et2o

1. It’s just a fact that if all reimbursement was currently Medicare-level, the existing hospital systems in NYC would run a massive deficit and couldn’t provide the services they do now. They wouldn’t be in business barring massive reductions in staffing, hours, services, salaries, etc.

I don’t know what you read in the NYT but this is well-known in healthcare. Hospitals lose money on Medicaid/Medicare patients in general and make it up on private insurance (also in general) in order to hopefully pull in a surplus each year. Look up the idea of “payor mix.” Private insurance reimbursement varies widely but is typically a multiple of Medicare/Medicaid.

2. Yes - it is already happening. I think it would likely get worse. I don’t think single payer insurance is going to cause a renaissance of PCPs, especially if the overall reimbursement for that kind of service goes down. Probably the other direction. Maybe I’m wrong.

3. I’m not exactly sure what happened at UCSF with your ultrasound. Not familiar with SF really. But you can look up mean wait time for most elective procedures in the USA vs. Canada or USA vs. the UK. Or access to new therapies.

Great points. Yes those are the major barriers. If you have all those, things can go well. Obviously heaps of people in the USA do not.

I said “if you have private insurance,” which I think is the key qualifier. One of the other commenters expanded upon it well below.

I’m not making an argument for cost-effectiveness either.

We can get private insurance to pay for elective surgeries, new medications, etc. that are either not covered in other countries or have extremely long wait periods. And the higher reimbursement I think is helpful for providing staffing and paying for equipment that they (in my admittedly n of 1 experience) simply didn’t have for me. I suppose it is a tradeoff.

I’m an MD who trained in NYC. I have also had emergency surgery in the NHS at one of their most prestigious hospitals in London and so I feel like I’ve seen the system a little bit from the inside.

It was far cheaper for me than it would have been as a Brit in the USA, but the standard of care was lower. They didn’t have some technical and staffing resources late in the afternoon that would be a baseline in any of the hospitals I’ve been at in the USA. The English doctors were just kind of apologetic and bashful about it, talking to someone they knew was an American doctor who knew what kind of specific diagnostic algorithm was appropriate.

The NHS hospital did have really excellent amounts of ancillary staff. Someone brought coffee and tea to me like 3-4 times a day, it wasn’t hard to get my luggage delivered to my bed, etc. Not like that in the USA from what I’ve seen.

The NYC hospitals are somewhat financially strained as it is. Especially the public hospitals (Bellevue, Elmhurst, Metropolitan).

Also related would be care at the VA hospitals, which is slower/worse than care at NYC flagship hospitals. But as a society we don’t want to prioritize or pay for good care for veterans, so it is what it is.

I predict this will continue to basically just produce a more two-tiered system in the US. Most doctors who have a choice (large group practices) will take the wealthy patients with private insurance, and the big hospitals and whomever else who don’t have a choice will be forced to accept the NY single payers (basically the existing model, where the poor and 65+ are already covered under Medicaid and Medicare already). It will likely strain these systems even further, as reimbursements from Medicaid/Medicaid are insufficient to run large health systems which depend on higher rates from private insurers (payor mix). Good luck there.

In NYC even more physicians and group practices will try to go to alternate models such as cash-only. Try being on Medicaid or Medicare and finding an outpatient psychiatrist in NYC now as it is. This will extend to more PCPs, chronic disease specialists, etc.

Some patients will get better and more affordable care, but some will also get much worse care. It will be interesting to see what happens. I’m not necessarily opposed, but this is absolutely not going to be a clear and decisive win on all fronts as some commenters are suggesting. The US healthcare system, if you have private insurance, is the best in the world already in terms of level of service and access to rapid specialty and high-end care.

I think that’s exactly what OP meant

He got a lot of sympathetic coverage because of the goals of his campaign, but if you look into the details he is clearly in fact guilty of bribery, corruption, and fabrication of evidence in Ecuador. Do the ends justify the means? He was also likely going to make a huge amount of money, it wasn’t quite as noble as it seems.

This is exactly the answer. Why would the manufacturer of a professional-targeted camera take an action that would destroy their business?

Do you really think Elon Musk cares about potentially making about 100 million on a pump and dump scheme? He’s worth 240 billion

I’m guessing the tradeoff in the air is worth it. Can’t stop to run an AED and if they need a shock it’s because they’re in a potentially fatal rhythym

Using cyanoacrylate glue is is very common in medicine for skin closure. Doesn’t seem ridiculous to use in other settings.

I’m not sure those people would make great surgeons or physicians as a rule. I don’t think lack of talent or intellectual horsepower in medicine is an issue at all.

Doesn’t apply to a wrong-sided procedure

The number of slots is limited. Am airline not using a spot could be replaced by one that will. This is good because it allows more travelers to travel.

I agree. I love using signal and have converted most of my friends to it, but $60/year is too high for me for a chat app. I’d pay a dollar a month, maybe two.

Tire wear is a complex interaction of various factors such as compound, slippage, road surfaces, torque, weather etc and not just wheel revolutions

CureVac did not have any pseudouridine modifications. This is relatively easy to do and I’m not sure why they did not do it.

Well put. We can actually detect well below 50 copies/mL in the laboratory setting as well; we don’t go below this to maintain adequate test specificity and sensitivity in the clinical setting.

There is no data that supports this assertion whatsoever. There is a lot of evidence going against it. Theoretically it may be possible, but the probability of this is on the order of 0 and so close to 0 it will likely never happen.

Think of it like chemistry. Sure, two covalently bonded hydrogen atoms at STP could have nuclei 1cm from each other due to random chance. However, the probability of this happening is so low that it is effectively 0.

Did you read about the ForcedEntry exploit? They implemented basically an entire emulator inside of one pass of an obscure PDF compression algorithm. It’s perhaps the most complicated hack I have ever seen by an order of magnitude at least.

Look at the third-to-final paragraph where it explicitly mentions recycling Kevlar vests.

Explanation: https://en.m.wikipedia.org/wiki/Graveyard_spiral

Lol

I was mostly just pretty amazed. Maybe other tech workers don’t realize how good they have it.

I wish I worked in a big tech company instead of healthcare. I get more harm inflicted on me everyday than this guy experienced over the entire story. Your lives are pretty good.

This is sophisticated intentional misinformation. HN readers are precisely the kind of people who would be deceived by this.

Definitely-would want to normalize distance by total state size, your formula works. I'm pretty sure NY would be the winner here, although Alaska might also be close by this metric.

After a brief search, Hawaii's is in the ocean between O'ahu and Moloka'i. DC's might be the closest to the state border (about 3.1 miles) but still just about directly in the center of the DC polygon.

Interestingly enough, the mean center of population for NY State is only about 9 miles from the NJ border. Given NYC's location, not suprising. I wonder if there are any states with centers of population closer to the border than that. Given NY's geometry, if NYC continues to grow relative to upstate, I could imagine the center of population of the state actually being outside of NY State boundaries.

It's also possible in the past the NJ's state center of population might have been in NY - if Newark and Northern NJ were more relatively populous, I think that the mean center of population might be in Staten Island or the NY-NJ harbor.

I thought they would already be marked on Google Maps, but they are not. It doesn't seem possible to add them even as a Tourist destination either. Interesting.

Dead wrong that a single bought of COVID is better than 3 vaccine shots. You need repeated exposure. Plus, I’m guessing you’re young-the point was to stop the > million deaths COVID is going to cause in the US alone soon. Nice work.