“Standardizing an interface between health care providers and insurance companies would be a huge win. No matter how badly designed, it would be better than the current mess, and save several percent of US GDP.”
Solving the sorts of problems highlighted in the article (from 2017) is well-recognized, by elected officials in 2023, as a priority of their constituents.
However, neither of the initiatives linked above will systematically address the underlying issues, which are:
1. Conflicting and overlapping objectives between federal, state and local governments, as well as between the different branches of government.
2. Partially privatized administration of government programs, such as Medicare. This inevitably results in further conflicts of objectives, and incentivizes gaming the system.
3. The only real way for the government to learn from failure, and adapt to it, is by creating a mountain of new regulations, which just makes everything more expensive / take longer.
4. Extreme caution, in regulated industries, around sharing information with external parties, due to liability concerns. This drives further consolidation.
None of those issues address the elephant in the room.
If you dismantle the incumbent system and introduce efficiencies that bring US health care spending in line with other developed countries, millions of health insurance workers would be out of their [parasitic] jobs. Which is politically untenable.
The underlying issue is incentive incompatibility. The health insurance industry is a behemoth 10x the size of the automotive industry, for example. You can imagine what kind of lobbying power they have as a result. And they are not interested in anything that destroys their jobs.
Not the TLC, but I agree with you. The biggest costs in healthcare are not insurance company or hospital dividends, or even pharmaceuticals. The biggest costs are the wages paid to doctors, nurses, and administrators. The sad part is that very little efforts seems to be directed to improving the patient experience, such as might be accomplished by introducing patient advocates or guides.
1. Lack of rigidity, excessive stickiness of molecules (Van der Waals force), constant random interactions (Brownian motion) at the microscale of cells means mechanistic intuitions from the macroscale don't apply.
2. High surface area (combined with VdW force) causes problems related to friction and energy dissipation.
I didn't want to navigate that PDF, so I read the author's IEEE article, which I think has similar content.
What a boring criticism! All of the things he mentions are easily approachable engineering challenges. His conclusion seems to be "mechanical engineering as with gears and pulleys won't work with nanobots". Duh! No one claimed otherwise.
> mechanistic intuitions about the microscale don't apply.
Obviously. Why would you or the author think nanotechnology optimists don't know this? Half the reason we don't have nanobots is because we don't yet have the engineering expertise and practical tools for these scales. The other half is that we're still working out efficient 3D nanofabrication. They are related problems. These are not physically insurmountable issues (as demonstrated thoroughly by organic life). There are a hundred different fields of study that are slowly eating away at the edges of the general purpose nanofabrication problem.
> All of the things he mentions are easily approachable engineering challenges.
If they are so "easily approachable," feel free to solve them any time. I think you'll find that solving problems in living systems (let alone in the clinic) is much more challenging than it might appear from a CS/physics perspective (https://www.quora.com/What-is-the-Andy-Grove-fallacy?share=1).
I'm not saying it's not worth trying (it's certainly a more worthwhile endeavor than getting people to click on more ads), but that it's important to be realistic (for example, that all disease is unlikely to be cured by 2100).
"Easily approachable" doesn't mean I can just go ahead do it. It means I can see how one would start working on it, and in fact many people are.
In fact, I am currently working in a nanotech lab, so I am hopefully helping a bit ;)
None of the problems you linked to are things that need to take a hundred years to solve. It's probably more accurate to measure development barriers in R&D costs than years. At the very least, we could just reverse engineer biology.
Doing experiments on animals (and especially humans or other vertebrates) is the exact opposite of something you can just go ahead and do. The best way to see that is to give it a go yourself.
> At the very least, we could just reverse engineer biology.
Many people in the past with a CS/physics mindset have made similar claims. If you try to work with living systems, I'm sure you'll see why these problems aren't just a matter of spending R&D dollars.
> Most of the methods in a biological wet lab are very far from standardized and need a great deal of troubleshooting. Most post-docs in a new lab spend a couple months just trying to get basic stuff working that they've done dozens of times before.
Having had experience with syn bio in grad school and trying to reconcile the empirical (biology) and first principles (CS/math) approaches, I've been thinking a lot lately about how to streamline the troubleshooting process for picking up and optimizing wet lab methods. I'd love to chat - my email's in my profile.
The most interesting part of this is how the compound was discovered:
> A multichannel device, the iChip, was used to simultaneously isolate and grow uncultured bacteria. A sample of soil is diluted so that approximately one bacterial cell is delivered to a given channel, after which the device is covered with two semi-permeable membranes and placed back in the soil. Diffusion of nutrients and growth factors through the chambers enables growth of uncultured bacteria in their natural environment. The growth recovery by this method approaches 50%, as compared to 1% of cells from soil that will grow on a nutrient Petri dish.
It's a fun read but not very technical, or rather, not technical at all. It's a story, I didn't learn anything about finance or business strategy from it.
Right, it's good for a weekend read. I wouldn't say it's completely devoid of educational value. It's interesting to see how Johnson manages his board relationships, as well as the details of the bidding process and how difficult it can be to form partnerships.
The late 80s were definitely a different time, though - the amount of money needed for the RJR LBO is much more easily accessible to people in similar positions in 2016. As of June 30th, KKR's AUM is $131B, while Blackstone is at $356B.
If you're interested in learning the technical details of corporate finance, you're probably best off starting with something like the Coursera class Introduction to Corporate Finance (https://www.coursera.org/learn/wharton-finance), and then reading the textbooks referenced by the course for a more in-depth understanding.
i read this book, it's good. i got the overwhelming feeling that once started, the buyout process is outside of any one person or group's control. it takes on a life of its own.
Either way it'd be a lot heavier than the one, two or three doors that buses have these days. But then, weight probably won't be that big of a factor given how it'd need to have a floor full of batteries anyway.
But then half you lose easy access for the half of seats not on the sidewalk side. There's not a good way to lose the aisle without condensing down to only a couple seats across.
A new regulation was actually proposed by the federal government a year ago to do that: https://www.cms.gov/priorities/key-initiatives/burden-reduct...
There’s also a new program to reduce fragmentation for dementia care in particular: https://www.cms.gov/priorities/innovation/innovation-models/...
Solving the sorts of problems highlighted in the article (from 2017) is well-recognized, by elected officials in 2023, as a priority of their constituents.
However, neither of the initiatives linked above will systematically address the underlying issues, which are:
1. Conflicting and overlapping objectives between federal, state and local governments, as well as between the different branches of government.
2. Partially privatized administration of government programs, such as Medicare. This inevitably results in further conflicts of objectives, and incentivizes gaming the system.
3. The only real way for the government to learn from failure, and adapt to it, is by creating a mountain of new regulations, which just makes everything more expensive / take longer.
4. Extreme caution, in regulated industries, around sharing information with external parties, due to liability concerns. This drives further consolidation.