Archive for the ‘technology’ Category

An Update on Medical Reform

Monday, July 21st, 2014

Cash medical practice or, in the phrase favored by leftists critics, “Concierge Medicine,” seems to be growing.

Becker is shifting to a new style of practice, sometimes called concierge or retainer medicine. With the help of a company that has been helping physicians make such shifts for over 13 years, he will cease caring for a total of 2,500 patients and instead cut back to about 600. These patients will pay an annual fee of $1,650. In exchange, they will receive a two-hour annual visit with a complete physical exam, same-day appointments, 24-hour physician phone access, and personalized, web-based resources to promote wellness.

The article suggest that all these doctors choosing to drop insurance and Medicare are primary care. Many are but I know orthopedists and even general surgeons who are dropping all insurance.

The concierge model of practice is growing, and it is estimated that more than 4,000 U.S. physicians have adopted some variation of it. Most are general internists, with family practitioners second. It is attractive to physicians because they are relieved of much of the pressure to move patients through quickly, and they can devote more time to prevention and wellness.

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Mozilla steps in it.

Saturday, April 5th, 2014

Firefox has been a browser that I use going back to the time it replaced Netscape.

Netscape stock traded from 1995 until 1999 when it was acquired by AOL in a pooling-of-interests transaction ultimately worth US$10 billion. Shortly before its acquisition by AOL, Netscape released the source code for its browser and created the Mozilla Organization to coordinate future development of its product. The Mozilla Organization rewrote the entire browser’s source code based on the Gecko rendering engine; all future Netscape releases were based on this rewritten code. The Gecko engine would later be used to power the Mozilla Foundation’s Firefox browser.

The Netscape browser was the original interface for the World Wide Web. It all began with Mosaic, which was a project of Marc Anfdreessen when he was a grad student at the U of Illinois.

“In the Web’s first generation, Tim Berners-Lee (of CERN) launched the Uniform Resource Locator (URL), Hypertext Transfer Protocol (HTTP), and HTML standards with prototype Unix-based servers and browsers. A few people noticed that the Web might be better than Gopher.

In the second generation, Marc Andreessen and Eric Bina developed NCSA Mosaic at the University of Illinois. Several million then suddenly noticed that the Web might be better than sex.

In the third generation, Andreessen and Bina left NCSA to found Netscape…”

It was originally founded under the name Mosaic Communications Corporation on April 4, 1994, the brainchild of Jim Clark who had recruited Marc Andreessen as co-founder and Kleiner Perkins Caufield & Byers as investors. Clark recruited other early team members from SGI and NCSA Mosaic, including Rosanne Siino who became Vice President of Communications. Jim Barksdale came on board as CEO in January 1995.

The name change was a result of action by the University.

The University of Illinois was unhappy with the company’s use of the Mosaic name, so Mosaic Communications changed its name to Netscape Communications, and its flagship Web browser was the Netscape Navigator.

Then came Microsoft which saw Netscape as a threat, which it was.

Microsoft released version 1.0 of Internet Explorer as a part of the Windows 95 Plus Pack add-on. According to former Spyglass developer Eric Sink, Internet Explorer was based not on NCSA Mosaic as commonly believed, but on a version of Mosaic developed at Spyglass (which itself was based upon NCSA Mosaic). Microsoft quickly released several successive versions of Internet Explorer, bundling them with Windows, never charging for them, financing their development and marketing with revenues from other areas of the company. This period of time became known as the browser wars

The free browser from Microsoft was able to win “the browser wars” even though it was an inferior product.

Andreessen has become a famous investor and “angel” of Silicone Valley startups. He has also been involved in a bit of politics.

Andreessen endorsed Democratic candidate Barack Obama during the 2008 presidential elections. In 2012, however, Andreessen switched his allegiance to the Republican candidate Mitt Romney

Hmmm…

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More Obamacare news

Saturday, January 18th, 2014

UPDATE: More News.

This is supposed to be reassuring.

Obamacare contains a $25 billion federal risk fund set up to benefit health insurance companies selling coverage on the state and federal health insurance exchanges as well as in the small group (less than 50 workers) market. The fund lasts only three years: 2014, 2015, and 2016.

The government’s risk management program for the insurers has three parts (the “3Rs”):
A revenue neutral Risk Adjustment System designed to level adverse claim costs between health plans.
A Reinsurance Program that caps big claim costs for insurers (individual plans only).
A Risk Corridor Program that limits overall losses for insurers.
Of the $25 billion, $20 billion is earmarked for the Reinsurance Program and $5 billion goes to the U.S. treasury.

First, the Reinsurance Program caps big individual claim costs for insurers––in 2014, 80% of individual costs between $45,000 and $250,000 are paid by the government, for example.

Then comes the Risk Corridor program. Participating health plans will receive payments from the federal government in any of the following circumstances:
The plan’s costs for any benefit year are more than 103% but not more than 108% of the health plan’s targeted amount. The feds will reimburse 50% of all costs in excess of 103% of the medical cost target.
If the plan’s costs are more than 108% of the annual target, the feds will first pay the health plan a flat 2.5% of the target and then reimburse the plan for 80% of their claim costs above the targeted amount––with no upside limit.
Target cost is simply defined in the new law as a health plan’s “total premiums (including any subsidies) reduced by the administrative costs of the plan.” It is whatever the health plan projected its premium needed to be to pay medical costs.

The CMS has a new contractor for Obamacare, not just the web site. The previous contractor, CGI Federal, has been replaced rather suddenly.

“Accenture, one of the world’s largest consulting firms, has extensive experience with computer systems on the state level and built California’s large new health-insurance exchange. But it has not done substantial work on any Health and Human Services Department program.
“The administration’s decision to end the contract with CGI reflects lingering unease over the performance of HealthCare.gov even as officials have touted recent improvements and the rising numbers of Americans who have used the marketplace to sign up for health coverage that took effect Jan. 1.”

CGI Federal is the company connected with Michelle Obama through her classmate, a fellow Princeton alumna.

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Building the airplane during takeoff.

Tuesday, November 19th, 2013

Henry-Chao

We are now learning that a large share of the Obamacare structure is still unbuilt. This is not the website but the guts of the system.

The revelation came out of questioning of Mr. Chao by Rep. Cory Gardner (R., Colo.). Gardner was trying to figure out how much of the IT infrastructure around the federal insurance exchange had been completed. “Well, how much do we have to build today, still? What do we need to build? 50 percent? 40 percent? 30 percent?” Chao replied, “I think it’s just an approximation—we’re probably sitting between 60 and 70 percent because we still have to build…”

Gardner replied, incredulously, “Wait, 60 or 70 percent that needs to be built, still?” Chao did not contradict Gardner, adding, “because we still have to build the payment systems to make payments to insurers in January.”

This is the guy who is the chief IT guy for CMS.

If the ability to pay the insurance companies is not yet written, how can anybody sign up ?

Gardner, a fourth time: “But the entire system is 60 to 70 percent away from being complete.” Chao: “There’s the back office systems, the accounting systems, the payment systems…they still need to be done.”

Gardner asked a fifth time: “Of those 60 to 70 percent of systems that are still being built, how are they going to be tested?”

The answer was the same way the rest was tested.

We are halfway down the runway and the engineers are still bolting on the engines.

Of course, the unions will resist any payment for “risk corridors”

Risk Corridors are plans to bail out insurance companies that are put at risk by Obama’s “fix” by stopping the mandate penalties.

If they decide to un-cancel some plans and end up taking a beating financially from the adverse selection that results, Uncle Sam will be there to make everything right. I must have read three dozen blog posts yesterday wondering how O would be able to keep insurers on his side, working together with the White House to implement Healthcare.gov and the rest of the law, now that he’s gone and made them scapegoats for the cancellation mess. Turns out the answer’s simple. He’s going to buy them off.

Part of this is the “reinsurance” plan. The unions want nothing to do with this.

A provision in Obamacare would collect a fee from health insurance companies and third-party administrators (TPAs) of administrative services only (ASO a.k.a. self-insured) group health plans, to fund a reinsurance program to help “stabilize” premiums available through the exchanges. A significant number of unions are self-insured. Unions were pissed they had to pay this fee of between $60 and $80 per insured (now said to start at $63 and reduce in following years), and as recently as last week were demanding President Obama change the law. Obama caved.

The unions are not stupid. They want no taxes on their plans.

The tax, known as the reinsurance fee, requires self-insured organizations, such as unions and some large companies, to pay $63 for each covered member and an additional $63 for each additional family member on a health plan.

Curiouser and curiouser. Some of these guys have read the small print.

Now, it’s gotten even worse. Obama is trapped !

The War on Drugs

Thursday, August 15th, 2013

My sentiments on the whole drug question have been influenced by some experience with the medical aspect of the problem. Drugs are slipping out of any control due to developments in synthetic variations of older substances that stimulate brain chemistry, sometimes in unknown ways. The traditional drugs, if we can use that term, are also slipping out of control with Mexican drug wars replacing the Columbian cartels even more violent than their predecessors.

What about marijuana ? It is widely used by the younger generation and, while I do think there are some harmful consequences, especially in potential schizophrenics, the fact is that the laws are widely ignored and do little good and much harm. First, what about the link to psychosis ?

Epidemiological studies suggest that Cannabis use during adolescence confers an increased risk for developing psychotic symptoms later in life. However, despite their interest, the epidemiological data are not conclusive, due to their heterogeneity; thus modeling the adolescent phase in animals is useful for investigating the impact of Cannabis use on deviations of adolescent brain development that might confer a vulnerability to later psychotic disorders. Although scant, preclinical data seem to support the presence of impaired social behaviors, cognitive and sensorimotor gating deficits as well as psychotic-like signs in adult rodents after adolescent cannabinoid exposure, clearly suggesting that this exposure may trigger a complex behavioral phenotype closely resembling a schizophrenia-like disorder. Similar treatments performed at adulthood were not able to produce such phenotype, thus pointing to a vulnerability of the adolescent brain towards cannabinoid exposure.

This suggests that adult use may be less harmful.

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Why Obamacare is collapsing.

Tuesday, July 9th, 2013

Government is not very good at constructing software or IT systems. The FBI spent a decade with a troubled software project, then abandoned it.

Some FBI officials began raising doubts about the bureau’s attempts to create a computerized case management system as early as 2003, two years before the $170 million project was abandoned altogether, according to a confidential report to the House Appropriations Committee.

By 2004, the report found, the FBI had identified 400 problems with early versions of the troubled software — but never told the contractor. The bureau also went ahead with a $17 million testing program last December, even though it was clear by then that the software would have to be scrapped, according to the review.

The 32-page report — prepared by the House committee’s Surveys and Investigations staff and obtained by The Washington Post — indicates that the FBI passed up numerous chances to cut its losses with the doomed Virtual Case File (VCF), instead forging ahead with a system that ultimately cost taxpayers more than $100 million in wasted expenditures.

This is the history of complex government projects like this. They will not hire private companies and let them design these projects. Banks use ATM software that is far more complex and which works reliably.

Now Obamacare is the latest failure. I have been predicting this for a year. The electronic medical record software is another boondoggle. It increases workload and is not secure. Now the exchange IT systems are not ready and will not be for a decade, if ever.

“It’s the joyous, simultaneous, nonlinear equation from hell,” said Kip Piper, a former top official at HHS and OMB who is now a consultant in close contact with IT vendors. Piper said it’s no surprise that the administration has given up on certain functions given the technological complexity needed and the short time-frame.

But the long-term nature of the bad news could be good news for those who hope that the new marketplaces will launch in some form on time.

The struggles with technology and administrative complexity have not come as a recent surprise to administration officials; they’ve been negotiating them for months already. By eliminating non-essential tasks, they may be violating the letter of the health reform law, with its rigorous timetables and multiple requirements, but they may be more likely to get the core functions right.

Or wrong as the case may be.

The FBI experience is revealing:

The system was part of Trilogy, a $581 million FBI program that includes a new computer network and thousands of new high-speed personal computers for agents and analysts. VCF would have been the final major step in the upgrade, providing a modern database for storing case information and allowing agents to share and search files electronically.

Numerous outside experts and panels have criticized the FBI’s paper-based records system as outmoded and inefficient, and the commission that investigated the Sept. 11, 2001, attacks concluded that the shortcomings may have contributed to the failure to detect the al Qaeda plot. The Justice Department’s inspector general warned in February that the FBI’s continuing technology problems had “national security implications” and that agents were “significantly hampered” in their efforts to prevent terrorism and combat other serious crimes.

The new report, which is not scheduled for public release, reveals that “some officials involved in VCF’s development began to see problems” in early 2003, about a year after the FBI and its contractor, Science Applications International Corp., began focusing on creating the case management software.

That report is from 2005. My daughter is an FBI agent. They finally abandoned the whole thing last year and have begun from scratch.

Obamacare will not be functional by 2020. They will lie about it and fake it but the thing will be a complete mess.

Magan McArdle has more on the changes. All that is happening is that all cost control is stripped out. All that is left is the spending.

Bioengineering is coming fast.

Tuesday, October 30th, 2012

An interesting article from bbc explains how concrete treated with a species of bacillus can “heal concrete” cracks by making more limestone.

Experimental concrete that patches up cracks by itself is to undergo outdoor testing.

The concrete contains limestone-producing bacteria, which are activated by corrosive rainwater working its way into the structure.

The new material could potentially increase the service life of the concrete – with considerable cost savings as a result.

The work is taking place at Delft Technical University, the Netherlands.

It is the brainchild of microbiologist Henk Jonkers and concrete technologist Eric Schlangen.

If all goes well, Dr Jonkers says they could start the process of commercialising the system in 2-3 years.

From the article, it sounds like these are not engineered bacteria but engineering may increase yield.

“Micro-cracks” are an expected part of the hardening process and do not directly cause strength loss. Fractures with a width of about 0.2mm are allowed under norms used by the concrete industry.

But over time, water – along with aggressive chemicals in it – gets into these cracks and corrodes the concrete.

“For durability reasons – in order to improve the service life of the construction – it is important to get these micro-cracks healed,” Dr Jonkers told BBC News.

Bacterial spores and the nutrients they will need to feed on are added as granules into the concrete mix. But water is the missing ingredient required for the microbes to grow. Concrete is the world’s most popular building material, but cracking is a problem

So the spores remain dormant until rainwater works its way into the cracks and activates them. The harmless bacteria – belonging to the Bacillus genus – then feed on the nutrients to produce limestone.

The bacterial food incorporated into the healing agent is calcium lactate – a component of milk. The microbes used in the granules are able to tolerate the highly alkaline environment of the concrete.

The cost will be high per unit but in the overall scheme of things, reduction in maintenance and longer functional life will dwarf cost issues.

Far out there.

Saturday, October 20th, 2012

Once again, Craig Venter is looking for new challenges. The latest may be Martian DNA.

I have thought for some time that life on Mars is going to consist of microorganisms and be buried several feet below the surface of the planet soil. I have even blogged about it before.

Now, there is a possibility of a nucleotide sequencer that could go to Mars on the next probe in 2018.

In what could become a race for the first extraterrestrial genome, researcher J. Craig Venter said Tuesday that his Maryland academic institute and his company, Synthetic Genomics, would develop a machine capable of sequencing and beaming back DNA data from the planet.

Separately, Jonathan Rothberg, founder of Ion Torrent, a DNA sequencing company, is collaborating on an effort to equip his company’s “Personal Genome Machine” for a similar task.

“We want to make sure an Ion Torrent goes to Mars,” Rothberg told Technology Review.

Although neither team yet has a berth on a Mars rocket, their plans reflect the belief that the simplest way to prove there is life on Mars is to send a DNA sequencing machine.

“There will be DNA life forms there,” Venter predicted Tuesday in New York, where he was speaking at the Wired Health Conference.

Venter said researchers working with him have already begun tests at a Mars-like site in the Mojave Desert. Their goal, he said, is to demonstrate a machine capable of autonomously isolating microbes from soil, sequencing their DNA, and then transmitting the information to a remote computer, as would be required on an unmanned Mars mission. Heather Kowalski, a spokeswoman for Venter, confirmed the existence of the project but said the prototype system was “not yet 100 percent robotic.”

Doing this on Mars would avoid the problem of contamination by earth organisms. New life forms that don’t use DNA might be a problem but most people who have thought about this believe that DNA is the genetic material of all life forms. Of course, protein, which may have been the original genetic material on earth could also be the Martian equivalent.

We are starting to see commercial spacecraft develop and one was used to reach the international space station recently. A Mars mission is another order of complexity but by 2018, it may be an option.

UPDATE: A new report describes obtaining natural gas (methane) from coal using bacteria or archea.

Many coal beds contain large amounts of methane that can be harvested by drilling wells. In recent decades, researchers have demonstrated that a large fraction of the natural gas found in the coal beds is produced by naturally occurring microörganisms that feed on coal, and they have found ways to stimulate the microbes to produce more methane. Luca Technologies, based in Golden, Colorado, is using this approach to increase production from coal beds with existing methane wells. Another company, Next Fuel, based in Sheridan, Wyoming, recently showed that it could use similar technology to produce methane from coal beds that didn’t already have methane in them, raising the possibility that vast amounts of coal that’s currently too expensive to mine could be converted into natural gas.

What will we find on Mars that might be an analogous system ?

Craig Venter and biofuels

Monday, October 15th, 2012

Biofuels have gotten somewhat of a bad rep with conservatives because they are linked to Obama’s green energy boondoggles. Steve Hayward, at Powerline, thinks that success will be enough to turn the greenies against them. First they will be genetically engineered and will be developed by “Big Oil” partnering with entrepreneurs like Craig Venter who deciphered the human genome with private resources. He was in competition with the government funded “Human Genome Project.” My book review of Venter’s autobiography is here.

Venter does well in explaining his research and the article follows it well.

Venter said in an interview, “It’s pretty obvious that there’s nothing in the natural world to make the levels that are needed,” and he pointed to algae oil yield volumes needing approximately 20,000 gallons per acre equivalent of algae.

Venter and his research team, of course, in spring 2010, successfully created the first synthetic bacterial cell, which was controlled completely by a synthetic genome. Or as Venter explained it in his recent interview, as the first cell “to have a computer for a parent,” or “designed DNA on a living system.” Venter now says he has increasingly realized that a fully synthetic cell is the way to go to create competitive algae fuel. When it comes to tweaking naturally occurring algae cells, he says, “you’ll never get there with that. We need a fundamental change to how we approach all this.”

This will be enough to antagonize the Luddite Greenies who are ideologically hostile to genetic engineering. Some writers are already predicting problems.

Venter, the first mapper of the human genome and creator of the first synthetic cell (pictured above), said his scientific team and ExxonMobil have failed to find naturally occurring algae strains that can be converted into a commercial-scale biofuel. ExxonMobil and Venter’s La Jolla, Ca.-based Synthetic Genomics Inc., or SGI, continue to attempt to manipulate natural algae, but he said he already sees the answer elsewhere — in the creation of a man-made strain. “I believe that a fully synthetic cell approach will be the best way to get to a truly disruptive change,” Venter told me in an email exchange.

Venter made his remarks before a conference this week on the future of energy at the New America Foundation in Washington, D.C., and in subsequent emailed replies to questions.

When announced in July 2009, the Venter-ExxonMobil alliance of colossals attracted wide publicity. It called for ExxonMobil to spend up to $600 million if publicly undisclosed milestones were reached in the lab. The Wall Street Journal said the partnership might signal “a coming of age” for algae biofuel. Greenbang fretted that the alliance might actually prove “unholy,” but not Gigaom, which said it could be “algae’s big break.”

The terms of the alliance omit the fully synthetic approach that Venter is now advocating, so he is conducting “an ongoing dialog” with Exxon about a new agreement, he said. He appeared to suggest that such a new compact would require more Exxon investment.

If I were in charge of investing in alternate energy research, I would take what Venter says very seriously.

I assume that our skill set in this area has been one of the attractions for Exxon to work with us. Our success at building the first synthetic cell is only from last year and had not been achieved when we formed the agreement between SGI and Exxon. So I would say it is an ongoing dialog.

The future lies with algae and modifications of coal. Ethanol is a dead end. Venter is not the only one interested.

One of the dangers of using the synthetic algae cells is the fear that the cells could somehow be let loose on the outside world, which Venter admits could wreak havoc like turning the oceans into a sea of lipids. But Venter says that designing an organism that has self-destructive properties (it can’t live outside a lab, or it dies with a certain time period) could contain such an organism.

Algae oil company Solazyme, went public this year, and plans to commercialize its algae fuel in the coming years. Solazyme tweaks existing efficient algal strains and grows its designer algae in fermentation tanks without sunlight by feeding it sugar and then using existing industrial equipment extracts the oil. Solazyme’s stock is trading a bit under $10, way down from its IPO price of $18.

I would bet on Venter, first of all because he thinks in terms of private, profit making business. His record is pretty impressive and he has hired a lot of the world’s experienced scientists. I have previously written a number of blog posts on related topics, here, and here, and here, and here.

It’s interesting that the Titanic is being eaten by “Rusticles” that that are eating the iron in the hull. Bacteria that eat iron in an oxygen-free environment are only one of the marvels that are being discovered in the depths of the ocean and in hot vents in volcanic pools.

The coming energy crisis

Friday, January 14th, 2011

The Obama administration is still in the throes of global warming mentality. They have cancelled leases for oil and gas in the huge deposits in western states like Montana. The vast boom going on just to the north in Alberta has not impressed Interior Secretary Salazar. They want to take millions of acres out of the energy search by naming them wilderness, just as Bill Clinton created a huge wilderness area out of good potential energy fields at the end of his administration. They have not made nuclear power plants any easier to build. The Gulf oil leases are still blocked and the moratorium, while allegedly ended, continues in a slow down. The only energy and his acolytes are interested in is “renewable” such as wind and sun. These are boutique power sources and even these are being blocked by Democratic politicians.

But the project is hardly shovel ready. Several regulatory hurdles remain, and opponents of the wind farm have vowed to go to court, potentially stalling Cape Wind for several more years.

For years the Cape Wind project has been the focusof pitched battles splitting politicians and environmental groups. While some environmentalists are prepared to go to court to stop the project, other major groups, including the Sierra Club and Greenpeace, support it.

Senator Edward M. Kennedy of Massachusetts, whose family compound overlooks Nantucket Sound and who died last year, had opposed the project, saying it was a giveaway to a private developer.

It has taken nine years to get this far. In California, another lefty state, a big solar project is being fought by enviros and Democrats. I wonder if the left wants any energy developed. It seems insane but we are getting very close to a tipping point when there will not be time to build new projects and find more oil and gas.

The Democrats, and the vast array of “activists” whom they enable, have demonstrated hostility to all practical forms of energy production and distribution. This is not just a matter of oil & gas drilling: as we have discussed many times on this blog, the U.S. electrical system faces a problematic future. There is every likelihood that, under a Democratic administration/Congress:

a)The building of new coal plants would go from “difficult” to “impossible”
b)The building of nuclear plants would continue to be virtually impossible
c)Even the building of new natural-gas-fired plants would be severely delayed by environmental lawsuits and regulatory maneuvering based on the CO2-is-a-pollutant theory.

Solar and wind, beloved of Democrats, have their uses, but they also have their limitations. I see no evidence that either Obama or the Dem Congressional leadership has any interest in understanding the technical and economic factors that govern the extent to which these technologies can be practically employed. The intermittent nature of wind and usable sun, the difficulty of storing electricity, the supply-chain constraints which govern the large-scale introduction of any new technology–there is much less interest in these things than in the glib repetition of catch-phrases. And even the use of environmentally-blessed technologies will be greatly inhibited by environmentalist protests against the transmission lines required to connect these systems to the cities that need their power. These activists would, of course, gain great impetus from a Democratic administration.

Obama talks a lot about the middle class. The existence of a large and affluent middle class is enabled by widely available and reasonably priced energy, especially electricity. If electric rates are driven up by a factor of 2X or 3X, as is entirely possible with Democratic policies, there will be not only a direct effect on consumers, but an effect on virtually all workers as U.S. businesses–especially manufacturing businesses but also things like data centers–become less competitive.

Lenin once remarked that “Communism is Soviet power plus electrification.” Our present “progressives” seem more interested in de-electrification. Where the New Deal (and the Soviets) wanted to build hydroelectric dams, today’s “progressives” are, for the most part, more interested in destroying them.

Remember, electrical infrastructure is a long-leadtime item, and if we dig outselves into a deep hole in this matter, it will take a long, long time to dig ourselves out..

That was written in 2008. Read the whole thing. It did a pretty good job of predicting the Obama administration’s policies.