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Small-Scale Question Sunday for January 1, 2023

Happy New Year!

Do you have a dumb question that you're kind of embarrassed to ask in the main thread? Is there something you're just not sure about?

This is your opportunity to ask questions. No question too simple or too silly.

Culture war topics are accepted, and proposals for a better intro post are appreciated.

Jump in the discussion.

No email address required.

Heat Recovery Ventilators

Does anyone have one? One drawback of rarely using the wood stove is fewer air changes, and I have to occasionally open the windows and blow fresh air through the house.

If HRVs aren't a scam I'd seriously consider getting one.

Tips for the GRE?

Study. It’s a pretty easy test.

Also, use adderall.

Here's a longshot: I'm trying to see if anyone else read (or wrote!) a comment on the National Review website ... from a few years ago.

A few months after Trump won the election, I started reading NR's investigation coverage. I stopped when they started paywalling Kevin Williamson, so the comment would have appeared somewhere between April 2017 and July 2021. The comment was an extremely persuasive compendium of offenses the mainstream media had committed against red America. In retrospect, I realize that it might have been copy/pasted from the motte, or perhaps written afresh by someone here (I didn't start reading the motte until 2020).

Does this sound familiar to anyone, or does anyone know of a similar resource?

Scott Alexander’s Paranoid Rant sounds like the type of thing you’re talking about, but it wasn’t posted on NR. I can’t find it online, but someone around here must have it saved.

Thank you. That is an excellent rant, but the comment I was looking for was a fairly long list of media statements that were clearly wrong and/or unfair, similar to "Rittenhouse the white supremacist", though the examples were generally less controversial, thus better for the project of persuasion.

I vaguely remember a comment here about how scientists were able to "rewire" microscopic creatures to become radically different shapes by modifying connectomes but I can't find anything about it. Can someone point me in the right direction?

I have a question that could turn into a culture war topic but I need some kind of sanity check before I flesh it out further:

Does anyone else feel as though, even as the general populace becomes less and less optimistic, the mainstream narrative has nonetheless converged on a message of unrelenting positivity?

It is hard to describe, but the best examples of what I'm talking about that spring to mind are The Rise of the "Corporate Memphis" art style and the seeming ubiquity of beauty filters as a default feature in smartphones.

Or in the way Youtube video comments have turned from a cesspit of trolls trolling trolls trolling trolls to basically a competition for who can heap the most bombastically hyperbolic praise on the subject video.

The common thread is that these techniques/styles end up minimizing the appearance of 'flaws' and 'ugliness' whilst also idealizing the subjects it examines so as to avoid... I don't know. Offense? Critique? Any possible negative emotional valence? Where before there might be depiction of ugliness as ugliness or actual examination of social and personal flaws in a way that risks causing offense, where before there were art styles that embraced ugliness (while still being aesthetic) and Cartoons like Ren and Stimpy could use unpleasant visuals for comedic effect now it seems like most products are produced with the intent of avoiding any unpleasant sensations on the viewer's part.

And this now seems to apply to every single product of modern culture, aside from some decrepit/degenerate corners of the internet. "Good vibes only" seems to be the accepted norm... with the exception of certain acceptable targets who may be used as punching bags.

I'm not even getting into possible causes, I'm literally just trying to see if this is an actual, noticeable phenomenon.

Have you felt as though mainstream/corporate-produced culture has reached increasing heights of 'toxic positivity' even as your own outlook on the state of the world has degraded?

I'm familiar with the phenomenon you're describing and I think it applies in the realm of UX, brand identities, graphic design etc., but I'm not sure how applicable it is beyond that.

If you compare any random film made in the last five years with a film made in the 90s, one of the first things that'll jump out at you is how washed-out, desaturated and visually dark modern films look compared to films from the 90s. Modern films tend to be filmed digitally rather than on film, which produces more washed-out, low-contrast visuals compared to film. They also tend to use VFX and CG extensively, and one of the most effective means of hiding imperfections in VFX work is just to make the whole image darker. Six years ago, Zack Snyder got a lot of stick for producing a desaturated high-contrast interpretation of the Caped Crusader; now, we're at the point where people are complaining that literal Disney films are too (visually, not tonally) dark. The same trend is obvious in prestige television.

10-15 years ago the big complaint in video games was that everyone was adopting the house style of Call of Duty and Battlefield and making everything brown or grey. The worm has turned and now lots of things are magenta instead, but it still isn't hard to find modern games which are washed-out, desaturated, dark and generally unpleasant to look at.

To my mind, most of the big trends in popular music in the last ten years have prominently featured a conscious embrace of ugliness and poor taste, whether it's the ear-splitting sonic assault of drill music; the self-aware tackiness and excess of hyperpop; the bored, amelodic, disaffected repetition of British and Irish sprechgesang bands; or the deliberate minimalism of modern trap and SoundCloud rap.

To my mind, most of the big trends in popular music in the last ten years have prominently featured a conscious embrace of ugliness and poor taste, whether it's the ear-splitting sonic assault of drill music; the self-aware tackiness and excess of hyperpop; the bored, amelodic, disaffected repetition of British and Irish sprechgesang bands; or the deliberate minimalism of modern trap and SoundCloud rap.

I don't see this as a fundamental lack of positivity and retreat to nihilism or misanthropy. At the risk of engaging in some serious "old man yells at clouds" style activities, I can't really emphasize enough how "irony" seems to have become the central social feature of Gen-Z. "Ugliness and poor taste?" No, I have great taste because I'm wearing this ugly outfit and my soundclap rap is mumbled gibberish. Kanye (before he want to planet Kanye) did this explicitly with one of his Yeezy lines that were specifically intended to look like dilapidated homeless people clothes. And have $1500+ prices per article.

But, wait, it gets worse! I'm seeing trends of irony-upon-irony. The embodiment of this is Pete Davidson who has made a career off of 1) Having a firefighter dad who died in 9/11 2) Joking about it 3) Talking about how it still makes him anxious and depressed 4) Making a horrible movie where he mixes both of these concepts 5) Being the heir to the Jimmy Fallon "I'm always breaking" role on SNL and 5) Dating megastars in Hollywood. That guy is incomprehensible to me because he doesn't ever seem to be serious even when he is professing huge sincerity. Again, the maybe-maybe-not self-awareness of that Taco Bell ad he's in where the extra says, at the end, "are you riffing or is this part of the bit?"

In my mind, I think pop culture, since about 2015 and the rise of real Gen-Z meme culture, has had a crisis of authenticity. It's now a rare commodity and, therefore, hard to reliable find and produce. The easy way is to double down on irony / sarcasm ... which further pollutes the message and so we get stuck into multi-layered cyclic irony. Trust disintegrates, people aren't sure if their emotions are common and understood or bizarrely unique personal hallucinations.

I don't see this as a fundamental lack of positivity and retreat to nihilism or misanthropy.

I think it certainly is in some cases. The dominant lyrical theme of drill music are "I am going to kill my rival drug dealers", while the dominant lyrical theme of cloud rap/emo rap/sadboi rap etc. is "I am abusing drugs because I am so miserable and depressed" (something which is acknowledged to be a stage persona in some instances, namely the late Lil Peep). Maybe these aren't nihilistic or misanthropic stances, but they're anything but "positive".

Hard disagree on Pete Davidson, I watched one of his recent Netflix specials and found him surprisingly candid and unpretentious. Perhaps a thick veneer of irony coated his earlier work but he seems to have grown out of it. Agree that, in the Anglosphere, ironic detachment is the air that we breathe (as a genre, the aforementioned hyperpop could not function without it).

"irony" seems to have become the central social feature of Gen-Z.

Posers just stole it from Gen-X. (Simpsons S07E24, May 1996)

The worm has turned and now lots of things are magenta instead

There's an interesting contrast to be made between the Call of Duty era where games went for 'gritty realism' and the, call it the Fortnite era where literally nothing needs to be taken seriously, and real life personalities and pre-existing characters are rendered as a perfected, cartoonish versions of themselves.

I won't even say one is better than the other, but Fortnite definitely represents the sort of unrelenting positivity, the hiding of ugliness, the avoidance of negative emotional valence that I'm talking about.

To my mind, most of the big trends in popular music in the last ten years have prominently featured a conscious embrace of ugliness and poor taste

On the other hand, I'd point at bands like Imagine Dragons and a lot of imitators that produce peppy and/or 'epic' sounding songs with aggressively positive/affirming lyrics that... also don't mean anything. They want to induce some positive emotional valence but without having any real 'message.' Other than a vague "YOU GOT THIS! YOU ARE UNSTOPPABLE, YOU CAN ACHIEVE ANYTHING YOU WANT" sort of statement. And these songs become MASSIVE HITS.

the mainstream narrative has nonetheless converged on a message of unrelenting positivity?

You mean the same narrative that tells us that

  • We live in a culture that systemically oppresses everyone who is not a white heterosexual male

  • Literally any person around us can be a hidden hateful bigot and we must be eternally vigilant to every word and action in case they slip and reveal themselves, and we can not let slide any offensive word, even if they were said by accident and without intent to offend, because it is worse than physical violence

  • Academic campuses and pretty much all major companies are permeated by rape culture and any woman can be - and often are - sexually assaulted at any moment there

  • Police are prowling all major cities looking for non-white people to kill for no reason at all

  • We are destroying our environment and the only way to avoid it is either massive depopulation or massive drop in the quality of life

  • At least half of the country are insane illiterate bigots who dream about murdering and enslaving anybody who does not look like them, and instituting a fascist dictatorship

  • We cannot ever show our faces in public ever again for the fear of dying in horrible agony

  • Convincing people to kill themselves is a viable solution to the problem of rationing medical care (and maybe other resource problems too) - this is only in some countries, but wait a bit

  • You can't eat a steak without feeling very guilty and you better learn to eat mealworms and crickets instead

  • Everything that exists around us was stolen from somebody, built by racists or enslaved people and every child that is born is born into the original sin and owes huge sums for that just for the fact of their birth into a wrong race

  • Internet is brimming with "misinformation" and only strict government-guided censorship can give us hope for the democracy to survive

That doesn't sound like a message of unrelenting positivity to me...

I agree with your post, but I also see where the OP is coming from.

I think it's mostly a process of infantilization. Corporations, states, media etc. behave towards the plebs more and more as if they were children. So yes, that means sometimes they will be extremely positive (you're a good kid!) and other times they will try to scare you (they're coming from you! you need our protection) or reprimand you (how dare you say that foo-ism, you disgusting bar-ist).

So I see OP as referring to the coddling, "nice" face that they adopt for well-behaved kids, which they (Cathedral people, not OP) probably would like to be the only face they have to adopt, because in their ideal world likely every pleb is a good child.

And it's not only about art styles, it's also about the language used and the patronizing, condescending or "overly cute" tone. For example, see the peppering of emojis in every online communication by many companies, states etc. Does anyone really need a finger pointing down to understand that "this image" refers, in fact, to the image shown below a post? To see the country flag after the name of the country? To see a snowflake after reading the word "winter"? (oh, babby understandy now, you mean time when it snowwy, thankies mommy!!) Etc.

An interesting exercise is to compare current textbooks to old textbooks. It's very salient in programming books. Most old programming books address the reader as if he were an intelligent, mature, adult person, even if they use jokes and puns sometimes; they show respect for the reader. Many current programming books try extremely hard to be "cute" and address the reader as a dumb, fragile baby. For example, compare Structure and Interpretation of Computer Programs to Learn You Some Erlang for Great Good!. SICP is not dry at all, in fact it's quite friendly and full of jokes and puns. But it clearly respects the reader and expects him to be mature and intelligent. The second one is written as a children's book, but meant for adults. This may be an extreme example, but the trend is definitely there.

The thing is, it seems that many people like to be addressed as children. Maybe because it "absolves" you from responsibility, thinking and anything else but "wanting" and "not wanting", being happy, sad or angry? I don't know.

That's what certain parts of the media are portraying, but notice the point that each of these is usually couched against some 'valid' target of ire, so there's always an outgroup to blame for the problem.

And the positivity tends to come from the general corporate/commercial messaging around a topic which simply frames any and every possible situation in the lightest way possible.

Let me zero in on a couple:

You can't eat a steak without feeling very guilty and you better learn to eat mealworms and crickets instead

This is often couched as "guess what! You can make an easy impact against climate change JUST by eating bugs!" as a positive, progressive viewpoint.

Convincing people to kill themselves is a viable solution to the problem of rationing medical care (and maybe other resource problems too)

There's a recent development of, again, framing this whole things as a positive in the marketing!!! This is what I mean! Rather than viewing the end of a human life as a generally tragic, possibly grim affair that should be viewed as a negative (discounting the afterlife). look at that fucking commercial portraying it as a beautiful event!

When did we hit the point where euthanasia was couched as a 'beautiful' thing rather than the ugly (sometimes) necessity that we try to avoid?

And likewise, can you find any corporation outside of the news media that allows any level of honesty, critique, or possible offense of any particular group in their corporate messaging?

If the group offended is not "woke people", then yes, easily. E.g. I have seen corporation sponsor "family friendly drag queen shows" (and publicly brag about it) - I'm pretty sure it is offensive to many people. It's just not the people that the Right Thinking People would care about offending.

But you don't see them sponsoring a Family Friendly Drag Queen show and depicting opponents to such a show as bigots.

Basically, they refuse to acknowledge that there's any negative side to it, and don't aim criticisms at any group. It's not their intent to offend, and part of that is to make it as annoyingly positive as possible.

Oh yes they do. Maybe not with drag queen shows (I can't say as I haven't witnessed specific communications to that effect) but certainly with other things. Example:

I think it's pretty offensive for anyone who supported the law (2/3 of voters by some polls) but somehow Delta - and many other companies - do not care. They think they are too big to fail anyway, so offending somebody who does not hold the power (and these aren't consumers anymore in the American system, not for a long time - it's those who control government budgets and subsidies) is completely fine.

Seems to me that OP was talking about art, or at least about art suitable for mass consumption, not public discourse.

Can art stay "unrelentingly positive" if all other culture is steeped in negativity? We're not living in an environment where the art can (or wants to) stay away from politics and cultural context.

Yes! There are multiple different things. these are not particularly negative. They suck, despite being "positive".

This is not art, this is grift.

It's a grift of unrelenting positivity. here, here's some unpolitical, "positive" art. stable diffusion 1 is a much better artist than this quirky person

What is scarce today is proportionate authenticity in positivity and negativity.

A question I like to ask with my bi-coastal over-educated early 30s cohort is "Yes, of course Orange Man was very very bad, but how did you life get appreciably worse between 2016 and 2020, barring anything related to COVID?" As almost all of my cohort got into manager+ levels of mostly tech corporate work, completed a masters, and/or got married ... they can't really come up with anything concrete beyond "well ... my anxiety...blah blah blah." But that's just the point - negativity (in media sources or elsewhere) doesn't seem, to me, to be about real proportionate evaluation, but a kind of circular mood-affiliation. Even the less emotionally charged WSJ frequently has articles along the lines of "workers are worried the economy is real bad and whatnot." The body of the article amounts to "a bunch of online surveys indicate people are worried ... in general ... here's a few interviews with people who are worried ... in general."

Now, flip the coin the other way. Anybody here who routinely uses Slack or and other chat app in a corporate job will be familiar with the "EVERYDAY AMAZING" hyper-praise that a lot of front line managers HEAP on their employees for ... doing the basics. "Timmy and Janey ABSOLUTELY CRUSHED THEIR STANDUP THIS MORNING!!!!!" Followed with dozens of emoji responses. First, I think this is maybe the number one issue with career development today - front line managers are turning into weird cheerleaders until annual performance reviews where they absolutely gut these same folks. Consistent and honest feedback is really hard to come by and it's nearly impossible to calibrate the relative strength of feedback when you're getting the above (OMG YOU SHOWED UP TO WORK) on the one hand, and a muted "Hey, I think you could've delivered that report better..." on the other. Wait a minute, did I fuck up or not? If I did, how do I improve? What's the most important part of my job?

I know I mixed some topics up above here, but I don't think they're that unrelated. I think about this a lot as somehow who's moved into the Senior Manager / Director phase of the career and, looking down, see a lot of individual contributors who truly don't trust the feedback from the system. As a citizen who reads the news, I see something similar happening with your average man-on-the-street who's looking around and seeing "THE END IS NEAR" on a daily basis, but who goes home, orders from Uber Eats and isn't worried a stranger is poisoning his food.

What is scarce today is proportionate authenticity in positivity and negativity.

Oof, yeah the "authenticity" question has been banging around in my head too, and I'd write an essay on it if I can confirm someone smarter hasn't written it already and I get the time to do it.

This rings true: people want to hear positive affirmations if they come from a place of honesty, and maybe don't like it when it's a condescending sort of affirmation or obviously isn't sincere.

And when it comes to positive affirmations from large corporations, you can largely conclude that they're not sincere because it's all designed around getting you to spend money and they have no particular connection with you as an individual to 'authenticate' the affirmation.

Anybody here who routinely uses Slack or and other chat app in a corporate job will be familiar with the "EVERYDAY AMAZING" hyper-praise that a lot of front line managers HEAP on their employees for ... doing the basics. "Timmy and Janey ABSOLUTELY CRUSHED THEIR STANDUP THIS MORNING!!!!!

Agreed, although I do not have a large corporate job.

front line managers are turning into weird cheerleaders until annual performance reviews where they absolutely gut these same folks.

Also agreed, and funny enough oftentimes it seems like the performance reviews will gut someone for NOT buying into the positivity culture and being an overall 'downer' at work even if that's simply the result of trying to be honest.

But that's just the point - negativity (in media sources or elsewhere) doesn't seem, to me, to be about real proportionate evaluation, but a kind of circular mood-affiliation.

The comedian Dara O'Briain expressed this as "Crime is down, but the FEAR of crime is up!"


Good Christ do I hate logging into LinkedIn for any reason.

I think you are correct to a large extent, but as someone who still subscribes to print media, much that focuses on politics, the economy and current events is very negative in tone. This is natural as these publications place focus on trying to warn readers about negative developments and things that need to be changed and improved. It is funny that when comparing the op-ed sections of the NYT to WSJ, the Spectator World to the Atlantic, or the New Criterion to Jacobin, the other side — whatever it is — is usually winning, as “things are going well for us” is less persuasive as a call to action.

but as someone who still subscribes to print media, much that focuses on politics, the economy and current events is very negative in tone.

Yes, I am not reading newspapers or watching cable news or indeed any mainstream news sources that don't bubble up through twitter, so I am definitely not exposed to the mainstream news messaging as much. Although it doesn't surprise me if they're still in 'fear and outrage mode.'

I think part of what I noticed, however, was how the messaging on inflation, supply chain issues, and energy prices seemed to focus on downplaying the severity of the situation and implying that it will be all fixed in short order. Part of that was due to the election year, to be sure.

Add on all the ridiculous puff pieces about Sam Bankman-Fried that ignore the thousands upon thousands that lost tons of money due to his actions.

I have noticed that a significant part of Reddit now seems to be "support talk". Instead of jokes and trolling, it's all people saying "terrible thing X happened to me" and all the responses are some variation of "oh my god I'm so sorry for you here's some hugs"

Interestingly enough I ran across discussion about this phenomenon just the other day. I sometimes watch a youtuber called Todd in the Shadows who talks about pop music (usually through a negative lens because most of anything is bad, but he appreciates good pop music). Every year he releases his "top 10 worst songs of the year" and he began this year's video with a diversion about how critic culture has morphed into fan culture. The discussion on reddit (on a similarly very "poptimist" subreddit) agreed how the culture of positivity is utterly cloying and suffocating. Specifically the genre of "self-empowerment/positivity" is called out as fake and saccharine.

I'm not really hooked into social media so I don't really have much else to add. I do know that RottenTomatoes and other kind of review sites have become utterly worthless as metrics of quality because big companies have realized how important internet cachet has become as an advertising mechanism, and the inevitable tyranny of Goodhart's Law follows. You do have to wonder how much of this endless positivity you talk about is organic. I don't think it's necessarily that all the comments are AI-generated or bots or whatever, but there's obviously corporate fingers tipping the scale. A simple example is youtube removing the dislike button so that the hoi polloi can't show their disdain.

A tangent:

I do know that RottenTomatoes and other kind of review sites have become utterly worthless as metrics of quality because big companies have realized how important internet cachet has become as an advertising mechanism, and the inevitable tyranny of Goodhart's Law follows.

Find a cinephile or three to follow on Letterboxd who’s taste you respect. You don’t even have to sign up for an account or visit the website as Letterboxd provides an RSS feed for each user account.

Is it possible to rate stuff and then get matched with someone like-minded?

That I don’t know. I’ve got three acquaintances I follow on there via their RSS feeds who are all cinephiles. I’ve not signed up for an account, myself, per my personal no social media policy.

I was going to mention the same video as a welcome change from the Pollyanna-isms.

I'm only a casual Youtube user but it's clear that they set up an aggressive automod for comments a few years ago and I assume people have begun conforming to the unwritten rules in order to have their comments posted instead of being shadow-banned. I suppose it was necessary and probably a net improvement, it gets a bit uncanny though when I watch the videos from SoftWhiteUnderbelly interviewing the by turns desperate and criminal denizens of LA's Skid Row and then read the comments and see they're full of glib praise and hollow platitudes for pimps, addicts and proud gang bangers (in both senses of the term).

I run a youtube channel just for fun with small viewership (~ 1k subscribers). I can tell you that even I (with no youtube partnership or monetization) have a whole bunch of automod options to filter out negative/aggressive comments. I imagine a lot of channels have this on by default, and have even more powerful options at their disposal

Wouldn't surprise me because I can remember when Youtube comments were, as mentioned, a cesspit.

But Youtube has just gone so far in the other directly, including removing the dislike count to prevent negative views/opinions becoming visible that people have adapted by becoming so aggressively positive that you'd think it was sarcasm.

I remember watching years ago on a guy who reviewed each episode of My Little Pony complaining that his videos that were positive always got a way better reception than his videos that were negative, regardless of the actual quality of the episode. He was pretty deeply upset it seemed that he couldn't honestly review shows, which his channel was supposed to be about, without crippling his channel.

At the same time "hate channels", whose purpose is to shit on stuff seem to do very well.

Yeah, I think in this case the novelty of a grown man liking MLP may have something to do with things.

I had some thoughts about how both the major films being produced, themselves, seem to play into this and as indicated the average mainstream critic seems to think their job is to validate whatever product is currently supposed to become the latest hit and look for any reason people should enjoy it rather than making an honest assessment of quality.

Critics finding as many reasons as they can to 'like' a work and downplaying obvious flaws seems like a far cry from the days of Siskel and Ebert.

minimizing the appearance of 'flaws' and 'ugliness' whilst also idealizing the subjects it examines so as to avoid

George Carlin was talking about this decades ago - Euphimisms

IMO, the content distribution has stayed the same, but content discovery has changed a lot. There is more of every thing. More flawed/yucky/ugly stuff and more sanitized garbage. It's just that when the recommendations systems don't know what you like, the sanitized garbage is pushed in your face more often than it used to be. The flipside is once you get into the ugly-offensive-flawed content, the recommendation systems will overwhelm you with that too.

It is about how content discovery changed. You can now eat straight sugar from the sachet, or straight black coffee. Our experiences aren't attenuated by having to all see the same 5 channels on network TV.

I think there are definitely still shows out there like Big Mouth which use ugliness for comedy. And you of course still see the news reporting on wars and terrorism. There are definitely some areas that are now optimizing for minimizing offense like social media algorithms, but I don't know if I'd say if society as a whole is significantly moving in a direction like this.

I think there are definitely still shows out there like Big Mouth which use ugliness for comedy.

I'd have to think pretty hard if this is the kind of 'ugliness' I'm talking about, but then I'm reminded of the whole subplot where one of the characters got his pillow pregnant and it had a little pillow baby and yeah, that's definitely a counterexample.

Asking for a friend... How would one go about hiring Aella's sexual services? It seems to be the case that she still works as an escort. Price is not an issue.

Who is this woman? Is she the e-girl of rationalists?

Her escorting alter-ego's page is still out there. I should've bookmarked it for you, because now I can't find it.

I dunno but 37 showers a year is pretty nasty. Find yourself someone that at least showers between guys.

If your microbiome is hopelessly damaged by a bit of water you've got bigger problems.

Oh wow, I hadn't realized that was actually Aella when I saw it posted elsewhere. The rationalist obsession with that woman is really one of the movements biggest red flags to me.

It's odd to me that she's made it this far on what's really, really common schtick. Go to any literary-debate club or half-serious political discussion group at an Ivy-Or-Similar school and there will be at least half a dozen girls making an absolute killing doing the exact same thing.

I think Aella is quite entertaining. She’s not the most insightful person but she doesn’t claim to be, and she has interesting ‘lived experience’. If you want to understand men, prostitutes are some of the best people.

I don't think there's any obsession, but she's maintaining pretty active media profile and she's more interesting than most of public rationalists (come on, situation report about mosquito nets in Africa or interview with a rationalist escort/camgirl - what are you clicking on?) for most of the public. I think if it's the biggest red flag, they're doing ok so far.

Ive heard her mentioned more times in places that shit on rationalists more than from rarionalists. Or just dont use twitter.

I don't think rationalists talk about Aella enough for it to be 'one of the biggest red flags'? I never see her mentioned on lesswrong, and only occasionally on SSC. She's more often seen on twitter of course.

I wouldn't say I'm the most rationalist community person, but I've been around this scene for over a decade, and I've never even heard her mentioned (or maybe I never noticed her being mentioned) before this very thread.

Probably the latter - she's all over rationalist twitter, and definitely has been mentioned in at least five scottposts.

That’s because she’s one of his personal, real-life friends, not because she’s central to anything.

I guess it's just that Scott sometimes talks about her in a way that kind of implies she's are very cached reference, throwing out her name in such a way that implies we're all pretty familiar.

No group is immune to e-girl bullshit.

(except explicitly gay groups)

Do they have e-guy bullshit, or does the easy availability of sex to gay men immunize them?

They absolutely do. Gay men 100% obsess over specific men the way that other gender-sexuality combinations do.

I was wondering if there was a gay equivalent to Aella. I suspect not because they lack enough reach and potential audience to start becoming known for things other than camwhoring.

You know some guys are gonna pay extra for that. 😂

Why are fast food french fries so dogshit?

They are literally billion dollar companies that literally made their billions making fried shit. Yet most fast food fries are limp dicked excuses of a french fry.

I am irrationally infuriated just sitting here thinking about the sad state of mcdonalds fries. Maybe the real social decay began when mcdonalds stopped frying using beef fat and switched to whatever mystery hydrocarbon they are using now. I am just offended how can you have a commercial deep fryer at your disposal and produce this soggy shit, like what level of not giving a shit about anything do you need to be in aggregate to fuck up french fries.

Back in the 80s, most restaurants used lard or tallow for deep frying. But then vegans/vegetarians 'convinced' restaurants to move away from animal fats. Or at least that was the excuse many chains gave. It was likely a cost issue, along with the demonization of fat in those days.

IIRC, McDonald's spent a lot of time, money, and effort to maintain the flavour of their fries when they switched. I wouldn't be particularly surprised if McDonald's pushed the change, in order to get their competitors to follow along with inferior fries, thereby gobbling up marketshare (which they did).

In 2007, McDonald's began moving away from trans fats. I believe this was because of Fred Kummerow, who then went on to petition the FDA to ban trans fats, then sued the FDA, then the FDA decided to ban it. The ban went into full effect in 2019.

I know I've definitely found fast food to have absolutely plummeted in quality over the past decade or so.

Anyways, I'm surprised there's no 'lab-grown tallow'. You'd think that would be easier and cheaper to make than lab-grown meat. Maybe there is? I wonder if it'd even be legal.

Now there's a growing war on PUFAs. We're just whittling down a major component of our diet. It's strange how regulation after regulation, meant to 'help' keep people 'healthy', results in an allegedly 'unhealthier' ingredient taking its place, which becomes justification for more and more regulations. Fats are the greatest enemy of the food industry, since fats make you feel fuller and eat less. They are going to fight until they can eliminate every single gram of fat from our diets, so we can consume more and more food. They'll fight to eliminate animal proteins, and make us use whatever proprietary protein source they've developed. They are turning the people into bottomless pits.

My thoughts on fast food fries:

  1. Culver's: always hot and fresh. Crinkle cut supremacy.

  2. Five Guys: greasy in a good way.

  3. Wendy's: the best of the low-tier fast food fries.

  4. McDonald's. Too small and thin for my tastes.

  5. Taco Bell. Yes, TACO BELL has better fries than...

  6. Burger King. Consistency/texture issues. Sometimes not fresh or hot. Not very salty.

Honorable mentions to Chick-fil-a and Whataburger. I haven't been able to patronize these establishments since my move, but the former would land somewhere around Wendy's, and the latter above BK.

Culver's: always hot and fresh. Crinkle cut supremacy.

Sadly I have the opposite take on crinkle cut, though I agree that Culver's fries are otherwise excellent. I won't eat fries from any place that has crinkle cut, because that cut just ruins the fry.

They serve crinkle cut in prison, and prison food is designed to be awful.

Never speak to me again. 😁

But, really, the greater surface area and angular surface enables superior ketchup coverage.

True, but it also ruins the ratio of crisp exterior to tender interior. And let me tell you, I can glob ketchup on even the thinnest, most nebulous of fries. 😉

Burger King's are just straight vessels for salt, I've found. Which, as I like salt, isn't a bad thing.

I've never understood the Five Guys excitement, and I have to say, I found them not greasy enough for my tastes. The rest of your list I agree with, barring Culver's, which I've never tried.

You also didn't include Arby's curly fries, which I'd put near the top if not at it.

Five Guys might get old if you go there frequently but I always enjoy the fries. Arby's... I've been there maybe two or three times in my life. Like KFC or Hardee's, it's just been in the background for my whole life.

Burger king's fries seem like their onion rings; potato paste that's extruded into fry shapes and fried.

Most fast food fries are pretty good in my experience. Are you getting them delivered by chance? delivery fries are always much much worse, it's one of the foods that suffers most from being steamed in a bad and let cool for 15+ minutes

McDonald's fries can be good if you eat them when they're piping hot. Similarly, Chick-Fil-A fries are actually really good if you eat them right away. But with both of those, even 10-15 minutes of cooling off (like if you're grabbing them and then driving home) makes a world of difference.

Yep, this is the key. Just the other day I was on the road and stopped for a snack, and the fries were fresh, crispy, and tasty. When they're hot, they're awesome. But if you let those suckers cool down...

I also really like CFA fries myself, even when they're not super fresh. I think it may just be the dipping sauce.

Transfats legislation killed the french fry, the hash brown patty, the corn dog.

When I was in fast food, we used peanut oil for the most delicious shoestring fries. Topped with ketchup, or chili and cheese, or even “everything,” they were practically a meal by themselves.

I have not since tasted their equal, though I have tasted their near lesser. If you ever pass through Albuquerque, go to Golden Pride, a local fast food chain. Their fries are delicious and crunchy, a real treat.

What does trans fats have to do with peanut oil?

I dont live in the US so no legislation where I live, but cost is a pretty good reason to use flavorless industrial oil products anyways. Mcdonalds and Burger King taste identical to the US.

I just dont understand why fries are so neglected, they are the second most important component in just about any fast food meal. I certainly would make the trip if I was offered half decent fries even at a respectable markup. Is no one else demanding better fries?

Honestly, Im contemplating just buying some beef fat and making my own, it feels like a distant memory since I had a good french fry.

Chic fil a and Five Guys still use peanut oil, Buffalo Wild Wings uses beef tallow, all of them charge a premium over their nearest competition, and all of them are known for somewhat better fries than the competition.

Whenever I fry pork belly, the leftover pork grease goes to making fries, and it's as good as or better than any restaurant fries I've ever had.

For someone who hasn't made fries at home. Explain like I'm five, please.

I'm not a great cook, but it's not a difficult dish. Wash and slice some potatoes. Heat a pot or pan of oil until it's hot. I'm not exactly sure how hot, probably around 150-175C. (It should be hot enough that if you drop one fry in, the fry should immediately bubble and float. But if the oil smokes, that's too hot. I've never actually measured the temperature, but you get a feel for it if you do it a couple times.) Drop your fries in the oil. The oil doesn't necessarily have to cover the top of the fries, but you need to stir so that everything gets cooked evenly. Cook about 4-ish minutes, or until it's your desired level of crispiness. The time will depend on the temperature of the oil and the thickness of your potatoes. Then take the fries out and let the oil drain off of them. Add toppings to taste.

You get a choice of the oil you use. You can't use olive oil because the smoke point is too low for good frying, but I like grapeseed oil because it has a neutral flavor. My above suggestion is to use the grease which is leftover from cooking pork. I also sometimes mix grapeseed oil and pork grease if I don't have enough grease, but it tastes better the higher the proportion of grease in the mix.

I had to visit the emergency room earlier this year for a nose bleed. At the time I was discharged (October 2022) I paid a 200$ bill to the hospital, foolishly believing that this was the entire cost of the visit. I subsequently received a 357$ physicians statement. This little episode in medical billing really irritated me since I felt that the hospital had hidden the actual cost of their services and because the amount was absurd for the services rendered (10 minutes for a physicians assistant to apply some topical TCX). As a result I have been thinking of not paying it and am trying to understand if recent changes to that the credit reporting agencies have made may allow me to get away with this without damaging my >800 credit score.

In particular it sounds like medical debts < 500$ will no longer impact a credit score starting in 2023 and I am trying to determine if this determination is made based on the date of the service(s) (october 2022) or the date that a bill is sold to a collections entity, which could occur in late January. I also discovered that paid medical debt collections haven't impacted a consumers credit score since 2022 (, so its my understanding that even if they are able to sell this bill to a collections entity, the worst that could happen is that I would simply have to pay the amount at a later time.

Does anyone know if this analysis is basically correct? Its my understanding that their only other recourse would be to try and sue me which is unlikely to happen over a 357$ bill.

Why would you have to pay it if they don't tell you the cost ahead of time? There's no contract.

Pretty normal to sign a document that says you are financially responsible for accrued charges.

Consider that when you walk into the ED with chest pain you can end up with a million dollar suite of cardiac surgery or thirty cents of tums and everyone has limited idea to predict which it is going to be ahead of time.

Wouldn't it make more sense for the hospitals to charge a flat rate for a given set of symptoms, tell you what that is upfront, and then take on the risk of whatever treatment you end up needing? The only downside is this gives the hospital an incentive to undertreat (although that's probably better than the current incentive to overtreat), but hospitals would have reputations and could potentially be sued for undertreating.

You'd think so and it's a fair question which is why I gave example somewhere else in this soup of comments. Elective procedures, stuff done at an outpatient surgery center, cosmetic things. Low rate of complications, low rate of fuck ups, pretty simple with a lower range of prices. Sure. Places will do that.

Hard to do for symptoms for so many reasons (is that headache a migraine, a stress headache, or a brain bleed? You are complaining about 8 things and the real problem is heart failure etc etc, the pain is referred and it's actually a very different kind of thing).

Once you've figured out what's going on it's feasible for some things, but the American population is really unhealthy and the one person where you open them up, find out it's bowel cancer and not appendicitis costs hundreds of times more than the regular appy.

It's the equivalent of those housing developments where everyone shares water fees but someone has a pool that they keep emptying and refilling every day.

Man this just seems like such bullshit. I never dealt with healthcare costs while I was growing up, but if I run the numbers having moved to the UK they look like this:

  • In London, my marginal tax rate is approximately the same as it would be in NYC (once state/local taxes are included)

  • The NHS is probably 75-85% as good as US healthcare, and you pay nothing at the point of use, ever.

  • For other stuff (eg if like me, you’re paranoid about getting various serious illnesses, cancer etc), you pay what amounts to a pittance (assuming you’re under 65) for private medical insurance for serious illnesses with a moderately high deductible, and which guarantees you a ‘US style’ of care (private rooms, the best doctors, better food, more nursing staff) if you’re unlucky enough to get really sick.

$400 for a nosebleed is bullshit. Doctors are not this valuable. An AI plus one minimum wage employee could treat this. The US medical cartel is a travesty, all the moreso because it actually negatively impacts innocent people’s lives. Anaesthesiologists make $600k a year to do work you could train any 105 IQ guy off the street to do for $55k a year in six months. Even lawyers are more open to competition; doctors literally think that I need some hyper-academic nerd who got a 98th percentile SAT score and suffered through a decade of higher education to prescribe me a basic treatment for a basic problem.

Is this for real? The person billing OP wasn't even a doctor, and no PA, NP, or doctor is getting paid that much for that type of work. Blame the admin and the billing people for the number, the PA has no control over it and is making 1/10 of that sticker price.

Again, as stated elsewhere doctors have been lobbying for their own competition for years, who proceed to do the same job for cheaper, with less training, and do a demonstrably worse job.

I'm always flabbergasted at how little people seem to know about this in relation to how enthusiastic their beliefs are.

Also the NHS is collapsing.

If American doctors wanted to open themselves to competition, the AMA would simply endorse the right of graduates of medical schools in ‘comparable’ countries (UK, Canada, Australia, Ireland, Western Europe + English language test) to work in the US after specialty training/residency, without having to redo the latter and without having to jump through any additional hoops. There should be zero restriction on an Australian dermatologist getting a simple work visa to the US and opening up a practice. This is largely how it works everywhere else in the Anglosphere (after trivial local reciprocal licensing) except the US, which is indicative of a very special US cartel. PAs have screwed doctors over, but the only reason they exist is because the AMA was well aware that there are another couple million doctors in the rest of the rich first world who would gladly work for half the price of the modal American physician in any specialty and don’t want to undercut their frequently unbelievably excessive pay for what amounts to a skilled trade. Unfortunately, because doctors are PMC, they have a political influence that plumbers do not.

Ah you took this a different angle than everyone which is a better one.

-Restrictions on open immigration are not unique to medicine, no field wants to import competition and generally countries don't want to fuck over their knowledge workers. While the U.S. is notable for you needing to redo residency, that doesn't mean it's actually possible to move over (Canada and Australia will happily take U.S. docs but Germany is incredibly hard) for other reasons.

-Related to that, most countries aren't excited about this because in many countries a lot of people want to move to the U.S. because it's the U.S. or because salaries are higher. If you offered everyone in the NHS the chance to move to the U.S. healthcare in England would collapse instantly. So both the push and pull are blocked.

-Despite this if you wanted to import family medicine doctors (the only area that has true real need) from other countries I don't think anyone would complain, including the family care doctors.

-Training is strictly controlled in the U.S. and is better than elsewhere (mostly by being harder, potentially for no reason) but is also very much so less variable. You picked good countries but you couldn't do this with say India because of the training programs are absolutely U.S. grade and some are incredibly deficient.

-We don't have much of a shortage of doctors in most specialties, we have an allocation problem. Most doctors want to live in a relatively small number of urban areas so those places are flooded and everywhere else is lacking. The reasons for this are complex but increasing supply is unlikely to fix it, but doctors for clamoring for an increase in supply (in the form of residency spots) ANYWAY and have zero control it - blame the government.

-Physician political influence is abysmal right now, we've spent decades propping up our own competition, everyone hates us (because of envy of salaries, political involvement with covid, accusations of racism etc etc) and what lobbying we do do is just left wing politics.

-Physician pay is not unbelievably excessive. The average family care doctor makes 220k. That's a lot of money, but the ceiling is low and it comes with unbelievable sacrifices to that point. When people think of ridiculous pay they think of the orthopedic surgeon making 750k but those guys are less than 1% of doctors, over 90% of doctors are in primary care in some form and those people aren't making the "real" money.

-Medicine in general can be described as a skilled trade, that's what nurses are. Physician work cannot. In the U.S. doctors get training in (and are expected to use these skills) teaching, leadership/management, and research science. Depending on the field soft skills vary from mandatory to almost all of the job (as in Heme/Onc, Psych, and Palliative). On top of that some fields do have the manual skills. That is not an upscale plumber. In the U.S. we've made many attempts to drop in people with less training and skills and they do a demonstrably worse job and unlike in emergency plumbing people actually die.

I'm just curious if you'll tell us about the severity of the nose bleed. I get them occasionally, but I have never had one so bad that required medical attention.

It was really bad (had gone on for about 3 hours). I recently moved to a much drier part of the country. I bought a humidifier and now use Vaseline a couple of time a week. This seems to have fixed the issue.

I live in dry, mile-high Albuquerque, a climate known as “high desert”. Were there no city here, it would be scrub grasslands as far as the eye could see. Relative Humidity is routinely 45%, as low as 30% in summer when temps reach 90F.

I stay hydrated by drinking water the moment I feel the least bit thirsty. This results in lips which never need Chapstick, and mucus membranes which are always moist. However, the nose still occasionally bleeds. I’ve gotten really, really good at avoiding nosebleeds lasting longer than a minute:

  • As soon as it starts, shove the nearest absorbent paper in the sanguine nostril: facial tissue (Kleenex), toilet paper, or paper towel in descending preferability.

  • Grab the nearest drinking water bottle, (unopened) press against nape of neck to chill. If summer, apply to front vessels as well. Water inside will be at most room temperature, usually cooler; shrink blood vessels and chill blood simultaneously. When neck flesh is chilled, apply to lower forehead/eyebrow ridge as well, and maybe sides of nose.

  • If no closed water bottle is nearby, apply cool tap water to neck and forehead, let evaporative cooling chill the flesh instead. Cool water on bridge of nose also.

  • Change out absorbent paper. Breathe out (never in) through both nostrils to help platelets clot via CO2 exposure. Always tilt head forward or upright, never back.

  • Repeat cooling if nosebleed lasts long enough for flesh to warm back up. Repeat nasal tampons until clotted.

scrub grasslands as far as the eye could see

It's fair to not count the Sandia forests, but what about the cottonwoods? "Bosque" might be a bit of an overstatement, but there's at least more than scrub and grass in that narrow strip next to the river.

True, the high desert is punctuated by a seasonal ribbon of water surrounded by gorgeous forest. Agriculture has attracted humans to the Rio Grande valley for millennia. Ancient red rock cliffs and multicolored rockscapes show ancient paths of much deeper waters, and towering mountains — the Sandias, Manzanos, Manzanitos, Sangre de Christos, and the giant cone of Mount Taylor — showcase the stunning variety of plant life our desert can boast.

But, as sure as the Rio Grande’s path down the heart of this vast state to become the border between Texas and Mexico, you can be certain that the mile-high dry air will yield nosebleeds.

  1. You should get insurance, this is what it is for. If you have a plan but it has a super annoying deductible....well yes that's how it works (if you don't and you were cash pay you should call the billing department as the other user pointed out, and then get insurance).

  2. I'm not sure if this will help but you should consider that (while it may appear superficially similar) medicine is not going to be like going to a mechanic. When you go to your dealership the work of analysis and diagnosis is often not paid for, then they'll tell you how much it is to fix the issue and you can take it or leave it. The cost is the labor and parts and replacement and repair. When you go to the emergency room you are paying the staff for the time and resources it takes to figure out what is going on. The treatment is often cheap (medicine, a splint, whatever) but the imaging, labs, and professional fees are time consuming and expensive. As a layman you aren't going to know what is going on under the hood (for instance in this case adults generally don't get nosebleeds that are bad enough to bring them to the hospital, so it could be because it's hella cold and dry outside, or it could be because the patient is having issues with clotting blah blah).

If you have chest pain and go to the ER, and after talking to you they give you tums and tell you to avoid spicy food the bill isn't for the tums it's for making sure you didn't have a heart attack.

You can see my responses below if you are interested in more details but I fundamentally don’t feel any moral obligation to a system where you have in network hospitals with out of network doctors.

Also it’s sort of stunning that americas credit bureaus appear to agree that the system is so exploitative that they simply ignore small

Amounts of medical debt when considering my probability of repaying other debt.

Do you believe health systems should be forced to provide care for someone who has no willingness and/or ability to pay? (They are - if you walk into an emergency room and say I will not pay for any care you provide me they are legally required to give you the same shit as anyone else).

If your response is "you know what I don't want any medical care" then my complaint is withdrawn, but otherwise it sounds like you want to "steal" because you don't like how the process works and don't have a lot of information about healthcare economics.*

*From your other post it sounds like you've been on the receiving end of a practice called surprise billing, which is controversial and legislated against in some jurisdictions but exists for a complicated and justifiable reason but is still annoying, as is usual the problem is health insurance companies being pretty much straight up evil and then blaming everyone else.

As for your frustration with medical debt, if people refuse to pay their medical bills all the hospitals go under and nobody gets medical care. I can understand you're frustrated but these things exist for a reason.

Having read through this whole thread, I wanted to say that I consider myself a strict capitalist in most things, but the whole industry of medical billing is so ridiculous for so many inscrutable reasons with everyone pointing fingers at each other that I find I'm unwilling to make any moral judgements at all for anything any particular patient chooses to do.

It is indeed pretty incredible that the situation is seen as ridiculous universally enough that the credit bureaus are now ignoring medical debt.

I don't know that I'm inclined or qualified to really defend any particular party in this mess. But I do notice that everyone seems to love to make the insurance companies the boogiemen. Aren't they all publicly traded though? If they're wildly profitable, can I invest in them and get some of that sweet healthcare cheat money? If not, well where's all the money going? What if they're just struggling to eke out some tiny profit while being constrained by an ever-changing maze of legislation and trying to juggle the conflicting demands of a dozen different groups, as the sole party with some responsibility to actually make the books balance somehow with the totality of everything that's going on?

Nothing about a market this regulated can really be described as capitalist. I don't understand how hard it is for people to draw the, to me, obvious line between level of regulation and dysfunction. Do people just think it's a coincidence that housing, medicine, schooling and banking are the industries everyone seems to constantly have problems with and costs seem absurd?

I agree, and that's why I don't consider the overall American healthcare market to be meaningfully capitalist from a consumer's viewpoint, and so in that case the morality of a capitalist system does not apply, in so far as owing the person doing a job for you a fair wage for the work that they performed.

Nothing about a market this regulated can really be described as capitalist.

That's only if one believes that capitalism and regulation are somehow opposite to each other.

This so where the scope creep of what counts as "capitalism" makes the conversation impossible. The previous post seemed moderately in favor of "capitalism" so I interpreted as "relatively free markets". If we're going to switch to using the "cabal of capitalists control everything" then the response is "of course that's bad but it's never existed and no one would ever claim to be usually in favor of that".

  1. Everyone has an opinion about healthcare, almost nobody expressing this opinion has the slightest idea what's going on and that often includes people in healthcare, often this is downstream of politics (ex: docs foaming at the mouth at anti-vaxxers, or advocating for "socialized" healthcare without knowing what that means) or arrogance (the "medicine isn't hard or complicated" crowd you see here frequently).

  2. Yes follow the money. Some high resource health systems are doing well, but many health systems are being bailed out or going under. Salaries are decreasing relative to inflation (or just overall), burnout is increasing and we've had a bunch of major major strikes/threats of strikes over poor pay and working conditions (like unsafe nursing staffing ratios). Meanwhile:

"The nation's largest insurers, UnitedHealth Group and Elevance Health, reported profits that were 28 percent and 7 percent higher than the same period last year, respectively. UnitedHealth raked in $5.3 billion, while Elevance took in $1.6 billion.

In contrast, some of the nation's largest health systems, HCA and Tenet, saw their profits fall dramatically compared to the third quarter of 2021. HCA reported $1.13 billion in profits, a decrease of 50 percent. Tenet took in $131 million, which is down 70 percent since last year."

Notably HCA and Tenet are both pretty evil companies (large for profit health systems) that will do WHATEVER to make a buck (and have been in legal trouble over it).

  1. Medical billing isn't "ridiculous" okay well it is, but it makes sense and is a well defined system that a lot of people don't understand... but again people don't understand it but everyone is forced to interact and therefore has opinions. Providers become the punching bag for appropriate medical decisions patients don't understand and administrative/billing decisions that providers have zero control or influence over (having being pushed out of medical leadership and admin for decades, sometimes by complicated government mandate).

  2. Speaking of which why is this shit so expensive? People like to blame salaries and labor shortages but that's a lack of understanding at best and jealousy at worst. Our population is getting less healthy (and other countries are catching up in costs as they become like us) and care is getting more complicated and expensive for good reasons. Additionally regulatory and administrative burden means lots of extra hands sucking at the teat. It's similar to academia (think professor to admin ratios, self-inflicted wounds like DEI staff etc).

"these things exist for a reason"

so what? whether something has a reason doesn't mean the reason is good or justifiable; you don't describe any of those reasons or justifications so there isn't anything to respond to here

trying to portray this as some sort of moral choice binary where you either never seek healthcare or you're stealing if you refuse to pay any bill any random biller in any random medical black box decides to send you empty moralizing and a bad argument

anyone who has legitimately tried to find out what services are going to cost in the medical industry knows how incredibly and intentionally dishonest and obfuscatory it is

As for your frustration with medical debt, if people refuse to pay their medical bills all the hospitals go under and nobody gets medical care.

lots of people refuse to pay their medical bills now (especially the full amount) and yet more healthcare is delivered now than ever before

the user isn't claiming no one should pay medical debts, but that at most people shouldn't pay ones which are the result of asinine practices intentionally designed for this outcome which is asinine

if more people refuse to abide by these asinine practices, then the practices would end not that no one would provide medical care to anyone else anymore as is the case in states and countries which ban this practice

If you have your car repaired and drive off without paying you are going to get reported, and you certainly don't get to come back and demand the next issue be fixed. It's absurd. Even in outpatient land you can't fire a patient (even with just cause like total refusal to pay or blatantly abusive behavior) without jumping through a ton of hoops.

Rural hospitals and suburban/urban hospitals with poor payor mix (in a lot of areas/for a lot of types of care medicare and medicaid pay less than cost) are going under left and right, and other places are closing their EDs in an attempt to stem the bleeding associated with most of the people least likely to pay. It's not getting a terribly large amount of attention outside the field because it's mostly poor whites and the media/left feels awkward about leaving healthcare out to hang after so much superficial support during the pandemic.

This specific practice (this explanation is abbreviated)* is driven by insurance companies refusing to negotiate with physician groups and just say lol I'm going to underpay you, fuck you. When providers try and negotiate the insurance companies label this "surprise billing" and lobby jurisdictions to ban, knowing that the result is professionals have to just not get paid or accept the lowball offer. It's a negotiating tactic. In the last few years providers and low resource health symptoms have seen total crashes in economic health while high resource systems and insurance companies are doing fantastic, but they don't replace the resources that are closing and retiring.

About half of the psychiatrists in the country are able to retire and they are just fucking right off instead of staying and during a time of sky rocketing mental health crisis. We have limited ability to train replacements if we even wanted to (for a number of reasons) and the stopgap (Psych NPs) are uniformly terrible and create more work for the leftover physicians (psychopharmacology is a lot more complicated than most management, as in diagnosis).

*Their are other explanations, you have stroke and the one neurologist on call doesn't take your insurance. Either they let you die, or work for free/try and bill your insurance anyway.

Do you think billing for car repair is in the same zipcode as medical billing? When I ask for how much something is going to cost to a car mechanic, they tell me how much it's going to cost. I don't find out a month later that, actually, a ringer car repair guy which costs $10,000 flew in town overnight and did the work. This isn't an appropriate comparison and it's why your attempt at moralizing in this way falls flat. When a person is complaining about a specific reason why this practice makes nonpayment justifiable, your analogy need to address that specific aspect of the justification.

leaving healthcare out to hang after so much superficial support during the pandemic.

the healthcare sector at every level delivers more care at higher prices and higher pay than ever before

given that context, a claim that people refusing to pay bills in situations the OP described is going to result in no services being offered is a stretch

Are places which ban the above practice more likely to suffer the effects you're talking about? If not, I don't really understand the relevance beyond a general criticism for nonpayment.

This specific practice (this explanation is abbreviated)*

when a patient criticizes a practice which is intentionally designed to extract more money in dishonest ways from patients, your response is to tell the patient they are morally obligated to either pay whatever bill is sent to them or not seek medical care at all and the real bad guys are those darn insurance companies

an easy response is for patients also not to pay, this is just "the system," tell you to whine into the wind at your congressperson, and blame those darn insurance companies

"we're getting screwed so we're going to screw someone else" doesn't magic some moral obligation on the part of the last screwed anyway

this justification is that you have more negotiating power over patients so you're going to use it to extract more money because you don't have that negotiating power against insurance companies; this aspect of the argument is even more true in the case of the individual patient vis-a-vis anything

you have stroke and the one neurologist on call doesn't take your insurance

okay, so what does this have to do with a physician's assistant in a non-emergency situation?

-Hospitals can't tell you how much things are going to cost because they don't know and insurances won't tell them they how much they'll reimburse. Insurance rules are complex, constantly changing, and do so with no notice, if a place says "it will be 500 dollars after insurance" they have no idea if that's accurate or enough, and that's when needs are static. And that's if you pretend cost of delivering care is static. It isn't. If a surgery costs on the median X a specific instance could be 0.8x (healthy thin young adult, 1.2x (obese 50 year old), or literally 100x (patient has a complication, crashes, ends up in the ICU). Is the hospital supposed to charge everyone 1.5x to cover for the one person who explodes? That's like involuntary insurance. Places will offer elective and simple procedures in a fixed price fashion but they are very very cautious with that.

-Healthcare in the U.S. is collapsing, many disciplines are moving out of public insurance (most OP specialties) or private insurance (psych, in a limited fashion). Hospitals and facilities are going under with enough frequency it is approaching a full blown crisis, but most of us live in big cities with a famous name brand academic hospital that just put up a 500 million dollar building and has a million billboards. Easy to miss the crisis.

-This process is not designed to extract money unnecessarily from patients, the insurance company is refusing to provide the paid for service and instead of refusing to pay the insurance company for sucking balls the patient is fucking a different victim who is also legally prohibited from retaliating. I don't understand how the hospital/practice management group (and keep in mind that no clinician at any point is involved with any of this) is the villain because the insurance company refuses to provide insurance.

-As is usual for legislation, surprise billing stuff has a tendency to be written by corporate interests that have a financial interest in making the stroke attending and the ED fast track PA the same situation on paper.

Hospitals can't tell you how much things are going to cost because they don't know and insurances won't tell them they how much they'll reimburse.

so how is this similar to the car mechanic bill situation?

besides, all sorts of other professions delivering all sorts of other services with non-fixed costs and complications manage to present agreed upon, known costs and estimates up front and don't send a surprise bill with an absurd amount attached

I've received healthcare at countries all over the world; there, despite the complications you describe w/re pricing, they're able to tell me an estimate which aligns with the bill I receive later. Even when there are complications. Even when a mechanic while looking at the drivetrain notices the transmission needs to be replaced. As far as I know, there is a single industry which does this and only in a single country in the world.

-Healthcare in the U.S. is collapsing

I am sure there are parts of the US which really struggle with medical services and have the problems you're describing, but on net no it is not or else it wouldn't be delivering more total healthcare, with higher salaries, and higher prices than ever.

Are places which ban the above practice more likely to suffer the effects you're talking about? If not, I don't really understand the relevance beyond a general criticism for nonpayment.

This process is not designed to extract money unnecessarily from patients

"Unnecessarily" doesn't have much explanatory weight, e.g., I promise to pay any bill I think is "reasonable," and I won't unnecessarily refuse to pay any bill I think it reasonable. This statement doesn't really mean anything.

Nothing about this is strictly "necessary" because if it was then it would be done in places which banned the practice except they don't and medical care is still delivered there. An accurate statement would be that they do it because they're trying to extract more money from the patient or their insurance, they don't have negotiating power with the insurance company, and so they're going to go after the weaker position patient.

I don't understand how the hospital/practice management group (and keep in mind that no clinician at any point is involved with any of this) is the villain because the insurance company refuses to provide insurance.

no one has to be the villain here, but it also doesn't mean by default it's just the patient who has some moral obligation to get screwed and fork over whatever amount some derp bureaucrat decides to send them

As is usual for legislation, surprise billing stuff has a tendency to be written by corporate interests that have a financial interest in making the stroke attending and the ED fast track PA the same situation on paper.

I don't doubt that. Judging by the ACA, insurance company lobbying groups will find a way to make it even worse. If the legislation is similar to efforts in my field, it may help some random person like the OP accidentally in certain situations but will mostly be used by megacorps to put them in better negotiating positions.

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Fundamentally, it sounds like you perceive that the problem is that people don’t pay enough for health care (whether that is through private insurance or through Medicaid).

This means that the hospital/physician is trying to take advantage of me because I am easier to negotiate with than my insurance company or the government. In the recent past where they could fuck my credit score they had most of the leverage and this would have worked and people like me would have been responsible for propping up a broken payment system. How is this not absurdly predatory?

Now that this is more difficult perhaps the AMA or the hospital lobby or any number of absurdly powerful interest groups which exist to guarantee the welfare of the healthcare industry, can take action on this instead?

I suppose they might also just increase bills so they always meet the 500$ credit reporting threshold but this will probably take them a few years since it will need to at least look somewhat what organic to avoid being sued by some ambitious attorney general somewhere.

The hospital and provider/provider group are definitely not making decisions based off of some credit reporting threshold, they don't have the time or energy for it and charges and costs are too often pegged to other things. The insurance company might be, can't speak to that.

I also make no claims as to if people aren't paying enough, I just want people to actually pay like they said they would (especially in the case of the ED where 9/10 visits are inappropriate and make things more expensive for the people who actually need the ED resources).

Now is the government or insurance paying enough, that's a separate question. No for some aspects of healthcare, in a very demonstrable sense (that is, if your hospital is being paid mostly by medicaid it WILL go out of business without another funding source like being directly propped up by the state government).

Another different discussion is "are providers overpaid" and while that's a much more nuanced question, in a very practical sense the answer is no - if you want to see a specialist outpatient (especially in something like neurology) you are going to wait two months or have private insurance. The healthcare sector of the economy has been trying to slowly boil docs with decreasing salary for decades and it's starting to boil over and you just wont get good care (or care at all in some fields like psychiatry) if you aren't rich. I'd not be shocked if life saving surgery is simply not available within the next 10-15 years because surgeons will just refuse.

But in this case the issue is that you have a problem with the customer service and overall service offered to you by your insurance company, and you are taking it out on the health system. The problem is the health insurance product you purchased not giving you what you want (because of blah blah negotiating with what's probably a private equity owned practice management group with no clinicians in the leadership structure at all). At no point was anyone directly in healthcare involved in what fucked you except for the person who actually helped with the epistaxis.

Generally speaking health systems are very willing to negate with patients paying out of pocket because the charges are made up as part of some bullshit voodoo dance with insurance and the government. The unwillingness to negotiate def increases the likelihood of that professional fee going to a private equity group (the PA probably got paid like 50 bucks for 30-45 minutes of work that was mostly invisible to you).

They lobbied to make it illegal for anyone outside their club to provide medical care and then they charge an arm and a leg for it. If they didn't require 10 years of school to fix a nosebleed then it wouldn't be this bad.