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Comment by nimbius | Hacker News Reader

I wonder if this is a "dont waste your time" issue coming from management?

As an anecdotal example, Im an engine mechanic who routinely sees older trucks from the 80s and 90s. mostly idler/pitman arm replacements, tires, diff fluid, etc... on these which is expected as many are pushing a million miles or more. I had a 1981 International S1700 limp into my garage one day with a misfire problem due to long, long overdue oil pressure problems. I fixed the oil pump and was getting ready to hook up the diagnostic computer when my boss stopped me and said "if you plug that thing in its going to light up like a christmas tree. You aint telling the driver anything they care about anyway."

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No, the argument is specifically that the harm from following up on false positives outweighs the benefit from finding true positives. While the 2011 study that the Medicare policy change is based on specifically concludes that this will not be the case, the concern is that the study found a lower false positive rate than would be seen in the wild, due to better skill and greater diligence from the radiologists participating in the study.

Harm from false positives is a real thing, especially for a test with a relatively high false positive rate and relatively invasive followup to false positives (they don't state it specifically, but the theater analogy implies 66X more false positives than true)

Furthermore, unlike an auto mechanic who might not be able to bill much for finding problems the owner doesn't want fixed, or following up on a diagnostic computer finding that turns out to not be a problem at all, the healthcare system at large stands to profit from both the screening and the follow up on those false positives, so the bean counting manager shouldn't be applying pressure to skip the screening.

I mean the overall incidence of lung cancer is too low for this to be the case, even in smokers. It's around 5-6 percent.

Do share more stories on working on old trucks! I have a '99 Ford with a 7.3, and everyone's saying it's not worth fixing, but I just like keeping it on the road...

What kind of MPG does that get?

22-24 highway, 15 city. It has zero emissions equipment though, so I'm sure it's killing us all

It would depend on what needs fixing? Are we talking engine internals of the stuff that hangs of the engine?

Nothing to my knowledge needs an overhaul yet, nearing 400k miles, and it's just been maintenance and consumables (except the turbo started leaking at 300k miles, which was replaced)

Typically, diesels are built with maintenance in mind (at least for trucks, no idea what you'd find in a diesel car). The cylinders are sleaved and meant to be replaced every couple 100k miles or so, so the cylinders themselves also last a long time (the sleaves take the brunt of the wear). I think theyre typically less complex than a standard gasoline engine. E.g. they have no spark plugs (and thus no distributor or ignition system), instead glow plugs to start the engine. Possibly more complex in other areas, such as emissions control.

I'm no expert on engines, so the the above may not be entirely accurate or current. Most of my knowledge comes from working for a semi truck/diesel engine manufacturer as an IT intern close to two decades ago and touring factories.

That's about right.

I thought the 7.3's were supposed to be super solid? How many miles does it have, what's wrong with it?

My extremely limited knowledge of diesel engines is something like "they go a ton of miles, then need a major overhaul, then go a ton more miles". If you're at some kind of major overhaul milestone, then I could see the response you're getting.

'99-ish Ford kicked off the Super Duty series, but it isn't sufficiently interestingly old to a lot of people, so I can understand their the why-bother attitude.

It's nearing 400k miles. It's had service - new turbo and engine control components, suspension and frontend, brakes, glow plugs, etc. Original everything else though, nothing fancy, just a work truck. But anything "newer", even 10 years old, is $25k minimum for any halfways decent duty truck.

Your 7.3 is gold, that engine will last till the heat death of the universe. And you’re maintaining it. For some reason people think that a well maintained vehicle is a grenade because it has service history, while one being run into the ground is great because they haven’t paid for anything recently.

Newer trucks aren’t more reliable. They’re just newer. You won’t find a truck cheaper to maintain than the one you’ve already got.

(The people who tell you your truck ain’t worth fixing sound like my mother in law who traded in her car ‘cause the windshield wipers broke.)

Please tell me the story about your mother-in-law is an exaggeration

Nope, literal truth. Lovely lady, but some decisions...

FWIW older generations' experience with cars is that they are unreliable money pits after 10+ years. That was true until relatively recently.

> they go a ton of miles, then need a major overhaul, then go a ton more miles

Yup. Not unusual for big rigs to go a million miles between overhauls.

Even for "consumer" diesels, the engine typically outlasts the vehicle around it.

I drove a '97 Dodge which had 300k on the odo, got tired of the poor interior and upgraded to an '06 with 200k. I even threw a mercedes diesel into a 67 chevy pickup, because diesels are great :) https://www.youtube.com/watch?v=yFd1ZL2hgMY

thank you for saying this ! The environmental "externalities" world is exactly like this! Saving generations of [insert-charismatic-species] from extinction in the wild is NOT PROFITABLE and will, in certain cases, be HIDDEN from investors and regulators.

Well, yes, paying for externalities is not profitable. That's the whole reason that people have to be forced to pay for them.

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