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It's a lot easier to maintain alignment when nothing's moving though.

Cheers

Phil Hobbs

Yup. Clever people have "working the system" down to a science.

That's what Obama and his people didn't understand. Instead, they prohibited catastrophic-only coverage which is exactly what frugal people need. Bush brought us pre-tax health savings accounts which is great. That's what then can be used to pay for regular stuff.

Bingo! It's just that most people do not understand that.

There are two things I had hoped Obamacare would have brought. First, open the charge master at hospitals so people can compare before they get sick, then pick the provider that is best. Most medical issues are not emergencies but stuff that just needs to be taken care of in due course. Due course doesn't mean in 15 minutes but in the next days or weeks.

The other thing was the ability to shop for health insurance and medication across statelines.

Needless to say, in both domains Obamacare did ... nothing.

It's in German but in essence those are the numbers of people on welfare

Well, I guess from people in the US they want money first.

No, what I meant was that the official unemplyment number is meaningless in almost any country. What matters is the real number of working age people not working, being on welfare, et cetera. Hartz-IV in Germany is basically a gigantic welfare system that covers up a lot of the problems.

Usually charters perform much better:

That is baloney. In fact, most charter schools I know were founded because a public school in that area had completely failed and usually it is an environment where kids came from problem families. Yet they made the thrive.

What? The days where engineers get nice company pensions are long gone.

Not everyone is selfish in that respect. Some people go where the need is greatest.

They probably didn't understand it because it generally doesn't seem to be true.

Health systems that work don't stop people coming in to have something they think is minor because they didn't have the cash to pay for something mino r.

The first job of a health system is to stop epidemics, and they want people to come in when they are even mildly sick.

How do you know something is going to be catastrophic before you have gone to the doctor?

Frugal people may want catastrophe-only coverage, but it isn't what the hea lth system needs to give them to do it's main job, which is to stop epidemi cs. Medical care for non-infectious diseases is essentially a bribe to get people to come in whenever they feel sick. It's a very expensive bribe - th e whole medical system spends most of its time dealing with non-infectious diseases and infectious diseases which are going to be come plagues - but p lague can be a civilisation-ending disaster, so extravagant over-kill isn't inappropriate.

James Arthur's father may have been a doctor, but that aspect of medicine h asn't registered with James.

It makes a broken system work a little better. It's not great.

For the excellent reason that people don't shop around for medical care. Wh en they are sick, they want to get cured, and delaying that by finding the cheapest possible cure isn't part of the program.

ks.

Picking the provider that is "best" is a non-trivial exercise. In the Neteh rlands, standard procedures have standard prices, negotiated between hospit als and the (closely regulated) medical insurance companies.

Better still, internationally ... formaise medical tourism.

Obamacare was what Obama and his team could negotiate with the American med ical insurance business. They managed to get rid of some mechanisms that th e insurance companies had used to cheat their customers - "pre-existing con ditions" had become an excuse for some very poor behaviour.

What was required was the kind of revolution which would have replaced the whole American medical insurance set-up with one that looked at lot more li ke the German, Dutch and French systems, but that would have redistributed a lot of money away from the people who had been collecting it, and that wa s never going to happen.

Bill Sloman, Sydney

Obamacare also prohibited Kaiser-like systems, where doctors are in charge and commit to total health care for a flat monthly fee.

There is a model of creativity that is a wideband noise source (equivalent to all possible ideas) and programmed FIR filters to spot the good ones. Since the filters are narrowband, high Q, their response time is slow, so the filtering process can take days or years.

Lots of people pre-filter the noise source to exclude the unconventional or "silly" ideas, before applying the application-specific final filters, so miss most of the opportunities. Or just don't use this mechanism.

Engineers don't talk about the creative process much. "Artists" talk about it all the time but few are actually any good at it.

We still kept Kaiser but after Obamacare became law the cost more than doubled while we had to accept high deductibles to keep in under $1k/month. But now people had the "right" to have a free sex change operation or whatever. A sorry state of affairs.

You seem to be uninformed. Obamacare insurance doesn't pay for "small stuff". One of the tenets of the ACA is to have large deductibles. Of course, you can pay higher premiums to get the deductible down, but you have to pay that yourself.

Rick C.

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Yes, I agree that the ACA didn't do enough. We can still improve on it rat her than focusing on repealing the thing which accomplishes nothing. I fir mly believe we are destined for universal health care for anyone who is sic k. Mostly I think we are headed for that because we continue to screw up a ll efforts to work toward something else that *might* be workable. The Dem ocrats can't seem to get any momentum to improve the ACA and the Republican s don't seem interested in actually providing something better, essentially they want "anything as long as it's not the ACA".

Rick C.

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That doesn't sound like a good approach to me. If Doctors get paid for you r care regardless of whether you get better or even get treated, how will t hat promote better care? Or did I misunderstand what you are saying? I've never been on a Kaiser system, so I don't know how it works other than tha t they seem to restrict and ration services.

Rick C.

This is worth pursuing. It would be interesting to hear what other engineers find useful.

My best ideas come from taking a short nap. I may be hell-bent on some approach that I cooked up in my own mind. I'm very intent on following it, but after a short nap, two or three words will enter my mind. These suggest a completely different approach. It is a beautiful suggestion, very simple and easy to follow, and works like a charm.

Sometimes it even works in broad daylight. I may be driving somewhere working on a difficult problem in my mind, and suddenly the solution silently enters my mind. This has happened a number of times. I grin from ear to ear, and drop what I was doing go back to the lab to try it. Works like a charm.

I find a bit of gratitude to whoever or wherever the idea comes from is a good idea.

I'd really like to find out how some of the others come up with their ideas. It would be interesting to see if there is any common ground, and if there is any way to encourage it.

Thanks to JL for opening the subject.

I'm on Medicaire now, so the Kaiser++ thing is something silly like $75 a month. Kaiser is wonderful, which is why Obama and the big insurance companies trashed the concept. If you are convinced that you know everything (proof being a Nobel Prize) you naturally see no need for competition.

I don't take naps, so I get my best ideas overnight. The answer is usually delivered in the shower.

Background processing is great: it takes no effort.

I don't know if this sort of creativity can be taught; I think so.

As I noted, engineers are in the design business but don't usually want to talk about the process.

Naive question...

Given that "doctors bury their mistakes", what's their incentive to keep alive someone that doesn't have any relatives and who needs expensive care?

That's the Dunning-Kruger effect. I spent literally thousands of hours over six years on a national panel studying the law, regulations, and the effects. I counseled groups, individuals, and briefed members of Congress. You studied nothing, know nothing, and consider me 'uninformed.'

You're simply wrong, stuck at the four-legs-good level of misunderstanding.

Cheers, James Arthur

That's how my brain works. I don't put a very high value on ideas since those come so easily. I live in a cacophony of them, almost stentorian; the key is sensing the ethereal relationships, vetting and plucking out the plausibles (winnowing and filtering), and chasing those.

I think that's why many of them do all sorts of random weird things, seeking inspiration. A walk through Home Depot looking at materials and products, machines, envisioning supply chains, etc., does that for me.

Cheers, James Arthur

Thank you for the clear, concise explanation of your position. I believe you basically replied with, "I'm rubber, you're glue...".

Rick C.

One of my favourite Picasso quotes is "When art critics get together, they talk about style, composition, and technique. When artists get together, all they talk about is where to get the best turpentine."

Cheers

Phil Hobbs

No, I indicated you're mistaken, that's all. That should be enough to get you researching that particular point, and if it isn't, that's not my problem.

I thought it constructive to chime in to Joerg with--from long study--my bird's-eye view of a solution to a national problem, that's all. But I'm not diving in to explain Obamacare in detail on s.e.d. to you personally. That's up to you.

Cheers, James Arthur

~~~ "In short, the same knowledge that underlies the ability to produce correct judgement is also the knowledge that underlies the ability to recognize correct judgement. To lack the former is to be deficient in the latter." Kruger and Dunning (1999)