[HN Gopher] Exoskeletons qualify for direct disability compensat...
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Exoskeletons qualify for direct disability compensation in Germany
Author : bookofjoe
Score : 125 points
Date : 2022-12-04 17:04 UTC (5 hours ago)
(HTM) web link (www.therobotreport.com)
(TXT) w3m dump (www.therobotreport.com)
| DoreenMichele wrote:
| Because of the importance of muscle action to the process of
| returning lymphatic fluid to the circulatory system, I would
| assume that exoskeletons are likely to be much better for one's
| health than a wheelchair.
|
| https://news.ycombinator.com/item?id=25427090
| hh3k0 wrote:
| Always bums me out a bit when I read about health insurance
| providers fighting tooth and nail to prevent or delay
| improvements in patient care.
| number6 wrote:
| Only acceptable answer would be to check if it really works and
| not some kind of scam.
| DoreenMichele wrote:
| Most health insurance really should not exist. It's a
| fundamentally messed up idea.
|
| Insurance is a _bet_. You look at the odds and price things
| accordingly so you can cover the occasional big payout with the
| premiums from people who don 't "win" so to speak. Playing with
| the lives and health of people to try to skew the bottom line
| one way or the other is fundamentally a stupid human practice.
|
| Government should provide some basic health services to protect
| the health of the nation as a whole, just like government tends
| to provide fire fighting services because letting one fool burn
| his own home down can burn down a lot more than just his home.
|
| It's a complicated topic and a pet peeve of mine. This approach
| to trying to keep people healthy is deeply flawed.
|
| Edit: Though I'm really not sure what your comment has to do
| with this article, to be honest.
| netrus wrote:
| Insurance is a bet for the person taking the insurance, not
| the one offering it. Just as casinos are not gambling. Law of
| large numbers and all that.
|
| I agree that it's a weird business to be in (and certainly
| the US has not figured out the best approach), but this
| article is about Germany, and generally I think we strike the
| right balance here. Not in every detail, there is still a lot
| of room for improvement (too many insurances, too little
| competition between them, some questionable decisions about
| reimbursement) - but I wouldn't dare to claim that I could
| consistently make better decisions.
| DoreenMichele wrote:
| I worked in insurance for over five years. It's a bet by
| both parties and the law of large numbers matters less in
| health than it does in other kinds of insurance because
| (most) health outcomes are not actually the result of a
| random number generator going "Tag! You are it!"
|
| People make health choices every minute of every day and
| the landscape of health insurance is rapidly evolving due
| to the ability to track biometrics with wearables, among
| other things.
|
| I'm thrilled to see this article. It seems like really good
| news for people with paralysis.
| oaiey wrote:
| That is most likely a general tactic. If you are an early
| adopter, you also carry the initial extra cost. Take
| exoskeleton, gene therapy, ... whatever. When they fight it for
| ... let us say ... 10 years, the cost has gone significantly
| down to a probably reasonable level.
|
| Health Insurance companies (especially non-totally-private
| ones) have an ugly battle of balancing the costs with the good
| of the many and not the individual.
| euroderf wrote:
| Robert Heinlein would be so psyched that exoskeleton battlesuits
| (potentially, at least: got mods?) are underwritten by the social
| welfare state.
| mrits wrote:
| Can't wait until they become mainstream and equipped with wifi.
| I can finally build my army
| theptip wrote:
| Here's a thought - at what price point is it cheaper to buy
| everyone that needs one an exoskeleton than to rebuild every
| building to be ADA accessible?
| dgant wrote:
| ADA accessibility adds value to more than just the disabled.
| Wielding a stroller provokes appreciation.
| harimau777 wrote:
| Maybe new parents could get an exoskeleton that lets them
| carry the stroller upstairs as easy as lifting a feather.
| Heaven knows new parents need all the help they can get!
| musingsole wrote:
| Around the same time that we cross that threshold, I expect
| we'll cross another where robots of various types might exist
| as infrastructure and so demand the same ramps as ADA but for
| different reasons.
| anonporridge wrote:
| Parallel thought.
|
| Would there be some resistance from some subset of disabled
| people to be forced to use exoskeletons in place of wheelchairs
| if we decided to go this route?
| SoftTalker wrote:
| There will always be resistance when people are told what
| they have to do. Look at recent experience with the pandemic.
| profile53 wrote:
| Interesting question. I suspect that would be intrinsically
| tied to rate of manufacture. The cost of manufacturing
| exoskeletons will decrease over time while the cost of labor
| and building modifications will likely decrease.
| nickphx wrote:
| I think there are far more benefits than more easy access to
| public accommodations.. From the article, the patients that
| used the exoskeletons had an improved quality of life,
| reduction in pain from being wheel chair bound and were able to
| taper dosage on pain medication.
| ralusek wrote:
| I propose that each building be equipped with a R2-D2/The
| Matrix brain jack terminal, so that the disabled can jack in to
| simulated experience of the building, thus freeing architecture
| from ADA constraints. I also vehemently oppose letting people
| connect from the comfort of their own homes, because it doesn't
| fit the aesthetic of my cyberpunk flavor.
| gibrown wrote:
| I think you are seriously overestimating the utility of these
| right now. It is not just about cost, they are more limited
| than wheelchairs in many ways.
| theptip wrote:
| I'm assuming they will continue to improve.
| agumonkey wrote:
| second order idea: give a lot of exoskeleton so rebuilding to
| ADA standard becomes cheap :)
| Cass wrote:
| Most wheelchair users are either elderly or suffering from some
| other deteriorating condition associated with pain, overall
| weakness, or instability, and will therefore likely not be able
| to use these. (Note that even in the promotional images, people
| are using crutches to balance in addition to the exo-
| skeletons.)
|
| The classic "strong above the waist, paralyzed from the waist
| down" image of a wheelchair user that people might have from eg
| the paralympics is the minority.
| amacbride wrote:
| One the insurance companies realize that this sort of device
| would be much cheaper than a home health aide, I expect adoption
| will grow.
| random314 wrote:
| Insurance companies want health expenses to increase, not
| decrease.
| kylevedder wrote:
| What? They want their bottom line to decrease, not increase.
| The fastest way to increase their bottom line is to cut
| costs.
| random314 wrote:
| Insurance can only have a fixed percentage profit mandated
| by US law.
|
| Decreasing the bottomline would literally decrease their
| profits.
| ben_w wrote:
| From what I'm seeing, I suspect insurance companies have
| multiple internal groups, at least one that want to reduce
| expenses and at least one that wants to increase revenues.
| Each is motivated independently of the other.
| ericd wrote:
| Insurance tends to have maximum profit percentages
| mandated, at least in the US. I'm not an expert in this,
| but I assume that this results in a bit of a perverse
| incentive where the only way to increase your profit is to
| increase your costs.
| rjtavares wrote:
| If that was the case expenses would never be rejected.
| The truth is more complicated than that.
| tedunangst wrote:
| No, because their income as capped at the premiums
| collected. They want to spend 80% on expenses, but not
| more than that. But they also want projected expenses for
| next year to go up.
| epgui wrote:
| I think all insurance companies care about is being able to
| price out the risk of fat tail events.
|
| It's not clear that higher overall costs are always
| beneficial to insurance companies, because rising premiums
| might reduce demand for their products. This would depend a
| lot on the regulatory framework (ie.: which country or laws
| apply).
| madsbuch wrote:
| I think the main argument is that the insurance companies, in
| particular in the US, wants a certain percentage discount
| with the health care providers. The easiest way to provide
| substantial discount to an insurance company is by increasing
| the general price.
|
| This is not the case in most European countries that they use
| a mostly publicly funded system.
| mwedwards wrote:
| Insurance companies want expenses to be predictable first and
| foremost, given the fixed nature of premiums.
| zyx321 wrote:
| Germany has free health care, so it's in the insurance's best
| interest to keep the cost low.
| lnsru wrote:
| There is nothing free in Germany. I see every month ~800EUR
| leaving my account. It's on par to Swiss one and as I heard
| not far from the one in USA. And it's not good!!! This free
| health care pays only for basic and/or old treatments.
| igorkraw wrote:
| With what income, which insurance and what type of issue?
| German public healthcare is pretty comprehensive and
| cheap (one of the few things I miss) and definitely not
| on par in terms of price with Switzerland which is _even_
| further away from the US nightmare
| luckylion wrote:
| In the same way that it's in the bureaucracy's best
| interest to be lean and efficient and serve the citizens,
| because they're funded by taxes. And we all know how that
| goes.
|
| Public insurance companies in Germany are motivated not to
| deviate too much from the average results of other public
| insurance companies, but they don't have any incentive
| (besides the same one that applies to the state in general)
| to lower the costs.
| igorkraw wrote:
| Not really. Public insurance in Germany was explicitly
| designed to have independent governing bodies, which is
| why you get to _vote_ on certain decisions. Few people
| do, but it 's one of the examples of non-state democratic
| governance that is a success story (another being
| cooperatives...)
| Cass wrote:
| Not in Germany, they don't. Barmer is a "gesetzliche
| Krankenkasse"/public insurance, which means most of their
| members' premiums are legally limited to a certain percentage
| of their members' income, and while they can and do raise
| their premiums occasionally, that's always a topic of
| political debate and needs a better justification than "a
| very small percentage of our members need expensive exo-
| skeletons now."
|
| They have no ability to raise premiums on specific members
| with high healthcare costs.
| random314 wrote:
| I was talking about US insurance where profit percentage is
| fixed, hence reducing bottomline reduces profits.
| GeckoEidechse wrote:
| Well the article is a about German health insurance so
| without mentioning it explicitly it's not clear that you
| were talking about the US system :P
| defrost wrote:
| There's more to the world than the parochial ways of
| central north america so such locale specific
| observations deserve to be qualified for the benefit of
| the wider HN readership.
| schleck8 wrote:
| This must be wrong because US health insurance is evil /s
| kevsamuel wrote:
| If they are private, yes. But in countries like France, they
| don't try to make money on health, and the goal is to get
| less people sick, not to milk them.
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