Month: August 2018

Big Data will send Medicare and Medicaid patients to the worst doctors

by philg

More lessons from my sojourn among the medical students…

As they gather more data, the insurance companies are getting smarter every year about kicking incompetent providers out of their networks. Eventually your private insurance company’s network will include only doctors with reasonably low rates of complications.

What about the doctors who are no longer in any private insurance company’s network. The good news for them is that Medicare/Medicaid can’t kick out anyone. They pay anyone who is licensed and legal to treat patients. When they do work with private insurers they make them sign contracts forbidding them from steering patients away from bad providers.

Big Data will thus inevitably create doctors, hospitals, etc. who see only Medicare/Medicaid patients? And these will be the worst providers in the U.S.?

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Trump Winery picks a holiday to celebrate

by philg

As a mail-order customer of the Trump Winery (nothing starts a conversation faster in Massachusetts than bringing Trump-brand sparkling wine to a party!), I get periodic emails from the enterprise. Today they picked a holiday to celebrate. August 26 is National Dog Day and Women’s Equality Day (celebrating the 1920 19th Amendment). Possibly due to the fact that the winery offers leashes and collars, the marketeers decided to pick National Dog Day. (But maybe Eric Schneiderman and his ladyfriends were customers for these Trump logo items?)

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Some things that I learned about the health insurance business

by philg

Some of the stuff that I learned about the health insurance business during a month at Harvard Medical School (earlier this year)…

Forcing people to get a second opinion prior to surgery was a “a stupid idea” and did not change costs or outcomes. [I don’t understand why. “Christopher had 323 doctor visits and 13 major surgeries. Here’s why his mom was arrested” (Fort Worth Star-Telegram) is an unfortunate story about a healthy child enduring a lot of medical torture. Wouldn’t he have had a lot fewer surgeries (maybe none?) if second opinions had been required? The media blames the mom, but could this even have happened in a country where doctors are on fixed salaries rather than being paid fee-for-service? And how much could have happened with a two-opinion system?]

The normal profit margin for health insurance is 1-2 percent (except for ACA/Obamacare, where the expectation is to lose money so it makes sense to withdraw). The Holy Grail for health insurers is to find an unregulated corner of the health care market in which high growth and high profit margins can be obtained.

Customers on the ACA/Obamacare exchanges are much more likely to go to the Emergency Room (“ED”), which represents a disaster for an insurer. (There are some differences in ER/ED usage due to age and gender ID. This article says “about 20 percent of women said they went to the ER, compared with 16 percent of men”. Young people are more likely to go as well, presumably because they can’t be bothered to put down their videogames for the hours of phone calls that it would take to find a non-ER solution.)

Insurance companies have limited outcome/health data. They know if a customer was readmitted to a hospital, but in a world where consumers are chased with surveys they never call up or email members to ask “How is your health?”

Much of “health insurance” is actually “healthcare billing administration.” The headline “health insurer” is not taking any risk. They are just negotiating rates with providers, haggling over bills, etc., on behalf of the real party at risk: your employer. If you’re upset because “the insurance company doesn’t cover X” it is actually your employer who decided that X wouldn’t be covered.

Employers (“plan sponsors”) start out wanting to cover everything. Then they find out what their generosity will cost and change their minds. In-vitro fertilization (IVF) is a good example. The employers are initially thrilled to help add more children to Spaceship Earth. Then they find out that 30% of IVF births are multiple, that the risk of prematurity is higher with multiple births, and that an average triplet birth is a $300,000 event compared to $11,000 when one baby emerges. IVF generates 1.6% of US births, but 16% of all twins and 38% of all triplets.

(Which plan sponsors are so stuffed full of cash that they don’t care about these costs? Universities and the U.S. military’s TRICARE.)

Why are premature babies so expensive? A NICU bed averages $3,000 per day on average (times 3 with triplets!). Advances in technology enable extremely premature infants to survive.

[There are new ethical questions to go with the new tech. For example, it is legal to abort a pregnancy up to 24 weeks of gestation in Massachusetts, but some of these would have been viable babies if born. Massachusetts also says it is legal to abort a child after that if it will harm the mother’s mental health. But what is more harmful to mental health than having a kid around? (see also: abortions sold for cash in Massachusetts)]

Enormous sums could be saved if patients could be moved around a little. There is at least a 2:1 ratio in cost of knee replacements, with the same quality, between higher cost and lower cost geographical areas. IVF is $25,000 in New York City; it is $7,000 in Baltimore (two and half hours away by AMTRAK Acela).

Enormous sums could be saved if patients could be redirected away from hospitals. The inefficiency of hospitals is truly staggering. In what other industry does buying the same service from a bigger enterprise cost 10X as much? Getting a shot or a pill at a hospital could cost 10X what it costs at an urgent care center such as a CVS clinic. But if you go to a big Petsmart you don’t pay 10X for dog grooming compared to what a local one-groomer shop would charge. The insurance companies spend a lot of time thinking about how to keep patients away from the ER/ED, but maybe it would be worth looking at why stepping through the front door of a hospital costs $1,000.

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Practical difference between Democrats and Republicans in Colorado

by philg

I recently visited a family in Boulder, Colorado whose 8-year-old son has figured out which way the political winds blow in that town: “I hate Trump.” Mom was in full accord with the child, but the father was unwilling to devote a large amount of brain space to righteous hatred. “Our neighbors find out that we’ve gone to Colorado Springs and they’ll say ‘How could you do that? I would never spend any time with people there.’ But if aliens visited Boulder and Colorado Springs they would say that people lived in exactly the same way in the two towns. They drive SUVs. They shop at Whole Foods. Hardly anyone walks or bikes. Maybe the Colorado Springs SUV has a ‘Focus on the Family’ bumper sticker and the Boulder SUV has a ‘Free Tibet,’ bumper sticker, but there is no practical difference in lifestyle.”

What about folks in Boulder? Don’t they spend more time and money helping the vulnerable? “No,” the father said. “Probably the Colorado Springs residents do more because they work through their churches instead of just posting on Facebook.”

How about the climate change alarmists at NCAR? Do they practice what they preach regarding CO2 reduction, at least when they’re not jetting off to climate change conferences? “I bike up that hill all the time for exercise. Most of the traffic on that road is SUVs occupied by one person.”

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Economic output should be proportional to the age of consent?

by philg

“Asia Argento, a #MeToo Leader, Made a Deal With Her Own Accuser” (nytimes):

The Italian actress and director Asia Argento was among the first women in the movie business to publicly accuse the producer Harvey Weinstein of sexual assault … Argento quietly arranged to pay $380,000 to her own accuser: Jimmy Bennett, a young actor and rock musician who said she had sexually assaulted him in a California hotel room years earlier, when he was only two months past his 17th birthday. She was 37. The age of consent in California is 18.

… the 2013 hotel-room encounter was a betrayal that precipitated a spiral of emotional problems, according to the documents.

Mr. Bennett’s notice of intent asked for $3.5 million in damages for the intentional infliction of emotional distress, lost wages, assault and battery. Mr. Bennett made more than $2.7 million in the five years before the 2013 meeting with Ms. Argento, but his income has since dropped to an average of $60,000 a year, which he attributes to the trauma that followed the sexual encounter with Ms. Argento, his lawyer wrote.

Ms. Argento asked the family member to leave so she could be alone with the actor. She gave him alcohol to drink…

For my late-1970s high school classmates, drinking alcohol and having sex were popular after-school activities (albeit not with movie stars). Today, however, it seems that an afternoon of consented-to sex can result in millions of dollars of harm to a teenager. Assuming that sexual activity among the young tracks the age of consent, I wonder if we should be able to see a correlation between age of consent and economic output. European countries have different ages of consent (Wikipedia), typically within a range of 14-16. Most U.S. states set the age at 16 (Wikipedia), but there are a substantial number at 17 or 18.

[Separately, I wonder if Donald Trump is running a time machine. When the New York Times accuses him of having encounters ]with various paid women back in 2006, these are reported as recent event. Yet for Ms. Argento, sex in 2013 is “years earlier” when viewed from the perspective of 2017. Does time move at a different pace for Donald Trump than for other people?]

Readers: Could teenage sexual activity explain the U.S.’s lackluster GDP per capita growth rate?

Related:

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Ukelele lessons for Angolans and Congolese

by philg

“Strummers in the city: Ukulele program gives Portland immigrant students head start” (The Forecaster):

PORTLAND [Maine] — Two dozen students filed into a classroom at Portland High School Monday for a ukulele lesson, strumming with determined fingers as part of a program to help them acclimate to the coming school year after emigrating to the city.

The students are housed at the city’s shelter for homeless families and are participating in a five-week-long Portland Public Schools’ summer program designed to give them a head start on school success and connect their families to school and city resources.

The theme this year, its second, is “Summer in the City.”

Most students are from Angola and the Republic of Congo, and communicate through interpreters during their time in the program.

Customers at Tony’s Donuts thought that ukulele skills would be useful: “They’re probably going to be on welfare for their entire lives so they need something to keep busy.”

 

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Female-to-male gender transition is a smart move for a 17-year-old applying to college?

by philg

A friend’s 17-year-old asserts a male gender ID (I refrained from pointing out that a room packed with cosmetics is not traditionally part of the male teenager lifestyle). The incomplete and non-surgical/non-hormonal transition is from heterosexual female to homosexual male.

Given that this gender-fluid person will soon be applying to colleges, I’m wondering if the new gender ID will be helpful. Except for elite schools, I think that admissions standards are lower for students identifying as “men” (the majority of college students identify as “women” and schools seek to avoid a gender ID imbalance).

Readers: What do you think? Is this 17-year-old best-off applying as (1) simply male, (2) transgender, or (3) gay male? College admission forms are heavy on race-related questions, but do they even ask if someone falls into an unusual gender or sexual-preference category?

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A new film camera system introduced in 2001

by philg

Digging through some old content I found this article on the Contax N1 system, a film SLR system to compete with Canon EOS and Nikon. It was introduced in 2001! (The Kodak (/Nikon) DCS digital SLR came out in 1991. The Canon D30 came out in May 2000; the professional EOS 1D in 2001)

There were a lot of bright people at Kyocera and Zeiss behind this. Let’s forgive ourselves next time we miss a trend that seems obvious in retrospect!

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Experiments with a new camera mount system for aircraft

by philg

One of the best things that I saw at Oshkosh was Flight Flix, a vibration-isolation system for mounting an action camera on an airplane or helicopter. I purchased mounts for the Cirrus SR20’s tie-down ring and the tow ball underneath the R44 and have begun testing these with the Drift action camera that the company favors due to its long battery life and easily rotated lens for proper “horizon up” orientation. I’m wondering if readers can help with critiques on a couple of tests from the SR20 under-wing mount:

Which one seems better? (“better” = “more stable”) Thanks in advance!

(It was a slightly challenging day for a “stable video” test, with winds gusting up to 18 knots and bumpy air through about 3,000′.)

Dream #1 is to get footage from a $199/hour airplane that looks as good as footage from a $199 drone. Dream #2 will be to get footage from a $369/hour helicopter that looks as good as footage from a $369 drone!

[So far I am not loving the Drift camera. The connection between the camera and the Drift app on an iPhone X is tenuous and I have found it tough to make the settings stick or even start and stop the camera reliably. By contrast, the integration between a phone and the DJI Osmo camera is so tight that feels like using a regular camera’s electronic viewfinder. Support from Flight Flix has been excellent, on the other hand, and they seem to have thought of almost everything. Flight Flix has produced some inspiring sample videos with the Drift, so I know that it can be done even if not by me! And the four-hour battery life (Wi-Fi off; bigger battery option) seems realistic.]

One thing that strikes me as odd is that airframe manufacturers haven’t added mounts for action cameras, both inside and outside, on their latest versions. Wouldn’t most people who spend $800,000+ on a new Cirrus want the option of making a recording without hanging something off a tie-down ring?

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Finding meaning in Academia

by philg

From a tenured (non-STEM) academic friend on Facebook:

What a great turnout at the session”And Yet She Persisted : Tools to Succeed as a Woman Academic”. I, along with 8 other female academics, shared stories of persistence. … probably the most personally meaningful session I ever participated in,

(A friend previously asked if a book titled “She Persisted” was about Massachusetts divorce plaintiffs.)

This was over a photo of a room filled with people… all of them appearing to identify as “female” (would it be okay to run a “Tools to Succeed as a Male Academic” session with an all-male audience? Women receive more than 50 percent of PhDs so men building careers are now in the minority.).

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