As a former student of Chinese history, this comment is right on target.
"Let a hundred schools of thought contend"
Ah, how history repeats itself.
234 karma · joined February 21, 2015
"Let a hundred schools of thought contend"
Ah, how history repeats itself.
[edit - noted attribution to wrong author, after a long day!]
Reading it sure did send a shiver down my spine though. Looking out over the harbor, with the mansion estates of The Battery directly at your back, knowing all the chapters of so many lives that began and ended there, suffering to create the wealth that built them.
It's certainly not your average spot to process a sidewalk history plaque - I recommend a visit sometime.
This is a movie I want to see made by a real director - it's an incredible story that deserves to be shared with the public.
About 30-40% of non-medicare America lives in non-expansion states, more if you include long-term resident undocumented (not just seasonal workers).
Medicaid is not available to 'unenemployed' people in most states in any sort of automatic way, so if you were employed in most middle class jobs, you won't qualify without serious tax shifting around the eligibility year enrollment cycle.
If you make under 133% of the federal poverty level in non-expansion states, you don't qualify for the exchanges.
Each non-expansion state's metrics for Medicaid qualification are slightly different. Unless you are under-18, a pregnant mother, or have ESRD, you probably don't qualify.
Also, to a different point above, COBRA is not 'discounted'. It temporary, but generally just as expensive as private insurance.
Kaiser Family Foundation is a great place for digestible data on US health care.
JH is actually on the traditional/conservative end of the healthcare spectrum when it comes to process/algo/checklist style care, for better or for worse.
I have a small team that is working with leaders in the space[1] to help many of the major EMR vendors support an open-standards based approach to medical record sharing.
We'll be seeking public feedback when some of the preliminary work is ready, but are very excited to get input from the community as we make progress.
The drug companies were represented by Billy Tauzin [1] who, as I am told by insiders that worked directly with him, was able to get the Pharmacos to not fight the ACA. Their support was not just critical, but a necessary factor in getting anything done.
It was a trade-off, whether or not is was worth it is hard to know.
As for your own care, I am sorry to hear about the lack of insurance. Some states (for often historical market reasons) make it hard for providers to sell or even give medications to their patients, which is also part of this problem.
If you look around, there are occasionally 'Direct Primary Care' providers or community clinics that stock generics for their own patients and will provide them at no or low-cost. Many organizations and states have processes for the uninsured to obtain medications at low cost as well. If you find a clinic with PCPs who are mission-driven, and they are out there, they perhaps can help you enroll.
I meant to point out the Express Scripts-Surescripts connection (and CVS, other pharmacy stakeholders...), which is part of why I think they may have dropped PillPack.
PillPack, and some of the other startups and smaller actors in the space, are potetial threats to the established players, like Express Scripts, that essentially collude through Surescripts to protect their access to the patient-provider origination channel.
It's the Surescripts network that has the near-monopoly on prescription EDI, and it acts to protect it's members interests. The tech is ancient and entrenched in a way that I imagine would greatly upset the HN crowd if they looked at it more closely.
Regulatory actors have not been paying enough attention here IMHO, and the nature of the market has led to an opaque situation that's prevented opportunities to advance research on important questions for social issues and patient care.
[1] http://surescripts.com/support/faqs/general/detail/who-owns-...
Surprised the HN crowd doesn't get more riled up about this, given the implications for science, opiate abuse, and other opportunities missed for improving the health system.
It's sure makes me feel better about all the time I've spent playing Go during the workday these past few weeks, anyway.
'Shared infrastructure in the hands of the public' means government or regulated monopoly.
The local government, with greater pressure from local industry failed in this case, which in my reading, is an argument for greater federal control.
What other way to implement the granting of a special privilege, oversight and judgment, is there for something like water quality? Yelp?
Hadn't heard of that engine before. Was a very pleasant way to take a break from emails. Thanks.
I would say that, at least academically, the difference between 'diminishing marginal utility' and 'loss aversion' is appreciated. To quote course material, 'When directly compared against each other, losses loom larger than gains'.
The difference in perception on the gain and loss side has been tested some, and the curve is supposed to look like this: https://goo.gl/PS8Z7c
What's also interesting, is that the US is likely a large net 'exporter' of medical tourism. I currently work with hospitals that are rapidly developing large businesses in medical tourism, because for all our needless systemic problems, people trust that, if you have the cash, you can find a good doctor.
You can. Routine, profitable procedures are not hard to arrange in the US. I have personally worked in a clinic where the exact experience described in this post happens every day.
>If you are a working, middle class person, the free market health care works extremely well.
It's pretty easy in most places in the world to get people to do something that makes them money, like the discectomy discussed here.
Managing a system where the poor and the unlucky get care is a little tougher. The US does it lousily, but so does most of the rest of the world. India doesn't do it at all.
edit:copy error
You use the phrase 'lingua franca' which provides and interesting analogy - it was implemented globally by a group of imperialists who controlled the trade transshipment points of a big chunk of the world by force of arms; is there a corollary in health care?
Actors on the web that have a profit motive to play together have adopted a set of norms (REST, JSON) to manage tasks that are usually trivial compared to medical knowledge representation. We still can't get an iCal right, for goodness' sake. Everyone else is buttoned up, and FB and GOOG don't exactly share network data with each other.
Regarding point four: if it get's specific to times, then you do have to indicate time zone, just ate the dateTime level: "If hours and minutes are specified, a time zone SHALL be populated." (https://www.hl7.org/fhir/datatypes.html#dateTime)
There are compromises in any API, and FHIR does a decent job of making common needs things simple, the alterative would be some RIM or graph based model that you'd have to get graduate degree in before you could say 'just GET me a Potassium result dammit'.
Please reach out if you see ways the spec could improve.
Of course, being written in MUMPS (just like some of the other biggies) doesn't help, but the failure of Vista to be implemented commercially has to do with market and human reasons that could have been engineered around. Missed opportunity for the US, really.
Happy to help anyone learn more about the spec @medhacker
[1] http://www.annemergmed.com/article/S0196-0644(15)00226-7/ful...
NNT, RR, basic statistical perspective. People are so often bad at understanding (or even acknowledging) the counterfactual.
In general, though, yes, whether or not the solutions will suffice comes down to the arbitrary decision of an administrator who probably doesn't understand the underlying tech issues. That will start changing soon though.
We have a pretty cool multi-tenant database solution that hospital parties could pool data into with highly granular authentication, access control, and auditability at both the db and API levels. No one else offers this yet, but it also may be more robust than the hospitals understand enough to care about.
Happy to discuss if you are interested at the commercial site listed in my profile. Also happy just to share our experiences in similar situations, or make recommendations for other more simple solutions on your own stack. Good luck!