> so why don't i just raise the cost to $100+$10000 where $10000 is the maximum the insurance will pay?
Theoretically because you are not the sole provider offering that service and the patient could go elsewhere, or in this case, the insurance company would require the patient to go elsewhere. Obviously, this sucks absolute donkey balls and health care will always involve a healthy dose of "I can't just shop around for where to get help for a heart attack".
In my naive opinion banning discriminatory pricing (no special negotiated insurance pricing), the sale of medical debt, and counting bill forgiveness as tax deductible charity would be a good start. With the absolute technical and capital-intensive marvel that is modern health care I just don't see anyone being able to reasonably get away with no insurance. Maybe there is a mandated co-insurance for all plans that could be covered by HSA accounts that everyone would get access to. That way there is a cost that is transparent to the patient that scales. At that point though I would just go to single payer.
(Rant incoming) Another thing that might need to happen is billing caps based off of certain outcomes. Especially in the emergency medicine realm. If you go to the emergency room and rack up a huge bill for something simple there should be a cap on the amount the hospital can actually recover. All I see is (rightfully) constant bitching and moaning from ER staff that people should be going to primary care or urgent care for issues which are less resource intensive and cheaper. The issue is the ER could provide those same services for just as cheap. Build out those same capabilities in or near the ER. The triage nurse can then send those low priority patients to the facility right down the hall. The issue is hospital admins have no incentive to do that, because as you said, why bill $200 when you can bill a minimum of $2,000 when you have your patient captive.
I also think it is silly we ask people to self-triage. It externalizes a lot of the costs to other parts of society. I can attest to this from the constant Volunteer Fire Department air-raid sirens I hear followed by a "EMS to Well Now Urgent Care for Patient in Distress". I'm sure the volleys love having their evening interrupted when it could have been a simple walk down an aisle.
Absolutely agree on the negotiated price bit. That is the root of an awful lot of evil.
I have no problem with the sale of medical debt--what's needed is sanity in the debt collection business. Combined with making one-party record the law of the land--you're automatically free to record telephone calls without notice.
Bill forgiveness as charity? No, that's counting twice. They didn't collect the debt in the first place, there is no profit to be taxed and thus you are deducting $0.
ER: Two problems here.
ERs are mandated to stabilize a patient, urgent cares are not. Thus you see people in ERs with situations that could be handled in an urgent care because the urgent care rejects them for unpaid bills. And the ER can't provide those services just as cheap--a big part of what you're paying for in the ER is potential even if it's not actually used. The freestanding radiologist books their machines as solid as can be done without too much friction. The ER needs the same machines but needs them available NOW. I've been in an urgent care over a kidney stone--they had a CAT manned and ready to go at 3am (the only urgent care in town even open at those hours even before you consider the machines--every ER needs those machines 24/7.) CATs don't cost much to run, the main cost is the machine and personnel time (operator and radiologist) and that's incurred whether it's doing anything useful or not. (And then the urgent care punted anyway. Yeah, you're right, stone, we can't deal with it, go over to the ER.)
I will also say that transport isn't always as simple as you make it out to be. Consider that stone I just mentioned--the ER was half a mile away, trivial under normal conditions. Even under those conditions I could have *slowly* walked it--except there was a major street in the way and I most definitely did not want to cross that. Is a taxi going to take the call? No. Call a friend/rideshare/ambulance.
RE medical debt sale - if you have the ability to just sell debt easily instead of having to go through the process of trying to collect it you are not incentivized to charge reasonable prices as you can overcharge and then be perfectly fine collecting much less (but still above your costs) via selling it to a third party. Any debt that is incurred forcibly or as a matter of health of the debtor should not be able to be moved around. The hospital should have some skin in the game.
Bill forgiveness doesn't necessarily target the for-profit hospitals. Not talking about debt discharge. It actually probably isn't even the right term. Essentially what shouldn't be allowed is non-profit hospitals counting discounts for low-income individuals as charity performed by hospital. The value of the charity shouldn't be sticker price but actual cost of services. Maybe that is already the case, but what I hear from randoms suggest that is why some hospitals are happy to "work" with you on your bill. I shouldn't have included "tax-deductible" in there, this is more about maintaining non-profit status.
RE ER. I don't see how keeping the ER and Urgent Care separate matters. In a combined system you would still have two sets of doctors, two sets of CAT scan machines and operators and radiologists, okay maybe not separate but the capacity for both (an appropriately reserved). In the current system you actually have more overhead from having a whole separate billing system, HR, building, landscaping, etc. Yes, the ER still needs to stabilize a patient whether they can pay or not but that becomes *cheaper* when you have a whole other pipeline to send them to. You aren't engaging a highly paid ER doctor and set of ER nurses to prescribe antibiotics to the homeless person that just came in. You can have the RN, or an internal medicine doctor do it instead in the area down the hall. If at any point that homeless person starts to code or the RN/Internal Med doc identifies something concerning, they can get them over to the ER. But again, if you are the hospital why would you do this? You can take in that homeless patient and charge them big money for some antibiotics and hopefully get reimbursed by the government. It's not like the hospital would even lose money on it, you would still charge for the urgent care services, just at the reduced reasonable price it takes to provide them plus a little more. Heck, I'm sure that an urgent care wing incorporated into an ER would beat any standalone urgent care in the business sense, you've generally got a whole waiting room full of prospective customers.. but alas.. you would cannibalize your ER "sales".
And if that cannibalization of ER sales would leave the ER unprofitable, then raise your prices! I don't think any reasonable person would be mad if you charged what it actually costs to provide lifesaving care. Insurance companies would be okay with paying real costs for the fewer cases of legitimate emergencies if they know that the much more common cases of people going to the ER for more minor things would be much cheaper. I would posit that with urgent care support you would need less ER capacity as you wouldn't have it filled up with non-emergent cases.
And yeah, it would be ideal to have them in the same building close together. Retrofitting would be hard or impossible. It would mostly be for new hospitals going forward. It all boils down to designing hospitals to be the most efficient as possible at providing care to patients, not efficiency on generating the most profits.
so long as insurances are the "single payer" the problem will never go away. The single payer should either be individuals or the government (by mandate).
> Are you being intentionally dense? Why wouldn't they be building it in their own territory if nobody was stopping them?
They actually could. This has been an ongoing discussion in South Korean politics for years. Nuclear Submarine shipbuilding is a large undertaking and it requires a lot of security to prevent sabotage in ways that other types of shipbuilding just don't have to put up with. So it is in many ways cheaper and more secure to just rely on the US for nuclear shipbuilding as we already have the infrastructure and we are on the opposite side of the world from any adversaries who would have interest in sabotage.
> Besides, I already replied to your other comment that South korea is not allowed to enrich uranium by the US.
This is not true. There are mutual agreements that set the limits on enriched uranium for military purposes but they are flexible agreements that can be renegotiated or broken off as needed. The US has them with everyone including our allies and our adversaries. It's essentially just a tool to say "hey you need to discuss this publicly within your country first before you can change it". Nothing more or less.
No, I am not being dense. From your continued lack of citations I am starting to assume there is no law stopping the RoK from enriching uranium (though I have been trying to find one). Uranium enrichment facilities are expensive. If you have a partner nation who is willing to sell you the enriched uranium that just makes sense. Again, it being the property of another nation, they have the right to judge who should have access it it and what they might do with it. If RoK wanted to spend a percentage of their GDP on enrichment facilities they could. They don't have an urgent reason to. Further they don't have any deposits of any uranium to begin with so they would still need to partner with another nation anyways, so I ask you - Why would RoK want their own enrichment facilities?
> If RoK wanted to spend a percentage of their GDP on enrichment facilities they could
And they have in the past. Guess who shut that down?
> They don't have an urgent reason to.
South korea is surrounded by 3 nuclear powers ( north korea, china, russia ) and militarily occupied by another nuclear power and yet, they have no urgent reason to? Good one.
> Why would RoK want their own enrichment facilities?
This is just absurd. Your questions answer themselves. And it's obvious you already know the answers but just are trying to distract.
You keep googling and I'll look for the citations. Okay buddy?
I don't think any country has the right to demand that another country hands over enriched uranium and allow them to move into a shipyard so that they could build a nuclear sub. Of course you need permission from a seller to buy products and use their facilities. I would recommend going beyond simply reading the headline.
> I don't think any country has the right to demand that another country hands over enriched uranium and allow them to move into a shipyard so that they could build a nuclear sub.
The US won't allow south korea to enrich uranium on their own. Want to try again?
> I would recommend going beyond simply reading the headline.
> 190 nations have signed the Non-Proliferation Treaty.
Who cares?
> This includes China, so the very US vs China premise here is misplaced.
Sure. But it wasn't china that stopped korea's and japan's secret nuclear programs. It was the US.
> [The US, UK, France, Russia, China and 185 other countries] won't allow south korea to enrich uranium on their own
Just like they prevented north korea...
Your response debunks your response. It's quite remarkable actually.
The only country that can prevent another country is the one militarily occupying it. China, France, Russia, UK and the other 185 countries don't militarily occupy south korea. The only reason north korea, israel, india, pakistan, etc were able to go nuclear is because they are not vassal states military occupied by a foreign power.
If india doesn't care, why should south korea? India only has 2 nuclear powers surrounding it. South korea has 4. Why should korea care more than india? I'd love to hear your thoughts as an indian on this matter. You are my goto indian guru on all matters geopolitics, politics, economics, tech, sports ( cricket, not baseball for obvious reasons ), etc. I await enlightenment.
I am fascinated by the extent to which people can mentalize their different senses. I can visualize most of my primary senses. Sight would probably be my weakest one. I am definitely not aphantasic, but the images seem much more ephemeral than what other people experience. I can conjure up an image at will but if I focus too much it will become fuzzier.
Fuzzy isn't even the best word to use though. It's not fuzzy but lacking detail while at the same time my brain isn't comprehending that it is lacking detail. It is almost as if my brain can only focus on a few aspects of the picture at once with the most striking characteristics being rendered while the other parts are inferred or filled in with the most perfect placeholder - something that perfectly represents the idea of what is missing, but which it is not.
None of my other senses suffer from this. I can smell pumpkin pie or treated lumber on command. I can conjure music in my head all day (and often do without trying). I can metalize the feeling of cold or warmth. I too can taste spaghetti and meatballs. When I read that my mind immediately went to those cheap pre-made meatballs in the frozen section, my teeth cutting through those dense almost hard meatballs that are somehow so bland yet over spiced.
I also wonder how much of our differences are often our inability to communicate our experiences in a sufficient manner.
I enjoyed walking through some of their docs which documented decisions and deliverables. Thought for sure it would have just been a dump of source code with little to no context.
As an aside, I've always thought of this when listening to discussions of technological advancement. I often hear the argument that in the early 20th century many people thought we were near the apex of technology. That often gets brought up when people claim the same today. I don't think we are quite there, but I get a feeling that the limit we are approaching is more a limit, not of knowledge, but of resources and engineering.
We have literal alchemy, but we don't have the capability to make useful amounts of gold. It is not that we don't know how to, but that it is not practical. How much more will material science, chemistry, and maybe even physics give us in practical (technology-wise) knowledge? Plenty for sure, but I don't think our rate of technological advancement will continue in these fields. That said, we have so much to learn even if it is not immediately applicable to technology.
Where I think there is an absolute abundance of applicable and practical knowledge to be collected is in the fields of biochemistry and biology. We haven't even scratched the surface there. We may never find a way to travel faster than light but if we can adapt our bodies to last for hundreds or thousands of years in stasis it may not matter. To me, being able to easily manipulate biology is so much more dangerous than nuclear proliferation. Anyways, not an expert of any of these fields.
> How much more will material science, chemistry, and maybe even physics give us in practical (technology-wise) knowledge? Plenty for sure, but I don't think our rate of technological advancement will continue in these fields.
Strong disagree. We have only scratched the surface of material science and chemistry; we are typically working with the bulk properties of relativity simple materials.
There’s a very wide design space of metamaterials and molecular machines that we have not explored.
Material science is still largely an art consisting of educated guesses, formulation followed by exhaustive (and exhausting) testing of very tiny variations in composition and process. This is mainly because while we have good theoretical frameworks, mathematical techniques and computation capabilities that works angstrom scale downwards (kinda... I think first principles computation of properties of collections of atoms beyond a few light ones is still difficult) or milli scale upwards (think FEM and similar used in mechanical engineering), nano to micro scale where all material properties arise is basically un-computable. Not being someone gifted with intuition of advanced math & calculus that could tackle inventing such, the nature of graduate work in the field did not appeal to me personally. You can see how Semiconductor Fabs & catalyst labs for instance have nevertheless successfully used the systematic exhaustive iterative experimentation approach to deliver massive progress.
Solving for computability of the nano-to-micro scale will absolutely drive a massive transformation in the world much like the industrial and information technology revolutions. Biological revolution i believe requies basically the simila computability to manipulate proteins though there seem to be shortcuts leveraging bacteria. In recent years that I occasionally have seen papers that hint at progress on math and computability at a nano to micro scale. So I'm quite hopeful we'll have massive progress technologically
I agree that there's an interesting question how far we can lean into this space of applying the knowledge and technology capability we have, because for however far ahead of the outer limits of our capabilities get in the outer limits of our understanding from that matter, there's a frontier of applicability that also has to advance in the wake of those. It's interesting to consider if there's any principle that articulates the relationship between that frontier and the frontier of discovery.
In some senses, I've thought we'd hit a wall in part just because of the highly visible challenges to democracy, the wall on processing power of computers, how enshittification has caught up services and taken them down from the inside, not being able to pull off things like high-speed rail, the halting progress of self-driving vehicles, or just realizing that the buildings that exist in cities are going to stay there for a long time and not be subject to any overnight cyberpunk makeover.
But I think if our era was not known for the threats to democracy, pandemics, and war, we might have otherwise have had enough breathing space to remember this historical era as one of true, truly major advances in the frontiers of science. There's plenty on that front that would have been "enough" to mark this historical era as a distinct one. CRISPR and AI, by themselves, are enough to be the signature achievements of an era. And so far as it relates back to your point, I suppose on balance I would say I feel that the advances we have made don't yet testify to an imminent slowdown in our ability to translate from a frontier of our knowledge into applicability. So I suppose I understand your idea but feel a little bit more optimistic.
And that standardized and plain format is simply typographically ugly.
The legal profession has done better. Just look at the opinions from the Supreme Court. Single spaced, nice typeface, good margin. Hallmarks of elegant typesetting and optimized for readability. Why aren't legal filings standardized based on this format?
Honestly, none of those sound like blockers for the use case I and many other diabetics would like - monitoring for general blood sugar responses (rough curve) after eating. Sure, you wouldn't be able to use the measurements to dose insulin or even measure your actual (numeric) glucose level, but measuring my A1C every three months is good enough to do that in mine and many other cases. I've had my blood sugar controlled through diet and metformin with it being in the range of 5.9 - 6.2. I could do so much better if I had a better understanding of how my body, specifically, reacts to certain foods, mealtimes, routines (exercise after eating), etc.
It would be super helpful to know (relative to other foods) how my body reacts to claimed low-carb foods. Is there a large spike (don't need to know the number) or is it a much more flat curve? How long in general does it take for the line to return to pre-meal levels? What does that trend look like over many months? Heck, I could even run a rudimentary and simple test to do comparative insulin response to a known amount of carbs to see if my insulin response is improving over time (using the period of the curve). I would love to get an alert that hey, we think your glucose level shot up a lot (don't care how much) so that I can remediate it through exercise then and there and avoid that food or timing going forward.
Really hoping the people in Medtech don't make perfect the enemy of good in this case. Although maybe what you listed would still be blockers for even getting general glucose curves. I've been planning on getting a CGM for at least a few months to achieve all of this, but it would be great to just have it in a watch or other simple wearable.
Agreed that the value of a CGM is in the change information, and that adding a CGM is probably the biggest quality of life increase for anyone with diabetes. Highly pro CGM if you can get it!
The issue with spectroscopic approaches is the amount of noise can be really hard to disentangle, to the point that you might get really unreliable trend information, where it might even be dangerous if you're making dosing decisions off it. And even if you aren't, getting incorrect trend information doesn't really help you any more than just not knowing it.
It sounds like you're a T2 diabetic, in which you're not taking insulin and high blood sugar over long periods of time is your risk profile.
Unfortunately T1 diabetics and insulin dependant T2 diabetics will get killed by a machine that tosses out numbers that can be considerably off to the point no manufacturer is going to make the risky product.
If you build the probe so that it has the spool of cable in it, then the probe has to be as large as the full load of cable. If you make the probe just big enough to do what it needs while pulling the cable from the lander then it can be much smaller. If using the smaller probe, then the cable will need to be fully movable as it melts deeper. The larger probe with the full length of cable will require much more energy as it needs to melt a much larger hole.
I think our breakdown in understanding here is our concept of cables. When I say cable (and many others here) I mean fiber optic cable. Even with 25km of fiber optic cable it is rather small and light. Drones, missiles, and torpedoes are already doing this with many miles of cable in a tight space. The issue with this which I am not sure about is the dynamic of the ice on the fiber optic cable and how well it would hold up to refreezing of the ice.
Refreezing isn't the big issue; shifting of the ice (causing physical severing of the line) is. We don't have a great handle yet on how much it moves around.
Yes, I think we definitely have a gigantic misunderstanding of cable here. Mine is based in reality, while yours seems to be very unrealistic. How in the world is a fiber optic cable going to do what needs to be done? Where is the power coming from to heat the probe via a fiber optic cable? Even a fiber optic cable at a length of 25km is a very large spool. If you want the probe to hold the spool and unwind as it goes, it must be at least the size of the spool of cable. If you think this would work with an unsheathed piece of bare fiber cable, then your just not even trying to be serious.
I see another misunderstanding then. With this method the actual probe would use nuclear material to melt its way through the ice. In addition, the heat of the nuclear probe on one side and the ice on another (or melting ice) would make for the ideal conditions of a peltier (or just use a traditional RTG) device to power onboard sensors and electronics. The fiber optic cable is only for communication.
Simple reactors can be designed to be turned up and down according to need. A 300w RTG is more than enough to run all the necessary electronics. The ice-melting 30,000w+ heater can be a second rector that is spooled up only when ice needs melting.
we're attempting to search for life and the thing you want to do is use radioactive heaters? we deliberately crashed a satellite into the planet to avoid having it potentially contaminate the moons we are curious about, and yet you're thinking they'd just irradiate everything like this? it's really just not logical
In the outer solar system, under miles of ice, in total darkness and cold .. it is nuclear or nothing. Short of antimatter batteries, there is no other source of power that would be even theoretically suitable.
The concern is more spreading Earth life. NASA's Planetary Protection team (which is a delightful job title) is largely concerned with sterilizing stuff we send out so any discovery of microbes on Mars doesn't turn out to be hitchhikers.
Even a fully fleged nuclear reactor isn't gonna do much damage to Europa and potential life. Swimming in a nuclear reactor's fuel pool is quite safe; water's some of the best shielding we have. https://what-if.xkcd.com/29/
Really? To heat and melt sufficient ice around 25km of cabling? I don't know what temperature this ice is at, I think on the surface Europa averages around -300F, so it's probably at least that low. I guess a lot is going to depend on whether you're fine with the ice refreezing around the cable - if the ice shifts at all, the cable breaks. Keeping the whole thing heated continuously seems implausible
No, not really. Water is very effective shielding, and you could melt a base station through the ice and do exploration with subs it sends out if you want fairly pristine samples. In the Jupiter system, it's also hardly the biggest radiation source around.
The spool can be a long, thin "pipe" of wound cable that goes with one end of the "pipe" pointing to the rear (up). You can put an arbitrary amount of cable in a given hole diameter by making the spool taller.
(Google image search suggests that a similar approach has been taken by the TOW, it's not a spool that could be reversed by adding a motor to an axis, more like a tightly packed coil that gets straightened as wire is pulled out)
As for the energy, I assumed GP was thinking of solar panels on the surface. I also assume that we share scepticism based on the low sun intensity out in the orbit of Jupiter... (and that's before you even start wondering how much further away from the melting point that ice will be than all ice of conventional human experience)
>You can put an arbitrary amount of cable in a given hole diameter by making the spool taller.
Wouldn't this be limited to the tensile strength of the material and the weight of the cable? Granted, Europa has much less gravity, but 25km is a lot of cable weight.
Consider something as small as fishing line; one online estimate gives it .245g/m. At 25km, that's over 3 tons of line weight hanging down a hole on Earth or nearly 800 lbs on Europa.
I think there are still mechanics at play that would have to be considered.
>The probe bears on the ice below it
This implies it is bearing the weight of the entire cable above it. So instead of the tensile stress being the limiting factor, it's not the compressive stress. If you're intent is to retract the spool, it would still be in tensile stress as it comes up. (And you'd need enough torque to do so. But maybe you the plan would be to abandon in place).
>What you have to worry about is the ice shifting and severing the cable.
Could you embed a series of metallic needles as you melted your way down, then communicate via radio waves that travel needle to needle? They would not need to be connected. Just close by.
Theoretically because you are not the sole provider offering that service and the patient could go elsewhere, or in this case, the insurance company would require the patient to go elsewhere. Obviously, this sucks absolute donkey balls and health care will always involve a healthy dose of "I can't just shop around for where to get help for a heart attack".
In my naive opinion banning discriminatory pricing (no special negotiated insurance pricing), the sale of medical debt, and counting bill forgiveness as tax deductible charity would be a good start. With the absolute technical and capital-intensive marvel that is modern health care I just don't see anyone being able to reasonably get away with no insurance. Maybe there is a mandated co-insurance for all plans that could be covered by HSA accounts that everyone would get access to. That way there is a cost that is transparent to the patient that scales. At that point though I would just go to single payer.
(Rant incoming) Another thing that might need to happen is billing caps based off of certain outcomes. Especially in the emergency medicine realm. If you go to the emergency room and rack up a huge bill for something simple there should be a cap on the amount the hospital can actually recover. All I see is (rightfully) constant bitching and moaning from ER staff that people should be going to primary care or urgent care for issues which are less resource intensive and cheaper. The issue is the ER could provide those same services for just as cheap. Build out those same capabilities in or near the ER. The triage nurse can then send those low priority patients to the facility right down the hall. The issue is hospital admins have no incentive to do that, because as you said, why bill $200 when you can bill a minimum of $2,000 when you have your patient captive.
I also think it is silly we ask people to self-triage. It externalizes a lot of the costs to other parts of society. I can attest to this from the constant Volunteer Fire Department air-raid sirens I hear followed by a "EMS to Well Now Urgent Care for Patient in Distress". I'm sure the volleys love having their evening interrupted when it could have been a simple walk down an aisle.