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Notes -
Some quick hits:
A) Cremieux argues that much of the gap in life expectancy between America and Europe is due to obesity. But America is good at one thing at least – spending money on health care. Combine high spending with effective weight loss drugs, and the U.S. is on track to significantly narrow its life expectancy gap with Europe.
Self-driving cars will close the gap further.
B) Drug overdose deaths are down in King County (Seattle area) this year after more the tripling between 2019–2023. This is probably because fentanyl has already killed a significant percentage of the junky population. There has also been some modest progress in cracking down on open air drug markets. In the last 2 years, about 1 in 1000 King County residents died of a drug overdose.
C) Health insurance companies have a terrible reputation. But it's hard to fix. It's a viscious cycle which goes something like this:
Company has bad reputation
Due to bad reputation, the company has trouble getting talent, so they compensate by paying a lot
This selects for people who care more about money than reputation
Money-grubbing behavior leads to bad reputation
If you were next in line at United Health, how would you fix the problem?
Note: Many societies in the past (India, Japan) created special undercastes to do necessary but unsavory work such as working with dead bodies. Should we do likewise and create a special caste of health insurance workers that are not allowed to work in other fields and we can treat like shit with impunity? Reddit probably thinks so.
D) Epistemic status: uncertain.
Many people in the China tariff post said that China is "not expansionist".
But what is today China was, 2500 years ago, just a small collection of states along the Yellow River. Gradually, over the millenia, they absorbed more and more territory into their country.
It's as if the Roman Empire still existed today and controlled all of Europe.
Genetically speaking, the Han people seem to have done much better than Rome. The Romans, the people who lived in the city of Rome circa 500 BC, essentially all died out. For centuries, Rome's population could only be sustained from continual influxes of people from the countryside, and later, far flung areas of the Roman sphere. This doesn't seem to be the case in China. Even today, there are people who can trace direct male lineage to Confucius who lived around 500 BC.
Seems like they’d be even more money-grubbing assholes.
Not a problem. We'll just have a pogrom every once in a while to take back our money and let off some steam.
I'm joking obviously, but the way that people on Reddit are talking about this murder is frankly concerning. These simpletons think that the reason health care is fucked up is because of insurance company profits, and if only the CEO was less evil everything would work out. Worse, they are fine with murdering this person because of their own incoherent beliefs.
Curious, why doctors rather than hospital administrators?
At least hospital administrators pay attention to how much things cost.
In many cases, doctors literally do not know how much the treatments they provide cost. This means that they simply don’t do any cost-benefit analysis. They will prescribe an expensive brand-name drug instead of a generic drug that does basically the same thing for no reason other than because they heard about it more recently.
Why is it the physicians job to know what things cost? A hospital will literally have hundreds of employees whose full-time job it is to figure out what things cost and deal with insurance companies, who are always changing things constantly. Even a small practice will usually have 2-3 employees minimum who spend most of their day figuring that stuff out.
It's entirely orthogonal to providing good medical care.
We do cost benefit analysis all the time, but it is in terms of the risks and benefits of a given intervention, wouldn't you rather us be focusing on that?
If you're not capable of doing it, then you need to figure out a workflow so that someone who is capable provides a price. This is a part of basically every other service in every other industry; it is not impossible.
To go to the auto shop example, you could equally imagine a mechanic-head praising the beauty and sanctity of the Art of
MotorcycleAutomotive Maintenance, and how carefully he considers the non-monetary risks/benefits of a given intervention, saying that in his view, the price is entirely orthogonal to providing good automotive care. He could be so educated and experienced that he thinks it would be an utter waste of his time to even put together estimates. I would say that perhaps he is right on all those points. I still want a price. I want it as a routine matter. Maybe he will have some customers who literally don't care, who have a unique, historical vehicle and a fat bank account, and they just want the artistic approach, damn the costs. But as a routine matter, I don't care how beautiful you think your orthogonal things are; you are running a service business where the customer needs to know the costs/benefits. It is doubly important in the medical domain for them to be informed of the costs/benefits if they're going to give informed consent.If you need to structure your workflow so that a different employee is up front assembling the estimate while the genius mechanic is spending every minute of his time on his craft, so be it. You have people that do that stuff anyway. Do it up front, not after-the-fact. Keep your patient informed. Just give him the damn price.
There are multiple parallel problems here.
The cost is fundamentally unknown. It is reasonable to determine what the average cost of a thing is, but that is not helpful information because when we leave the average the costs can become profoundly immense. More people are upset with an estimate that is off by multiple orders of magnitude than by no estimate at all, and that will happen.
To torture your mechanic analogy, it's like if you go to buy a car and ask for a Corolla, but 5% of the time you get a Bentley whether you want it or not.
The average cost is not necessarily known to your doctor. If I'm your surgeon I know what my professional fees are and how long my average case takes. I probably know the billing codes used, if I'm business minded I may know something about the average cost of supplies, instruments, and equipment. However a run of the mill routine surgery requires a team of 40+ people between the office visit, PAT, pre-op, intra-op, PACU, and post-op. It is unbelievable how many hands are involved and it is incredibly difficult to keep track. You immediately start running into problems like "cleaning staff are a critical part of the OR and are a cost to the hospital but are not usually considered a part of the surgery, is that a cost or is it not a cost?" or "does this facility charge by the minute for anesthetic gases or use a flat fee" both options are viable, your anesthesiologist probably knows, your surgeon probably doesn't. Keep track of "costs" is a full time job with an entire department just for the OR. Your surgeon might be able to say "your surgery probably costs 10k" because they asked someone in a billing meeting what all the averages on the spreadsheets said, but nobody wants to have a 20 minute conversation about how much of an oversimplification that is.
Additionally that is fundamentally not the surgeons job and does nothing to improve the surgeons provision of medical care. We evaluate whether to perform a case or not based off of the medical risks and benefits, not the cost. This is part of why healthcare is expensive in the U.S. but most people prefer that to the alternative.
Doctors wear a lot of hats. Things like increased regulatory burden and the dance with insurance below mean that you have of multiple departments involved in figuring out how to deal with the above. We already do a lot of things like that slow us down and prevent us from actually spending time with patients. Making it worse is not desirable to us or our patients.
The cost is irrelevant, which disincentivizes processes involved in streamlining all these things and makes it useless for your doctor to know and be able to relay to you. Almost all procedures are paid for by insurance or involuntary charity care by the hospital, with a small rarity of actual self-pay. Getting insurance to pay for something involves complicated negotiations where they try and pay you less than "cost" so you exaggerate cost as much as possible in hopes you don't actually lose money. It is not uncommon for the payment mix to end up being something like medicaid reimbursing 80% of cost, medicare 85% and private insurance 110%. If you mostly care for medicare and medicaid patients you go out of business (which has happened a lot lately) or require government bailouts. This is why the sticker price is so insane, and hospitals will almost always drop 90% of the bill if you end up being cash pay. You have to negotiate with the insurance company and that involves the "official cost" of a gallbladder removal being 100k instead of 5k or whatever.
A surgery has more in common with a government procurement and bidding process than getting a car repaired.
Even more simple things like an office visit are a pain in the ass to figure out. Unless you are doing very specific types of PCP practice or outpatient cash Psychiatry you are taking insurance. Therefore I don't know what the visit costs. I know what my billing team will try and charge for my time, they'll use the specific office visit billing code, I'm told to make sure to put X and Y thing in my note so they actually cover the work I did, but then I know that even the insurance company is supposed to pay for that code they'll make a big stink about it and require hours of the billing teams time going back and forth to make sure that its not worth it to actually get paid for that, even though the other insurance company always takes it if I put in X and Y, so my office staff will adjust the coding and bill you for the down coded visit even though that's not what I did and that's somewhat illegal, and your sister will get billed the actual billing code because she has "better" insurance.
All kinds of asinine shit like that happens for the most routine interaction with healthcare.
This is why psychiatrists are like "dude just pay me 100 an hour and we are good" and why there are now multiple forms of primary care that avoid working with insurance.
"What's my rate for a visit" is never a viable question because every insurance company pays me differently and its constantly changing year to year and I'm effectively only paid for by insurance.
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I'm curious as to why you think it would ever be in the best interests of the medical industry to provide price transparency.
Like, obviously they could develop ways to formalize price estimates and communicate them to customers. If anything, that's confirmed by the poor quality of the countervailing arguments in the thread below. But why would they ever want to?
Having the ability to inflate prices without reducing demand, because nobody at the point of consumption has any idea what anything costs, seems like a pretty sweet situation. Likewise, high salaries and various other forms of grift and waste across healthcare are made possible by the broader cultural perception that the industry provides priceless, sanctified Human Care Through Science rather than some mere grubby service like your hairdresser or auto mechanic. Giving patients the power to participate in rational cost-benefit analysis about their healthcare seems like it'd work out worse for every single level of the industry.
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I don’t know at what point this went off the rails, but you both eventually end up sounding like assholes. @ControlsFreak, you’ve been specifically warned for arguing with this exact poster! One or both of you needs to make use of the block feature.
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Doctors will also just blithely lie to you and make stuff up. They'll tell you to your face, in the exam room, that something is totally covered, but as you say, they have no idea whatsoever. You have to either force them to have someone actually verify it (which will annoy them, as they'll view it as just a waste of their precious time), or roll the dice and hope to not get slapped with a huge bill after the fact (that could be literally anything, could be gigantic enough to make whatever the service is completely not worth it to you).
I've said it before, and I'm becoming more obstinate about it; the entire medical industry is absolutely addicted to complete and total price opacity. This is only one of the many dysfunctions, but it's a big one. Forcing them to put their prices up on some website, in a way that would require you writing your own JSON or whatever parser, make your own interface, and still not be able to figure out what the price is because the doctor can't even tell you what the procedure code is... has simply failed as a "price transparency" law. I would be open to literally any other solution that anyone can think of, but I can't think of any other than simply forcing them to give you a price. Could declare that patients cannot exercise legally-valid informed consent to a procedure unless they've already been provided a price, in writing, for example.
EDIT: Forgot to add that when you call up the billing department to ask, "What the hell? I thought this was supposed to be covered?" they'll just bluntly tell you that the doctors don't have a clue and that "they probably just guessedsorrybut not sorry enough to have you not pay this".
I'm not sure I fully understand this, even a car mechanic won't give you a price up front, they'll give you an estimate, and sometimes, even with a machine, a repair doesn't go the way they expect, and your bill is higher than the estimate. Are you asking for medical care to have set, up-front pricing unlike car repair, or are you saying their estimates are significantly worse / harder to get?
What mechanic are you going to? Every mechanic I've seen has standard prices based on hours worked and cost of parts. I mean if I bring in a car without knowing what's wrong with it, yeah the cost of "Make this car work again" is unknown. But with a known problem the cost is fixed and they can tell you the exact price to replace a transmission, change the breaks, swap out a strut, you name it.
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This bit. They won't even give you an estimate (or they might just lie to you). Sometimes, they'll claim that it's "impossible for them to know" (that's a fun one to get into; they try to hide behind the fact that an insurance company will be involved; just wait, I'm sure someone will try to jump in here and claim this). And this will be the case even for many procedures that are pretty standard, without much likelihood of something happening.
I'd be perfectly fine with the same sort of, "Looks like you've got a bad CV joint; we're gonna replace that, and it'll cost this much," with an always-implied, "...and if we get in there and see something else, we'll let you know." Just tell us what you plan to do, what you plan for it to entail, and what the price will be for your plan.
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It seems like the natural control group is veterinary medicine, which is fairly cost conscious by nature. Veterinarians have similar education requirements. What's the difference between veterinary medical costs and human medical costs for routine things(let's exclude end of life care for obvious reasons).
That should be a natural ceiling to how much of healthcare costs are inflated by cost-insensitivity.
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Well:
I don't think everything would work out for everyone if the CEO was less evil, but I think a strategy of vigorously denying claims at an exceptional rate is actually pretty evil and destroys a lot of lives in service of increasing margins. That the CEO being less evil wouldn't solve literally everything in healthcare access and funding isn't exactly a defense of the CEO being evil.
Yeah - what happens with a denial?
Well I can appeal, and often the appeal is successful, but generally what will happen is that they'll tell me we'll have a call at X time, which means I need to reschedule or be late to appointments, maybe skip my lunch or charting time, or even stay late. I'll sit on the phone for an extended period of time and then have a retired outpatient OB nurse who has no fucking clue what she is talk about go "oh yeah sure that's fine, we'll approve" or "wow I don't know about this, let's schedule another phone call with a relevant specialist, but I'm going to deny or now" or whatever other insane shit they do.
The goal is to make paying for things as inconvenient and expensive as possible. That means less time spent on actual patient care and more burnout and exhaustion in physicians.
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There's a reason far-left governments turn into skull factories within 5 minutes of coming to power. It may be concerning but it shouldn't be surprising. Once Reddit (or similarly far-left dominated communities) manage to coordinate deciding that some individual or group be put to death, they're not going to be quiet or subtle about it.
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Health care is a bit more important than shoveling shit or working with the dead as well. People might be disgusted by that kind of work but it's unlikely it'd spiral into real hatred. With something as important as healthcare this caste could end up straight genocided, as people directly blame them for their ailments, and if the genocide failed they could end up a protected class with extra powers that controls a necessary and lucrative industry which would give them a lot of power over society.
I mean, health insurance also has human capital requirements that undertaking or shit shoveling don’t.
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I saw one of these guys in Qufu when I was a student. He was writing and selling calligraphic scrolls on the side of the road. He had a sign with his portrait on it and some official-looking, diploma-like certificate stapled to his sign. "Wow, is he really an actual descendent of Confucius?" I asked my professor, who was born and raised not far away. "Probably, I don't know. There are a lot of them." she replied. She seemed completely unimpressed. And that was when I began to wonder if I was a bit naïve.
Westerners often credulously believe claims like this because (1) Chinese have a radically different view of "lying" that Westerners don't have natural defenses against unless they've lived in China or a similar third world country, (2) Chinese (individuals too, not just the government) find it in their interest to promote stories that prove China's equality or superiority to the West, (3) all the sources that would debunk nonsense claims like this are written in Chinese and this unable to diffuse into the Western consciousness.
"China" does not have 5,000 years of history any more than "France" has 3,000 years of history.
Chinese did not invent soccer, or sashimi, or beer, or the seismograph.
Chinese cannot trace descent from antiquity with a level of confidence that would be taken seriously in the West.
"Truth" in China is not the same as "Truth" in the West.
The nature of exponential increase means that all modern Europeans are descended from Charlemagne (probably). Charlemagne lived about 600 years ago. Confucius lived about 2500 years ago. I would assume that all Chinese are descended from him, if not exclusively through the male line.
1200 years ago.
@jeroboam
If, as this article says, 80% of all europeans who lived a thousand years ago are ancestors of every single european living today, it’s almost certainly true of the europeans who lived two thousand years ago, ie romans.
Plus that bit about the Romans dying out isn’t exactly true, at least not in the implied timeframe. The eastern Roman Empire didn’t fall until 1453 and those people and their descendants absolutely thought of themselves, correctly, as Roman.
There’s actually a famous story about this; in the Greek war of independence in the 1820s the Greek army liberated one of the islands between Greece and Asia Minor. The soldiers were marching through the streets and some boys came up to them and pointed and shouted “Look! The Greeks are here!” And one of the soldiers was utterly perplexed and stated “What are you talking about? You’re Greek! We are speaking Greek right now.” And the boys replied “No, we aren’t Greek. We’re Roman.”
That was almost 400 years after the de facto end of the Roman polity, one that had lasted in some form for about 2000 years.
That plus the modern Romanians are descendants of the Roman people after Dacia was heavily romanized by state decree, it was settled heavily by Latin speaking people who eventually became the Romanian people through ethnogenisis.
Whether or not they thought of themselves as Roman, they weren't. When your people haven't lived in the city of Rome for a millennium or so, calling yourself "Roman" is not remotely accurate. Put it this way - Taiwan considers themselves to be Chinese (and the legitimate Chinese government at that), but nobody else does. Possession matters.
No, what happened is what it is to be Roman simply changed. In the beginning it meant living in the city and surrounding area of Rome, then it denoted a status being a citizen of the empire, and after that it became essentially a sort of super-ethnic category that rested atop more specific ethnicity, much like “Latino” or “Arab” or “Desi”.
They went through a process of ethnogenesis. It’s a historically common process, ethnic groups don’t just spring from the earth.
After the 3rd century or so Rome wasn’t even the most important Roman city anymore in any given year.
I don't agree with that at all. To be Roman without involving the city of Rome is a completely incoherent idea. It didn't change.
I’m sorry to say, but you’re simply wrong about this, and any level of cursory knowledge of the Roman Empire would reveal this to you.
Literally millions of people living outside of Rome were considered Roman, even by the people living in Rome. They had the rights of citizens, they called themselves Roman, and other people called them Roman, including their enemies.
Contributions to Roman philosophy, literature and poetry frequently came from outside the city of Rome.
They followed and were subject to Roman law, practiced Roman rites of religion, when the empire converted to Christianity they did too, they had a “Roman way of life” that was particular to them ie culture.
It’s like thinking someone who lives in Dallas isn’t American just because at one point Texas was part of Mexico.
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I’m not sure this supports the point you’re trying to make.
It is obviously true that (modulo a small population of foreigners and Taiwanese aboriginals) virtually all inhabitants of Taiwan today are descended from people who came from China. And if you’ve ever paid a visit to the National Palace Museum in Taipei, you’d know that there’s a very real sense in which the people of present-day Taiwan are the heirs to, and the custodians of, the Chinese civilizational patrimony. Perhaps not uniquely so—the overseas Chinese of Malaysia and Singapore, and of course the mainland Chinese, have similar claims, with varying degrees of plausibility—but then again, no one said that the Romanians or the inhabitants of minor outlying islands in the Aegean were the only surviving Sons of Romulus, either.
Sure I would agree that the people in Taiwan are descended from the Chinese (as the Byzantines were from the Romans). But that doesn't make them Chinese, any more than Australians are English because most of the population is descended from English convicts. Like I said, possession matters. Perhaps the first generation or even second generation of the Byzantines after the fall of Rome could legitimately claim to be Roman. But at some point, it doesn't hold water any more.
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The difference is that the PRC only really cares about the KMTs dispute of continuity of government from the 1911 Xinhai revolution, which is the theoretical successor to the Imperial China polity and its associated territorial claims. Cultural successors to different time/regions of China include the San Francisco and Flushing Chinatowns which practice the Cantonese ways of the 1800s, the Thai Chinese who practice a syncretic Thai-Teochew pattern of especially gaudy taoism (other southeast Asians are migrants who hold little affection for the mainland), and even the Joseon who at one point proclaimed they were the successors/avengers of Ming China following the Manchu conquest of the Han. Yet all of these are unimportant to the PRC because no one else claims legitimacy over the mainland.
The KMT are in fact colonizers in the truest sense, being a foreign people (KMT nationalist government, soldiers and displaced Nanjing intellectuals) that displaced the local power structures and cultures (Ainu/Japanese colonial subjects+local bureaucrats) while acting as a disputed successor to a foreign regime that had not ruled over Taiwanese for half a century. These putonghua speaking nobles ran roughshod over the minnanyu speaking islanders who cared not for the squabbles of the mainland. That the KMT was entertaining thoughts of reclaiming mainland China through an Operation Revival style invasion of the Inner Sphere was the maim reason for the continual dispute between the PRC and ROC.
Fast forward about 60 years and a LOT of cultural upheavals roiling the world, and the PRC obsession with the ROC seems less like actual intra-Chinese dynastic succession politics that basically characterized the vast majority of Chinese imperial history and more a consequence of a heavily interconnected world with a force of first resort actually able to project power to its vassals. The eastern roman themes draped the livery of Constantinople on their standards, but no levy of Aleppo trained with a Hellenic muster. By contrast the Taiwanese Armed Forces practically beg to be placed under the command and responsibility of their US friends, for force competency and blame absolution purposes. Whether this assessment is accurate or even shared by the PRC is unknown, but it certainly seems that Taiwans irredentist claims to the Qing holdings would not be maintained if Taiwan did not have the US 7th fleet nearby.
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You are misinterpreting me. I made no claims about the Roman state (a rump of which survived until 1453).
But the people of Rome in 500 BC died out. Even the patrician lines vanished. Alexios I Komnenos was not a member of Gens Claudia or something. His ancestors were Greeks.
Does this mean that the Romans of 500 BC had literally zero descendants that survived to today? No, of course not. But hundreds of years of subreplacement fertility means their genetic contribution to the current mix is negligible.
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That seems unlikely. What percentage of people at that time didn't have any children survive to adulthood and were immediately removed from the gene pool?
But let's say it's more like 50% or whatever. There's still important distinctions to be made from those within the 50%. Perhaps person A has 100x as much weight in the current gene mix as person B, even though their genes are both in gene pool somewhere.
In the Middle Ages in England, nobles often had many surviving children, the middle class had a couple, and the poor were lucky to have any. Over hundreds of years, this resulted in massive downward mobility and class replacement. By 1900, almost all of the gene pool of England came from people who were nobles in the year 1200. It was basically a slow-motion genocide of the lower classes, even if small amounts of peasant DNA are still in the mix.
But unlike those hearty English nobleman, Roman families had sub-replacement fertility due to disease and cultural factors. A person who lived in Rome circa 500 BC would have a very small contribution to the modern gene pool, mostly represented by descendants who left Rome at some point.
Around 16%? The overwhelming majority of adults reproduce.
While in principle, I accept that even a small difference in reproductive fitness can have large consequences way down the generations, I’d like a source for the modern english being around 100 times “more descended” from 13th century nobles than commoners.
The end of old patrician family names means nothing. They had daughters and illegitimate children.
I also doubt that ancient chinese city dwellers managed to considerably out-reproduce the romans despite the same urban constraints and diseases. What’s different about the romans? The chinese were at various times also conquered by barbarian people, who proceeded to establish themselves as the new dynasty and nobility. Shouldn’t then, by your own reasoning, the modern chinese mostly be the descendants of steppe conquerors, while the han peasantry died out?
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I'm not sure the guy you saw was real, but it's a real thing, and it's been traced for thousands of years:
https://en.wikipedia.org/wiki/Family_tree_of_Confucius_in_the_main_line_of_descent
The current head of the Kong family lives in Taiwan.
Yeah, real in that people make the claim. As @hydroacetylene pointed out, tons of people also claim descent from Muhammad. This lineage also has a wiki page, does that prove that it's "real?"
Hell, my family claims descent from Jean Lafitte and tons of people I know claim descent from Washington, Lee, or both. Statistically, most of them are wrong, and nobody knows where Jean Lafitte went even if it isn't implausible that he retired to obscurity in southern Louisiana.
Claiming descent from illustrious figures is a cultural universal, I believe. No doubt people in England implausibly claim some incredibly diluted royal blood.
I am personally descended from William the Conqueror along with like half of England.
But the Romans essentially died out. Where is the line of Julius Caesar? Of the old patrician families? Gone, baby, gone.
How could one confirm this? Do we have ancient dna to run the analysis ?
Before modern sanitation cities were dens of disease and filth. They generally continuously took in population from the countryside.
The central and northern Italian countryside have strong genetic links to iron age Romans. They're basically the same people. We don't have records of the old patrician lines to modern times but I doubt they are actually extinct.
Yeah I doubt they are as well, OP seems over confident
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What do you mean by Iron Age Romans?
That would imply a time period before 700 BC when Rome was a village. Rome didn't expand into northern Italy until 250 BC at the earliest.
But yes, people who occupied the countryside of Italy in the Iron Age did not suffer subreplacement fertility and obviously remain extremely relevant to the genetic mix of Italy today, even if there was significant admixture from Germans (northern Italy) and Arabs (southern Italy).
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Julius's line died out with his children. But Augustus's line may survive; we don't have the information to know.
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There were people who claimed it and their descendants are still alive today.
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In China, it's real enough that the guy who was head of the Kong family in the 1930's was offered the chance to become Japan's puppet Chinese emperor (he wisely refused and fled) and later got to help draft the constitution for the Republic of China and was officially a senior advisor to the president of the ROC/Taiwan from 1948-2000.
I mean it was real enough that an occupation government thought it would be politically useful. I mean there are living descendants of Tsar Nicholas II who might be plausible heads of the Russian Empire. Whether or not they’re actually related is not nearly as important as that they’d be acceptable to the people of Russia and whatever power decides to put them on the throne. Claims to royal lineage are political claims and are thus vetted less through factual evidence than through the lens of acceptable political reality. If the Kong family were not seen as reliably pliant, the line would have been publicly discredited even if true.
A correction to point out, Nicholas II certainly has no legitimate living descendants, the communists killed all his family and the remains for all children were identified in and around the mine shaft (Anastasia's spurious survival is disproven). Current pretenders I think are descendants of Alexander III (father of Nicholas II) or Nicholas I (grandfather of Nicholas II).
Happy St. Nicholas (the bishop of Myra) Day all!
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He knew that if King Kong came to Japan, Godzilla would surely follow.
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Some of those guys are probably mythical, but I would expect that a lineage like that has had sufficient eyes on it over time that it's real. Obviously there's a chance of infidelity along the way, but that's almost missing the point in this context - it's clearly about who was recognized as the heir even if they were illegitimate.
I bet tons of guys claim descent from Confucius and it's bullshit, but that doesn't mean that every claim is bullshit.
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Can you write more about this? It seems like a very important cultural distinction.
Truth is much more fluid than we often given it credit, even in the West. Yeah nerdy/sciency/rationalist types are going to focus on statements being made with "truth" but compare with "no defund the police doesn't mean defund the police" types or "don't take Trump literally" most people engage with reality in a more flexible way "this is the best meal/game/movie ever" is felt in the moment despite the hyperbolic content.
For non-Western examples, in many countries scamming is taken as a fault of the victim, and face saving activities are more important than literal truth (as is the case in China).
Not sure what OP is talking about specifically but it is likely the way that "lying" is considered more acceptable in China (with the idea that most people in the cultural milieu know what it is exaggerated, false, and accurate).
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Have you considered that the reason she's completely unimpressed and said 'there are a lot of them' is, well, that there are indeed a lot of them? Given Confucius's birth in 550 BC and that his main lineage spans 80 generations (and that each main line descendant was given official titles, land, and privileges, so they likely had to be well documented), it's possible that a significant number of modern Chinese can trace their ancestry back to him.
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Relatedly, there are a lot of descendants of Muhammed. Almost like such a thing is convenient to claim and you kind of lose track of things over thousands of years.
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I think most such claims should be taken with a large dose of salt, and I regard anything older than about 200 years so easy to fake that it’s not worth taking seriously. I’ve done my own tree and while the charts would allow me to “claim” William the Conqueror, there’s absolutely no way to prove the entire lineage. And the reason is that it’s easy enough to make mistakes and motivated changes in a genealogy before the widespread use of birth certificates and other documents. Even with them, there’s a fair chance that someone in your family was unfaithful and that ancestor is actually the child of a servant or some random person. It’s just silly on some level for people to take seriously the claims that they’re related to ancient people.
I don’t think for a second that this is something that only happens in China, the bias, I think, comes from growing up in a world where everything is documented by printed documents stored in safes or on a server somewhere. For most of history, that wasn’t true at all. The documents were written by scribes hired by people or organizations rich enough to afford to hire them. Inserting a famous ancestor into your family tree is easy to do when you’re the only people with that record and you want to be related to some great historical figure. The other thing is that because the documents are hand copied, barring a historical accident, most of the stuff that survives to this day is there because it supports those who eventually won. That’s not “a different kind of lying” it’s just history being history at a time when records were kept by hand.
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If a city has a fentanyl epidemic, is it best to do nothing and let it run through the junkies ? Gate them to a neighborhood, soft limiting how many new junkies can join them. But don't fix it.
Set up a 'clean up insurance' job with a wholly owned subsidiary 3rd party. Instantly high prestige.
Something like "Health insurance companies spend too much money on goodies making your healthcare expensive. Healthcare Janitor comes in to eliminate wasteage and make insurance cheaper." Really it's like any capital efficiency, accounting, analytics job. Hire STEM grads to keep the activists out. Markets are happy cause it saves company money, people are happy because Insurance seems to have a watchdog, employees are happy because they are supposedly reigning in the greedy insurers.
Separately, this assassination sets a terrible precedent. Logistically, Assassinations are easy. In NYC,USA where crowded streets, guns & hoodies are common, you may even escape. If a felon is going to recidivate, then might as well go big. Grand conspiracies are hard to keep under wraps. But, one off killings have perfect secrecy by definition. In imperfect conditions, the Homicide clearance rate is 50%. With a perfect disguise, you'd have much better odds.
The only reason we don't see more assassinations is because "we live in a society." American society has broken down before (Inner city gang violence), but it localized to intra-ghetto squabbles. A (resigned) cultural acceptance for freak assassinations may develop. Then the pandoras box is open. I bet freak assassinations follow a similar social virality pattern as suicides. Similar to suicides, once it becomes a cultural meme, it's hard to take it below a certain base rate.
I do find it surprising assassinations aren’t more common given Americas high suicide rate. If you already feel like checking out of life, why aren’t you doing other reckless stuff beforehand? Of course there are mass shootings, but those seem so pointless and nihilistic.
If you're suicidal, you're most likely in a deep, deep depression. Depressed people don't exactly have high motivation or impetus to do stuff, and assassinations - even if you're not planning to survive it - take planning and effort. Tracking down one random person (who presumably, because of their high-profile statute, puts effort into maintaining their personal privacy and security) and actually getting to them with a lethal weapon of some type seems like an awful lot of work.
But we still get mass shootings by depressed people, just not assassinations.
Mass shootings are easier, as horrible and macabre as it is to say it. Soft institutional targets that don't move and don't have to be tracked down.
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The other poster nailed it, most people who are suicidal have severe depression which will involve low levels of motivation, planning, concentration, and energy.
Some people with other forms of mental illness can end up violent and suicidal but those generally involve significant disorganization (medical impairment, substance abuse, psychosis, and mania).
Most people who are personality disordered and like this are also disorganized and shitty at planning (as in severe borderline personality disorder). Anti-socials and narcissists are better at forethought (ish) but typically mostly care about themselves and don't usually see the benefit of making this kind of statement.
So you need something weird like malignant narcissism, a relevant delusional disorder, and so on.
Mentally healthy and well people with other motivation (such as a person with terminal illness who is handling it well but knows they will pass away soon) are much more able to complete this type of action but don't do so because...healthy and well.
You need the perfect storm of ability, interest, and organization.
Most with those three find better ways to spend their time but politicization may change that.
we still get mass shootings by depressed people, just not assassinations. Is it just that mass shootings are easier?
Not all subjective depression and depression symptoms come from major depressive disorder. People with psychosis are also depressed, as are those with borderline personality disorder (well-ish, that's more complicated).
I've read some papers identifying the mass shooting type as typical narcissists (specifically malignant narcissist), which may be superficially depressed but it manifests in a very different way.
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Moreover, it seems the technology for carrying out assassinations without being caught has improved by leaps and bounds since, say, the heyday of Weather Underground in the 1960s and ‘70s; 3D printed ghost guns and improvements in robotics and computer vision, not to mention the Internet, mean that it’s possible to set up an untraceable, remote-controlled, perhaps even autonomous killbot to assassinate someone without even being physically present at the time. Yes, CCTV and vastly higher amounts of SIGINT from ubiquitous smartphones do make catching criminals easier. But I still think the balance favors the would-be assassin; if the killbot can be assembled days or weeks in advance, in, say, an abandoned warehouse overlooking a parade where the victim will be marching, good luck finding the assassin.
Uh, this is all theoretical of course.
Anyhow, I chalk it up to us being an older, fatter, richer, and more docile society than we were during the Days of Rage.
Without being an expert, I would be dubious about assassinating someone with a killbot. Even if you make it self-destructing, it would be so easy to accidentally contaminate it - to leave some data from when you flashed it, or for your activation signal to be registered on the wifi / phone / satellite network you use. It may well be possible, but you would need institutional knowledge like Mossad probably has to reliably pull it off.
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Because you're incapable of doing those things, by that condition's definition.
Mass shootings are not generally perpetrated by those kinds of people- the vast majority of them are targeted, and the death [functionally, execution] of the criminal is simply priced in as their cost of doing that violence.
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How do we prevent this from succumbing to the same thing that caused insurers to become the hated avatars of bloat and inefficiency?
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This is the classic argument against Narcan, sure.
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If I'm in a car accident, my auto insurance company pretty much just pays for my accident (or at least that was my limited experience and the experience of others I know). There are occasional disputes about the amounts and autobody companies do have to deal with those disputes, but I am not aware of any auto insurance companies that attempt to just delay approval of repairs until their customers give up or die. In principle, it seems like they could do that - the insured party may decide they can't afford to wait and argue, they just need their car fixed, and then the insurance company can refuse to pay. I'm sure that does happen from time-to-time, but it doesn't really seem like a going concern.
My infinitely naïve solution is to just offer insurance products that you intend to actually make good on rather than deceiving people into believing they're covered in order to create additional profit margins. I'm sure many people would still be bitter about actual facts, but it seems clear that health insurance companies aren't simply dealing with cold actuarial facts and communicating costs clearly, they're lying to people, they're fighting legitimate medical care, and they profit from figuring out ways to legally avoid paying for treatment.
The auto/medical insurance comparison is a good one to think about. Another distinction between the two is that auto insurance is mostly viewed as an individual thing, where the only real public purpose in getting involved is to make sure people internalize the costs that their decisions may have on others (i.e., basically every jurisdiction requires liability insurance). Whereas in the medical industry, the entire apparatus of the industry and relevant government entities (many of which are entirely captured by the same worldview) is so entirely bound by the view that we must subsidize, that we must transfer incomes via regulation of the medical industry, that they descend into such contorted reasoning along the lines of Everything Not Obligatory Is Forbidden. Those are the only two options once we've decided to implement a system that, instead of being oriented toward individuals internalizing the costs of their choices, is oriented specifically for the purpose of externalizing the cost of every single choice you make, no matter how minor, so long as it pushes around some mathematically-computable risk factor in a PubMed article somewhere. This is why such folks literally think that the only option other than strictly making things with some medical risk forbidden (unless you pay someone with a special government license to give you permission) is to literally put a bullet in the heads of anyone who does anything with computable medical risk. This sort of thing would be unthinkable to even express in the automotive world, because the entire mindset is starting from a completely different frame.
Unsurprisingly, this sort of reasoning is incoherent on its own terms. As mentioned in the other topic in the OP, the vastly dominant risk factor driving obscene amounts of medical spending is obesity. Why doesn't the exact same logic work? Why are we not forced to put a bullet in the head of anyone who uses food irresponsibly (perhaps anyone who attempts to purchase some food that hasn't been prescribed by a government-licensed dietitian)? Why wouldn't we have to put a bullet in the head of anyone who works on or drives their own car, rather than having it serviced by a government-licensed mechanic and be chauffeured around by a government-licensed driver? But this is truly the type of reasoning that has infected anyone who is remotely influential in medical policy. Transferring incomes via medical policy is in their bones, like a sacred value. From this core flows most of the ridiculous policy choices we've made, which have built up hack upon hack, ultimately resulting in messed up incentives for insurance companies. Insurance companies are basically not allowed to be honest and provide an honest product at this point, but that's only one of the many effects of a complete error in mindset.
I don't buy this. Everyone dies of something. The efficient way to reduce medical expenses is to die of something that kills you relatively fast. Any claim that people's actions "cause them to have medical expenses" has to be seen in this light. It's by no means clear that some activities cause medical expenses at all just because they lead to early illness and death (I believe cigarette smoking reduces medical expenses for this reason). And even if they do, are they really something we wish to discourage? (do we want to blame people for being nonsmokers because that increases their medical expenses for old age care?)
Why it would even work?
I expect that smokers are more likely to die due to prolonged lung-related diseases rather than something acting quickly. And therefore increase costs.
But they also die much earlier and without elderly care, which is on a totally different level of cost. Also significant savings on social security: the state loves a man who dies on his 65th birthday and covers payments for a lawyer who lives to 98.
the claim was
which seem very unlikely to be true. Pension is surely not a medical expense?
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Fair enough. I was definitely being too strong in my language. If anything, it sort of highlights how difficult it is to even know how to compute it. Upon further reflection, I'd say that it's probably highly nonlinear and complicated, perhaps somewhat resistant to traditional methods (let's be honest; it's going to be a variant on OLS). For example, suppose two people use very similar amounts of fentanyl (to hit another topic in the OP), but just different enough or the people being just different enough in size or whatever that one of them dies and the other one is left alive, but with major organ issues or whatever. Maybe they're scared straight or are physically unable to go out and get drugs anymore, but their life just drags on for a long time, with ever-increasing medical bills. How, then, does one account for this risk factor in the calculus?
I think this actually brings me back to my initial position, though. I don't want to have to solve these wicked estimation problems in order to do public policy. I shouldn't have to. It should be mostly a meaningless question, at least for the purposes of public policy, if we were focused on setting things up so that folks internalized the costs of their choices rather than doing everything we can to externalize everything and transfer incomes.
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The more I think about it, the more the auto/medical insurance comparison is driving me up a wall.
I mean, imagine if auto insurance worked like health insurance. For starters, it would be the equivalent of accident insurance plus a maintenance contract. If they had to accept "pre-existing conditions" people would be driving their cars around until fumes were filling the cabin for unknown reasons, get insurance during an open enrollment period, and then dumping their clunker on the nearest garage with entitled demands to "just fix it". Further, imagine car mechanics had some sort of "duty of care" to these cars, and couldn't just turn them away. Imagine of mechanics had to fix cars, regardless of cost, of anyone who could tow them to the garage. And then a bunch of these people just took their cars and drove off into the sunset without paying a dime.
Suddenly car insurance companies would be desperate for anything they could possibly due to stay solvent. And garages would just be making prices up out of thin air to stay solvent. They'd both have virtually uncapped and unavoidable liabilities, and limited means of income. Absolutely every single interaction with a "customer" would be an arms race where they need to either fleece this person as thoroughly as possible, lest they risk getting taken by this person for as much as possible.
Conversely, if health insurance were just like car insurance, they'd pay for traumatic injuries and sudden illness and that would be it. Chronic issues are on you, lifestyle issues are on you. Furthermore, they'd probably calculate your estimated years of life left, versus cost of treatment, to render a decision about whether you are "totaled" or not. They'd probably be a lot more like life insurance too, where they go over you with a fine toothed comb in deciding what the cost to insure you should be. Hospitals and doctors would expect payment for services up front, but hopefully would drop the arms race and just have generally consistent pricing for x-rays, casts, stitches, etc.
Now, things get thorny, in both directions, when you consider the state requiring you to have car or health insurance. Many states do currently require car insurance, and many states are also experiencing the effects of society shifting towards low trust defect-bots where illegal immigrants without insurance are crashing left, right and center ruining things for everyone, and despite breaking all the laws, nobody does jack or shit about it. Likewise when the ACA attempted to make having health insurance mandatory, the cost of plans was so ruinous many people just ate the penalty, and the whole scheme was so unpopular Trump got the mandate revoked.
But maybe we could pretend we still lived in a functional high trust society where everyone bought health insurance and the prices were reasonable, with all of the above. I still don't think people would accept the tradeoffs of health insurance being "just like" car insurance.
Yeah… ultimately, a lot of Americans view health insurance as a general paypig for health-related expenditures, in a way they don’t when it comes to car or home insurance (not yet, at least, as they’re getting there with regard to uninsured motorists [a Noticer might ask: and who are these "uninsured motorists"?]). From their point of view, health insurance companies exist just to approve claims and send money.
They’re not entirely blameworthy in that view, descriptively-speaking. Where the US government does its usual subsidization of demand and restriction of supply, and turning intrapersonal reallocation of risk into stealth interpersonal redistribution of wealth (another example would be Social Security).
However, prescriptively, it’s also an ought for many Americans—not just an is—that Someone Else should pay for their healthcare (especially if they’re frequent flyers due to some meme “diseases”/”disabilities”), that Someone Else should pay for their parents’ end-of-life care to eke out a few more months (lest they have to do a cost-benefit analysis using their parents’ estate—or heaven forbid—their own net-worth), that Someone Else should pay for the healthcare of Vulnerable Communities such as women, non-Asian minorities, and Persons of Under-documented Citizenship.
The notion that health insurance companies might perform actuarial risk/reward assessments is out of their personal Overton Windows. On DataSecretsLox (where I’m but a humble, occasional lurker), there were two back-to-back comments that I thought summarized the situation nicely:
Lumifer:
EchoChaos:
Illegals, who everyone just bluntly refers to as illegals or ‘Venezuelans’ when they’re around them. It’s not some big secret; when I went to driving school they straight up told us it was a good idea to have uninsured motorist protection in case you got into an accident with an illegal.
This isn’t some kind of politically incorrect knowledge that everyone pretends not to have like 13/52 or drunk driving rates by ethnicity.
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Car insurance is actual insurance; health insurance is by and large prepayment.
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This is variable. While I've personally never had to experience it(knock on wood), I've had associates deal with insurance issues, such as debating on wether repair or totaling of the car is the more beneficial option(for the insurance company). Which, if you're without a vehicle and reliant on it for a job, can be very annoying and stressful.
Personal experience, my increase in insurance cost escalated to the point where my 6-month bill came in, I calculated the cost, and it was the equivalent of paying for a second car note.
I called up the company and more or less forced them to give me a lower rate, but come on.
Then, there's predatory regulations I've seen(and had to deal with) in terms of home insurance. Wasted money, in my opinion, required by the banks as an additional cost of home ownership and much better put aside into a savings account.
I won't even go into life insurance. I've seen both sides of that fence, and it's bad.
Insurance as a whole has a roundly negative opinion from people. You could schedule a death-game with insurance CEOs as the participants and you'd probably have people lining up for miles, cheering the spectacle on.
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Car insurance companies can declare a car totalled, refuse to fix it, and pay out a humble Kelly Blue Book value. Health Insurers have no such option because everyone wants to live forever regardless of cost. They don't behave the way they do to get rich. They are compelled by law to play out 80 cents of every dollar collected in premiums. They behave how they do to stay solvent.
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The comparison between America and Western Europe is usually done because they are seen as peer developed countries. But after 15 years of no meaningful economic growth in much of Western Europe. the U.S is on track to no longer have European countries as it's peer, but rather sit entirely above them in it's own category. The U.S. can buy its way to higher life expectancy not because it's good at spending money on healthcare, but because it has the money to spend on healthcare.
And critically, there will be something to buy with that money.
Gains in life expectancy are not typically easy to buy. For all its spending, US life expectancy is on par with Costa Rica or Albania.
Traditionally, medical intervention does not add much, at least once you get past basic sanitation and vaccines. For example, if we outright cured cancer it would only add 3 years to life expectancy.
But GLP-1s agonist are a game changer.
This is not for lack of an awesome medical care system. It's more nuanced.
Of people who reach 65 in the US, they can expect to have the highest longevity in the world. Our medical system is really good at this. (Whether or not they're quality years and you want to live them is a different debate).
The US has a lot of other factors that depress life expectancy at birth though
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The US has peer countries in Europe, but when you look at median income (the best statistic) they’re limited to Norway, Switzerland and Luxembourg. Disposable income is still higher in the US but overfocusing on that doesn’t provide you with the whole story.
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It's more like the size of the various dynasties ebbed and flowed. They at various had control of north Korea and Vietnam, and of course the Yuan dynasty was essentially the continuation of Genghis Khan and could make a claim for much of Asia.
If you look at recent history China seems pretty non-expansionist, with Tibet the only exception. They famously turned away from the opportunities of colonialism at the peak of China's power
Another similarity between China and the Roman Empire is Terminus, the god of boundaries.
Ancient Romans believed that territory, once captured, should never be surrendered.
China seems to believe mostly the same thing. All they want is all the territory they've ever had. That's how they have gradually expanded to their current size (although still slightly less than the Qing dynasty peak). The recapture of Tibet is the largest acquisition of territory by any country since the end of WWII.
Even now, China is busy colonizing and Han-ifying its own country. I think they are very expansionist, but just move very slowly.
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Tibet's capture can directly be traced to brain-dead actions by India.
Tibet's hostile terrain makes it difficult to capture, and even harder to hold on to. It's a on-your-feet infantry operation. No air force, no navy, no tanks and limited use of vehicles. It's rural Afghanistan on steroids. It's Hitler marching into Russia. Tibet is invadable for 3 months of the year. India could've helped Tibet stay independent with limited assistance. Nehru is fully to blame for this, as he is for a lot of boneheaded decisions through his tenure.
It would've given India a buffer state the size of the 10th biggest country in the world. No embarrassment of 1962. No worries of a 2 front war between Pakistan & China. No direct land route between China and Pakistan. Easier to keep Kashmir stable. Direct access to Central Asia.
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I don't think that vicious cycle is the main reason health insurance companies have terrible reputations. I'm not even sure if that vicious cycle even exists - it has a lot of assumptions baked into it that may or may not be true. Do health insurance companies actually have a lot of trouble getting talent? Do health insurance companies actually pay a lot more than other companies for equivalent workers? Do workers who care about money more than reputation actually lead to products that customers hate? Is money-grubbing actually the main reason health insurance companies have bad reputations? Maybe some of those are true to some extent, but I am highly skeptical that all of those things are true and that they explain the core reputational issue.
IMHO there are many reasons health insurance companies have terrible reputations, but I think the main two are:
They are massive bureaucratic organizations, and massive bureaucratic organizations are really annoying to deal with when you venture off the happy path. And that often happens due to the complexity of the healthcare system.
Health insurance companies are the part of the healthcare system that is mostly responsible for billing people and rationing care, which means they are highly visible to people.
Neither of those problems are really fixable as the CEO of UHC. The healthcare system will be massive, no matter what I do. And a health insurance company does need to charge money and ration care.
I hope that whoever is next in line at UHC is not worrying about fixing these impossible problems, and instead is focused on running the company as best he can.
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Random Critical Analysis argued similarly back in the day https://randomcriticalanalysis.com/why-conventional-wisdom-on-health-care-is-wrong-a-primer/
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I'm not certain about that. The EV of self-driving cars is very strongly dependent on P(WWIII), because nobody takes cybersecurity seriously enough so if/when WWIII comes around you're going to get headlines of "50% OF SELF-DRIVING CARS TURNED HOMICIDAL, STARTED MOWING DOWN PEDESTRIANS AND DRIVING THE WRONG WAY ON MOTORWAYS!" and that one horrible day wipes out all the gains they've ever made and then some.
Admittedly, a lot of modern cars that aren't technically self-driving cars still have substantial hacking dangers due to the various "safety" features that put a computer between the inputs and outputs, but not to the extent of self-driving ones.
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