There's a stronger case for world hunger being bottlenecked than healthcare. World hunger is a logistics problem now, but no amount of money lets you print doctors.
You can't just throw money at the world hunger problem, it will end up in some warlord's coffers. Hunger still exists because it is politically useful to keep people hungry.
With a little bit of lag time (school) we could have a metric fuckton of doctors. We have a metric fuckton of shitty lawyers. Doctors are artificially gated in the US
What’s the joke? “What do you call the person who graduated last in their class from med school? A doctor.”
The optimal amount of bad doctors is not zero. But there is a point of "ChatGPT does a better job than this man does, and we're talking GPT-4o, not GPT-5 Pro". In which case we have a problem.
I don't know what wealth distribution means in this context, or why it's relevant at all, but food grows fast and doctors take like 20 years to grow no matter how much money you throw at it or where you get the money. And the context above was more specifically "fully pay health care costs" which is a comical fantasy the moment you try to actually define what that means, because the limit is not the price.
Changing the entire paradigm of medical care would be possible with enough money. There's no logical reason it takes 20 years to become a doctor. The fact that it does severely hampers both the quantity and quality of doctors. Becoming a doctor is much less about knowledge and intelligence than it is about attrition resistance. Loads of capable students disregard medical careers each year for more rapidly attainable positions. In many cases these are the MOST capable students because they recognize the problems with pursuing medical degrees.
Certainly the most skilled and advanced in the medical field will need significant schooling but there needs to be a major reform in healthcare training. One that produces more knowledgeable and skilled professionals and not a glut of questionably competent nurse practitioners.
> Doesn't America alone already spend 2 or 3 trillion a year on healthcare?
There's a huge difference between "paying for healthcare" and "paying a healthcare provider" here in the United States. Oftentimes the latter has 2 or 3 additional zeroes attached.
Sure, but Congress invariably pretend to say the former but mean the latter. You're asking for single-payer instead of privatized health insurance, they will sooner bankrupt the country than switch to sanity. Congress and its funding sources are now captured by privatized health insurance:
In 2023-4, Health came #7 in total political donations, #8 is Lawyers & Lobbyists; the combined "Finance/Insur/RealEst" is #1; would be useful to see "Insurance" broken out by health insurers vs non-health (can anyone cite a more granular breakdown?). [https://www.opensecrets.org/elections-overview/sectors]
It's not single payer vs privatized insurance. Why is this myth so persistent in US?? There are many different options for public healthcare, of which single payer is but one, and it's not even the most popular worldwide. Many European countries are not single payer, including e.g. Germany.
That would just be just reopening decades of debate in the US.
For whatever reasons, the consensus in the US after decades of talking comes down to single payer vs privatized insurance. Congress isn't going to implement single-payer, so the menu reduces to either we choose good or bad regulation of privatized insurance.
We don't have time for yet another decade of debate, since health insurance premiums (net, post-tax-credit) in the US are about to jump this November open enrollment by median 18% overall, or 114% for people on ACA due to the expiration of enhanced premium tax credits [0]. Expect that to feature prominently in the news cycle by Thanksgiving.
(Germany's multi-payer system (government + mandatory statutory contributory insurance + optional private insurance) would in theory be fine if US Congress was ever incentivized to implement such a thing. But it very clearly isn't, since the 1950s - look at the lobbying money trails. Let the good not be the enemy of the perfect. The ACA was the closest the US (briefly) came to mandatory statutory contributory insurance, but the federal mandate was abolished back in calendar 2019 by the "Tax Cuts and Jobs Act of 2017").
Have you considered that those decades of debate haven't resulted in a public healthcare system precisely because single payer is what was pushed by the pro side, and many people in US (rightly or wrongly) have a problem with the notion of government telling them that they can't pay money for better healthcare?
I have done a lot of research into this area. Obesity and other self inflicted health issues are definitely a factor, but not, by far, the whole picture.
Our cost per service is 2-4x or more, and the larger reliance on specialists creates significant complexity and even more costs. So, we do spend 2x, but we get 1/3 to 1/4 of "care" per dollar. In other words, we get less actual care. And the care is biased to fixing things as opposed to preventing things. And it is also biased to those who are wealthier.
Some of the cost drivers:
- Administration is 25% of costs, far less in other countries. Insurance company profits and complex administration with confusing and overlapping methodologies that obfuscate costs and comparisons.
- Capital costs are 25% of costs, far less in other countries. Multiple, private, and overlapping hospitals demand more capital and private capital with its expected returns
- Doctor compensation is 2x to 4x more, nursers 2x. Specialists here get truly rich, not true in other countries.
So, quite a lot of the extra spend is not efficient, and goes to insurers, owners of hospitals, and doctors.
I also have personal experience. To get a simple ultrasound, you are talking about $450 for a primary care visit to get a referral for a $650 specialist to get a $1000 ultrasound ($800 scan plus $200 reading), to get a $650 follow-up visit with the specialist to discuss the results. That is almost $3,000 of actual out of pocket costs to me, with a good insurance plan ($2K per month for a couple), the "claimed" costs were significantly higher. MRI and CT are even higher. Similar for a broken ankle, which cost me over $4000 out of pocket.
I am, relatively speaking, well off compared to average, and was able to do this, but that hurt, and significantly disincentivizes me in the future.
Our health system is broken, and pumping more money into only makes it worse.
It's neither, your outcomes are poorer because access is not uniform. If you can afford it, US healthcare is the best in the world, but if you can't you basically don't get it (or at least, you don't get it until the problems are bad enough it's an emergency and you get saddled with life-crushing debt for the bare minimum to stabilise you from the ER)
If that's true, all you have to do is convince other people that it's true and they can just vote for someone to deploy that money. Don't need to wait for someone else to do it.
`pass` is an excellent case for storing passwords locally that you don't need to carry with you. I use a lot of login credentials for work on `pass` and it works great. If/when I need to upgrade laptops I can just back it up in git.
I use BW for all my personal stuff because my wife and I use it.
I've been giving some thought to this. I wonder if an iPad would suffice in front of the tv and just ssh into a Mac Mini for dev work. I'd love an iPad but I can't justify it either because of the limitation of hardware capabilities. I also don't really want to purchase two machines just for dev tasks and travel. But, I think having that kind of lifestyle will be expensive no matter the approach.
Cutting off access to purchased game in countries where you cannot create a PSN account and you can no longer refund the game, because most likely you've played more than 2 hours. PSN isn't even available in every European country, despite the game being sold globally.
And if an email isn't much, then an kernel anticheat won't change much privacy-wise either.
> In Japan, we will implement a next career support program. Details will be communicated separately.
Why not do this for every country? This type of support should be required for mass layoffs.
I understand the strategic impact of such large decisions but I don't understand why these types of programs can't be implemented in the 21st century even if laws need to necessitate such programs existence.
This experience has zero to do with clean code. The title is very much a misnomer and incredibly misleading.
This is an elaboration on the experience of abhorrent engineering culture at this company. From people who can't professionally speak with one another to a manager who cannot seem to effectively solve the core issues underlying the problems at the company. Instead of a moment of reflection on HOW to improve the root cause of the problem, it feels like they're kicking that can down the road.
Two things I'd like to point out:
1. It's nice to see some form of humbling commentary from the author; albeit, I don't think it targets the right solution to the problem.
2. I still think there's a lesson here for any org to digest and that is communication is such a vital and integral part of "a raising the tide lifts all boats", so to speak.
> “If we even got a couple percent improvement in productivity, this would be worth it. And our goals are actually to do quite a bit better than that.”
So your engineers will get a productivity salary increase, right? RIGHT?!
The engineers get paid to do the work, but won't partake in the profits of the company (except by prior agreement like a bonus target reached etc). I suppose equity grants straddle the fence regarding this, since such productivity gains would translate to higher prices for equity.
