So health care costs in US grow faster than Income and Economy. It surely can be partially blamed to how inefficient and high overhead the system is but I think fundomental reason is different. Medicine has to offer a lot to people these days – I did the MRI another day and was surprised to see how many artificial things people can have in their body. The more advanced medicine is just more expensive – in terms of development, training, care.
The cost of what medicine could provide for individual is so high everyone can’t possibly get the health care at the maximum extent possible. This is scary – the life is sacred and we want to believe everything possible would be made to save our life but this is just not possible. Furthermore with continuing development the gap between average health care society can afford and what medicine can provide will widen.
What does universal health care do ? It fixes the costs which in the end means it limits amount of health care one can get. In my life I lived in 3 countries with universal health care – Russia, UK and Sweden and there is a lot in common. You would have the long lines for certain specialists and procedures or the doctor will plainly refuse to send you to specialist for the same condition as you would have no problem going advanced diagnostics in US.
Just in the last month I had a routine MRI check. I could schedule it the next day. My mother in UK also needs one… she is still to get back the letter when her appointment to be scheduled and expects it to be at least 6 months away.
True, the state run health insurance usually treats life threatening conditions seriously and you can get diagnostics you need, but because of economy on screening and diagnostics or outdated equipment you have less chance to be diagnosed in time.
Available drugs is also the question. During my time in UK there was a big scandal with national health care not covering expensive last stage cancer drug. It extended people life few years but it was considered too expensive still – the same money could save more lifes being invested in something else.
As I mentioned the numbers of course matter. Litigations as well as salaries play its role. Russia for example can afford much more doctors because they are paid much less. The doctors in state run hospitals could be earning as little as $200 a month. Doctors in UK and Sweden of course earn much more than that but still no match for their US collegues.
Insurance companies (at least some) also place the limit on the medical expenses. I think my insurance covers expenses up to $2M in a life time.
There is no free cheese and if health care is provided to everyone there is going to be caps on the services provided. The only question for me if this is going to be honest and clear what services are available or would it be making services available in theory but impossible to get in reality.
One of the core values I had for Percona is providing indepentent/bias free services for the customers focusing on just their needs and benefits and avoiding the things which would stop this from happening. As I was thinking about this matter over the years I see there are number of things which forms the bias or breaks tru independense and some are harder to deal with than overs.
Product Sales – if you own the product you’re doing consulting around it is very hard to be independent. It would take a lot of guts for consultant to go out there and say the competitor product would work better for the customer and it takes a lot of leadership to ensure such opinions can be exposed without putting the job at risk. At Percona we’re in good position about this one because we made a choice not to sell any products – all software we develop is freely available and we do not have any direct insensitive to push our software to be deployed. True we think it does provide value and improves effectiveness in many cases but it is not the same thing.
Partnership Commissions – Another insensitive company may have is to push product or services by the partners earning comission on the deal. In this case it is similar to Product Sales issue as there is a motivation to recommend partners which pay highest commission and avoid solutions which do not pay any. This is harder one to solve. If we simply to refer the customer to someone we do not want any comission on this. If someone would like to give a token of appreciation to Percona we would rather see in form of discount to our customer. We’re paid for bias free recomendation of best solution for the client and this is what we do. If however customer wants to work with Partner through Percona we have to charge certain fair margin to keep operations running. If we subcontract we’re exposed to legal risks, financial risks of failing to get the payment from the customer and quality risk, potentially being forced to seek solutions at our cost for mediocree work partner has done. We try to structure our deals in this case to ensure we fairly share revenue with partner and so we have limited insensitive choosing one partner over another. Of course relationships does matter in this case – if some partner does a great job performing some task he naturaly becomes preferrable.
Personal Preferences – Here is another hard one. Personal preferences. There are people who love Linux others love FreeBSD – they know one better and would be naturally biased towards that. Everyone has their individual experience which leans us way or another. The only solution I see here is education for consultants to be factual and really evaluate situation based on facts rather their personal preferences as well as disclosure of customer experience in regards to matter. For example if you’re compating AIX to Linux and never had experience with AIX you only can say that, as well as state the fact there are much fewer people running MySQL on AIX than Linux so risk of platform specific issues is higher and there is less “community” experience.
Resource Availability – As a company we have experience with some technologies and less or no experience with others. This of course means we’re not as confident recommending technology we do not know – for example comparing MySQL to CouchDB it would be hard to be objective for us because we know much more about first than the second one. Though full disclosure helps in this case to make sure advice is interpreted correctly. The other issue is – if customer decides on CouchDB he will likely hire another company to work with, while if it is MySQL – business stays home. This really requires consultant integrity and this is important personal skill for Percona hires. Another way is to ensure we as the company have experience for relevant technologies. If CouchDB is better than MySQL for large class of application this means we better to get experience on CouchDB either inhouse or via partner.
Any other problems you see or solutions for stated ones ?
The Parcell Tax initiative has failed here in Pleasanton which means a lot of staff and program cuts from the Schools, which is something this area is proud of.
To partially offset the problem there is a fund drive. For example you can donate to PSEE to save music classes.
Now I can understand why parcell tax measure failed – there are a lot of old people in Pleasanton having kids out of School. I however do not understand why not to make these extra activities, which have no money for them in budget to come at added cost ? There are some paid additional classes at the school already such as computer typing classes and I do not understand why this makes the difference.
I did donation more than to cover my fair share but I think this is a bad way to collect money for such an activities. If you look at my (or other individual) choices – I can skip donating and potentially enjoy free ride because somebody else paid my share or well it may be it would not be enough to support the program. If I do donate I have to donate more than my fair share to keep program in place because there will be people who will not donate. This is screwed as it provides and extra excurses and motivation for people who can pay their share but choose not to do that.
Of course there are children which parents can’t afford to pay, though I think they are a small minority in this pretty expensive town. I would much rather see they applying for scolarship or something like it to enroll into the classes and I even do not mind donating some money for it. Such approach would ensure you’re not the most rewarded for the absolutely passive approach of sitting there and doing nothing as donation based funding rewards.