3 ms·

I feel for you - this kind of thing just shouldn't happen. I think that medicine is a bad example of the point you are trying to make though... It has a lot of

by Gatsky 10y ago

I feel for you - this kind of thing just shouldn't happen. I think that medicine is a bad example of the point you are trying to make though... It has a lot of embedded costs and roadblocks that aren't really related to regulation. For example - the procedure you describe is highly specialised, and can only be learnt in certain places. Say there are 4 people that can do this procedure at a hospital. Attracting a doctor who can do the procedure is often a complicated task. In a highly specialised field thay may need to be incentivised, which also costs money. It is very difficult to control where doctors work - they invariably want to work in large established centres, which are already saturated (and so they don't work full time, they end up taking small bits of work here and there). This problem isn't necessarily solved by training an order of magnitude more - increasing the true training capacity of the health system is actually very hard, and takes a long time. Pumping up the inflow of trainees at one end just means that competition increases, doctors spend more time optimising for selection onto programs and working in certain places rather than doing their training. They also develop a sense of entitlement due to the high debt and difficult and competitive training ie they feel like they should be able to work wherever they want to work, not where they are forced to go. There is limited space in the endoscopy suites usually - increasing capacity means building a new suite, buying all the equipment, paying the nurses, rostering another anaesthetist. The added cost is easily more than a million dollars just to get started, without the doctor even doing any procedures. There could also be other bottlenecks like sufficient recovery areas and clerical staff. This high threshold means that an overloaded service will languish for long periods before capacity is increased.

maxharris 10y ago
It is true that medicine is expensive, but so is setting up the technology for a major cloud provider (on the scale of Amazon), or a car coordination platform/system like Uber. The difference is that the tech examples I've provided have not had the ability to progress (and the financial reward for doing so) regulated out of them. The wait time for this is not something that just happened yesterday, and what I'm saying is there's a systematic reason for it that goes deeper than just the nature and cost of the people/equipment/training. An example of this from another field: In a 10-year span during the 1880-1890s, J. J. Hill coordinated and financed the construction of a transcontinental railroad, without any government aid. This was done without the benefit of bulldozers, tunnel-boring-machines, automated track-laying equipment, etc. Today, Seattle's transportation authority says that it'll take 25 years for it to put down six miles of rail between Ballard and downtown. I'd be dead for sure in 1890 (no CT scanners, etc.), but the rate of progress has definitely been restricted. And the difference is just in our ideas, not things, or any inherent rule in nature.
- gregpilling 10y ago
  Is it regulation, or vested interests? When J.J. Hill did his thing, there was no landowners to argue with (comparatively). In Seattle, there must be a thousand landowners to consider in that 6 mile stretch. Each one with their own view of the need and cost/benefit analysis of the 6 mile improvement. Eminent domain is not without legal challenge of course, so this drags out the timeline. Underfunded court systems move slower than desired, adding to delays in the process. The 'regulations' would be about safety, electrical wiring, setback etc, which just define how things should be done for the most part and do not add time. It is dealing with all the vested interests of the property owners involved, and the sheer number of them. I am a property owner myself; if the city came to me a decided that my house was in the way of a new freeway on ramp, you had better believe that I am going to want my day in court to fight it. I have the resources to drag it out as long as possible - with extensions, delays, studies, blah blah blah. It does not take much thought to understand how to slow things down in court. I am sure there is a youtube video for it. Would you protest if your own house was to be destroyed by the 6 mile change? I assume you live in the Seattle area or you would not know about the statement. So if your own person domicile was to be destroyed, and it was a beloved place with a lifetime of memories for you, would you be complacent about its destruction or would you fight it tooth and claw? (I would fight) I think the overwhelming majority would fight. And then it takes 25 years to go 6 miles. It is not regulation but property owners. Specifying the diameter of a ground rod in an electrical panel does not slow things down, it speed them up by removing the need to think about it. Just build to code - someone else has figured it out. I don't need to calculate loads of the panels versus the density of the square root of the moon yesterday - I just sink in 2 ground rods 20 feet deep and 40 feet apart and am happy that someone else did the math. Life is an open book test, the printed regulations are the answer key. TL:DR Money not rules is the delay maker.
maxharris 10y ago
One of the roadblocks I forgot to mention is the federal government, which effectively sets limits on the number of new residents that are trained each year: https://www.aamc.org/advocacy/gme/71178/gme_gme0012.html https://www.aamc.org/advocacy/gme/71178/gme_gme0012.html (Not enough people know this, because there would be real outrage if they did.)
- maxerickson 10y ago
  Those are funding caps, which aren't quite the same as limits. I'm not aware that there is anything stopping private hospitals funding residency slots. Hospital systems with hundreds of millions of dollars of profit could easily afford to fund a few residencies. Medicare is probably a pretty smart and fair place to pull the funding from (it's a broad based tax and key patient focused component of the US healthcare system), but it certainly isn't the only entity with money.

by Gatsky 10y ago

maxharris 10y ago

It is true that medicine is expensive, but so is setting up the technology for a major cloud provider (on the scale of Amazon), or a car coordination platform/system like Uber. The difference is that the tech examples I've provided have not had the ability to progress (and the financial reward for doing so) regulated out of them. The wait time for this is not something that just happened yesterday, and what I'm saying is there's a systematic reason for it that goes deeper than just the nature and cost of the people/equipment/training. An example of this from another field: In a 10-year span during the 1880-1890s, J. J. Hill coordinated and financed the construction of a transcontinental railroad, without any government aid. This was done without the benefit of bulldozers, tunnel-boring-machines, automated track-laying equipment, etc. Today, Seattle's transportation authority says that it'll take 25 years for it to put down six miles of rail between Ballard and downtown. I'd be dead for sure in 1890 (no CT scanners, etc.), but the rate of progress has definitely been restricted. And the difference is just in our ideas, not things, or any inherent rule in nature.

gregpilling 10y ago
Is it regulation, or vested interests? When J.J. Hill did his thing, there was no landowners to argue with (comparatively). In Seattle, there must be a thousand landowners to consider in that 6 mile stretch. Each one with their own view of the need and cost/benefit analysis of the 6 mile improvement. Eminent domain is not without legal challenge of course, so this drags out the timeline. Underfunded court systems move slower than desired, adding to delays in the process. The 'regulations' would be about safety, electrical wiring, setback etc, which just define how things should be done for the most part and do not add time. It is dealing with all the vested interests of the property owners involved, and the sheer number of them. I am a property owner myself; if the city came to me a decided that my house was in the way of a new freeway on ramp, you had better believe that I am going to want my day in court to fight it. I have the resources to drag it out as long as possible - with extensions, delays, studies, blah blah blah. It does not take much thought to understand how to slow things down in court. I am sure there is a youtube video for it. Would you protest if your own house was to be destroyed by the 6 mile change? I assume you live in the Seattle area or you would not know about the statement. So if your own person domicile was to be destroyed, and it was a beloved place with a lifetime of memories for you, would you be complacent about its destruction or would you fight it tooth and claw? (I would fight) I think the overwhelming majority would fight. And then it takes 25 years to go 6 miles. It is not regulation but property owners. Specifying the diameter of a ground rod in an electrical panel does not slow things down, it speed them up by removing the need to think about it. Just build to code - someone else has figured it out. I don't need to calculate loads of the panels versus the density of the square root of the moon yesterday - I just sink in 2 ground rods 20 feet deep and 40 feet apart and am happy that someone else did the math. Life is an open book test, the printed regulations are the answer key. TL:DR Money not rules is the delay maker.

maxharris 10y ago

One of the roadblocks I forgot to mention is the federal government, which effectively sets limits on the number of new residents that are trained each year: https://www.aamc.org/advocacy/gme/71178/gme_gme0012.html https://www.aamc.org/advocacy/gme/71178/gme_gme0012.html (Not enough people know this, because there would be real outrage if they did.)

maxerickson 10y ago
Those are funding caps, which aren't quite the same as limits. I'm not aware that there is anything stopping private hospitals funding residency slots. Hospital systems with hundreds of millions of dollars of profit could easily afford to fund a few residencies. Medicare is probably a pretty smart and fair place to pull the funding from (it's a broad based tax and key patient focused component of the US healthcare system), but it certainly isn't the only entity with money.