In a broker/agent model agents are people doing most of the client-facing work, but they defer an offset of both liabilities and earnings to a broker. This is how real estate agents, lawyers, teachers, doctors, and many others enter their professions, at least in the US. Because the broker carries civil, and possibly criminal, liable for the violations of their represented agents they have a vested interest in the quality of product/service those agents deliver. In the medical industry the agent phase is described as residency and internship. Its a matter of who actually holds the license that allows a person to perform professionally.
In criminal enterprise drug mules and prostitutes often subscribe to this business model. Drug mules will transport drugs as part of an illegal enterprise and are paid by criminal organizations that have vested interest in the successful completion of the logistical services provided by the drug mules. Likewise, in some geographies prostitutes will voluntarily pay pimps a percentage of their earnings in exchange for physical security and those pimps stake the value of their services on the success and reputation of the services they provide to their prostitute agents.
You also have to understand most of the software industry loves to bitch and cry about all these problems they see in hiring and practicing and yet don't really want any of these problems to be solved.
I almost purchased a Kindle Scribe this year but went with a Supernote Manta instead. I couldn’t be happier. It runs the Kindle app but also KOReader so I can read pdfs transferred from my computer. It’s awesome for papers and pdf copies of documentation.
My favorite book is Douglas Adams’ Last Chance to See. He talks about it here [0] and IIRC he says it was his favorite book to write. Adams took a dark subject - endangered animals and our role in their extinction - and told a story that’s equally hilarious and hopeful.
It’s absolutely one of my favourite books too. His style of humour was a perfect dichotomy of reverent/irreverent that made him the perfect author for a book like this. Beautiful appreciation of the world meets shake-you-awake, perspective-bending humour.
We’re talking about hospitals. Many areas are served by one local hospital. And where there are several, it’s typically the ambulance who decides where you go. It’s also pretty difficult to compare one hospital with another.
IMO hospitals resemble utilities where market forces aren’t enough to guarantee good service.
> And where there are several, it’s typically the ambulance who decides where you go, not you.
Don't necessarily disagree with most of your sentiment, however the vast majority of hospital patients do not arrive in an ambulance, or even through the ER.
A lot of hospital services are elective or planned (surgeries, pregnancies, etc) and for those I've found it very helpful to 'shop' for the best options.
Also, the one time I was in an ambulance, they asked which hospital I wanted my daughter transported to.
All that said, it isn't always possible or feasible to choose - but it's not because of an ambulance.
> We’re talking about hospitals. Many areas are served by one local hospital. And where there are several, it’s typically the ambulance who decides where you go. It’s also pretty difficult to compare one hospital with another.
Paramedic here. It's typically, effectively, your insurance that dictates how we decide where you go.
If you're an acute, time-sensitive patient, then from a multitude of angles, "closest appropriate facility" makes sense.
Perhaps you dislike a hospital, or it's inconvenient, and you're not as acute or timely a patient, and your view is "I want to go to X hospital, and since I'm paying, why shouldn't I get to choose?"
As a paramedic, personally, I don't care.
However.
Your insurance does. And their perspective (sometimes rightly, and quite regularly wrongly) is that if you are well enough to bypass a hospital or multiple hospitals en route to a "chosen" facility, then did you need the ambulance? And if you didn't need it, why are "they" paying for it? And they can, and absolutely will, kick bills back to the ambulance company with a "please justify why an EMS transport was required versus advising POV (privately owned vehicle) transport or physician followup".
What they want to see happen, and what generally is actually the better option, as a provider is "we will go to the closest facility where they will assess and stabilize you as needed. if you then wish to be -transferred- to your facility of choice, they will organize that" (and, since the insurance criteria and questions are met, and a physician ordered the EMS transport, you should be covered). Though it is certainly less "convenient" for you.
Even beyond that, the area I'm in we have two hospitals. One is a Level 2 Trauma Center, one is a Level 3, but they're mostly comparable except for, well, acute trauma. We as providers will have a solid perspective of patient load in the ED of those hospitals, so I might ASK, not TELL you, hey, we might want to go to Hospital B, not A. And occasionally, though diversion is a convenience, not a concept under EMTALA (we can still absolutely show up at the ED with a patient even if they're "on divert"), some of the facilities here will round-robin to balance patient loads.
(Also, don't start me on Certificates of Need, where new hospitals essentially have to get the permission of existing hospitals in the area before they can open - essentially, "will you be okay if we take patients away from you"...)
And if you have several in the area, you might only have one that is in your insurance network. And that one may actually be substantially farther away than ones that aren't.
maybe if regulations and taxes weren't so high, there could be more competition? Transparency and the like would help...
Increasing taxes and removing alternatives is never a good deal.
"market forces aren't enough" government forces aren't enough either.
The VA is the penultimate example and I wouldn't wish that upon my worst enemy. That's where our veterans go to commit suicide in the parking lots waiting on help.
"The VA is the penultimate example and I wouldn't wish that upon my worst enemy. That's where our veterans go to commit suicide in the parking lots waiting on help."
The people I know who use the VA are quite OK with it. It's not perfect but none of them would want to put up with the insanity the rest of us has to.
Yeah... and the people that commit suicide in the parking lots waiting on help? They are chopped liver? They don't matter.
"it's not perfect" It's garbage and a prime example of government programs. Works for a few and fucks over the rest.
The ACA helps a few... and is built on lies - keep your plan? keep your doctor? save $2500 a year? Lies, lies, lies... a few million get help. The other 100m pay more, higher deductibles, lose their plans, lose their doctors.
But who cares about the 100m if the 1m get helped, eh?
the biggest problem is the wasted money, the lies and the people dying in the parking lots.
If you care about the people, look at the numbers across many different countries, not just US. The picture is pretty clear: US, with its mostly privately run and for-profit healthcare system, spends significantly more money per patient while achieving worse results for that money. The vast majority of Americans would get a better deal as far as their healthcare goes in literally every other developed country.
And it's gotten worse the more the government steps in to help.
The problem is the suggestion that government solutions will solve government created problems.
I have no problem admitting things can be fixed... but stuff like the unAffordable Care Act which is built on lies (Like your plan? Like your doctor? save $2500/year) is not going to solve the issues - nor is single payer, government ran solutions.
You'll never solve government created problems with government ran beauracracy.
Those other countries that have it better than we do have healthcare systems either run directly by their governments, or tightly regulated by it in a way that effectively means that the government decides how things are run.
Those other countries also have problems and people with money still go elsewhere when they need help. Rationing exists. Long lines exist. Denials exist. Shortages of doctors exist. etc.
The problem is that the conversation only focuses on the good parts of those systems and ignores the issues.
You can't have a real conversation and claim "have it better" when that may be true in parts but not in whole.
I don't claim the US system is better... or the best. But claiming that government ran or government overregulation leads to better is a lie. The VA is proof of that. the lies around the unACA is proof of that. The ever increasing prices and decreasing results due to government influence is proof of that.
Destroying what we have with something like the ACA isn't proof that government ran will be better... it's simply proof that people are willing to destroy what was working and claim that the destroyers will do a better job if only they have more money and more power.
That's like CA solving homelessness. "more money, more power and we'll solve homelessness" and there's never been more homelessness or less affordability in CA.
You're making an assumption that a hospital is a monopoly. I explicitly said "unless it's a monopoly".
Ok, if "many areas have one hospital"... I don't think that's true at all. Most areas have multiple hospitals. Most people live in metropolitan or suburban areas.
Depends on your definition. Do you only have 1 local hospital if there is another in a city that is a 2 hour drive away? Maybe only 1 hour? 30 minutes? Where do you draw the line?
This is my favorite possibility, that space has a “finite volume but no edges: if you travel farther than the scale of the universe, you end up back where you started.” It’s comforting on an existential level to imagine the amount of stuff around us is finite.
“ The torus moves into itself and comes out at the other end, where the locations of ‘coming out’ could be what is driving what we observe as the expansion of the universe.”
It's also possible particles increase causing expansion, this is just theoretical still. But if that's true, then it is finite but perpetually increasing. Potentially infinitely.
Relative to what it was before. It has an intrinsic size. Think of it in terms of matter density if you find it more comfortable. The density simply goes down over time; distandes between galaxies increase.
Just because you can't measure something directly doesn't mean it doesn't exist. There's plenty of things we only know only through indirect measurement.
Suppose the rules changed so that some authority guarantees your right to sell your house at the price you bought it, but only at that price: when you find your next home, you get back the cost of your old one, which is then auctioned off to its next owner. Individuals are protected from falling house prices and no longer treat their homes as investments. The authority takes on that risk, now distributed across many homes, some of which appreciate. How do you think this would play out?
As shittily as every other "experiment" in human history where someone thought they were smart enough to set all the rules for other people and treat them as if they were too stupid to make decisions for themselves.
I can't remember if it was a comedian or just some other person I'd seen a quote from; but they basically joked about how teacher's always said to pay attention and do well in school, or you would grow up to be a garbageman, but the teacher failed to tell you that garbagemen earned more than the teacher did.
