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Comment: Re:nonsense (Score 1) 455

by nbauman (#49633899) Attached to: The Medical Bill Mystery

Well, I guess it is preferable that in third world countries they will go ahead and admit you without insurance, but not know how to do anything about it. This is assuming you live in a large city that has a hospital, as most of the rural areas have nothing, or might have a nurse or a midwife, but no medicine or tools.

You might be worse off in parts of Africa, but a typical resident of the South Bronx could get better health care in Cuba.

Comment: Re:Brand? (Score 1) 180

by hey! (#49633499) Attached to: 17-Year-Old Radio Astronomy Mystery Traced Back To Kitchen Microwave

I'd like to know which brand of microwave lasts 17 years?

Any brand, so long as it was made more than 25 years ago or so.

My kids like to watch vintage TV shows, and in one sitcom from the early 80s there was a plot line involving a TV remote -- this was back when remotes were still an expensive novelty. I paused and pointed out the thing in question. It was huge blocky moster of metal and wood, and looked like it had been forged by Durin in the deeps of Mount Gundabad. While virtually everything they use is incomparably more sophisticated than that thing, nothing approaches the build quality; physically it's all injection-molded crap that's been designed to be discarded after two or three years and replaced.

We can thank Bill Clinton and his China trade deals for amazingly cheap consumer goods that are designed to fail after a couple of years and be impossible to repair.

Comment: Re:Vaginosis/Vaginitis Plus (Score 1) 455

by nbauman (#49633145) Attached to: The Medical Bill Mystery

Like a lot of New York Times reporters, Elisabeth Rosenthal is an MD (Harvard '86).

Of course for each (expensive) new test there's a big debate about whether it contributes anything to a better outcome.

I think the broader point is that there are people like Steve Brill who say that we can significantly reduce health care costs if everybody knew the benefits of each treatment, and could shop around for the best price, the way we buy a refrigerator. Rosenthal seems to be tempted by that philosophy.

I don't think it's going to work. Kenneth Arrow, the Nobel laureate in economics, write an article years ago about why health care isn't a free market like other markets. The consumer doesn't have enough information to make an informed decision.

Even doctors can't make informed decisions about their own treatment. Eugene Braunwald, the cardiologist, said that when he needs a doctor, he doesn't want to be a medical consumer. He wants to go to a doctor he trusts, and let his doctor make the decisions. I don't think you can improve on that. If you don't have a doctor you can trust, you're doomed.

If you're a patient, I think NICE does a pretty good job of making your decisions for you. If NICE thinks I need an EM and IF, I'll get it.

Comment: Re:Available information limmited by law (Score 1) 455

by nbauman (#49632915) Attached to: The Medical Bill Mystery

Since you can't legally share a lot of patient information with "unknown third parties", a consequence is that bills are going to be decidedly lacking in specific information. Even if you want to ascribe that to malice, it isn't necessarily the hospital that you should point the finger at first.

Under HIPAA, doctors and hospitals can share patient information for operational purposes, which is pretty broadly defined to include certainly the insurance companies, any doctor who's treating the patient, the pharmacy, and a poorly-defined group of hospital personnel and hangers-on.

But in Elisabeth Rosenthal's example, they claimed that for privacy reasons they couldn't share billing information with the patient herself. In the course of a day's work, a big part of a clerk's work is to just make up bullshit to get rid of people.

Comment: Re:"the software industry" lol wut (Score 1) 455

by nbauman (#49632841) Attached to: The Medical Bill Mystery

>> "The software industry has pretty much decided what information patients should receive, and to my knowledge, they have not had any stakeholder input..."

Um...yeah. I'm sure it was a bunch of developers who decided one night to pound a bunch of Mountain Dew and then set up a billing system for a bunch of multi-billion dollar hospital groups that contained hundreds of thousands of items that magically skirt around insurance limits and pre-negotiated fees, then tack on expensive and low-value items, and follow it all up by adding on mysterious charges from other providers months after the original procedures happened.

Actually I used to write about medical software for the medical magazines, when they were first installing it. It was indeed pretty haphazard. They started out as billing systems, for which it worked pretty well, and tacked on other modules, like prescription drug ordering, for which it was not all that successful.

One of the major medical office systems was written by a chiropractor, who designed it after a general accounting program that was used for hardware stores or restaurants and modified for each customer. It worked great for everything that a medical office had in common with hardware stores, but not for the unique stuff that doctors had to do, like saving medical records and reminding patients to come in for followups.

The main thing that medical software did well was meet the billing needs of the insurance companies. They didn't meet the needs of doctors too well. If the doctor didn't repeat every fucking thing he did into a record field, the insurance company wouldn't pay for it. They wound up with enormous billing records, with field after field of data that the insurance companies decided it would be "nice to have," but were useless for doctors (is this prescription a pill or a capsule?). Even today, doctors complain that they have to spend an additional hour a day filling in EMR forms.

What they don't have, and still don't have, is a short narrative that would take 4 handwritten lines in an old medical record, explaining concisely what the fucking problem is with this patient and what the doctor thinks is the best way to manage it. Instead they wind up with a 100-page record that literally no one ever reads, most of which is for the irrational requirements of the insurance company, most of which is transmitted unread to the insurance company's computer.

So the insurance companies are basically spamming the doctor's medical records with billing trivia.

I saw a good book on this recently called the Digital Doctor by Robert Wachter http://www.amazon.com/The-Digi... although if you don't want to buy it you can just read his New York Times op-ed http://www.nytimes.com/2015/03...

The great thing Wachter did was go to Boeing and talk to the engineers who designed jet cockpits about human factors design. The EMRs, which peoples' lives depend on, were designed and pushed on doctors without the basic usability testing that an auto company would use for a cup holder.

Comment: Re:nonsense (Score 1) 455

by nbauman (#49632485) Attached to: The Medical Bill Mystery

Dude, we are the only first-world country with a third world healthcare system. Wake up

Anybody who thinks that our healthcare system is third world has obviously never been to the third world. I have been to several third world countries and I can tell you that our system is hundreds of times more functional then theirs.

If you think that, you have obviously never been to low-income places in the US like the South Bronx or rural Louisiana or Mississippi, where the infant mortality rates and life expectancy are lower than Cuba.

In the US, you can have cancer and be kicked out of a hospital because you can't afford to pay for the treatment. http://www.wsj.com/articles/SB...

Comment: Re:nonsense (Score 1) 455

by nbauman (#49632421) Attached to: The Medical Bill Mystery

Um, that's not even accurate. Our medical care is second to none in quality and capability.

You're complaining about the payment process. It's useful to go back and remember exactly what the problem is we are trying to solve, or we get solutions that don't fix anything.

I don't know where you got that from. There was an article in The Lancet comparing cancer outcomes in 4 English-speaking countries -- US, UK, Canada and Australia.

They said that the first thing to do in comparing international cancer statistics is to separate the black and white population in the US. The white US population has outcomes comparable to the rest of the world. The black population has outcomes that are much worse.

Comment: Re:To think I once subscribed to this site (Score 1) 227

Another good story in Vice. Just remember, perjury is a felony, these cops are committing crimes on the witness stand, and the district attorneys and judges let them get away with it and encourage it.

http://www.vice.com/read/testi...
Testilying: Cops Are Liars Who Get Away with Perjury
February 3, 2013
By Nick Malinowski

(Former NYPD Detective Carlton Berkley says that police routinely lie in order to justify arrests, and district attorneys and judges knowingly accept those lies.)

On November 17, 2012, a 40-year-old father from Harlem, Greg Allen, defending himself pro se (Latin, he says, for when you fire your attorney), won acquittal in a case brought against him by the Brooklyn District Attorney and the New York City Police Department. The Judge determined that the witnesses, two officers from Brooklyn’s notorious 73rd precinct, had lied.
The police officers, William Gardner and John Blanco, had accused him of disorderly conduct and obstructing government administration (crimes he did not commit), and the cop’s own video evidence showed his innocence. The police and the district attorney prosecuted the case anyway even though their own videotapes exposed the police testimony as a fabrication. They refused to back down from their original story. The judge didn’t buy it.
"It's like you're sitting there in the courtroom watching a video with the judge and the cops, and the cops are just saying something totally different than what the video shows," Allen says.
So used to this absurd process was the young prosecutor, Seth Zuckerman, that he never flinched as the cops went through the charade. Perhaps more tellingly, the district attorney’s office, Zuckerman’s bosses, didn’t drop the case even after learning that their only physical evidence contradicted the officer’s story of the arrest.
A few weeks later, US District Court Judge Shira Scheindlin upheld claims of NYPD misconduct in another case, finding the testimony made by police officers Miguel Santiago and Kieron Ramdeen not credible. Scheindlin sort of piled it on. The officers’ account “makes nosense,” it was “implausible,” she said. She noted that Santiago had previously lied in the scope of his police work, issuing summonses to an innocent person to help a friend of his in a bizarre revenge scheme.
Scheindlin’s ruling hinged on the fact that officers in the Bronx, Santiago and Ramdeen among them, routinely invented justifications for stopping people outside certain buildings in the borough and at times made arrests without cause. People doing nothing wrong were stopped, harassed, illegally searched, and arrested at the whim of the officers who then created legal justifications for their actions after the fact.
First- and second-degree perjury is a felony, and yet none of these cops will face any charges for straight up lying in a courtroom under oath. The rules are different for cops. As infuriating as that might seem, this pattern of behavior has been known fact for decades.

Comment: Re:To think I once subscribed to this site (Score 1) 227

I'm not going to pretend I know which side is correct, if either. But to play Devil's advocate, I'd bet dollars to donuts the vast majority of the people making these completes are criminals

I've complained about police several times, and I wasn't arrested but I thought they were behaving in an unprofessional and illegal manner. I spend days on my complaints, and got nowhere.

The stop and frisk laws in New York City (which were discussed before on Slashdot) have given us an enormous database of complaints by people who were clearly innocent, and of cops who were clearly abusive. Like a black college teacher who was minding his own business on his own stoop when a cop came over and (illegally) demanded to stop and frisk him. These were cases that were investigated by lawyers and had testimony in court, so we know what happened. And now more of these cases are on video.

or otherwise people on the police radar. As such, they are motivated to claim police brutality -- especially since Rodney King, which made it en vogue.

What the cops and DAs mean when they say this is, "We don't have evidence to arrest and convict him, but we want to harass him anyway and maybe pin a false charge on him."

Think about that for a second. You don't have evidence but you want to convict him anyway. Who are the criminals here?

Comment: Re:To think I once subscribed to this site (Score 2) 227

There are any number of abuses that can go on behind the shield, cops can be among the best criminals because they know the job and know how not to get caught, they know forensics etc etc etc. There are dirty cops out there and unfortunately in this day and age the good ones are the minority. I don't think cops in Seattle with dysfunction and abuse is a localized problem to either the department or the region, it is a national problem.

Not only that, but when they do get caught, they get a free pass from their fellow pigsxxxx cops who refuse to arrest them, from the district attorneys who refuse to prosecute them, from judges who pretend to believe blatant lies, and from the juries who talk themselves into believing blatant lies.
http://www.vice.com/read/testi...
Testilying: Cops Are Liars Who Get Away with Perjury
February 3, 2013
By Nick Malinowski

Beware of bugs in the above code; I have only proved it correct, not tried it. -- Donald Knuth

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