US scientists find potentially habitable planet near Earth - <AUTHOR> http://news.yahoo.com/s/afp/20100929/sc_afp/usastronomyplanet_20100929210707 <comment><USER2> Phil Plait just posted a writeup about this: [http://blogs.discovermagazine.com/badastronomy/2010/09/29/po...](http://blogs.discovermagazine.com/badastronomy/2010/09/29/possible- earthlike-planet-found-in-the-goldilocks-zone-of-a-nearby-star/)

<comment><USER3> His write up is far more suitable for the HN audience, has plenty of science, grains of salt and uses the very scientific word "probably" a lot (that isn't a joke).

<comment><USER4> _His write up is far more suitable for the HN audience, has plenty of science, grains of salt and uses the very scientific word "probably" a lot (that isn't a joke)._

I agree. I submitted the link fully expecting that it would simply vote up someone else's submission, but apparently it hadn't been submitted yet. Now it has been: <http://news.ycombinator.com/item?id=1742200>

</comment></comment></comment><comment><USER5> Voyager 2 (man's fastest space craft) is traveling 35,000 miles per hour / 60 = 583 miles per second.

187,000 miles per second equals the speed of light.

Light can travel 57,395,520,000,000 miles in one year (roughly 5.7 trillion miles).

So, in 21 years that would equal 57,395,520,000,000 miles x 21 years, or roughly 120 trillion miles.

Thus, if Voyager 2 was our space craft we'd have 583 miles per second x 60 seconds x 60 minutes x 24 hours x 365 days x 21 years to get 386,095,248,000 billion miles towards our new planet.

There is a huge gap between 386 billion and 120 trillion miles, like 311 times.

That means it would take us roughly 310 x 21 years = 6528 years to get there using current technology.

I just don't see us going there as being very practical.

\</comment><comment>--

EDIT: I'm getting down voted for doing the math! Seriously?

<comment><USER6> Wow. I'd never thought I'd see Voyager 2 being cited as the state-of-the-art.

<comment><USER7> We just need to put our heads together and create a warp drive. Come on people, let's do it. It must be possible! "Warp drive by 2030" - next Obama speech.

</comment></comment></comment><comment><USER8> The fastest space craft we have (twin Helios probes) travels at 250 000 km/h

(20 light years) / (250 000 km/h) = 86,340 years

<comment><USER9> That was my first thought. Sounds close but is unimaginably far away. I keep flipping back to the difficulties for stone-age man to cross the english channel, and the exponential speed of technological progress, and yet I still can't see it happening for a long, long time. But 100 years ago we couldn't fly the length of a football field, now we do it as a matter of routine.

Thus my mind is a flip-flopping mess of 'can't be done', 'you never know', 'can't be done'... you ge the picture.

Then I start worrying about technological progress being lost through war/politics/religion and having a library of Alexandria moment and having to start all over again.

<comment><USER10> English Channel: until about 9000 years ago you could walk across. Stone age people had boats too.No historical analogy can come close to interstellar distances.

<comment><USER9> Fine ; Atlantic Ocean to stone age man. In hindsight, sure, boat development was coming along and it was only a matter of time. But you take the average stone age man, and tell him that you can sail (or fly) across the ocean one day to another land - that's the sort of leap of faith we require now to believe in interstellar travel. Sure the distances are bigger than any analogy, but distances are just a function of speed. At the moment, it can't be done, so we have to rely on some nebulous concept of 'in the future the technology will be developed'. I want to say 'can't be done' but such challenges continually get overcome by the relentless march of technology. So I have to say 'can't say can't'. Thus it messes with my head.

</comment></comment></comment></comment><comment><USER11> This is exciting, if not surprising, news. We knew that potentially habitable planets must be out there somewhere, but I'm still very excited that we now know where the first one is.

Expect to hear the name "Gliese 581g" a lot more in the future, because this will be the standard hypothetical nearby life-bearing system people will be talking about for years to come. Habitable and only twenty light years away?

The tidally locked nature of the planet is a bit of a bummer, though. If there _were_ water on the surface, I wonder what would happen to it. Will there be a liquid-water ring, or will the water inevitably wind up getting stuck on the cold side, never to remelt? Perhaps a constant system of glaciers flowing from cold side to hot side, melting, blowing to the cold side and snowing down again?

<comment><USER12> It's pretty unlikely this will remain highly talked about after Kepler releases its findings in a few months. Preliminary results show huge numbers of small earth-like planets. I believe they expect to find dozens or hundreds in the habitable zone. Kepler is really what everybody is waiting for and should completely revolutionize planet-finding.

<comment><USER13> Actually, the most interesting results won't be here til the second half of 2012, if you take the following [somewhat chauvinistic] criteria into account:

\- A really interesting planet orbits a planet similar to the sun.

\- The goldilocks zone around a planet similar to the sun puts it in an orbit radius of around 1 year (give or take 20% or so) because orbit period is a function of solar mass and distance.

\- It takes three occurances to be sure that a "dip" you see in light emissions is probably a _pattern_ rather than a _coincidence_. It's like colinear points on a plane: two points always make a line, but for three points to be on a line you're pretty damn lucky.

\- Kepler was launched in 2009.

So in the end of 2012 we'll have a list of (hopefully hundreds of) confirmed earth-like planets that orbit sol-like stars with a rotation period around 1 year. That is _awesome_.

</comment></comment></comment><comment><USER14> My first thought was "use big heat pipes to transfer heat from the hot side to the cool side".

<comment><USER11> Indeed, anyone living there would not have an energy problem at all.

</comment></comment><comment><USER15> "Time dilation would make it possible for passengers in a fast-moving vehicle to travel further into the future while aging very little, in that their great speed slows down the rate of passage of on-board time. That is, the ship's clock (and according to relativity, any human travelling with it) shows less elapsed time than the clocks of observers on Earth. For sufficiently high speeds the effect is dramatic. For example, one year of travel might correspond to ten years at home. Indeed, a constant 1 g acceleration would permit humans to travel as far as light has been able to travel since the big bang (some 13.7 billion light years) in one human lifetime. The space travellers could return to Earth billions of years in the future. A scenario based on this idea was presented in the novel Planet of the Apes by Pierre Boulle." - [http://en.wikipedia.org/wiki/Time_dilation#Time_dilation_and...](http://en.wikipedia.org/wiki/Time_dilation#Time_dilation_and_space_flight)

<comment><USER16> "A scenario based on this idea was presented in the novel Planet of the Apes by Pierre Boulle." — also The Forever War by Joe Haldeman: <http://en.wikipedia.org/wiki/The_Forever_War>

<comment><USER17> Also, A World Out of Time, by Larry Niven - where a ramjet pilot returns to earth, only to find it ruined and way too hot: <http://en.wikipedia.org/wiki/A_World_Out_of_Time>

</comment></comment></comment><comment><USER18> Sweet, it's only 20 light years away. A quick 10 month journey at warp 3.

<comment><USER19> <http://en.wikipedia.org/wiki/Time_dilation>

<comment><USER20> Clearly fleitz is assuming he'll be a passenger.

<comment><USER11> Talking about warp factors and talking about time dilation don't go well together, unfortunately. The Star Trek universe is, as best I can figure out, nonrelativistic.

<comment><USER21> This is a bit of hand waving (which is OK because we're talking about imaginary sci-fi constructs) but it was my understanding that since warp drive bends space _around_ you, you're not actually going anywhere near the speed of light, and therefore you experience time similarly relative to people at rest.

<comment><USER11> I'd have to see that on a Minkowski diagram before I believed it made sense.

<comment><USER22> Two words- Minkowski Compensators.

<comment><USER23> Just reverse the phase polarity in the coupler coils.

</comment></comment></comment></comment></comment></comment></comment></comment><comment><USER24> From [http://blogs.discovermagazine.com/badastronomy/2010/09/29/po...](http://blogs.discovermagazine.com/badastronomy/2010/09/29/possible- earthlike-planet-found-in-the-goldilocks-zone-of-a-nearby-star/)

"But perhaps the most interesting and exciting aspect of all this is what it implies. The Milky Way galaxy is composed of about 200 billion stars, and is 100,000 light years across. The fact that we found a planet that is even anything like the Earth at all orbiting another star only 20 light years away makes me extremely optimistic that earthlike planets are everywhere in our galaxy. 20 light years is practically in our lap compared to the vast size of our galaxy, so statistically speaking, it seems very likely it's not unique. I don't want to extrapolate from a data set of two (us and them), but if this is typical, there could be millions of such planets in the galaxy. Millions."

</comment><comment><USER25> Does anyone know if the "Message from Earth"[1] sent towards Gliese 581c can conceivably be received at this new planet?

If there is intelligent life in that system capable of detecting and transmitting signals of that form (NOT assuming that by any stretch), a response is due in ~2049.

While we're on that topic, wouldn't such a hypothetical civilization already have discovered other electromagnetic radiation from our system by now? Or does it have to be a focused high-power signal as this one?

[1] <http://en.wikipedia.org/wiki/A_Message_From_Earth>

</comment><comment><USER26> I find the idea of inhabiting a planet "tidally locked" to its star fascinating. I'd never heard of such a thing until reading that article.

<comment><USER27> IANAP, but it seems pretty unlikely that this would be possible, at least in any way short of living in underground bunkers. I would expect that either the atmosphere would boil off from the hot side (if there wasn't enough gravity to retain it), or the gravity COULD retain it in which case you would get constant world-wide hurricane force winds.

<comment><USER11> IAAP but I'm not so sure what would happen, it's nonobvious. I did find this short article, based on a more thorough research paper from 1997, suggesting it might be possible though:

<http://www.treitel.org/Richard/rass/tidelock01.txt>

 _In short, not only can such a tide-locked planet maintain an atmosphere, but it might even be habitable over much of its surface, with an active water cycle and maybe even a near-breathable surface._

<comment><USER27> That is really cool. Thank you for the correction, and for the article.

</comment></comment></comment></comment><comment><USER28> This was announced a year or two ago, right - is there anything new there?

EDIT: OK, that was Gliese 581 C. This is the new best hope.

</comment><comment><USER29> Do you guys think we'll come up with a catchy name for this planet (or future "habitable" planets discovered?) Any idea how that naming process would work?

I can't imagine seeing "Gliese 581g" in headlines for years to come.

<comment><USER6> How about 'Tarsonis'?

<comment><USER30> Bipolarland would work too. It literally has a split planetary personality.

</comment></comment></comment><comment><USER31> It's amazing to watch the increasing habitability of newly discovered extra- solar planets. Remember a few years ago when a super jovian was an exciting discovery? Sure it was an easy assumption: planets ought to be common, if our system had 9 (yes back before poor pluto was demoted). The spector of the anthropic principle was always there though. Now, to see the discoveries mount - as fast and earthlike as our instruments are capable? That's exciting. Hell, 20 light-years? That's not so far away from the planned orion interstellar trip.

</comment><comment><USER32> "The planet is tidally locked to the star, meaning that one side is always facing the star "

How is the gravity about the same as earths if the planet does not spin, or is the planet spinning at the same rate that it is revolving around it's star, like the moon. So I guess gravity does not just come from the centripetal force. Are there any other forces that contribute to planetary gravity? If not the planetary year should be very small.

...rambling

<comment><USER33> Gravitational force is dependent on mass, not how much an object is spinning.

<comment><USER32> So centripetal force is independent from planetary gravitational force...

</comment></comment></comment><comment><USER29> A couple more questions. Would the presence of a magnetic field affect habitability? If so how? How likely is a planet this size to have a magnetic field like Earth's?

Say we did colonize this planet, would be be able to launch crafts into orbit from the surface? It seems like our rockets can barely escape Earth's gravity?

</comment><comment><USER34> That is great, but have they determined whether or not it has unobtainium deposits yet?

On a serious note, how is it that the planet has 4 times the mass of Earth but the surface gravity is "the same or slightly higher" than Earth's?

<comment><USER35> > On a serious note, how is it that the planet has 4 times the mass of Earth > but the surface gravity is "the same or slightly higher" than Earth's?

It could be bigger than Earth: [http://www.wolframalpha.com/input/?i=surface+gravity+of+4+ea...](http://www.wolframalpha.com/input/?i=surface+gravity+of+4+earth+mass+and+2+earth+radius)

</comment></comment><comment><USER36> Time to blow this popsicle stand! So long, suckers!

</comment><comment><USER37> I wonder if we ll reach it on a speed-o-light craft or teleport to it?

</comment><comment><USER38> > Gliese 581g, has a mass three to four times that of Earth

> The surface gravity would be about the same or slightly higher than Earth's

I'm confused. Maybe it's way less dense than earth, so on the surface you're far from the center of gravity?

<comment><USER11> The density is unknown, but we assume it to be rocky because... well, at 2 Earth masses there's not much else it could be made of. It can't be ice because it's too warm, and it can't be gas because gas planets that size won't hold together.

But by my calculations a four Earth-mass planet with the same density as Earth should have gravity of about 1.73g. (using <http://www.ericjamesstone.com/weird_stuff/gravitator.htm>) Which is not _that_ similar to Earth gravity, but not too far off either, in the scheme of things.

<comment><USER39> That's a very cool calculator. I tried to work out the math based on sphere volume: V=4/3 x PI x R^3.

      Earth Mass   Radius   Surface Gravity
        1X         6378km        1.00g
        2X         8035km        1.26g
        3X         9198km        1.45g
        4X        10124km        1.59g
        5X        10906km        1.71g

If it's 2X or 3X, it's just adding 30% to 40% body weight. For 4X or 5X, it's like adding 100lb to an 150lb body. We have plenty of people in the 250lb to 350lb range and they have no problem in mobility. Human body can handle the load. It might still be helpful to have exoskeleton help.

<comment><USER11> You'd probably still have issues if you tried to live there. Your legs can support twice your body weight if they need to, but can your neck support a double-weight head? Human spines are already pretty under-spec for their task, so people living in 2g gravity would probably suffer from a lot more back problems.

It's a pretty small-beer problem on the scale of colonise-another-star-system problems though.

<comment><USER40> Not to mention that large humans do take time to become large. A 200 pound man doesn't wake up one day weighing 340 pounds. Yes, a human body can adapt to it, massive health problems notwithstanding, but that doesn't mean you can step off a space craft into that situation. To say nothing of doing so after a multi-generation trip through bone- and muscle-wasting space.

</comment></comment></comment></comment></comment><comment><USER41> This is old news - James Cameron already made a documentary about this place.

edit: My point here, not well made, was that the potential of a discovery of this magnitude, i.e. a virgin planet capable of sustaining humans etc will eventually be exploited and ruined much the same way we have done to earth. The earth or this new planet is not the problem, but the way we exist on it.

<comment><USER42> If you were meant to live in perfect harmony with nature, you'd be a tree.</comment></comment>


Do Lawyers Make Better CEOs Than MBAs? - <AUTHOR> https://hbr.org/2017/08/do-lawyers-make-better-ceos-than-mbas <comment><USER2> What was it they said about article names that have click-baity names that end in a question mark? Something about "the answer is no, don't click the link."

By the by these are pretty much Disney-villain level options here, either an evil litigator who sues for everything or a man who does nothing but raise cash for the purpose of raising more cash.

</comment><comment><USER3> Because of course we can only choose between a rule-bound shyster and a parasitic financier. Sad state of society when those are the two most common choices. Either guide the corporation through the twisty maze of litigating your way to the top, or financialize everything.</comment>


Two hackers get kicked out of Hack the North for clock bomb jokes on Facebook - <AUTHOR> http://news.mlh.io/when-jokes-go-too-far-09-19-2015#comments <comment><USER2> It appears that the manufacture of offense is a growth industry. Booming, in fact.

</comment><comment><USER3> That's worse than arresting a kid for a clock you think is a bomb.

Also, whenever this kind of thing happens, people claim that "someone didn't feel safe". I don't believe it for a second. When you have to lie to justify something that tells you that you're in the wrong.</comment>


Cardiogr.am – Heart Rate Analytics for AppleWatch and AndroidWear - <AUTHOR> http://smrtwat.ch/cardiogrm

<comment><USER2> Any plan on supporting fitbit ?</comment>


Update on T-Mobile Network Issues (postmortem) - <AUTHOR> https://www.t-mobile.com/news/update-for-customers-on-network-issues <comment><AUTHOR> "The trigger event is known to be a leased fiber circuit failure from a third party provider in the Southeast. This is something that happens on every mobile network, so we've worked with our vendors to build redundancy and resiliency to make sure that these types of circuit failures don't affect customers. This redundancy failed us and resulted in an overload situation that was then compounded by other factors. This overload resulted in an IP traffic storm that spread from the Southeast to create significant capacity issues across the IMS (IP multimedia Subsystem) core network that supports VoLTE calls"

I find it interesting that rerouting telephony data was enough to take down the system. I guess the event was something similar to when a small ISP breaks their BGP and routes the entire internet (or a large chunk) through a network that can not handle it?</comment>


The ultimate Dilbert moment: 100% Customer Dissatisfaction - <AUTHOR> http://blog.supportbee.com/2011/05/06/the-ultimate-dilbert-moment-100-customer-dissatisfaction/

<comment><USER2> Hehe =)

That said, a software system which sorts and analyzes customer complaints based of language recognition could provide a lot of value.

Having it send automated, keyword based responses, probably not the best idea, though.

</comment><comment><USER3> Never forget: your customers will advertise your business for free, _whether you want them to or not_.</comment>


Reinventing HOTorNOT, Part II - <AUTHOR> http://james.hotornot.com/2007/07/reinventing-hotornot-part-ii.html

<comment><USER2> Seems like they're trading in a simple business model (give customers what they want and charge them for it) with a complicated one (try to give customers what they want while trying to charge advertisers.)

</comment><comment><USER3> They're targeting the most vapid of users with a concept designed for marketers first and users second. It may be profitable but it just seems so unbelievably boring.

</comment><comment><USER4> sigh - expressing one's individuality by splattering brand logos all over one's profile? Perhaps some teenagers will actually fall for it.

Fun application: calculate a profile's "individuality" (ie how many people in the world have tattoed themselves with the same brands as you).</comment>


Pegasus Mail - <AUTHOR> http://www.pmail.com/ <comment><USER2> Thunderbird also seems to be facing a massive rewrite.[0] Are there any good FLOSS, local (with a local mail store, if desired), cross-platform, secure (with security protocols implemented) email clients that support standard features and have a reliable future? And any of those that I could give to non-technical end users?

I know the names of a few, but I haven't tried them: Sylpheed, Claws, Evolution (cross-platform?), Kmail (cross-platform?), N1 by Nylon, MailPile (FLOSS?) ...

[0] See this discussion, for example: [https://mail.mozilla.org/pipermail/tb- planning/2017-March/00...](https://mail.mozilla.org/pipermail/tb- planning/2017-March/005298.html)

<comment><USER3> A friend of mine swears by [https://en.wikipedia.org/wiki/MH_Message_Handling_System](https://en.wikipedia.org/wiki/MH_Message_Handling_System)

</comment></comment><comment><USER4> There's a developer news update for April 2017:

[http://www.pmail.com/devnews.htm](http://www.pmail.com/devnews.htm)

<comment><USER5> I really wasn't sure whether this post is an April fool's joke at first. Besides the WaP lightheartednes, the list of things he has already done sound like a _huge_ amount of work. Assuming he just ricked me with the date, what a trooper! Kudos

</comment></comment><comment><USER6> Unrelated but their website is remarkably well rendered in w3m.

[http://imgur.com/a/QOdMd](http://imgur.com/a/QOdMd)

<comment><USER7> If I had just seen that, I would have just assumed that _was_ the site!

</comment></comment><comment><USER8> Check out the email etiquette page [http://www.pmail.com/etqtte.htm](http://www.pmail.com/etqtte.htm)

<comment><USER9> "This will often help a postmaster recognize the real recipient of the message if the address is invalid."

There were services where humans actually sometimes tried to manually route an email?

<comment><USER10> You must be new here. firstname.lastname@example.com used to be working mailboxes. :)

EDIT: Ah, [http://www.faqs.org/rfcs/rfc2821.html](http://www.faqs.org/rfcs/rfc2821.html) states it should still be so.

<comment><USER11> See also the USENIX Short Topics in System Administration booklets, specifically "#15: Internet Postmaster: Duties and Responsibilities".

Sigh.

<comment><USER10> Cool - I just tested sending an email to postmaster@ my Fastmail domain, and they had indeed implemented a redirect to my username@. Smiles :)

</comment></comment></comment></comment></comment><comment><USER12> Heh, I still use Pegasus as my primary email client. Not so much because I really like it (though I can't say that I dislike it, as I've gotten used to it in the past 21 years), but mostly because I haven't found any other email clients that are better. Pegasus Mail is quite slow with IMAP even on a LAN and has some weird issues, but its mail filtering ability is really flexible. I've tried Thunderbird, Sylpheed, Outlook, Outlook Express, even Windows Mail and Apple Mail, and every one of those annoys me no end. For me, Pegasus Mail is not necessarily the best, but still the route of least annoyance.

<comment><USER13> give mailmate (osx) a spin, has nice filtering options

<comment><USER12> Thanks, I'll give it a try. I only use Mac OS at work, though, where my needs are a little different.

In the documentation for MailMate, I don't see the kind of filtering that I use with Pegasus Mail. This is one of the things I miss most in all other clients: I prefer to collect the mails in my inbox, without filtering. When I close the inbox, Pegasus runs a large ruleset with hundreds of rules, moving all the read mail to archive folders and leaving the unread mail in the inbox. I've not yet seen any other client capable of doing this.

</comment></comment></comment><comment><USER14> >The other major issue with Pegasus Mail is that it uses a proprietary third- party product as its core editor, and I would not be able to take that product with me into an Open Source environment.

Portability issues aside, that's a questionable foundation.

<comment><USER15> Yeah, it seems a bit short sighted that he didn't just grab one of the many free, open source, fully featured cross-platform text editors available in 1993.

</comment></comment><comment><USER16> Do a view source on that page to get some lovely 90's era HTML nostalgia. (If you're wondering why the in-page menu behaves like that... it's because they're images, swapped out for their hover state with JavaScript, with the off state actually an animated GIF!)

<comment><USER17> No CSS! Fantastic

</comment></comment><comment><USER18> Ha!!! That header image has been there for a while, I can tell you [https://web-beta.archive.org/web/20000510165803/http://www.p...](https://web- beta.archive.org/web/20000510165803/http://www.pmail.com/).

If I recall things right this had a built in email list management. I had acquired a CSV of all the student and staff addresses. While I was goofing around with this I accidentally sent out a to a really strange email to everybody (but it kind of looked like it was addressed to them because everybody was in BCC). Next day at school was terrible.

</comment><comment><USER19> Still Windows-only. Too bad the author didn't take the opportunity of rewriting it into portable code.

<comment><USER20> Nobody's happy until everything's an Electron app.

</comment></comment><comment><USER21> Working at a technical university in germany right now. Our secretary is still using pegasus.

</comment><comment><USER22> Pegasus was my introduction to email in the 90's. Glad it's still around.

</comment><comment><USER23> I used pegasus, back in the 20th century.

</comment><comment><USER24> I distinctly remember David Harris at Auckland University, and I think this is the same guy who wrote PegasusMail. Nice, unassuming geeky dude. Surprised this is still working.

</comment><comment><USER25> Wow, Pegasus is still a thing?

<comment><USER26> Apperantly. But it's outdated. I moved to Eudora. Never looked back.

<comment><USER27> LOL, indeed. I ran an ISP in the 94-99 era, and we used to distribute Pegasus for the first couple of years.

But it was buggy and not very friendly, so we migrated to Eudora, and indeed users never looked back.

<comment><USER28> Yes but Eudora was quite heavy. 486 owners did not really have a choice, but Pegasus was quite cool on it. I have fond memories of it.

</comment></comment></comment></comment><comment><USER29> We had pegasus in college at in about 1996 ... everyone went mad using it basically as an instant messenger clogging up all the computer rooms.

<comment><USER30> We used it as well. One of the kids in my year searched for "e" in the address book, and then sent a mass email saying "You have an 'e' in your name". He repeated that with all the vowels and some other letters, and then the server crashed.

</comment></comment><comment><USER31> Wow, that's a blast from the past...

<comment><USER32> I know, right? That was the email client my dad used back when we first got dialup in the early 90's.

<comment><USER33> Pegasus is so old it was around before people started saying, "I know, right?"

The English language has actually changed during Pegasus' lifetime.

</comment></comment></comment><comment><USER34> Is this the same as PGMail? I remember using PGMail back in elementary school on what was probably Windows 1 or something. It was all blue and you would Ctrl-Enter to send a message.

<comment><USER35> > you would Ctrl-Enter to send a message

Don't most email clients have that? That's how I send emails on Gmail and Outlook.

<comment><USER34> Sorry - that was the only way to send the message if I remember correctly. It was like 25 years ago.

<comment><USER35> Hah! It's cool to know that a "trick" I picked up a couple of years ago was the standard method a couple of decades ago.</comment></comment></comment></comment>


Ask HN: How much would you pay for something like Calibre that Doesn't Suck? - <AUTHOR> <comment><USER2> If you mean "e-book library manager", I wouldn't. I don't like being tied to whatever idea some software has with regard to managing my _files_ that contain e-books.

</comment><comment><USER3> i'd maybe pay <=$10 for an awesome _reader_. i can manage the files myself.

<comment><AUTHOR> There are lots of existing readers, and I didn't think there was much to displaying that content.

What could be better about them?

</comment></comment><comment><USER4> The font or the ebook software?</comment>


Hospitals pledge to fight admin price transparency plan in court - <AUTHOR> https://www.healthcaredive.com/news/hospitals-pledge-to-fight-trump-admin-price-transparency-plan-in-court/567474/ <comment><USER2> I spent 45 minutes at the hospital where I was to get a lab test done, trying to get a quote for said test.

Prescribing doctor didn't know the cost. Lab tech didn't know. Billing department told me I needed a procedure code. Lab tech who was ready to draw blood couldn't tell me the needed code even after spending five minutes at a computer looking for it. Prescribing doctor gave me the code. Called back billing. They will call me back in 2 to 5 days with a quote. Weeks later, I've yet to hear from anyone.

This was at The Ohio State University Wexner Medical Center.

<comment><USER3> I was in Japan two years ago; got pneumonia and needed antibiotics.

Went to a hospital with no insurance and no appointment. I was being seen by a doctor within 30 minutes. Doctor wanted to do some additional labs just to rule other things out, but _he_ was worried that it would be expensive for me given the lack of insurance. He called up billing with me still in the room and had a price within a couple minutes: ~$70 USD.

Ultimately I left the hospital after being seen, getting chest xrays, the additional labs, and antibiotics in hand. No insurance and I paid less than ~$160 USD.

<comment><USER4> Exactly the way it works in a SE Asian country I grew up. The private and public hospitals have price quotes on different procedures and it's for everyone to see. The comments above using Boglehead's quote as a justification of why medical pricing has a lot of variance is mostly a lie. My wife, who is a doctor trained in our home (SE Asian) country and is doing her residency in the US, and I were just laughing at the fact that it's much, much more expensive to get an X-ray here in the US than it is in our country (which costs ~$4 at most). Here, there's no price list for procedure as simple as taking an X-ray.

Hospitals, doctors, insurance companies and pharma companies are all scamming the US population. Every evening, my wife and I watch TV (WNBC to be exact) and we see many commercials from hospital networks, insurance companies and drug companies. This reminds us everyday that medicine and healthcare is commercialized to the max in this country and the only way from here is downhill. We both don't hope to retire in the US; when we grow old, we will go back to our home country and live there in the hope of getting much more affordable (and yet, of more or less similar quality) medical treatments.

<comment><USER5> Have you seen radiologist salaries?

It's a scam, Jim.

There are four pigs at the trough of US health care:

Insurance Device/Drug Lawyers Doctors

Everyone points the finger at other people and desperately fight to maintain their bloated share of the bloating pie.

Unfortunately doctors are not your friends in hospitals. They are trying to get billing.

<comment><USER4> Indeed! As she was applying for residency programs, my wife briefly entertained the thought of becoming a radiologist because boy, they made a load of money for 8am-2pm work! We both are 100% self-aware that healthcare industry has a lot of bad actors including doctors, pharma companies, hospital admins, lawyers and pretty much everyone involved.

If residents cry about 60+ hours/week of work during the first year residency, I don't pity them much. First of all, the hours aren't really that bad even for a hospital in metro NY area (speaking from my wife's residency experience so far). In our home country, residents have it worse; my wife had night float EVERY THREE DAYS over there. In the US, it's at most four times a month! Second of all, the "grueling hours" are for the first year of residency (in fact, during those hours, there's not much happening especially in night floats, so you can get decent sleep) and after that, things got much, much better. Sacrificing just one year and paying exorbitant exam/school fees--in the region of ~$250K total--to make $250K as starting salary is TOTALLY WORTH it. If any of the doctors complain that they are debt-laden, they are either fiscally irresponsible or are simply exaggerating. They can repay $250K debt + interest in less than 5 years if they really want to. Of course, it's much easier to use these (debt and hours/years sacrificed) as excuses to justify their pay.

If the doctors are true and honest, they should be advocating AMA to relax the residency and medical school requirements. No more than five years total (no undergrad necessary) is needed to treat garden variety problems. Then each specialty/fellowship can take however long it needs to take. But AMA and its leechers (KAPLAN, ECFMG, USMLE, FSMB, etc.) won't allow that because they make loads of money from exam and preparation fees. Everything about healthcare is business now and whether it is good or bad depends on one's moral compass (and how strongly one feels about capitalism).

<comment><USER6> "advocating AMA to relax the residency and medical school requirements"

People talk about the constriction of supply of doctors, but aren't NPs and PAs doing everything these days anyway?

</comment></comment></comment></comment></comment></comment><comment><USER7> I'm being offered $550 by my insurance in "gift cards" if I use certain facilities for any MRIs or other diagnostics. I think that shows just how wildly variable different locations charge, and how much they get away with.

I'd love to see a published price list for standard procedures, because I think hospitals have become too used to being cash cows for administrators and CEOs. This isn't to say I think nurses or doctors are overpaid or underworked, or don't deliver good care. I just wish that people in the USA could get good healthcare without having to claim bankruptcy.

I really miss the NHS and Bupa private insurance in the UK. NHS was great for so much stuff, but when I needed multiple surgeries on my leg metalwork, I chose to use private health insurance. This let me have the same consultant as the NHS hospital, same surgeons, but in a smaller "fancier" hospital that took really good care of me. What's funny to me is that extra private insurance was just a few pounds a month, and nothing at all like the thousands we spend here in the USA.

<comment><USER8> > This isn't to say I think nurses or doctors are overpaid

The probably are. Clearly hospital executives and administrators are raking in most of the money, but we can't sit here and pretend that caregivers don't directly benefit from such an arrangement as well.

There's a reason urgent care centers and small clinics pay their doctors less than most of us make, or skip employing doctors at all in favor of nurse practitioners, and their nursing staff makes ~1/3 what they would be earning in a hospital setting. Labor is expensive; specialized labor is even more so.

<comment><USER9> > skip employing doctors at all in favor of nurse practitioners

Hold up. I hope you're not being negative on hiring NPs. As someone who is in favor of NPs (and knows many NPs), they provide excellent primary care and hiring them can help bring down the overall cost of healthcare. I say we should teach and hire MORE NPs to provide cheaper primary and preventative care, not blame clinics for hiring them.

<comment><USER10> This, and exactly this. NP's are great for the run-of-the-mill sicknesses and minor injuries that most adults and children get. In conjunction with a PCP, they provide excellent primary care even for more complicated patients.

In addition, specialist nurses are a great addition to a specialist's team. I don't see a neurologist all that often, but I have checkups with one of the team of wonderful nurses at the office, some of which specialize in the disease I have. It works out wonderfully and allows the specialist to take care of more patients and still provide pretty wonderful service.

</comment></comment></comment></comment><comment><USER11> The previous administration had a similar effort that failed. I hope that this effort is successful.

>"For instance, it could allow one provider to follow and match the prices of the other provider (like two gas stations across the street from one another who face no other competition)," Garmon said.

I understand this argument, but I think they underrate how much people are willing to shop around when they actually have prices to use as a metric. I would be willing to travel to get a cheaper hip replacement if I actually know what the local price is, rather than being surprised by it every time.

<comment><USER12> I'd pay more for quality. If I knew hospital X is better at hip replacement I'd pay extra to go there. Of course how much extra I'm not sure, and I'm also not sure how you compare hip replacement quality like that.

It is only emergency rooms where I don't get a choice - if you need an emergency room close is important.

<comment><USER13> > It is only emergency rooms where I don't get a choice - if you need an > emergency room close is important.

i feel like the folks on here peddling this line have not ever spent any time watching who comes through an ER.

most of the people who go into an ER aren't dying, or screaming in pain. they've just got a problem that can't wait until urgent care opens up again in the morning. or they need something done that urgent cares aren't equipped to do (fancier diagnostic equipment; whatever). they've got plenty of time to consult with a hypothetical "find a cheap/good ER near me" app.

<comment><USER14> I think lots of people say "ER" for trauma center.

<comment><USER15> I think lots of people say "ER" for "ED" Emergency Department became the most common term about a decade ago and Emergency Room faded from building guides and hospital documents.

<comment><USER14> Either way most don't have trauma centers, in SF I think only SF General is the only level 1 trauma center although some of the people also rotate through UCSF's ED.

<comment><USER15> Yea, very true. Up here in Seattle I believe we are in the same boat, a single level 1 trauma center.

</comment></comment></comment></comment></comment></comment></comment><comment><USER16> Of course doctors and hospitals don't want price transparency. That would create pricing competition, which would drive down consumer prices, lower profit margins, and force them to become more efficient. Price transparency is one of the key elements of the highly successful Singapore healthcare system. Add in universal tax-free (or tax-deferred) Health Savings Accounts, and we could not only improve the US healthcare system but also help more Americans save for retirement and build wealth. There's no excuse not to try simple regulatory solutions before committing to a massive government takeover. I hope we get bipartisan support for price transparency.

<comment><USER17> > doctors and hospitals don't want price transparency

Well, I do want price transparency - IF it works the way they promise. It's hard for me, as a programmer, not to draw parallels to every employer's expectation that I should be able to listen to them describe a software problem and quote them a timeframe on the spot (which, of course, they'll then try to "negotiate" down). On the one hand, as a non-medical-professional outsider looking in, it seems to me that _of course_ they should be able to say ahead of time how much a cataract removal surgery should cost, they've done it hundreds of times (I hope). On the other hand, I know how much variability occurs in software projects and how little of that is trivially predictable.

On the other other hand, I can't for the life of me imagine any possible reason why they can't say EXACTLY how much an MRI will cost before they do it.

<comment><USER18> Yeah but come on. It's one thing to program something with nebulous requirements.

The cost of the X-ray machine is known. The cost of collecting X-rays can be calculated deterministically.

The only thing similar to programming is trying to diagnose a rare disease or tricky condition. But for run-of-the-mill deterministic procedures, the cost should absolutely be known.

<comment><USER17> Well, I think so too, but - just to play devil's advocate - many of my former bosses would almost certainly say something like, "the cost of the web server is known. The cost of collecting the web traffic can be calculated deterministically. We're just talking about a website here, the cost should absolutely be known."

<comment><USER19> The prices don't change in a supermarket if you edit your shopping list, eh?

A hospital can't predict everything a patient will need (their shopping list), but they should be able to account for the cost of each procedure/drug/test/bandage/etc... eh?

<comment><USER20> The problem is a lot of that isn't deterministic. There's a lot of "If Then" statements that aren't easy to price ahead of time.

Like, your procedure is very different if your doctor decides they could use a specialist consult.

<comment><USER19> > your procedure is very different if your doctor decides they could use a > specialist consult.

The necessity of the specialist consult may be unexpected, but it doesn't follow that the cost of it should be secret or obscure, eh?

The intrinsic unpredictability of health care isn't an excuse for additional unpredictability of cost.

<comment><USER20> Agreed, but a lot of people interpret "transparency" as "Your knee surgery will cost $4500", not a flow chart of possible costs.

<comment><USER19> Sure, but that's their problem, eh?

</comment></comment></comment></comment></comment></comment></comment></comment></comment><comment><USER21> We need price transparency!

Went to a quick care the other day because of a flu that would not go away, was seen and diagnosed with bronchitis in less than 5 minutes. The quick care billed my insurance $1,840, which they talked down to $300, and had me pay $115. What?

<comment><USER22> From the UK. Health care cost stories in the US seem incredibly dreadful. Hard to grasp how a huge power like the US can't get itself around decently-priced healthcare.

<comment><USER12> It is incentives. Most people get their heath care from insurance, which is subsidized by their job. I can legally buy my own insurance, but it will cost a lot more than what I pay through work so of course I don't. My boss wants me to keep working, and so high medical costs keep me from quiting to start my on competitive business. I can live for a couple years on cheap food and little else, but I need at least emergency health coverage as a just in case.

Lack of transparent prices is one tool the system has to ensure I don't have any other option.

<comment><USER23> > I can legally buy my own insurance, but it will cost a lot more than what I > pay through work so of course I don't.

Which is entirely frustrating too. This only happens because employers only subsidize specific health plans, instead of letting the employee spend that money on the health plan that they deem best for themselves. Isn't that ridiculous? Why would my employer care what health insurance I get anyways, they don't know my health situation. I should be able to use the money they spend on my health insurance however I want!

<comment><USER24> > Why would my employer care what health insurance I get anyways,

Two reasons.

One is that it gives people pause before leaving for another job, as they might have to figure out new healthcare providers.

Second is that it gives larger employers the benefit of paying less for insurance, especially if their employee group consists of younger healthier white collar workers. It also helps them because businesses can pay for health insurance with pre tax dollars, which helps compete against small businesses that can't afford to pay for health insurance for employees, whose employees have to pay for their own health insurance with after tax money.

</comment></comment></comment></comment></comment><comment><USER25> The Econtalk podcast latest episode is about a surgery clinic in Oklahoma that has full price-transparency policy. I am outsider to US healthcare system, but after listening to it, it seems hardly controversial what would be the right thing to do here:

[https://www.econtalk.org/keith-smith-on-free-market- health-c...](https://www.econtalk.org/keith-smith-on-free-market-health-care/)

<comment><USER26> Texas Free Market Surgery offers a near identical business model based out of Austin.

Green Imaging (who I used to work for) offers cash-pay imaging services for all modalities across Texas, and are in the process of expanding nationally. Because they contract with existing imaging facilities, they don't post prices publicly to avoid poaching patients, but if you call in or message them through the website, they'll give you an up-front price for any service they offer.

For family practice/general medicine, there's a business model called "Direct Primary Care" that offers you unlimited primary care services, usually for a cost of $50-80/month, and most big cities will have a few providers following this model.

A lot of progress is being made in terms of transparent/affordable outpatient and day surgery services, but it's hard to get spread the word because the current healthcare model is so entrenched.

<comment><USER5> The South is almost a total loss when it comes to medical fraud. Combined with the more unhealthy population, it is just a boondoggle.

There's a reason the Tricare South contract is so coveted.

</comment></comment></comment><comment><USER27> This is IMO the "simple solution" to healthcare - nothing will bring down healthcare costs faster than the following

\- be allowed to choose

\- know how much something costs

\- pay some of the cost themselves (co-pay, health savings account) etc.

<comment><USER28> Americans already have co-pays, deductibles, coinsurance and whatever other terms the insurance industry has cooked up, with no visible effects on costs. In addition to your other changes the following would also help:

\- Allow competition. Don't give hospitals the power to veto new hospitals in their area.

\- Disallow regional consolidation of hospital systems and medical practices. Regional monopolies are bad.

\- Increase resident slots and supply of doctors. Make foreign degrees easier to transfer to the US.

\- Outright ban pharmaceutical advertising. Nothing whatsoever of importance would be lost and all the pharma companies would save millions every year.

<comment><USER29> There's an argument to be made with respect to advertising to physicians, but not the general public. Doctors have limited time and they ought to know what meds are available somehow..

<comment><USER28> I thought that was called pharma marketing, not advertising. That too has had corruption and perverse incentives in the past. However, I did mean banning advertising to the general public.

Doctors have the knowledge and expertise to critically evaluate statements presented to them by marketing materials (whether they do so or not is a different story). The general public, modulo the odd autodidactic genius, largely does not. If someone from the general public wants this information, they are free to find it on the Internet. In fact maybe we could make it mandatory that any materials presented to doctors are also posted on the company's website for anyone to see.

</comment></comment></comment></comment><comment><USER30> Here in Canada, there is no price transparency whatsoever. Just when people are facing the stress and uncertainty of fighting a crisis like Cancer, they are given absolutely no inkling what their treatment will cost.

When a physician makes an appointment for you with a plastic surgeon to discuss reconstructive surgery... No transparency about the cost.

When they prescribe chemotherapy... No transparency about what the doses cost.*

When they schedule surgery... You don't have any idea if they'll pull in another nurse or surgeon during the procedure, and again... No transparency about cost.

\---

I feel icky making jokes about this. But seriously, price transparency is a perfect example of the "XY Problem."

America asks, "How do we make paying for health care an efficient and transparent marketplace," but the correct answer is, "If what you want is a functioning, civilized country, stop trying to make healthcare a marketplace."

[https://en.wikipedia.org/wiki/XY_problem](https://en.wikipedia.org/wiki/XY_problem)

\---

* Prescription drugs are still a quagmire in Canada. Basic chemotherapy is somewhat covered by various provincial drug plans, but if you're employed you usually rely on your employment benefits for prescription drugs much as Americans do.

Many of the things covered by employment plans are more convenient than those covered by the public plans. For example, the public plan may require a dose a day, while the product that only requires a dose a week is only covered by an employment plan.

But the bottom line is that if you aren't employed and can't afford chemotherapy, you will get treated.

<comment><USER31> There are shades of bad. The US health care system with price transparency is better than the US health care system without it.

The same procedure can cost 1,000x more if you go across town. It's been long reported that Hospitals mostly pull prices out of their asses. The health care problem in the US is not just a health insurance problem, it is also a health care provider problem. Even if you had a single payer system, pricing like this is insane.

<comment><USER30> What you say is true, but does not negate or discount what I said in any way.

Again, with the XY problem...

If someone asks for X, but really needs Y and there is a better way to get Y than to help them with X... Of course X is better than no X and no Y.

But that doesn't change the fact that Y is much, much better than X. And in the case of health care, it is not even close. Price transparency may lead to each person paying a little less, or at least being less stressed, but it still won't fix the fact that America has the most expensive system, with the worst outcomes, in the developed world.

So yeah, X is better than --X, and ++X even better than X, but that doesn't change the fact that Y is still the correct solution when you focus on the problem you really want to solve rather than making the incorrect solution slightly less incorrect.

\---

Also, IANAE, but I do not believe that in Canada, hospitals are permitted to have a 1000x variance in pricing. I think that for those things we socialize, the government sets the price.

<comment><USER19> I think you're right (profit motive and health care don't mix) but then how do you cut the Gordian Knot? I'm cautiously hopeful that price transparency might be a start.

<comment><USER32> Honestly? Stop electing people who scream that public health is a communist devil plot?

<comment><USER19> I'll see what I can do.

</comment></comment></comment></comment></comment></comment><comment><USER33> My uncle wrecked his motorcycle once. He ended up in a ditch unconscious.

Someone called 911. For what ever reason a life flight helicopter was then called and picked him up and took him to a local county hospital. He woke up there a few hours later. After they had already ran all kinds of tests. They had a large list of all the problems from busted spleen, broken bones, head concussion, etc.

After a day of rest in the bed, the only thing wrong was a sore ankle and some deep scratches on his face. He checked himself out and we went and drove him home. They sent a bill of $16,000 the next month to him. He asked why it was so high since the only thing they did was give him a helicopter ride and a bed to sleep in (none of which he consented to but of course hard to consent when you are unconscious).

He sent them a check for $16 which was the minimum amount required. He fully expected to pay $16 per month for the rest of his life, but they never sent another bill and he never asked... That was 15 years ago.

<comment><USER34> Confused, so they flat out lied about broken bones? Something doesn't seem right.

<comment><USER33> I think the term they used was "fractured"

<comment><USER34> Yeah, and my dictionary lists "bone break" as the 1st definition of that. I don't think it means anything else?

</comment></comment></comment></comment><comment><USER35> > Transparency is not going to work where there is no competition, Emily Gee, > a health economist at the left-leaning Center for American Progress, told > Healthcare Dive.

That's bs. I will drive to a further away hospital if it saves me $75 an hour of time spent...

(edit: clearly I'm talking about non-emergency here)

<comment><USER12> But it won't. Your insurance will pay for it either way, so you are spending an hour of your time to save your insurance $75 - which won't even be given back to you in form of lower premium.

<comment><USER35> > Your insurance will pay for it either way

This is an assumption based on a very good insurance package. Most have out of pocket co-pays . So yes, we have to gross it up by the co-pay percent and discount it by the Annual deductible limitt, but generally the point stands. If I can save enough money I might travel away from the monopoly. Until that data is transparently available I can't optimize that scenario w/ my own choices.

> which won't even be given back to you in form of lower premium

Systemically it will eventually if insurance companies are competing with eachother for your business

<comment><USER36> Sort of; in my experience, even with a high deductible health insurance plan, the insurance company's negotiated rates are still in effect. In other words, if a visit would be billed to an uninsured person at $200, but my insurance caps it at $100, then $100 is the price accepted by the doctor's office no matter if I'm paying because I haven't reached my high deductible or insurance is paying because I have a regular, not high deductible plan.

<comment><USER35> right, but now you're talking about in-network vs out-of-network rates. I believe should disappear with price transparency...

</comment></comment></comment></comment></comment><comment><USER37> We have obviously routed out a LOT of fraud by forcing the auto repair industry to change its practices to inspect -> quote -> customer decision.

I guess the question becomes this - is there so much fraud in this industry that we need to do this change?

Even if it's NOT fraud, have hospitals simply become used to charging anything they want because they have no competition?

<comment><USER38> The problem is you can't inspect -> quote -> customer decision with someone who's having a heart attack. Even if the person is lucid, they are unlikely to say no to any price if they're at death's door. No amount of competition changes the simple fact that health care is not a fungible service. CPR at facility A can't be exchanged for CPR at facility B if B is even a few minutes away.

Combined with the emotional state most patients are in (something other industries, like mortuaries, prey on as well) and you have a recipe for gouging even under ideal competitive regulations.

<comment><USER37> I don't see a problem with ambulance coming in -> charge them to the moon because if we don't do what we're going to do, they are going to die.

There's a problem with applying that logic to - hey I have a pain in my hand because I was rowing a boat today without warming up. Take this 800mg Ibuprofen. 3 months later $800. (So that's a true experience with my wife and rowing a boat)

</comment></comment></comment><comment><USER39> While publishing the negotiated prices for each procedure code would be interesting, I don't see how it would change much since it wouldn't necessarily be the price they would actually charge me, and it wouldn't help me know beforehand what sort of add-on procedure codes/bills were going to be part of my care.

The policy I would like to see is that patients should only be legally liable for costs that they sign off on up front (at least for most elective care). It never ceases to bother me that every time I go to the doctor I have no option but to give the hospital a blank check and have to cross fingers that they will not hit me a month later with ridiculous charges.

<comment><USER40> Eventually the published price will be close to the amount you are being charged. I would expect health care providers to stick with their promise to post the highest possible cost but as people being to use these prices to shop around (both these numbers are exorbitant, but this one is less so, etc.), I am confident they will abandon this gambit.

IMHO, it's kind of nuts they are even starting out with this argument.

</comment></comment><comment><USER41> This is why we need single payer and to abolish/greatly diminish private insurance. Hospitals and insurance companies continuously demonstrate the failed state of the healthcare market. Market-based healthcare will always be unworkable due to impossible to reconcile conflicting incentives.

</comment><comment><USER42> An interesting interview this week on Econtalk about price transparency. The interview happened before Trump's price transparency plan was announced but the podcast just made it up this week.

[https://www.econtalk.org/keith-smith-on-free-market- health-c...](https://www.econtalk.org/keith-smith-on-free-market-health-care/)

Some guy has been running a non-insurance based surgery center for years, the surgeons make more and patients pay less or so he claims. All prices are listed on their website. They claimed they don't change prices. If a doctor misses something and needs to do extra work their policy is that's the doctors fault for not doing enough due diligence beforehand.

He also claimed there are some perverse incentives like he claimed a hospital might bill an $100k but only receive $13k. But, they can claim a $87k loss which the government will partly reimburse. He further claimed that insurance companies often have contracts with employers where the employer is supposed to pay a percentage of the amount the insurance company saved for them. In other words, the insurance company will say "we managed to save you $87k on your $100k bill, pay us 20% of the savings" so they have an incentive to ask the hospital to charge more.

Note: I have no idea how backed up this is. Just passing on the podcast, hoping to see more knowledgeable feedback.

</comment><comment><USER43> The most salient issue is insurance providers being able to proclaim arbitrary hospitals as "in-network" and "out-of-network". My significant other claims that hospitals are now hiring contractors, who are always by definition "out- of-network". This hurts the career prospects of the contractor and lowers the level of care received.

And for nothing! Insurance should not be certifying which doctors you can and cannot see. That's for the medical boards to decide.

<comment><USER36> Yeah, if I go to an in-network facility, then they have an out-of-network provider walk into my room, how am I supposed to know? The same is true of labs. My wife had her blood drawn and sent to a lab every couple of years without issue until one year they sent it to a different lab unbeknownst to her. It was out-of-network and cost $800.

<comment><USER44> I've had good luck arguing with the insurance company on that kind of thing. It's worth a phone call.

<comment><USER36> It's been way too long now, but thanks for the tip. We called insurance and the doctor's office several times each to no avail. Insurance's answer was that we should sit in the exam room with an insurance representative on the phone to ask where each vial of blood is going and what for, then relay that to the insurance representative to give a verdict.

</comment></comment></comment></comment><comment><USER14> Yes, hospitals, that's the way to win hearts and minds.

Fortunately both parties seem to welcome this idea, to lesser and greater degrees...

<comment><USER45> Hospitals don't care about hearts, minds, or patient wellbeing for that matter.

You will be brought there and they will extract $8000 for a simple procedure. That's all that matters for them.

</comment></comment><comment><USER46> There should be a basic law of health care: no person is liable for a debt they incurred before they were presented with the price and had an opportunity to refuse. I'd give some amount of leeway for unconscious patients, but aside from that every single penny of expense should be agreed to up front. The absence of this policy explains a lot about how things have become so perversely broken.

<comment><USER47> Or we could just make healthcare a human right. No debt at all.

<comment><USER48> It's an interesting question. Health care is a human right. Therefore it must be free.

A prompt and fair trial is also a human right. Therefore legal help must be free.

Moving around, staying warm and basic hygiene - a lot of stuff sound like basic human rights, but very few argue that transportation, heating and sewer draining services should be free.

I think most people around don't mind paying for the service. They just want the prices to be reasonable and predictable.

<comment><USER49> I don't see any contradiction in what you are saying. Yes, they are rights and should be free.

They are not right now, but that's because we are operating in a world of a limited resources, but not because it is a right state of thing.

</comment></comment></comment></comment><comment><USER50> Price transparency is a losing battle.

Let's say they make prices transparent. You ask them about the cost of getting an X-ray done and they quote you $Number. You go and get an x-ray done and you're billed for $number plus a few extra thousand for any number of unknown costs.

Hospital billing is a lot like getting billed for internet/phone/cable etc. They'll throw all kinds of bullshit charges, ding you for not using certain things and more. Then you have to waste energy calling them up to talk with someone whose job is to get you off the line.

That's assuming you can even shop for your needs. If it's an emergency then you're screwed either way. The only change this would cause is that insurers and hospitals would adapt and figure out other ways to sneak in charges.

If you want to fix this problem at the core, then trying to make it more of a free market won't work. You need stronger oversight and control to keep things in check.

</comment><comment><USER51> Plug for Econtalk episode on exactly this topic - transparency in prices for healthcare: [http://files.libertyfund.org/econtalk/y2019/SmithKhealthcare...](http://files.libertyfund.org/econtalk/y2019/SmithKhealthcare.mp3)

</comment><comment><USER15> I think the bigger scam is how they break apart the hospital/doctors offices into separate companies. Now I'm not complaining how I go from one building to get blood drawn and a different building for the emergency department.

I'm complaining how I walk across the hallway in my doctors walled garden inside the building but when I enter that room, in his area, and get an x-ray that is a completely different company that bills me separately and I have to pay a different co-pay to.

</comment><comment><USER52> > Instead of helping patients know their out-of-pocket costs, this rule will > introduce widespread confusion, accelerate anticompetitive behavior among > health insurers, and stymie innovations in value-based care.

So people are too dumb to understand prices, and unlike any other economic system to ever succeed, knowing the value of a thing will DECREASE pricing competition.

I was waiting for the good argument on why this is a bad idea. Instead we got _that_.

</comment><comment><USER53> Additional anecdata: Enjoyed an extended honeymoon through Thailand, Singapore, and Malaysia in 2016 and my wife was bitten by a stray dog in rural Thailand early on -> 7 medical interactions involving post-exposure prophylaxis and rabies shots in all 3 countries over that next month. (She's fine BTW!). Price transparency was really amazing in all these places and I think it might be a single reform that's broadly ameliorative of the max- friction / painful experience of US healthcare. In each country, we basically called around, asked "do you have this shot and how much is it" and got a more or less straight answer, despite having some language issues everywhere but Singapore. Whole experience cost ~ $1k, including some visits for 2nd opinions to high-end private clinic in Singapore and we just gave up bothering with it on our US insurance b/c of deductibles and hassle.

</comment><comment><USER54> Doctors' wages have grown minimally ocer the last 20 years. Increased costs go to big pharma, 'not for profit' hospitals, and insurance companies, the "cartel". Meanwhile, the expense and number of years of training for high end docs increases. I am 57 and still did 4 years undergrad, 4 years med school, and 5 years postgrad. I did not do the 1 or 2 year fellowship now required for many radiology positions. Read the Proscan law suit about what happens when undertrained folks read imaging exams. It is not the shortcut needed to save healthcare. We can pay docs fairly if we get 80 percent of care away from hospitals where it costs 3 times more than it does elsewhere. Because hospitals employ or subsidize 70 percent of docs, most care happens there. That is really a huge part of the problem.

</comment><comment><USER55> I'm surprised there is no startup that sells you membership in offshore healthcare. If you want to do anything, you just jump on a short hop flight to a man made island in international waters and get healthcare. Or, coupled with a trip to Thailand. It would be disruptive and cheaper.

My wife is a doctor and last night she tried to renew her credentials at a major hospital network here. She could not, despite clear instructions, open the PDF locally to add her signature. I inspected the web view in chrome tools and see it is an awful Microsoft product behind the scenes.

This is the reason this attempt by Trump will never happen (I'm supportive even though I despise Trump). My wife's incentives and the hospital incentives are aligned, even though no one will admit it. Even if hospitals are forced to give price transparency, they will just go and buy a shitty solution from Microsoft (I'm using Microsoft as a placeholder, but it can be any large tech company who wants in on the action), who will be happy to certify it for the law. It won't work and the hospitals can blame Microsoft. Microsoft will lobby politicians to water down the law so they won't pay anything but a pittance if things don't work. Consumers will get continually screwed. The doctors and the hospitals will continue to make great money because they will still not have to admit pricing this way, with zero transparency, is the golden goose of healthcare and why costs are insane in the US.

</comment><comment><USER56> Right now healthcare in the U.S. is the worst of capitalism (basic health is tied to income/employment, perverse profit-incentives) _and_ the worst of anti-capitalism (anti-competitive monopolies/cartels) at the same time. I don't think improving its ability to function as a free market will ever be a real solution, but it certainly can't hurt.

</comment><comment><USER54> The problem with transparency at the hospital level is the CPT coding system, for which all medical entities including the govt pay the AMA millions of dollars to use, which splits up exams and procedures into components. So even though the knee MRI might cost $1600 (ridiculous but typical), that does not include the radiologist's interp, billed separately by the rad group, or the $300 orbit xray to screen for metal. Also anesthesia is paid based on time, cannot predict that. It is all a sham. And, they can get out of it for a $300 a day fine....well worth it to most of them.

</comment><comment><USER57> My dad, who is in his late 60s, has about $200k to live off of in his retirement. Provided I outlive him, I have a sneaking suspicion that his savings will not only be siphoned out by whatever hospital system inevitably treats him, but that _I_ will have to cough up the remainder! Granted, this isn't a discussion he and I have had. Just goes to show that if you have some terminal condition in this broken country, it's better to just be hit by a bus or drown, than be "treated" comfortably in a hospital bed for $5k+ a night.

</comment><comment><USER19> (EXPLETIVE DELETED! I try to avoid low-content comments, i do, but goddmnit it pisses me off to hear them say, "Oh the poor patients will be so confused!")

</comment><comment><USER58> I would be awesome to see more sites like this:

[https://www.mdsave.com/](https://www.mdsave.com/)

Wish it worked with insurance

</comment><comment><USER51> Plug for an Econtalk episode on exactly the topic of transparency in healthcare prices. [http://files.libertyfund.org/econtalk/y2019/SmithKhealthcare...](http://files.libertyfund.org/econtalk/y2019/SmithKhealthcare.mp3)

</comment><comment><USER59> This is purely anecdotal, but I had a 15 minute (literally) ultrasound. Hospital "facility use" fee: $800. 15 minutes of technician's time: $250. Bill came down to $650 after adjustments.

This is messed up.

I imagine people with serious health problems just kill themselves or ruin their lives forever.

<comment><USER60> I got 1 stitch at the ER (before I was aware that Urgent Care was a a thing). First hospital visit in my adult life. Some saline solution, an alcohol wipe, a shot of Novocaine, and 1 stitch. $3,200. I now avoid the hospital like the plague (ironically).

<comment><USER61> I got the same procedure at a cash-only walk-in clinic. (Eight stitches, actually -- a chunk of flesh was literally dangling from my finger.) $200.

We will never get control of the insane cost of health care until we force medical facilities to actually _compete_ with each other.

<comment><USER62> Normal countries do this by imposing price controls, and it works remarkably well to contain costs. Why can't the US do the same?

<comment><USER61> Unfortunately, central planning stifles innovation. We have the best cutting- edge medical technology in the world for the few who would like it and can afford it. But by eliminating pricing transparency we've also eliminated the incentive to make those technologies cheaper and more accessible to the common man.

<comment><USER62> You don't need innovation for the usual complaints that you see a primary care physician for - broken arm, throat infection &c. That stuff lends itself to standardization and following of protocols.

<comment><USER63> Except when your broken arm needs to be reduced or you have an open fracture and you require moderate sedation to have a physician perform those procedures. Not so standardized and not to protocolized.

</comment></comment></comment></comment></comment></comment></comment><comment><USER64> What an excellent way for hospitals to help convince everyone to switch to a single-payer system.

</comment><comment><USER65> Insurers must have data on pricing. You can call up some already before having imaging procedures for some guidance on cost. Maybe they can expand price transparency as a differentiator to their competitors.

</comment><comment><USER57> This, IMO, is the best thing to happen under the Trump administration. Hospitals will have a hard time arguing on behalf of price-shrouding.

</comment><comment><USER66> I really hope this goes through - this one item will allow people to actually have educated discussions about care and ROI. It will allow people to compete, to specialize, to better serve those who are ill.

</comment><comment><USER67> I dislike the Trump admin a lot. But I like this a lot. The federal government ought to make this step 1 in a strategic effort to make a consumer report campaign for patients. 100pct consumer driven all about where the money goes, why, by whom, how prices are assessed, how they differ geographically, and outcomes to money spent. Put the consumer in charge of their money

</comment><comment><USER68> You cannot do any good in this industry.

</comment><comment><USER69> This is one thing Trump is doing that _should_ get broad support. It probably won't though, because some people are physically incapable of agreeing with him.

<comment><USER70> I honestly didn't even know this was in the works. It's amazing how much effort is put towards blocking out any positive news about this administration.

<comment><USER11> It was actually one of his campaign promises: [https://www.politifact.com/truth-o- meter/promises/trumpomete...](https://www.politifact.com/truth-o- meter/promises/trumpometer/promise/1393/require-price-transparency-health- care-providers/)

</comment></comment></comment><comment><USER71> I called a pharmacy once and asked how much a vaccination would be. I had insurance. They told me they couldn't tell me how much it would be until after I got the shot.

<comment><USER72> PBS has an excellent report about flu vaccinations and the widely varying prices. Millions of shots given every year and prices from free to $85.

I wonder what the actual vaccination vile costs in this whole scheme compared to the overhead.

[https://www.pbs.org/newshour/health/the-hidden-costs-of- free...](https://www.pbs.org/newshour/health/the-hidden-costs-of-free-flu- shots)

</comment></comment><comment><USER73> I don't think anyone who has had to pay hospital bills would agree with the hospital lobby's decision to fight this. The article's title makes it give the impression this is okay because, orange man bad, however regardless of the party pushing for transparency it is something everyone would benefit from (other than the heal care industry/insurance company's profits).

<comment><USER60> I _thoroughly_ dislike the bad orange man, but I will save my strongest words for a more appropriate forum. That said, just because you may dislike someone doesn't mean that you have to opposed _everything_ they do. I do agree with this push for price transparency.

<comment><USER74> Right? I always find myself wondering why antitrust isn't applicable?

The hospitals clearly work together to ensure that consumers don't have accurate or correct pricing information, which has always seemed like it should be classified as anticompetitive behavior.

<comment><USER12> I don't think they are working together so much as the system is setup to reward their anti competitive behavior so they all have followed the rewards to the same end.

</comment></comment></comment></comment><comment><USER75> Surprise, state monopoly wants to keep their monopoly.

</comment><comment><USER76> Obligatory reminder socialized medicine exists, is cheaper [1], controls costs better [2] has better health outcomes [3], complete price transparency (for instance [4]) and no surprise billing. Also, a reminder that a majority of Americans want it [5].

And yet here we are, once again.

[1] [https://en.wikipedia.org/wiki/List_of_countries_by_total_hea...](https://en.wikipedia.org/wiki/List_of_countries_by_total_health_expenditure_per_capita)

[2] [https://www.healthaffairs.org/do/10.1377/hblog20110920.01339...](https://www.healthaffairs.org/do/10.1377/hblog20110920.013390/full/)

[3] [https://www.oecd.org/unitedstates/Health-at-a- Glance-2017-Ke...](https://www.oecd.org/unitedstates/Health-at-a- Glance-2017-Key-Findings-UNITED-STATES.pdf)

[4] [http://www.health.gov.on.ca/en/pro/programs/ohip/sob/physser...](http://www.health.gov.on.ca/en/pro/programs/ohip/sob/physserv/sob_master20191001.pdf)

[5] [https://www.commondreams.org/news/2019/07/02/people-dont- ins...](https://www.commondreams.org/news/2019/07/02/people-dont-insurance- companies-they-their-doctors-poll-shows-majority-voters)</comment>


Show HN: Architectural floor plans for Airbnb hosts - <AUTHOR> https://archibnb.com/ <comment><AUTHOR> I am looking for feedback on my website and service. I create custom floor plans for short term rental hosts (mostly aimed at Airbnb hosts). I am a professional architect / interior designer.

For various reasons I believe it's really nice for Airbnb listings to have a floor plan. It shows the layout at a glance - so no false expectations and disappointed guests. It also gives information about privacy of the bedrooms and bathrooms, especially in the case of renting private rooms. I also added a highlight color to the drawings, showcasing highlights of the property. The client has to send me a hand made sketch of the property before I begin work.

The floor plans are mostly black and white with an accent color. There are no complex 3D models and textures because I think this is best left for the actual photos.

I would appreciate any feedback on the idea and the technical implementation. Thanks!</comment>


Renewables Can't Power Modern Civilization Because They Were Never Meant To - <AUTHOR> https://www.forbes.com/sites/michaelshellenberger/2019/05/06/the-reason-renewables-cant-power-modern-civilization-is-because-they-were-never-meant-to/ <comment><USER2> Yes, just like hydrocarbons.</comment>


Intel 7nm delayed to 2022/23. Will happen during TSMC 3nm - <AUTHOR> https://arstechnica.com/gadgets/2020/07/as-7nm-schedule-continues-slipping-intel-contemplates-3rd-party-fabs <comment><AUTHOR> ...and in related news, Apple, Huawei, and Qualcomm to begin shipping their 5nm chips later this year 2020.

[https://www.phonearena.com/news/tsmc-to-start-risk- productio...](https://www.phonearena.com/news/tsmc-to-start-risk-production- of-3nm-chips-in-2021_id126025)</comment>


Do We Write Differently on a Screen? - <AUTHOR> https://www.newyorker.com/culture/cultural-comment/do-we-write-differently-on-a-screen <comment><USER2> _The mental space feels different when you work with paper. It is quieter. A momentum builds up, a spell between page and hand and eye._

A printed page is easier to read than handwriting, so when I want to review what I've written, I'll type it on the computer for printing out. But that is pretty much the extent of my computer's role in the writing process. I just find that I can think more deeply about something when working on paper, and I don't have a strong theory as to why that is.</comment>