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How Big Data Is Destroying the US Healthcare System

Soulskill posted about a year ago | from the optimizing-for-profit-does-not-optimize-for-health dept.

Medicine 507

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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so... (2, Interesting)

msauve (701917) | about a year ago | (#45275409)

Is this the real Robert X. Cringley [infoworld.com] , or the dishonest Sears Robert X. Cringley [wikipedia.org] .

As an Asshole, I support this (5, Funny)

Anonymous Coward | about a year ago | (#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!

Re:As an Asshole, I support this (3, Insightful)

Mitchell314 (1576581) | about a year ago | (#45275827)

Mods, I think this is a parody.

Yes, it is a parody, and yet... (2, Insightful)

Anonymous Coward | about a year ago | (#45276065)

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.

However, everybody dies sooner or later. rich or poor.

Basic needs are one thing, but then there are "wants"... if you want to live? too bad, everyone dies. You want transportation? Society says the public bus is good enough. Want a chauffeur driven Mercedes? Earn it. Need an antibiotic? Society says, yeah, hear ya go. Want to extend your life with an expensive procedure? Earn it.

* don't confuse healthcare with insurance.

Sounds like a problem... (5, Insightful)

SeaFox (739806) | about a year ago | (#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).

Re:Sounds like a problem... (-1, Troll)

Anonymous Coward | about a year ago | (#45275471)

Full capitalist. Free market solutions always work better.

You can see the government solution raising prices across the board today. Big fail.

Re:Sounds like a problem... (5, Informative)

Impy the Impiuos Imp (442658) | about a year ago | (#45275593)

Before people go apoplectic keep in mind the concept of medical tourism, where people go overseas to places like India for heart or other major surgeries for ten cents on the dollar or less, with success rates that are only marginally worse than that in the US.

There's more to competition than just nominal competitors. Hampering, even due to well-meaning regulations, transparently occurs, and to our detriment.

Go watch the Tucker film, about the guy trying to start a competitor to the big car companies in the 1950s. The big companies used every manner of regulation, requiring expensive development and lawyers and nitpicking, just to satisfy, and used it to effectively bar entry into the market.

All done 100% "in the name of the people's safety".

Fair enough, if you still wanna defend utterly massive regulation, but you pay for it in increased costs. Apparently about 5-10x in increased costs in medicine in the US.

Re:Sounds like a problem... (1)

Anonymous Coward | about a year ago | (#45275759)

No action is free of consequence, or even unintended consequence.

But no, bad regulation, or corrupted regulation doesn't mean regulation is absolutely flawed, any more than a distorted free market that leads a totalitarian faux capitalism to prosper means you don't have any free market. You can also apply this to religion.

It just requires constant vigilance.

As most complex systems do.

Re:Sounds like a problem... (4, Insightful)

Moryath (553296) | about a year ago | (#45275779)

Funny how medical tourism turns out to only be available to the wealthy...

Re:Sounds like a problem... (4, Interesting)

CRCulver (715279) | about a year ago | (#45276027)

That is only due to the US's relative geographical isolation. In Europe, if you are unhappy with the free care offered to you (typically because cosmetic treatments require long waiting times or prohibitive prices), even people who are not particularly wealthy can take a Ryanair flight a few countries over and get it done there right away for cheap. Hungary and Estonia do a brisk trade in laser eye surgery, and all of Eastern Europe is attractive for people wanting cheap dental treatments. It's not wealthy people going there, but any citizen who can pony up the paltry cost of a Ryanair flight.

Re:Sounds like a problem... (2)

knightghost (861069) | about a year ago | (#45275829)

90% of drug cost in the USA is unproductive sales, marketing, profit, etc. Unbalanced capitalism.

Re:Sounds like a problem... (0)

Anonymous Coward | about a year ago | (#45275919)

The regulations on our system are weighing us down even though our system costs 2-3x what comparable care under single-payer systems costs? How do you reckon?

Re:Sounds like a problem... (2, Interesting)

Anonymous Coward | about a year ago | (#45275769)

You're forgetting that a healthy free market requires healthy competition and intelligent consumers who are willing and capable of shopping around. In healthcare, neither is generally true.

If you are on an ambulance speeding towards the nearest hospital, you are hardly in a position to ask for prices (particularly if unconscious), and you couldn't get the EMTs to re-route to a different hospital even if you tried.

In cases where a patient is in need of non-critical care, it's highly unlikely that he or she has enough medical training to make informed decisions about which treatment should or should not be performed. Hospitals do not regularly advertise prices so you can shop around, either.

Re:Sounds like a problem... (4)

Cordus Mortain (3004429) | about a year ago | (#45275883)

Not only that - if the drug company tells you that'll be $7 per month to buy the pill that will save your life, you pay the $7 and go on living. If the same drug company tells you that the pill is $100 per week or you die, then guess what - you'd better find that extra $100 per week or you die.

Free market economics doesn't work with healthcare because you are not free to make those choices. This doesn't happen anywhere else in the free market.

Re:Sounds like a problem... (5, Insightful)

pyro_peter_911 (447333) | about a year ago | (#45276215)

But what if the proper cost of that pill actually is $100? (Or, for that matter, $1,000,000) Are you and I, by sole virtue of being citizens entitled to that life saving pill, regardless of the cost?

This is a struggle for me. It seems reasonable to me that there should be access to basic medical care for all citizens with as little standing in the way of this care as possible. No one should die from Dysentery in the United States. On the other hand, if Pyro_Peter's Nuclear Anti-cancer Medicines, Inc. spends $10,000 to make each Fermium Armed Genetically Tailored Smart Bomb Anti-Cancer Pill then I completely understand that if we want more FAGTSBAC Pills (*whew* that was close to being a really baaaad acronym) then Pyro_Peter's Nuke Pills, Inc. must charge more than $10,000 for that pill.

I think the tough part here is that the line for "reasonable access to basic care" is in different places for different societies. I'd also be concerned that the act of drawing that line would be sufficient force to prevent it from naturally rising with time. What if that line was drawn in the 1920's US? Where would medicine be today? Would we have some metric like the Consumer Price Index but for medical care to keep moving that line up?

Finally, and I know this is diverging from the actual topic of this thread, it is clear to me that your right to health care is a different sort of right than your right to free speech or your right to be free from unreasonable searches. No one else has to do anything for you to speak or for you to not be searched. Health care is different. Someone else has to do something for you to have a right to health care. What if they don't want to? Can you (or a government agent working on your behalf) compel someone else to provide you care?

It is a complex issue and the more closely I look at it the more complex it seems to get.

Peter

Re:Sounds like a problem... (2, Insightful)

Anonymous Coward | about a year ago | (#45276321)

Right to free speech - You can practice with no one else involved
Right to healthcare - You cannot have without imposing on others and either taking resources from them or forcing them, like indentured servitude, to provide for you. If no one decides to become a doctor or nurse, how does the government provide "reasonable access to healthcare"?

You are wiser than most to realize that there is a distinction between Constitutionally granted rights and what many people are now declaring is a right. One is natural and the other is at the point of a gun. I think you just didn't come to the full obvious conclusion yet.

Another point on your post. In a single payer system, that $10,000 pill would never be developed because it would never be administered. So do you want a society where the pinnicle of healthcare is decided by what the "death panels" decide is approprate, or one where your ability to pay decides what the pinnicle is.

Re:Sounds like a problem... (1)

BradMajors (995624) | about a year ago | (#45276107)

It is easy to price compare and to save a lot money if you want to. Most people are too lazy to be bothered.

I have had no problem obtaining price quotes from every medical provider I have used and I have saved a substantial amount of money by doing price comparisons. For those who are too meek to do their own price negotiation, there are companies who will negotiate price discounts for you at the cost of a percentage of the discount obtained. Here is an example: http://www.medicalcostadvocate.com/default.aspx?group=hcbluebook [medicalcostadvocate.com]

Re:Sounds like a problem... (2)

Shavano (2541114) | about a year ago | (#45275847)

How do free market solutions address your bleeding chest wound?

How do they address the young couple with no money and a kid on the way?

How do they address the situation where you need a drug and only one company makes it?

Re:Sounds like a problem... (0)

Anonymous Coward | about a year ago | (#45275905)

How do they address the young couple with no money and a kid on the way?

Just wanted to throw in a recent story: a friend of mine had a kid and no insurance. Hospital bill for the `baby delivery': $20k. Bam. Just like that.

Re: Sounds like a problem... (0)

Anonymous Coward | about a year ago | (#45275897)

Yeah, because the capitalist solution produced a model of efficiency and lower costs for decades. Bigger fail!

Re:Sounds like a problem... (0)

Anonymous Coward | about a year ago | (#45276153)

Just like a law system. Imagine a freemarket based law and justice system. Military should also be freemarket.

Why the PPACA was necessary (4, Insightful)

Beryllium Sphere(tm) (193358) | about a year ago | (#45275473)

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.

Re:Why the PPACA was necessary (0)

smitty_one_each (243267) | about a year ago | (#45275879)

Please explain why, if there are that many loose customers about, that a different business model is impossible.
There may be reasons, for example, ludicrous regulatory overhead.

Re:Why the PPACA was necessary (2)

AtariEric (571910) | about a year ago | (#45276011)

The problem is not whether a business model is possible or impossible, but whether it is profitable. If you can explain how a different business model is profitable, well, what are you doing here - get some investors!

Re:Why the PPACA was necessary (1)

sailingmishap (1236532) | about a year ago | (#45276225)

The question is whether it would be profitable in a free market, not whether it is profitable in the existing market. Clearly it is not profitable in the existing market because nobody is doing it.

Re:Why the PPACA was necessary (3, Insightful)

TheGratefulNet (143330) | about a year ago | (#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 (5, Insightful)

rsilvergun (571051) | about a year ago | (#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:Sounds like a problem... (1, Funny)

michaelmalak (91262) | about a year ago | (#45275479)

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 has proposed for Social Security.

Re:Sounds like a problem... (1)

Anonymous Coward | about a year ago | (#45275543)

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 has proposed for Social Security.

Then the insurance companies will simply rate insurance based on the genetic background of the parents purchasing the insurance. And then based on the genetic backgrounds and traits, they'll simply price coverage lower or higher, or deny coverage altogether. Hope you aren't the kid who got denied coverage before you were even conceived.

Re:Sounds like a problem... (0)

michaelmalak (91262) | about a year ago | (#45275613)

Then the insurance companies will simply rate insurance based on the genetic background of the parents purchasing the insurance.

It is not the responsibility of health insurance companies to equalize everyone's genes to ensure everyone can have babies of the same health level.

Re:Sounds like a problem... (1)

Anonymous Coward | about a year ago | (#45275559)

So under your system, if you are born to poor parents, you are screwed for life? Land of opportunity indeed.

Captcha password for this post was "condemns." Rather fitting.

Re:Sounds like a problem... (0)

michaelmalak (91262) | about a year ago | (#45275639)

So under your system, if you are born to poor parents, you are screwed for life? Land of opportunity indeed.

There is no way the U.S. federal government should be (in the long term) involved in health insurance. States could create their own safety nets. But they should be constructed in a way that do not violate the principle of subsidiarity.

Re:Sounds like a problem... (1)

berashith (222128) | about a year ago | (#45275703)

as the least centralized authority is the individual, it seems you are either trying to outlaw insurance companies, or legalize and new form of robbery. It is hard to distinguish your policy from pure individual responsibility for payment and possibly replace any insurance with a line of credit.

Im not saying your wrong, but I am saying that you are not discussing insurance.

Re:Sounds like a problem... (2)

michaelmalak (91262) | about a year ago | (#45275751)

Insurance is supposed to be about spreading risk of uncertain futures, not giving hand-outs (wealth redistribution) when futures are known. Wealth redistribution is fine (even though it's not insurance) as long as it follows the precedence outlined by the principle of subsidiarity: self, family, community or church, provincial government, national government, world government.

Re:Sounds like a problem... (1)

Anonymous Coward | about a year ago | (#45275941)

In our modern world, government is "community or church". In the 21st century, it is no longer reasonable to expect people to belong to a church (do you really want to perpetuate superstition just to get a non-governmental safety net?), and in a democratic system the government is made up of the same people as one's community, acts with their voices and puts their funds to use.

While the principle of subsidiary is a convenient rule of thumb, the social exigencies of a given population determine the exact allocation of services, and it is clear that in many places, local or national government is thought to be the right place. Human beings are social animals, one cannot expect them to behave like automatons in service of an abstract legal principle that you wave around.

Re:Sounds like a problem... (1)

Mr. Slippery (47854) | about a year ago | (#45275921)

There is no way the U.S. federal government should be (in the long term) involved in health insurance.

The federal government was intended from the start to have wide authority over commerce.

Health insurance is commerce. Unless you require insurers to each operate only in a single state, it's interstate commerce.

Re:Sounds like a problem... (1)

Bartles (1198017) | about a year ago | (#45276089)

Health insurance is commerce. Unless you require insurers to each operate only in a single state, it's interstate commerce.

You mean like the McCarran-Ferguson act of 1945?

Re:Sounds like a problem... (2, Insightful)

Anonymous Coward | about a year ago | (#45275705)

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.

Re:Sounds like a problem... (1)

michaelmalak (91262) | about a year ago | (#45275777)

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.

Re:Sounds like a problem... (1)

tomthepom (314977) | about a year ago | (#45276055)

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.

Re:Sounds like a problem... (1)

michaelmalak (91262) | about a year ago | (#45276177)

Fractional reserve banking is fraud, but the government does not prosecute it. In fact, it encourages it.

Re: Sounds like a problem... (0)

Anonymous Coward | about a year ago | (#45275845)

something tells me you will be sleeping late tomorrow. as always.

Re:Sounds like a problem... (5, Insightful)

Herder Of Code (2989779) | about a year ago | (#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.

Re:Sounds like a problem... (5, Insightful)

L4m3rthanyou (1015323) | about a year ago | (#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.

Re:Sounds like a problem... (5, Insightful)

Moryath (553296) | about a year ago | (#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.

Re:Sounds like a problem... (-1, Troll)

Gothmolly (148874) | about a year ago | (#45276213)

If you think the US is "laissez-faire anarcho-libertarian" you're stupider than you are a troll.

Re:Sounds like a problem... (5, Interesting)

sailingmishap (1236532) | about a year ago | (#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?

Re:Sounds like a problem... (0)

Anonymous Coward | about a year ago | (#45276269)

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

That's a big part of the problem, in my opinion. Things like regular checkup (electric toothbrush, etc.) are not insurance. Insurance is a mechanism that spreads risks by collecting a premium from a pool of people

A regular dental cleaning, done by EVERYONE is a fixed expense, not insurance. So perhaps things that are not 100%-probability needed for all humans (I don't mean pre-existing condition, I mean things that are inherent to everyone) should be out of insurance coverage. Health-plan, perhaps?

Re:Sounds like a problem... (0)

Anonymous Coward | about a year ago | (#45276277)

We already provide free healthcare(by law) at an emergency room. We've already made the choice healthcare is essential, we're just taking forever to get there.

We at one point let old people die in the streets instead of having the social security system. Now it's essential. Funny how that works.

Re:Sounds like a problem... (1)

BradMajors (995624) | about a year ago | (#45276181)

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.

Re:Sounds like a problem... (3)

TheGratefulNet (143330) | about a year ago | (#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.

Re:Sounds like a problem... (2)

TheGratefulNet (143330) | about a year ago | (#45276311)

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.

Re:Sounds like a problem... (2)

DigiShaman (671371) | about a year ago | (#45275745)

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.

Re:Sounds like a problem... (1)

Shavano (2541114) | about a year ago | (#45275811)

What do you think the Affordable Care Act does?

Re:Sounds like a problem... (0)

Anonymous Coward | about a year ago | (#45275991)

an actual heath care system for all and an end to regular private insurance.

These two absolutely do not contradict each other.

Re:Sounds like a problem... (1)

Gothmolly (148874) | about a year ago | (#45276203)

That will require a government solution.

Why?

Re:Sounds like a problem... (1)

tomthepom (314977) | about a year ago | (#45276221)

If by 'full capitalist' you mean 'free market', how does that fit in with getting rid of insurance? There will always be a demand for health insurance of some kind to pool risk, simply because on an individual basis it's impossible to financially plan in advance for risks of accidents and random illness. And even if you're lucky enough to have a long, healthy life, there's still no way to know if at the end you're going to be taken out quickly (and cheaply) by a stroke or heart attack, or die slowly and expensively of cancer, dementia etc.

Option 3 (1)

rsilvergun (571051) | about a year ago | (#45276327)

people don't have health care unless they can afford health insurance. Health Care becomes a luxury that you only get if you earn it.

A sizable number of Americans think this way already, and an equally sizable think that if we try paying for health care for everyone then there won't be enough for them. All you need to do is convince 51% of Americans of this (because we're 2 party, not a parliament) and Option 3 takes effect.

That's sorta why we ended up with the Affordable Care Act. It was the closest we could get to universal health care with two big blocks of the country convinced that Universal Health Care is impossible. It's odd really, since these same people are convinced we're both the greatest people on earth ("American Exceptionalism") and completely incapable to taking care of one another....

What "full capitalist" would mean (1)

walterbyrd (182728) | about a year ago | (#45276347)

Anybody could practice medicine. You could not lie about your credentials, but no degrees, or licenses, would ever be required.

Any drug would be available to anybody, any time. Anybody could buy a kilo of opium, or cocaine, or whatever, from Walgreen's.

No such thing as malpractice.

Insurance is not the health system... (5, Insightful)

ndykman (659315) | about a year ago | (#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.

Re:Insurance is not the health system... (1)

ndykman (659315) | about a year ago | (#45275697)

s/off/out/g. I can't brain today.

Re:Insurance is not the health system... (-1)

Anonymous Coward | about a year ago | (#45275787)

they aren't doing less and less
  a lot more drugs and treatments now than 30 years ago. almost 50% of americans are on some prescription drug on a regular basis unlike 30 years ago when you would just die from high cholesterol or put up with your allergies or drink away your depression

Healthcare vs. Insurance (4, Insightful)

sunderland56 (621843) | about a year ago | (#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.

Re:Healthcare vs. Insurance (3, Insightful)

ShanghaiBill (739463) | about a year ago | (#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.

Re:Healthcare vs. Insurance (1)

Overzeetop (214511) | about a year ago | (#45275783)

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).

Re:Healthcare vs. Insurance (0)

Anonymous Coward | about a year ago | (#45275841)

If your car is already wrecked that you can probably buy another car.
A quite usable pre-owned car is not expensive. If your health is wrecked
and you cannot get medical care you just die (well to be honest you go
to ER and the government pays, which just shows that the insurance
companies are actually ripping off the government).

Re:Healthcare vs. Insurance (4, Insightful)

tragedy (27079) | about a year ago | (#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).

Re:Healthcare vs. Insurance (1)

Shavano (2541114) | about a year ago | (#45275865)

This.

Re:Healthcare vs. Insurance (1)

smitty_one_each (243267) | about a year ago | (#45275889)

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.

Re:Healthcare vs. Insurance (4, Insightful)

bzipitidoo (647217) | about a year ago | (#45275967)

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.

Personalization (1)

Kontophoros (2651371) | about a year ago | (#45275497)

We'd better get used to things being more "personalized," this is what we're moving to.

Re:Personalization (1)

Anonymous Coward | about a year ago | (#45275627)

You need to get used to that everyone gets treated, no matter the person's wealth. And everyone pays for it. There you have it. Is that so very strange?

Re:Personalization (5, Insightful)

jc42 (318812) | about a year ago | (#45275901)

We'd better get used to things being more "personalized," this is what we're moving to.

Various economic (and business) theorists have pointed out that this is part of a general pattern that's well understood: Insurance is based on spreading the cost of unpredictable events over a population, so that the victims of such events aren't bankrupt/homeless/dead/whatever if a disaster hits them. Insurance is basically a gambling game. If an event becomes predictable, insurance no longer works, since only those susceptible to a disaster will want insurance, but the insurance companies will refuse to sell policies to exactly those people.

A classical textbook example is flood insurance. There are many cases where the probability of a disastrous flood event has become predictable. The people and companies in the high-risk area want insurance, but the price is so high that a policy will bankrupt them. Such "insurance" can then only be provided by the government, but in reality, it's more in the nature of planned disaster prevention/recovery than insurance.

Various other theorists studying the medical field have been predicting that this will rapidly happen in medicine, too. Medical insurance made sense when most diseases were poorly understood, and it was impossible to predict with any accuracy who might be susceptible to which medial problems.

But we are getting more knowledgeable about such things. Medical problems are becoming much more predictable in general, and many major medical tests have much better accuracy than a few decades ago. Again, the inevitable result is that insurance companies will get access to the information, and will refuse to sell coverage (or will price it at bankruptcy levels) to people whose tests predict imminent medical problems. Eventually, this will mean all of us. This is how insurance has always worked, and medical insurance is not significantly different.

(Well, except for the fact that we know the exact probability that each of us will eventually have a major medical problem: 100% ;-)

Insurance isn't medical care. it's what insurance always is: a way of spreading the cost around in an unpredictable world. It only helps if the problems are unpredictable, but don't hit everyone. Medical problems are becoming more predictable, so medical insurance is slowly becoming irrelevant and unworkable.

In summary: The real problem here is using "insurance" to pay for health care. We don't need insurance; we need health care. As medical knowledge improves, the insurers will do what they always do: They'll collect premiums until just before you are likely to need something expensive, and then they'll refuse to renew your coverage. That's how their business works, when knowledge becomes available and the results of a gamble can be predicted. The "Free Market" system rewards companies that get good at this, and those that aren't as good go out of business.

One advantage of Obamacare (5, Insightful)

surfdaddy (930829) | about a year ago | (#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.

Re:One advantage of Obamacare (1)

raind (174356) | about a year ago | (#45276313)

That happened to me, laid off no cobra insurance coverage, prexisting condition - screwed.

Meh... (0)

Anonymous Coward | about a year ago | (#45275533)

Excessive greed is destroying the us healthcare system.

I did a test of local doctors looking for a good. (-1)

Anonymous Coward | about a year ago | (#45275595)

I have something no that dont go away I went to three diffrent doctors not telling any what the others said looking for help got three different answers that did not work.
Then i put the three different diagnoses on a dart board and let the dart pick one. Then I told the doctor what it said I had and needless to say that is what he said it was then when he prescribe the same thing that failed I showed him the empty prescription and said that did not work.
Suddenly it back to a more expensive doctor specialist the same one that already failed.

They are all way to full of themselves.

Beatuiful segue from the previous article (2)

Anonymous Coward | about a year ago | (#45275601)

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

Using Big Data to MAXIMIZE Healthcare Cost (3, Informative)

theodp (442580) | about a year ago | (#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.

Re:Using Big Data to MAXIMIZE Healthcare Cost (1)

sc0ob5 (836562) | about a year ago | (#45275911)

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.

Re:Using Big Data to MAXIMIZE Healthcare Cost (2)

sqrt(2) (786011) | about a year ago | (#45276009)

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.

Re:Using Big Data to MAXIMIZE Healthcare Cost (0)

Anonymous Coward | about a year ago | (#45276091)

1 billion over five years is less than the rate of inflation, given their 2005 budget was over 400 billion dollars.

No, it's people (1)

50000BTU_barbecue (588132) | about a year ago | (#45275671)

People decide to use technology a certain way, and people submit to it. Russell Brand is right, it's time for a revolution.

aca will fix it (0)

Anonymous Coward | about a year ago | (#45275717)

The ACA, a 995 page act expanded into 10,000 pages of new federal regulations, will improve the Doctor/Patient/Insurance/Government relationship in the same way that the 73,000 pages of IRS Tax Code promotes the middle class.

Makes Perfect Sense (4, Interesting)

archer, the (887288) | about a year ago | (#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.

Insurers will only insure the healthy and wealthy (0)

Anonymous Coward | about a year ago | (#45275739)

Government will insure the rest. That's where the 'system' is headed.

Unhealthy and not wealthy: government involved at every level
Healthy: many more choices from insurer.
Wealthy: chooses own doctors, procedures and schedules. Not limited by insurers.

Moot point (0)

argStyopa (232550) | about a year ago | (#45275743)

The fact is that with the planned disaster that's Obamacare, everything is going to go south badly enough that eventually we'll be forced to scrap it and go along with a single payer system.

Game, set, match: democrats.

Re:Moot point (1)

Dereck1701 (1922824) | about a year ago | (#45276143)

I could be misinformed, but last I heard most of the single payer systems (UK, Australia, etc) were trying to wean people off into private health insurers because of unsustainable increases in costs. Not that the our private health system is a sparkling example of efficiency (OK its a dismal nightmare that more than doubles in cost every 10 years) but the answer does not seem to lie in either the single payer system or the private insurance system.

New Nickname? (0)

Jane Q. Public (1010737) | about a year ago | (#45275765)

I think this is the first time I've seen Obama referred to as "Big Dada".

Broken to begin with. (1)

YukariHirai (2674609) | about a year ago | (#45275815)

The US "health care system" was already broken. This is just showing why.

I thought this is what we wanted (1, Interesting)

russotto (537200) | about a year ago | (#45275925)

This is "evidence-based medicine", n'est-ce pas?

The insurance industry is destroying Healthcare (0)

Anonymous Coward | about a year ago | (#45275969)

It's the insurance industry that's destroying the US Healthcare System.

If you think... (2)

FuzzNugget (2840687) | about a year ago | (#45275985)

If you think that America's foremost healthcare problems have anything at all to do with technology, you are hopelessly deluded.

What a load of BS (0)

scottbomb (1290580) | about a year ago | (#45275987)

Over decades of gainful employment I have signed up for health insurance plans numerous times. I've never, ever, been asked any questions about my health or anything else for that matter when signing up for health insurance at any employer.

The author says "big data" is ruining healthcare. Who are the assholes taking over the system in the US? It's our BIG FUCKING GOVERNMENT with that albatross OBAMACARE that's causing people's plans to get cancelled and rates to go up.

Re:What a load of BS (4, Insightful)

MMORG (311325) | about a year ago | (#45276273)

The fact that a majority of Americans get no-questions-asked health insurance through their employers is exactly the problem and why we can't implement a sane system like the rest of the civilized world. Too many people think it's just fine the way it is.

And it is "just fine", until you decide you want to become self-employed and start your own business. Then all of a sudden, oops, you have a pre-existing condition? Sorry, no insurance for you. Or maybe you get laid off from work and can't find another job for a long time (hello, recession!). Sorry, no insurance for you. Or you're young and the only thing you qualify for is an entry-level job that doesn't offer health insurance as an employee benefit. Sorry, no insurance for you.

People who've worked stereotypical job-with-healthcare-benefits all their life can't fathom what it's like to not be in that position. And most importantly, they don't have a good understanding of how easily they could lose their nice job, along with their health insurance, in an instant and through no fault of their own.

The only reasonable health insurance system is to put absolutely everyone in in the same risk pool from birth until death. Anything else ends in having to tell some people, "Well, better hope you die quickly."

this is banned starting next year (2)

jfruh (300774) | about a year ago | (#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.)

Obama Health Care System Is A Ponzi Scheme (-1)

Anonymous Coward | about a year ago | (#45276003)

Roberts analysis is good but off target.

The purpose of the existence of the Affordable Care Act aka Obamacare is to enable Barak Hussein Obama to fraud the citizens of U.S.A. of their Social Security moneys in order to inflate Obama's Social Security account from which the National Democratic Party is drawing money's from on an hourly basis.

The function of the NSA 'internet and phone vacuum operations even in Europe is to gather intel on U.S.A. citizens' for Obama.

Old Roman Proverb: the One who benefits from a murder is the murderer.

QED

Big Data Can Also Drive Positive Change (2)

Digital Eco Freak (3881) | about a year ago | (#45276047)

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.

Individuals can't support themselves (1)

Brien Coffield (3026589) | about a year ago | (#45276171)

As a young person who pays much more than I receive in benefits, I only hope that when I'm old I will receive a little bit of what I'm contributing. The young should support the old and incapable. Hopefully some sort of program will catch me when I fall. Isn't that what a central authority is for?

The decline of the middle class (3, Interesting)

swb (14022) | about a year ago | (#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.

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