Our fridge just emailed us to say we opened its door too many times

>Do people have the right through collective indirection to implement blatantly discriminatory control mechanisms that obfuscate the actual costs of things? (I'd argue not.)

More accurately distributing cost of risks to those engaging in the risky behavior seems like it would be the opposite of obfuscating costs. Tobacco users pay more, why shouldn’t alcohol users? Or sugar users?

if that were the case then i should be able open the door right after i closed it. realistically, even a pump could not be that fast. electromagnets sound like a much better explanation. simple logic too. whenever the temperature is higher than expected, turn the magnets on.

This entire subthread is predicated on not trusting the physician/clinician/device manufacturer. If those people really can't be trusted, then I'd suggest that the posters simply never go to the doctor.

I've been involved in medical device development for close to two decades. It's like pulling teeth to get data collected and sent off remotely because it raises the device manufacturing cost, increases device development cost to add those features (and yeah, security is being taken a lot more seriously these days), raises operational cost because you either need your own server farm or to pay for a HIPAA-compliant online database, there's more work to be done in developing a frontend for the clinicians to view and use the data, etc.

In short, no one is adding cell data upload to a device on a whim. I remember a device I worked on a year ago that decided to avoid this although it was expected that many of the users would be in remote areasor had mobility problems. Instead the customer decided to store data on an SD card (need to record results from the patient so their therapy could be adjusted as needed) and have the clinician download it from the device (they made weekly visits) using a tablet that would then email it directly to the physican who prescribed the device.

I understand that we're all losing trust, but this is getting ridiculous.

That would depend on your agreement with the device manufacturer, assuming you had one.

The products I worked on that had remote monitoring built-in were purchased directly by hospitals or medical labs and in those cases we did have contracts that specified what we would do with the data. IIRC, one of the agreements was that if we (the manufacturer) noted that the device was malfunctioning, we would alert them.

Without an agreement to do something with the data, you'd have a hard time making a case. Especially since without an agreement, they wouldn't be able to access your identifying information.

Im sorry, but this is not true

>>>>>The patient and doctor are free to negotiate a deal that avoids third parties such as the insurance company.

Just like im free to negotiate a deal for some stock of TLSA directly from Musk, and not buy it via 401k.

On top of the transaction cost of getting elon musk in the same room with me, there's a huge difference: 401k purchases are pretax. Buying from Musk is not pretax.

Same is true for a "negotiated" transaction with a doctor, vs buying insurance from employer.

>>>>>Patient chooses insurance to manage their care, because they do not know what they are buying, or how much it should cost.

Wow. Those are some claims. Lets test them. I dont even know how to change the oil from my car. I barely know how it operates, and i couldn't repair one without years of training. Yet anyone with cash can and does buy these $30,000+ machines.

How can something worth $50 - $300 be hard to understand? Also, I have an extremely powerful heuristic to know if its worth it, or not. ( feeling better = return to doctor. Feeling worse = change doctor ). No one needs insurance to buy medicine. Medical insurance is just simply a membership racket, legalized by the govt.

History is not on your side. Medical insurance was an irrelevant, minuscule market until well after ww2. Why its sudden emergence? Government mandates (Medicare + federal insurance mandates to employers, for returning vets)

>>>>>It is very naive and counterproductive to label insurers as the bad guy because "insurers maximizing revenue"

Insurers are not the only bad guy. I'll give you that. But to say they are not a bad guy, is fraudulent or really naive on your part.

So, Who are all the bad guys? Follow the money. Which players are going in acquisition sprees? Hospitals, Insurers, large Pharma, and PBMs.

1) Hospital "nonprofits", such as childrens hopsitals that have the gall to do community fundraising from bake sales while paying CEOs 5M+, while the CEO of the red cross is in hot water for making 500k. [1].

2) Insurers that buy a medical practice in NJ, and then suddently cut off the competing practice from the insurance network, thus grating the newly acquired practice a local monopoly.[2]

Or for a more recent example, take the lobbying to scare Biden's admin & CMS to permanently suspend the Trump administration mandate to force hospitals and insurers to disclose real medical pricing in 2021. [3] It begs the question on why Covid19 bigcos were giving Biden real time updates on covid19 drug development, while trump -the actual president- was kept in the dark. I know the bad guys were sweating bullets on that one!

3) PBMs? Creating formularies to favor sweetheart rebates to them, obscuring real cost from patients and regulators, while making patients and employers foot the bill? or

4) Pharma, racking in cash from drug $20 copays without disclosing to customers that they offer the same pills for pennies if you "cash pay" (not use insurance).

Bad guys galore in healthcare. Insurers are most certainly in the podium.

[1] Marty Makary : Unnacountable book

[2] https://www.nj.com/healthfit/2020/02/an-insurance-titan-is-d...

[3]https://www.natlawreview.com/article/cms-backs-price-transpa...