Tough Questions on Healthcare Reform

I was watching Dateline last night when they covered problems people were having getting insurance companies to cover treatment. The show was named “Critical Condition” and it was pretty heartbreaking to watch. The theme of the show was that insurance companies were denying critical treatment for patients. My thinking is there were much bigger issues at play. And these issues didn’t have as simple answers as you were led to believe.

The first segment was on Patrick Gannon, who suffered a heart attack at 41. The doctors applied $1,000,000 worth of treatment to the man to save his life over the course of several weeks. The result was a man that required full time care, unable to walk, talk or mange his own life. After paying out all that money, the insurance company opted for a cheaper rehabilitation route that the one that family wanted. The claimed result is that this approach drastically affected Patrick outcome.

Let’s remove the emotion. The doctors performed $1M of treatment on a poor outcome that left Patrick in a predicable state and probably wouldn’t have knowingly consented to. It destroyed his family financially in the process. To apply that much medical intervention on an infarction, you have to be dealing with little more than a corpse. Someone during this period should have realized that this was going to be a very bad outcome and let him die peacefully. The emotional and financial toll on his family will continue and it’s unknown how it will affect his daughter. There isn’t a good answer to all this, but I’m really not seeing the insurance company as the bad guy here. I’m surprised they covered as much as they did.

The second was a firefighter named Rick Crusoe with a rare form of cancer. The insurance company balked at an experimental treatment that had a 10%-15% chance of prolonging his life an undetermined length of time. I can’t speak specifically to the numbers involved, but they were requesting an authorization of up to $250,000. Would you give up your house for a 15% of helping someone live for a couple of months maybe years? I’m not sure many people would take that bet. Maybe a grieving mother or husband. How many lives could that money save if put to better use like paying for vaccines or other more certain treatment?

For last patient, we have Nataline Sarkisyan who was in need of a liver transplant. It was about $500,000 for a bridge to keep her alive for many months while they continued to treat her leukemia. My reading is that the treatment will probably kill her new liver and she would have to have another later on. They had already authorized a bone marrow transplant that could run up to $700,000. We could be looking at a total of $1.7M and that’s assuming she could find the second liver. Again, where is this money best spent?

In summary, I got the following from this report. First, medical costs are too high. This is obvious, but they always will be as long as research is expensive and risky. Therefore, we need to deal with this reality. Second, if you have insurance, you hope that your money isn’t being wasted on questionable medical decisions that will increase your costs. However, if it’s your loved one, you want them to spend everything they have. This is referred to as The Prisoner’s Dilemma. Someone external to the situation needs to make those decisions. Currently, only the insurance companies will do it because it affects their bottom line. And perhaps that’s the best way. Honestly with the material presented, I didn’t fault them for their decisions.

Third, doctors need to understand long term quality of life issues relating to the decisions that they make. Traumatic Brain Injury or Neurological Impairment with regard to heroic lifesaving measures are life shattering and a poor outcomes can usually be predicted early. Present the facts clearly so families can make sound decisions. But even then, people will override medical advice. And Patrick Gannon may have well been one of those cases.

 

What is the iPad?

I’m watching all the Apple fanboys buzzing over the new iPad. General consensus seems to be that it’s underwhelming, but I think Apple may have found an interesting market niche. It’s not a computer and it not a competitor for the netbook segment. It’s a media/surf terminal. A little toy you piddle with while you’re watching TV to answer questions that pop up like “Who played Lumpy on leave it to beaver?” or “What else was that actor in?”. Or perhaps you look up the playoff scores and read your email. Just Plain Old Surfing. New acronym – JPOS ™- you heard it here first! :)

A lot of people use their laptops for this type of stuff (me included). But if you don’t have a laptop and you find your iPhone or Droid is a little inadequate for regular couch surfing, this would be a better replacement that a $$$ macbook. IMHO, a netbook is a better and more versatile option, but for an Apple person, it isn’t as desireable. As for mass market adoption, you might snag some ebook people and perhaps some that find it a sexier alternative to the eeePC. But I don’t see another iPod craze on the horizon.

My only question is ergonomics. What does it do to your wrists to balance that thing for a couple of hours? You can’t read it if you lay it down. And how do you use the keyboard on your lap? Time will tell.

The biggest threat to Microsoft is Microsoft

I was reading this article on Microsoft having it’s revenue eroded because of low cost hardware. The author made some interesting points, but I think there is a bigger issue that Microsoft is facing. While the market is pushing toward lower cost hardware, this trend has been going on for years and isn’t the big problem. The elephant in the room resides in your pocket, lets mom know you’re safe and comes with nifty ringtones.

Modern PC’s are used for a great many tasks and they do them quite well. So well in fact that the only technological advances that we’ve seen in this area have been incremental. Quicken 2008 looks like 2009 and 2010. We’ve plateaued, at least for now. Current innovations are in real-time, portable, personal media and communications. PC’s aren’t the platform and never will be.

Smartphones are the new technological touchstone. They are dynamic, constantly following us on our kinetic lives, connecting us with our loved ones and documenting our adventures. And now they are the interface for the human experience. Witness the smarthone’s effect on the Iranian revolution. Apple saw this to some extent and threw fuel on the fire with the iPhone. RIM(Blackberry) is playing catch-up but appears to be hobbled by their devotion to corporate America. Android is a small but growing contender. Microsoft, however, completely blew it. It has had a foothold in smartphones since the Palm days, but couldn’t close.

The reason? Microsoft’s financial foundation is built upon legacy revenue streams. It is this market that it’s afraid to disrupt. And all new technology is fundamentally disruptive. Smartphones could eat into the PC’s market if they became too powerful. Why buy Outlook when your email and calendar are in you hand? And who will buy a $300 package for a smartphone they probably got for free? It’s not a platform for Microsoft’s sales model.

Thus they made the conservative choice and failed to innovate. This is a very serious problem for them as it appears that the consumer market is moving away from the platforms that Windows is geared towards. Windows 7 is a move in the right direction, but the competitors are nipping at its heels. The reality is that Microsoft is being outflanked in nearly all areas, with the possible exception of the Xbox.

What will the future hold? Microsoft has touted that Windows is installed on over 75% of all new netbooks. However, this is considerably less than the 90% dominance that it enjoys on the PC market. If this trend holds, then we will see further market erosion. Firefox has already established itself on 30% of PC’s and according to some sources will soon approach 50%. Clearly, Microsoft is losing consumer mindshare. The safe money appears to be on the open source software movement from which Linux, Android, your beloved Tivo and to some degree Apple Mac OS X are built upon.

The Real Green Revolution

I live in an area near one of the last hangouts of an endangered mussel known as the Carolina Heelsplitter. There has been considerable protest over this little critter in the last few years, bring development to a halt and even running a construction company out of business. I’m all for conservation, and don’t really have a problem with the protests beyond they fact that they are affecting my ability to get to Taco Bell in a timely manner. But the group is a little fringy IMHO as I know a couple of them and some of their other causes. In particular the rush for renewable energy

I was wondering if those same people were aware of the side effects of the all the renewable technology they are pursuing. It’s typically accepted that hydro power is pretty green, but check out this article. It’s doesn’t even describe the effect on fish migration and spawning which are well documented. We’ve seen the effect on diverting food crops to ethanol on the world food supply. Oops. That was quickly reversed. Wind affects the migration paths of birds. What happens when these confused avians get lost en mass, can’t find mates and begin to decline in numbers? Solar appears to be pretty benign until the change in weather patterns starts affecting crops and food production.

Looks like a green revolution may occur with the green revolution.

The Panty Bomber

With all the outrage over lax security, it is inevitable that we will enact further weird and useless measures to make our flights safe. Military tacticians have stated that in asymmetrical warfare, the defender is always at a disadvantage. We continually spend money to patch up the current crisis, while new attack vectors are already being planned. They started with traditional hijacking involving guns and grenades in the 1970′s. Our response was to install metal detectors. Richard Reid, the shoe bomber, got everyone taking off their Nikes. Now the Underbomber has got us scrambling for body scanners.

Where does technology eventually lead us in this cat and mouse game? Let’s move forward a few years to the era of the BioBomber. This twisted individual will ingest a cocktail of explosive ingredients. They might be poisonous, but not in the time frame that he is concerned with. Next, immediately before entering security he ingests a primer in a time delay capsule. Once the protective coating is breached, the explosive is triggered. This is the ultimate smartbomb. You are not going to find this dude by searching old ladies and toddlers. Do we intend on endoscoping all passengers? Of course, they could always go old school and set off a bomb vest in the security checkpoint, maybe even in the scanner.

The point is that the TSA is political theater designed to keep the masses feeling comfortable. If we expect to make people truly safe, no-fly lists and body scanners aren’t the answer. You are going to have to take proactive measures that get to the root of the problem. People want to blow us up. Why is that? “W” said it was because they were evil. I doubt seriously it’s that simple. Afghanistan and Pakistan house part of the problem, but let’s not forget about Israel and Palestine. It is a festering wound that is a great source of many of our troubles and a great recruiting tool for Al Qaeda.

Before you flame me for giving them ideas, realize that they have already thought about this. What else are they going to do sitting up in a cave in Waziristan?

Am I the least interesting person in the world?

Seems like everyone on the intertubes is running their own blog, so I decided to jump in. My site at http://www.unconventional-wisdom.org houses a lot of extended essays on various topics relating to politics and technology. However, because of their formal nature, I don’t update them more than once or twice a year. There are a lot more thoughts I’m interested in expressing, so I’m going to try a little stream of consciousness posting to see where that leads. No promises. I might well end up being the least interesting person in the world. :)

Stick around and let’s see if I can amuse you.