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Medicine Technology

How Big Data Is Destroying the US Healthcare System 507

Posted by Soulskill
from the optimizing-for-profit-does-not-optimize-for-health dept.
KindMind writes "Robert Cringely writes on the idea that technological advances have changed the health care system, and not for the better. The idea is that companies now rate individuals instead of groups, and so move to a mode of simply avoiding policies that might lose money, instead of the traditional way that insurance costs were spread over a group. From the article: 'Then in the 1990s something happened: the cost of computing came down to the point where it was cost-effective to calculate likely health outcomes on an individual basis. This moved the health insurance business from being based on setting rates to denying coverage. In the U.S. the health insurance business model switched from covering as many people as possible to covering as few people as possible — selling insurance only to healthy people who didn't much need the healthcare system.'"
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How Big Data Is Destroying the US Healthcare System

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  • so... (Score:3, Interesting)

    by msauve (701917) on Tuesday October 29, 2013 @09:12PM (#45275409)
    Is this the real Robert X. Cringley [infoworld.com], or the dishonest Sears Robert X. Cringley [wikipedia.org].
  • by Anonymous Coward on Tuesday October 29, 2013 @09:12PM (#45275417)

    Insurance companies can do what they like - who are we to tell them what policies they can and cannot agree to? Furthermore, by keeping the future-sick out of the pool, they lower costs for the patriotically healthy.

    Down with Statism! Towards a Individualist Future for All!

    • by Mitchell314 (1576581) on Tuesday October 29, 2013 @10:06PM (#45275827)
      Mods, I think this is a parody.
      • by Anonymous Coward
        Think about it from the point of view from the insurance* provider...

        If one provider takes on coverage for "suspected losing cases", then they will go out of business, especially if their competitor is always only taking "profitable cases".

        Really, doesn't it all boil down to charity and one's lot in life? As a society, it would be nice to provide the basics, such as trauma care, like a few sutures to stop some bleeding, fixing broken bones, toss in some antibiotics, etc. because that is cheap.

        How
        • by jythie (914043) on Wednesday October 30, 2013 @07:36AM (#45278433)
          Well, that gets into the game theory aspect of it and how a free market results in a destructive spiral. For any given insurance company it is in their best interest to insure the most healthy people and have OTHER insurance companies cover the less desirable cases. Any insurance company that goes against its interests will fall in the market, so they have a powerful incentive to all race for that one demographic. However the most profitable (both directly and indirectly due to general economic growth) is to have the largest and healthiest population possible.

          So it is the classic problem of "behavior B is best for everyone, but behavior A is best if others are doing B or A", so unless some force changes the payouts (i.e. regulation) to make B more attractive and A less.
        • by DuckDodgers (541817) <keeper_of_the_wo ... m minus caffeine> on Wednesday October 30, 2013 @09:07AM (#45278987)
          But I don't need the insurance if all it is going to cover is antibiotics and simple stitches and setting bones. So you're arguing for a hypocritical position, where the insurance against expensive medical events is purchased by people who don't use it, and not available for purchase, or at least not available for purchase at anything near an affordable cost, by the people that need it.

          The whole free market angle on health insurance is complicated by the fact that the people who require the most expensive medical care can't work. This isn't like shopping for night classes, maids, smart phones, cars, or new housing - in all of those cases you have an income while you search for a deal on new service. With health insurance, if you desperately need expensive medical treatment there's a good chance you aren't able to work to pay for it.

          In addition to that, while some people with expensive medical costs will never recover fully and will always be a net financial drain on the system and the economy, others can. If your cancer treatment fails or prolongs your life slightly but you still die of cancer, then that is tragic and expensive. But increasingly people do go into remission and live and work another ten, twenty, or forty years after their cancer diagnosis. Likewise surgery and care to recover from an accident, assault, etc... might take years but you could emerge at the other end a fully functioning member of society again.
        • by Jawnn (445279)

          If one provider takes on coverage for "suspected losing cases", then they will go out of business, especially if their competitor is always only taking "profitable cases".

          Try reading TFA. Pay attention to the part where (as in the summary) they explain the shift away from an all risks pool to a preferred risk pool.

          Next, learn something about why healthcare is so expensive, because you clearly have no fucking idea. Hint: it is related to the business model of the insurers, not the actual cost of the delivering the care. If it were, all those other countries who are delivering better healthcare for far less money would not be doing so.

          • by stdarg (456557)

            The business model of American insurance companies (as if they all have the same model anyway) has little to do with the cost of health care. The high cost of health care in this country is due to an almost total lack of regulation over health care prices.

            As an example, if there are price controls for drugs, the cost of drugs will come down, whether there's an evil capitalist insurance company involved or not.

    • by bickerdyke (670000) on Wednesday October 30, 2013 @06:44AM (#45278217)

      I know it's parody, but there is a really good point in it:

      Yes, in a free market, companies are free to do what they want. (policy and contract wise)

      But... if they do what they want, who is doing what should be done? Namely providing health insurance to the ones who need it (which may be anyone here at some point)

      And that's the point where the state had to step in, because the insurance companies didn't do what they were supposed to do.

      • by RabidReindeer (2625839) on Wednesday October 30, 2013 @07:50AM (#45278519)

        This is the difference between Insurance and Insurance Companies.

        Insurance is a bet between the insurer and the insured that the insured will not need to cash in. By setting appropriate odds, the insured pays less for benefits than if he/she covered them directly and the insurer makes a profit.

        This scheme can be extended in 2 ways. First, the insurer can take some of the premiums and invest them, insuring more profit, since the invested money helps reduce the amount of reserve cash that has to be held in order to meet obligations.

        The second way to extend this is to broaden the pool. Take lots of people. It's possible to compute over a statistical population how many people will cash in and set rates, reserves, and investments accordingly. This is what actuaries are for. You also deepen this pool by extending it through time, since the claims rates for many insurable conditions vary with age.

        That was the original idea. Insurance companies were early and enthusiastic adopters of computer technology since computers helped with the bookkeeping of the large pools of insured people as well as being able to assist with actuarial computations.

        More recently, however, 2 things have distorted that plan. One the one hand, advances in technology have skewed the original actuarial computations. Car crashes are more survivable, cancer isn't a guaranteed death sentence, and so forth. You have people paying in longer, but the expense of the payouts has also risen, and the likelihood that multiple payout events later in an otherwise curtailed life will occur likewise.

        The other distortion has been that really cheap computing has led to the development of sophisticated data mining. This, in turn has led to the processes of "cherry picking" (favoring those who will pay in but not make a claim) and "lemon dropping" (dropping the policies of people most likely to prove unprofitable). All of which makes the process more efficient.

        The problem is, this efficiency is gained at the expense of one of the primary benefits originally accorded to organized insurance. The pools become shallower and narrower. The insurance companies get more profit, but the outliers in the insured base pay for it. The more likely you are to truly need insurance, the less likely you'll get it. If not from outright denial, simply because in order to support these extra profits, you'll pay a higher premium rate. If you can afford it at all.

  • by SeaFox (739806) on Tuesday October 29, 2013 @09:14PM (#45275433)

    That will require a government solution. Either laws preventing health insurance companies from turning down coverage on individuals in that manner, or an actual heath care system for all and an end to regular private insurance.

    Or we can go full capitalist and just get rid of health insurance, then the cost of heathcare will have no choice but come down because almost no one will be able to afford the service (causing the providers to go out of business).

    • by Beryllium Sphere(tm) (193358) on Tuesday October 29, 2013 @09:19PM (#45275473) Homepage Journal

      A business that makes money by turning customers away does not lend itself to "free market solutions".

      So Obamacare prevents companies from refusing coverage or dropping it when the customer gets sick.

      • by TheGratefulNet (143330) on Tuesday October 29, 2013 @11:10PM (#45276283)

        So Obamacare prevents companies from refusing coverage or dropping it when the customer gets sick.

        hmm, I now see why the republicans hate this idea. its bad for Big Business and good for the little guy.

      • Not really (Score:5, Insightful)

        by rsilvergun (571051) on Tuesday October 29, 2013 @11:20PM (#45276355)
        Any successful business man will tell you that there is such a thing as a customer you don't want. Ones that tie up your employees and resources are bad. It's only when you're selling commodities with a fixed price and a high turnover rate (Milk, eggs, oil, beer) that you can take all comers.

        At the risk of being modded troll, let me say that that's the trouble with Capitalism. The real world doesn't fit into it's principles and ideas. Health care is too complex and purchased too rarely to make Capitalism a good fit for acquiring it. The classic example is that it's tough to comparison shop on a heart transplant....
    • Re: (Score:2, Funny)

      by michaelmalak (91262)

      That will require a government solution.

      I agree, even though I am a free market advocate. The long-term solution to healthcare is completely free market: your parents buy you a health insurance plan before you're born (similar to how parents know they have to pay for their kids' college and braces). In the meantime, for those of us already born, Medicare should be expanded to cover everyone born before (e.g.) 2015, and no one else -- ever. A 100-year phase out of Medicare similar to the phase-out Ron Paul h

      • Re: (Score:2, Insightful)

        by Anonymous Coward

        I like it!!!! I am going to register a corporation tomorrow to get ready for this. I will then offer by far the cheapest option available. For getting such a huge piece of the market I will of course pay myself tens of millions per year in salary. In 15 years, when it turns out I cannot actually cover their health care, I'll simply have to close the company and leave the poor saps who bought my insurance dangling in the wind. I'm going to have my hundreds of millions though, so whatever.

        • That would be fraud, which is in the purview of the government to prosecute. Prevention of such a calamity is in the purview of the private sector, where private ratings agencies would conduct audits on the financial solvency of insurance companies.
          • by tomthepom (314977)

            That would be fraud, which is in the purview of the government to prosecute. Prevention of such a calamity is in the purview of the private sector, where private ratings agencies would conduct audits on the financial solvency of insurance companies.

            If we replace the term 'private insurance companies' with 'banks' we can see just how disastrously naive that notion can be.

            • Fractional reserve banking is fraud, but the government does not prosecute it. In fact, it encourages it.
      • by Herder Of Code (2989779) on Tuesday October 29, 2013 @10:59PM (#45276201)
        I prefer Canada long term plan :) Sorry, being Canadian I find all the hand wringing about government run health care in the states hilarious. Just do the switch like we did back then, no half measure, no bullshit, you just pull the plug on the whole private insurance thing and send them a thank you note for all their effort.
    • by L4m3rthanyou (1015323) on Tuesday October 29, 2013 @09:48PM (#45275693)

      I'm generally not a "government solutions" kind of person, but I do wonder how private insurance is allowed to exist for essential things like health care. How does the profit motive not create an inherent, unethical conflict of interest?

      Also, insurance spreads risk and expense over a pool of policy holders. Pretty much everyone needs health care. Coverage-wise, it would seem like one large, central pool would be the best case. And, if the insurer isn't out to make money, it could instead focus on, say, reducing premiums.

      • by Moryath (553296) on Tuesday October 29, 2013 @10:04PM (#45275795)

        That's why in sane countries they've gone Single Payer, as opposed to the USA which is run by lunatics who still think laissez-faire anarcho-libertarian economic theory does anything but cause monopolism and boom/bust depression cycles.

      • by sailingmishap (1236532) on Tuesday October 29, 2013 @10:23PM (#45275963)

        I'm generally not a "government solutions" kind of person, but I do wonder how private insurance is allowed to exist for essential things like health care.

        How is essential defined here? Which of the following goods and services are essential?

        • insulin for a diabetic
        • acetaminophen for someone with a broken arm
        • acetaminophen for a child with muscle pains
        • a refrigerator at home to prevent food spoilage
        • hospice for a terminally ill patient
        • a liver transplant
        • a sex-change operation
        • a mammogram for a 55-year-old
        • a mammogram for a 16-year-old
        • genetic testing for Huntington's
        • jaw surgery to eliminate TMJ
        • a high-quality mattress
        • a quadruple bypass
        • a gastric bypass
        • cholesterol-lowering drugs
        • anxiety-reducing drugs
        • an electric toothbrush
        • sex
        • setting a broken leg

        Every single one of these things could save lives or drastically improve one's quality of life. Some of these are commercially available, some are available in hospitals, some are neither. Is it the presence of a doctor that turns some of these things into "essentials" and others into goods? Which of these should we allow profits on? If a government system does not cover any of these things, is it unethical?

        If profits are unethical, should we allow profits on anything? Why?

        I know this is a smarmy post—I'm not trolling, honestly. But I find people come into these conversations with a pre-existing mental framework that "health = essential" and therefore "profiting on health is unethical" without much exploration. Not everything offered in the health care industry is essential or life-saving, and many goods and services which are absolutely essential and life-saving are offered privately with no objections from anybody (e.g., refrigerators). What makes "health care" exist outside of the framework of goods and services in general? Most health care spending is dedicated to gradually improving quality of life, not saving people from axe wounds. If allowing profit and unrestricted competition is a bad way to improve people's quality of life, why are we even talking about health? Shouldn't we jump to the conclusion that anything that improves people's lives should be strictly non-profit and centrally planned?

        • by c0d3g33k (102699)

          I think that most people don't have a problem with *reasonable* profit earned by providing essential things, as hard as reasonable is to define. They have a problem with "gouging you for as much as they can take from you because you need it and have no choice but to die or live a life of suffering". That's no longer profit, that's just plain exploitation.

        • I don't think people from the other side (like me) who are sane think capitalism is bad. The issue is capitalism isn't the point of society, instead, it should be a tool to promote common good, to increase the utility of society.

          So, profit isn't bad, as it increases utility in society. Whoever, when capitalism becomes the point, the motivation, that is when we draw the line. It's like a CS instructor focusing on teaching C or C++ but not teaching how to program with any tool they can find. Some tools are be

        • by Anonymous Coward on Wednesday October 30, 2013 @12:38AM (#45276885)

          LIfe, liberty, property, pursuit of happiness and all that.

          Still, I don't know why we get all hung up in debate. National health care works. There is proof everywhere. The question you ask really is irrelevant. There are models that work well we can simply copy.

          When a broken limb doesn't carry the threat of crippling debt and care of a chronic but treatable illness isn't a severe financial burden life is simply better. Getting injured and having a many-nights stay in a hospital in Europe might cost you all of 20 dollars, not tens or hundreds of thousands. No years-long fight with medical providers and insurance companies afterward either. If you're an American, this is probably really shocking to you.

          Does this hurt some companies business models? Sure does.
          Are we going to have to kick a bunch of crooked politicians out of office? Yep.
          Are we going to have to tell a bunch of ignorant conservatives to sit down and shut the fuck up? Yes. (Yes. They are the problem. It's time to grow up and talk like adults.)

          • by Terwin (412356)

            Still, I don't know why we get all hung up in debate. National health care works. There is proof everywhere. The question you ask really is irrelevant. There are models that work well we can simply copy.

            My problem is less with Single Payer, but more with who will be in charge of it all.

            There have been 18 government shut-downs since 1976 (http://en.wikipedia.org/wiki/Government_shutdown_in_the_United_States).
            The Us government has a track-record of grasping for more and more power, regardless of the cost.(Income tax was originally a 'wartime' thing, and taxes are currently used to manipulate every sector of the economy)
            The US government has a track record of poor management and blatant cronyism(Copyright ref

        • The thing that makes health care special is that offering medical services for money is very close to exploitation, and it's very easy to cross the line. So it's important to have a lot of rules to prevent that from happening too frequently across the country.

          The problem is that human nature being what it is, we are all addicted to life, and it is a well known fact that nearly all of us will do whatever it takes to preserve our own life and health if we think that is required.

          So since this is a known fa

      • Insurance companies price insurance based upon an individual's risk. The fact that some people can not afford the price of their insurance either because they are poor or because they are high risk is not the insurance company's problem.... it is the government's problem. The government could leave the insurance market alone, but provide medicaid to the poor and high-risk pools to those who are of high risk.

        • by TheGratefulNet (143330) on Tuesday October 29, 2013 @11:19PM (#45276345)

          or, the government could kick the companies' ass and force them to abandon the concept of PROFIT when it comes to human life.

          we don't have a profit motive for giving us roads, clean water, electricity. well, there is some, but its mostly an infrastructure INVESTMENT in our own people.

          if those things (roads, water, etc) were left entirely to companies, the rich would have them and no one else would.

          is this the kind of world you want to live in? not me!

          we (the US) is one of the richest countries in the world, if not the richest. the fact that people lose their houses over being sick and unlucky enough to be poor enough to not afford insurance (or to have insurance and the greedy bastard company cancelling you!) is an insult. a damned shame and a preventable problem. we have the money here. but the wealth distribution is skewed so that the uber rich who can afford to get sick don't actually care about insurance. the rest of us do care and we are only a few paychecks away from being homeless if we get unlucky and very sick.

          some things should not be capitalistic. providing care for sick people is one of them.

          unless you are a monster, that is. and we clearly have quite a few of those running around and running things, here.

      • How does the profit motive not create an inherent, unethical conflict of interest?

        it does!

        but that's beside the point. if you disagree, I'll invoke the danger word: SOCIALISM! you're programmed to hate anything that is even close to being attached to this word.

    • Well, we know how well the last government solution turned out... But in all seriousness, yes, there needs to be government regulation acting as the referee for an open market solution. I say this because, wait till they get ahold of your DNA and digitally synthesize your body. Protein folding and all. I mean, it's better than out-right cloning from a pure data extraction methodology.

    • by Shavano (2541114)

      What do you think the Affordable Care Act does?

    • by Gothmolly (148874)

      That will require a government solution.

      Why?

  • by ndykman (659315) on Tuesday October 29, 2013 @09:17PM (#45275457)

    It's to their credit that we as a culture see them as the gateway to health care, and they have done many, many things to insure that people don't interact directly with providers, but in the end, they are middlemen. Nothing more. They do not provide care. Doctors, nurses, clinics and hospitals do. And, given the current state of things, they have done nothing to control costs.

    Big Data isn't destroying the US health system. It's the lack of coverage, for-profit insurance protecting their margins by charging everyone more and more to do less and less, to deny payment (and therefore care) so that people get so sick that they lose their jobs and their coverage, passing on the burden to providers and taxpayers that, by law, can not deny essential care. It's a system that only pays up when absolutely necessary, that does not to help people stay off of the doctor's office.

    It's a culture that insists that chronic illness or disability is a moral failing and that it is the fault of the person for merely being ill. It's the insistence that health is a privilege, not a right. It's not some computing trend that insurance companies are using to discriminate. Insurance companies have been doing that forever.

  • by sunderland56 (621843) on Tuesday October 29, 2013 @09:18PM (#45275465)

    This is not destroying the healthcare system - it is (potentially) destroying the health insurance industry. The two are different things.

    The auto insurance industry has had very fine grained data on drivers and their habits for many, many years. That hasn't affected the auto industry at all, and it doesn't seem to have materially affected the auto insurance industry either.

    • by ShanghaiBill (739463) on Tuesday October 29, 2013 @09:55PM (#45275731)

      The auto insurance industry has had very fine grained data on drivers and their habits for many, many years. That hasn't affected the auto industry at all, and it doesn't seem to have materially affected the auto insurance industry either.

      If the government required auto insurance companies to insure people with pre-existing conditions (i.e. their car is already wrecked) then the situation would be different.

      • It still wouldn't affect the auto industry, only the insurance (and potentially auto-body and mechanic shops, which would stand to benefit). Though, as always, the analogy is horribly flawed. If you kill or injure yourself, you can go buy a new one.

        In fact, auto insurance is nothing like health "insurance" because no auto insurer covers routine maintenance (checkups) or design flaws (existing conditions).

    • by tragedy (27079) on Tuesday October 29, 2013 @10:01PM (#45275773)

      In the auto insurance industry, if you can't get insured, you don't get to drive (legally). In the health insurance industry, if you can't get insured, you die. Slight difference. Also, if you can't get auto insurance, it's generally your own doing. If you can't get health insurance it's generally due to factors beyond your control (regardless of the statistically poorer health of people who take worse care of themselves).

    • by Shavano (2541114)

      This.

    • Now, how are we to pronounce a fatwah against the Tea Party in the presence of lucid arguments like that?
      Get back to the shrill, hormonally-driven stuff, please.
    • by bzipitidoo (647217) <bzipitidoo@yahoo.com> on Tuesday October 29, 2013 @10:24PM (#45275967) Journal

      Health insurers are destroying themselves. Why do you think people like me don't have insurance? We've figured out the game. If they are willing to insure a person, it can only be because that person doesn't need health care. So those who need it are denied, and those who don't shouldn't buy insurance because it is a ripoff. Either way, no one should be a customer of a health insurance company.

      If you get insurance anyway, should change insurers about every 2 years so you don't get charged a huge "inertia tax", the penalty they love to levy on loyal customers for being loyal and not changing. And changing is only if you haven't developed some problem they can claim is a pre-existing condition that they shouldn't have to cover. And be ready to get a lawyer to sue them if you are injured and actually need health care. They will deny half the claims on various technicalities. They're testing you, seeing if you'll roll over, play dead, and let them get away with it. If you have family and friends to help you fight back, or aren't too beat up to fight back yourself, then they try to walk the fine line of denying just enough that it's not quite worth suing them. They'll try to wear you down, bury you in paperwork. They'll occasionally take your side and save you from an outrageous bill here and there.

      The medical community's outrageous prices are the only thing keeping insurance going. If not for that, it'd be better to deal directly with the doctors. You still can, so I've heard. Have to do a lot of haggling, but it can be done. You may also need the leverage of not having any money, to get them to cut you some deals. They'd rather get some money than no money, if you should go bankrupt and get all those medical debts erased. Of course if you're hurt or sick, haggling sessions are the last thing you need on your plate. Medical debt is the #1 cause of bankruptcy in the US. Medical debt is also quite peculiar-- it doesn't seem to count the same as other kinds of debt, and I've heard it is possible to defer paying it and still be able to buy the basic necessities and even have a credit card. For this reason, many doctors won't even see you if you don't have insurance. Too easy to stiff them entirely.

    • You go in for an oil change. It costs $5 no matter what. You get a statement from the auto insurance company that is "not a bill" which is a good thing, because it shows that you were charged $500/qt. for oil.

      The $5 oil change would be great, except that your auto insurance bill is $3000/mo, up from $2700/mo last year. Your lucky though. You're a 40 year old driver who hasn't had a ticket in 15 years. Family man. You've heard the horror stories about the young people and seniors trying to get car insu

  • by surfdaddy (930829) on Tuesday October 29, 2013 @09:25PM (#45275511)
    The ability to deny coverage to higher risk individuals has been eliminated with Obamacare, and that's a good thing. If you are filthy rich you cover yourself. If you are poor you are covered by the government. If you were middle class and had some health condition you were screwed if you didn't have employer-based insurance. It didn't take much to be denied - things like macular degeneration or asthma or hyperthyroidism would deny you. One big sickness away from bankruptcy. In the richest country in the world.
  • by Anonymous Coward

    Great timing to have an article about insurance companies using big data to isolate individuals, when the previous article is about researchers putting together a database of people's family ties...
    http://tech.slashdot.org/story/13/10/29/2223231/genome-hacker-uncovers-13-million-member-family-tree

  • by theodp (442580) on Tuesday October 29, 2013 @09:43PM (#45275655)

    Medicare Bills Rise As Records Turn Electronic [slashdot.org]: The goal was not only to improve efficiency and patient safety, but also to reduce health care costs. But, in reality, the move to electronic health records may be contributing to billions of dollars in higher costs for Medicare, private insurers and patients by making it easier for hospitals and physicians to bill more for their services, whether or not they provide additional care. Hospitals received $1 billion more in Medicare reimbursements in 2010 than they did five years earlier, at least in part by changing the billing codes they assign to patients in emergency rooms, according to a NY Times analysis.

    • by sc0ob5 (836562)
      I don't see how changing to electronic records is the problem here. It's the fact that staff at the hospitals have been coding the patients incorrectly and under paying the doctors and hospitals performing the procedures, in addition to possibly over paying for other procedures.

      This is why the rest of the world uses ICD-10 coding.

    • by sqrt(2) (786011)

      I've worked in health care biling. Here's what's happening. EMR (electronic medical records) allow doctors to easily bill for all the services they should always have been billing. Before, with paper forms, it was a huge hassle and lots of things were just written off and not followed up on, or got lost in the shuffle. Now that it it's automatic, there's no reason not to take every dollar you're entitled to by law. Solution: change the law.

  • People decide to use technology a certain way, and people submit to it. Russell Brand is right, it's time for a revolution.
  • Makes Perfect Sense (Score:5, Interesting)

    by archer, the (887288) on Tuesday October 29, 2013 @09:54PM (#45275725)
    Several years ago, I was called by the company providing the extended warranty on my appliances. The were offering me a renewal of the warranty. I said I'd only renew on the dishwasher. They responded that it was the only appliance they wouldn't cover. When I declined the extension, they reminded me that things are more likely to break the older they get.

    I didn't feel like pointing out the reason they were declining coverage on the one appliance was probably because it was the only one that needed to be repaired, and twice at that. As such, it would be the most likely to fail again. And it did.

    Still don't make it right though.
  • The US "health care system" was already broken. This is just showing why.
  • This is "evidence-based medicine", n'est-ce pas?

    • I always think of this [bmj.com] when I think of evidence based medicine. It is a reminder that the details of implementation are important, often more important than the big picture ideology surrounding them.
  • by FuzzNugget (2840687) on Tuesday October 29, 2013 @10:26PM (#45275985)
    If you think that America's foremost healthcare problems have anything at all to do with technology, you are hopelessly deluded.
  • by jfruh (300774) on Tuesday October 29, 2013 @10:29PM (#45276001)

    Kind of bizarre that this whole jeremiad seems to ignore the fact that the Obamacare reforms ban exactly this practice starting in 2014? This is responsible for a lot of the disruptions to the market we're seeing now -- some young healthy people are going to be paying more, and some older sicker people are going to be paying less. (The other disruptions are that some of the old policies had coverage caps that wouldn't have covered expensive catastrophic illnesses; that's also banned, and their replacements are more expensive.)

  • If you take out the ability of insurance companies to selectively deny coverage (which the ACA does), this ability to model outcomes can enable new more effective ways of paying doctors for care and hopefully improving outcomes. Given an expected outcome, an insurance company can pay for improving that outcome rather than just paying for every test run or treatment rendered.

  • by swb (14022) on Tuesday October 29, 2013 @11:03PM (#45276229)

    This is slightly off topic, but I think it's not just the application of computing power to medical data, but the application of computing power to control and recover a lot of costs has generally been so successful that I think it's actually cutting the "slack" out of the economy and contributing to the decline of the middle class and growing economic inequality.

    They're shaving the savings off the top and putting it in their own pockets, but the economic byproducts of the savings (cheaper goods) doesn't offset the economic loss of the savings not being spent on goods and labor, like additional inventory or additional workers.

    Say a business sells a widget for $10. Their cost to make the widget is $4 and because of imperfect data/processing, sales forecasts, shipping, etc are all less accurate. They have to carry inventories to meet customer needs. Inventories require workers, facilities (which need construction...), they have to buy more raw materials. So $2 is added in overhead to the $4 and the profit on the widget is only $4.

    With improved data/processing, they gain efficiencies. They carry as close to zero inventory as possible. They buy less raw materials. Need fewer workers. Smaller facilities (...less construction, fewer carptenters, less building materials, less ....) and so on. But the nominal cost of the widget doesn't go down, but the margin increases to $5 per widget because they save $1 in costs.

    Since the price of the widget doesn't go down and at best rises slower, the consumer is only marginally benefitting, especially since the depressed employment resulting from greater operating efficiency results in lower wages, further mitigating any price declines or slowing price increases.

    The $1 that was previously "lost" on administrative costs is now executive salaries, bonuses and benefits where it produces less economic impact than had it been spent on productive economic activity.

Swap read error. You lose your mind.

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