Healthcare Reform – Irrational Consumers

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The actual thought of price comparisons on medical services seems almost ridiculous. You don’t cut costs on your health. But that’s exactly the problem. If you had forethought and a choice between two procedures; One was $10,000 and the other $100,000, both with equal chance of success, which would you choose?

An individual having a heart attack typically does not provide a preference for which hospital they are taken to by ambulance. It typically is based on distance. Unless one is specifically staffed for cardiac emergencies, you will most likely be taken to the closest.

You probably don’t have time to the go on line and check the prices for cardiac services. Even then, these prices are typically are not available. Think about this. When is last time you when to a restaurant and ate without knowing the price of the meal? Would you even entertain eating at such a place? Probably not because you don’t know if the veal is $10 or $150. These are rational consumer choices that you apply to everything except health care.

These choices are not typically provided to us and they are mechanism through which competitive market forces prices down. We don’t allow this to happen, thus we are irrational consumers.

HMO’s do provide this service to a limited extent by in network and out of network coverage. They pre-negotiate rates to try to get the best prices on services. If you work with in their network, you are getting the best rates they could find.

On the individual side, Heath Savings Accounts try to encourage this behavior. This type of account combines a tax free savings account with a high deductible health plan. The idea is that the consumer controls spending from the HSA up to the deductible. Since the consumer is in charge, they tend to make better choices.

Healthcare – Market Reform

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A core problem with the American health care system is that its market is fundamentally flawed. Part of this is due to laws created to provide humanitarian treatment during medical emergencies. In 1986, congress passed the Emergency Medical Treatment and Active Labor Act. Before EMTALA, if you showed up at an emergency room without proof of insurance, you could be turned away. Under this new law, hospitals would be required to provide services no matter the financial status of the patient.

Under EMTALA, there became less of an incentive for people to get insurance since emergency care would always be provided. And since the uninsured will be will be far less likely to pay their bill, someone has to cover these costs which are estimated at 55% of all emergency services. This results in hospitals raising their prices for services, which typically falls on the insured, raising premiums. Thus, you have a perverse incentive for the purchase of health insurance.

A large percentage of the uninsured are young healthy Americans. These individuals would contribute more to insurance revenues rather than costs. Therefore, a possible solution is to require obligatory coverage. By doing so, we expand the risk pool of Americans to lower per capita insurance costs. Since most Americans are now insured, the cost of EMTALA is reduced, which lowers costs across the board. This is a market based approach to the concept of socialized medicine.

There is another positive side effect. Since insurance is mandatory, anyone showing up for treatment without insurance would most like be an undocumented alien. These individuals could be treated and turned over to immigration officials thus easing the loads on ICE. However, it is also likely that illegals would purchase insurance to prevent easy discovery. Either outcome is a net positive for health care.

As a libertarian, the thought of mandated insurance is in exact opposite to my core principles. But the other solution is to turn away people at the hospital that are not insured or don’t have an insurance bond. I’m not sure any libertarian could support that ideal.

Healthcare – Cost Benefit Analysis

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People complain about HMO’s and “drive-by medicine.” They say that hospital stays should be longer and more comprehensive. But what happens when the controls are released and the floodgates are open? Let’s say that an indigent mother gives birth to a premature child. We have the medical technology to save the child. But at what cost? $100,000 to $1,000,000 is not uncommon for this type of service today. Perhaps you think it’s ok for the taxpayer to foot this bill at this level. But, what happens when it becomes $10,000,000?

We have not come to the point of accepting that actuarial decisions MUST be part of health care. If you have X dollars to spend and there is a request for $1,000,000 in treatment for a single case, it has to be determined how that money is best spent. A bleeding heart liberal would say the insurance companies make too much profit so make them save everyone. But the insurance companies just pass those costs on to the consumers, which is our current problem.

On a related note, will someone please take Sarah Palin moose hunting and not bring her tired ass back? Her idiocy in blabbering about supposed “Death Panels” was the stupidest thing that a conservative could have done. End of life counseling was the one sound fiscally conservative aspect of the heath care reform bill. But no, politics are more important than real reform.

On the Nature of Human Intelligence

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What is the nature of intelligence? Is it just you or the sum of you and any tools you have at your disposal? For the purposes of an IQ test, it would be just the organic part. However, on your job were it really counts, all bets are off. You are allowed any trick in the book to achieve your goal. And in your personal life, you set the rules. I submit that we have already entered the Cyborg age. It may not be exactly what you expected from reading science fiction, but the details are just speed and interface.

The typical techie has some type of wireless Internet access at most times, be it 3G, EVDO or wifi hotspot. With this technology, you are able to access such on-line resources such as Wikipedia, Wolfram Alpha, or the Internet Move Database. If you can access this information at any time and place, doesn’t it make it part your smarts? I mean you can get the information, perhaps not with the speedof Marilyn vos Savant. But you could easily wax her tail with the sheer volume of information available. Who played Lumpy on leave it to Beaver? Suck on that, Marilyn. It’s given that only part of intelligence is pure recall, but it’s an important part. Original and theoretical constructs are key piece of total cranial horsepower. But even each of these are based on a foundation of basic recall.You could argue based on the premise that we have been in the Cybernetic age since the first written word. But I submit that carrying around the Library of Congress is impractical. It is only the confluence of wireless devices and the Internet that finally makes the total of human knowledge available on demand.

There was a time when students weren’t allowed to use calculators during a test. Now its pretty common if not encouraged. And now we are seeing Internet access accepted on tests as well. Thus, the total of the human experience now includes handheld devices.

4chan: Defenders of the Internet?

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4chan is at it again, bless their little trollish hearts. They’ve taken up the role of vigilante force for the media pirates on the Internet. I pointed out at some point in the past that the evolution of the Internet would include a de-facto police force, since meat space jurisprudence can’t work at cyber speed. I think we are starting to see that take place.

The current tactics, however, will probably not make much of an impact. The sites being targeted are of very little economic importance. If you take down the web site for a bunch of lawyers, you are really aren’t affecting their ability to do their job. However, if they start to wise up and focus their efforts on better targets, they could have a significant impact.

For example, if one were to properly approach the problem, then the impact to commerce must be maximized. There are a number of weak spots they could focus on. I wonder the effect of DDOS’ing a major motion picture studio’s web site for a new movie, right before the big release. If it could have an impact on the opening weekend numbers, then you might have something. Particularly, if the studio blamed the failure of their movie on 4chan. Now that would make CNN and the other studios would sit up and take notice. They also might think really hard about their participation in the RIAA campaigns.

Of course it could stir up the Obama justice squad, too.

Antibiotics, Sewage and Superbugs

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>Do you know where the next plague will come from? Neither do I, but the smart money might be on the sewage treatment plant around the corner from your house. The medical establishment has known for a while that the over prescribing of common antibiotics has created a series of newly resistant bacteria. I submit that the sludge slithering under your street may be a bigger problem in the long run.

Very few antibiotics are fully metabolized. You excrete some amount whenever you use the toilet. When you are sick, you excrete some of the bacteria as well. Plus, there are many types of moderately harmful bacteria that exist in even the cleanest bathrooms such as Staphylococcus, Streptococcus, E-coli, Salmonella and Campylobactor. All this is floating around in raw sewage, which is a fantastically rich growth medium.

So what you have here is a large, open air petri dish. Bacteria are free to grow, divide and mutate at will. Combine multiple strains of bacteria competing within this medium and you have a little evolutionary microcosm, with weaker strains dying and the stronger flourishing. Just wait until one of the winners hitches a ride out of the plant and makes its way to the general population.

Is the risk small? Certainly. Is it zero? You wish.

Android and the Linux Desktop

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I’m going to break one of my own rules by making a prediction. The year of the Linux desktop will be in 2014. Now, let’s talk about how I’ve arrived at this conclusion.

Android is picking up steam, and from what I’ve seen, I don’t think there will be anything to stop it. Apple currently owns more market share and the iPad will give Mr. Jobs a momentary boost, but the problem is this; Apple controls the hardware and the software. There is no room for any other company to make money. And companies love money.

In the past, this would have meant that Motorola, Samsung, et al would have gone it alone to attempt to control a piece of the market. But, with android they can join forces to an extent and take advantage of a huge development community. This “friendly” competition will push prices down and keep android more affordable than the iPhone. Also, this results in Apple vs. the world, AND Apple doesn’t have significant vendor lock in. Additional factors are: AT&T’s quality of service, and the Google factor. There should be a strong and steady migration to the android smartphone platform with a strongly superior market share by mid 2011.

The Ipad may revolutionize computing, but my bet is more like a solid selling niche product. However, android is hot on it’s heels in this market as well, with a number of tablets soon to be released at significantly lower price points. Based on early price projections, the rest of the market is aiming to undercut the iPad significantly. At the current estimates, I would expect for android to surpass the iPad’s market share by late 2012.

With one or two important computing platforms invading people lives, it will eventual become necessary to get more serious with some of the data and applications. While touch interfaces are a leap forward in usability in the mobile arena, they aren’t very information dense compared to a keyboard. Imagine writing a book using gestures. Therefore, there will be a natural progression toward systems that allow the user to more fully utilize the android environment.

This may come in the form of an android based netbooks or a full linux distro. I’m expecting android netbooks to hit the market around mid 2012. If the price point stays in line with the currnet android tablet projections, there should be significant market share by early 2014.

Thus, we have the year of the Linux Desktop (er, netbook)

Ubuntu usabilty is going downhill

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I have a serious usability issue with the MI at a corporate installation.

When a new instant message is received with the chat window closed, we have to navigate a menu to interact with it. Click-Navigate-click. Before, we simply double-clicked the flashing icon and the window appeared. This might not seem like much to many of you, but they have to deal with 100-150 email/IM interactions a day. This is a major PITA.

I’ve deployed Lucid on about 6 desktops with individuals all expressing the same problem. I’ve delayed the roll-out on the additional machines until I could determine the suitability for deployment for the rest of the organization.

The general perception is that NotifyOSD is taunting them with the message without an immediate solution. This isn’t a fair characterization, but it persists. People are a little frustrated. I’m going to have to pull the MI at this location if I’m going to continue to deploy Lucid.

They’ve been running lucid since beta1. That’s about two months. With the current rate of interactivity, if they haven’t learned it by now, they aren’t going to.

Is this a corner case? I’ll leave it for you to decide.

Celebrity Muses

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After the Quail Hollow golf tournament was over and Tiger failed to qualify, I started wondering about the reasons for his failure. Most of sport writers assumed that it was the recent public revelations of his infidelity and the distractions associated with it.

However, what if the issue is a little deeper. One could argue that as a professional athlete, Tiger knew exactly what he needed to be at the best in the his game. And perhaps the quenching of his libido with a harem of trashy chicks might have had medicial purposes. Medical science has established the people will subconsciously self-medicate. Perhaps these dalliances are necessary to perform at his level?

Another related example is that of Aaron Sorkin, the writer for “The West Wing”, “Sport Night” and few other well known TV shows and films. He had a rather public arrest at an airport with marijuana, mushrooms and other assorted mind altering substances. At first, he stated that he used them for the creative process. But then the PC police cracked down and he “admitted” he had a problem. Went through rehab and everything. Hasn’t written a descent script since.

In the PC world, Tiger was probably just a skirt chaser. But in the UW world, maybe not…

Android is more than a phone

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Google is a self described information company, so why would they enter into the phone market? One obvious answer is that they see mobile as a major advertising platform and wanted to capture the market. While this is true, it’s not the full story.

Google’s thing is information and this has to be captured in some fashion. We all know that Google makes use of the data we submit in searches, gmail and gtalk. They have even sent around street view vehicles to take pictures of our houses and streets. But with android, they no longer have to do this. We are doing a lot for them. Through use of android, we are a mass of mobile information gathering nodes for the Google collective.

For example, Google would be very interested in the locations of the wireless hotspots you’ve run into today. You can also correct navigation data on the fly and crowd-source traffic information. You already upload pictures to picasa with geotag information. And the GPS records your coming and goings while driving, working and shopping. All valuable information to marketers and this information is silently recorded by your android handset.

In many ways this is a little creepy. Big brother and all that. But in others, this is a great experiment in digitizing the human experience. We just need to be vigilant that our rights are not trampled along the way.