Hacker News Board Hacker News, browsed like a classic message board
Live data from Hacker News

The U.S. tried to build a new fleet of ventilators

nytimes.com

Post reply on HN
Print view View original

31–40 of 355 posts

Re: The U.S. tried to build a new fleet of ventilators

#31

Post by blunte »

agrenader wrote: post #14

"Companies submitted bids for the Project Aura job. The research agency ... chose Newport Medical Instruments, a small outfit in Costa Mesa, Calif" This is the problem. Instead of allowing several companies to compete for a large order of new ventilators, the $ were given to one company to be spend on design not on the product.

No, that is specifically not the problem. The problem is that the company had demonstrated a working design and was near production... but then the wheels of finance (by way of publicly traded company) stepped in with a profit-only motive.

If three companies were all competing, there's absolutely no guarantee that each of those three would not have been bought in the same way. No large company would have gone for such a contract unless it had no other way to make money; there wasn't enough profit incentive.

Re: The U.S. tried to build a new fleet of ventilators

#32

Post by gregoriol »

Nambia wrote: post #23
toomuchtodo wrote: post #9

Earlier quoted context omitted.

There is a narrow range of pressure where you're not damaging the alveoli from underpressure, but not bursting the lungs from overpressure. You need a mechanical scalpel, not a butcher's knife.

Honest question: is the pressure range actually that narrow? People can survive at high altitudes, which will see pressure of 70% sea level (or less, especially when considering mountain climbing). Additionally, when SCUBA diving, something like 30 feet of depth = 1 atmosphere. I feel like I'm missing something here. Any ideas?

It's really a complicated subject. One of the best reads I've seen these days is https://hackaday.com/2020/03/25/ventilators-101-what-they-do... and they explain how many factors there is to consider: it's actually "very" complicated to make right.

Re: The U.S. tried to build a new fleet of ventilators

#33

Post by lukevp »

toomuchtodo wrote: post #9
lukevp wrote: post #7

what is so complicated about ventilators? Serious question as I don’t know enough about this. I see a lot of DIY posts that are probably not 100% the same thing but are they even close? This opens up a bigger question too, is there such a thing as a path for open source medical devices to be built and certified and deployed? Is there a company that supports something like this? I follow Scott hanselman, a Microsoft e…

There is a narrow range of pressure where you're not damaging the alveoli from underpressure, but not bursting the lungs from overpressure. You need a mechanical scalpel, not a butcher's knife.

What’s the limiting factor there? The pressure regulation, pressure production, measurement accuracy? There’s open source ECUs that measure dozens of sensors at 1000hz+ and keep an engine perfectly timed using a $35 raspberry pi. Is this problem harder somehow?

Re: The U.S. tried to build a new fleet of ventilators

#34

Post by neffy »

pdonis wrote: post #22
onetimemanytime wrote: post #15

Earlier quoted context omitted.

Why should hospital X buy 100 ventilators...just in case, unless the gov made them do it?

> Why should hospital X buy 100 ventilators...just in case Well, of course. That's what we're talking about, right? Somebody has to do the long-term planning for emergencies like this one. I understand that most of us thought it was the government's job to do this long-term planning so individual facilities wouldn't have to, but this article shows that the government failed at that job. Unless we have some reason to…

But private entities can't do it, because the market forces them not to - those that the spend the money will be out-competed in the short term by those that don't.

Re: The U.S. tried to build a new fleet of ventilators

#35

Post by lukevp »

gregoriol wrote: post #25
lukevp wrote: post #7

what is so complicated about ventilators? Serious question as I don’t know enough about this. I see a lot of DIY posts that are probably not 100% the same thing but are they even close? This opens up a bigger question too, is there such a thing as a path for open source medical devices to be built and certified and deployed? Is there a company that supports something like this? I follow Scott hanselman, a Microsoft e…

Here is an interesting read on the subject: https://hackaday.com/2020/03/25/ventilators-101-what-they-do...

Thanks for the link, I’ll read up on it!

Re: The U.S. tried to build a new fleet of ventilators

#36

Post by smacktoward »

pdonis wrote: post #4
m0xte wrote: post #2

I’ve always said that governments should use our tax money to design and validate key health and infrastructure components and only outsource manufacturing and only to local businesses. Governments are so utterly broken and inefficient that they can’t do it. However even if they produced a design now we have supply chain problems globally. Edit: I seem to have stirred up capitalist defence here. To clarify: The gover…

> Governments are so utterly broken and inefficient that they can’t do it. Exactly. Which means we should not be depending on governments to do it. This is exactly the sort of thing that private startup companies should be doing, without trying to involve the government's bloated and inefficient bureaucracy. > even if they produced a design now we have supply chain problems globally For this particular crisis, yes. B…

There is no profit to be made in building up huge stockpiles of ventilators that will only be used in the event of a freak disaster. Government has to pay for such things, because no economically rational private investor would.

Re: The U.S. tried to build a new fleet of ventilators

#37

Post by pdonis »

worik wrote: post #26
pdonis wrote: post #4

Earlier quoted context omitted.

> Governments are so utterly broken and inefficient that they can’t do it. Exactly. Which means we should not be depending on governments to do it. This is exactly the sort of thing that private startup companies should be doing, without trying to involve the government's bloated and inefficient bureaucracy. > even if they produced a design now we have supply chain problems globally For this particular crisis, yes. B…

I completely disagree. If the government had done it in house they could have succeeded. The problem here was the profit motive. Cheep ventilators endanger profits. It is a side effect of free markets (I like free markets) that big firms get bigger, get more market power, kill off competition then price gouge. Health is a bad bad place to have free markets as the incentives are almost all wrong (exceptions: E.g. runn…

> If the government had done it in house they could have succeeded.

Ok, so how do we get the government to do it in house, and stick to it long enough so that the stockpile is there when the next disease crisis happens, which might not be for another 10 years? That's five Congressional elections and at least two changes of Presidential administration.

Re: The U.S. tried to build a new fleet of ventilators

#38

Post by maxerickson »

pdonis wrote: post #18
maxerickson wrote: post #16

Earlier quoted context omitted.

Yes, that's one thing contracts are used for, to specify what you get in exchange for payments, in a durable way.

But the government agreed to cancel the contract at the big company's request. I don't see how the deliverable being the design instead of the ventilator itself would have changed that.

Sure.

If I had a government slush fund to develop a low cost ventilator, I would try to structure the payments in the contract to be based on milestones with concrete deliverables. Not a tenuous agreement to buy a bunch of ventilators at below market price (it's implied in the article that the sales to the stockpile wouldn't justify the project for the company).

There's of course a possibility that the government wrote the most aggressive contract they could find someone to work on. But I doubt that is what happened.

Re: The U.S. tried to build a new fleet of ventilators

#39

Post by pdonis »

neffy wrote: post #27
pdonis wrote: post #21

Earlier quoted context omitted.

The government tried, but then canceled the contract at the request of the big company that had bought out the small company they originally had the contract with.

Exactly. The issue in some sense isn't government, it's the corruption of government by corporations that have been allowed to become to big and to powerful, to the extent that the US Government itself has been deliberately defunded. (Sure, I know Government spending grows every year, but so does the money supply and corporate profits. Control for monetary expansion, and the US Government's portion of the economy has…

> The issue in some sense isn't government, it's the corruption of government

Ok, so how do we keep the government from being corrupted? Nobody has yet solved that problem, and people have been trying for centuries.

> Control for monetary expansion, and the US Government's portion of the economy has been steadily shrinking.

The money supply is not the same as the economy. Government spending as a percentage of GDP, which is the closest estimate we have to "the size of the economy", has been growing, not shrinking.

Re: The U.S. tried to build a new fleet of ventilators

#40

Post by worik »

pdonis wrote: post #37
worik wrote: post #26

Earlier quoted context omitted.

I completely disagree. If the government had done it in house they could have succeeded. The problem here was the profit motive. Cheep ventilators endanger profits. It is a side effect of free markets (I like free markets) that big firms get bigger, get more market power, kill off competition then price gouge. Health is a bad bad place to have free markets as the incentives are almost all wrong (exceptions: E.g. runn…

> If the government had done it in house they could have succeeded. Ok, so how do we get the government to do it in house, and stick to it long enough so that the stockpile is there when the next disease crisis happens, which might not be for another 10 years? That's five Congressional elections and at least two changes of Presidential administration.

Government is not congress, or a president. It is civil servants beavering away.
Post reply on HN