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Comment Re:MUMPS, ancient and rarely used (Score 1) 166

If you think EPIC might be a bad place to work, try to actually use their products. They are expensive (so expensive we are legally prohibited in the EULA from discussing how much) and difficult/slow to use (cannot say more, specific performance analyses are also prohibited by their NDA.) That $84k they are offering comes from somewhere...their largely captive market customers.

Comment Re:thanks (Score 1) 211

It's not even comparable as the entire setup here is different compared to a fully socialized system. There simply is nothing like the Medicare and Medicaid payment schedule in those countries as the government directly owns, administers, and runs the healthcare system rather than using independent contractors as in the U.S. The "cash price" that one might encounter in such a system as a foreigner is going to be a lot different than the cash price here because ironically that actually is a free market, while our "cash prices" are directly controlled by the government.

One huge reason that things cost so much more here is regulatory compliance. That is fairly minimal in directly government-run systems as the government isn't very interested in grossly running up its own costs in a fully socialized sytem. But with independent contractors, sure, make them document everything in quadruplicate and check 187 checkboxes in a very clunky inefficient mandated electronic medical record system for every patient visit and spend billions and billions of dollars in complying with arcane HIPAA, JCAHO and CMS regulations. (Note that the one fully socialized system in the U.S., the VA, is exempt from all of that.) And then fine them/reduce their reimbursements if they don't jump through all of the hoops properly. It saves the government a little money but costs the healthcare system as a whole a fortune.

The whole bit about "poorer outcomes" is mainly a combination of cherry-picked facts and factors well outside of the control of the healthcare system. For example, infant mortality in the U.S. as reported by the "socialized medicine is teh awesome" crowd is higher than most European countries. Why? We have a very different method of counting what a live birth is than Europe (they count a lot of extremely preterm births as "nonviable stillbirths," we do not), and when we use the same metrics as they do, our stats suddenly look a bunch better. Our survival rate for extremely preterm births is #1 in the world and also cancer mortality is very low as well. You don't see them touting those stats though. We do have some issues with certain populations essentially ignoring their health (such as having a higher smoking rate than most of Europe) but that is a cultural issue and has remained very resistant to even massive interventions by the healthcare field. You can't blame the healthcare field in the U.S. for that.

Comment Re: News (Score 1) 211

The reason policies cost more is that now we all are paying for everybody's everything instead of the people who were likely to run up certain costs largely being made to pay for them in higher premiums. The insurance costs pre-Obamacare for a healthy 25 year old woman compared to a healthy 25 year old male were relatively similar if the woman did not get maternity coverage. If she got that coverage, it was many times higher because a 25 year old woman is very likely to run up maternity costs. Now what's happened is the 25 year old male's rates shot up many fold because now maternity care has to be covered there is little differential pricing allowed (unless you smoke) under Obamacare.

So, while a 60 year old woman may not be running up maternity costs, others are and she is paying for it indirectly.

Comment Re:thanks (Score 1) 211

1. There is a lot of pressure to reduce costs even in the commercial insurance world. Obamacare forced insurers to pay out a lot more in costs (through a lot of things such as birth control required to be covered with no copay) and they can pass some but not all of the costs along to the employers and individuals who buy the insurance. The Obamacare "mandate" penalty is a lot less than what insurance actually costs and the bigger the delta, the more people who will eschew insurance. Those that eschew insurance are going to be the suckers, ahem "young healthies" who have few or no expenses and subsidize the people with multiple poorly-controlled chronic diseases who cost a bundle. Therefore the insurers can't simply keep raising costs forever.

2. Medicare and Medicaid pay for something like 75% of all medical charges in the country and they absolutely are decreasing what they pay hospitals and physicians (to the point they generally pay below the actual cost of providing services, especially Medicaid.) They are highly incentivized to reduce costs because it makes the federal and state budget deficits associated with their operation smaller.

3. Physician and hospital reimbursement is largely determined by Medicare. If you participate in Medicare (nearly all doctors and facilities do), your pricing structures are essentially set by CMS's "allowable charges" as laid out in the RVBRS. The actual reimbursements paid also don't vary much as private insurers know what Medicare pays (it's public) and stick pretty close to the Medicare rates.

The really screwy thing about healthcare it's essentially a government run market and health "insurance" is a third-party prepayment system. If we wanted to decrease the out of pocket for most people, it would be in having health insurance revert to actual catastrophic insurance instead of being a prepaid system and allowing balance billing (the patient pays the difference between the charged amount and what insurance pays.) That would currently be against several laws but the only reason it's illegal is that it makes a lot of sense, and would result in a relatively small number of people in highly politically valuable groups losing a bunch of discounts, subsidies, and freebies.

Comment Re:So there's 100 or so unimmunized? (Score 1) 387

1. The flu vaccines have very, very little egg in them to begin with. Also, there are now completely egg-free flu vaccines out there, namely the ccIIV4 vaccines. Most of the cases of iatrogenically-induced anaphylaxis are to other medications with a known propensity to do that, such as IM antibiotics, IV contrast, allergy shots, and quite a few chemotherapy drugs. That is why you have to wait in the office for 30 minutes after you get them. 2. Celiac disease IS an allergy! You are describing a solely autoimmune process, which would NOT abate with dietary elimination since the body would be solely sensitized to one of its own antigens instead of wreaking collateral damage in an allergic reaction. Nope, you stop eating gluten if you have celiac and you stop the disease process, you heal, and you have no symptoms...until you eat gluten again. The eating gluten part is absolutely critical to the disease being active. 3. No. That would be for things like inflammatory bowel disease which IS solely an autoimmune process and has somewhat of a genetic predisposition. You have to take meds to quiet that down, it doesn't go away with not eating certain foods like celiac disease. 4. The fact that there are unpredictable results on RASTs for drugs is why it isn't generally done. Ask your local immunologist or allergist about that one. 5. No, my understanding is based on quite a bit more education than that. I strongly suggest that YOU read up as you are the one making significantly erroneous statements.

Comment Re:So there's 100 or so unimmunized? (Score 1) 387

Did you actually read my post and the rest of the thread before you replied? First of all, we were talking about drug and vaccine allergies. Secondly, I specifically mentioned the different types of allergies possible INCLUDING the textbook example, celiac disease. Celiac disease absolutely IS an allergy, being a Type IV (delayed-type) hypersensitivity reaction which gives a specific set of GI symptoms in people who know they have the disorder. The familial tendency towards allergy manifsts itself as asthma/atopy/allergic rhinitis, not with allergies to specific drugs or foods. There has been a lot of research on the matter and this has been demonstrated many times over. Also you should know that the blood test (RAST) is absolutely worthless to determine if somebody is allergic to something if they have never been exposed to it before, such as for drugs. You have to have the initial antigen presentation from the allergen be able to get the antibody formation which is detected in the RAST. Basic immunology such as that should have been covered in your general college biology classes, if you took them.

Comment Re:So there's 100 or so unimmunized? (Score 5, Insightful) 387

There are at least two things you wrote which are generally medically incorrect. First of all, having only a stomach ache after ingesting a drug is very unlikely to be an allergy. True (IgE/T-cell-mediated) allergies usually cause things like hives, throat/lip/face swelling, low blood pressure, and trouble breathing. You simply describe a very well known NON-ALLERGIC adverse effect common to all opioids. True allergies are generally not heritable either, so the "my relative was allergic to X, so I can't take it" is nonsense. Your aunt and uncle simply had the same very common NON-ALLERGIC adverse effect you did. The exception to this is in people who have things like celiac disease who have a T-cell-mediated response to gluten in the medication which is an allergy. But you'd have a telltale set of symptoms involving more than just nausea if that was indeed the case for you. The only reason I mention this is because many people say they're "allergic" to vaccinations for similar nonsense reasons. A moderate fever and redness/aching at the injection site is a known adverse effect due to how vaccines work. You have symptoms of an immune response because you have to elicit an immune response for vaccines to work.

Comment Re:3D capable models (Score 1) 207

There are multiple medical studies that prove that the ability of the human eye to discriminate between images over approximately 30 Hz is limited and discrimination over 60 Hz just doesn't happen. There is a lot of evidence in the environment to back that up. Movies recorded on film are shot at 24 Hz (fps). Most digital video is 29.997 Hz. The frequency of AC electricity was set at 50-60 Hz due to that being more than enough to cause a tungsten filament to appear to be constantly glowing to the human eye instead of flickering. Same with the 60 Hz (in effect, 30 Hz) refresh with the interlaced scan of the glowing phosphors of an old CRT computer monitor. I'd strongly bet that you could not reliably tell the difference between an otherwise similar 60 Hz setup and your 120 Hz setup if you were in fact blinded to which one you were using.

That being said, having a GPU capable of framerates over 60 Hz (60 fps) isn't a bad idea at all, because the minimum framerate there is really what matters more than the maximum. A GPU only able to muster 60 fps max might very well dip into the 20s during difficult parts and you can certainly see that. That's a different issue than having a monitor capable of >60 Hz refresh.

Comment Re:3D capable models (Score 1) 207

They will probably be available in a year or two. We moved from hackish 30 Hz split-input panels to native 60 Hz single-input panels in about a year. However anything beyond 60 Hz is pretty much useless except for bragging rights as you can't see it anyway. Broadcast TV and movies are shot at 29.997 and 24 Hz, respectively. The lack of benefit of higher refresh rates is especially true on a display that is capable of displaying static images like an LCD.

Comment a patient, I'm hoping you MEMORIZE it (Score 1) 217

Besides, about half of what you learn in your M1 year is obsolete by the time you graduate. Take notes with pen and paper, cram for the cram-and-dump trivia regurgitation test (which is what all med school tests are) and then throw away the notes after the test as they are useless and worthless. Anything that you really want to remember later can be found easily on UpToDate or a similar site and will be up to date instead of likely outdated.

Comment Re:It's about time! (Score 1) 446

The thing we are forgetting here is that how the bridge funding was supposed to have been thought of is "well, we residents of this area need a bridge here, here's $100M of our tax dollars to do so." Not this "the government is its own entity" junk. But that's what has been happening when the funding and decision making moves away from locals deciding how to spend their money to a big nebulous "black box" of a federal bureaucracy taking money from some people in one area and spending it somewhere wholly different.

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