Thursday, September 14, 2017

CBO Healthcare Costs for those Under 65

The CBO published a report indicating the 2017 costs of Healthcare for those under 65. Note Medicaid is $300 billion plus and Medicare, for those disabled, is $100 billion plus. The dominant driver is the expended Medicaid from the ACA.

They continue:

According to CBO and JCT’s estimates, a monthly average of about 244 million noninstitutionalized civilians under age 65 will have health insurance in 2017. Almost two-thirds of them will have coverage through an employer, and about a quarter will be enrolled in Medicaid or the Children’s Health Insurance Program (CHIP). A smaller number will have nongroup coverage, coverage that is provided by Medicare, or coverage obtained from various other sources. On average, about 28 million people—10 percent of all noninstitutionalized civilians younger than 65—will be uninsured in 2017, CBO and JCT estimate (see Figure 1). Between 2017 and 2018, the number of uninsured people rises by 2 million in the agencies’ projections, mainly because premiums in the nongroup market are expected to be higher. From 2018 through 2027, the number of people with coverage is expected to grow from 242 million to 247 million. But the number of uninsured people is also expected to grow, from 30 million to 31 million, keeping the uninsured share of the under-65  population stable at 11 percent.

Now under Medicare we have an annual cost of $10,000 per person. Thus Medicare for all at 330 million people is $3.3 trillion a year! Yep, a large number.

At least when Thomas Paine made his suggestions in the 1790s, he had the courage to estimate the costs as well as the source of payment. Where are Thomas Paines when we need them?

Thursday, September 7, 2017

AI and the Academy

In a Press Release MIT announces that it has entered into a $240 million dollar effort with IBM to establish a joint AI Laboratory. They state:

IBM and MIT today announced that IBM plans to make a 10-year, $240 million investment to create the MIT–IBM Watson AI Lab in partnership with MIT. The lab will carry out fundamental artificial intelligence (AI) research and seek to propel scientific breakthroughs that unlock the potential of AI. The collaboration aims to advance AI hardware, software, and algorithms related to deep learning and other areas; increase AI’s impact on industries, such as health care and cybersecurity; and explore the economic and ethical implications of AI on society. IBM’s $240 million investment in the lab will support research by IBM and MIT scientists. The new lab will be one of the largest long-term university-industry AI collaborations to date, mobilizing the talent of more than 100 AI scientists, professors, and students to pursue joint research at IBM's Research Lab in Cambridge, Massachusetts — co-located with the IBM Watson Health and IBM Security headquarters in Kendall Square — and on the neighboring MIT campus.

This comes after much criticism of the IBM Watson venture as more hype than reality. But it does raise many major questions.

1. MIT is an academic institution and what research which is done there has always been of a public nature. MIT Lincoln Lab is an exception but that Lab, as was the Draper Instrumentation Lab, considered an off shoot, not on the main campus and not an academic department.

2. IBM one would assume is investing $240 million and expects a return to shareholder value. That must mean that IBM has not only first dibs on whatever is developed but also there is some form of proprietary ownership which seems to be antagonistic to normal academic freedom.

3. If one does a study in this "Lab" then can one take what expertise one has created and take it to a competitor?

4. Why IBM. Is IBM desperate to get something out of Watson that they would dump a quarter of a billion into this effort? Motives count.

5. MIT was a Land Grant School, and as a result had an obligation to support US industry and interests as a goal if not a primary goal. Does this enhance or subrogate that goal?

Needless to say this makes for good PR but is it good science and engineering? I wonder.

Wednesday, September 6, 2017

Over Rated?

There is an explosion of AI related products. One of the most significant is Watson, the IBM entry which continually gets great praise. STAT has published an excellent piece worth reading by anyone concerned.

The article concludes:

While not specific to Watson’s health care products, the report said potential clients are backing away from the system because of significant consulting costs associated with its implementation. It also noted that Amazon has 10 times the job listings of IBM, which recently didn’t renew a small number of contractors that worked for the company following its acquisition of Truven, a company it bought for $2.6 billion last year to gain access to 100 million patient records. In its statement, IBM said that the workers’ contracts ended and that it is continuing to hire aggressively in the Cambridge, Mass.-based Watson Health and other units, with more than 5,000 positions open in the U.S. But the outlook for Watson for Oncology is challenging, say those who have worked closest with it. ...the lead trainer at Memorial Sloan Kettering, said the system has the potential to improve care and ensure more patients get expert treatment. But like a medical student, Watson is just learning to perform in the real world. “Nobody wants to hear this,” ... said. “All they want to hear is that Watson is the answer. And it always has the right answer, and you get it right away, and it will be cheaper. But like anything else, it’s kind of human.”

 Medicine is complex, and especially cancer care. No patient is the same. It is not only the pathology but the patient's approach to the disease. Even in such centers such as MSKCC there are a multiplicity of treatments. Also even the current immunotherapy treatments may work 40% of the time. Why the 40% and why not the 60% is the question without an answer.

IBM used to be a service company, selling hardware and software services. It then morphed into a consulting company, a real service business. One wonders just what business they are in now.

This is an article well worth the reading.

Monday, September 4, 2017

We Told You So!

In a just released re-study of the PCa mortality and PSA tests the authors note:

Screening was estimated to confer a 7% to 9% reduction in the risk for prostate cancer death per year of MLT. This translated into estimates of 25% to 31% and 27% to 32% lower risk for prostate cancer death with screening as performed in the ERSPC and PLCO intervention groups, respectively, compared with no screening...After differences in implementation and settings are accounted for, the ERSPC and PLCO provide compatible evidence that screening reduces prostate cancer mortality.

And the reasons are what he had noted when these, in my opinion fatally flawed, trials were performed.

Perhaps they could now calculate how many mend died as a result.

As Eureka notes:

After differences in implementation and settings were accounted for, two important prostate cancer screening trials provide compatible evidence that screening reduces prostate cancer mortality. These findings suggest that current guidelines recommending against routine PSA-based screening may be revised. However, questions remain about how to implement screening so that the benefits outweigh the potential harms of overdiagnosis and overtreatment. 

 It is a shame!

Saturday, September 2, 2017

The FCC and Net Neutrality

It appears as if the current FCC management is about to undo what is called Net Neutrality. A while back I wrote a long piece in Internet Neutrality while still back at MIT. My point was simply that a carrier is just that, a carrier, and since the days of Elizabeth I this concept was accepted and became the element which led to the dominance of England in world trade. Now comes the FCC and the incumbents. The FCC has never been known for much more than a political equivocator depending on whose party is in charge. So one should not expect anything more than an expression, nay and echo, of what the powers to be or those in charge really want.

Wired magazine has a piece that somehow thinks this is all new. They state:

This past April, the Federal Communications Commission invited the American people to weigh in on whether the federal government should roll back the rules currently in place to protect net neutrality. By the time the online comment submission period ended last Wednesday, the agency had collected 21.9 million comments, an astounding level of participation on what at first glance appears to be a rather esoteric telecommunications policy issue. (For comparison, when the FCC received around 500,000 postcards and emails about its media ownership rule changes in 2003, it was considered a big deal. Even Janet Jackson's wardrobe malfunction at the 2004 Super Bowl garnered only about 1.4 million comments.) So what did the people say? The industry group Broadband for America, which opposes the FCC's current rules, recently commissioned an analysis of the comments from a company called Emprata. The study determined that a majority of the comments–about 60 percent–favor keeping the FCC's current rules, which classify internet service providers as "Title II" common carriers like mobile and landline phone companies and ban them from blocking or interfering with lawful content. If you look only at unique comments, as opposed to form letters using boilerplate text, those in favor of keeping the Title II rules outweigh those who want to jettison the rules 1.52 million to 23,000. The only hitch: the commenting process was such a debacle that the legitimacy of the entire body of comments is now in question.

Should one be surprised that the FCC's system  is so let us say reckless? Hardly. It is a Government controlled process. Some Beltway Bandit probably wrote the specs, then another Beltway Bandit did the software. And in the midst of this no one is really responsible for anything. So one expects rational actions from these folks.

In my experience and in my opinion I saw the FCC up close. If I went in with some issue, my opponent was in the waiting room after I finished to rebut my position. How did they find out? Simple, the Sunshine rule, the FCC tells everyone everything. In those days one filed a paper document. Yes it was cumbersome and yes form was important. But it meant that someone had to give some thought to the process and multiple filings were difficult. The on line approach allows for slamming of various types not to mention the system allows the uploading on anything, yes folks anything.

These then are the people who will control our information flow. One should understand that the main ISPs, such as Comcast, Verizon, AT&T are also  in the media business and promulgate their own interests. They carry a big stick, and they also have great carrots for FCC officials when they go out in the world. Just look at the heads of major industry lobbying groups!

So what will happen with Net Neutrality; ask the largest bidder!

Thursday, August 31, 2017

A Modifier of a Verb is Called an Adverb

In the NY Times there is a piece recounting the alleged work ethic of Silicon Valley. They start by stating:

Silicon Valley prides itself on “thinking different.” So maybe it makes sense that just as a lot of industries have begun paying more attention to work-life balance, Silicon Valley is taking the opposite approach — and branding workaholism as a desirable lifestyle choice. An entire cottage industry has sprung up there, selling an internet-centric prosperity gospel that says that there is no higher calling than to start your own company, and that to succeed you must be willing to give up everything.

First, grammatically it is "thinking differently" if one wants to modify how one thinks. If however if it is used as a predicate then "I think different." means somehow that this thing called different is "what" you think.

Now in the 14th Century all students took the Trivium, Grammar, Logic, and Rhetoric. Why you may ask. To express themselves to each other clearly and correctly. Now Scholasticism was ending with Ockham and minimalism but this use of language correctly and unambiguously allowed for the development of English Law which may be one of the greatest creations of Mankind. I am not a lawyer for full disclosure.

Now back to the work ethic. Just being busy for 24 hours is meaningless unless you are productively doing something. I managed for a decade to work more than 24 hours a day, traveling to beat the sun to my some two dozen countries. I have seen lawyers book more than 24 hours in a day the same way. But that is a trick.

The question is; what are you producing during that time. Writing code is not "producing", it is effecting and idea. Creating a new system architecture is "producing", whereas writing code to do what you were told to do is akin to typing a Tolstoy novel. You are not Tolstoy, you are a typist. Thus the content of what is produced is critical. It begs the question of a Post Doc performing hundreds of tests for some Principal Investigator. Is that also akin to programming or is value added? Or is that why they are just a Post Doc.

The article continues:

Good grief. The guy is developing an app that lets you visualize how a coffee table from a catalog might look in your living room. I suppose that’s cool, but is it really more important than seeing your kids? Is the chance to raise some venture-capital funding really “the ultimate reward”? 

There are two issues in this statement. First, is another App of any value, period! Fifty years ago one built a better communications system, an improved medical imaging system, an innovative therapeutic, or any other thing that was real, advanced humanity as a whole. But a new App, get real. Second is the issue of who is doing what. In my experience the true start up is one , perhaps two people. There is a visionary, a Founder, and that person assembles a team. That person is the "dream merchant" selling the vision, laying out its implementation, convincing customers, and yes raising money. For the most part every one else is an employee, a follower. Thus this begs the question; do all people have to hustle, or just the leader?

Recently while trying to sort through some possible start up ideas at MIT we had one where the alleged CEO disappeared. I finally found him and the reason was because his wife had a baby and he was taking his Paternity Leave as she was taking her Maternity Leave. My daughter was delivered by me and the Resident and I went back to the Institute and picked my wife and daughter up the next morning between classes. That was fifty years ago. Did not skip a beat. No leave anywhere, and that is truly a Hustle. Today I guess we all get leave, paid and all. Unless you are not in Silicon Valley of course!