6 ms·

I appreciate a lot of Gates' statements here, since they are substantive and not just posturing. The issue is that the US medical system is rotten to the core.

I appreciate a lot of Gates' statements here, since they are substantive and not just posturing. The issue is that the US medical system is rotten to the core. There are hundreds of thousands of wonderful individual practitioners and even thousands of excellent teams, but the system as a whole is broken. His idea that no one should be paid for a test result if it takes more than 24 hours to result is not bad, but the existing system is not set up for it. Decades of regulation of all aspects of the US medical system, from billing codes even to electronic health records, would prevent that kind of change from being adopted overnight. If we adopted this change, you'd very likely see almost no one running any COVID tests at all - the risk and infrastructure investment would be too high, for too little payout. (Recouping the cost of lab tests is generally hard as is, since the costs of running a medical lab are almost entirely fixed, both in terms of labor and capital. Routine maintenance must be performed, the lab must have a certain contingent on duty to handle stat tests, etc.) I'm not sure the US system can be improved unless we have some practitioners who want to make a clean break from the existing regime, and they get some cover from the government to actually innovate. I'm not holding my breath.

R0b0t1 6y ago
I have been worried for some time the only solution is the democratization of healthcare due to advances in biology and chemistry. People are 3d printing their own prosthetic mounts and getting better results than trained and heavily credentialed professionals. Maybe some day people will be able to design their own medication and targeted supplements. What worries me is this may be decades away.
- youngNed 6y ago
  > Maybe some day people will be able to design their own medication and targeted supplements. > What worries me is this may be decades away. First the good news: That day is here!! Now the bad news: that medication isn't working out great for them. Apparently some wingnut told people that drinking bleach was a potential cure for some ills. Didn't go great. And thats the problem with what you wish for - a popular facebooker, youtuber, instagrammer, president tells people that they can design their own medication, people are going to do it.
  - baryphonic 6y ago
    Who was telling people to drink bleach? Can you cite a specific instance?
    - youngNed 6y ago
      While stopping short of suggesting injestion of bleach trump certainly posited whether bleach used internally (on the lungs) could be an effective medication - so yeah, maybe he didn't mean drinking it, maybe he meant injecting it?
    - deleted 6y ago
      [deleted]
    - me_me_me 6y ago
      https://quackwatch.org/cases/board/med/buttar/complaint_20091/ https://quackwatch.org/cases/board/med/buttar/complaint_2009... There one example
    - frederikb 6y ago
      US President Trump seriously suggested research into injecting bleach to the horror of doctors and medical professionals everywhere: https://www.bbc.com/news/world-us-canada-52407177 https://www.bbc.com/news/world-us-canada-52407177 It lead to actual problems of US American citizens ingesting/consuming bleach which forced government agencies to put out warnings: https://www.forbes.com/sites/nicholasreimann/2020/08/24/some-americans-are-tragically-still-drinking-bleach-as-a-coronavirus-cure/ https://www.forbes.com/sites/nicholasreimann/2020/08/24/some...
      - hiram112 6y ago
        You can read his exact quote here: https://www.statesman.com/news/20200713/fact-check-did-trump-tell-people-to-drink-bleach-to-kill-coronavirus https://www.statesman.com/news/20200713/fact-check-did-trump... Never once does he mention the word 'bleach'. He uses the terms UV light and disinfectant. But I guess using disinfectant, to the average American reader, is synonymous with literally injecting bleach into your body or guzzling it down your throat... Remember when NPR came out with this article entitled: "No, You Don't Need To Disinfect Your Groceries", and the media was outraged because millions of Americans were dumb enough to start soaking their food in bleach? Yeah, me neither. https://www.npr.org/sections/health-shots/2020/04/12/832269202/no-you-dont-need-to-disinfect-your-groceries-but-here-s-to-shop-safely https://www.npr.org/sections/health-shots/2020/04/12/8322692... Interestingly, looks like he was right about it anyway: https://www.nbcnews.com/nightly-news/video/using-uv-light-to-fight-covid-19-what-to-know-about-its-effectiveness-91729989602 https://www.nbcnews.com/nightly-news/video/using-uv-light-to...
- api 6y ago
  The problem is that without strict regulation any health care market will be flooded instantly with quacks. Quackery is much easier than actual medicine. Quacks don't have to spend anything on R&D and quack medicines are a lot easier to manufacture (look up the synthesis pathways for popular pharmaceuticals!), and this means quacks can spend more on marketing and operate with much higher margins. This translates into a huge market advantage. Pretty soon you'll have nothing but quacks. Medicine has a unique and extreme case of the "uninformed consumer problem." In medicine it's incredibly difficult even for professionals to tell whether something actually works, let alone individuals. "Do your own research" doesn't work at all in medicine unless you have a billion dollars burning a hole in your pocket and can assemble your own research lab. Excluding emergency medicine and the most instantly and dramatically effective drugs, it's really hard as an individual consumer of health care to tell whether a treatment is working over the short term. Check out gwern.net and how much work he's put into trying to tell if various nootropics work and how much uncertainty remains. The fact that individual discernment is so hard in medicine means defrauding people is incredibly easy. It's a market that is inherently vulnerable to massive fraud, and there is no easy way (that we know of) to fix this. Even with the FDA there is still a tremendous amount of quackery. Without the FDA and strict licensing and supervision there would be only quackery. BTW news seems to suffer from a similar problem. Actual investigative journalism is expensive, hard, and sometimes dangerous. (Old PI joke: How do you know if a conspiracy theorist might be right? They are missing and presumed dead.) Fake news is cheap and easy, and since it's fake you can craft your stories for maximum click bait appeal without having to be limited by pesky "reality" and "honesty" constraints. The reader meanwhile has neither the time nor the ability nor the expertise to really fact check anything. In general markets where the consumer is unable or unwilling to discern tend to be flooded with and overcome by fraud.
  - chopin 6y ago
    > Medicine has a unique and extreme case of the "uninformed consumer problem." In medicine it's incredibly difficult even for professionals to tell whether something actually works, let alone individuals. It's extreme but not unique. Do you know what's running in any of your devices? Almost not, I believe. Yesterday I had the pleasure of needing to copy some medical reports of mine on a multipurpose printer I own. I shortly gave it a pause being not sure whether the contents would be sent immediately to the mothership. I then realized that when the printer was set up initially that I set up the router to prevent calls to the outside for this machine. But: although I configured the router, I would need to go to great lengths to actually verify that the printer can't phone home. And don't get me started about quality (as in endurance and serviceability). It's a nightmare as price is not a deciding factor in my experience. Neither is brand.
PragmaticPulp 6y ago
> If we adopted this change, you'd very likely see almost no one running any COVID tests at all This is especially true for providers who aren't running the tests in-house. If your doctor takes a test and sends it out to an external lab like LabCorp, who is responsible if the complete process takes more than 24 hours? In reality, your doctor would simply stop testing for Coronavirus and instead refer you to a LabCorp collection center, where they could keep you waiting in line until they had enough testing capacity to take your sample and start the 24-hour clock. Everyone loses. Not to mention all of effort required to retool billing and accounting systems to account for time-based costing. This alone would drive the cost of testing upward by huge amounts. Or more realistically, providers would simply not offer tests unless patients paid in cash to avoid this mess. This is a great example of how regulation can end up making the situation worse, despite good intentions.
- scsilver 6y ago
  Im currently in grand teton national park and need to get a test before seeing my parents. This area that has 5+ million visitors a summer has about 3 covid tedting sites in an 2-3 hour drive. The main hospital needs a referal to give you s test. Any referals from out of the area will have their tests sent to another site, results are expected in 5-7 buisness days. When asked how much it would cost, they said they have no idea, they will bill the insurance. We have decided not to take this test and wait till we are in a major city and get the 15 minute test. Naturally, they have plenty of open appointments to administer the test. Our healthcare is completely broken. These national parks are intersections of people from all over the US and one of the most important places to have rapid testing and its just completely unavailable.
  - lumberingjack 6y ago
    Imagine a virus so bad you got to get tested in order to know if you have it or not. You made the choice to go to the park nobody forced you to go there you're going to have to sacrifice some stuff if you want to be 100% safe but trust me buddy CDC websites says 003% that anything is going to happen
raxxorrax 6y ago
His statements are also not uncontested and he gets his arguments from other doctors, hopefully. Most doctors still do the brain torture testing and the data might indicate it is the safer option. There are conflicting studies. There are of course also conspiracies that your brain gets damaged from the test...
api 6y ago
I've put it this way for a long time: "The US system combines everything that is bad about socialized medicine with everything that is bad about privatized medicine."
nimbius 6y ago
TL;DR: Billionaire who snored through fifty years of tax cuts for the rich that inevitably gutted basic healthcare in the US now appalled at the US governments inability to marshal even basic care for its citizens.

R0b0t1 6y ago

I have been worried for some time the only solution is the democratization of healthcare due to advances in biology and chemistry. People are 3d printing their own prosthetic mounts and getting better results than trained and heavily credentialed professionals. Maybe some day people will be able to design their own medication and targeted supplements. What worries me is this may be decades away.

youngNed 6y ago
> Maybe some day people will be able to design their own medication and targeted supplements. > What worries me is this may be decades away. First the good news: That day is here!! Now the bad news: that medication isn't working out great for them. Apparently some wingnut told people that drinking bleach was a potential cure for some ills. Didn't go great. And thats the problem with what you wish for - a popular facebooker, youtuber, instagrammer, president tells people that they can design their own medication, people are going to do it.
- baryphonic 6y ago
  Who was telling people to drink bleach? Can you cite a specific instance?
  - youngNed 6y ago
    While stopping short of suggesting injestion of bleach trump certainly posited whether bleach used internally (on the lungs) could be an effective medication - so yeah, maybe he didn't mean drinking it, maybe he meant injecting it?
  - deleted 6y ago
    [deleted]
  - me_me_me 6y ago
    https://quackwatch.org/cases/board/med/buttar/complaint_20091/ https://quackwatch.org/cases/board/med/buttar/complaint_2009... There one example
  - frederikb 6y ago
    US President Trump seriously suggested research into injecting bleach to the horror of doctors and medical professionals everywhere: https://www.bbc.com/news/world-us-canada-52407177 https://www.bbc.com/news/world-us-canada-52407177 It lead to actual problems of US American citizens ingesting/consuming bleach which forced government agencies to put out warnings: https://www.forbes.com/sites/nicholasreimann/2020/08/24/some-americans-are-tragically-still-drinking-bleach-as-a-coronavirus-cure/ https://www.forbes.com/sites/nicholasreimann/2020/08/24/some...
    - hiram112 6y ago
      You can read his exact quote here: https://www.statesman.com/news/20200713/fact-check-did-trump-tell-people-to-drink-bleach-to-kill-coronavirus https://www.statesman.com/news/20200713/fact-check-did-trump... Never once does he mention the word 'bleach'. He uses the terms UV light and disinfectant. But I guess using disinfectant, to the average American reader, is synonymous with literally injecting bleach into your body or guzzling it down your throat... Remember when NPR came out with this article entitled: "No, You Don't Need To Disinfect Your Groceries", and the media was outraged because millions of Americans were dumb enough to start soaking their food in bleach? Yeah, me neither. https://www.npr.org/sections/health-shots/2020/04/12/832269202/no-you-dont-need-to-disinfect-your-groceries-but-here-s-to-shop-safely https://www.npr.org/sections/health-shots/2020/04/12/8322692... Interestingly, looks like he was right about it anyway: https://www.nbcnews.com/nightly-news/video/using-uv-light-to-fight-covid-19-what-to-know-about-its-effectiveness-91729989602 https://www.nbcnews.com/nightly-news/video/using-uv-light-to...
api 6y ago
The problem is that without strict regulation any health care market will be flooded instantly with quacks. Quackery is much easier than actual medicine. Quacks don't have to spend anything on R&D and quack medicines are a lot easier to manufacture (look up the synthesis pathways for popular pharmaceuticals!), and this means quacks can spend more on marketing and operate with much higher margins. This translates into a huge market advantage. Pretty soon you'll have nothing but quacks. Medicine has a unique and extreme case of the "uninformed consumer problem." In medicine it's incredibly difficult even for professionals to tell whether something actually works, let alone individuals. "Do your own research" doesn't work at all in medicine unless you have a billion dollars burning a hole in your pocket and can assemble your own research lab. Excluding emergency medicine and the most instantly and dramatically effective drugs, it's really hard as an individual consumer of health care to tell whether a treatment is working over the short term. Check out gwern.net and how much work he's put into trying to tell if various nootropics work and how much uncertainty remains. The fact that individual discernment is so hard in medicine means defrauding people is incredibly easy. It's a market that is inherently vulnerable to massive fraud, and there is no easy way (that we know of) to fix this. Even with the FDA there is still a tremendous amount of quackery. Without the FDA and strict licensing and supervision there would be only quackery. BTW news seems to suffer from a similar problem. Actual investigative journalism is expensive, hard, and sometimes dangerous. (Old PI joke: How do you know if a conspiracy theorist might be right? They are missing and presumed dead.) Fake news is cheap and easy, and since it's fake you can craft your stories for maximum click bait appeal without having to be limited by pesky "reality" and "honesty" constraints. The reader meanwhile has neither the time nor the ability nor the expertise to really fact check anything. In general markets where the consumer is unable or unwilling to discern tend to be flooded with and overcome by fraud.
- chopin 6y ago
  > Medicine has a unique and extreme case of the "uninformed consumer problem." In medicine it's incredibly difficult even for professionals to tell whether something actually works, let alone individuals. It's extreme but not unique. Do you know what's running in any of your devices? Almost not, I believe. Yesterday I had the pleasure of needing to copy some medical reports of mine on a multipurpose printer I own. I shortly gave it a pause being not sure whether the contents would be sent immediately to the mothership. I then realized that when the printer was set up initially that I set up the router to prevent calls to the outside for this machine. But: although I configured the router, I would need to go to great lengths to actually verify that the printer can't phone home. And don't get me started about quality (as in endurance and serviceability). It's a nightmare as price is not a deciding factor in my experience. Neither is brand.

PragmaticPulp 6y ago

> If we adopted this change, you'd very likely see almost no one running any COVID tests at all This is especially true for providers who aren't running the tests in-house. If your doctor takes a test and sends it out to an external lab like LabCorp, who is responsible if the complete process takes more than 24 hours? In reality, your doctor would simply stop testing for Coronavirus and instead refer you to a LabCorp collection center, where they could keep you waiting in line until they had enough testing capacity to take your sample and start the 24-hour clock. Everyone loses. Not to mention all of effort required to retool billing and accounting systems to account for time-based costing. This alone would drive the cost of testing upward by huge amounts. Or more realistically, providers would simply not offer tests unless patients paid in cash to avoid this mess. This is a great example of how regulation can end up making the situation worse, despite good intentions.

scsilver 6y ago
Im currently in grand teton national park and need to get a test before seeing my parents. This area that has 5+ million visitors a summer has about 3 covid tedting sites in an 2-3 hour drive. The main hospital needs a referal to give you s test. Any referals from out of the area will have their tests sent to another site, results are expected in 5-7 buisness days. When asked how much it would cost, they said they have no idea, they will bill the insurance. We have decided not to take this test and wait till we are in a major city and get the 15 minute test. Naturally, they have plenty of open appointments to administer the test. Our healthcare is completely broken. These national parks are intersections of people from all over the US and one of the most important places to have rapid testing and its just completely unavailable.
- lumberingjack 6y ago
  Imagine a virus so bad you got to get tested in order to know if you have it or not. You made the choice to go to the park nobody forced you to go there you're going to have to sacrifice some stuff if you want to be 100% safe but trust me buddy CDC websites says 003% that anything is going to happen

raxxorrax 6y ago

His statements are also not uncontested and he gets his arguments from other doctors, hopefully. Most doctors still do the brain torture testing and the data might indicate it is the safer option. There are conflicting studies. There are of course also conspiracies that your brain gets damaged from the test...

api 6y ago

I've put it this way for a long time: "The US system combines everything that is bad about socialized medicine with everything that is bad about privatized medicine."

nimbius 6y ago

TL;DR: Billionaire who snored through fifty years of tax cuts for the rich that inevitably gutted basic healthcare in the US now appalled at the US governments inability to marshal even basic care for its citizens.