10 ms·

Tim Armstrong has an incredible ability to say the wrong thing. The underlying topic, however, is fascinating. I do healthcare analytics for a living so I see

Tim Armstrong has an incredible ability to say the wrong thing. The underlying topic, however, is fascinating. I do healthcare analytics for a living so I see how often a single neonatal ICU incident can consume 30% of an entire company's healthcare budget for the year (note: if you don't really understand healthcare, e.g. what self insuring means, please don't respond with comments that the insurance company pays the bills, this is what insurance is for, etc.). The economics of healthcare combined with the inability to have a rational discussion on how to allocate resources means that doctors / researchers will apply their research efforts where they will be rewarded. The race to keep younger and younger babies alive is fueled with ego and dollars. No one wants to talk about scarce resources and how to allocate dollars to have the most impact. I wish conversations stemming from idiotic comments like Armstrong's ended up being productive but they always end up with non-actionable ranting around taking executive pay and giving it to sick people. Unless someone proposes a mechanism to achieve that, it's just a dream / rant.

pavlov 13y ago
The race to keep younger and younger babies alive is fueled with ego and dollars. If you actually look at the global data on neonatal mortality [1], that doesn't seem to be true. Countries like Finland, France and Cuba perform better than the United States on this metric. These countries offer completely free healthcare to babies and pregnant mothers. Frankly, I find your assumption borderline offensive. Maybe you should take your USD-tinted healthcare analytics glasses off for a while and contemplate the possibility that human lives are worth saving. [1] http://data.worldbank.org/indicator/SH.DYN.NMRT http://data.worldbank.org/indicator/SH.DYN.NMRT
- thaumasiotes 13y ago
  You can look at the data, but you can't conclude much from it; those numbers are not comparable to each other. From 2008: http://pjmedia.com/blog/the-doctor-is-in-infant-mortality-comparisons-a-statistical-miscarriage/?singlepage=true http://pjmedia.com/blog/the-doctor-is-in-infant-mortality-co... Some (OK, rather extensive) points from the link: > In the United States, all infants who show signs of life at birth (take a breath, move voluntarily, have a heartbeat) are considered alive. > In Belgium and France — in fact, in most European Union countries — any baby born before 26 weeks gestation is not considered alive and therefore does not “count” against reported infant mortality rates. The baby at issue here would have been just under 22 weeks. (France changed their standard in 2008-2009; their page defining stillbirth ( http://www.insee.fr/en/methodes/default.asp?page=definitions/enfant-sans-vie.htm http://www.insee.fr/en/methodes/default.asp?page=definitions... ) now includes a warning that French numbers cannot be compared to other European neonatal mortality numbers, so it seems safe to assume the rest of Europe has carried on as before.) > According to the way statistics are calculated in Canada, Germany, and Austria, a premature baby weighing <500g is not considered a living child. The article baby weighed well over 500g. But this is quite relevant to the question of who has better neonatal mortality. > In Switzerland and other parts of Europe, a baby born who is less than 30 centimeters long is not counted as a live birth. Therefore, unlike in the U.S., such high-risk infants cannot affect Swiss infant mortality rates. This baby's length is not reported, so this is of questionable relevance to this particular baby. But, again, it remains very relevant to the question of "do countries like Finland, France, and Cuba have better neonatal mortality than the US?" > If a child in Hong Kong or Japan is born alive but dies within the first 24 hours of birth, he or she is reported as a “miscarriage” and does not affect the country’s reported infant mortality rates. This could be a non-premature, 8-pound baby! > Efforts to salvage these tiny babies reflect this classification. Since 2000, 42 of the world’s 52 surviving babies weighing less than 400g (0.9 lbs.) were born in the United States. Still think "USD-tinted healthcare analytics" biases you against saving premature babies? Full disclosure: I'm with your parent; I consider spending so much pumping life into these very premature "babies" a self-aggrandizing waste of time, effort, and money. But your comment seems to be grotesquely misinformed.
  - pavlov 13y ago
    The article you quote is out of date. Many of the countries mentioned, like Germany and Austria, are self-aggrandizingly wasting time and tax money pumping life into <500g babies regardless of whether the law considers these living children or not. After all it's the doctor who makes the call, not a lawyer. You can verify this by looking at the Tiniest Babies Registry [1], which was also mentioned in the article (those 52 surviving babies -- but the toll today is already at 155). The numbers are not so skewed towards the US as they were in 2008. In recent years, about half of these tiny babies were born in Europe, Japan or South Korea. [1] http://webapps1.healthcare.uiowa.edu/tiniestbabies/ http://webapps1.healthcare.uiowa.edu/tiniestbabies/
- a3n 13y ago
  > contemplate the possibility that human lives are worth saving. Here fucking here. What do we want to accomplish with the most advanced civilization history has ever seen? Advertising? A flourishing human condition? Fart apps? All? None? Anarchic meritocracy? It's all on the table.
  - dangrossman 13y ago
    "Hear hear", imploring people to listen to someone. /pedantic
    - a3n 13y ago
      Thanks. I was actually thinking about that when I wrote it, but opted for full-on indignation of the moment, rather than calm and contemplative dictionary checking.
  - adwn 13y ago
    This is one of the most profound and insightful comments on this page, and I wish I could upvote it more than once. Did we come all this way so that we could buy a second SUV for 25 people, or do we instead want to save a human being with a life full of potential (and spare incredible grief from at least two other persons in the process)? We should do a cost benefit analysis! [0] [0] https://news.ycombinator.com/item?id=7206436 https://news.ycombinator.com/item?id=7206436
- judk 13y ago
  Google search [Premature]
- bigchewy 13y ago
  sigh. >> Maybe you should take your USD-tinted healthcare analytics glasses off for a while and contemplate the possibility that human lives are worth saving. FYI - I've dedicated the last 10 years of my life to the cause of saving and improving as many lives as possible. Haven't had a paycheck for going on 4 years. Personal attacks like yours don't bother me but are frustrating because it's an example of the difficulty we face as a nation in our effort to improve our healthcare system. We all (myself included) get emotional over individual stories (e.g. Armstrong's comments over 2 lives) but have a much harder time seeing the invisible wreckage and thousands of people dying because of our distorted economic incentives.
jbapple 13y ago
> (note: if you don't really understand healthcare, e.g. what self insuring means, please don't respond with comments that the insurance company pays the bills, this is what insurance is for, etc.). Could you explain more about how self insuring works?
- lutusp 13y ago
  > Could you explain more about how self insuring works? In normal insurance, the policy payments go into an investment pool that benefits the corporation's stockholders. In self-insurance, the set-aside funds go into an investment pool that benefits you (or your company). The drawback to self-insurance are outlier claims that can more than wipe out the set-aside (as in the case under discussion). Obviously an insurance corporation has (or should have) a larger pool to deal with outliers than an individual or small company. This is not to say that big insurance companies aren't sometimes wiped out by a sudden unexpected uptick in legitimate claims. In that case, the company may simply declare bankruptcy and the policy holders are left out in the cold -- just as though they had self-insured. But that's a rare occurrence. More here: http://arachnoid.com/wrong/index.html#Insurance http://arachnoid.com/wrong/index.html#Insurance
  - a3n 13y ago
    Insurance companies re-insure. Can't a self-insured company do the same? https://en.wikipedia.org/wiki/Reinsurance https://en.wikipedia.org/wiki/Reinsurance
    - lutusp 13y ago
      The problem with a self-insurance plan re-insuring is that it undermines the very reason for the self-insurance -- it erodes the advantage of local investment of the set-asides.
      - a3n 13y ago
        But not totally, and would presumably protect against catastrophic catastrophes by spreading the meta-risk. You could make the same argument against having home or medical insurance, that it erodes the advantage of having the totality of your take home pay. But it seems responsible to have home insurance and medical insurance, and it would seem responsible for a self-insurer to reinsure.
ItendToDisagree 13y ago
How exactly are outliers like this not "what insurance is for"? I'm curious (not arguing). I could understand that 'self insuring' is a different beast, but isn't the point of insurance in general (not just healthcare), to protect against outliers? If the company didn't put aside enough money to account for unexpected cases, such as this, arn't they just being negligent (or at the very least causing their own financial problems)?
- lutusp 13y ago
  > the point of insurance in general (not just healthcare), to protect against outliers? No, the point of insurance is to enrich the stockholders of the insurance company. This might sound like a leftist rant, but it's actually the singe most important thing to understand about the insurance business. If a policy term doesn't contribute to the bottom line, it's changed to disfavor the policy holder. If a deductible amount eats too much into corporate profits, it's changed to disfavor the policy holder. These facts explain why some companies and individuals choose to self-insure. If you buy an insurance policy, the policy's payments go into a corporate investment pool that benefits only the company's stockholders. If you self-insure, the funds you set aside to pay claims go into a personal investment pool that benefits you. For the life of me, I can't understand why more people don't know this. More here: http://arachnoid.com/wrong/index.html#Insurance http://arachnoid.com/wrong/index.html#Insurance
  - a3n 13y ago
    But it's sold to payers of premiums as protection against outliers. And if it's sold as such, but isn't really, then it's fraud. Let a hundred lawsuits bloom.
    - lutusp 13y ago
      That's all true, but even gigantic insurance companies are sometimes overwhelmed by a surge in claims. Is that fraud too? People need to understand that insurance is a kind of gambling -- a bet that claims won't wipe out the fund pool, that a random act of nature won't undermine the actuarial assumptions on which the pool is designed.
lmm 13y ago
> No one wants to talk about scarce resources and how to allocate dollars to have the most impact. I wish conversations stemming from idiotic comments like Armstrong's ended up being productive but they always end up with non-actionable ranting around taking executive pay and giving it to sick people. Unless someone proposes a mechanism to achieve that, it's just a dream / rant. What about progressive taxation and nationalized healthcare, like most wealthy countries do?
keithpeter 13y ago
What is the frequency of these kinds of incident per thousand live births? What I'm saying is should you not be in favour of a much larger risk pool? Is there any way self-insuring corporations can pool risk without the overheads of an actual insurance company? UK perspective: I'm interested in the concept of 'health analytics' as our present government are sort of dancing round the edges of the NHS (knowing that any form of direct privitisation/move to insurance based benefits would result in prompt removal from office).

pavlov 13y ago

The race to keep younger and younger babies alive is fueled with ego and dollars. If you actually look at the global data on neonatal mortality [1], that doesn't seem to be true. Countries like Finland, France and Cuba perform better than the United States on this metric. These countries offer completely free healthcare to babies and pregnant mothers. Frankly, I find your assumption borderline offensive. Maybe you should take your USD-tinted healthcare analytics glasses off for a while and contemplate the possibility that human lives are worth saving. [1] http://data.worldbank.org/indicator/SH.DYN.NMRT http://data.worldbank.org/indicator/SH.DYN.NMRT

thaumasiotes 13y ago
You can look at the data, but you can't conclude much from it; those numbers are not comparable to each other. From 2008: http://pjmedia.com/blog/the-doctor-is-in-infant-mortality-comparisons-a-statistical-miscarriage/?singlepage=true http://pjmedia.com/blog/the-doctor-is-in-infant-mortality-co... Some (OK, rather extensive) points from the link: > In the United States, all infants who show signs of life at birth (take a breath, move voluntarily, have a heartbeat) are considered alive. > In Belgium and France — in fact, in most European Union countries — any baby born before 26 weeks gestation is not considered alive and therefore does not “count” against reported infant mortality rates. The baby at issue here would have been just under 22 weeks. (France changed their standard in 2008-2009; their page defining stillbirth ( http://www.insee.fr/en/methodes/default.asp?page=definitions/enfant-sans-vie.htm http://www.insee.fr/en/methodes/default.asp?page=definitions... ) now includes a warning that French numbers cannot be compared to other European neonatal mortality numbers, so it seems safe to assume the rest of Europe has carried on as before.) > According to the way statistics are calculated in Canada, Germany, and Austria, a premature baby weighing <500g is not considered a living child. The article baby weighed well over 500g. But this is quite relevant to the question of who has better neonatal mortality. > In Switzerland and other parts of Europe, a baby born who is less than 30 centimeters long is not counted as a live birth. Therefore, unlike in the U.S., such high-risk infants cannot affect Swiss infant mortality rates. This baby's length is not reported, so this is of questionable relevance to this particular baby. But, again, it remains very relevant to the question of "do countries like Finland, France, and Cuba have better neonatal mortality than the US?" > If a child in Hong Kong or Japan is born alive but dies within the first 24 hours of birth, he or she is reported as a “miscarriage” and does not affect the country’s reported infant mortality rates. This could be a non-premature, 8-pound baby! > Efforts to salvage these tiny babies reflect this classification. Since 2000, 42 of the world’s 52 surviving babies weighing less than 400g (0.9 lbs.) were born in the United States. Still think "USD-tinted healthcare analytics" biases you against saving premature babies? Full disclosure: I'm with your parent; I consider spending so much pumping life into these very premature "babies" a self-aggrandizing waste of time, effort, and money. But your comment seems to be grotesquely misinformed.
- pavlov 13y ago
  The article you quote is out of date. Many of the countries mentioned, like Germany and Austria, are self-aggrandizingly wasting time and tax money pumping life into <500g babies regardless of whether the law considers these living children or not. After all it's the doctor who makes the call, not a lawyer. You can verify this by looking at the Tiniest Babies Registry [1], which was also mentioned in the article (those 52 surviving babies -- but the toll today is already at 155). The numbers are not so skewed towards the US as they were in 2008. In recent years, about half of these tiny babies were born in Europe, Japan or South Korea. [1] http://webapps1.healthcare.uiowa.edu/tiniestbabies/ http://webapps1.healthcare.uiowa.edu/tiniestbabies/
a3n 13y ago
> contemplate the possibility that human lives are worth saving. Here fucking here. What do we want to accomplish with the most advanced civilization history has ever seen? Advertising? A flourishing human condition? Fart apps? All? None? Anarchic meritocracy? It's all on the table.
- dangrossman 13y ago
  "Hear hear", imploring people to listen to someone. /pedantic
  - a3n 13y ago
    Thanks. I was actually thinking about that when I wrote it, but opted for full-on indignation of the moment, rather than calm and contemplative dictionary checking.
- adwn 13y ago
  This is one of the most profound and insightful comments on this page, and I wish I could upvote it more than once. Did we come all this way so that we could buy a second SUV for 25 people, or do we instead want to save a human being with a life full of potential (and spare incredible grief from at least two other persons in the process)? We should do a cost benefit analysis! [0] [0] https://news.ycombinator.com/item?id=7206436 https://news.ycombinator.com/item?id=7206436
judk 13y ago
Google search [Premature]
bigchewy 13y ago
sigh. >> Maybe you should take your USD-tinted healthcare analytics glasses off for a while and contemplate the possibility that human lives are worth saving. FYI - I've dedicated the last 10 years of my life to the cause of saving and improving as many lives as possible. Haven't had a paycheck for going on 4 years. Personal attacks like yours don't bother me but are frustrating because it's an example of the difficulty we face as a nation in our effort to improve our healthcare system. We all (myself included) get emotional over individual stories (e.g. Armstrong's comments over 2 lives) but have a much harder time seeing the invisible wreckage and thousands of people dying because of our distorted economic incentives.

jbapple 13y ago

> (note: if you don't really understand healthcare, e.g. what self insuring means, please don't respond with comments that the insurance company pays the bills, this is what insurance is for, etc.). Could you explain more about how self insuring works?

lutusp 13y ago
> Could you explain more about how self insuring works? In normal insurance, the policy payments go into an investment pool that benefits the corporation's stockholders. In self-insurance, the set-aside funds go into an investment pool that benefits you (or your company). The drawback to self-insurance are outlier claims that can more than wipe out the set-aside (as in the case under discussion). Obviously an insurance corporation has (or should have) a larger pool to deal with outliers than an individual or small company. This is not to say that big insurance companies aren't sometimes wiped out by a sudden unexpected uptick in legitimate claims. In that case, the company may simply declare bankruptcy and the policy holders are left out in the cold -- just as though they had self-insured. But that's a rare occurrence. More here: http://arachnoid.com/wrong/index.html#Insurance http://arachnoid.com/wrong/index.html#Insurance
- a3n 13y ago
  Insurance companies re-insure. Can't a self-insured company do the same? https://en.wikipedia.org/wiki/Reinsurance https://en.wikipedia.org/wiki/Reinsurance
  - lutusp 13y ago
    The problem with a self-insurance plan re-insuring is that it undermines the very reason for the self-insurance -- it erodes the advantage of local investment of the set-asides.
    - a3n 13y ago
      But not totally, and would presumably protect against catastrophic catastrophes by spreading the meta-risk. You could make the same argument against having home or medical insurance, that it erodes the advantage of having the totality of your take home pay. But it seems responsible to have home insurance and medical insurance, and it would seem responsible for a self-insurer to reinsure.

ItendToDisagree 13y ago

How exactly are outliers like this not "what insurance is for"? I'm curious (not arguing). I could understand that 'self insuring' is a different beast, but isn't the point of insurance in general (not just healthcare), to protect against outliers? If the company didn't put aside enough money to account for unexpected cases, such as this, arn't they just being negligent (or at the very least causing their own financial problems)?

lutusp 13y ago
> the point of insurance in general (not just healthcare), to protect against outliers? No, the point of insurance is to enrich the stockholders of the insurance company. This might sound like a leftist rant, but it's actually the singe most important thing to understand about the insurance business. If a policy term doesn't contribute to the bottom line, it's changed to disfavor the policy holder. If a deductible amount eats too much into corporate profits, it's changed to disfavor the policy holder. These facts explain why some companies and individuals choose to self-insure. If you buy an insurance policy, the policy's payments go into a corporate investment pool that benefits only the company's stockholders. If you self-insure, the funds you set aside to pay claims go into a personal investment pool that benefits you. For the life of me, I can't understand why more people don't know this. More here: http://arachnoid.com/wrong/index.html#Insurance http://arachnoid.com/wrong/index.html#Insurance
- a3n 13y ago
  But it's sold to payers of premiums as protection against outliers. And if it's sold as such, but isn't really, then it's fraud. Let a hundred lawsuits bloom.
  - lutusp 13y ago
    That's all true, but even gigantic insurance companies are sometimes overwhelmed by a surge in claims. Is that fraud too? People need to understand that insurance is a kind of gambling -- a bet that claims won't wipe out the fund pool, that a random act of nature won't undermine the actuarial assumptions on which the pool is designed.

lmm 13y ago

> No one wants to talk about scarce resources and how to allocate dollars to have the most impact. I wish conversations stemming from idiotic comments like Armstrong's ended up being productive but they always end up with non-actionable ranting around taking executive pay and giving it to sick people. Unless someone proposes a mechanism to achieve that, it's just a dream / rant. What about progressive taxation and nationalized healthcare, like most wealthy countries do?

keithpeter 13y ago

What is the frequency of these kinds of incident per thousand live births? What I'm saying is should you not be in favour of a much larger risk pool? Is there any way self-insuring corporations can pool risk without the overheads of an actual insurance company? UK perspective: I'm interested in the concept of 'health analytics' as our present government are sort of dancing round the edges of the NHS (knowing that any form of direct privitisation/move to insurance based benefits would result in prompt removal from office).