouch interface as well.
Incidentally I have a first-gen Shuffle and the volume control on that is effectively a rocker switch too. It seems to work ok--I don't feel like it's a deficiency compared to my iPod Mini. It depends on how fine the gradations are, and how it responds to extended holds in one direction.
Every cell phone I've owned has had the screen right below the ear piece. Every single one has picked up smudges and smears and oil from being pressed against my face while I'm on a call. My current phone is the Motorola V325, a flip phone with a big glossy color screen that goes right against my ear and cheek...it's about 95 degrees + high humidity here in DC lately, so can imagine how that screen looks after a bit of a walk-and-talk outside.
If you put any cell phone to your ear at all, you're going to have to wipe the screen on a regular basis. I just rub mine on my shirt or pants 2 or 3 times. It doesn't mark the clothes and it cleans it well enough. The key question is whether the screen will pick up scratches from this. So far the V325 is good to go on this score. With a glass screen, I'm guessing the iPhone will probably do ok too.
With only Safari as the platform for 3rd party apps, there is a much smaller set of APIs to secure against a malicious app essentially being able to spy on every phone call, email;
Not an issue; that functionality is already handled by AT&T.
This is more evidence that if you want to write a killer iPhone app, Safari+AJAX may not have the power you need. Apple sure didn't find that combo to have the horespower when it went to implement Google Maps and now YouTube.
We don't know how those clients were built. It's conceivable that they were built on top of iPhone Safari 3.0 using special additional browser features. We already know that they've added a proprietary link type to initiate phone calls.
In 2000, Microsoft introduced a new, non-standard feature into IE to support what was basically a custom application: Outlook Web Access. It was then aped by the other browsers and went on to form the basis for a revolution in Web interfaces. I think Apple has thought long and hard about that. They have the reputation for UI innovation, but in this case the road to the future started in Redmond not Cupertino. I think the point of Safari on the iPhone, Safari on Windows, etc, is that soon Safari will start to have features built into it that allow Apple--and developers--to do things above and beyond the typical Web app development. I would not put it past them to try to compete with what Adobe is trying to do with Apollo.
The laws and regulations on the books are so complex, and the nation so diverse, that unintended consequences are a frequent result of anything the government changes. The civil service is on the whole a bunch of smart, hard-working folk, but even with such a large government there is just no possible way they could hold expertise on every subject under the sun. Who's going to know (or care) about the implications of every new law and regulation for left-handed widget makers? Pretty much no one but the left-handed widget makers. And since they're busy making widgets, and they're not experts on law anyway, they hire someone to keep track of government activity as it relates to their business, and to speak on their behalf to the government. A lobbyist.
If you think the OS was purposely degrading the performance of the alternatives you're so far off base that you strain credibility.
First of all I don't claim the performance degradation, the article paraphrases Google as claiming it. Whether it exists, or was deliberate, I have no way to know. At a minimum I'm betting MS would have tested the performance of their search vs. the established products from Google, Yahoo, etc, and so would have been aware of performance conflicts. Certainly Microsoft backed down rather quickly...perhaps they wanted to avoid even the appearance that were purposefully causing grief again.
"We will bind the (Windows) shell to the Internet Explorer, so that running any other browser is a jolting experience." - Brad Chase of Microsoft, 1995
This is like asking if big corporate IT is going to support the new iMac--it's missing the point.
The iPhone is like the iMac with iLife. It is intended to bring capabilities that in the past were reserved for professionals, to the general public. 10 years ago, only pros and real geeks did digital audio management, digital non-linear video editing, DVD production. Today millions of everyday folks can do it.
You can go back even further to things like print layout--formerly the domain of a whole class of high skilled professionals. Today anyone can produce a nice-looking newsletter with custom fonts, inline graphics and photos, pagination, etc. The original Mac helped push that development.
Apple doesn't want a slice of the corporate pie. They want to redefine how everyday people use their phone--just like they redefined how people used their computers with the iMac and iLife and iTunes. That is why they are emphasizing consumer products like Google Maps, Yahoo mail, iPod audio, movies, TV shows, etc. The whole point is to empower the individual as a private person, not an extension of a corporation. This is exactly the same as their desktop and laptop strategies.
Apple hopes that years from now, we remember when "smart phones" were primarily business productivity tools.
Google filed a 49-page document with the Justice Department in April claiming Vista's desktop search tool slowed down competing programs, including Google's own free offering, and that it's difficult for users to figure out how to turn off the Microsoft program.
Emphasis mine. This was not about choice--users could install alternative desktop search software regardless of whether the MS search was turned off. The point was that something in the OS was degrading the performance of those alternatives. Based on how quickly MS has backed down, I'm guessing it was deliberate, or at least known and accepted.
"The greatest trick the devil ever pulled was convincing the world he doesn't exist," and the greatest success of the political industry is convincing people that they have no power and the system is broken.
The truth is that our system of government is great, but like any human system its performance is heavily dependent on the people within it. Everyone knows you can't reorganize a corporation to success if you don't have good employees. You can't reshuffle a bunch of bored, bad programmers to produce awesome software. You need good people who care and are engaged. The system organizes them but it can't substitute for them.
There are huge barriers to change, but when aren't there?? Change is always hard, but it's always possible. It just takes commitment, energy, smarts, and hard work. Disengaging and complaining has never fixed or improved anything, anywhere.
Sorry, but they showed us two charts, representing "before" and "after", and the "before" chart contained Firefox and Opera, and the "after" chart did not. There's only one way to interpret that.
Yup, as a joke. Watch it again, and listen to the people laughing in the audience.
If you insist on taking everything in the Keynote at face value, though, good luck deciding which version of Leopard to buy--Basic, Premium, Business, Enterprise, or Ultimate!
There are plenty of steps that could be taken far short of saying it's illegal to skip your yearly physical. For example, mandating that employers give people the time off that they need to obtain preventative care. How about making such care free? Or actually paying people for especially effective procedures?
I love the idea of mandatory preventative care time. I don't like the idea of "free" care because it doesn't exist. "Free" care this year actually has to be paid by taxes from last year. And the U.S., like Europe, has a shrinking worker-to-payee ratio. It's going to get harder, not easier, to pay for government programs. That's not a political statement, it's just demographics.
As for "people make the choices they make," it's hardly that simple...[examples snipped]...Simply put, the market doesn't just reflect peoples' wants, it actively alters them.
This is exactly my point. Why not put this power to use for good instead of evil? The same techniques that convince people to spend obscene money on a diamond, also convince them to buy more fuel efficient cars and appliances and lightbulbs. If preventative and family care clinics sold directly to people (instead of to insurance agency bureaucrats), they would use marketing to convince people to come in and use their services. You'd see advertisements for annual physicals the same way you see advertisements for car tune-ups and brake repairs.
These are all really good points, and the only thing I'll add is that sometimes the people sitting in ER waiting rooms don't actually need an ER. What they need is a doctor or a clinic. But since ERs are open all the time, easy to find, and don't turn people away (unlike most doctor offices or clinics), people end up there.
My question is how can we better serve these people without clogging up ERs? We would need clinics that are open, easy to find, don't require paperwork or insurance, and are inexpensive. I don't know how to build that, but I think (hope?) someone could figure it out. My concern is that there is no incentive to now, because the entire industry revolves around structured government or insurance payments, rather than the consumer/care recipient.
Granted--this is not a solution to all health care costs. Frankly I don't think there is a solution for the expense of critical care, and that's why we will always need insurance. But I think it can go a long way toward skimming off the more easily treated from the expensive ERs.
We need a comprehensive reform that addresses the entire medical industry. A free market does not do that.
Perhaps I did not make myself clear above, but what I'm talking about is a targetted reform that better harnesses consumer market forces for certain segments of care. I never said the whole has to be a "free market," whatever that is--the term is basically an epithet these days. What I want is to divorce preventative and common care from the insurance gatekeeper, and introduce consumer choice. The government backstop would benefit from the resulting cost reductions as much as individuals would.
I disagree that we have to transform all of U.S. health care in one fell swoop. For one thing, there's a lot about our health care system that does work well, so why trash it. For another, such radical change won't run the political traps successfully. Incremental is the way to go--pick one problem and solve it, then reevaluate.
The greatest efficiency that we can achieve is a system of preventative care that prevents higher cost treatment later.
How does a market driven health care solve this problem? The short answer is "It doesn't". People don't buy things they think they don't need. The lower middle class and low income people will not shop around for an annual physical. They will rely on the same method they have now: Go to the emergency room for my current illness and let the government pick up the tab.
So what's your alternative--force people to get preventative care? In the U.S. at least, people make whatever choices they make. If you want them to change their habits you have to convince them it's in their best interest to do so, and then make it easy for them to change. Markets are very good at both of these.
Those coatings help prevent the minor surface scratches (often called fogging) that can occur when people clean their plastic lenses with their cotton t-shirts. They don't do anything to prevent actual gouges of the lens material. If you put your polycarb glasses in your pocket with your keys and coins, they will get scratched--coating or no.
For real scratch and gouge resistance, glass is better. It is much harder, and the property is intrinsic--nothing to wear off or deform.
I have one and have dropped it a number of times with no ill effect. I think that unless the screen strikes a pointy thing directly, the durability depends on the strength of the case. If the case is strong and stiff enough to resist deformation, the glass won't break. So far so good with my iPod.
However, it is almost impossible to shop around for the best price. We don't know the actual cost of treatment and it is impossible to tell what the cost is going to be upfront. A basic physical at one office may not include the same bloodwork as another office. You can't compare services to get accurate price comparisons.
Exactly the problem I was getting at in my last paragraph. The solution is to directly connect the consumers to their care financially as much as possible. Substituting the government for the insurance companies will do nothing to solve this basic failure.
The problem in healthcare is that the unit cost is going up--regardless of who is paying. Medicare costs are going up as fast as private costs, proving that the problem is not related to private vs. public funding. What is needed is pressure to drive the efficiencies up and the prices down. Regulation can provide pressure, but it is inflexible--requires legislation, rule-making, and often court cases. Market competition is a more flexible and powerful way.
You can't call a doctor's office and ask for a quote on Strep throat treatment.
Depends on the doctor's office. Minute Clinic is IMO a prototype for the future of healthcare. Complications can ensue from any treatment, but they are often the exception rather than the rule. The market should be able to handle the most common things; right now the entire structure is built to handle the exceptions.
The second problem with elasticity is the desire to deal with a single doctor regardless of price. This is a business built on relationships and is not extremely price sensitive. If my Doc charges $50 more than the guy down the street, I will probably still go to him because of trust.
This is also a factor with lawyers, mechanics, financial advisors, handymen, personal trainers--basically anyone who provides us a service. For some people the effect might be stronger for doctors, for others, not. (I've never had a "close" doctor and don't care if I ever do.) The key is to allow that to be one factor in individual decision-making, rather than enforce it as a structure for everyone. If someone wants to save money by jumping from doctor to doctor for their physicals, shouldn't they be able to?
Incidentally, this is one area where technology can make a huge difference. Right now the big problem in jumping from doctor to doctor is your medical history. It's typically on paper and needs to be sent from old office to new office (remember that Seinfeld episode?). This is just dying for an IT solution. Medical records are information, and if there's one thing we've improved in the last 20 years, it's the storage and movement of information. Except in the medical field.
Actually, it works fairly well for legal services since they aren't universally required, but works horribly for food and housing. If it worked so well, why do we have a huge number of homeless and hungry people?
The number of people who actually starve to death in the United States is very, very low. Hunger is far from a solved problem, but consider that way more people die from influenza or heart disease than from hunger. Likewise, the number of homeless people in the United States is, as a percentage of population, very low. Again--not a solved problem, but numerically a much, much smaller problem than what we see in health care today.
There will always be the disadvantaged, poor, and (yes) mentally ill, who will require some assistance. These are not easy problems to solve. What we see today in health care is that not only are these groups not adequately served, but neither are huge swaths of lower and middle class people who are gainfully employed, housed, clothed, fed, etc. People who can pay their way in every other aspect of their lives, cannot afford health care. To me that makes it obvious that the problem is systemic.
Most medical care is not emergency, but rather falls into three categories: - Proactive care (physicals, etc) - Non-emergency illness (flu, strep throat, etc--treatable at doctor's office rather than ER) - Treatment of chronic conditions (diabetes, high blood pressure, arthritis, etc)
These aspects of medical care can easily satisfy the requirements for market forces, at least as much as other markets.
- Information - There is no shortage of information available on proper proactive care and the most common illnesses and conditions, as well as their most common and effective treatments. Patients are awash in information today.
- Elasticity - The numbers of people who get sick are not dependent on market forces, but where they go is. If people had to pay for their own strep treatment, don't you think they'd drive an extra 15 minutes to the next clinic to save $50? If it's not a life-threatening emergency--and most medical visits are not--then there is elasticity.
- Barriers to entry - Of course it's still hard to get a doctor's license. But it turns out that many of the services above can be performed by nurse practioners or physican assistants. And, this is not an issue with who is paying, but rather with the nature of the service. Many other specialized-skill markets suffer from this deficiency.
Furthermore, it's not like medical care is the only market that has the aspects you describe. In fact the conditions you describe are true for many specialized professions. For instance the legal market suffers from all the same deficiencies in information, elasticity, and barrier to entry. Same with civil engineering.
Finally, your garbage collection analogy is terrible. For one thing, garbage collection works the same for everyone--and typically anything outside the norm is not collected. And garbage collection is a mature technology. There is no great need to encourage innovation in garbage collection.
Put another way: garbage collection is a commodity. But even that doesn't automatically qualify it for goverment provision. Food is a commodity too, one that suffers from many of the defects you list above. Yet, the private market does just fine providing it to most people.
What many people do is look at the medical system and envision a system that is mostly provided by government, with some private service on top. But that system sucks when it comes to flexibility and innovation. A better system is one that is mostly private markets, with the governement picking up the few at the bottom, who the market does not serve. It works for food and housing and legal care.
It's important to keep in mind that the failure of our medical system today is a failure of this particular system, not all private systems. History is full of industries that were inefficient until the right market structure or business model or technology came along.
We need to better expose consumers to the actual cost of their most common care. Right now the system is actually run pretty close to a garbage-collection system, with the insurance companies as the intermediary between consumers and their care. What is needed is a system where consumers can better force down the cost of the most typical, non-emergency health care. Insurance should be for broken legs and other emergencies, not a pill you take every day for your asthma. We don't pay for all home improvements and repairs through an insurance company--just the emergency stuff. Health care should work the same way.
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Thanks for providing a good example of how hard it can be to understand science.
This project has the potential to be meaningful, but it has a long way to go yet. They need a hypothesis, a rigorous way to test it, and repeatable results.
What the surfacestations project has right now is the beginnings of a hypothesis--that local changes have biased the long-term trends that weather stations have recorded. It's not really a strong one yet because they don't have good coverage yet...last time I checked there were like 15 station reports, out of well over a thousand, and that's just the NOAA stations.
Once they have good coverage they'll need to devise a quantitative way to test for bias in the readings. This might involve placing duplicate weather stations nearby but further from the alleged bias factors, and looking for long-term differences in readings. Or it might involve comparative statistical analysis to check the data trends from these terrestial stations with satellite and other terrestrial data sets. The point is, they are going to have to do some testing or comparison involving precise numerical data.
Then their conclusions have to be peer reviewed and published, where they will become public knowledge for other scientists to poke around in, look for flaws, and try to repeat.
Unfortunately you jumped right past all that stuff, straight to a belief that the mere existence of this site somehow provides support for your pet theory. It doesn't.
Then I guess you've never seen the awesomest picture of all time.
And cell networks are generally the worst networks out there right now--lowest bandwidth and highest latency. That may change in the future, but right now it is a big hurdle to the scenario you're describing. Particularly with a converged device like the iPhone, you're going to have to plug it into your PC at some point because not even 802.11n can move large chunks of data as fast as a USB 2.0 cable. This is probably a big reason Apple did not provide direct iTMS access from the phone. Even a 4 minute single would take significant time to pull down over EDGE, let alone a TV show or movie.
The iPhone is not a thin client. It's probably one of the thickest clients in the mobile market right now, with claims of a "full" version of OS X and Safari, plus all the media functions.
The tech behind multitouch is the same behind the iPod clickwheel and laptop trackpads--the capacitance of your finger. Thin gloves might or might not work. They make gloves specifically for iPod's clickwheel, and these might work with the multitouch interface as well.
Just like on most cell phones.
Incidentally I have a first-gen Shuffle and the volume control on that is effectively a rocker switch too. It seems to work ok--I don't feel like it's a deficiency compared to my iPod Mini. It depends on how fine the gradations are, and how it responds to extended holds in one direction.
Every cell phone I've owned has had the screen right below the ear piece. Every single one has picked up smudges and smears and oil from being pressed against my face while I'm on a call. My current phone is the Motorola V325, a flip phone with a big glossy color screen that goes right against my ear and cheek...it's about 95 degrees + high humidity here in DC lately, so can imagine how that screen looks after a bit of a walk-and-talk outside.
If you put any cell phone to your ear at all, you're going to have to wipe the screen on a regular basis. I just rub mine on my shirt or pants 2 or 3 times. It doesn't mark the clothes and it cleans it well enough. The key question is whether the screen will pick up scratches from this. So far the V325 is good to go on this score. With a glass screen, I'm guessing the iPhone will probably do ok too.
Never heard it put that way, actually. That is pretty clever.
With only Safari as the platform for 3rd party apps, there is a much smaller set of APIs to secure against a malicious app essentially being able to spy on every phone call, email;
Not an issue; that functionality is already handled by AT&T.
What about the iPhone?
This is more evidence that if you want to write a killer iPhone app, Safari+AJAX may not have the power you need. Apple sure didn't find that combo to have the horespower when it went to implement Google Maps and now YouTube.
We don't know how those clients were built. It's conceivable that they were built on top of iPhone Safari 3.0 using special additional browser features. We already know that they've added a proprietary link type to initiate phone calls.
In 2000, Microsoft introduced a new, non-standard feature into IE to support what was basically a custom application: Outlook Web Access. It was then aped by the other browsers and went on to form the basis for a revolution in Web interfaces. I think Apple has thought long and hard about that. They have the reputation for UI innovation, but in this case the road to the future started in Redmond not Cupertino. I think the point of Safari on the iPhone, Safari on Windows, etc, is that soon Safari will start to have features built into it that allow Apple--and developers--to do things above and beyond the typical Web app development. I would not put it past them to try to compete with what Adobe is trying to do with Apollo.
The laws and regulations on the books are so complex, and the nation so diverse, that unintended consequences are a frequent result of anything the government changes. The civil service is on the whole a bunch of smart, hard-working folk, but even with such a large government there is just no possible way they could hold expertise on every subject under the sun. Who's going to know (or care) about the implications of every new law and regulation for left-handed widget makers? Pretty much no one but the left-handed widget makers. And since they're busy making widgets, and they're not experts on law anyway, they hire someone to keep track of government activity as it relates to their business, and to speak on their behalf to the government. A lobbyist.
If you think the OS was purposely degrading the performance of the alternatives you're so far off base that you strain credibility.
First of all I don't claim the performance degradation, the article paraphrases Google as claiming it. Whether it exists, or was deliberate, I have no way to know. At a minimum I'm betting MS would have tested the performance of their search vs. the established products from Google, Yahoo, etc, and so would have been aware of performance conflicts. Certainly Microsoft backed down rather quickly...perhaps they wanted to avoid even the appearance that were purposefully causing grief again.
"We will bind the (Windows) shell to the Internet Explorer, so that running any other browser is a jolting experience." - Brad Chase of Microsoft, 1995
This is like asking if big corporate IT is going to support the new iMac--it's missing the point.
The iPhone is like the iMac with iLife. It is intended to bring capabilities that in the past were reserved for professionals, to the general public. 10 years ago, only pros and real geeks did digital audio management, digital non-linear video editing, DVD production. Today millions of everyday folks can do it.
You can go back even further to things like print layout--formerly the domain of a whole class of high skilled professionals. Today anyone can produce a nice-looking newsletter with custom fonts, inline graphics and photos, pagination, etc. The original Mac helped push that development.
Apple doesn't want a slice of the corporate pie. They want to redefine how everyday people use their phone--just like they redefined how people used their computers with the iMac and iLife and iTunes. That is why they are emphasizing consumer products like Google Maps, Yahoo mail, iPod audio, movies, TV shows, etc. The whole point is to empower the individual as a private person, not an extension of a corporation. This is exactly the same as their desktop and laptop strategies.
Apple hopes that years from now, we remember when "smart phones" were primarily business productivity tools.
From the article:
Google filed a 49-page document with the Justice Department in April claiming Vista's desktop search tool slowed down competing programs, including Google's own free offering, and that it's difficult for users to figure out how to turn off the Microsoft program.
Emphasis mine. This was not about choice--users could install alternative desktop search software regardless of whether the MS search was turned off. The point was that something in the OS was degrading the performance of those alternatives. Based on how quickly MS has backed down, I'm guessing it was deliberate, or at least known and accepted.
"The greatest trick the devil ever pulled was convincing the world he doesn't exist," and the greatest success of the political industry is convincing people that they have no power and the system is broken.
The truth is that our system of government is great, but like any human system its performance is heavily dependent on the people within it. Everyone knows you can't reorganize a corporation to success if you don't have good employees. You can't reshuffle a bunch of bored, bad programmers to produce awesome software. You need good people who care and are engaged. The system organizes them but it can't substitute for them.
There are huge barriers to change, but when aren't there?? Change is always hard, but it's always possible. It just takes commitment, energy, smarts, and hard work. Disengaging and complaining has never fixed or improved anything, anywhere.
Sorry, but they showed us two charts, representing "before" and "after", and the "before" chart contained Firefox and Opera, and the "after" chart did not. There's only one way to interpret that.
Yup, as a joke. Watch it again, and listen to the people laughing in the audience.
If you insist on taking everything in the Keynote at face value, though, good luck deciding which version of Leopard to buy--Basic, Premium, Business, Enterprise, or Ultimate!
Why "force people to get preventative care"?
Exactly! You can't.
There are plenty of steps that could be taken far short of saying it's illegal to skip your yearly physical. For example, mandating that employers give people the time off that they need to obtain preventative care. How about making such care free? Or actually paying people for especially effective procedures?
I love the idea of mandatory preventative care time. I don't like the idea of "free" care because it doesn't exist. "Free" care this year actually has to be paid by taxes from last year. And the U.S., like Europe, has a shrinking worker-to-payee ratio. It's going to get harder, not easier, to pay for government programs. That's not a political statement, it's just demographics.
As for "people make the choices they make," it's hardly that simple...[examples snipped]...Simply put, the market doesn't just reflect peoples' wants, it actively alters them.
This is exactly my point. Why not put this power to use for good instead of evil? The same techniques that convince people to spend obscene money on a diamond, also convince them to buy more fuel efficient cars and appliances and lightbulbs. If preventative and family care clinics sold directly to people (instead of to insurance agency bureaucrats), they would use marketing to convince people to come in and use their services. You'd see advertisements for annual physicals the same way you see advertisements for car tune-ups and brake repairs.
These are all really good points, and the only thing I'll add is that sometimes the people sitting in ER waiting rooms don't actually need an ER. What they need is a doctor or a clinic. But since ERs are open all the time, easy to find, and don't turn people away (unlike most doctor offices or clinics), people end up there.
My question is how can we better serve these people without clogging up ERs? We would need clinics that are open, easy to find, don't require paperwork or insurance, and are inexpensive. I don't know how to build that, but I think (hope?) someone could figure it out. My concern is that there is no incentive to now, because the entire industry revolves around structured government or insurance payments, rather than the consumer/care recipient.
Granted--this is not a solution to all health care costs. Frankly I don't think there is a solution for the expense of critical care, and that's why we will always need insurance. But I think it can go a long way toward skimming off the more easily treated from the expensive ERs.
We need a comprehensive reform that addresses the entire medical industry. A free market does not do that.
Perhaps I did not make myself clear above, but what I'm talking about is a targetted reform that better harnesses consumer market forces for certain segments of care. I never said the whole has to be a "free market," whatever that is--the term is basically an epithet these days. What I want is to divorce preventative and common care from the insurance gatekeeper, and introduce consumer choice. The government backstop would benefit from the resulting cost reductions as much as individuals would.
I disagree that we have to transform all of U.S. health care in one fell swoop. For one thing, there's a lot about our health care system that does work well, so why trash it. For another, such radical change won't run the political traps successfully. Incremental is the way to go--pick one problem and solve it, then reevaluate.
The greatest efficiency that we can achieve is a system of preventative care that prevents higher cost treatment later.
How does a market driven health care solve this problem? The short answer is "It doesn't". People don't buy things they think they don't need. The lower middle class and low income people will not shop around for an annual physical. They will rely on the same method they have now: Go to the emergency room for my current illness and let the government pick up the tab.
So what's your alternative--force people to get preventative care? In the U.S. at least, people make whatever choices they make. If you want them to change their habits you have to convince them it's in their best interest to do so, and then make it easy for them to change. Markets are very good at both of these.
Those coatings help prevent the minor surface scratches (often called fogging) that can occur when people clean their plastic lenses with their cotton t-shirts. They don't do anything to prevent actual gouges of the lens material. If you put your polycarb glasses in your pocket with your keys and coins, they will get scratched--coating or no.
For real scratch and gouge resistance, glass is better. It is much harder, and the property is intrinsic--nothing to wear off or deform.
I have one and have dropped it a number of times with no ill effect. I think that unless the screen strikes a pointy thing directly, the durability depends on the strength of the case. If the case is strong and stiff enough to resist deformation, the glass won't break. So far so good with my iPod.
However, it is almost impossible to shop around for the best price. We don't know the actual cost of treatment and it is impossible to tell what the cost is going to be upfront. A basic physical at one office may not include the same bloodwork as another office. You can't compare services to get accurate price comparisons.
Exactly the problem I was getting at in my last paragraph. The solution is to directly connect the consumers to their care financially as much as possible. Substituting the government for the insurance companies will do nothing to solve this basic failure.
The problem in healthcare is that the unit cost is going up--regardless of who is paying. Medicare costs are going up as fast as private costs, proving that the problem is not related to private vs. public funding. What is needed is pressure to drive the efficiencies up and the prices down. Regulation can provide pressure, but it is inflexible--requires legislation, rule-making, and often court cases. Market competition is a more flexible and powerful way.
You can't call a doctor's office and ask for a quote on Strep throat treatment.
Depends on the doctor's office. Minute Clinic is IMO a prototype for the future of healthcare. Complications can ensue from any treatment, but they are often the exception rather than the rule. The market should be able to handle the most common things; right now the entire structure is built to handle the exceptions.
The second problem with elasticity is the desire to deal with a single doctor regardless of price. This is a business built on relationships and is not extremely price sensitive. If my Doc charges $50 more than the guy down the street, I will probably still go to him because of trust.
This is also a factor with lawyers, mechanics, financial advisors, handymen, personal trainers--basically anyone who provides us a service. For some people the effect might be stronger for doctors, for others, not. (I've never had a "close" doctor and don't care if I ever do.) The key is to allow that to be one factor in individual decision-making, rather than enforce it as a structure for everyone. If someone wants to save money by jumping from doctor to doctor for their physicals, shouldn't they be able to?
Incidentally, this is one area where technology can make a huge difference. Right now the big problem in jumping from doctor to doctor is your medical history. It's typically on paper and needs to be sent from old office to new office (remember that Seinfeld episode?). This is just dying for an IT solution. Medical records are information, and if there's one thing we've improved in the last 20 years, it's the storage and movement of information. Except in the medical field.
Actually, it works fairly well for legal services since they aren't universally required, but works horribly for food and housing. If it worked so well, why do we have a huge number of homeless and hungry people?
The number of people who actually starve to death in the United States is very, very low. Hunger is far from a solved problem, but consider that way more people die from influenza or heart disease than from hunger. Likewise, the number of homeless people in the United States is, as a percentage of population, very low. Again--not a solved problem, but numerically a much, much smaller problem than what we see in health care today.
There will always be the disadvantaged, poor, and (yes) mentally ill, who will require some assistance. These are not easy problems to solve. What we see today in health care is that not only are these groups not adequately served, but neither are huge swaths of lower and middle class people who are gainfully employed, housed, clothed, fed, etc. People who can pay their way in every other aspect of their lives, cannot afford health care. To me that makes it obvious that the problem is systemic.
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Most medical care is not emergency, but rather falls into three categories:
- Proactive care (physicals, etc)
- Non-emergency illness (flu, strep throat, etc--treatable at doctor's office rather than ER)
- Treatment of chronic conditions (diabetes, high blood pressure, arthritis, etc)
These aspects of medical care can easily satisfy the requirements for market forces, at least as much as other markets.
- Information - There is no shortage of information available on proper proactive care and the most common illnesses and conditions, as well as their most common and effective treatments. Patients are awash in information today.
- Elasticity - The numbers of people who get sick are not dependent on market forces, but where they go is. If people had to pay for their own strep treatment, don't you think they'd drive an extra 15 minutes to the next clinic to save $50? If it's not a life-threatening emergency--and most medical visits are not--then there is elasticity.
- Barriers to entry - Of course it's still hard to get a doctor's license. But it turns out that many of the services above can be performed by nurse practioners or physican assistants. And, this is not an issue with who is paying, but rather with the nature of the service. Many other specialized-skill markets suffer from this deficiency.
Furthermore, it's not like medical care is the only market that has the aspects you describe. In fact the conditions you describe are true for many specialized professions. For instance the legal market suffers from all the same deficiencies in information, elasticity, and barrier to entry. Same with civil engineering.
Finally, your garbage collection analogy is terrible. For one thing, garbage collection works the same for everyone--and typically anything outside the norm is not collected. And garbage collection is a mature technology. There is no great need to encourage innovation in garbage collection.
Put another way: garbage collection is a commodity. But even that doesn't automatically qualify it for goverment provision. Food is a commodity too, one that suffers from many of the defects you list above. Yet, the private market does just fine providing it to most people.
What many people do is look at the medical system and envision a system that is mostly provided by government, with some private service on top. But that system sucks when it comes to flexibility and innovation. A better system is one that is mostly private markets, with the governement picking up the few at the bottom, who the market does not serve. It works for food and housing and legal care.
It's important to keep in mind that the failure of our medical system today is a failure of this particular system, not all private systems. History is full of industries that were inefficient until the right market structure or business model or technology came along.
We need to better expose consumers to the actual cost of their most common care. Right now the system is actually run pretty close to a garbage-collection system, with the insurance companies as the intermediary between consumers and their care. What is needed is a system where consumers can better force down the cost of the most typical, non-emergency health care. Insurance should be for broken legs and other emergencies, not a pill you take every day for your asthma. We don't pay for all home improvements and repairs through an insurance company--just the emergency stuff. Health care should work the same way.