Study shows hotels' Internet connections unsafe - <AUTHOR> http://www.physorg.com/news142098431.html <comment><USER2> Perhaps I'm missing something, but I've never understood what it means to be connecting to an "unsafe" wifi point. Isn't most of my data ultimately going over the Internet unencrypted anyway? Does this just mean there's no firewall blocking traffic on certain ports between me and bad guys?</comment>


Musical Chord Progression Arpeggiator - <AUTHOR> https://www.outpan.com/app/3ef086df04/musical-chord-progression-arpeggiator <comment><USER2> This is straight up lifted from this demo - [https://codepen.io/jakealbaugh/pen/qNrZyw](https://codepen.io/jakealbaugh/pen/qNrZyw) (previous HN convo - [https://news.ycombinator.com/item?id=13273901](https://news.ycombinator.com/item?id=13273901))

Actually, this whole site is pretty strange. Lots of code and open source projects just kinda copied into an app library.

<comment> master-litty The website claims it's a monetization method for projects: [https://www.outpan.com/developers](https://www.outpan.com/developers)

Not trying to be overly cynical, but I don't know how true that is. It's still possible this was lifted without the creator's consent.

<comment><USER3> If you click on the 'i' at the bottom right it shows this dialogue:

"Musical Chord Progression Arpeggiator by LetsPlayAGame A quick way to sketch out musical chord progressions.

Copyright (c) 2019 by Jake Albaugh

Permission is hereby granted, free of charge, to any person obtaining a copy of this software and associated documentation files (the "Software"), to deal in the Software without restriction, including without limitation the rights to use, copy, modify, merge, publish, distribute, sublicense, and/or sell copies of the Software, and to permit persons to whom the Software is furnished to do so, subject to the following conditions:

The above copyright notice and this permission notice shall be included in all copies or substantial portions of the Software.

THE SOFTWARE IS PROVIDED "AS IS", WITHOUT WARRANTY OF ANY KIND, EXPRESS OR IMPLIED, INCLUDING BUT NOT LIMITED TO THE WARRANTIES OF MERCHANTABILITY, FITNESS FOR A PARTICULAR PURPOSE AND NONINFRINGEMENT. IN NO EVENT SHALL THE AUTHORS OR COPYRIGHT HOLDERS BE LIABLE FOR ANY CLAIM, DAMAGES OR OTHER LIABILITY, WHETHER IN AN ACTION OF CONTRACT, TORT OR OTHERWISE, ARISING FROM, OUT OF OR IN CONNECTION WITH THE SOFTWARE OR THE USE OR OTHER DEALINGS IN THE SOFTWARE."

So that looks to be mostly in the clear, but it would be nice to know if the uploader really is the creator.

</comment></comment></comment><comment><USER3> That's a beautiful tool. I should collect and organize all my music links from the past six months or so there are all kinds of very nice tools out there.

For instance this one:

[http://www.brandlew.com/keyboard/keys.htm](http://www.brandlew.com/keyboard/keys.htm)

<comment><AUTHOR> Thank you, looks great and it's open source too! This is another favorite of mine: [https://grunfy.com/scaler.html](https://grunfy.com/scaler.html)

</comment></comment><comment><USER4> Great work, Jake Albaugh. Needs one critical revision, though: I, V, VI, IV in major MUST NOT be allowed!

[https://www.youtube.com/watch?v=oOlDewpCfZQ](https://www.youtube.com/watch?v=oOlDewpCfZQ)

</comment><comment> jay-anderson Pretty neat. It'd be nice to be able to choose more chords. For instance with some inversions the voice leading can be improved. Also it'd allow for using secondary dominant and other chords with non-scale notes.

</comment><comment><USER5> Pretty cool, though it seems there are many common progressions that it can't make, as it forces you to choose a single scale for everything (the block titled "mode" should really say "scale"). For example, minor progressions rarely stick to a single scale like this tool requires.

With that said, you can still make a wealth of cool progressions in a single scale, and the limitation is interesting to work with.

<comment><USER6> Perhaps "scale" should be its own block. The first 7 modes listed are in fact modes of the same scale so the name is fitting. But "Melodic" and "Harmonic" are their own scales, each with a corresponding set of 7 modes.

It would be cool to select modes of those scales as well. For example Phrygian Dominant (mode of Harmonic minor) is very common in a lot of metal music, some classical, Eastern European, etc.

As an aside, the line visual for the arpeggio styles is really cool! It would be neat to select different arpeggios for each chord and see the whole progression drawn out as a line.

</comment></comment><comment><USER7> I'm launching an IDE for music composition soon [http://ngrid.io](http://ngrid.io)

<comment><USER8> Everything on there sounds pretty interesting, especially if it can deliver the goods :) I signed up to be notified, but is there a rough idea of when you're planning to launch?</comment></comment>


Introducing Turbo: 5x faster than Yarn and NPM, and runs natively in-browser - <AUTHOR> https://medium.com/@ericsimons/introducing-turbo-5x-faster-than-yarn-npm-and-runs-natively-in-browser-cc2c39715403 <comment><AUTHOR> "Turbo's speed & efficiency is largely achieved by utilizing the same techniques modern frontend applications use for snappy performance—tree- shaking, lazy-loading, and plain ol' XHR/fetch with gzip... \- Retrieves only the files you need, on-demand \- Robust caching with multiple failover strategies \- Lightning fast dependency resolution \- Proven to work at scale

An interesting new in-browser pkg manage to explore.</comment>


The "OpenStyles" browser extension isn't fully safe - <AUTHOR> https://github.com/openstyles/stylus/issues/431 <comment><AUTHOR> Most people moved from Stylish to Stylus when [https://news.ycombinator.com/item?id=17447816](https://news.ycombinator.com/item?id=17447816) was reported.

It isn't completely better though since it still connects you to the website of the original Stylish devs.

IMO, a better alternative is Dark Reader.</comment>


Dalga: Job scheduler written in Go - <AUTHOR> https://github.com/cenkalti/dalga

<comment><USER2> Have you looked at Rundeck? [http://rundeck.org/](http://rundeck.org/)

It has rest based interface to do everything + UI to make it easier when you need to do one off things. It allows you to control execution across multiple nodes. Good thing is you can setup your processes by tag of a node in Dev and export the project as is on Production and it will still work.

It's a runbook automation tool but can be used like in place of chronos, oozie, spark job server etc.

</comment><comment><USER3> Why Dalga instead of plain cron?

<comment><AUTHOR> * Dalga stores jobs in a MySQL table which is handy if you are already using MySQL (backups, etc.)

* Dalga can schedule one-off jobs.

* Dalga has built-in retry mechanism.

<comment><USER4> A tight dependency on MySQL is somewhat limiting. Have you considered making that an interface with a default implementation that uses MySQL? It pretty much ought to be a mechanical transform where you simply extract all the places you touch MySQL into a method, then write an interface around that method.

</comment></comment></comment><comment><USER5> Why Dalga instead of of some other job scheduler? Because all service software will eventually be rewritten in golang, apparently ;). Don't hate the player.

<comment><USER6> To be honest, I like the fact that a lot of the 'old` stuff is being rewritten in Go because I find it a much easier language to grasp than C, C++ or Java. So I say rewrite them all! (just my opinion of course)

<comment><USER5> Well that's a driver for golang for sure. Additionally, while we're complaining about golang not measuring up to our programming sensibilities, the people who write us checks want 1) correct, 2) on time, and 3)in budget. If golang helps us do that better than other languages in spite of the fact that it doesn't have generics or whatever (anecdotally seems to be the case), no need to apologize for it.

</comment></comment></comment><comment><USER7> Why Dalga instead of Kala? [https://news.ycombinator.com/item?id=10046164](https://news.ycombinator.com/item?id=10046164) Aren't they very similar? Isn't it better to join the efforts?

<comment><AUTHOR> Kala is in Alpha stage. Dalga is stable and used in production ~2 years at [https://put.io](https://put.io).

<comment><USER8> On a completely different note, kudos for the idea of charging a small amount that gets contributed to charity for trial accounts (on [https://put.io/](https://put.io/)).

Not sure if you guys came up with that, but it's the first instance I've come across. Great idea -- filters out freeloaders from potential true customers.

</comment></comment></comment><comment><USER9> Does Dalga support job dependencies? I.e. job A can only run after e.g. job B and C have finished first.

<comment><AUTHOR> No.</comment></comment>


Show HN: Graph Playground - Make Graphs/Networks and run Algorithms - <AUTHOR> https://mikedombo.github.io/graphPlayground/ <comment><USER2> Here's a link to the git repo: [https://github.com/MikeDombo/graphPlayground](https://github.com/MikeDombo/graphPlayground)

</comment><comment><USER3> This idea is very cool!

Would you be interested in splitting out the predefined graphs into another repo / into an npm package? I'd love to use+extend as part of PyGraphistry!

<comment><AUTHOR> I'll definitely consider that. The whole predefined graphs file is only about 90 lines for the relevant bits if you just want to copy that into your project.

</comment></comment><comment><USER4> If you label the nodes in the graph with a value (e.g. 'A') then try running one of the search algorithms (BFS) with 'A' to 'C' or whatever, it doesn't work.

I think you're supposed to put a node ID in there instead, but it's not very clear

<comment><AUTHOR> It still needs some polish work like converting labels to Id's when appropriate and catching errors otherwise. I'll do that stuff this week.

<comment><AUTHOR> I added a conversion so that you can enter the ID or the label.

</comment></comment></comment><comment><USER5> Very nice.

Doesn't work if cookies are blocked. Use a try/catch to feature-test localStorage.

So many times but it's not getting to me.

<comment><AUTHOR> Thanks for the tip, I'll definitely look into it. Cookies shouldn't matter since I don't use them, but localstorage would be a tiny problem.

<comment><AUTHOR> I added a check so it should be working now without localStorage.

</comment></comment></comment><comment><USER6> The Königsberg bridges graph is wrong. There should be seven edges. [https://en.wikipedia.org/wiki/Seven_Bridges_of_K%C3%B6nigsbe...](https://en.wikipedia.org/wiki/Seven_Bridges_of_K%C3%B6nigsberg)

<comment><AUTHOR> You're correct, right now it doesn't support multigraphs because of a library I'm using. I'll modify it soon to add that support and then the bridges will be correct.

<comment><AUTHOR> Multigraphs are now supported and so the bridge graph is now correct.</comment></comment></comment>


ZenPayroll is now Gusto - <AUTHOR> https://medium.com/@ZenPayroll/zenpayroll-is-now-gusto-f962a68fe5a4 <comment><USER2> More than just a name change - they'll start offering health benefits and simplify workers' comp payments.</comment>


We're the Chrome team, here to answer questions about building a better web - <AUTHOR> https://www.reddit.com/r/webdev/comments/6zpgu1/were_the_chrome_team_here_to_answer_questions/ <comment><USER2> Top 2 comments:

'How much do you value privacy in your web browser compared to others? I've noticed that even when using the private browsing feature of Chrome, I'm still subjected to targeted ads. When I use the same feature in Firefox, I'm not. Even though neither should be tracking my actions from the client perspective, I've noticed this distinction.

[–]Stan9965 84 points 21 days ago

No answer. LOL'

This is one of the reasons why I've stubbornly stuck with Firefox since '04.</comment>


Hospital creates bidding war by posting pricing online - <AUTHOR> http://kfor.com/2013/07/08/okc-hospital-posting-surgery-prices-online/ <comment><USER2> I really salute these guys for doing this. It's freakin' awesome. This I've added to my next letter to my representatives in Congress:

 _" Dr. Smith said federal Medicare regulation would not allow for their online price menu. They have avoided government regulation and control in that area by choosing not to accept Medicaid or Medicare payments."_

I've suggested that one non-controversial way in which Healthcare could be "reformed" would be to make it easier for hospitals to be transparent about their prices. Any sort of regulation that prevents hospitals from disclosing their prices is bad for the citizenry, please fix that part of the regulations.

<comment><USER3> Copying my comment below. The government not only allows healthcare providers to reveal their prices, it encourages it. The graf about the government is a political statement, not a policy fact, and does not belong in a news story.

\-----

Medicare/caid prices are standardized and public. They also release data on what specific hospitals bill for the most common procedures.

[http://www.cms.gov/Research-Statistics-Data-and- Systems/Stat...](http://www.cms.gov/Research-Statistics-Data-and- Systems/Statistics-Trends-and-Reports/Medicare-Provider-Charge-Data/)

Dealing with Medicare/caid involves lots of additional overhead and billing oversight, but that graf is a political cheap shot, not anything related to transparency.

\-----

Hijacking my top comment with a more info edit -

If you don't know, Pricing Data in the US for health care is super insane, partially because both insurers and regulators need billing to fall into a semi-standardized set of 'billing codes' that don't really map well to actual care.

There are regulations about only billing the government for 'procedures' and not 'overhead', and medical procedures often don't map well to billing codes because they're new or slightly different. So basically after a procedure or hospital stay, the care givers make up a basic list of the things they did and the drugs given, etc, and it's passed on to a billing department, who maps to a set of codes that might differ depending on who's paying (gov't vs insurer 1 vs insurer 2). This is by definition lossy.

It's an oversimplification, but one hospital might say "Well we've got a superstar brain surgeon here whose time is 3x as expensive as normal, but can only bill for 'BRAIN SURGEON - 1 HOUR', so we'll crank the prices up on the scalpel and the tylenol to compensate", where another picks totally different things to compensate the prices on because they have a different cost structure.

Big insurers expect to be negotiated with separately for competitive advantage reasons, and sometimes use different billing codes anyway, so even if you had the closely guarded master price list of the hospital, it wouldn't necessarily do you any good.

For the uninsured, the occasional price-insensitive person rolls in (aka the "Saudi Prince wants his own wing for cancer treatment" situation), so they jack the uninsured prices WAY up only expecting a few percent back from 98% of patients. This further breaks the pricing data, and causes major problems for less-saavy people who are used to seeing a bill and being expected to pay it, as opposed to negotiate.

Bottom line: It's complicated, and politically fraught. If you're interested, Oreilly's "Hacking Healthcare" is a great intro to how billing and the new CMS Meaninful use stuff works.

<comment><USER4> I worked in a billing office for 5 years, there are literally thousands of codes for EACH insurance company, again EACH insurance company.

The reason the cost of healthcare is so high is because medicare pays roughly 15% of a bill, others are somewhere between 20-50% of a bill depending. That is to say if the doctor charges you $40,000 you pay your 10% co-pay of $4,000 and the insurance then only pays maybe another $8,000.

Also, just so everyone knows, it's pretty easy to negotiate down your bill. The reason healthcare is so expensive is so many people don't pay it. If you are willing to pay say 40% of your bill it's already 25% better than medicare.

<comment><USER5> _The reason the cost of healthcare is so high is because medicare pays roughly 15% of a bill, others are somewhere between 20-50% of a bill depending. That is to say if the doctor charges you $40,000 you pay your 10% co-pay of $4,000 and the insurance then only pays maybe another $8,000._

Another reason is the supply of doctors is artificially restricted by the AMA.

<comment><USER6> The supply of doctors is not restricted by the AMA. The supply of doctors is determined by the number of residency spots available to new graduates; that number is entirely determined by the Centers for Medicare and Medicaid (CMS). Thanks to the Balance Budget Act of 1997, Graduate Medical Education (GME) was dramatically slowed due to decreases in Medicare funding of residency positions. [1]

As long as we require physicians to be US trained and to have completed a US residency, the bottleneck will be GME funding. To fix that, the AMA or any other concerned citizen can lobby Congress for an increase.

[1]: [http://jama.jamanetwork.com/article.aspx?articleid=182532](http://jama.jamanetwork.com/article.aspx?articleid=182532)

<comment><USER5> I wasn't referring to residency spots at accredited medical schools.

I was referring to medical school accreditation itself.

<comment><USER7> Medical schools are free to set their own limits on the number of students they admit. But they aren't going to admit more students than they predict can find a residency spot. It would look bad to have a high percentage of your students not be able to find a residency.

The real reason why there are fewer doctors is that it simply doesn't make any economic sense to be a doctor anymore. You need too much school, at too high a price, and you push off any real earning potential 6-9 years away from your peers. If you specialize, you can add an extra 2-4 years on top of that. And you really don't make enough over the long run to justify the lost opportunity costs.

So yes, there is a shortage of doctors, but that isn't going to change anytime soon.

<comment><USER8> Sheer and utter nonsense. First there are a huge number of students who wish to go to medical school and don't get in. There's no shortage of applicants at all. Second the incredibly high compensation for speciality doctors quickly overcomes both opportunity cost and tuition costs as compared to almost any other profession.

I encourage you to run the numbers. You will find that $250k/year catches up very quickly to $100k/year even with a 10 year head start and $300,000 in extra debt.

<comment><USER7> I encourage you to talk to some doctors. No one makes $250k per year, except maybe a few surgery specialists (and maybe ER). Primary care doctors (the ones that where there actually is a shortage) can can easily start at under $100k and the max can be below $200k. And if you are a pediatrician or a pediatric specialist, expect to take a cut in pay relative to your adult colleagues.

<comment><USER8> Why would I solicit anecdotes, when there is data available?

Median compensation for all physicians is above $200,000/yr for every region of the country.[1] The highest averge earning speciality is not surgery but radiology at $315,000. [2]

Focusing on primary care doctors is a goalpost shift. Your original talking about the extensive opportunity costs for all doctors and specifically mentioned the additional time needed to specialize. Furthermore foreign born and educated doctors, who faced very different trade-offs, make up a disproportionate percentage of primary care physicians.[3] Finally, primary care is the area most suitable for less expensive medical professions, if only doctors quit engaging in anti-competitive lobbying.

In any event, medical school applications alone put lie to any sort of overall compensation-driven doctor shortage, which was your original complaint.

Maybe it's because I'm not a Christian, but I'm puzzled as to how a profession can be plagued simultaneously with God complexes and Martyr complexes.

[1] [http://www.medscape.com/features/slideshow/compensation/2012...](http://www.medscape.com/features/slideshow/compensation/2012/public) pg 5 [2] ibid pg 2 [3] [http://www.nytimes.com/2010/08/12/health/12chen.html](http://www.nytimes.com/2010/08/12/health/12chen.html)

<comment><USER7> I'm replying to a comment days later, only because I didn't see this earlier.

Median compensation for _all_ physicians. I encourage you to look at the actual distributions, based on age of the doctor and specialty. Early doctors make very little, and primary care doctors (GP, family practice, pediatrians), make the least. Oh, and while they are in training (residency, fellowhips), they wouldn't quality in the median compensation calculation, because even though they are MDs and treat patients, they are still considered students/trainees, and they make very little (~40K residency, ~60K fellowship, depending on area of the country). Those are the specialties that are in need - hence the reason to focus on those.

Really, I don't know why you're arguing this so much...

The cost of health care is a very complicated topic, and not one that is conducive to this type of forum.

My source: me, my wife, and a bunch of our friends. I _almost_ became an MD, but left med school to get a PhD. I left for a variety of reasons, but once factor was the math didn't add up. My wife is an MD/PhD (pediatrics with a specialty). And we know many other doctors - all young, the category I was focusing on, and some make a lot, and others make very little.

Your data model is too simplistic to get a full grasp of the situation.

</comment></comment></comment></comment></comment></comment></comment></comment></comment></comment></comment><comment><USER9> I dream of a day when I can walk into an area which offers 'services' and be offered a pricing chart. From hospitals, banks, loan officers, home loans, cars, etc.

A cryptic itemized list, such as a mortgage's Good Faith Estimate (GFE), which falls short of describing the items in the list still fails my test.

This hope is not for me. Its for the misfortunate who run on impulse and have weak mathematical logic. Many people will nod their heads when you mention simple/compound interest or amortization. They will easily dig themselves into holes and take on the realization far too late in the game.

Another favorite which gets thrown in the air: 'Purchase this warranty.' Countless friends and family have worried that their purchase or lack of warranty was a mistake. Asking about said warranty usually results in: 'read the small text in the agreement.' Typically, walking away from the situation completely misinformed by a seller.

As I prepare to move out of my apartment, I received an itemized list (hidden among a contract and various other documentation) which in total amounted to $11,500 in charges for potential neglect in leaving the apartment. Simple things on the list: patch holes ($80/hole), steam clean carpet with receipt ($500/room), replace drip pan ($200), etc. Nothing warns you of the potential threat.

<comment><USER10> > I dream of a day when I can walk into an area which offers 'services' and be > offered a pricing chart.

I don't want to be offered a pricing chart when I have a kidney stone or get violently mugged. When that happens I don't want to have to deal with that sort of thing.

The free market in medicine is plain weird. Everyone needs the doctor on occasion, and everyone needs tyres on their car. Both things are pretty standardized, medicine is an established science, and tyres just need to have the correct dimensions and speed rating.

You show up at the doctor's, and they will treat you according to established procedure, most patients do not have complex illnesses, and you show up at your mechanic, and they will put new tyres on. It's very simple.

Yet on TV you see many many more ads for the local hospital or medication for condition X that you see for tyres. How come?

<comment><USER11> _The free market in medicine is plain weird_

Says you. Time and again, Lasik surgery and cosmetic surgeries not covered by insurance or hindered by over-regulation have shown us that transparent pricing and competition work to make those procedures more affordable -- just like these forces work in other markets.

The State has perverted the medical market for more than half a century and you're just used to seeing it in its current screwed up state.

<comment><USER12> It's also important to consider that Lasik and cosmetic surgeries are elective procedures characterized by elastic demand. Having a trauma surgeon remove a ruptured spleen, or being treated for a heart attack, are situations where demand is completely inelastic.

One might shop around for the best way to spend a spare $10,000 for an eye lift, but who can be expected to shop for an economically satisfying deal while in a life-threatening situation? Reducing regulation would not change this essential qualitative difference.

<comment><USER13> While emergency care needs to be taken into account, most medical issues are just not emergencies, they are merely pressing. Even super expensive, life threatening ones (ie, a cancer diagnosis) allow for a bit of shopping around, second opinions and such.

So if most surgery, and near all outpatient procedures are not-pressing and possible to shop around for, why can't I know how much it costs ahead of time?

</comment></comment></comment></comment></comment><comment><USER10> This happens _only now_? In more civilized countries like Germany, prices for procedures have been set since time immorial. There is a provision for surcharges from the physician, but these aren't common, and the physician will have to have a good cause or the insurer will not pay it.

Same thing for new medications: they are not permitted in the clinic unless there is a genuine advantage for the patient.

All this is of course due to political circumstances: medicine is just too profitable.

<comment><USER14> _All this is of course due to political circumstances: medicine is just too profitable._

No. Medicine in inelastic. There is no such thing as a rational demand side, as you don't get to choose if you need healthcare or not. When demand is inelastic, and supply is limited, prices will rise accordingly with no relief in sight.

The solution? Either set market prices (at the cost of stifling supply) or flood the market with supply (using technology to both drive down costs and replace what people do).

<comment><USER15> >There is no such thing as a rational demand side, as you don't get to choose if you need healthcare or not

That's not true in many cases. I bump my head or get a sore throat, I can choose to seek medical treatment or not. There are also lots of things like "yearly checkups", etc...

<comment><USER14> Fine. Sure, you bump your head or get a sore throat, you walk it off.

What happens when you try to "walk off" something you think is minor, and you're in the ER 24-72 hours later? Hello $20K-$50K bill.

My wife and I were in a car accident a year ago (someone turned in front of us while we were doing 40mph). My wife required an ambulance for transportation due to damage to her right foot. The ambulance didn't exactly let us compare prices and pick which hospital to go to.

<comment><USER16> That's what insurance is for. Catastrophic situations. Or perhaps there's a way to pre-purchase emergency care at a discount. Or you set your emergency provider ahead of time based on price. I don't know. There must be creative ways to solve this problem rather than being all fatalist about it.

<comment><USER14> Counterpoint: At the time, we had insurance. Great insurance through Blue Cross Blue Shield. Also, had State Farm for auto. Our medical policy on our auto policy was exhausted solely from the hospital visit and ambulance ride, and the other at-fault party's coverage (also State Farm) barely covered the first few doctor visits for my wife.

I've now had to pay several thousand dollars out of pocket for my wife's physical therapy, MRIs, and prosthetics, and have been told I will need to sue State Farm to recoup my out of pocket expenses.

<comment><USER16> I'm deeply sorry for what you had to endure, and I didn't mean to trivialize your situation.

<comment><USER14> No need to be sorry. I just wanted to demonstrate that even with insurance, healthcare is hard.

<comment><USER17> I'm not saying it is easy (it often isn't) but government provided accident insurance is provided to all (visitors included) within New Zealand. It provides medical cover and compensation for accidents for pretty much all situations. Wen you have a straight forward accident all is easy and it just works. The trouble arrives when you try to define accident or your injury was difficult to pin point. Botched operation? You might be covered. Infected mosquito bite? Not an accident, not covered. Infected insect bite? Accident, you're covered! Swallowed a chunk of glass? Accident IF it caused injury. No swallowed foreign body is classed as an injury unless it caused damage. Administering and defining this crap must often cost more than just paying out would. If you're filling out the paperwork, be very careful to write as little as possible and use the broadest terms possible.

</comment></comment></comment></comment></comment></comment></comment></comment></comment><comment><USER18> One thing to keep in mind is that there's more to good medical care than a fair price:

Post-op infection rate - do all clinical employees regularly wash their hands before and after each patient encounter?

Re-admission rate - does the institution or surgeon do enough cases of a particular procedure to be proficient?

Error Rate - Are pre-op checklists ALWAYS used?

Post-op care - Are supportive therapies like Physiotherapy available?

It bugs me to see medical interventions treated like a commodity, these "products" don't always follow generally accepted market principles - a price cut in colonoscopies will not significantly increase demand.

<comment><USER19> I generally agree with your sentiment. However, here's something to consider \- medical practices mostly over-charge to avoid insurance fraud. Wait, what?? Yes, here's how it works: if they were to ask you, "what insurance do you have" and then charge you differently (i.e. one insurance pays them better than the other, so they'd charge more), they'd be committing a crime.

So, instead, they charge EVERYONE a crazy amount, and then they get X% of the amount billed from one insurance, Y% from another insurance, etc. Fair? Not really -- if you don't have insurance, you get hit with the FULL amount (since you don't have the negotiating power the insurance company has). So while company X paid $200 for an MRI, you'd pay out of pocket $2500 without insurance.

In reality, what happens? Normally, people without insurance are an underserved population. They send them letters, and they don't pay. At the end of the day, the hospital/private practice just ends up writing this amount off, and they call it a day. It ends up being a silly game where they bill knowing they won't get paid, and then spend more money on trying to collect rather than give more realistic prices.

I, therefore, welcome this transparency.

source: I work for one of the largest and prestigious medical/research institutions in the US, and I used to do Analytics for their financial data warehouse.

<comment><USER20> Do they actually negotiate deals with insurance companies where they lose money on some procedures?

If they don't, then the problem is that they want the revenue from the higher paying insurance, not worries over fraud.

<comment><USER19> Yes, they want more money from higher paying insurance. But if they were to officially have a menu of prices for different entities (self pay, insurance A, insurance B, etc), that'd be against the law. So they come up a "catch all" number, and they grab as much as they can get from each entity.

<comment><USER20> My point was that there is some matter of perspective in there. They could just as well offer a single price that reasonably covered their costs, but instead they are engaging in revenue maximization. So the menu is a rational tradeoff of revenue maximization and fraud avoidance, but it isn't the only one.

"Insurance companies won't play the game that way" is sort of an answer, but it isn't very satisfying.

I guess fraud statutes might benefit from some rules about the ratio between average negotiated prices and stated prices (I'm a little uncomfortable telling entities how they are allowed to price things, but large medical institutions clearly have some dysfunction in this area).

</comment></comment></comment></comment></comment><comment><USER21> As someone with an High Deductible Healthcare Plan, I pay most medical costs out of pocket up to an annual limit. It's crazy that for such expensive services I NEVER know what my bill is going to be until months after the procedure has happened. I always try to guesstimate costs beforehand, but I've been off by an order of magnitude on more than one occasion. Having transparent pricing in the healthcare world, even if it was just an estimate, would help people with HDHPs immensely.

<comment><USER22> Same situation here.

I get looked-at like I'm crazy when I try to explain my insurance and that I'd like to know more about the cost of a procedure or prescription before I agree to it.

I've always tried to just pay cash for services. Increasingly, though, I'm finding that providers are being put under exclusive contracts which prevent them from allowing me to pay cash. As soon as they find out who my insurer is they clam up, explain that they're under contract w/ that insurer, and say they can't give me cash pricing. It's doubly frustrating because they usually won't talk to me at all if I don't tell them who my insurer is. Catch-22.

The provider ends up billing my insurer who doesn't pay because I haven't reached my deductible. Then I get a bill from the provider, 4 - 6 weeks later. _Sometimes_ the provider allows me to pay the "negotiated price" my insurer would have paid, but other times I've had to pay the full non-discounted amount.

What a screwed-up mess.

</comment></comment><comment><USER4> Let me start off with I worked in a medical billing office for the last 5 years and here are some things you'll never hear about:

Medicare pays only 15-25% of what they are charged, that is to say, if a surgery costs $40,000 they will only pay the doctor $10,000.

This isn't only medicare, it's literally every company. Every single insurance company pays only a fraction (usually 50%$ or less) of what the hospital actually charges you. If you don't have insurance you can just call up and usually if your semi-nice and fairly strait forward you can get the bill reduced to a fraction (30-40%) because that's about what they accept from insurance anyways.

Their prices are simply what they'll get paid in either case, so good job to these doctors, hope it helps less people get scammed and pay their full bills.

</comment><comment><USER23>
        They have avoided government regulation and control in
        that area by choosing not to accept Medicaid or Medicare
        payments.

I don't understand how the government itself is causing lack of price transparency, but this should be addressed by any president or congressman who imagines he's going to do something about healthcare costs. If you don't have price transparency, you have no chance at cost cutting.

<comment><USER3> Medicare/caid prices are standardized and public. They also release data on what specific hospitals bill for the most common procedures.

[http://www.cms.gov/Research-Statistics-Data-and- Systems/Stat...](http://www.cms.gov/Research-Statistics-Data-and- Systems/Statistics-Trends-and-Reports/Medicare-Provider-Charge-Data/)

Dealing with Medicare/caid involves lots of additional overhead and billing oversight, but that graf is a political shot, not a fact related to transparent pricing.

<comment><USER24> Isn't this a recent development, like two months ago?

[http://www.nytimes.com/2013/05/08/business/hospital- billing-...](http://www.nytimes.com/2013/05/08/business/hospital-billing- varies-wildly-us-data-shows.html?pagewanted=all)

<comment><USER3> The specific provider data is recent, but the 'here's what we'll reimburse for what procedures' data has always been public, as far as I know.

I think this is a link to it, but I'm not 100% sure - [http://www.cms.gov/Medicare/Medicare-Fee-for-Service- Payment...](http://www.cms.gov/Medicare/Medicare-Fee-for-Service- Payment/PhysicianFeeSched/index.html?redirect=/physicianfeesched/)

</comment></comment></comment></comment><comment><USER25> Congress froze the number of Medicare-supported residency slots at 100,000 under the Balanced Budget act of 1997 [1]. The cap remains in place to this day, despite a massive shortage of physicians.

The AMA's official position in 1996:

"To decrease the rate of physician supply, limits must be placed on the number of medical school graduates entering GME [graduate medical education]. Since the federal government currently plays a major role in financing GME and is responsible for establishing immigration laws that affect IMG participation in GME in this country, it is imperative that the federal government partner with the medical education community to achieve this goal." [2]

The AMA worked closely with then Speaker of the House Newt Gringich to overhaul Medicare's relationship with physicians. [3]

The AMA is typically the biggest spender among lobbying groups in the health care sector.

[1] [http://usatoday30.usatoday.com/News/health/2005-03-02-doctor...](http://usatoday30.usatoday.com/News/health/2005-03-02-doctor- shortage_x.htm)

[2] [http://www.ama- assn.org/resources/doc/PolicyFinder/policyfil...](http://www.ama- assn.org/resources/doc/PolicyFinder/policyfiles/HnE/H-305.968.HTM)

[3] [http://www.clintonlibrary.gov/assets/storage/Research%20-%20...](http://www.clintonlibrary.gov/assets/storage/Research%20-%20Digital%20Library/jennings- hsa/Box%20046/647904-hsa-congressman-gingrich-AMA-deal.pdf.pdf)

</comment><comment><USER17> Mercy Hospital charged $16, 244 for a breast biopsy; the procedure will cost $3,500 at Surgery Center of Oklahoma.

WTF?!? I don't know what we charge for a routine biopsy, but for an MRI guided one with vacuum assistance - vasty more complicated, expensive and time consuming - we charge about $2000USD. Come and have a holiday in New Zealand at the same time and it may still be cheaper.

</comment><comment><USER26> In Singapore it's required for all hospitals to post their prices and they have some of the lowest health care costs around. This should be mandatory in the United States.

<comment><USER27> Related: [http://www.moh.gov.sg/content/moh_web/home/costs_and_financi...](http://www.moh.gov.sg/content/moh_web/home/costs_and_financing.html)

</comment></comment><comment><USER28> "Dr. Smith said federal Medicare regulation would not allow for their online price menu.

They have avoided government regulation and control in that area by choosing not to accept Medicaid or Medicare payments."

This is simply not true. If they were undercutting Medicare with their pricing, the government would likely have issue with it (i.e. if they were contracted with Medicare but charging Medicare more than what they charge other insurers/patients - this never happens). But their pricing is multiple times what a Medicare claimant would have to pay, so it's a non-issue.

Take, for example, the One Medical Group. They accept Medicare and although the services they provide are limited to primary care, they are transparent with their basic fees. [http://www.onemedical.com/nyc/pricing/insurance](http://www.onemedical.com/nyc/pricing/insurance)

Our own medical group is heading in the direction of transparent pricing as well, and we accept Medicare.

</comment><comment><USER29> The article uses the term "bidding war" like it's a race to the bottom.

Isn't clear pricing supposed to be a good thing? Shouldn't it be actually _enforced_ by law?

<comment><USER30> This is the kind of wording the medical industry has set. The reasoning goes like this: clear prices => competition => iron law of wages for specialised professionals => corners being cut.

Crony capitalism only believes in competition for others. Competition in their own sector suddenly brings doom and the Iron Law of Wages.

The US is one of the countries with the highest expenditure per capita in healthcare and the results simply don't match that. See the graph here: [http://www.forbes.com/sites/toddhixon/2012/03/01/why-are- u-s...](http://www.forbes.com/sites/toddhixon/2012/03/01/why-are-u-s-health- care-costs-so-high/)

</comment></comment><comment><USER31> Great story but

 _" OKLAHOMA CITY – An Oklahoma City surgery center is offering a new kind of price transparency, posting guaranteed all-inclusive surgery prices online. The move is revolutionizing medical billing in Oklahoma and around the world."_

Around the world? Really?

<comment><USER32> By around the world I think they mean Canada :)

<comment><USER33> I just spilled my morning coffee from laughing so hard... :-D

</comment></comment></comment><comment><USER34> One of the major problems with U.S. healthcare is that, financially speaking, patients have been increasingly taken out of the mix beginning in the fifties. Providers and insurance carriers shield consumers from actual costs giving a false impression of the value of competent healthcare. Insurance companies' reimbursement rates are a fraction of the billed amount. Of course, it is the person without insurance, who is stuck with what can be a very inflated invoice. Of course, there are manifold problems with this industry; but until patients are exposed to accurate financial comparisons, the costs will continue to escalate.

</comment><comment><USER35> > Dr. Smith said federal Medicare regulation would not allow for their online > price menu.

> They have avoided government regulation and control in that area by choosing > not to accept Medicaid or Medicare payments.

Obama, better close up that loophole! Wouldn't want people to find out that capitalism works in every. single. industry.

<comment><USER36> every. single. industry where efficiency and profit are the main concerns and externalities are captured accurately and true competition can exist. That is not always true. Off the top of my head the justice system and emergency service providers (think fire/hazmat etc) come to mind.

Lets not let the bizarre state of the US medical industry act as some sort of straw man to support some ultra libertarian viewpoint.

<comment><USER35> > true competition can exist.

True competition can always exist unless force is used against someone to stop it (in 99.9% of cases, that's done via government regulation).

> the justice system

The justice system isn't an industry, it's a proper function of government.

> emergency service providers (think fire/hazmat etc)

As someone who has been screwed over by government emergency service providers, I beg to differ.

> Lets not let the bizarre state of the US medical industry act as some sort > of straw man to support some ultra libertarian viewpoint.

Actually, lets. The US medical system is a total clusterfuck and is only getting worse. It is _hard_ to get good medical care in the US. There is only one way this complete nightmare could have come about, and that's because people aren't free to act in their own interest.

We could never remotely approach this nightmare in any non-highly-regulated industry.

In fact, practically all non-highly-regulated industries make amazing advances over time, whereas healthcare delivery has seen amazing regress in the last few decades.

This is not an appeal to some ideology that is divorced from reality. _The empirical evidence is all on my side_ , plus a causal explanation for the results. But liberals are covering up their ears and shouting, "We can't (won't) hear you!". As a result, my lifespan and those of my loved ones will likely be significantly curtailed.

<comment><USER36> There are lots of reasons for competition to not exist in capitalist systems other than force. Things like high cost barriers to entry, monopolistic practices, or oligarchic systems all can lead to situations where competition will not bring down prices.

Most of the first world believes that health care is also a proper government function, because you disagree doesn't mean that the justice system is not an industry. Lots and lots of profit driven companies exist purely based on the justice system, just like lots and lots of profit driven companies exist to provide health care.

We've tried to have private emergency service providers. For most of the history of our continent basic services like fire fighting, property security & education were provided as free market enterprise. Early 19th century New York city has lots of examples of how very very bad the results from those practices can be.

As far as your empirical evidence for free market health services, I'd love to see it. By nearly every standard I've seen the best health care in the world is provided by governmental, or quasi-governmental heavily regulated single payer systems.

The fact that the US medical system is bad is neither an indictment of free market libertarian principles, nor leftist socialist ones, because the system we have currently is a mix of the worst aspects of all possible options. Like most other things, partisan rhetoric is neither correct nor helpful in sussing out the proper solution to complex problems.

</comment></comment></comment></comment><comment><USER37> I really like their footer section :)

"FREE MARKET-LOVING, PRICE-DISPLAYING, STATE-OF-THE-ART, AAAHC ACCREDITED, DOCTOR OWNED, MULTISPECIALTY SURGICAL FACILITY IN CENTRAL OK."

[Edit]: The footer of the hospital in the article: [http://www.surgerycenterok.com/](http://www.surgerycenterok.com/)

</comment><comment><USER38> Can you call transparent pricing a "revolution" when the status quo is purposefully obfuscated and archaic in order to nickle and dime you? It seems more like just doing the right thing.

<comment><USER39> Can you call desegregation revolutionary since it was just "doing the right thing?"

In a corrupt market or system, doing the right thing is in and of itself a revolutionary act. Doctors standing up for what's right instead of their pocketbook and pharma reps is a revolutionary act.

</comment></comment><comment><USER40> I don't know if other states do this, but at least in California hospitals report their prices (known as a chargemaster or master charge description file) online at OSHPD ([http://www.oshpd.ca.gov/chargemaster/](http://www.oshpd.ca.gov/chargemaster/)). Even looking through these you'd be surprised what prices there are.

This isn't a new controversy, but still quite problematic - for some fun try Googling "usual, customary and reasonable" (UCR charges).

</comment><comment><USER41> Some other techniques off the top of my head:

\-- offer a "price match guarantee" against any procedures versus in-network hospitals

\-- offer a discount for low-risk patients (non-diabetic non-obese) who need to have surgery done

\-- do "bundle deals" with local hotels and/or attractions like they do with plane flights, so if you are travelling to the hospital you would have something for the family to do

\-- free 1-month nurse concierge where you can call a hotline to followup after any procedure (would be great for baby deliveries)

\-- discount on 3-months of physical training, along with a bundle deal at a local gym

\-- offer a "retainer" that would lockin a price of any procedure for 5 years. Good for those who are family planning or have a low-priority surgery

It just seems like there's a market for something-that-doesn't-suck in healthcare.

<comment><USER42> > offer a "retainer" that would lockin a price of any procedure for 5 years. > Good for those who are family planning or have a low-priority surgery

This sounds to me like an insurance premium, no?

<comment><USER41> This particular hospital is catering to the high-deductible crowd, so that's why I put that one in there.

</comment></comment></comment><comment><USER22> Their price for a procedure I had in 2000, today, is half of what I paid out- of-pocket back then. Wow.

This is great, and I hope it's a sign of a trend.

</comment><comment><USER43> While i know how health-care is working in the US, every time i read something about it i'm astonished and incredibly sad. How broke can a system be to put a price on health? And everybody cheering that someone is doing it in a trasparent way. Woooow. I wonder how you will all react if you'll find out, in future, that the surgery/procedure you actually need is too expensive for your pockets and not covere by the insurance (if you are elegible/have one).

Sorry to say this but: This whole system is a shame. And i just can't understand why the people in the US just don't realize it.

<comment><USER44> Not so broke, as it turns out, as the US pays more per capita in health care than pretty much every other country on the planet... It's not about being broke, it's about being dysfunctional.

</comment></comment><comment><USER45> At hospitals in the US, every payer is charged a different price. Large insurers and HMO's negotiate large discounts which shifts costs onto smaller insurers who get smaller discounts and thus pay part of the costs of their larger competitors. The non-poor uninsured, who often can least afford to pay, are charged the most -- often 5X, 10X or more than what Medicare or a large insurer would pay. In all states other than Maryland, which has state-wide "all-payer" pricing, what you are charged depends more on who you are and how much negotiating power you have than what was done for you.

The solution is to let the "free market" work. Of course, that means we need to regulate the market to fix the existing "market failure." Free markets are regulated markets. (Although not all regulated markets are free.)

All states should pass laws saying that hospitals are free to charge what they want but that their prices must be posted and apply to "all-payers" without discounting. Additionally, states should develop all-payer databases like those advocated by: [http://www.apcdcouncil.org/](http://www.apcdcouncil.org/)

Much has been said about Medicare in the comments here that isn't quite accurate. The reality is that Medicare ignores hospital charges (except in Maryland) and pays according to their own calculations of hospitals' costs. In most cases, that means they pay much less than they are charged. However, in some cases, it means that they pay more.

For some additional background on this issue, from a New York perspective, see my PDF on the subject linked to at: [http://bobwyman.blogspot.com/2013/04/RFC- FRAND.html](http://bobwyman.blogspot.com/2013/04/RFC-FRAND.html)

</comment><comment><USER46> This article is a bit misleading. An outpatient surgery center has the luxury of "skimming" the easy uncomplicated same-day surgeries while leaving the hospitals to do the heavy lifting. It is _not_ a hospital

Surgery centers do not have the cost of carry of a pharmacy(24/7), a fully functioning diagnostic lab(24/7), an emergency room(24/7), 200-1000 beds, ICU,CCU, radiology department(24/7) etc and an infrastructure that is impressively expensive.

Its very very very easy to offer these surgeries at a cheaper price than a hospital but when you need a complicated surgery or an emergency that surgery center _will not_ be there for you.

I like the idea of pricing transparency but it should be hand in hand with outcome and quality statistics and comparisons should be fair.

I did not see Oklahoma surgery center compare themselves to other surgery centers which are likely very close in price.

One last thing. In healthcare - price is not everything (its an important issue) but as we drive down the price, we must not sacrifice but rather improve outcome measurement and quality.

</comment><comment><USER47> When you think of upfront pricing it just makes sense. Recently someone posted a breakdown of their surgery here on HN (don't remember the kind of surgery it was, but it totalled about $30k), I don't understand how a hospital with the same medically trained staff as any other hospital (with exception of specialists of course which would vary) can be 4 times the price as this hospital is offerng to do it for and most likely the same level of care. I encourage everyone to read this Harvard Business Review article here which gives some insight into just how the American healtrh system runs: [http://hbr.org/web/extras/insight-center/health-care/why- inn...](http://hbr.org/web/extras/insight-center/health-care/why-innovation- in-health-care-is-so-hard)

</comment><comment><USER48> I can't really see how charging this much to ease people's suffering is humanly possible. Sure Surgery Center was a lot cheaper than the rest, but even that is still expensive. For example, if I want to gosurgery center and get an brain/heart surgery, I'd be looking at possibly $500 in overnight fees but not really anything else.

How is anyone inhumane enough to start a business like these hospitals? Any medical care should be available to everyone. Breaking a finger shouldn't cost $2805 either. Countries like USA think they're superiour but yet they do not help their fellow citizens. If they would drop the war on the rest of the world(incl their own) they would probably afford to provide free medical care as well.

</comment><comment><USER49> So, I've had this idea for a while and I'm wondering why no one has done it yet:

An Expedia for health care services.

You pop in your zip code, the service you need (if you know it), and out comes a list of hospital and doctors with prices for that particular service.

I imagine you could start very simple: call 50-100 clinics and ask how much they would charge for a simple checkup, upload it, see how many people start booking doctor visits via your site.

Check out Zoomcare:

[http://www.zoomcare.com/info/services- prices](http://www.zoomcare.com/info/services-prices)

I went there in Portland and service was great! I loved the transparency. I just wonder why more independent clinics aren't trying this.

Is there some major legal obstacle I'm not seeing?

</comment><comment><USER50> Similarly, at least to me, Birthing Centers are offering a much lower cost alternative to the whole delivery process at hospitals. From experience, the price difference can be 10:1 which is just insane. 10 being what is billed to insurance, 1 what you'd pay directly. Still, comparing apples to apples, it's 3:1. Again, from recent experience.

Bottom line, hospitals are big business and they can get away with billing insurance for a ton... and many times the extra "care" is unnecessary.

</comment><comment><USER51> Healthy people can work and be productive.

When progressive startups say things like "We want you to work, and not worry about your income, so we're trying to pay you a salary that allows you to do just that" we all respect that, right?

Why can we not do the same with healthcare and just say its "free" (aka paid by our pseudo-employer - the Government) so we can all be productive and contribute to making the country/world a better place. Plain and simple...

</comment><comment><USER52> Their pricing site should drop all the ".00" cents figures... it seems unnecessary and subconsciously makes the numbers look bigger than they are.

</comment><comment><USER53> Posting your prices is revolutionary? It's about time for this sort of thing, but damn the medical market must be in an unhealthy state.

</comment><comment><USER54> Price transparency is a key part of Obamacare and is apparently beginning to work. For example, insurance companies in Oregon reduced premiums after seeing competitor prices [1].

1: [http://www.oregonlive.com/health/index.ssf/2013/05/two_orego...](http://www.oregonlive.com/health/index.ssf/2013/05/two_oregon_insurers_reconsider.html)

<comment><USER55> Insurance price transparency != hospital price transparency. It's actually easy to avoid insurance price transparency by manipulating deductibles, co- pays, and lists of supported medications.

</comment></comment><comment><USER55> Not a hospital, but I patronize this medical group partially because they have a list of cash prices posted online

[http://www.caduceusmedicalgroup.com/cash-prices/cash- prices....](http://www.caduceusmedicalgroup.com/cash-prices/cash-prices.html)

Even though I never needed it, having insurance through my employer, it's the transparency that I liked.

</comment><comment><USER56> "hospital" may be a misnomer - these may be private facilities set up to do high-volume "day surgeries" that don't require ICU's or CCU's that tertiary care hospitals provide. They aren't expected to offer the full suite of hospital services, i.e. emergency, trauma, in-house pharmacy, etc.

</comment><comment><USER57> The great thing about this is that could enable me to be my own insurance company. If I know how much things cost, then I can budget appropriately and invest in an index fund to store my health fun. If bad things happen, then I'm covered. If they don't happen, then I get a boat.

</comment><comment><USER58> FYI for all Florida patients, under the FL Patient Bill of Rights FL Statute 381.026(4)(c)(3): "A health care provider or a health care facility shall, upon request, furnish a patient, prior to provision of medical services, a reasonable estimate of charges for such services."

</comment><comment><USER59> It's called medical tourism, and it's absolutely rife in Asia. [http://en.wikipedia.org/wiki/Medical_tourism](http://en.wikipedia.org/wiki/Medical_tourism) (I guess Oklahoma is the new Mexico, or something.)

</comment><comment><USER60> So...let's create a reverse auction platform for self-pay surgeries? Not at all sure what the regulatory issues would be around that, but seems like it would make sense especially when you add in time and availability of specialist surgeons on certain days.

</comment><comment><USER61> > The move is revolutionizing medical billing in Oklahoma and around the > world.

Around the world? Not really.

</comment><comment><USER62> It should be the law that they must provide the pricing online and via an API so that it can be easily collated and compared with every other hospital. Imagine the type of apps you could create with this information.

</comment><comment><USER63> Oh man I want this to be the new norm _so bad_. The American health care system really needs to be shaken up. Republican dissent in Congress blocked that when Obama was championing it; perhaps the Republican's stated goal of a free market is going to be what affects the change. Where are the free market republicans supporting these practices? Why are they so upset about people coming to work in America but not the fact that hospitals are able to use the insurance system to gouge consumers?

The cited $30,000 surgery costing a fifth of that at the centre makes it well worth the effort to fly from out of state to get your operation on. The old system of charging whatever you can get away with because the patient doesn't have options needs to die a horrible death.

<comment><USER64> > Where are the free market republicans supporting these practices?

Yes, where? You'd think they and the Ron Paul fans would be all over this.

<comment><USER65> What, you think they'll schedule some elective surgery when they learn of this? People all over the political map have been complaining about healthcare for a long time. I'm surprised you haven't heard any of that.

Seriously, political solutions to this sort of complex problem in the USA are very difficult. Blaming any particular political group for a lack of same is kind of dumb.

If this Dr. Smith is improving the state of healthcare as most comments here seem to indicate, then you'll be scandalized by the Gustave de Molinari quote on his blog. It's more Ron-Paulian than Ron Paul.

</comment></comment></comment><comment><USER66> So who on this thread has already started coding a kayak for hospitals?

<comment> alok-g Am waiting for the day when it shows up!

</comment></comment><comment><USER67> If the whole point of the current healthcare system is to embrace a free market, why isn't this SOP already? Why did no one do this previously?

</comment><comment><USER68> Hospitals and medication MUST be free for everyone! fsck companies and money. Health doesn't have a price!

</comment><comment><USER69> Thats quite a bit cheaper than Australia for a Tonsillectomy at least, 3k vs 5k.

</comment><comment><USER70> Will we ever see a search engine for hospital quotes? Why not a startup idea.

</comment><comment><USER71> Well this is a shot across the bow of the AMA. Let's see what they do.

<comment><USER46> This really has very little to do with the AMA.

This is hospitals vs outpatient centers(who can do the easy stuff much cheaper than hospitals can)

</comment></comment><comment><USER72> An Orbitz for healthcare procedures is sorely needed. Does one exist?

</comment><comment><USER73> I don't care how transparent there pricing structure is. Letting Kevin Smith practice medicine at you is a bad idea. Chasing Amy was pretty good, tho.</comment>


How our SaaS startup went from 8 Weeks of cash in the bank to profitability - <AUTHOR> https://medium.com/team-tettra/navigating-the-depths-of-nearly-failing-to-profitability-part-3-land-ho-ea5a6aa5676e <comment><AUTHOR> Hi HN - Andy from Tettra here, the author of this post.

I wrote this article because startups tend to be a rollercoaster of emotional highs and lows. In my opinion there's not enough open discussion about the low points. Usually when a startup founder gets asked, how's it going?", they automatically respond, "we're killing it."

This is my attempt to shed some light on what we actually did to turn around our startup from almost failing to getting to profitability.

Tried to be as honest as possible about what happened with our real numbers. Would love to hear your comments, feedback or answer any questions here in the thread.</comment>


Don Draper Presents Facebook Timeline - <AUTHOR> http://vidque.com/lukas/45217/don-draper-presents-facebook-timeline

<comment><USER2> Yeah, that is a perfect fit. The lives of quiet desperation led by the main characters in Mad Men match the Facebook audience.</comment>


Researchers identify command servers behind Google attack - <AUTHOR> http://arstechnica.com/security/news/2010/01/researchers-identify-command-servers-behind-google-attack.ars?utm_source=rss&utm_medium=rss&utm_campaign=rss# <comment><USER2> "Citing sources in the defense contracting and intelligence consulting community, the iDefense report unambiguously declares that the Chinese government was, in fact, behind the effort."

OK, good. It's not yet been proved in court, but at least it allows us, in further discussion, to comfortably assume that it was in fact China.

Some time soon I'd like to see: an end to end trace of the attack, identifying computers, their physical locations and ownership/control; a broad and coherent description of the of the crime itself, including how they first got in and how they operated while in; and a description of what was taken or changed. I'd like the analysis to be unusually forthcoming and direct.

This is not to force the Chinese govt to fess up. They know they did it, they know we know, and they'll deny it forever, even if we find a picture of the chief general of the PLA crouching over the disemboweled corpse with blood dripping from his teeth and a deer-in-headlights expression.

This is for US citizens and the rest of the world to see unambiguously what the Chinese have done and how much effort they put into it, and the cost. As such I'd like to see it first in a popular magazine, maybe a special edition. After that I'd like to see the same information dragged back and forth in Congressional hearings.

It's one thing to vaguely assume in some sort of hip, jaded way that "of course the Chinese are spying on us." It's quite another thing to see the (I assume) enormous extent and effect of what they're actually doing.

"The servers used in both attacks ... are currently pointing to IP addresses owned by Linode, a US-based company that offers Virtual Private Server hosting. ... "Considering this proximity, it is possible that the two attacks are one and the same, and that the organizations targeted in the Silicon Valley attacks have been compromised since July."

If the report's findings are correct, it suggests that the government of China has been engaged for months in a massive campaign of industrial espionage against US companies."

 _SON_ of a ...</comment>