Daniel Eran Dilger
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Roger Ebert adds to health care debate on iPhone, Mac use

Prince McLean, AppleInsider

Film critic Roger Ebert gave Apple’s VoiceOver technology two thumbs up in allowing him to communicate after losing his voice to cancer surgery, but said his health insurance would only offer to cover an $8,000 device that didn’t work nearly as well.

Roger Ebert adds to health care debate on iPhone, Mac use
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Many users with disabilities are barred from choosing cheap, off the shelf technologies by Medicare or private insurance companies who insist on only covering far more expensive devices that don’t work as well.

An article in the New York Times profiled Kara Lynn, a mother who lost her voice to ALS. To help her communicate, Medicare paid for an $8,000 Windows PC running speech synthesis software.

Government rules require the PC be disabled from doing anything other than speech, in the fear that Lynn might benefit from features unrelated to her disability, such as web browsing. The Times reported that Medicare’s PC vendor, DynaVox, “disables the general computing tools. After the insurer pays, customers can pay $50 to DynaVox to reactivate the full functions.”

Instead of using the “clunky” PC, Lynn bought herself a $300 iPhone 3G running a $150 text to speech app. Lynn said that “it worked better and let her ‘wear her voice’ around her neck while snuggling with her 5-year-old son, Aiden, who has Down syndrome.” Medicare won’t cover devices like the iPhone however.

Asked why Medicare refused to cover cheaper, better alternatives for users, Peter Ashkenaz, a spokesman for the federal Centers for Medicare and Medicaid Services told the Times, “We would not cover the iPhones and netbooks with speech-generating software capabilities because they are useful in the absence of an illness or injury.”

Instead, Medicare reimburses specialty companies who bill it as much as a 2,000% premium on the hardware they provide. “Prentke Romich, for example, charges $250 for a Bluetooth wireless adapter similar to those that cost $20 in stores,” the Times reported.

Death Panel Technology

Responding to the article, Ebert wrote a letter to the editor noting that he was similarly offered an $8,000 solution after having lost his ability to speak.

“After trying an $8,000 custom device with little computing power and a small, dim screen, I tried the built-in speech software on my MacBook and found it much more practical,” he wrote. “It will read anything aloud, including what I define on a Web page or in an e-mail message. Several voices are built into the computer, and others are downloadable at moderate prices.

”I combine talking and Web surfing — for example, sharing a news headline with my wife,“ he said. ”It’s stupid of insurance companies to insist on an inferior device costing 10 times as much.“

The Obama administration is working to enact health care reform efforts to address outdated spending rules and investigate how Medicare can use more efficient and modern technologies. Critics suggest that any cuts to the status quo of Medicare spending, which would impact a variety of connected companies like DynaVox and Prentke Romich, might instead result in a government euthanasia program that uses death panels to slaughter old people.

Others fear that Obama’s plans to reform health care will result in Medicare being taken over by the government, unaware that Medicare itself is a single payer, government-run healthcare program and has been since 1965.

Cost savings involved in using low cost, modern technology available in off the shelf devices is a significant component of the Obama’s health care plan, which includes a provision to ”create an independent Commission, made up of doctors and medical experts, to make recommendations to Congress each year on how to promote greater efficiency and higher quality in Medicare. The Commission will not be authorized to propose or implement Medicare changes that ration care or affect benefits, eligibility or beneficiary access to care.“

  • http://bkpfd.org qka

    The most important sentence in the original article:
    “But the health care system has long had trouble keeping up with Moore’s Law, the principle that computing power rapidly increases even as costs fall sharply.”

    The insurance industry, in addition to being run by the greedy, is run by Luddites.

  • Hypothesard

    Living in France, I struggle understanding how USA has such a shitty Healthcare system driven by Moneymakers, and how Free minimal Efficient (for patient) health care system isn’t added to the constitution as a universal right…

    Sure the french Health Care is in Financial Deep shit but at least, every resident (not only french or people allowed to work) has acces to real doctors, real prescribed Medicaments AT NO COST…

  • enzos

    To relay my response on AI:
    >>Originally Posted by crees! .. What people fear is gov’t running private insurers out of business…. To quote a wise man, “Everyday Congress meets we lose a little bit more of our liberty.”

    >On the contrary, governments can and do run health programs effectively. In most of the *civilized* world, governments guarantee essential healthcare and do so for a mere fraction of the per GDP cost that the for-profit private system in the USA can manage. Moreover, it’s not just a matter of cost, it’s also a matter of quality: people who live under universal healthcare systems live longer than Americans do (look up the WHO tables) and it is widely recognized that life expectancy is predicated by the quality and availability of health-care.
    >Getting back to Mr Ebert, I do hope he gets better… the world of public entertainment is diminished without him.

    @Hypothesard… I’ve lived and worked in Australia and Canada and, albeit briefly, in the USA and cannot for the life of me understand why the Americans put up with such a shonky and outrageously expensive health system. Here in Fiji there is no universal healthcare because they think they can’t afford it. My insurance is the two three-hour flights a day to Australia where no matter what treatment is needed I know I can get it and it won’t cost me a red cent (not that we have cents any more ;)

    -Enz

  • gus2000

    “why do Americans put up with it?”

    That’s a far more complicated question than I can answer in this little box, but I would think it comes from our history. The earliest settlers to America were escaping opressive governments and cultures, so a great deal of our foundational law is designed to keep power away from the government. Deep in our collective psyche is the paranoia that “They” will take over if given the chance.

  • enzos

    As good a short answer as I’ve seen, Gus. While not a socialist (OK, maybe by Republican standards I am ;) I would argue that governments should have a minimum duty of care to the health and security of its citizens… and that citizens should be able to trust that their democratically elected government will carry out that duty in an equitable fashion.

  • walter

    First, we see a scathing criticism of the inefficiencies of government-controlled Medicare. How is the answer to this problem making government-controlled health insurance more prevalent? Do you really think the idiots in Washington are going to magically start making better decisions because we give them more power? On what basis?

    Next, we see one post that points out that people in developed countries with universal health insurance live longer than Americans. The problem is that people with life-threatening illnesses actually live longer in America than anywhere else. The things shortening the lives of Americans are the crime rate, greater transportation time and distances, and other consequences of our liberty, not a lack of access to good medical care.

    We then see a post that claims that the French system is wonderful, while arguing that it is in “Financial Deep shit” (sic). You can’t operate anything indefinitely if it is in financial trouble. Eventually you have to pay the piper, and then everything comes crashing down.

    Note also that more than half of the lifetime cost of medical coverage is spent in the last six months of one’s life. Americans are merely exercising their ability to do everything in their power to ensure longevity. After all, you can’t take the money with you, and shouldn’t it be an individual’s decision whether he wants to leave his wealth to his children, or spent it to stay alive for awhile longer?

    Note also that every person in America, citizen or otherwise, has access to important medical care whether insured or not, and whether or not he can afford it. Care will be provided, and often times payment plans will be worked out to allow the individual to compensate the provider.

    Note finally that the cost of health insurance and medical care could be dramatically reduced with interstate insurance availability, a lack of government mandates for coverage levels to give people more freedom to selective insure themselves, and a reduction in the number of frivolous malpractice lawsuits that drive up the cost of malpractice insurance to providers.

    Despite the “dire” situation with medical coverage, people aren’t dropping like flies.

  • hmciv

    “We would not cover the iPhones and netbooks with speech-generating software capabilities because they are useful in the absence of an illness or injury.”

    Okay so the big question is how does the government regulate a new system to prevent abusers from would faking illness/disability to get an iPhone?

  • enzos

    >The problem is that people with life-threatening illnesses actually live longer in America than anywhere else.

    That’s a matter of technology, not the efficacy of public health.
    >>The United States life expectancy … is a year shorter than the overall figure in Western Europe, and three to four years lower than that of Norway, Switzerland, Australia and Canada. Over the past two decades, the country’s rank in life expectancy has dropped from 11th to 42nd in the world. The infant mortality rate of 6.37 per thousand likewise places the United States 42nd out of 221 countries, behind all of Western Europe.

    >The things shortening the lives of Americans are the crime rate, greater transportation time and distances, and other consequences of our liberty, not a lack of access to good medical care.

    Nonsense.

  • enzos

    From the Medhunters site.. Americans going overseas for health-care..

    Comment from Jessica Toohey
    Thank you so much for this artical. I live in the US, born and raised and am now 24 yrs old. I am sickend by the US health care system. Due to an accident my sister had to file bankruptcy at age 25, we have to pay out the ear for everything, even tho i have employer based insurance. There is nothing right about our system. I work for aarp and take calls concerning this health care reform all day long, and hear horror stories from the older population about the lack of care they recieve. I have been considering moving to Aussie for about a year, and have began saving money to make this move by january 2011, and i couldnt be more happy about it!

  • walter

    Enzos: The efficacy of a health insurance system is linked to the technologies that it makes available to ints consumers. Why else do you think we have better technology, and other nations don’t adopt the same technologies?

    If you think it is nonsense that things like increased travel and crime rates are causing premature death, but you agree that Americans live longer with life-threatening illness, what do you suppose is killing off Americans?

  • enzos

    Heart disease, cancers and degenerative diseases are killing off Americans, as elsewhere. Gun deaths, crime and driving around a lot to protect one’s liberty doesn’t figure significantly in the stats.

    Less people get to the life-threatening stage and they live longer if basic health care is cheap, and essential health care is free. This has been proven in practice all over the world. And even the most expensive, deluxe government-run health systems (as per France) are far cheaper than the USA for-profit system (15% of GDP and growing fast).

  • walter

    Cancer is one of those niggling little things that tends to be more survivable in the US than elsewhere with “deluxe” medical coverage, such as the UK, Canada, or France (for males, with higher mortality rates than women). (Source: http://rex.nci.nih.gov/NCI_Pub_Interface/raterisk/rates38.html)

    You’re right that things like murders are a small factor relative to the cancer death rate. Nevertheless, the murder rate in the US is the highest of any developed nation, and beats the next-highest developed nation (Finland) by a factor of two. (Source: http://www.nationmaster.com/graph/cri_mur_percap-crime-murders-per-capita)

    Heart disease rates are actually right in the middle of many developed countries. (Source: http://www.nationmaster.com/graph/hea_hea_dis_dea-health-heart-disease-deaths) I also submit that a significant percentage of heart disease is caused by poor health in general, resulting not from lack of care but instead from lack of good judgment. For example, the obese are likely to contract numerous health issues, but they aren’t obese because they aren’t seeing doctors. And they aren’t obese because they don’t know any better. Poor habits are often to blame. Unless you outlaw McDonald’s and force them to exercise, well, you’re not going to make these people healthier. Things like common obesity are reflective both of culture and a general reflection of the relative wealth of even “poor” Americans. How many obese people do you see in Uganda?

    I would also submit my libertarian viewpoint that most of the diseases killing most Americans are neither contagious nor fast-acting. The people dying from a lack of health insurance are not a risk to other citizens. Since most of the “40 million” Americans that don’t have health insurance are either well above the poverty line, illegal aliens, or already eligible for government-provided care (Source http://risch.senate.gov/public/?p=BreakdownoftheUninsured or read any of Google’s results for “breakdown 47 million uninsured” for further analysis), anybody in this category that dies from such conditions gets no sympathy from me. It is not a social good to keep those alive whose death poses no risk to others and who are too irresponsible to acquire their own care.

    As for those that legitimately can’t afford insurance, if it is a social good to care for them, we might as well just send them checks.

    [“people dying from a lack of health insurance are not a risk to other citizens” … Centuries of critically important public health services indicate that *if* this is the case, it’s *because* the government has involved itself to cure and prevent diseases from polio to syphilis to everything else. To suddenly stop and suggest that this is “finished” and that the government should stop serving the public good over ideological theory sounds poorly conceived to a fantastically ridiculous degree.

    The US health care debate involves a lot of very different issues, from predatory insurance practices that have become pandemic to fraud (against both private and public insurance), to ineffectual services mandated by insurance companies out of bad science (like the examples above), to many other things that combined make fixing the problems critical, not optional.

    To step back and say, “my personal view on the matter is that government should only exist to lower taxes and fund wars via debt” is not really debate, its just a cop out. We have a huge government and there is corruption. But radical ideology is not the answer, and Libertarianism is just as radical as Communism. Fortunately, in this century both have been reduced to all talk and no action.

    What I think we need is to move ahead making some palatable sausage and stop shining the TV cameras on people who have few motivations in life outside of greed and hatred for minorities.

    Also, your comment that it is “not a social good to keep those alive whose death poses no risk to others and who are too irresponsible to acquire their own care” is based on a (source-free) chart that says there are 12 million Americans who lack affordable options, and distinguishes these from 5 million legal immigrants (and 5.2 million illegals). Another 18.7 million are said to be “eligible” for govt programs or earn more than $75k.

    That really says very little about why the govt should pursue a death panel approach that says “we don’t care about doing anything to help *insurance* reach 47 million people.” It’s actually pretty sickeningly immoral that you would support a continuation of this pro-insurance profiteering that has made one of the worlds richest nations a place where 47 million people are routinely scheduled for euthanasia by the “pro-life” republican death panels. – Dan]

  • walter

    I think I’ll concede this argument to Dan. How can I argue with his infallible logic about “funding wars via debt” or “routinely [scheduling]” 47 million people for euthanasia by “republican death panels”? He has managed a spot-on refutation of all my arguments.

    I am now convinced that only insurance companies make fallible decisions in the name of “bad science”, and I no longer fear that a government option which will likely lead to a single payer (http://www.breitbart.tv/obama-in-03-id-like-to-see-a-single-payer-health-care-plan/) will make equally-bad or worse decisions while depriving us of the choice to select a different provider. Obviously, a genius like Obama has figured out all of these issues, but just can’t explain it to the average idiot.

    I, for one, welcome our new government insurance overlord!

    [When has the modern Republican party not funded wars via debt? Reagan turned the US into a debtor nation while he funded illegal wars in Latin America financed by terrorist arms deals with Iran. Then the same people funded war crimes in Iraq against Iran. Then GW Bush spent $4 trillion (in debt, not paid for by taxes or by spending cuts) on Iraq to hasten the Rapture for fundamentalists while trying and failing to appropriate the nation’s oil wealth. If you can’t keep up with the argument, you are obligated to concede failure before running away!

    Also, if you’re going to chat up “death panels” in the same breath as saying you’re happy with writing off the lives of 47 million people in the US because some of them might be from other countries, then you can’t really be upset when I point out how ridiculous your line of reasoning is.

    The US would be far better off with single payer health care. Obama has said it is not attainable however. You can have a differing opinion on that, but you still need to refute facts and answer facts raised that obliterate your opinion. That’s how argument works – Dan ]

  • gus2000

    “Free-market insurance” is a oxymoron. The very concept of insurance is based on Socialism. Take a little from all, and give only to those in need. It’s a redistribution of risk. The insurance companies maximize profits by attempting to lure customers that are low risk and excluding those who are likely to need benefits. But doesn’t the system work best when everyone is included, maximizing the risk distribution?

    It seems to me that The Government, representing everyone, should act as a secondary insurer. The insurance companies would all pay a percentage, and then get paid out for certain high-risk (read: expensive) people. In this way the risk is distributed across all, and there is no need for insurance companies to try to exclude those at risk or with pre-existing conditions. Rates would be lower to insurers that promote preventative care. This would be “single payer”ish, but preserve competition.

  • gus2000

    I’m sure that the “single-use” clause for the text-to-speech devices was indeed designed to prevent fraud. But even if 9 out of 10 patients are faking, we still save over $5000 by giving them all an iPod Touch instead of just the one $8000 el crapo device.

    Tell you what: let’s jailbreak a Touch and cripple it to only run Text-To-Speech. We’ll sell it for half the price of the competition at $4000. Then for $50 we sell an App that does the same thing, so all they must do is reload the iPod and install the App.

    Heck, for $6000 we can include a similarly crippled Mac Mini that we can “unlock” too, and still be 25% cheaper than the competition. Anybody wanna go into business with me?

  • walter

    Insurance is not based on socialism, and it isn’t a mechanism to redistribute risk from one person to another. Instead, insurance attempts to level an individual’s risk over his own lifetime.

    [Absolutely wrong – insurance is precisely a way to socialize risk. It was invented by shipbuilders to realized that storms and other bad luck could wipe out an individual or a regional group of companies. By joining a risk pool, each company could manage risk by paying a known amount, rather than gambling that they’d never be left destitute by a random act of god they could not control.

    Socialism is the same thing, although it ranges between the fantasy fringe of communism and the very practical types of socialism that pervade America, from public schools to the public freeway system. ]

    It’s true that group insurance plans spread risk amongst many individuals, and everybody in the group pays the same rate because there is an aggregate risk of payout from the insurance company. But when individuals seek insurance, they pay varying rates depending on the risk that they will demand a payout. In a socialist system, rates wouldn’t depend on individual factors.

    [Asking people to pay more for health insurance because they smoke is sensible. Asking people who have cancer to pay more is eugenics. Be aware that what you are describing associates you with some rather dangerous ideological bullshit.]

    Typical consumers of insurance always lose money on the deal, which is why insurance companies are profitable. In the aggregate, it is never financially sensible to buy health insurance, because you are better off keeping your money and paying for care directly. This is why very wealthy people don’t buy insurance. Why pay somebody to pay your bills when you can do it yourself? Average people like me get insurance while knowing we are losing money because we don’t want the financial risk associated with low-probability but expensive procedures.

    [Rich people don’t pay for insurance because they can self-insure. The potential risks of crashing their car or getting sick are negligible for the very rich. For everyone else, carrying car or health insurance is a dangerous gamble, as one unfortunate accident could wipe out everything you own along with your credit. ]

    Insurance companies don’t ensure pre-existing conditions because there is no risk associated with them. It’s like gambling on a horse race when the race is already over, or putting money down on the roulette table when the ball has stopped moving. If the insurance company is to stay in business, it would have to charge people with pre-existing conditions more than they would have to pay directly.

    [There is no risk? No, there is certain risk! Insurance companies don’t want to accept risk, they just want to profit. But companies that hold massive leverage over consumers need regulation to prevent abuse, and terminating people who the insurer realizes might get sick after they’ve paid premiums for decades is a good example of that.]

    Take life insurance policies as an example. There is no uncertainty in the fact that the policyholder will die. Instead, the insurance company wagers that the premiums paid will exceed the final payout. Hence, the more likely an individual is to die within a certain timeframe, the larger the premiums. If you take out a million-dollar policy against your life for a six-month term and you are on your deathbed, the insurance company will charge you almost a million dollars for a premium.

    Car insurance provides other examples. Why do your car insurance rates go up if you file a lot of claims or violate lots of traffic laws? Because you have demonstrated that you are a riskier individual. Socialist auto insurance policies wouldn’t care about this, because all risk would be investigated in the aggregate. By the same token, auto insurance doesn’t pay to fill your gas tank or pay for your routine maintenance. These costs are “pre-existing conditions” of operating a vehicle, and carry no risk.

    Can somebody explain to me why it’s okay for Apple to turn a profit for offering goods and services, and it’s okay for the auto mechanic down the street to turn a product for offering goods and services, but insurance companies are devils because they turn a profit for offering services? Their profit margins aren’t even very high: http://mjperry.blogspot.com/2009/08/health-insurance-industry-ranks-86-by.html

    [Apple exists in an industry full of competition. Insurance companies do not. Few people have a choice beyond the two or three options offered by their company, and self employed people have even fewer options. It’s not because the market can’t solve the problem, but because the right has worked to allow and protect monopolized oligarchy among health insurance companies.

    You talk a lot about “socialism,” but you’re really advocating corporate socialism, where big companies’ profits are subsidized by the government (and health insurance most definitely is) without any benefits to American citizens. Forcing them to compete isn’t more socialism, it’s less cronyism. – Dan]

  • walter

    N.B. The other aspect of health insurance that differs from socialism is that contribution in a health insurance plan is entirely voluntary. Socialist nations and socialized medicine give their people no say in whether or not they will contribute.

    [Most states mandate car insurance; how does that compare?

    When you talk about “socialist nations,” are you speaking of rich European countries that have better health care than us, lower child deaths, less desperate poverty, no pandemic of personal bankruptcies over health care expenses (by people who mostly all have private insurance!) and yet spend less on health care? Because what’s wrong with that?

    The US pays MORE to subsidize illegal immigrants and the uninsured at the ER (which is what we’re doing now) than we’d pay to simply get them covered and paying what they can into the health care system. That’s what every other wealthy nation on earth does, and it WORKS. American is FAILING. How hard is this to figure out? The problem isn’t controversial any more than Obama’s citizenship. What is at issue is whether Americans are stupid enough to swallow pro-corporate propaganda that says nothing should be offered by the government to address areas where profiteering has FAILED to meet expectations.

    So is it really a fiscally conservative position you hold, or just blind ideology based on an emotional knee jerk reaction to the word “socialism”? Are you also in favor of the US handing over Freeways to private profiteers? How about allowing water/gas/cable utilities to all go unrestrictedly private and begin ripping us off egregiously? Would Hyatt and Disney be able to run our National Parks better? Because the market doesn’t solve all problems, and every government on earth knows this, including the USA.

    That is WHY we HAVE a GOVERNMENT. – Dan ]

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  • http://backaccessward.blogspot.com beetle

    Dan, the other socialism you forgot to mention are fire and police protection. Walter, do you want that privatized?

    The other systemic problem with our current practice is being underinsured. The vast majority of people who declare bankruptcy due to medical costs have “good” insurance! The status quo is a huge fraud.

  • gus2000

    The most terrifying words in the English language are “Hello, I’m from the government and I’m here to help.”

    Unless, that is, your house is on fire.