Super Jellyfish

Since I got food poisoning a couple days ago, I’ve been steadfastly avoiding ordering room service. I’m still not 100% sure what caused me to get sick. It could have been a number of things. I went on a trip to a nature preserve this weekend and also whitewater rafting in a river.. according to our guide the river could “cause meningitis” if the water was swallowed. Hmmmm.

So what could’ve caused me to get sick?:

• Eating a garlic fish on Saturday night
• Swallowing toxic river water on Sunday morning when I swam in the river — however, I don’t remember swallowing any water
• Eating not completely safe homemade coffee ice cream after lunch at the lodge I was staying at
• Using a possibly dirty straw to drink my apple juice box on Sunday night
• Eating a rather gross barbeque chicken dish from room service on Sunday evening

I think it’s the last — the barbeque chicken dish — so I’ve been trying to refrain from ordering room service. Unfortunately, I am entirely tired of processed, canned food, so now I just try to totally fill up at lunch time, eating every last plantain and bit of rice, so that I won’t starve at night.

Last night, I ate a can of corn and a can of mandarin oranges for dinner.

Tonight, I was going to cook some spicy Nissin ramen noodles, but then I looked into the Rival Hot Pot Express I had purchased from an Ace store at the mall two weekends ago and I saw that it had rusted!! When I made ramen last Friday evening, I didn’t dump out the water immediately like I should have. I just let it sit and now, 5 days later, there’s orange rust on the bottom!! That’s never happened to me before!

I have a Hot Pot water boiler thing in my apartment in NYC and we would leave water in it all the time. Never once did it rust! I am guessing the one I have here rusted because I scratched up the non-stick surface with my wool sponge the first time I cleaned it???

Sigh.

So, left without any alternatives, I turned to the can of Underwood Deviled Ham that I had purchased a couple of weeks ago. I even tried to search on the Internet for some reviews (no luck there and who are we kidding, who wants to review deviled ham??) Then, of course, my Internet died, so I had to give up on research and finally just opened up the can and spread it on my “Bimbo” white bread.

Blech! I forced myself to eat one slice with it, and then just shred half of the second slice and flushed it down the toilet. I felt like I was eating salty puke!!

Sigh, so now all I have left are my mini-cans of mandarin orange fruit, a couple slices of bread, a wonderful jar of nutella and several packages of uncookable ramen.

Maybe I should invest in a hot plate and some pots after all.. or should I try room service again??? The first couple times I ordered it - I was fine. I had some chicken tacos the first time and huevos rancheros the second time. No problem and pretty tasty, too! It’s just that last time and one night of pure misery that makes me really hesitate.

Well, at least I guess I will be quite thin when I get back this summer… unless all the sodium I keep consuming puffs me up of course!

(As an aside, I wish I could find some chunky chicken spread. I used to love that stuff when I was a kid. I think I could eat those type of sandwiches for a while!)

It seems like all companies with products where the marginal cost to serve is minimal are struggling with their business models — look at drug companies, film companies, music companies. It costs quite a bit to develop the product upfront, either through R&D or costs to film. But once the product is developed, the cost to distribute another item is pretty inconsequential.

That’s why you get 90% margins on some drugs or 90% margins to print another DVD. But the cost of creating the product isn’t encapsulated in the physical components of the product — it’s in the intellectual content needed to make the product.

Is there a solution to this dilemma?

External link:
Through Charities, Drug Makers Help People - and Themselves [WSJ]

But isn’t it just human nature to want to pay for things when you have to? And not want to pay for “preventive” type things that will *prevent* huge, but uncertain expenditures down the road?

U.S. Lacks Vaccines, Antibiotics [WSJ]

“Michael Kremer, an economist at Harvard University, says under the current incentive system, drugs that treat disease are more lucrative than vaccines to prevent it partly because people are more inclined to pay for a medicine that treats a condition they already have. In one economic model, Dr. Kremer and a colleague concluded that revenue from drugs to treat AIDS would be twice as high as from vaccines to prevent it. Also, Dr. Kremer notes, a successful vaccine may devour its own market by eradicating the disease it protects against.”

When I consider healthcare now, I see something now that I didn’t see before. Doctors are *most concerned* about liability (e.g. negative to the doctor), not incentives to make money (positive to a doctor). Since American society is so litigious, doctors order a battery of tests, needed or not, because they do not want to be sued in the remote possibility that the tests detect an ailment.

It makes so much sense now!

The provision of healthcare is by its very nature an assessment of risk. Doctors and patients have to trade-off the risk and the benefit of expensive tests and treatments.

In a hypothetical situation, let’s say a patient goes to a doctor feeling sick. The doctor examines the patient, and based on physical symptoms and descriptions by the patient, the doctor makes the judgment that the patient has a low chance of having a terminal, life-threatening disease. Say a 1% chance. However, the doctor cannot be 100% certain, unless he or she runs a battery of expensive tests.

Since the doctor (1) wants to make sure the patient is healthy and (2) is worried about *not* detecting a potentially serious and being blamed by the patient and subsequently sued, the doctor will order the expensive tests.

The first result (health of the patient) can probably be determined most cost effectively through doctor’s own training and experience assessing the potential for disease. But as in most situations in life, nothing is 100% certain, and there is a risk the doctor could have made an error. Since the doctor is afraid, he or she will choose the sure thing, the no-blame course of action, and order the tests. The benefit to the doctor personally far outweighs the costs of the tests, since he or she is *not* going to pay for the expensive (and potentially unnecessary tests).

The patient just wants to make sure he or she is really okay. That there is nothing more serious wrong. As long as the tests are not too arduous or difficult, the patient will likely agree to taking additional tests to *make sure* nothing is wrong. Even though, the doctor might be 99% confident, nothing is wrong.

For the patient, the benefit of taking the test (more certainty around disease status) far outweighs the benefits of not taking the test (saving money and time). The doctor feels the same way.

I don’t believe this is the only reason that healthcare costs are skyrocketing, but I do feel it is one reason. As more and more advanced tests become available, able to detect a myriad of rare diseases, don’t doctors have a *responsibility* to check their patients in the remote possibility the patient has the disease?

And wouldn’t patients prefer to take the tests themselves for peace of mind?

Even if the tests are not really effective or accurate or even better at detecting a disease than simple analysis, the doctor can say, “Hey, I gave the test. Nothing was wrong. I did my duty, so you can’t blame me if something was wrong.”

There is no incentive for the ones spending the money to reign in these types of costs.

Nothing in life is 100% certain, where do we draw the line at acceptable risk vs. unacceptable risk? At what cost?

Why is healthcare such a mess in the states?

The NYT has another article on the nightmare that is patient billing. I can heartily agree with most of the things the article describes! Any simple visit to a doctor or hospital results in bil upon bill without indescribable and unclear codes and messages… and scary dollar values.

From the article:

“Walk into any drugstore, and the next few minutes of your life are fairly predictable. After considering the choices, you make your purchases and head for the cashier. Seconds after the transaction, you are handed a receipt that reports to the penny what you paid for each product, along with its brand, its size, and the date, time and location of the purchase. But become a patient, and you enter a world of paperwork so surreal that it belongs in one of Kafka’s tales of the triumph of faceless bureaucracies. And although some insurers and hospitals are trying to streamline and simplify bills, the efforts have been piecemeal.”

Another analogy:

‘”Suppose you walk into a restaurant,” he said, “and you don’t get a menu, you don’t get any choice of what food you’ll eat, they don’t tell you what it is when they’re serving it to you, they don’t tell you what it’s going to cost.”

“Then, weeks or months later, you get a bill that tells you all the food you ate and the drinks you had, some of which you remember and some you don’t, and although you get the bill, you still can’t figure out what you really owe,” Dr. Brailer said.’

I just can’t imagine what it would be like to have to deal with all of it if you are sick on top of it. How terrible!!!

Why can’t everyone in the U.S. pay a set dollar amount per month for healthcare? And let the rest be free. Yes, yes, I know there is a problem with over-utilization, etc. etc., but most patients really *don’t* want to be in the hospital and likely would prefer not to get more and more treatment. Who checks into the hospital for fun?

So I’d say patients incentives are not skewed towards over-utilization. Yes, patients probably want more tests, because they want to be sure they aren’t sick. And maybe they just want to see their doctor regularly or see a specialist if they have a problem…

But doctors, while they are incented to make sure their patients get well, they have an incentive to sell more services too. What if doctors were paid fixed dollar amounts, regardless of the number of procedures they performed? I think that would create a dis-incentive to do an excessive number of procedures. But then, I guess you run the risk of a doctor not doing *any* procedures at all. Is this likely? Probably not, if you assume that individuals who choose to become doctors likely were motivated by factors other than compensation. (Wouldn’t they have gone into investment banking? Or something?) And it doesn’t make sense to compensate doctors based on patient outcomes — or does it? I mean, it seems like there would be a lot of things influencing the outcome for a patient that outside of a doctor’s control. Did the patient take the medicine he or she was supposed to? The list of outside factors goes on and on.

And finally for the payors — the insurance companies — they have an incentive to pay as little as they can. They want to make sure they are *not* overbilled, and probably having complex billing reimbursement procedures results in some lost “claims” which would definitely help their bottom line, right?

Is there a way to create an incentive structure which will result in a win-win for everyone?

• Efficient and reliable care for a patient, at a set price
• Decent salary for a doctor and less time devoted to admin and more time to seeing patients
• A reasonable level of profits for managed care companies

Sigh, with so many opinions, it will be hard to come to an answer.

Oh, and I forgot another stakeholder. In the case of U.S. healthcare, a big stakeholder are U.S. corporations. And they are ones who pick the insurance company. What are the things they look for when choosing an insurance provider? Probably good service.. maybe price, although that in itself is confusing. Most likely a good partner to sort through the troubles of gaining access to a healthcare network and managing the billing process itself…

I think this is a brilliant development — convenient walk-in clinics for patients with minor health problems:

“They offer patients fast access to routine medical services such as strep-throat tests, sports physicals and flu shots. The clinics, which typically charge between $25 and $60 per visit, don’t require an appointment and are open during pharmacy hours including evenings and weekends.”

The WSJ has an article on the development (account required).

I do think it’s unfortunate that these clinics are staffed by nurse practitioners instead of doctors — are real doctors just too expensive?

However, I think it’s great that technology is being used to increase efficiency:

“The clinic model relies heavily on technology to increase the efficiency of care. When patients arrive, they check themselves in at a touch-screen computer terminal — much like an airline self-check-in kiosk — where they can swipe a credit card and enter basic information about their symptoms and family history… If the nurse practitioner disagrees with a computer-generated diagnosis, he or she can opt to override the system. When a prescription is written, it will be transmitted electronically to the store pharmacy, or another pharmacy. The system will also create an electronic medical record for each patient that can be transferred to a primary-care physician.”

This goes along with my rant from a couple of days ago on urgent care clinics.

I’m not sure if the for-profit model is the way to go, but certainly for-profit organizations tend to be more efficient than not-for-profit counterparts. I’m also not sure if Target or Walgreens is the place for these types of clinics, but I do agree there are synergies with the pharmacy counter. Intriguing idea…

A couple links:

• Minute Clinic
• Take Care Health

I wonder who funded these guys? Looks like Bain Capital Ventures, Axcel Partners and TGap Venture for Minute Clinic and I would guess that Take Care Health is self-funded — the CEO sold his travel firm to American Express for a big price several years ago.

Articles on Minute Clinic:

• Fortune
• Fast Company

Was reading the Freakonomics blog today, and I had like fifty entries to go through.

In any case, one entry in particular interested me about waiting hours in the ER:

“Emergency rooms serve as the front lines in the world of medicine. Many (most?) visits to ERs are not emergencies at all, but rather, routine visits by people with limited access to health care. As a consequence, waiting for hours to be seen is not uncommon. Forced to take all patients, the ER raises the “price” by making you wait.”

(As a side note, the blog entry highlights a study that showed that ER visits drop when championship baseball games are played.

“An obvious conclusion is that people would rather watch a good baseball game than go to the emergency room. Also obvious is that some people who go to the ER could just as well visit their doctor. “

)

I have no doubt that emergency room visits are one reason why health care costs are soaring in the U.S. (along with a host of other inefficiencies.)

How many times are there when an unexpected health issue crops up — unexpected, but maybe not URGENT exactly, but you want to get it taken care of right away, because when you aren’t feeling well… who wouldn’t want to feel better soon?

Why aren’t there more “urgent care” centers for non-emergency care, but where you can drop in for a quick visit to get something looked at? Like if your throat is killing you, and it’s obviously not life threatening, but it would be great to have someone look at it.

I do have a primary care doctor, but how many of us have established relationships with our doctors?

It seems that having a mix of real emergency issues and not-so-urgent issues all dealt with in one place causes a lot of inefficiency and results in additional costs for everyone (monetary and not.)

Watch out! Some medicines sold in the U.S. are sold under different names abroad [WSJ]

“In Brazil, for example, the brand name Dilacor refers to verapamil for irregular heart rhythm and hypertension. But in the U.S., Dilacor is a blood-pressure drug known generically as diltiazem. And in Serbia, Dilacor is the brand name for digoxin, used to treat heart failure…

It isn’t known how long such name-sharing has been going on, but the problem came to light only recently after a serious mix-up was reported at a hospital in Michigan. Because there is no regulatory body that keeps track of names globally, there is the potential for more and deadlier cases to occur.”

Yikes!

Fat man walking.com/
This 350 pound guy is walking across the United States to lose weight! And chronicling it on his blog… craziness!

PC Tea [NYT]

“Launched in 1998, Honest Tea now sells more than a dozen varieties of bottled tea (and some bag teas as well), had revenues of nearly $6 million last year and expects to hit $9 million this year, according to the company.

The easiest answer is that Honest Tea is part of the ”organics” category, which has lately been quite popular with consumers. ”

When Instructors Don’t Intervene on Content [Bright Mystery]

“So the problem wasn’t Pat’s skill with the material so much — the processing skill was the problem. Accordingly, when Pat would ask me a question such as, “Can you tell me how to do problem 7?”, I would say: Let’s start by asking the right questions. What are you being asked to do in this problem? What information is given to you in the problem statement? And what do you know from the course, your reading, or your work on other exercises that will help get you to the goal? I made it a point to NEVER give Pat explicit help on content unless it was a last resort — Pat absolutely HAD to cut the apron-strings from me an learn how to approach, analyze, and solve a problem alone, or else Pat’s chances for success in a future career or even making it through college didn’t look good. “