domain:philippelemoine.com
The_Nybbler
If you win the rat race you're still a rat. But you're also still a winner.
7hr ago
I mean, the patient likely can get the treatment regardless (see also the main NYT article). Doing so with a not-yet-settled pre-auth battle is approximately equivalent to doing so without a pre-auth battle at all.
If you do it without pre-auth, the insurance company's next move will be to say you violated their pre-auth policy so they're not obligated to pay in any case. They may or may not get away with that, but it's another line of defense between the provider and the insurance money.
This isn't really true, though. If they get the treatment without the pre-auth completed and agreed (or none done at all), and the insurer ultimately denies it after-the-fact, the patient still owes the bill.
Yes, the patient owes it. But they can simply... not pay it. Especially true if they can't pay it. Then the provider is stuck with the bill, or sells it to some shady medical debt collector for rather less than face value.
stuckinbathroom
7hr ago
but I think it’s the first serious attempt to construct an arcology
Is the Kowloon Walled City not "serious"?
The_Nybbler
If you win the rat race you're still a rat. But you're also still a winner.
7hr ago
the COVID vaccines are highly imperfect and not that important for young, healthy adults or children
And yet public health officials keep pressing for COVID vaccines for young, healthy adults and children.
There is no concerted effort to suppress a spree of cardiac myopathies
Maybe there isn't such an effort ANY MORE.
When promising cures for things like aggressive pancreatic cancers are caught in the cross-fire
Are they? Or is that just marketing, because the mRNA producers are looking for applications that sound really good? What I find when searching for that is particularly unpromising -- it's a personalized mRNA vaccine to be used after surgery. Even it works, it'll be eleventy-billion dollars a dose, and you still have to have the surgery.
Grant_us_eyes
7hr ago
Vintage Story has alot of difficulty gates for survival that give you plenty to do in-game, above and beyond acquiring metals - it can also cause some emergent hilarity. Just last night while playing, what turned into a scouting mission for more pine resin flipped into an effort to capture and bring back a female goat for my domestication efforts before quickly devolving down to fighting for my life against a horde of wolves in order to capture said damn goat.
All because if you make sure your diet has enough variety, it increases your health, and I need to work on dairy production.
Fun times.
MaiqTheTrue
Renrijra Krin
7hr ago
My sense of the thing is that a lot of advice fails due to the advice being hard to actually do. For example if I wanted to lose weight, the actual advice is the same for almost everyone: fork put downs. That’s it. If you want to lose weight, you have to eat less than you do now (for general health it’s also good to eat better foods and exercise). But of course this is hard to do. You have to resist the urge to eat, probably a lot. You have to be hungry at times. You probably are going t9 be working out a lot and thus be tired and have sore muscles. In short following the advice sucks. And if you’re busy it’s probably going to be hard to resist the drive thru on the way home, or easy to skip the gym. Is the advice wrong? Not really. But people have a hard time sticking to the “suck” until they make the habit stick.
The advice for school success, again, is pretty universal. You have to study, do lots of practice problems, read the textbook, write those papers, and in general apply your ass to chair and grind. It’s easy advice to give, and much like dieting, if you actually do it, you’ll see results. The problem, again is that doing that sucks. You can’t game as much if you’re studying and writing papers and doing practice problems. You miss out on parties. Maybe you can’t go on as many dates. Resisting those things is hard. Forcing yourself to work when you don’t feel like it is hard. And eventually most people fall off, maybe excusing a night or two for fun. Maybe not doing quite as much homework or researching just a little less. And most people won’t stick it out through the suck to get the results. Again, the advice isn’t the problem. It’s the person not sticking with the advice long enough to make a good habit and see results.
NewCharlesInCharge
8hr ago
You could make a state-funded lender of last resort for such cases.
If you're denied then the state advances the funds at the same cost that would have been charged to the insurance company. The loan becomes non-dischargeable and the state is able to garnish wages and seize assets should it become necessary.
They also assume the right to represent the patient to the insurance company and demand payment. Should the treatment have actually been approved according to the insurance policy, the insurer has some penalty big enough to incentivize them not to play denial games and to keep the lender solvent.
This could lead to interest rates being a function of insurer denial accuracy. If it's very likely the state will recover from insurers, interest rates could be very low. If insurers are exceptionally accurate and you're very unlikely to recover, then insurance rates could approach the same as any unsecured loan for a person of your creditworthiness.
This is part of why principled groups can stay principled so easily. An organization like FIRE truly believes that free speech is beneficial.
The rest of the post makes arguments I consider weak but this bit is laughable. Groups do not, in fact, stay principled easily. That's the entire problem.
FIRE was founded in 1999. The ACLU was a significantly older and more effective advocate for free speech before the anti-Trump hysteria split it between principled liberals and activists. In fact, FIRE probably owes a lot of its current prominence (and its position in your post) to the fact that it's very much not easy to stay principled
MaiqTheTrue
Renrijra Krin
8hr ago
I mean I don’t think I’ve seen anyone in a position of power have concrete plans that they stuck to even at risk of losing. TBH, looking at how people in power actually behave, principles are not how you understand government. Principles and ideas are not end points, but tools to get power. And if you watch politics with such a thing in mind, outside of a few crazy true believers, you can probably figure out where the chips will fall with 80-90% accuracy.
Rov_Scam
8hr ago
I was supposed to be hearing a lot about arcologies in the near future since at least 1993. I don't know that there's much call for anything self-contained, since the megaprojects of the 1960s that promised housing, retail, and office space all without leaving the building mostly went out of business when they discovered that people like going outside from time to time.
self_made_human
amaratvaṃ prāpnuhi, athavā yatamāno mṛtyum āpnuhi
8hr ago
Ah... This is so good. I didn't know I needed to read this, thank you. The Missile Officer is a character.
anon_
8hr ago
Sure. So 1/2 the price of Concorde but connects all the major cities of the world at Mach 1.7 instead of the 0.85 of a 777?
ActuallyATleilaxuGhola
Axolotl Tank Class of '24
8hr ago
Faster Than Light. Yes, I'm late to the party.
You're a lone spaceship trying to outrun a massive, constantly advancing enemy space fleet while you must fight random enemies and avoid running out of fuel and ammo. It's a roguelike so sometimes you just get screwed by RNG.
The best part of the game is the tension during difficult moments. You are low on fuel and only have a few missiles left, and the enemy fleet is only two jumps behind you. Suddenly, as you try to jump past a star, a well-armed mercenary ship uncloaks and demands you give up your ship and your crew as slaves. As you begin to engage, a warning blares across the screen -- the nearby star is unstable! Moments later your ship is hit with a massive solar flare, causing random fires to break on your ship. Your crew scrambles to put these out, sustaining burns in the process. Luckily, you've kept your best pilot and gunner away from the fires, but BANG! the merc ship has fired a hull-piercing missile into your ship's bridge which is now rapidly decompressing. Your pilot attempts to repair the hull breach, but you're not sure he'll be able to fix it before asphyxiating. You may need to sacrifice a different crew member to perform this repair to have any hope of escape. You pause the game to consider your options...
ToaKraka
Dislikes you
8hr ago
Nobody wants to live in Antarctica. I would rather raise kids on a container ship.
Wikipedia indicates that British Antartica is only a little colder than Greenland, and actually warmer than Nunavut and Siberia. So it really isn't the most outlandish place to live, assuming that services are available.
philosoraptor
8hr ago
Anecdotally from someone who's never watched any of it, I have actually heard of all the other ponies you named save Rarity, but not Fluttershy.
Why political revenge narratives don't make sense to me.
I submit it's because you subscribe to a revenge framing in the first place, as opposed to a relationship framing. So long as you adopt a misleading framing, you will continue to be misled.
For example, when you give this paragraph-
After all if you care about the country, I would assume you want good and effective policy. If you see the left's policy ideas as bad and harmful to our future, it's not a great idea to join in on the self-harm. Unless you're a traitor and hate the country, you would be pushing for what you think is the best policy. Now people might disagree on what is best for growth, what is best for the people, and what is best for the country but we should expect them to pursue their ideas in the same way if they care about America, towards ideas they think are good.
-this leads off with abstractions ('the country', 'the left'), but no acknowledgement of a relationship. Even the traitor allegation is framing it as treat to the abstraction (hate the country). Even that treats the action as an initiation, as opposed to a response, as if treason is a state of being unprompted at odds with a natural/healthy state of behavior.
This is wrong in the same way that 'the organization decided to do something' is wrong. Organizations do not make decisions. People in organizations make decisions. Political parties do not try to appeal to, or deliberately offend, parts of the population. People within political parties try to appeal to, or deliberately offend, other people in the population. The tolerance / encouragement of such behavior is not conducted by The Party, but by the consent / support of other people within the party.
When people make a series of decisions over time in regards to, and affecting, other people, this connection is a relationship. Sometimes the established relationship is amicable, and sometimes the relationship is hostile.
People responding negatively to a hostile relationship are not traitors. Nor does their response to hostile relationship come off as them never believing the words they were saying.
...unless, perhaps, the only paradigm you can conceptualize for responding negatively to a hostile relationship is 'revenge' against abstractions.
Throwaway05
8hr ago
This is probably the best summary I've ever seen on this topic. Thank you.
Quantumfreakonomics
8hr ago
Going on ill-fated Antarctic expeditions is exactly the kind of long-lost British passtime that could reutite civic pride.
self_made_human
amaratvaṃ prāpnuhi, athavā yatamāno mṛtyum āpnuhi
9hr ago
I am very much not a survival game person, but I do appreciate the idea of a Minecraft for adults. I've seen a bit of gameplay, and it's clear to me that the game conveys 1% of the difficulty of bootstrapping even medieval civilization from scratch (which is a hundred times more than most offer). People seem ready to weep when they finally get copper tooling.
Throwaway05
9hr ago
Usually (and especially here) my angst is generated by people's frustration with physician salaries, as it's an easy target for frustration but is A (but not the) load bearing feature of the U.S. health system and angry people don't care.
netstack
Texas is freedom land
9hr ago
I’d say suicide-by-Antarctica is a lot more trouble than suicide-at-home…but this is the UK we’re talking about.
I mean, the patient likely can get the treatment regardless (see also the main NYT article). Doing so with a not-yet-settled pre-auth battle is approximately equivalent to doing so without a pre-auth battle at all.
Also without pre-auth, the patient has more leverage; it's the provider who is on the hook if nothing is done
This isn't really true, though. If they get the treatment without the pre-auth completed and agreed (or none done at all), and the insurer ultimately denies it after-the-fact, the patient still owes the bill. There's still a whole range of things that can occur with the resulting cluster of a negotiation after-the-fact. The only thing that I see that has changed is that services have already been rendered, the patient is now potentially liable for a gigantic bill, and the negotiation for who actually pays what just hasn't happened yet. The patient has even less leverage, because they've already agreed to buy the thing. They almost certainly can't un-buy the thing. They're purely at the mercy of the other parties to decide how much they're going to get stuck paying.
OliveTapenade
9hr ago
Hm, it wouldn't be that surprising, I suppose, if the materialist Mormon cosmos, and relatively creaturely God, lends itself to a very different type of science fiction story than the Catholic cosmos.
I might need to unpack that a bit further to myself, though, and since we've rolled over into the next week's thread, I'll leave that here for now.
Skibboleth
It's never 4D Chess
9hr ago
The US has a very peculiar arrangement where you don't buy healthcare. Your insurance provider buys healthcare on your behalf from healthcare providers, (except when they don't). But at least you buy health insurance, so if you get bad service from your insurance provider you can switch Your health insurance, in turn, is bought for you by your employer. Basically everyone in the system has terrible incentives.
- Healthcare providers are incentivized to overtreat because it mitigates risk (less likely to get sued for malpractice), allows them to charge more, and the patient (usually) isn't footing most of the bill, so they're often price insensitive. (Also, the patients are clueless so they have no real ability to argue with the doctors about treatment plans)
- Health Insurers are generally trying to sell the cheapest product possible to employers and pay out as little as possible to providers. They're not terribly worried about customer service quality beyond an absolute bare minimum, because their customers have limited ability to leave. So they stiff patients and deny coverage whenever they can get away with it.
- Employers are generally trying to conform to their legal obligations and need to retain employees as cheaply as possible. Fortunately for them, your employees aren't sick most of the time, so you can actually get away with buying them fairly low quality health insurance.
- The patient wants treatment, but lacks the information and expertise to make an informed decision. Almost as importantly, they want to avoid being left holding the bag. If the doctor recommends it and insurance approves it, they'll probably agree to it, because better safe than sorry. After all, it's (mostly) not their money (until it is).
The result is that the consumer (i.e. patient) is marooned in an incredibly capricious system which is only tenuously interested in his welfare and which may saddle him with a colossal bill as a result of processes completely opaque to him.
I think you've put it perfectly here. I wasn't intending to use it as a counterpoint, instead I was just interested in how they might respond. I think a QALY-based calculation is a transparent and reasonable approach, at the very least moreso than the convoluted mess we have now, but I find a lot of people will, as you say, find the calculus unsettling.
I find this particularly interesting. I suppose there are significant UK/US cultural differences in this regard, because I cannot imagine such a thing going well over here (My doctor friends told me once about Daughter from California Syndrome. I don't suppose you have an equivalent over there?).
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