Bill forgiveness doesn't necessarily target the for-profit hospitals. Not talking about debt discharge. It actually probably isn't even the right term. Essentially what shouldn't be allowed is non-profit hospitals counting discounts for low-income individuals as charity performed by hospital. The value of the charity shouldn't be sticker price but actual cost of services. Maybe that is already the case, but what I hear from randoms suggest that is why some hospitals are happy to "work" with you on your bill. I shouldn't have included "tax-deductible" in there, this is more about maintaining non-profit status.

RE ER. I don't see how keeping the ER and Urgent Care separate matters. In a combined system you would still have two sets of doctors, two sets of CAT scan machines and operators and radiologists, okay maybe not separate but the capacity for both (an appropriately reserved). In the current system you actually have more overhead from having a whole separate billing system, HR, building, landscaping, etc. Yes, the ER still needs to stabilize a patient whether they can pay or not but that becomes *cheaper* when you have a whole other pipeline to send them to. You aren't engaging a highly paid ER doctor and set of ER nurses to prescribe antibiotics to the homeless person that just came in. You can have the RN, or an internal medicine doctor do it instead in the area down the hall. If at any point that homeless person starts to code or the RN/Internal Med doc identifies something concerning, they can get them over to the ER. But again, if you are the hospital why would you do this? You can take in that homeless patient and charge them big money for some antibiotics and hopefully get reimbursed by the government. It's not like the hospital would even lose money on it, you would still charge for the urgent care services, just at the reduced reasonable price it takes to provide them plus a little more. Heck, I'm sure that an urgent care wing incorporated into an ER would beat any standalone urgent care in the business sense, you've generally got a whole waiting room full of prospective customers.. but alas.. you would cannibalize your ER "sales".

And if that cannibalization of ER sales would leave the ER unprofitable, then raise your prices! I don't think any reasonable person would be mad if you charged what it actually costs to provide lifesaving care. Insurance companies would be okay with paying real costs for the fewer cases of legitimate emergencies if they know that the much more common cases of people going to the ER for more minor things would be much cheaper. I would posit that with urgent care support you would need less ER capacity as you wouldn't have it filled up with non-emergent cases.

And yeah, it would be ideal to have them in the same building close together. Retrofitting would be hard or impossible. It would mostly be for new hospitals going forward. It all boils down to designing hospitals to be the most efficient as possible at providing care to patients, not efficiency on generating the most profits.

Theoretically because you are not the sole provider offering that service and the patient could go elsewhere, or in this case, the insurance company would require the patient to go elsewhere. Obviously, this sucks absolute donkey balls and health care will always involve a healthy dose of "I can't just shop around for where to get help for a heart attack".

In my naive opinion banning discriminatory pricing (no special negotiated insurance pricing), the sale of medical debt, and counting bill forgiveness as tax deductible charity would be a good start. With the absolute technical and capital-intensive marvel that is modern health care I just don't see anyone being able to reasonably get away with no insurance. Maybe there is a mandated co-insurance for all plans that could be covered by HSA accounts that everyone would get access to. That way there is a cost that is transparent to the patient that scales. At that point though I would just go to single payer.

(Rant incoming) Another thing that might need to happen is billing caps based off of certain outcomes. Especially in the emergency medicine realm. If you go to the emergency room and rack up a huge bill for something simple there should be a cap on the amount the hospital can actually recover. All I see is (rightfully) constant bitching and moaning from ER staff that people should be going to primary care or urgent care for issues which are less resource intensive and cheaper. The issue is the ER could provide those same services for just as cheap. Build out those same capabilities in or near the ER. The triage nurse can then send those low priority patients to the facility right down the hall. The issue is hospital admins have no incentive to do that, because as you said, why bill $200 when you can bill a minimum of $2,000 when you have your patient captive.

I also think it is silly we ask people to self-triage. It externalizes a lot of the costs to other parts of society. I can attest to this from the constant Volunteer Fire Department air-raid sirens I hear followed by a "EMS to Well Now Urgent Care for Patient in Distress". I'm sure the volleys love having their evening interrupted when it could have been a simple walk down an aisle.

Fuzzy isn't even the best word to use though. It's not fuzzy but lacking detail while at the same time my brain isn't comprehending that it is lacking detail. It is almost as if my brain can only focus on a few aspects of the picture at once with the most striking characteristics being rendered while the other parts are inferred or filled in with the most perfect placeholder - something that perfectly represents the idea of what is missing, but which it is not.

None of my other senses suffer from this. I can smell pumpkin pie or treated lumber on command. I can conjure music in my head all day (and often do without trying). I can metalize the feeling of cold or warmth. I too can taste spaghetti and meatballs. When I read that my mind immediately went to those cheap pre-made meatballs in the frozen section, my teeth cutting through those dense almost hard meatballs that are somehow so bland yet over spiced.

I also wonder how much of our differences are often our inability to communicate our experiences in a sufficient manner.

We have literal alchemy, but we don't have the capability to make useful amounts of gold. It is not that we don't know how to, but that it is not practical. How much more will material science, chemistry, and maybe even physics give us in practical (technology-wise) knowledge? Plenty for sure, but I don't think our rate of technological advancement will continue in these fields. That said, we have so much to learn even if it is not immediately applicable to technology.

Where I think there is an absolute abundance of applicable and practical knowledge to be collected is in the fields of biochemistry and biology. We haven't even scratched the surface there. We may never find a way to travel faster than light but if we can adapt our bodies to last for hundreds or thousands of years in stasis it may not matter. To me, being able to easily manipulate biology is so much more dangerous than nuclear proliferation. Anyways, not an expert of any of these fields.

It would be super helpful to know (relative to other foods) how my body reacts to claimed low-carb foods. Is there a large spike (don't need to know the number) or is it a much more flat curve? How long in general does it take for the line to return to pre-meal levels? What does that trend look like over many months? Heck, I could even run a rudimentary and simple test to do comparative insulin response to a known amount of carbs to see if my insulin response is improving over time (using the period of the curve). I would love to get an alert that hey, we think your glucose level shot up a lot (don't care how much) so that I can remediate it through exercise then and there and avoid that food or timing going forward.

Really hoping the people in Medtech don't make perfect the enemy of good in this case. Although maybe what you listed would still be blockers for even getting general glucose curves. I've been planning on getting a CGM for at least a few months to achieve all of this, but it would be great to just have it in a watch or other simple wearable.

With something like Starship I wouldn't be surprised to see SpaceX cheaply provide a starship approaching end of life to a scientific mission. With cheaper and readily available launch opportunities we could see deep space missions that utilize larger amounts of probes manufactured more cheaply that have much less longevity (die after a year of data collecting) but can do a greater amount of science over their shorter lives. Essentially, using a large launch vehicle like starship as a mothership until they get to their destination. Reducing the need for RTGs.

They estimate that 75% of the ocean trash in the Great Pacific Garbage Patch is from fishing boats.

Of course, but the average Joe does not want to wear ear protection when running their laptop. Nor do they want the battery to last 40 minutes or have it be huge brick, or have to pour liquid nitrogen on it to not get it to not thermal throttle.

Apple innovated by making chips that fit the form and function most people need in their personal devices. They don't need to be the absolute fastest, but innovation isn't solely tied to the computing power of a processor. It make sense that Intel excels in the market segment where people do need to wear ear protection to go near their products. If they need to crank in an extra 30 watts to achieve their new better compute then so be it.

We don't know the specifics of the conversations between Apple and Intel. Hopefully for Intel it was just the fact that they didn't want to innovate for personal computing processors and not that they couldn't.