I have had a couple instances of ventricular fibrillation. I have an implant which brings me back to life when that happens; I would be dead without it. However, I do go unconscious for a few seconds until I get shocked back to life.
Although my case is infrequent enough that it is not thought of as a risk by the medical community, for peace of mind what I would really like to have is a link between a watch of some sort and a car capable of self driving. Should I be driving when I go unconscious, all the car would need to do is automatically kick in autopilot mode while gradually slowing down, until a heart rhythm is detected again.
The risk is small, if you consider the percentage of time I'm behind the wheel, but it would be good for peace of mind. It would also be helpful for others who do not yet know they have a heart condition, or those who are having a stroke or epileptic attack while at the wheel. There are others with worse conditions than mine who are basically advised not to drive, so it would help them as well.
If falling asleep can be detected by any biological signals, that would also be a useful autopilot trigger while waking the driver up, for the general population.
Currently most cars require manually activating the autopilot mode; what I'm proposing is a vital sign monitor to automatically begin self-driving if the human is incapacitated.
If the human doesn't wake up within a half a minute or so, the car could also self-drive itself to a hospital. I think we're far enough with self-driving tech that that saved life would far outweigh the risks of the self-driving system having any issues en route.
> the car could also self-drive itself to a hospital
I think you're onto a good idea, except for the above quote. It would be a much better idea to have the car automatically pull over to the shoulder, stop, engage the flashers, and call 911. Paramedics can keep you alive en route to the hospital with drugs, cardioversion, and CPR. Your car cannot.
Which hospital is nearest? Which can be reached within the self-driving capabilities of the car? Which has Advanced Cardiac Life Support staff and equipment? Which is still open? Which is not already handling another cardiac emergency? Which route has the least traffic?
Paramedics and EMTs can work these questions quickly and they have lights and sirens to get through traffic. Your car will probably google "hospitals" and (slowly) take you to the nearest one, which might be a closed methadone clinic.
In most cities, an ambulance is going to get to your car much quicker than your car would get you to an appropriate hospital. A modern ACLS rescue unit is effectively a heart hospital on wheels. So calling 911 brings the hospital to you, without putting anybody else on the road in danger from your car's not-yet-quite-ready-for-unsupervised-operation autopilot software.
So what it is needed is that the car communicates with 911 and an automated system will tell it to wait for help, go to a destination where help will go to, or go to a help center (hospital or similar) where help will be waiting.
It could even work if you are at home and have an emergency. Call 911 and if they decide you should go to a health center on your own it will send where to go to your car.
Of course at first wait for help should be the default, but when automated driving improves, and the processing of emergencies improves too, an automated response system should be the norm for most of the time.
Agreed. Technology could help. There are significant elements of assessment, planning, and optimization that now are done manually by emergency responders that probably could be automated.
Very location dependent for response times and traffic. Getting to any ER is better than nothing and the device is unlikely to differentiate cardiac arrest from a ton of other issues that might not need that cardiac team.
Just so people understand, in the present day, what you're proposing involves a $5M mission package with $200M worth of airborne combat control systems and related ground support. Oh, and then the "bring dead guy back to life" bit once they get the intercept.
The idea that we're going to start vectoring ambulances to intercept self-driving cars carrying heart attack victims is pretty crazy awesome.
Sending ambulances to cars where a heart attack victim is detected is, however, a feasible use case.
Where I live, in the order of 10 % of road casualties are actually casualties of heart attack or stroke; there is no actual road accident at all except that the car perhaps stops - but yes, the government still counts them as "road casualties" because that validates car and fuel taxes.
Theres no reason with C2C communication coming online that cars will simply move out of the way if you put the car into emergency mode. Obviously we would build anti-abuse features into the system.
Pushed out further, I don't mind if some rich guy wants me to pull over to get out of his way for a 50 dollar micropayment.
Objectively speaking it's infrequent enough (only 3 times in my life so far) that it's statistically noise compared to the probability of an accident due to other reasons, including other drivers. There's actually a medical paper that calculates these probabilities, and the gist of it is that I should be okay to drive a small vehicle point-to-point for personal reasons but not be a professional driver that drives a large vehicle multiple hours per day every day.
I'm also thought to be under control via medications now, and also am scheduled for an ablation procedure which may cure it altogether. The bad news about medications, and that procedure, is that it's hard to know whether it cured it, considering how infrequently they happen. I could go another 10 years without incident and then it happens again -- or I could go my entire life and it never happens -- nobody knows. So the best I can do at the moment is to just carry on with life.
That said though, I would still feel emotionally safer if the car drove itself, or at least could detect such things. Not only for myself, but for the sake of those people who have incurable frequent instances of incapacitation -- they actually are not advised to never drive -- as well as the entire rest of the population that is over-stressed and under-slept.
Also, I feel what has happened to me could happen to anyone. Doctors haven't been able to diagnose any particular cause, but I have been under extreme work stress over the years, and the connection between that and heart failure among other things is really not well understood. Extreme electrolyte loss is another way any otherwise normal person could go into ventricular fibrillation as well, and that's not something everyone is educated about.
I bike most of the time, and drive only occasionally, by the way. If you look at that in isolation, yes, I'm more likely to die being incapacitated on a bike than in a car. But if you look at the problem holistically, biking is more likely to improve my cardiac condition over time via much needed exercise, as well as the reduction in stress by doing stuff I enjoy doing. For all we know, living a life of abstaining from everything could be far more likely to pile on stress that could potentially make things worse.
>> I think we're far enough with self-driving tech that that saved life would far outweigh the risks of the self-driving system having any issues en route.
What if the self-driving tech kills both you and someone else on the route?
Seatbelt can already kill you. Statistically it save more life than it kill.
The self driving tech of today is enough to do a controlled emergency stop that is statically better than an uncontrolled vehicle.
If you put a popular device, with a medical detection tool into the wider population, it would be logical that the device would pick up on patients who would other not notice the symptoms (at least initially, if any).
So then the question becomes what other daily device(s) could be made to do automatic health checks of certain specific indicators, which would give an early indication to the possible condition, thus improving life expectancy and quality of life, while lowering associated medical costs.
i.e. toothbrushes that detect cavities, sunglasses that check your pupils for certain symptoms, hats that monitor your EEG. These are obviously extreme examples, but you get the idea...
This will lead to a massive increase in false positives, unnecessary treatment and worry; par for the course for precautionary screening and preventive medicine generally.
> Preventive Care Saves Money? Sorry, It’s Too Good to Be True
> The idea that spending more on preventive care will reduce overall health care spending is widely believed and often promoted as a reason to support reform. It’s thought that too many people with chronic illnesses wait until they are truly ill before seeking care, often in emergency rooms, where it costs more. It should follow then that treating diseases earlier, or screening for them before they become more serious, would wind up saving money in the long run.
Pretty much the entirety of the article you're selectively quoting is praising preventative care.
The byline is "Contrary to conventional wisdom, it tends to cost money, but it improves quality of life at a very reasonable price."
and the article closes with this
But money doesn’t have to be saved to make something worthwhile. Prevention improves outcomes. It makes people healthier. It improves quality of life. It often does so for a very reasonable price.
There are many good arguments for increasing our focus on prevention. Almost all have to do with improving quality, though, not reducing spending. We would do well to admit that and move forward.
I’m not arguing over affect, I’m arguing over truth claims. The article leads with the facts and then argues that despite being a poor use of money we should still pay for preventive medicine for the warm fuzzy feelings it gives us. Pay attention to the facts, not the argument that we should ignore the facts for the warm fuzzy feelings.
If we’re going to spend huge amounts of money we should spend it better than on preventive care, on areas where the money can do more good. That money could be spent on foreign aid, on saving lives, not improving them, on earned income tax credit, to encourage people to get back into work or gain more work experience, on basic research or subsidy to get us to carbon neutral faster.
And the article completely fails to note the false positives, the unnecessary tests and the worry caused by preventive screening.
Money spent on preventive medicine isn’t wasted but it could certainly be better spent.
> In 2009, as part of the Robert Wood Johnson Foundation’s Synthesis Project, Sarah Goodell, Joshua Cohen and Peter Neumann exhaustively explored the evidence. They examined more than 500 peer-reviewed studies that looked at primary (stopping something from happening in the first place) or secondary (stopping something from getting worse) prevention. Of all the interventions they looked at, only two were truly cost-saving: childhood immunizations (a no-brainer) and the counseling of adults on the use of low-dose aspirin. An additional 15 preventive services were cost-effective, meaning that they cost less than $50,000 to $100,000 per quality adjusted life-year gained.
> I’m not arguing over affect, I’m arguing over truth claims. The article leads with the facts and then argues that despite being a poor use of money we should still pay for preventive medicine for the warm fuzzy feelings it gives us. Pay attention to the facts, not the argument that we should ignore the facts for the warm fuzzy feelings.
That's a very disingenuous summary born out of a "economics trump everything" mentality. If you believe that humans are more important than money it is wrong and the original articles byline is a better summary:
Contrary to conventional wisdom, it tends to cost money, but it improves quality of life at a very reasonable price.
Humans are more important than money; that’s why we should spend the money on saving human lives in the developing world, not making the lives of already healthy, wealthy first world inhabitants slightly more comfortable, why we should spend it on investments in the future not hideously wasteful consumption in the present. If we’re going to spend the money that inefficiently give people a tax cut instead. There are many better ways to spend the money than a tax cut but preventive health care isn’t it.
If we want to improve health outcomes we could do many things more effective than increasing preventive care. Nurse practitioners cost half as much as doctors and are just as effective at primary care. That’s a genuine huge bang for the buck intervention that could be done and isn’t. Never mind preventive medicine. Do something that actually works instead.
Primary Care Outcomes in Patients Treated by Nurse Practitioners or Physicians: A Randomized Trial. JAMA : the journal of the American Medical Association. 283. 59-68. 10.1097/00132586-200012000-00026.
This strikes me as an exceptionally difficult problem to solve. I'll be impressed if someone brings a workable solution to market in any reasonable time-frame. I guess if you can retrain people in how they use their toilet, you might be able to simplify some of the challenges, but many people use their toilet as a generalized soft/liquid garbage can.
What if on major airports (or other similar venues) there were paid toilets where you could do whatever business you want to do there and exit, only to receive a test result later on if something weird showed up?
Could this be doable?
Perhaps by taking a photo of the solid & liquid expelled from your body and trying to eliminate or reduce water contamination from the solid parts, and collecting it as you usually do in a lab?
Sorry if this all sounds stupid. My experience with biology is close to zero, and I have no clue about what I'm talking about — just thinking out loud.
Well that’s just it the UX of using a toilet would remain the same and the smart toilet wpuld collect the sample(as a toilet does now)/analyze it and send the data if it detects irregularities to your doctor. He/she then analyzes it and schedules a follow up appointment if needed.
Right, I also want a machine that magically makes me lose weight while I sleep, while not affecting my sleep and costing $5 ... that doesn’t mean it’s mechanically or physically possible with current technology though.
I've read about automated phone calls to the elderly to build up data on response times. It was a dementia early detection tool.
Seemed to be a pretty smart approach just to ring the home phone or mobile and ask for them to say a word. Takes no time.an requires recall and cognition. Also confirms the old person isn't dead.
Would you like this if you were an old person (maybe any person)? Faceless machine bugs you at home (were you napping?), rates you and you can't speak to a human about it.
No one would like this. It is an interesting idea.
As someone who suffers from a bit of health anxiety: let's at least be very careful about false positives and inaccurate tests. The mere suggestion of health issues have sent me down spirals before.
> thus improving life expectancy and quality of life, while lowering associated medical costs
Be careful with this. Look into the result of increase PSA testing:
> Although experts are somewhat split on the value of PSA tests as a screening tool, there is widespread agreement on two major points: overdiagnosis and overtreatment rates are far too high, and there is an urgent need to refine PSA testing to be a more effective screening tool. [1]
Or mammograms
> We conclude that the mammography FP rate in North America is in excess... [2]
Arguably, the issue is that we just lack good baseline data, but you have to consider all the false positives you'll get with more data collection.
This is indeed an awesome area that I’ve barely ever considered. If I had to go do another PhD, it might be in this. I’ve seen research about using cell phones to detect drug use (and try to prevent the urge).
What other everyday objects could be utilized? What about my phone’s front facing camera to scan my face looking for muscle twitches or eye issues?
from the article: "Did my Apple Watch save my life? I think in my case, that’s a bit of an overstatement."
Thanks to an Apple Watch w/ ECG, I now have a cardiologist, too. My A-fib burden is only 4% and at my age without diabetes my increased stroke risk is minimal, so my Dr. basically asked why I was bothering to wear this thing if it was just worrying me unnecessarily.
I mostly agree. It is nice to finally know what's going on because I've been having irregular heartbeat when exercising for over 5 years & a stress test (ECG on a treadmill) didn't show anything. Now I've had 2 weeks of monitoring with an iRhythm Zio & an echocardiogram so I know I'm reasonably safe to continue exercising.
Is it worth the $$$ insurance paid for all of it? I'm really not sure about that. I kind of wish the Dr. had told me "lose some weight or you'll drop dead" because I would have listened. I'm also not sure what I would have done if I hadn't been able to figure out what was happening. Probably just continue to keep my rate under 150 as it's a high rate that usually correlates with irregular beats.
So you’re cardiologist is saying it’s not a big deal to be in afib (unless you’re on blood thinners)? I don’t understand how that could be a reasonable thought.
And that's exactly why anyone who isn't a cardiologist shouldn't be making judgements about the state if your heart.
The heart is pretty complex for being 'just a pump'. Things can and do go wrong in ~100% of the population. Whether or not that's a problem that should be monitored, medicated or operated on, depends on many factors. It isn't as clearcut as saying "you've got afib and we need to fix that".
My cardiologist is saying that it's not a big deal for me to be in afib 4% of the time with the longest lasting 3 hours 10 mins over a 2 week period. I haven't had a stroke or transient ischemic attack previously, don't have diabetes, hypertension or congestive heart failure. I'm male and 51 years old. Thus, my CHADS₂ and CHA₂DS₂-VASc scores are zero.
It is odd to me how he keeps describing his $500/month insurance as being useless: he is generally in excellent health and his yearly expenditures are low enough that he is always paying down the deductible.
Does he feel car insurance and home insurance are useless since he didn't total his car last year and his house didn't burn down?
He knows this (as he mentions it obliquely) that he could lower his deductible but his costs would go up. Is he complaining that he is on the wrong part of that tradeoff curve? Or does he expect low-cost insurance with a low deductible that covers all of his routine medical expenses?
Imagine a regular sized family of 4, you have to shell out more than $20K/year for the most basic health insurance for your family if you are self employed, $20,000! and you still have to pay for EVERY doctor visit for your kids and regular checkups, and your family deductible is around $10-12K. And every year they send you a new increased quote by 10-15%. There should be some kind of a discount for families, like when you have multiple cars under your insurance your rate barely goes up when you add another one.
In my expensive area of CA, a gold insurance plan for a family of 4 costs $20,400 per year. That’s an insurance plan with a $0 deductible and $30 co-pay per doctor visit. That is far from the most basic health plan. A plan with a $12k deductible is $13,500 per year.
Even so, a $20k a year is peanuts compared to the out-of-pocket expenses of a serious medical emergency. Don’t fall into the trap of thinking insurance is not with it just because you haven’t had to use it yet.
> $20k a year is peanuts compared to the out-of-pocket expenses of a serious medical emergency.
And that’s the most annoying part. The fact that $20,000 is considered peanuts in a medical condition is already outrageous. My friend’s wife had a c-section child delivery and was billed $38,000...for a 3 days stay at the hospital. No complications just a planned c-section. I understand that’s the reason why the insurance is so high
There was a lot of effort, planning, and training that goes into making sure that there aren't any complications. Not to mention the fact that even routine procedures can have unexpected complications that have to be planned for and addressed. I think that $38k for a surgical procedure with post-operative care for the mother and child isn't necessarily that outrageous. Just imagine the people, training, facilities, etc...
EDIT: Now that I'm thinking about it -- was the $38k bill with or without insurance? Meaning, was this their out of pocket costs with insurance? If so, that does seem rather unreasonable. If that was the billed rate for the insurance company and your friend's out of pocket costs were lower, that would make more sense.
Another data point: Japan is a first-world country with one of the lowest infant mortality rates in the world. Births are not covered by insurance. We paid US$5,500 out of pocket, for a birth in a private clinic that ended in an unplanned C-section and 10 days in hospital (in a premium upcharge private room). $3,500 was later refunded in a birth stipend from the city.
Given that you are quoting the price in Euros, I suspect the funding mechanism for your hospital is very different than the hospital costs the parent was talking about.
I know nothing about how the financial side of European hospitals work though... but I assume they still have internal costs that are tracked and tallied. Your kids' deliveries may not have cost you, but there was a total cost somewhere in the system. It probably wasn't anywhere near $38k, but even that isn't a fair comparison due to the substantial differences between the medical systems and the way indirect costs could be covered.
(I'm not trying to defend one system or the other, just pointing out that the systems are different so direct comparisons like $38k vs €0 aren't that straightforward. It gets even less straightforward when you factor in the US medical insurance system.)
In France a 1 day stand in hospital is billed around 1000€, of course it is almost entirely covered by insurance. You have to pay a fee of 17€ a day if you have some standard insurance package. If you 'stay' at the hospital then all costs are bundled in this price, if you only follow exams they can actually get more expensive in total (usually they offer you to stay the night if you have exams that would cost more than a "full-pension")
This was a few years ago so the prices may have changed.
Thanks for the insight into how things work in France. Like I said -- I don't know much about how non-US healthcare systems are funded.
But, I think the main question I was trying to get at is -- how much are the French (or Japanese from a different thread) hospitals subsidized by the government. I expect for there to be indirect costs that might have to be covered by direct billing in one country, but not another. For example, electricity bills (or the cost of the building, etc)... is this covered by the 1000€ bill, or is is paid for by some other means? I recognize that US hospitals also get some level of subsidy, but there are hidden costs that aren't always apparent.
This is what I was trying to get at... that direct comparisons of costs aren't always that straightforward when comparing different systems. A 2000€ or $2000 bill might represent only a fraction of the actual cost of treatment. And given the opaque nature of heathcare billing, it's very hard to know.
> Like I said -- I don't know much about how non-US healthcare systems are funded.
Then shouldn't you read up on that before expounding upon how a 38k price tag for a scheduled routine procedure is reasonable? Healthcare billing isn't that shocking when you travel outside of the states.
I simply believe that not becoming broke by a scheduled or unscheduled medical procedure is a human right and it's realistic to achieve. I'm not saying it should be free - I pay quite a bit of medical insurance to the state, but it's mostly transparent as it's included in the income tax deductions.
In my area (Seattle) such plans aren't even available. So don't blindly assume that they're available outside CA. The deductible ranges between "high" and "crazy". Dental that you can buy through health exchange doesn't cover anything at all. I'm seriously at a loss as to why anyone would pay for it, if you can buy a better plan from the same company outside the exchange. And this year, Kaiser Permanente just nonchalantly raised the premium by a little under 20%. It'll probably do the same thing next year, too, because hell, why not. We need to seriously look into opening up (and stimulating) competition between health insurance companies, hospitals, and so on, to upend this blood sucker of an industry.
But the uninsured are more likely to be poor (and use the error for basic care because they can't afford it, raising the cost for everyone) or healthy (adding less to the cost more than they share of it). Thise two ideas are the heart and trade-off of the individual mandate: insurers must cover anyone without giant markups and in exchange everyone was forced to buy insurance to help cover those costs.
Eh, with cars you can only be driving one at a time so it doesn't make sense for insurance to double or triple just because you now have two or three cars.
With family members, they are all absolutely living in parallel and at the same time.
I've owned 5 cars at one point, and dropping or adding cars never changed the amount of the premium attributed to the other cars. (That is to say adding car 5 was an increase similar to adding car 4, for example.) I never understood why, seeing as how I can only drive one at a time, but I've always just assumed this is customary.
Which the Trump administration and DOJ have now apparently chosen to actively target again, much to the apparent dismay of just about every Republican who has to run for election.
The combination of a federal judge (Reed O'Connor in Texas) deciding that Congress does not in fact have the legal authority to revise legislation and the administration announcing that the DOJ will not be defending any aspect of the ACA whatsoever basically means that everything is in place to run it up through District, Circuit/Appellate and Supreme Court levels and kill it off.
As I said elsewhere on the thread, this rebuttal proves too much; unless you're really saying that it's structurally impossible due to the US Constitution or our unique culture to have decent health care, you'll have to do better than "anything the Democrats pass, the Republicans will try to repeal".
you'll have to do better than "anything the Democrats pass, the Republicans will try to repeal"
It's not that, though there's some element of it in there. It's much more complex than that and I think a huge amount of it is driven by internal fractures within the Republican party even though legislatively they've seemingly been moving in lockstep. Without the branding most of the components of the ACA are or were fairly popular or at least understood/accepted by a big chunk of Republican voters (e.g. Kynect), but there's a big enough subset that are opposed to make the politics within the party such that anyone voicing approval couldn't get enough votes to remain in office.
The long-term impact is that killing off the compromise system that is the ACA is going to make it more likely that the USA will go to some form of single-payer or hybrid system with a single-payer level and private insurance for extended options (much like Medicare + Medigap). I think if the Republicans had succeeded in killing it off in 2017 we'd probably be looking at something like Medicare expansion starting around 2023, if they do it now I'd figure that might still be the case but it may be extended out to 2025 for the starting point. Whether it's something completely new or simply an expansion of "You can buy into Medicare" to ever-earlier ages is too soon to tell.
It's hard for me to understand how the ACA can be perilously insecure due to legislative pressure from the GOP, but single payer would not be. The ACA is a conservative health policy.
That is a very true argument, which is why I expect anything in the future on this to be an expansion of Medicare instead of something completely new.
The ACA being a conservative health policy matters relatively little because it's not the ACA that's being targeted - it's "Obamacare." [edited out a ton of crap you likely already know if you care to] Basically it's not the policy that matters, it's who passed it.
Yeah the negativity struck me as well. After being in Afib for a month, he was at high risk for having a stroke. I guarantee you that insurance would have been appreciated then.
Just to add to the discussion, I've been self employed and on ACA plans for several years now (with my family). I'm grateful to have the option, and it's miles ahead of what we had prior to the ACA.
It seems to me that only people who were born in the US "appreciate" paying this much money for health insurance and see someone criticizing it as being negative.
The whole health system in the US is horrible. Nobody should need to go through a middle-man (a.k.a. insurance) in the first place.
No wonder prices for everything are absurdly high.
Edit: and I have an anecdote about this too. Last year I had an episode of AFib. I've been taking medication since then. So after almost 1 year taking a certain medication, my insurance rejected it, saying they wouldn't pay for it and that I had to switch to something else. Now, why is it OK for an insurance company to dictate what I can or cannot take, if my doctor prescribed me something? How on earth is it OK for insurance to dictate what treatments I can or cannot have? I feel like a piece of meat when I go to a clinic and they need to call my insurance to see if it is OK to give me a certain treatment. This is nuts.
Many countries rely on privately-managed health insurers (Germany, Switzerland, Netherlands, etc.).
> Edit: and I have an anecdote about this too. Last year I had an episode of AFib. I've been taking medication since then. So after almost 1 year taking a certain medication, my insurance rejected it, saying they wouldn't pay for it and that I had to switch to something else. Now, why is it OK for an insurance company to dictate what I can or cannot take, if my doctor prescribed me something? How on earth is it OK for insurance to dictate what treatments I can or cannot have? I feel like a piece of meat when I go to a clinic and they need to call my insurance to see if it is OK to give me a certain treatment. This is nuts.
Dictating what treatments you can and cannot have is how health systems all over the world control costs. Many systems do this much more aggressively than in the U.S. The U.K. NHS, for example, will only spend about 20-30,000 pounds per "quality-adjusted life year," or about double that for end-of-life drugs. In the U.S., it is routine to spend hundreds of thousands of dollars just to get a couple of extra years. (The historic practice in the U.S. was to have lifetime limits--typically in the several million dollar range, but even those are illegal under the ACA.)
For what it's worth, the US system under the ACA has many of these (probably in large part because Switzerland has them, as our system is modeled in part on theirs). We don't do strong price controls, but we do mandatory insurance, with mandatory coverage levels, that can't be denied or repriced based on age, and public funding subsidizes a large fraction of the insured.
The difference is that Medicaid is a patchwork of various state systems rather than a no-questions-asked federal subsidy. Some states are hostile to Medicaid (e.g. Kentucky with its work requirements). Furthermore, the entire future of the ACA system is in doubt, because of executive sabotage, legislative attempts at repeal, and judicial overreach. All of that leads to people not being confident that they will be able to get the health insurance they need. That's why the Swiss system can fairly be described as universal health care, while the American system cannot.
I don't know. I'm not sold on single payer either, mind you. The only long-term solution I can really see is for the Republicans to fail at repealing the ACA so many times, and for public opinion to be sufficiently against them, that they basically give up.
But it’s not single payer, it’s still insurance, and there is still a “middle man,” which is what OP was complaining about. That still means, for example, that the medical industry itself is largely privatized, as opposed to say the UK where NHS is a government entity and doctors are public employees.
I don't disagree. I would love the option in the US for everyone to have basic health care through medicare or a public option insurance plan (with prices starting at zero).
My point was to compare it to pre ACA. Our system improved significantly when the ACA was passed.
Now, if you're sharing the cost of a treatment with someone, they're always going to have a say in the treatment you get, unfortunately.
Not necessarily.
If the insurance wants to you take a different medication from a different brand which is cheaper but contains the same active ingredient, I don't see a problem with that.
Your doctor may have been incentivized by the pharma company to prescribe their more expensive product.
I'm not the author, but I pay out of pocket for my health insurance, too. To answer one of your other questions:
I don't own a home. I drive an old (and thus, inexpensive to replace) car. To save money, I have the highest deductible offered by my insurance company. That ensures that when something small happens, unless it affects drivability, I'm not going to fix it.
The value I see that I get out of car insurance (besides the legal requirement) is its health insurance, e.g., if I get in a crash and need $50K for emergency surgery, or if I get in a wreck with another driver who was (illegally) driving without insurance and they needed surgery.
In other words, apart from the health insurance aspect (which should be single-payer anyway), yes, I think car insurance is pretty much useless for me.
I understand why governments institute requirements like this -- it's a systems-thinking solution which is probably better than not having it -- but pretty much by definition any private insurance system is going to be a financial loser for a lot of people.
I don't have to pay to insure my money -- the bank pays the FDIC from my capital. It seems weird to me that I have to pay for personal insurance at all. Why don't fuel taxes and license fees provide for auto insurance? Why doesn't federal income tax provide for health insurance? Various other countries do these and they seem to work fine. Yeah, I know: politics.
I honestly find this baffling that there is a "limit" on how much treatment you can have done based on an arbitrary $ cost.
Australia generally has great "free" healthcare but even then it is complicated with rebates and gaps etc, its not completely "free" but there isn't exactly a limit on what you can have done under Medicare. If you have private medical insurance (an option not a requirement) then you can get a nicer hospital and not pay for the extra requirements.
In the UK you just get fixed and never see a bill in your life - everyones tax pays for it. Again not exactly "free" but you don't "pay" for it. Again, if you have private you can get a better hospital, choose your doctor etc.
The way I see it the US could 'have its cake and eat it' but there is significant opposition to anything that seems "Socialist" because the moguls who run these private health insurance companies are making too much money to change the system.
No, the Australian medicare system is not remotely close to being great. When a simple CT scan/MRI can take 4 months waiting time [1], I wouldn't jump up and defend such a failed system. It is not great, it is the complete opposite of that. Ever tried to do some dentals using that "free" healthcare you mentioned or ever tried 12-18 months elective surgery waiting time?
OK, so this is Australia's system (from patient's perspective). I'm a T2 diabetic, obese, 55, have had one heart attack, angiogram/stent, second angiogram, quad bypass:
0. Everyone pays a 1.5% "extra" tax for Medicare, but that's actually just a cover. The actual cost to government is much higher, but is paid out of general revenue.
1. GPs and specialists are reimbursed by the government at a govt decided rate for different procedures.
2. The GPs/specialists can "bulk bill" in which case patients don't pay, or there is a "gap" that has to be paid by the patient. The gap cannot be covered by insurance (by law).
3. Medicines that are approved by an independent body are subsidized on the Pharmaceutical Benefits System (PBS). Once on that list (and most meds are), the cost to the patient is $35 for a prescription, subsidized to $6 for those on welfare. My meds (statin, beta blocker, ACE inhibitor, metformin etc) cost me about $100/month.
4. Public hospitals are free at point of use by patients. This includes all ER, surgery etc. However, because this is a limited resource, there are waiting lists for different procedures, managed based on urgency. If I'd gone to a public hospital ER for my heart attack, the treatment would have been as quick and as good as what I got when I went to a private hospital ER. Oh, except that the private ER cost me $400.
5. Private insurance is available. For me, the insurance costs $300/month (ie, $3600 pa). This allows me to use private hospitals within a wide network (with a $400/per admittance excess), ancilliary benefits like optical ($200 pa) etc. It also allows me the choice of specialist/surgeons in hospital and things like private rooms.
It may not be "great", but compared to the US it's much much better. There are no/zero/nada cases of "medical bankruptcy" here. ER costs are not in the thousands, bills aren't ridiculous, my entire treatment regime over 2 years and 2 admittals to hospital cost me less than $10K because I chose my cardiologist and surgeon. If I'd gone "public", the cost would have been $0.
Our public hospitals are the "teaching hospitals" and our medical research and results are world leading. Our GPs are primarily focussed on care and patient outcomes, they now spend a lot of time as case managers, for example, my T2 care plan is managed by my GP but involves a dietician, an endocrenologist etc.
Great write up! I do find the Australian system a bit confusing but that is basically because on the NHS in the UK there are literally no "costs" other than prescription costs. It seems a much simpler way but as you can see there the gubberment doesn't like this because they can't make money off it.
I am very happy with the healthcare in Australia so far (I haven't had to use it much thankfully) and like the NHS there will always be waiting times for non urgent surgeries - I think most people would prefer than than a 6 figure bill (which they can also choose to have if they go private)...
Dental and optical are two areas that Medicare punts on, and yeah, they are expensive and suck. That seems like a testimony for the rest of the system rather than a damning.
I don't know if you can hold up that 2GB article as anything conclusive. The plural of anecdotes not being data and all that.
I've lived under the UK, AU and US systems. Ours isn't the best, but fuck living under the nightmare that is healthcare in the US.
It’s pretty good for my daughter. She was born with Spina Bifida and we’re paying $300 a month for an ACA plan. She’s cost probably a million dollars by this point so it’s worked out pretty well for us. In a country with socialized medicine they’d probably have just let her die, as the doctors had given her a prognosis that she might not last a year. My wife dug up some research on some treatments they hadn’t considered, and now our daughter’s condition is greatly improved, and her prognosis adjusted to slightly below average lifespan (Spina Bifida adults have kidney problems because they often have to catheter themselves and suffer long term backing up into the kidneys, which eventually causes kidney failure).
It’s a weird case too because if she gets the care she needs she stands to live a long life, be of normal intelligence, she has a good chance of walking, etc. She’s so darned cute and gregarious, cooing and laughing, you’d never know she had all these problems if you saw her out and about.
So I guess my daughter is the reason insurance is so expensive. But after getting page after page of “100% covered $3000” pages for each day she’s spent in the hospital, I’m really glad to have the insurance I do, because a place where the government decides how much to spend on care would have given up on her months ago.
In a "country with socialized medicine" that is in the 1st world (ie US/CA/UK/AU/NZ/EU etc) she'd probably get exactly the same treatments. Oh and the cost of that hospital room would have been literally a tenth of the cost.
I (or my insurance) wasn't charged half of that for a post-operative 48 hours in an ICU after quad bypass surgery.
The US already has a third of its population covered by "socialized medicine". That's what Medicare/Medicaid/Tricare /VA are. The "socialized" adjective is a canard introduced by the health care "industry" in the US to scare people.
US Medicare admin costs are below 5% pa, the health insurance "industry" doing the same thing, are 20% of their revenue.
You’re right I guess. My uncle has no insurance and was just diagnosed with cancer. He’s getting chemo same as anyone else. He supposedly owes tons of money in medical debts but still has over 800 credit score. The US medical system is a really weird beast.
There is _some_ truth to what you're saying, but only a bit.
> the government decides how much to spend on care
This is true, there are limits to what the government will pay. The NHS, which isn't far from the gold-standard for socialized medical care, does indeed not stock some drugs that are deemed too expensive. Here's a good write-up of QALY's and the NHS:
If your child had been born with spina bifida in the UK, all treatment would have been free. This treatment would include (from 2018) pre-natal surgery, post-natal surgery, physiotherapy for life, occupational therapy for life, special educational needs, mobility aids for life, and all manner of treatment for association problems, including kidney treatment for life[0]. Here's a summary of the NHS treatment for it:
> In a country with socialized medicine they’d probably have just let her die
How much research did you actually do on this point? I'm always amazed by how much Americans suck up the death panels bullshit. If a fraction of what all y'all believe about socialized medicine was true, then free medical care wouldn't be free at point of use in literally every other civilized country on the planet.
That you are willing to believe all the world except Americans are idiots for the way we have our healthcare setup beggars belief, and reflects poorly.
The rumors of "death panels" in countries with socialized medicine are pure scare mongering. In France I've seen multiple cases of no expanses spared in clearly hopeless cases, to the point I think it was borderline excessive and that palliative care would have been better...
While this is great for Afib detection it's its very rare CDC says 2.7-6 Million people[1]. Still great for those people! I still think we need to do much better. High BP and hypertension is way more important to measure since they can be diagnostic in a larger percentage.
My dad is a triple bypass heart patient. ECG and stress tests did diddly squat to detect it, until it was too late and it was diagnosed by a CT Angiogram. I now get CT Angiogram with contrasts every few years just to be safe because of family history.
Do you know how many sieverts you get each time? I had one of those and I think I got one year's worth of background radiation in those few seconds that it lasted.
Have your kidney function checked after contrast is used on you. It can put you in kidney failure. Happened to me, had to be on dialysis for a short time. Dialysis SUCKS. You'll know exactly how an orange feels after it's juiced.
This is the 2nd or 3rd story I've heard like this about the Apple Watch's new ECG feature. I wasn't interested in smartwatches before, but now I am considering getting an Apple Watch, even if it's just for my parents.
Edit: Still not in Canada, though it seems to be in more countries. Very frustrating!
Original: I don't think they enable the ECG feature for anyone outside the US. It's locked based on the point of sale last I checked. Very frustrating to buy something so expensive to find out it's been region-locked!
> The watchOS 5.2 update expands the availability of the ECG app to Hong Kong and 19 European countries, including Austria, Belgium, Denmark, Finland, France, Germany, Greece, Hungary, Ireland, Italy, Luxembourg, Netherlands, Norway, Portugal, Romania, Spain, Sweden, Switzerland, and the UK
Correct! The frustrating part (for me) is Apple’s lack of transparency in the extended delay in the release of this feature. It was heavily promoted, yet to find out that the ECG feature wasn’t available prior to purchase you had to dig through their support documents to find the list of countries it is available in - which at the time of my purchase, was between 1-4.
But I only found that out after spending 3 days income on the device - because who would expect that a heavily promoted feature WASN’T available?
I understand Apple’s choices of communication from their perspective as a for-profit business, which only makes me unhappier.
First time I’m interested too. I hate wearing watches and stuck to an iPhone and MacBook only until now but I’m at a high risk for heart disease. My dad died when he was only 43 from clogged arteries. I have familial high cholesterol, but statins have helped me lower to normal levels. My dad died in 1992 before statins. With statins and ecg on a watch we are all very fortunate to live in the time we do.
A friend of mine in his early twenties drowned a few months back due to a cardiac event related to atrial fibrillation. He was otherwise in phenomenal shape and living life to the fullest.
I’m really sorry that happened to your friend and to you. I think the best outcome of tech like this is that it makes what seems like maybe small and maybe seemingly mundane improvements that reduce the frequency that things like this happen.
I'm sorry about your friend. I hope this isn't insensitive, but could you elaborate any more on what happened? I'm an a-fib sufferer with a pool so I'm quite curious.
Yeah, he didn't exactly need an Apple watch to tell him something is going on. That's a bit under double what his heart rate should be. Equivalent to what someone in reasonable shape would have when they're jogging. It's amazing he never got it checked out before.
It's possible he may not have noticed, or may not have realised that his RHR was unusually high. I mean, in day to day living how many of us are really conscious of what our hearts are doing outside of periods of heavy exertion?
120 is an "uncomfortable" heart rate though; you'd feel it at rest, it would somewhat get in the way of concentrating or sleeping. (Although it's easy to dismiss as resulting from anxiety or infection.)
As even the tiniest bit of research will show, that is insanely high. Well over 99th percentile for that age group, according to US CDC. While it might be counterproductive to get anxious about minor symptoms, when one of the most critical indicators of overall health is off the charts I think "you should be worried" (with "go see a doctor" as the express or implied followup) is the humane response. "Meh" or denying the statistical reality is IMO irresponsible.
The average person's resting heart rate is 70 bpm. The "maximum" heart rate is roughly 207 - 2/3 of your age.
So for someone who is say 30, your maximum rate is ~187. But a rate over 90 when resting is considered outside normal levels.
If you have no history of cardiac disease and aren't taking any medications that would cause an increased rate, if your resting rate is 113-120, you need to be checked.
I'd consult if mine was over 90 at night for no apparent reason (usually below 50, but went as high as 80 during a hard hiking week). Monitoring my nightly heart rate (Samsung Watch) gave me quite an insight on my general shape. When sickish, definitely not going as low as usual...
Yeah, my dad died of a heart attack at a relatively young age, and I've been paranoid about my cardiovascular health ever since. Half an hour of that HR at rest and I'd be off to the ER.
I’m definitely aware that I suffer from hypochondria, but what if I’m just imagining that I do? All joking aside, I never even thought about getting help for that, maybe I should.
It's very common, and it often starts after an illness or health scare. In some people it gets worse and worse, they start going to the ER all the time because they feel something is wrong etc. It can be debilitating. If you feel like it's having a negative impact on your life, don't hesitate to seek help. It's always easier to nip it in the bud sooner rather than later.
Hah, too late now, I kind of got over it on my own, but it was debilitating for a while. The catch 22 is that the brain that's tricking itself isn't aware that it's tricking itself. Once I realized over time that I was imagining it, I was able to put it behind. Also, no doctor that I went to see for my imagined problems ever suggested that I should seek treatment for health anxiety, which I guess I don't blame them for because they are supposed to take people's complaints seriously.
No, that's not quite what it is. You can have an unusually rapid, but regular (i.e. normal sinus) rhythm and that's called tachycardia. During tachycardia, the electrical impulses that control the muscles of your heart fire in the correct sequence, intensity, and spacing between impulses, they just go through a cycle much more quickly. If you looked at an ECG and measured the distances between the peaks and valleys, they'd be at consistent distances, just really close.
During a-fib, the electrical impulses are all off. The peaks and valleys are irregularly spaced and the amplitudes vary from cycle to cycle. This usually results in a rapid heart rate as a second order effect because, due to the "misfiring" not enough blood is pumping through and your heart is working harder to make up for the difference.
> It’s also worth noting at this point in the story that Atrial Fibrillation is extremely rare in men my age. Less than two percent of people in my demographic have it. Go figure. When I do something, I go big I guess.
This is looking at it backwards. How many serious health problems have similar rates of affliction? If there are 50 different potential health problems then he has a 2 in 3 chance of having at least one of those.
This reminds me of Lupus and Guillain-Barre syndrome both rare diseases. But I know half a dosen people with lupus and four people that had Guillain-Barre and suffer lingering effects.
So if you're a doctor it's really unlikely that you patient has either of those. But start adding up all of those rare syndromes and it starts getting scary.
> "I continue to pay for my insurance because thanks to the Affordable Care Act, I have to. It’s the law. And I’m okay with that. Because I know paying into the system helps others who make less money than me have access to care."
One had better be okay with it, because if you don't consent, they'll take the money from you by force.
I don't think I submitted it to HN. I felt it would be viewed as fluff.
But we have incredible and constantly increasing opportunities to casually check biometrics that previously required serious medical exams and lab work, etc. It's absolutely changing things.
So I do. But nothing he does touches on this subject, at least I think. Maybe I'm not in the right age group for him to bother. He listens to my heart and checks blood pressure. My sense is that this is just so unlikely given what he does know about my health that he doesn't explore further.
Still bad advice when you examine the tradeoffs. 1 ecg per year, with a yearly recurring cost, vs a cheaper watch that lets you take 20 ecg’s a day if you want to for the rest of the watch’s lifespan.
Remember it’s possible to not be in constant afib. That’s where the watch really shines.
Here in Italy in order to subscribe to a gym you need to bring your ECG (not mandatory by law but a number of gyms will ask for it), and every year you need to make a new one, so I would say that the percentage of "active" population that is not regularly checked is small. How is this matter in the rest of the world?
Israel used to be this way and it used to be a requirement by the government (not an ECG but a doctor note). Like a lot of other regulation it made it less likely for people to work out.
Now it's a questionnaire instead. I think the new system works better here since it's one less hurdle to get over before you can sign up for a gym and work out.
I would say yes and not: yes it may become a barrier, but no, here most gyms organized that they have a doctor inside and for 40 euros they do the doctor checkup + ECG.
Oh, in Israel getting a doctor checkup or an ECG is free and most gyms don't have doctors or even a nurse (all gym instructors must get CPR certification though).
I love the matter-of-factness of this article. Not only is it a great example of how technology can have unexpected positive outcomes for users, the author also manages to sneak in some extremely relaxed observations about the ACA and having to subsidise healthcare of others. I am impressed!
> "Since I don’t have a “job job,” I pay roughly $500 a month for “health insurance” out of my own pocket"
Tangential question, related to the above:
I am currently paying for COBRA, and the amount paid is outragerous. Anyone has suggestions for a cheaper, good enough alternative?
One thing to note: portable ECGs are <$100 on amazon. Not as feature rich as the apple watch, sure, but the watch only measures from one location, normally you want to measure from a few, usually at least 3: leg, arm, and chest.
For each of the three locations I mentioned, you also need to contact the portable ECG with your finger. The finger is being used to create a closed loop. It is not a measurement site.
It takes the form of a combination of very high output training (BJJ) coupled with regular, sustained aerobic training at a high percentage of my aerobic capacity (running and plyometrics).
It sounds like I'm being flip, or worse, self-satisfied - but I am quite serious.
If my heart started behaving strangely, or weakened in some way, I would notice immediately. It would be quite marked. Things that I partake in, and think about, and feel, would suddenly be off.
Or to put it more technically, I am running my body at a much lower set of tolerances where defects are immediately identifiable.[1]
I have a suspicion that my cardiologist is actually better than the apple one, since I could feel some differences that might not yet manifest themselves in some kind of measurable heart output.
The downside to all of this, in the faraway future (I am currently 42 years old) is that "heart trouble" might manifest itself during exercise in a sudden and acute fashion that leaves me dead. On the other hand, the exercise makes that, statistically, less likely.
The downside to all of this, in the faraway future (I am currently 42 years old) is that "heart trouble" might manifest itself during exercise in a sudden and acute fashion that leaves me dead. On the other hand, the exercise makes that, statistically, less likely.
Actually depending on your condition and your activities, it’s entirely possible that the first warning you’d have is dropping dead. I’m also not being flip or self-satisfied, and I also have an anecdote to share. A good friend of mine who was a serious tennis players, and later an equally serious swimmer and runner got his “warning” about two years ago. He was at a conference and complained of feeling a bit ill. Then he experienced sudden cardiac arrest and despite an AED on premises he died.
He wasn’t much older than you, was in perfect shape and ate well his whole life, saw his doctor and had good lab numbers. The “far future” you imagine is hopefully just that, far in the future, but it might not be. Like a lawyer as their own client, don’t be a fool and pretend to be your own cardiologist.
You placed that possibility in, and I quote, “the faraway future” and all in the context of your fitness regime being an early warning system better than a cardiologist. Even taking your post with a generous helping of charitable interpretation, it seems Ill-conceived.
"Better a diamond with a flaw than a pebble without." [1]
Are people be better off without the watch altogether if it does not have perfect detection?
Don't let perfection be the enemy of good. I don't think we should hold Apple/the watch accountable for type II errors for similar reasons as to why we have Good Samaritan laws.
IDK about this. I find it kinda creepy to have my heart beat monitored & sent to a server far away and not under my control. I mean, ad companies already have so much data about me, do they also need to know how my heartbeat reacts to an ad? Does my insurer need to know it? I wonder whether it can detect sex and be used to e.g. track infidelity.
On the other hand, of course it's great to save lives and help you detect possibly harmful conditions. The thing that makes me uneasy is not the idea of a heart tracker watch per se, but the possibility that maybe one day the facebook app wants access or chrome because of WebHeartBeat API or whatever. This trend of constantly increasing amounts of data sources sent to the cloud is sick.
> I find it kinda creepy to have my heart beat monitored & sent to a server far away and not under my control.
Heart rate information, like all health information gathered by Apple Watch, stays on your device unless you choose to back it up to iCloud. In this case it is end-to-end encrypted.
Although my case is infrequent enough that it is not thought of as a risk by the medical community, for peace of mind what I would really like to have is a link between a watch of some sort and a car capable of self driving. Should I be driving when I go unconscious, all the car would need to do is automatically kick in autopilot mode while gradually slowing down, until a heart rhythm is detected again.
The risk is small, if you consider the percentage of time I'm behind the wheel, but it would be good for peace of mind. It would also be helpful for others who do not yet know they have a heart condition, or those who are having a stroke or epileptic attack while at the wheel. There are others with worse conditions than mine who are basically advised not to drive, so it would help them as well.
If falling asleep can be detected by any biological signals, that would also be a useful autopilot trigger while waking the driver up, for the general population.
Currently most cars require manually activating the autopilot mode; what I'm proposing is a vital sign monitor to automatically begin self-driving if the human is incapacitated.
If the human doesn't wake up within a half a minute or so, the car could also self-drive itself to a hospital. I think we're far enough with self-driving tech that that saved life would far outweigh the risks of the self-driving system having any issues en route.