Leaderboard

Welcome to Fuwanovel, and hope that sometime in the future you could create your own VN later. Hope you enjoy yourself here.

Punching Doctors to Reduce Healthcare Spending in the United States Abstract Healthcare costs in the United States are the highest of any country in the world, even when adjusting for relative wealth1 (Figure 1). In spite of this, life expectancy in the United States falls behind that of other OECD countries2, as demonstrated in Figure 2. Considering the disparity in life expectancy by income quintile3―a disparity that is not nearly as pronounced in other countries4―it is presumable that the overall life expectancy in the United States would increase significantly if universal coverage were achieved5, thereby granting the poor, who are disproportionately represented by uninsurance and underinsurance6, access to basic preventative services. Figure 1: Healthcare spending (public + private) per capita in several OECD countries. Source: The Kaiser Family Foundation Figure 2: Life Expectancy at Birth of OECD Countries, 2011. Opinions regarding the manner in which universal coverage can be achieved, or should be achieved, vary widely by partisan affiliation7. However, in consideration of the fact that Medicaid, the United States federal program that seeks to alleviate uninsurance among the poor, yields high returns on investment8, bipartisan support should exist for a proposal in which funds accrued from an agreeable health-related policy change were earmarked to expand coverage under Medicaid. In particular, Republican politicians widely favor tort reform9, whereby legislation is enacted to minimize malpractice lawsuits against doctors. These costly lawsuits, it is reasoned, not only waste time and money where the cause for litigation is often trivial, but also incentivize medical practitioners to order unnecessary and expensive testing. This investigation proposes an alternative to tort reform: Violence against doctors. Theory The phenomenon of violence against doctors and other medical practitioners exists primarily in China, where, accordingly, malpractice lawsuits are less common than in other countries10. As patients find it difficult to successfully sue practitioners who provide inadequate care or order unnecessary tests (often at the expense of the patient in the form of co-pays and deductibles), they instead retaliate by violence against those practitioners. While the patient may make this decision out of personal emotions, this phenomenon theoretically works to the benefit of the healthcare system at large, because this incentivization against malpractice is much less expensive than lawsuits. The conservative think tank American Action Forum estimates that tort reform enacted nation-wide could save $15 billion11. This figure will serve as the minimum amount of savings required for this "Violence Against Doctors" system to be considered successful. (In fact, this system will likely have additional benefits not shared with tort reform; for example, tort reform enacted in Texas simply capped the plaintiff's allowed expenditure of medical malpractice lawsuits12, which does not necessarily disincentivize the doctor from committing malpractice or ordering excessive testing.) In 2008, there were 63,370 medical malpractice lawsuits costing a total $55.6 billion across the system, meaning that the mean lawsuit costs approximately $877,387. In order to save $15 billion, therefore, 17,096 lawsuits (or roughly 27% of all medical malpractice lawsuits) would have to be avoided by violence-induced disincentivization. In order to standardize the amount of violence against doctors, we will use "punches" by the patient against the practitioner as the unit of measurement. Figure 3 demonstrates the theoretical relationship between each punch and the amount of averted medical malpractice lawsuits. Figure 3: Relationship between punches and resultant averted lawsuits. Because 0 punches should result in 0 averted lawsuits, the regression does not have a y-intercept. Therefore, the relationship between the two variables is y = mx, where "m" represents the amount of lawsuits averted per punch. For example, if a patient punching a practitioner results in two fewer lawsuits, then m = (1 punch)/(2 averted lawsuits) = 0.5 punches per averted lawsuit. However, intuitively, it is much more probable that the value of m exceeds 1, meaning that multiple punches are required to avoid a lawsuit. Therefore, to achieve the desired number of averted lawsuits (17,096), it is necessary to estimate the required number of overall punches, p, multiplied by the inverse of the coefficient m. Figure 4: Number of punches required to avert desired number of lawsuits. In the above relationship, the quantity p (punches) × m-1 (averted lawsuits/punch) = averted lawsuits. Randomized control trial(s) will be necessary to yield the values of m and p. Analysis The following factors may contribute to uncertainty: Other units, such as "kicks" and "karate chops" can be utilized in lieu of or in coordination with punches, and separate experiments may need to be conducted in order to measure the coefficient m of these alternative methods. Less discrete methods, such as "rear naked chokes, "kimuras," and "Batista Bombs," may be utilized by the patient in practice but would be difficult to quantify as a function of m. The value of m is subject to variation depending on the medical practitioner's income: An identical number of punches administered to two separate practitioners should result in more averted lawsuits from the better-paid practitioner. This effectively makes the legislation progressive in terms of revenue, which should please Democrats. In many cases, the medical practitioner may retaliate by engaging in combat with the patient; this would result in an increase in the value of m and thus a decrease in the value of p, indicating that more punches will be required to achieve 17,096 averted lawsuits. The above factor is exacerbated by the fact that the constitution of patients, by definition, is usually inferior to that of the medical practitioner. Care centers may enact measures to retaliate against potential violence by patients. In China, for example, hospital staff have been taught kung fu13 and security personnel recruited to minimize violence. This problem could be alleviated by outlawing such defensive measures. Practitioners who receive an excessive amount of punches may end up as patients themselves; subsequently, they may be the victim of malpractice by another practitioner, prompting further violence and possibly resulting in a death spiral. Conclusions Depending on the findings of potential experimentation, public healthcare spending may be significantly decreased by implementing at the federal level laws with the following effects: Patients who perceive malpractice on the part of their medical practitioners may punch those practitioners without personal repercussion. As the effectiveness of alternative methods of violence are revealed by reliable experimentation, those methods will be permitted (and encouraged) alongside punches. Immediate family members of the patients who perceive malpractice on the part of their medical practitioners may punch those practitioners without personal repercussion. Medical practitioners are not allowed to carry weapons within a 2-mile radius of any care center in which they work. Medical practitioners are not allowed to practice martial arts within a 2-mile radius of any care center in which they work. Add an exception to this rule when the medical practitioner is administering outpatient care and a robber invades the patient's home. Improve price transparency. Yearly analyses by the Congressional Budget Office will be performed in order to determine the increased revenue resulting from these provisions, and this revenue will be earmarked to expand Medicaid. References http://kff.org/health-costs/issue-brief/snapshots-health-care-spending-in-the-united-states-selected-oecd-countries/ https://aneconomicsense.org/2013/11/22/us-health-care-high-cost-and-mediocre-results/ https://www.washingtonpost.com/news/wonk/wp/2015/09/18/the-government-is-spending-more-to-help-rich-seniors-than-poor-ones/?utm_term=.b78a869d9c01 https://www.ncbi.nlm.nih.gov/books/NBK62373/ http://keepthemiddleclassalive.com/inequality-and-health/ http://kff.org/uninsured/fact-sheet/key-facts-about-the-uninsured-population/ http://www.pewresearch.org/fact-tank/2017/01/13/more-americans-say-government-should-ensure-health-care-coverage/ http://ccf.georgetown.edu/2015/07/28/medicaid-provides-excellent-long-term-return-investment/ https://www.washingtonpost.com/news/to-your-health/wp/2016/12/30/top-republicans-say-theres-a-medical-malpractice-crisis-experts-say-there-isnt/?utm_term=.7046065be43e https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4261607/#CR3 https://www.americanactionforum.org/research/tort-reforms-impact-health-care-costs/ http://www.legalmatch.com/law-library/article/texass-cap-for-medical-malpractice-damages.html http://world.time.com/2013/11/06/kung-fu-doctors-shanghai-hospitals-train-medical-staff-for-attacks/

These rules technically apply to every mode! So what do you do? You come to me, kneel if you so desire, and then you ask me along the lines of: "Give me something good!" (Or something along those lines) And give you somethin good" I shall. Ah but I'd appreciate it if you give me a link to your anime list! If you don't have one, so be it, but just saying, it'll speed up the process of me finding you an anime if I know what you've seen before Remember though this is MY say. You won't have any say in what kind of anime you get; you ask me for something, you get what you get! Meaning you can't ask for a specific genre. (Try something new, you might like it!) Simple as that. Oh, but I'm not a total jerk, I'll give you every right to request the following: Sub or dub (UNLESS I SAY TO WATCH ONE SPECIFICALLY, this doesn't happen often.) The length of the anime (I understand some people have less time than others, so if you only have time for 12 episodes, I got you) And that's all you can ask for in regards of what you're looking for with anime. (Again try something new, you might like the anime I give you).

''Patisserie "La Soleil", run by Kashou Minaduki, is flourishing thanks to the help of two catgirls: Maple, full of pride and a little on the haughty side, and Cinnamon, an impulsive daydreamer.'' http://store.steampowered.com/app/602520/NEKOPARA_Vol_3/ NSFW https://denpasoft.com/shop/nekopara-vol-3/ Hotly anticipated(!) title is finally out after a delay.Kashou continues to enlare his harem.I think he will bang his sister in the fourth one. Still i think i will play.Its probably 3-4 hours long so it won't hurt.

Nyohohohohoho~~

@PapaRabbi: Great! Hope you enjoy! If you want to ask for another anime after you're done with that one feel free to do so.

Finished Umineko 1-4. It's quite nice and the amount of trolling kek. I hope Chiru have more trolling as how I often heard Bern dubbed as Trollkastel XD Expecting murder mystery, got ">implying" debate and chuunifest as a bonus kek

Happy birthday to our somehwat known lurkers, @Kaykeiokay and @Noumi Kudryavka Have a good one, you two.

This masterpiece is called Grand Blue.

@PapaRabbi: You have been forced into: Akagami no Shirayuki-hime (Also known as Snow White with the Red Hair).

Like I said in my intro thread, I bought this game recently, and I've just completed my second ending... and I wasn't really satisfied. I "accidentally" got the Safe Ending on my second playthrough, yeah. Thought I was heading for the Knife Ending, but I guess I messed something up. And due to that, I've now ruined the whole pacing of the story by finding out certain twists that would have been much more satisfying later on, not to mention getting that emotional scene with "Snake" very early too. Sigh. That's one of the complaints I have. I don't think you can accidentally stumble onto such an ending with Fate/Stay Night, IIRC. I don't know why the designers made it like this. It really ruins the experience. They should have kept it locked away like other visual novels. Another complaint is that some of the characters, when trying to escape a room with you, would give you certain hints about how certain devices or mechanism would be useful later on. It's such a fourth-wall breaking moment they might as well wink to the audience in the screen and say, "Remember this thing! It will become important when you find this other thing later on!" Talk about bad writing. There's no way Seven would have realized what A would be used for before I find B later on. Other than that, I want to say I would have enjoyed the story and characters were it not for the ruined pacing. I also accidentally spoiled myself about who the killer was beforehand, but that was a fault on my part. Oh well. Now that I've gotten the Safe Ending, I don't think there's much value in completing the other endings now though, and I might as well just head to the True Ending and get it over with. There should've been a label on the game that says, "FOLLOW A GAME GUIDE AND DO THE ENDINGS IN THE CORRECT ORDER, STUPID!" Also, regarding the characters... On my second playthrough, I tried to take a path that would allow me to get to know Clover much better, as she's almost absent the entire time before her "breakdown", rendering her an annoying whiner for the rest of the game. So I thought I would at least get to know her before the breakdown so that I could like her more and actually care for her fate. Buuuuut nope. Picking Door 4 or 5 doesn't matter because Clover gets separated either way, and by the time you come out and meet each other again later, the breakdown happens and she's turned to a boring shell of her former self. Great. There are other characters that I feel could've been written better as well, but let's leave that for another rant.

Context is in the spoiler tags and it somehow makes this better

reread your signature you have something to complete

1. As Dergonu says 2. Only played it a bit, will read after finish hatsukoi 3. arigathanks gozaimuch For saying sorry you can use sorrymasen

Glad to hear you found another translator. I've been wanting to read this VN for awhile so the better chance of release is great news! Good luck!

Hatsukoi 1/1 Summary Yuuma is a second year student at the prestigious public school Hoshioka Gakuen. It is known for offering a fulfilling school life, but he has yet to experience love and spends his days lacking any satisfaction. He hasn’t made any progress with his classmates nor his osananajimi. All he can do is look at his love interest, the student council leader Midori, from a distance. One day, he saw her with a troubled face. It seemed that the remaining members of the school cafeteria improvement committee had resigned. After giving it some thought, he volunteered to lead the committee. After that fateful moment, his surroundings became a lot more lively and before long, his first love had blossomed. Ending Guideline / Suggested Route Order This VN has five heroines, Maya, Kyou, Midori, Yukino, and Runa. Since this is charage, feel free to play whatever order you like. That said, Route Guideline As for the choices that didn't exist in this walkthrough, all of those were available after past May 2nd in which you're already locked at one route. Therefore, if you see the choice after May 2nd, feel free to chose whichever you like. Tsukishima Kyou Tokizaki Maya Makabe Midori Fujikawa Runa Morino Yukino Attribution This walkthrough is based from the walkthrough made by the translator themselves with some adjustment made by myself.