This future is just so damn depressing and I think a lot of people are in active denial.

That's the glass half empty view. I prefer the glass half full view that the future is going to be an exciting continuation of the endless and universal arms race between attackers and defenders. Life would be boring if there was no conflict.

I expect a more likely outcome will be that all systems move to an offline-dumb model by default because it will be cheaper and more reliable to pay a contractor that comes in occasionally to flip some dials than it is to deal with contractors that are constantly losing an ever-present arms-race.

I'm guessing the comment was more aimed at a future where needing a subscription to run your freezer is a thing.

À la https://arstechnica.com/gaming/2020/01/unauthorized-bread-a-...

Nice Internet you have there. Be a shame if anything happened to it.

Viewing the glass now requires a subscription and permanent internet access in case you try to view the glass without having an active license. For more details, check this gargantuan EULA that you had to sign to open the box where the glass came in. It also says that you owe us money for asking this question.

And it pays well too.

There’s even more hospitals and clinics who have a radiology department but no Radiologist onsite to read the exams. It’s all sent offsite to remote Radiologists sometimes 100+ miles away.

Disrupt the internet and good luck getting your emergent studies read by doctors who don’t look at anything to do with the scans and X-rays they order other than the Radiologists report.

That seems unrelated to me. I can (for example) email an image to someone anywhere in the world without ever connecting my camera to the internet.

a) USB sticks are a vector for infection too you know b) Inserting a clumsy sneakernet step into a time critical life or death decision might be a bad idea.

Surgeons look at X-rays all the time in the OR. Especially ortho.

In a crisis, the surgeons will do the radiology. And they will bitch about it, but it will get done.

Be lucky when they send the DICOM reports via a secure socket. Mostly it's plain http.

I can see how a subscription model would be appealing if it was in lieu of outright buying expensive equipment. Operating expenses for some machines are cheap but the machines are expensive enough that the tests themselves are expensive to pay off the machine.

Of course, the reality is more likely that the hospital still has to buy things and the subscription is a net loss on top of that so patients (or the people paying for the care) are screwed twice.

Or the equipment is otherwise expensive up-front to a small clinic. Ophthalmology, for example. The subscription feature is cheaper than becoming a financier.

I don’t think I have ever even once been in a product design session where the stated reason for going with a subscription model was, “So the customer can pay us less money.”

Of course the customer is going to pay more in the long term.

Even if the TCO for the clinic were exactly the same over X number of years, the manufacturer that sells subscriptions still comes out ahead because they're effectively in the financing business, too. Why tell a customer to go borrow money from somebody else when you can make them borrow from you?

Arguably the customer gains the option of not paying, which has some value. Whether that option value is close to the extra they pay through the subscription is left as an exercise for the reader.

How?

I was far from it, but ophthalmic firms didn’t know how often this diagnostic would be used. A high up-front would make it difficult to compare to the alternative (contracting per-use with a rival). So we offered a low up-front with a known, guaranteed per-use subscription.

Getting a loan from a bank would be cheaper than subscription pricing.

There are two reasons to use subscription pricing:

1) Price discrimination: You want to charge a large customer more for the same device

2) Lowering the capital expenditure by hiding the true price in operating costs

You could argue that (1) is good for small clinics, because they get access to the same machines as big clinics for a smaller cost. But I believe it's just a way to remove opportunities for competitors and results in everyone paying higher prices, even smaller clinics.

It also creates a HARD dependency on internet access.

If you get your teeth whitened at the dentist, it's likely your dentist has a whitening machine that has a subscription model too.

Niche but lucrative market for credit-hacking big expensive medical devices.

I doubt their security is all that good.

We did this at a local makerspace on an old medical laser for tattoo removal (we wanted to use it for non medical purposes). It was pretty trivial, the credits mechanism was as low tech as you might expect :) it used a mifare classic card in a slot and simply deducted credits from a counter until 0.

> many of the people on HN worked for firms that built the technology required to use internet based subscription models

And I hope we all start calling these people out more for what they've done. I've worked in tech a long time but I would never contribute to something like this.

A lot of hospital and lab equipment has worked like this for a long time. Often done with “credits” on a mag card, smart card, usb, or something downloaded. I definitely recall seeing floppy disks in use for it way back…

This is because, in some cases, the machine is actually rented or leased and the maintenance and supply costs are charged based on usage rather than as capex. Maintaining these machines is not cheap, especially calibration and testing.

Aw, so caring of them to introduce a subscription model to help the hospitals, and for a reduction in income. The only true saints left in the tech sector.

It’s definitely not a good thing :D

The credits cost a fortune

The leased + remote diagnostics model is widespread across pretty much every sector that uses equipment which needs specialist maintenance. Even things like jet engines are moving from manual data uploads to two-way networked comms.

Subscription can make sense for some cases. There is no reason to try to push it everywhere except that some people mindset is so deeply altered by greed that whenever they see a nail they see an opportunity for creating a hammer subscription fee managed by some transitional holding which will be "fiscally optimized."

Truly, capitalism is eating itself

Those machines require certified consumables to operate, as well as regular calibration and maintenance anyway. Labs have to follow quality assurance procedures. It's not just some random piece of equipment you can yolo.