TheWama

An interesting data point in the electronic medical records discussion.

Those (admittedly few) primary care practices which choose not to interact with the insurance companies, and operate on a cash basis, also happen to be the ones who are pushing through higher efficiencies through technology. Hello Health (https://www.hellohealth.com/), in Brooklyn, uses and develops a medical web platform through its software arm, Myca. Qliance (http://qliance.com/), in Seattle, has been using an electronic records system from the start, which was described to me as "just a glorified CMS".

It does seem strange that paper is the word of the insurance world, and I don't know the industry well enough to explain the problem, but it seems the problem may have something to do with the doctor-insurer dynamic.

> Love jQuery. Hate monopolies.

What's the meeaning of the word "monopoly" in a situation where breaking the monopoly means switching to another library? A library which, by the way, won't exist unless someone sees significant enough failings in the existing one to create an alternative, from scratch or through a fork.

Barrier to entry is the property which enables abusive monopolies, and in the open source world, is there such a thing?

This is the kind of pigeon-holing which prevents one from actually considering an idea on its merits.

For example, what did OP say that suggests they don't allow themselves to think broadly? It's a baseless assumption rooted in your own personal biases, and has nothing to do with the idea at hand.

Which is not to say that I'm particularly enthusiastic about sea-steading. Who's to say though, that its time won't come?

> it's very hard to make macro economic calculations like this. There are so many more factors that haven't been mentioned and surely there are some of those unknown unknowns lurking somewhere as well :-)

Right, in which case we should evaluate it some other way. I think a good analogy can be illuminating.

Say we have an island population which consumes umbrellas (for shade) and coconuts (for food). If there's a bubble in umbrellas, that means the island society built too many of them, falsely thinking it would be worthwhile to do so. Since there's a glut of umbrellas, all the builder takes a loss, and probably lays off some or all of his newly-hired umbrella-building workforce.

But the umbrellas don't disappear, so it's not all bad, right? Over time, the umbrellas will wear out and those in storage can be used. That seems to be the gist of the article.

But this argument falls apart if you realize that the goal of any economic system, and particularly the free market system, is the efficient allocation of capital. The most efficient arrangement on our hypothetical island would have been to make only umbrellas as are needed, when they're needed, built by a consistent, maintainable workforce, and leaving others free to do as they will.

This is true of infrastructure as well; businesses and societies flourish when the find the most efficient ways of doing things, and businesses found out a long time ago that holding excess stock is wasteful (see http://en.wikipedia.org/wiki/Just_in_time_manufacturing). We should accept this and not try to paint a pretty face on waste.

They say that:

> Luxury riverside developments that now dot the banks of the Thames in London may be empty for the moment but will find occupiers eventually

but they fail to mention that by over-allocating goods and labor to large, luxury apartments they've reduced access to other things. For example, more modest, economically sustainable apartments could have been built in the place of these, which would have meant more efficient, denser land-use.

Anyway, IMO this is all hogwash. Of course it's not all for naught, but that doesn't means it's any good.

Another interesting development is primary care for cash, or "direct primary care". Somewhere between retail health clinics at the low end and concierge medicine at the high end, these are doctors you subscribe with for something on the order of $50 a month for a personal relationship with a primary care doctor.

Because of the compensation model, they've embraced conveniences like e-mail, phone calls and text messaging for communication, as well as once-common house calls.

They're also able to better-compensate their doctors and provide longer, more immediate appointments because they don't have nearly the overhead of an insurance-financed medical practice. This could help stem the tide of doctors leaving primary care practice (http://www.entrepreneurialmd.com/index/2008/11/18/angry-prim...), a trend which does not bode well for the future state of preventative medical care.

It's a very early trend, but I'm looking forward to seeing it develop. I currently know of Qliance (http://qliance.com/) in Seattle and Hello Health (http://hellohealth.com/) in Brooklyn. For more, you can check out videos from each organizations' founder: Dr. Garrison Bliss (http://www.tvw.org/media/mediaplayer.cfm?evid=2008030136C...) and Dr. Jay Parkinson (http://vimeo.com/2082073)

You did state rather unequivocally that WWII fixed the economy:

> It didn't suffer through it at all, it got fixed by it.

And now, you're attempting to declare post hoc, ergo propter hoc? The whole point of what I'm saying is that there are thousands or millions of changes in policy, technology, demographics, sentiment, which had an impact on the economy, we don't know which did what.

I could just as easily explain the post-war years by saying that it's natural that any country which does not get bombed to smithereens will experience relative prosperity, whether or not it participated in bombing other countries, as we did in WWII. Perhaps it was only that advantage which overwhelmed the tax of war spending.

Again, I can't say for sure, but neither can you. I'm inclined to think you're wrong though, from the simple perspective the the allocation of resources over time.

The fallacy is that you don't know, can't know, what our economy would have been after that period, absent WWII. What if we were on the cusp of recovery anyway and we had spent 5 years building railroad and machinery rather than tanks and bombs? The end result would have been a more efficient application of industry over time, resulting in a more abundant society, right?

But I can't say that was the case, would have been the case, any more than you can say the opposite, because we don't know what would have happened if we had tweaked x or y, and can't test it. That's why economics is a social science, not a science. That's why economists are still arguing over what caused the great depression, as well as what ended it.

Ex-Freddie-Mac-Now-Cato-Economist Arnold Kling claims (in this interview: http://bloggingheads.tv/diavlogs/14744) that Fannie basically had to lower their requirements in order to meet the HUD requirements mentioned at the end of this article. So a well-intentioned but unaccountable leader makes a decision with unintended consequences, but because that decision reverberates through the market power of enormous governmental structures, it leaves a much larger mark than would be otherwise possible or likely.

Okay, we can't downvote spam... how about a report button? You could auto-hide and review by moderators after x# reports.

Design needs work on 2 levels:

User-friendliness

* when using the categories on the left to narrow a search, clicking a category always adds it to the end of the search, even when it's already included, even when it doesn't have any effect.

* likewise, while you can "drill down" by selecting additional narrower categories, you can't back out by selecting a parent category or de-selecting a category.

* the numbers here are off a bit. "Floor Care" gives 97 results, but the category on the left claims 71

These little details can lead to frustration for the user.

Visual Design / Branding

* Particularly considering your target market here, you guys desperately need a visual designer to create an attractive look for your site, and to give your site a feeling. Look for example at http://www.projectwedding.com/. They do a great job of design, where every element of the page is intended to evoke an emotion or association in the mind of the viewer, from their logo to the color scheme, to the (I assume) hand-picked lead imagery for the front page. Of course yours will be different, because your target market is different, but you can get a general idea from them.

* For example, you should not just have text examples, but show the thing that your buyer wants, so they can more easily make the association, and even make the leap to thinking what their home would look like if only they had those drapes &c.

* You also need a name and logo which can mean something to the user. Even non-sense brand names are chosen specifically to evoke an idea or emotion, to make some association. You should pick a name which really communicates what your site is, though not necessarily in direct terms.

I agree with others though, that the site looks promising. Good luck!

They corrected for this in the tests:

> the tests were repeated using gallons per 100 miles

You could also say "aught-5 gallons per mile," where the decimal is placed by convention. Though then you run into trouble with the .009 gpm cars...

There are some young approaches to solving this problem. One I just discovered today is Qliance, a low-cost version of boutique care, dubbed "direct primary care."

No insurance needed or accepted (thus no coding or paperwork), ~$50 a month, same or next-day appointments, 24hr access to care, they take their own xrays for free and dispense their own medicine at cost, &c.

Aside from making workloads managable (800 patients instead of 2-3000), the really interesting part is how this does away with the perverse incentives of insurance payments (which reward procedures rather than health, and which turns primary care into 10 minute referral-fests, rather than actual care), as well as sets up other good incentives, which reward the doctors for keeping the patient healthy (healthy patients don't need to spend a bunch of time in your office) and so on. His talk is really interesting: http://health.scribemedia.org/2008/01/21/garrison-bliss-pion...

Agree in general, with one note:

> capitalist market responses would be vastly better at "dealing" with it than anything the gubmint could do with carbon tax revenues

Carbon taxes have two sides, the costs and the revenues. The costs do work with and contribute to the capitalist market responses, by making more polluting products more expensive, relative to the less polluting.

On the revenues side, I agree again, but why not use that money for general expenditures? Why not tax the bad things (pollution & other negative externalities) more, and the good things less (sales, income, investment)?

Investment return rate, rent/buy cost ratio, inflation and home appreciation (or depreciation) rates all matter. It's a lot to consider.

Luckily, the NYTimes put out a great calculator for just this:

http://www.nytimes.com/2007/04/10/business/2007_BUYRENT_GRAP...

Shouldn't he be using median rather than average values? Zaitratsu could have just had one mega-posting and a bunch of mediocre ones. AFAIK, the conclusions he's drawing, while they may be true, aren't supported by the data he presents.

The disastrous thing is that it would be less useful to have a maximized window be 10x the size of its contents. For example, IMO the behavior of safari on maximize is just beautiful, because it's tailored to the specific website you're viewing.

If the application is a window into your data, why make that window bigger than necessary, thus obscuring your desktop, or some other window behind it? That may not be disastrous, but I think its intent makes sense.

Without further explanation, I end up suspecting that when he writes: "it almost never does what you’d want or expect it to," the emphasis is on his expectations as a Windows user, not on what he would prefer, all things being equal.

[and for the record, I'm speaking as an Ubuntu user, who has never owned a mac]

+1 for content negotiation. Extension-less URLs are just plain sexy.

This one is good for brainstorming ideas with immediate feedback: http://instantdomainsearch.com/

Indeed. On the subject of long vs. short term thinking, or the time-value of money, the most clear example is the case of rent-to-own stores.

Rent-to-own is a form of financing, equivalent to taking on debt, but unlike other forms of debt, we know that it's used specifically for buying certain classes of durable goods, such as furniture, appliances and televisions. Due to the nature of these goods, we can assume that in most cases the owning of a given piece of furniture, for example, is not a necessity, and further, that buying these goods new is not the lowest cost alternative, when speaking about the total or even initial price. For example, I might be able to get a sofa off the street or sleep on a mattress without a frame or box springs.

Rent-to-own is also heavily favored by poor folks, who have another opportunity, which is to save up and replace their television or furniture at a later date for a lower total cost.

Making the latter choice is the rational one, if your personal discount function for the future value of money is sufficiently low. That is, if you have a long-term perspective, you value future abundance nearly as much as present abundance, and so save up for an outright purchase. However, if you have a short-term perspective, the extra you paid for the television would seem insignificant, because it accrued far in the future, and you're more concerned with immediate abundance.

One day I'd like to start one or more schools based on the Monitorial (not Montessori) approach (http://en.wikipedia.org/wiki/Monitorial_schools).

It takes a good amount of capital and respect to start a school and have people trust you to apply an uncommon (though potentially very beneficial) approach to schooling on their kids, so in the mean time I'm trying to earn that respect/capital.

I have a love/hate relationship with Condorcet's paradox (http://en.wikipedia.org/wiki/Condorcet's_paradox):

love: it illustrates a fundamental limitation of democratic processes

hate: it's the main reason the IMO best known voting method (http://en.wikipedia.org/wiki/Condorcet_method) is difficult to explain/advocate for...

I was going to launch pre-Railsconf and maybe recruit there, but this gives me an extra week or two of leeway... and hopefully filters out the corporate types, so I'm sold!

Curious how much you paid for that domain...

It's not just curiosity driving me; I'm trying to decide how much I'm willing to put down to save 1 letter and a syllable. :-P