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Delivering Health
Apple: Our Most Important Health Care Company?

Apple’s most important new project is making U.S. health care cheaper. In the Washington Post, Vivek Wadhwa discusses Apple’s latest health care foray: the Apple ResearchKit aimed at making it easier and cheaper to run clinical trials. The platform allows anyone with an iPhone to download apps that measure their vital signs and conditions, and that data can be used for developing new treatments. Wadhwa situates the ResearchKit within the overall improvements in health monitoring technology.

We will soon have sensors that monitor almost every aspect of our body’s functioning, inside and out. They will be packaged in watches, Band-Aids, clothing, and contact lenses. They will be in our toothbrushes, toilets and showers.  They will be embedded in smart pills that we swallow. The data from these will be uploaded into cloud-based platforms such as Apple’s HealthKit […]

ResearchKit apps will enable constant monitoring of symptoms and of reactions to medications. Today, clinical trials are done on a relatively small number of patients, and pharmaceutical companies sometimes choose to ignore information that does not suit them. Data that our devices gather will be used to accurately analyze what medications patients have taken, in order to determine which of them truly had a positive effect; which simply created adverse reactions and new ailments; and which did both.

The future is impossible to predict. But one thing we do know is that new technologies have made it cheaper to purchase services in other industries but not in health care so far. This gap is in part due to the over-investment in new kinds of treatments rather than in how to deliver health care more cheaply. If the Apple revolution works, and the remote monitoring it enables brings down the costs of managing chronic illnesses as well as creating new treatments, then price drops cannot be very far off.

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  • Andrew Allison

    “This gap is in part due to the over-investment in new kinds of treatments rather than in how to deliver health care more cheaply.” is the crux of the problem. It seems that there’s more money to be made in new treatments and, especially, drugs than in lowering the cost of delivering healthcare. We need to incentivise cost-reduction.

  • FriendlyGoat

    Being monitored from the inside out is cool as long as neither your employer nor your for-profit insurer are forcing you to do it.

    • f1b0nacc1

      But it is OK if a non-profit or the government is doing it? Even for you, that is pretty silly….
      I share your concerns about the potential invasion of privacy that this represents, but profit/non-profit/government/etc., the threat is the same, and it is equally disturbing.

      • FriendlyGoat

        Generally, on medical matters, for-profit companies are trying to get your last nickel or leave you hanging for all the risk. Government, not so much.

        • f1b0nacc1

          The same government that ADMITS to discriminating against all sorts of people (I won’t bother you with the IRS, but how about the endless discrimination against blacks and gays in the past?), you trust them? How cute…

          • FriendlyGoat

            This isn’t about discrimination. It’s about who forces you to monitor your body and report your medical data in order to have a job or have insurance. For-profits are the ones who will be after you on this.

          • f1b0nacc1

            If a private company abuses information gathered from me, I have recourse against them. If the Government abuses it, I have none. That is a crucial difference all by itself.
            As for the trustworthiness of the parties involved, you ignored my point. The government has killed, imprisoned, fined, infected with disease (the syphilis experiments on blacks ring a bell?), and attempted to abuse the liberties of individuals in just about every way imaginable over the last two hundred years DESPITE being the best government on the planet. Private actors are hardly without shame, but they fail to meet any sort of comparison with that sad record. The fact that the government has a proven track record of misusing information and power (the recent IRS scandal is an excellent example, but I am sure that you can find some slight from the Bush era for your own concerns, or we could both point to Nixon as a prime example of a bad actor), makes me far, far less willing to trust them and their motives.
            A for-profit company cannot force me to share information unless I consent to do so, the government can, and further it backs that demand with deadly force. If you want to address that issue (rather than simply bleat that you don’t like profits, we all got that long ago) by all means do so, but you haven’t done so yet.

          • FriendlyGoat

            Would I be crazy to ask you how well you like profits made off of you?

            The only reason I ever made a comment here in the first place is that some employees are already being driven nuts with employers’ intrusive “wellness plans” and the like. The subject matter here sounded to me like new tools to make that problem potentially worse.

            OF COURSE we don’t want government to have an Apple-monitored probe up our proverbial wazoo either.

          • f1b0nacc1

            If the private company offers me a service, and I freely choose to consume that service, I expect them to be making a profit off of me and hope that they make significant ones. There is nothing evil or even sinister in profit-making, and in fact it represents a general social good. Trade makes us all richer, which is why the capitalist West is the richest society in history, and the socialists (those that are not already on history’s ash-heap) live in poverty and despair.
            I happen to work for a company with an aggressive wellness plan, and I simply ignore it. I don’t care for it, true, but as long as I am not compelled to participate, why should it bother me? A private company cannot force me to consume their products, but the government can (see Obamacare), which is the real threat here. Many of these new tools indeed do make the situation worse (most wellness programs, are for instance, utterly ineffectual), and I believe we agree that their use is pointless. With that said, as the Government intrudes into areas such as healthcare, the real threat is that they will (and do) mandate these intrusive measures using the force of law.

          • FriendlyGoat

            We all agree we do not want an Orwellian government. We all agree that legitimate profit is a good thing and a required element of beneficial commerce. We all agree that free enterprise is the best system anywhere.

            I’m glad government supervises insurance including medical insurance. I’m glad we have consumer-oriented standards and not just “anything” is allowed to be hidden in fine print. I’m glad we have the FDA and the Centers for Disease Control. I’m glad Obamacare defines minimum essential coverage.

            I’m glad your employer is not yet threatening you or your job with its wellness plan. I hope our government puts a limit on how far employers can go with that. You say you are not “compelled” and I hope government fixes it so you CANNOT be. We really don’t want people’s private-sector jobs DEPENDENT upon cholesterol, blood pressure or blood sugar readings. Fair enough?

          • f1b0nacc1

            You say a lot of nice things in the first paragraph, though what you mean by ‘legitimate profit’ makes me wonder a bit. What is legitimate vs illegitimate profit?

            Then we part company. The government shouldn’t be ‘supervising’ anything. Setting basic rules of commerce (fraud, contract law, etc.) is about the limit. Establishing standards can be handled quite nicely be the marketplace, i.e. the free exchange between consenting adults. Government regulation (and ultimately that is what ‘supervision’ is a nice word for) inevitably becomes corrupted whether by the various actors in the marketplace, or by the government itself. The FDA has probably been responsible (through delaying the introduction of new drugs or making others too expensive to develop and market) for more misery and death than it has prevented, and could easily be replaced by industry-wide groups that certify privately. Underwriters Laboratory would be a good model to work with here. The CDC has done some good work, certainly, but nothing that a decently funded private lab or research university could do better and with less political oversight. The recent move of the CDC into non-health related matters such as gun control is a perfect example of the sort of mission creep that makes even the best governmental agencies become wasteful and even counterproductive. As for Obamacare and its standards for coverage, why not let consumers make their own choices. If you don’t think that they know enough, educate them by all means, but don’t infantilize them.

            I would regret it if my employer (an exceptional organization) undertook to try to manipulate my life as a condition of my employment, but ultimately that is their right TO ATTEMPT, just as it is my right to resist. If they feel that such control is more important than my services, well then I can go elsewhere…that is what a free market is all about. Government cannot FIX anything, all they can do is limit my choices and those of my employer, and ultimately reduce options for both of us. Some individuals might not mind having their employment based upon employer intrusion into these matters, they should be free to make that choice, shouldn’t they?

            We differ on the principle of liberty, something too precious to give up, and infinitely difficult to regain once lost. I don’t doubt that you have good intentions (we know where those lead us, however!…grin), but you have a tendency to ignore what happens when we let our laudable goals lead us to foreswear our liberties. I don’t deny that free markets have their downsides (they produce losers as well as winners), but one cannot eliminate the losers without generating problems elsewhere in the system. Madison, the brains behind that finest of all documents, the constitution put it best when he said:

            “But what is government itself, but the greatest of all reflections on human nature. If men were angels, no government would be necessary. If angels were to govern men, neither external nor internal controls on government would be necessary. In forming a government which is to be administered by men over men, the great difficulty lies in this: you must first enable government to control the governed; and in the next place oblige it to control itself.”
            I can do no better than that…

          • FriendlyGoat

            Illegitimate profit has been defined in the past by some of the things we have passed laws against. Monopolies in restraint of competition come to mind. So do usurious interest rates (although we recently seem unable to overcome the lobbyists for payday/car title lending). In health care, I would offer the examples of absurd pricing in the retail charge-masters of some hospitals. Blood tests which can be done anywhere for less than $100 should not be billed at as much as $10,000, as was recently disclosed in a study of pricing. Only government is ever going to force HC pricing into bright light.

            I also happen to think that companies having license to drive their employees with pre-existing conditions off their payrolls would be a bad public policy benefiting only the profit of some organization. (Like I said, I hope they don’t come after you with that wellness plan.)

            Moving down to the question at end of your third paragraph, no (EMPHATICALLY NO), an employer should NOT have the right to demand an unconstitutional search of the condition of your body just because somebody can be found to say he or she “doesn’t mind”. (Gee, why do YOU mind? YOU must be a problem!)

            Madison and the gang were fine fellows, but we are ABLE and free to define and solve problems that they didn’t. We are not bound to ignore everything they somehow failed to mention They didn’t fix anti-trust or hardly anything respecting what corporations may or may not do to people or do to the environment. Heck, they didn’t even fix slavery, for heavens sake.

          • f1b0nacc1

            Monopolies in restraint of trade largely exist because they are enabled by the government and its regulatory apparatus (take a look at the rise of Standard Oil as an example, or for that matter the numerous modern examples of regulatory capture). There is little evidence that usurious interest rates (which survive government scrutiny all the time, as long as they kick back to the right politicians) are quite resistant to the heavy hand of government. Hence your arguments about ‘illegitimate profits’ fails to hold water. Profits are not illegitimate, only the methods by which they are obtained are. If we are not discussing fraud, violation of contract, then there is nothing illegitimate.

            Your comments on healthcare are similarly ill-informed. The only reason that the medical industry can get away with the gouging that they do is that consumers simply cannot go elsewhere, and the reason that they cannot is that they are locked in by government regulation. Insurance companies (the payers) and hospitals/doctors (vendors) aren’t ‘playing’ with their own money, they are playing with yours, but since they are in a closed marketplace (not really a market at all), they can easily get away without having to open themselves to competition. If they did, then this sort of gouging would quickly disappear as consumers went to cheaper, more transparent alternatives. Government regulation limits the number of competitors (see ‘barriers to entry’, a nice variation on regulator capture), and hence makes the whole ugly business possible. Why do you think that the insurance companies had such a big part of writing Obamacare in the first place, and why they supported it so strongly?

            As for pre-existing conditions, once you prohibit businesses from declining to insure them, you give insurers no way to do business unless they can force everyone to be insured. This is the individual mandate so hated by the population, as it forces the young and to subsidize the sick and elderly. Worse, since the program depends upon heavy subsidies in the first place, you are placing a double burden on the healthy and productive. The money to pay for this has to come from somewhere, and the books simply do not balance, much as you would like to pretend otherwise. A subsidized catastrophic insurance for the elderly or the sick (very sick, not just everyone) might be a worthwhile option to examine, but what we have instead with Obamacare is a huge set of mandates that cover virtually every aspect of individual healthcare. This removes any market incentives to save money, and adds several to increase consumption and cost. By the way, the fed are already looking into using EMR data (the same stuff you fear that an evil corporation will collect) for ‘decision-making’ and have pointedly refused to address privacy concerns with data sharing. Given the recent IRS scandals, one can only wonder what they have in mind….

            An employer may in fact make all sorts of demands with regard to searches of your person…keep in mind that the constitution’s bill of rights does NOT apply to private actors, nor should it. Now there are some limits (the 14th amendment and its extensions come to mind here), but the courts have ruled repeatedly that drug testing, for instance, is entirely legal. I can hardly think of a more invasive test than ones blood. And why shouldn’t I be able to share information with my employer if I choose to? Who is the government, or you for that matter, to tell me otherwise. A private contract between consenting entities is the foundation of liberty. Is there the potential for abuse, certainly, and there is the potential for abuse in any relationship, but this does not grant any sort of power of veto to third parties, nor should it.

            I see you missed the entire point of my quote from Madison, though I suppose I shouldn’t be too surprised. I was not making an originalist argument (though I strongly support it), but rather I was pointing to Madison’s wisdom in suggesting that just as we must have some government because mankind is not perfect, we must equally restrain government because those who run it (mankind) are not perfect. The more power and authority we give it, the greater the danger. Suggesting that the founders didn’t anticipate all problems ignores that they left the ability to (with great difficulty) amend the constitution with just this eventuality in mind. That path has been taken, sometimes for good, sometimes not, but just because it is a difficult one is not a reason to ignore the document itself. You don’t like the wisdom of the 18th century, here is an older bit for you:

            WILLIAM ROPER: So, now you give the Devil the benefit of law!

            SIR THOMAS MORE: Yes! What would you do? Cut a great road through the law to get after the Devil?

            ROPER: I’d cut down every law in England to do that!

            MORE: Oh? And when the last law was down, and the Devil turned ’round on you, where would you hide, Roper, the laws all being flat? This country is planted thick with laws, from coast to coast, Man’s laws, not God’s! And if you cut them down, and you’re just the man to do it, do you really think you could stand upright in the winds that would blow then? Yes, I’d give the Devil benefit of law, for my own safety’s sake!

          • FriendlyGoat

            1) We ARE discussing fraud. Medical procedures with artificially high and secretive pricing ARE fraud. Making a family member sign for Mom to be billed at the nobody-knows-what’s-in-it over-priced “charge-master” while she is having a heart attack and cannot “shop around” IS fraud.

            2) Drug testing is a safety issue in nearly any workplace. It is not the same thing as saying to you, if you’re older, “Sorry, since we have employee health care costs, you’re fired because we found a younger guy who has lower blood pressure and less likely to be pre-diabetic. It’s not “personal”, you understand, just business”. I guarantee you would not just be okey-dokey with that, regardless of all this comment-section smoke blown here.

            3) I knew you were supporting “originalism” even though you didn’t mention it.

            4) Why don’t you take your Roper and More quotes up to even the five most-conservative members of our present Supreme Court and see if they’ll use them to justify a decision in public?

          • f1b0nacc1

            1) Fraud is a word with a specific definition. Pricing practices that you don’t care for are just that, things you don’t like, not fraud. Think that they are fraudulent? Get some victims of that fraud together and take them to court, you will make a mint. It has been tried before and it fails because it is NOT FRAUD. It is interesting that you choose today to prattle on about this because it happens to be the one year anniversary of my wife being diagnosed with breast cancer, a particularly nasty and virulent variety at that. We kept our heads, and got information, and (thank God) things have gone well. The cases of a panicked family member signing away the house due to mom having a heart attack are figments of your imagination. Now there are cases where people do not bother to inform themselves about the costs of medical care and made poor decisions under pressure, but this is roughly the same sort of thing that happens with home purchases, credit cards, etc. People who make poor choices are unfortunate, but that doesn’t mean that those who take advantage of it are doing anything illegal. Fraud has a specific meaning, what you are describing is unethical and regrettable…shame those people, surely, don’t patronize their business, absolutely….but Fraud?….you can do better than that. Note that if you make competition easier (even possible) those unethical businesses wont last long anyway….
            2) I am 55, overweight, diabetic (nothing “pre-” about it), and ugly to boot (grin). Worse still, I am a refugee from academia and consulting who works in IT, the most youth-worshipping business in the world after Hollywood. My company doesn’t need a blood test or a profile to discriminate against me, and guess what…they don’t. I offer value for what am paid (and I am the highest paid person in a VERY large IT group by a large margin), and my employers are well aware of it. I am under no illusions that if they thought that they could get similar quality at a lower price (off-shoring, outsourcing, younger workers, etc.) they would do so in a heartbeat. Guess what, if I thought I could get more money/better working conditions/supermodels, etc. by changing jobs, I would do it. that is the nature of markets, and there is nothing in the world wrong with it. I worked for Microsoft for a while during the outsourcing craze there, and had to leave as a result, but that is part of life, and I accept it. Do I enjoy it…of course not….but there is a big difference between not liking something and thinking that it should be illegal.
            3) Glad your reading comprehension is improving. You still managed to miss the original point (about originalism!)
            4) As I remember, Scalia has actually used that quote in the past, it is an excellent one. I wonder if you got the point at all….

          • FriendlyGoat

            1) Glad to hear things have gone well for your wife.

            Separately, some things which are new forms of “taking advantage” should be made illegal when we get around to it. “Unethical”, as you put it, is close enough to fraud for me to call it fraud.
            It was a long time before we addressed rolling back mileage on odometers at used car lots, but we finally did. Pricing that “might be” $100 or “might be” $10,000 for the same thing in medicine needs attention. The move for that is underway a little. If it gets done, government will be involved.

            2) Glad to hear you have a good job and are hanging on in spite of age and medical issues. Not so for too many.

            3) We’re not going to agree on “originalism”. As far as I’m concerned, it’s the new code word for the GOP sneaking everything I am against in politics past citizens. Likewise Jeb Bush’s “right to rise”. Or the old “ownership society” from his brother.
            Baloney on a stick.

            4) Scalia wrote that in a real opinion?

          • f1b0nacc1

            1) Unethical has nothing to do with fraud, and to conflate the two is to water down what ‘fraud’ is. Rolling back mileage on used cars is outright deception, and hence fraud (by the way, check out the movie ‘Used Cars’ for a very funny take on that), but pricing based upon inconsistent conditions (however unethical) is not. The former is actionable, the latter is not. If you want to get rid of this practice (and I do), get rid of the government protection for organizations that do this, and that means deregulation.
            2) I am under no illusions that my circumstances are the result of good fortune, but I want to expand those opportunities for others, not protect the incumbents. That means deregulation and flexibility, not simply coming up with ever more complicated rules that favor the rich and powerful (who have lawyers and other resources to navigate those rules).
            3) Originalism has little to do with sneaking anything past anyone, it is about reading the words that were written. The ‘living constitution’ is in fact how you sneak things past citizens, as you have no idea what it encompasses prior to the next surprise ruling by an unelected judge. I am far more comfortable putting my fate in the clear meaning of a document than in the ever changing interpretations of judges who are accountable to nobody. Remember, if you want to change the constitution, you can amend it, it has been done…
            4) Yes, he did, though I don’t have the decision in front of me (my employers frown upon me keeping my law books around….grin…) It is an excellent quote, and one that you might want to ponder upon a bit….

          • FriendlyGoat

            1) Maybe you think of fraud as merely not doing as promised. I think of fraud as not doing what should have been reasonably promised in a situation. A $100 medical test should not be priced up to $10,000. That seeks to create the illusion that the service was worth $10,000 when it wasn’t. A jeweler can price a jewelry piece to any level he wishes. Health care is not the same thing. We’re not going to agree on this.

            2) Deregulation is not a remedy to counter companies which like to otherwise lawyer up to skirt regulation. Just giving up is not a sensible option for citizens. We’re not going to agree on this.


          • f1b0nacc1

            1) Your definition of fraud is simply incorrect. What it sounds like you are describing is the Marxist notion of ‘intrinsic value’, i.e. that goods and services have an intrinsic value that is not dependent upon context. For instance, a glass of water would be worth (just for discussions sake) 5 cents, whether one is getting it no the shore of Lake Erie or in the middle of the Sahara. If such an method of valuation was accepted (and it is not), then you MIGHT consider the current medical pricing as gouging (in which case it is unethical, if legal), but it is not fraud. You continue to attempt to apply terms such as fraud to practices that you disapprove of, but are not fraud. This is the very reason that I challenged your notion of ‘reasonable’ profits in the first place. Adam Smith said it best, ‘Everything is worth what a buyer can be induced to pay for it’, meaning that there is no such thing as a ‘reasonable’ price or a ‘reasonable profit’. If I can convince you (without fraud or illegal deception) that you should pay me $100 for that 5 cent glass of water, then that is what it is worth, and my profit is reasonable. That may be unpleasant, unethical, and not at all nice, but it is NOT fraud, however much you might wish for it to be.
            2) You make an assertion (deregulation is not a solution), but you offer no argument as to why it would not be. More regulation in fact FAVORS larger companies that ‘lawyer up’, something that individuals and small businesses do not have the option of doing. This isn’t a matter of opinion, it is easily demonstrated fact. More layers of regulation only compound the problem….can you provide even a single counter example?
            3) In the case of the FAA, you in fact make an excellent originalist argument, congratulations! The founders would in fact have agreed with you, and while they did not have aircraft, they did have canals (which served much the same function), so we can get a view of their thinking on this subject. Absent interstate commerce (which they properly DID give the Federal government a role in), they argued that the states should have the lead in regulation. This is entirely consistent with the Tenth Amendment, as well as the various arguments set forward in the Federalist papers. You may not agree, and you might not prefer this, but it is absolutely what the founders had in mind, and in fact anticipated. The Founders, I should point out, made it clear that their reason for this preference (Federalism) was their deep suspicion of large centralized governments as inherently susceptible to tyranny. My point here is that unless you wish to make the argument that we should junk federalism and that no established law should have primacy(in which case Mr. More would like to have a chat with you), your objections make little sense.
            Indeed we are not going to agree, and that in and of itself is fine. However, if you are going to cloak your preferences and assertions by referring to ‘fraud’, and suggesting that another new layer of regulations will succeed where the others have failed, or that by altering the constitution on the whim of judges we are maintaining our liberty, then you are not offering a different opinion, you are simply wrong. The opinions themselves (the policy preferences I mean) are entirely your choice, but supporting them with misuse of words, or ignoring clear evidence to the contrary is another matter entirely. If you want to make an argument, rather than just toss out assertions, you must in fact engage the parameters of that argument.

          • FriendlyGoat

            I have little doubt that you can commission a poll to ask Americans on both the “left” and the “right” whether different hospitals should be allowed to charge uninsured individuals either $100 or $10,000—at their sole discretion—- for the same test (which actually costs less than $100).

            You KNOW what response will be given by virtually every person you can find. If, after eliciting each answer, the poll takers then call each respondent a Marxist for answering the question with common sense, then we would expect some of the respondents to assault the poll takers.

          • f1b0nacc1

            1) You actually make my point for me. Insurance companies get the ‘lower’ rates because they simply won’t pay higher ones, hence the marketplace works. When individuals take the same steps (and short of the emergency room, this is not difficult to do, I speak from experience), the rates come down. Not immediately, but certainly over time. Take a look at what happened to airlines and telecommunications once deregulation occurred, the prices came down VERY quickly. As for words like ‘fraud’, this isn’t an arcane debate at all…Fraud is a felony, and carries with it penalties under the law. Unethical behavior, while disreputable, does not. That isn’t a minor point, and attempting to ignore it undermines the rule of law in and of itself.
            As for asking people to say what ‘they feel’ something is worth, we have a way of doing that already, and it is called the marketplace. Asking people to vote on the value of goods and services supplied by others is hardly a recipe for success (though I suggest you contact the former rulers of most of Eastern Europe or the old Soviet Union for some second opinions on the subject), and typically leads to shortages and declines in quality as producers exit the market. Why would a doctor work for less than he can make simply because a poll results suggests he is overpaid?
            2) So overtime is a simple regulation? As it happens, I am working right now with our HR department on this very subject, and the 200 pages of legal minutae I am reading suggests that you either doing know what you are talking about, or are simply lying. Some employees are exempt, some are not, some are part time, some are full time, some are compensated in lump sums, some are contractors, etc. The notion that a one-size-fits-all model works even in this very simple area is ludicrous, and quite frankly I expected better even from you. As for big companies having not comparative advantage here, I suggest you have a chat with the folks who are even now suing Microsoft over this very subject.

          • FriendlyGoat

            1) Why should an ill or injured patient need to do the shopping and cajoling to get a health care price down to URC level? Why not just have a requirement that health care prices be posted by all providers in public all the time—–so societal pressure forces the “unethical and disreputable” players to fall in line. We have Kelley Blue Book for new and used cars, for heavens sake. No car dealers can hide from it. We need the same in medical care and only government can get it done. If a private solution to this existed, it would have been done 40 years ago.

            2) Careful with the “simply lying” accusations. Goes both ways, you know.
            We are all aware of companies mis-classifying employees as supervisors when they aren’t and seeking to make every possible person a contractor when they are, by definition, employees. Shall every voter in America say, “Well, this stuff is hard and complicated—–soooo, we’ll just drop that old idea of time and a half for overtime”. That’s the corporate dream, but not even “conservative” employees will do it as voters—–unless duped by your side’s style of disingenuous communication. “Vote for guns, boys, (so we can get rid of your Fair Labor Standards). Happens every day.

          • f1b0nacc1

            1) Why not? The Kelly Blue Book (and its imitators) are private initiatives, there is no heavy hand of the government to force vendors to cooperate with them. Why do you think that this is? You yourself admits that it works…
            Government regulation (HIPAA, etc.) is a big part of this process, especially the regulatory regimes that shield insurance companies from meaningful competition. After all, a medical Kelly Blue Book (a Red Book?) would have few interested consumers, as they don’t spend their own money for the service…they don’t have any real incentive to shop around. You have in fact answered your own question, and made precisely the point that I wanted to make…
            2) So in fact you are acknowledging that this isn’t as simple as you say, and that any attempt to apply more regulations will make it more complicated. Congratulations, you are taking your first step into a wider world!
            The corporate dream world you are referring to exists only in your desires to justify your own beliefs. I work for a company that is run by people way to the right of even me (and I make Atilla the Hun look like a bloody Hippie!), and they provide a menu of benefits that is quite impressive. I have worked for folks of just about every conceivable political persuasion, and the cheapest skinflints of them all are liberals…something that is borne out in studies showing that lefties are far less generous in charitable contributions than their right wing neighbors. My company knows what it takes to attract and keep talent, so they spend what they have to (and make sure that the corporate culture in place supports it) to get and retain it. This really isn’t complicated, it is a matter of enlightened self-interest, and has a long and proud history. Take a look at the contemptible labor practices of Silicon Valley and Hollywood (two of the most liberal groups in the world), or better still Academe if you want to see gross misbehavior and abuse of labor. When an employer needs you, they treat you well…which is pretty much what employees do regarding their employers. Hardly a big problem with that.
            It might make you feel better to say these things, but you really have a hard time backing them up.

          • FriendlyGoat

            1) You cannot embarrass the purveyors of over-priced medical services if you cannot get them to voluntarily disclose their prices to a monitor such as a website. This is why government will be needed to drag them into the spotlight.

            Everybody in the country has an interest in lowering the cost of health care. I “think” we are entering the period where the public is going to demand full disclosure. We’ll see.

            2) I never “acknowledged” that more regulation would make the determining factors for overtime more complicated. We need more enforcement, not less. More lawsuits, not less. We do not need more nuanced exceptions. We need easy clear-cut classification standards and we need to simply prosecute the questionable end runs around those standards.

          • f1b0nacc1

            1) It has nothing to do with embarrassment, it is a matter of enlightened self-interest. Car dealers accepted the existence of Kelly’s because it was in their interest to do so, and those who didn’t would be at a competitive disadvantage. The key word here is ‘competitive’. Insurance companies who have regulatory barriers to entry don’t face competition, and thus don’t respond to market forces. You keep pretending that there is some magic price behind all of this that the government can expose (really, this seems like you have watched too many movies), and there simply is not. Markets don’t work the way you seem to believe in, and while I understand it is hard to give up fairy tales, you strike me as someone old enough that this process shouldn’t be impossible for you. You provide excellent examples of how this information can be put into the marketplace….
            2) You acknowledged that even something as simple as overtime wasn’t so straightforward that a clear-cut standard would work. You call for more lawsuits, more enforcement, more regulations…just who would benefit from that? Who is BEST suited to defend themselves against those lawsuits or those regulatory groups? Big corporations, who can hire lawyers and buy politicians….and you are going to give them even more incentive to do so? You would be funny if you weren’t pathetic…
            Just how do you intend to tax those evil corps into spending more on their employees? Another set of regulations? The Brits tried that in the 60s and 70s, and ended up with company cars and company houses for the big shots, and layoffs and declining salaries for everyone else. Go further to the left and you find the Venezuelans, literally floating on oil, who cannot maintain a steady supply of toilet paper! If you think you can capture everything with taxes, consider that the companies in question will simply move away and take their taxes with them. This isn’t theory, they have done it before! More taxes, more regulation only benefits those who already have the money, they can buy lawyers to shield it, accountants to hide it, and politicians to change the rules.

          • FriendlyGoat

            1) There is nothing imaginary about this. We are reading again and again about how medical price studies are popping up to expose some pricing way out of the curve or completely off a graph. Some doctors have even admitted they didn’t know they were the highest in a city and DO NOT want to be known for that. We have recently read about saline solution bags in hospitals being billed at $400 when they cost less than $1. And I didn’t just invent that story about $10,000 blood tests.

            Disclosure, disclosure, disclosure is the KEY to the competition you conservatives rave about.

            2) The idea that we will all just acquiesce to being defeated by purchased lawyers, accountants and politicians is unacceptable.

          • f1b0nacc1

            1) You forget, I have a wife with cancer, I know all about the odd billing. The problem is that as long as someone else is paying for it (which is the case with insurers or single payers), who really cares. Put individuals back in the loop and you will see the medical equivalent of Kelly’s pop up as the demand for more information grows. We actually agree that more information makes markets work better….but you aren’t going to get it by fiat…the same groups that hide their costs now will do so until they have a good reason not to…and that doesn’t mean some ‘crat telling them so. When it costs less to disclose, they will do it, not until.
            2) You might not like being ‘defeated’, but it isn’t defeat, it is reality. You seem to think that anything that doesn’t involve brute force against those you don’t like is defeat….I suggest you consider treating your fellow citizens and their enterprises as equals, not as cows to be milked. Deregulation, particularly removing barriers to entry to allow more competition is the way to empower the little guy, the small business…isn’t that who you are supposed to be helping? You are married to this sick revenge fantasy at the expense of real results. Like it or not, the big corps have beaten the decaying corpse of the New Deal…the legacy isn’t glorious, it is pathetic…give up the sad old dream and embrace a better way forward….you are actually on the same side, if you would only give up the notion of revenge against those who hve beaten you.

          • FriendlyGoat

            Why do I get the feeling you are doing ye olde Rush Limbaugh routine of pretending that liberals are all defeated self-loathers seeking revenge? Oh, I know. Because you are.

            If I was as personally defeated as you imagine, I would not be in a position to spend as much time arguing with the negative gripers here at TAI as I do. You are the one who said you have former colleagues and former students in a mess. I’m not in one. But I do care about countering the arguments of those who would willingly put struggling people in a bigger mess. The “better way forward” you are teasing about would be cool if it wasn’t an empty basket, or worse, a deliberate hoax lacking any substantive detail that is comprehensible. Night, night.

          • f1b0nacc1

            So let me see if I have this right….you have time (by which I mean money or some other form of income/support) that lets you sit here and debate, and that makes you a winner? That is your criteria? By that standard a hedge-fund manager who cruises the web in between fleecing widows and orphans and eating puppies (sorry, I couldn’t resist…) is a winner too…. Glad we got that straight.
            I am not the one who obsesses about punishing those who have done well in our society, nor do I find it necessary to blindly defend the questionable legacy of one ideology, arguing that nothing good has ever come out of the other. Like all healthy people, I try to see, and in fact enjoy, the rich complexity (dare I say ‘diversity’?) of the way ideas interact with the real world, and find a way forward with that. You really do need to get out more….
            Do you really think that conservatives would really want to WILLINGLY (your word) choose to put struggling people in a worse position? In other words you think that they are not only wrong, but that they are outright evil… says a whole lot about who you are, doesn’t it?

          • FriendlyGoat

            I was just pointing out that I am not personally in defeat seeking “revenge”, as you alleged.

            And, yes, of course conservatives are more than willing to put struggling people in a worse position. That is actually most of their whole agenda and the reason I rail against them.

          • f1b0nacc1

            You really believe that? People who disagree with you are not only in disagreement but evil?
            By all means, rail away…I can think of little that discredits that line of reasoning more completely than your admission of your motives, which, by the way, certainly make you a loser.

          • FriendlyGoat

            As Ronald Reagan said, “There you go again.”

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