I'm investing in property in places that will allow me to get permanent residency without jumping through too many hoops.
You theoretically lose yield compared to the S&P average - but if you're hedging your bets against the US possibly going to shit - the S&P is unlikely to perform as well as its historic average IFF that scenario unfolds.
Seems like a better hedge than gold, but my crystal ball isn't working.
It's hard to say if there's anything new under the Sun...
There were always unqualified people coming out of college, but the amount of people in interviews that can literally do nothing these days seems higher than before.
There was always some cohort of people that somehow managed to graduate from college with a CS degree, and seemingly not learning anything, or at least not learn how to even write basic code (independently).
It seems like AI is not reducing that percentage - possibly increasing it.
> It seems like AI is not reducing that percentage - possibly increasing it.
AI is definitely increasing it. I barely type out any code now, and simply sit back and review what Claude dumps out. Even if it's a minor UI change, I just request the LLM and it executes the change for me. Thankfully I don't write code for my day-job anymore and mostly just sit in my office and pontificate :). I know my code skills and inclination to write code have atrophied to an extent, thanks to AI. Currently what I'm able to do with AI far surpasses the capabilities of what I was able to do without relying on AI.
Now if my employees were relying on LLMs to do their coding for them, I would be very disappointed. And I think that that limited space in algorithmic and HFT trading is where exceptionally talented programmers will find room in, leaving the others to dry out and wither.
Perhaps the best example of frogs in a boiling pot are all these folks in frontier AI companies themselves who are building the blocks for the very things that are going to replace them, if not already. Maybe they'll make off like bandits before their work gets adversely affected, or maybe not.
It's interesting how much money is spent lobbying at the primary stage, when you can always just shop around congress AFTER the electins for the cheapest whore to buy out and find someone for pennies on the dollar.
In jurisdictions in which there's a large imbalance between the parties the general election is a foregone conclusion; the primary of the dominant party becomes the real election. Primaries still have lower turnout and feature candidates with less name recognition, so the potential impact of money is quite high.
The candidate doesn't own you anything and cannot receive donations directly anymore. Thus you get to pull the corruption, illegal, or indirect, less effective, cards.
Supporting the candidate to get him elected is much different.
Menlo Park was never a "middle class" town. The 101 was always the (literal) redline.
The median household income is $210K [0] and it's the same demographic, unlike historically lower middle class but now upper middle class San Mateo [1].
A Menlo Park home address that is on the correct side of the 101 opens the same doors in the Bay that a Bel Air address does in Los Angeles or an Austin Hills address does in Austin.
Rich doesn't equal conspicuous, especially in the Bay Area - "Wealth is quiet, rich is loud, poor is flashy"
Yep! That's what I meant - Rob Roy, Westlake Hills, Barton Creek around the country clubs, and Lost Creek. Those are the equivalents of much of Menlo Park and Atherton, and I know of a number of people who lived in Menlo+Atherton and moved to those areas of Austin in order to front-run taxes in the run-up of some significant exits.
280 to El Camino is "oldish rich" (made their millions in the 1980s-2000s), the El Camino to 101 is "new rich" (made their millions in the 2000s-2010s), and 101 to Meta used to be a Samoan ghetto (literally, redlining was legal until the 60s and unofficially the norm until the 90s) until they were gentrified out.
The old money (rich before tech) to the West of 280 in Woodside and Portola Valley.
It's interesting to me how much effort the AI companies (and bloggers) put into claiming they can do things they can't, when there's almost an unlimited list of things they actually can do.
This generally just keeps being the "the Emperor has no clothes" moment for all these AI bull companies.
Microsoft just replaced their native Windows Copilot application with an Electron one. Highly ironic.
Obviously the native version should run much faster and will use less memory. If Copilot (via either GPT or Claude) is so godlike at either agentic or guided coding, why didn't they just improve or rewrite the native Copilot application to be blazing fast, with all known bugs fixed?
And many of them so unexpected, given the unusual nature of their intellegence emerging from language prediction. They excel wherever you need to digest or produce massive amounts of text. They can synthesize some pretty impressive solutions from pre-existing stuff. Hell, I use it like a thesaurus to sus out words or phrases that are new or on the tip of my tounge. They have a great hold on the general corpus of information, much better than any search engine (even before the internet was cluttered with their output). It's much easier to find concrete words for what you're looking for through an indirect search via an LLM. The fact that, say, a 32GB model seemingly holds approximate knowlege of everything implies some unexplored relationship between inteligence and compression.
What they can't they do? Pretty much anything reliably or unsupervised. But then again, who can?
They also tend to fail creatively, given their synthesize existing ideas. And with things involving physical intuition. And tasks involving meta-knowlege of their tokens (like asking them how long a given word is). And they tend to yap too much for my liking (perhaps this could be fixed with an additional thinking stage to increase terseness before reporting to the user)
My current way of thinking about LLMs is "an echo of human intelligence embedded in language".
It's kind of like in those sci fi or fantasy stories where someone dies and what's left behind as a ghost in the ether or the machine isn't actually them; it's just an echo, an shallow, incomplete copy.
Only because they have compressed and encoded the entire sum of human knowledge at their disposal. There are models for everything in there, but they can only do what has been done before.
What's more amazing to me is the average human, only able to hold a relatively small body on knowledge in their mind, can generate things that are completely novel.
People assume training on past data means no novelty, but novelty comes from recombination. No one has written your exact function, with your exact inputs, constraints, and edge cases, yet an LLM can generate a working version from a prompt. That’s new output. The real limitation isn’t novelty, it’s grounding.
Just because there are lots of tasks which can be accomplished without the need for anything novel doesn't mean LLMs can match a human. It just means humans spend a lot of time doing some really boring stuff.
I hear this constantly. Can you produce something novel, right here, demonstrably, that an LLM couldnt have produced? Nobody ever can, but it’s sure easy to claim.
I'm going to assume you mean this seriously, so I will answer with that in mind.
Yes, I can.
- I can build an unusual, but functional piece of furniture, not describe it, not design it. I can create a chair I can sit on it. An LLM is just an algorithm. I am a physically embodied intelligence in a physical world.
- I can write a good piece of fiction. LLMs have not demonstrated the ability to do that yet. They can write something similar, but it fails on multiple levels if you've been reading any of the most recent examples.
- I can produce a viable natural intelligence capable of doing anything human beings do (with a couple of decades of care, and training, and love). One of the perks of being a living organism, but that is an intrinsic part of what I am.
- I can have a novel thought, a feeling, based on qualia that arise from a system of hormones, physics, complex actions and inhibitors, outrageously diverse senses, memories, quirks. Few of which we've even begun to understand let alone simulate.
- And yes I can both count the 'r's in strawberry, and make you feel a reflection of the joy I feel when my granddaughter's eyes shine when she eats a fresh strawberry, and I think how close we came to losing her one night when someone put 90 rounds through the house next door, just a few feet from where her and her mother were sleeping.
So yeah, I'm sure I can create things an LLM can't.
So the only thing I am seeing here is physical or personal (I have no idea how you feel or what your emotions are. You are a black box just as an LLM is a black box.)
The only thing you mentioned is the fan fic and I would happily take the bet that an LLM could win out against a skilled person based on a blind vote.
Was an individual mind responsible for us as humanity landing on the moon? No. Could an individual mind have achieved this feat? Also no.
Put differently, we should be comparing the compressed blob of human knowledge against humanity as a collective rather than as individuals.
Of course, if my individual mind could be scaled such that it could learn and retain all of human knowledge in a few years, then sure, that would be a fair comparison.
I want to see an LLM create an entirely novel genre of music that synthesizes influences from many different other genres and then spreads that genre to other musicians. None of this insulated crap. Actual cultural spread of novel ideas.
The hype has gotta keep going or the money will dry up. And hype can be quantified by velocity and acceleration, rather than distance. They need to keep the innovation accelerating, or the money stops. This is of course completely unreasonable, but also why the odd claims keep happening.
Why would the money dry up when we have companies willing to spend $1000/developer/month on AI tooling when they would have balked at $5/u/mo for some basic tooling 2-3 years ago?
First in some cases it is more than $1000/dev/month.
Those companies spending 1000+/developer are doing it with the same hope that at some point those $1000/month will replace the developer salary per month. Or because by doing so more investors will put more money into them.
Take away the promise of AI replacing developers and see how much a company is willing to pay for LLMs. It is not zero as there are very good cases for coding assisted by LLM or agentic engineering.
Because most of these things are not multi-trillion-dollar ideas. "We found a way to make illustrators, copyeditors, and paralegals, and several dozen other professions, somewhat obsolete" in no way justifies the valuations of OpenAI or Nvidia.
>Because most of these things are not multi-trillion-dollar ideas.
That's right, but there's more. When you think about the cost of compute and power for these LLM companies, they have no choice. It MUST be a multi-trillion-dollar idea or it's completely uninvestable. That's the only way they can sucker more and more money into this scheme.
This is literally the first time I've heard this. What is your source? I can type the exact same query three times and though the general meaning may be the same, the actual output is unique every single time. How do you explain this if it's cached?
I don't know about OpenAI, but Nvidia's valuation seems more justifiable based on their actually known revenue and profit, and because it's publicly traded.
Though if the bubble(?) bursts and Nvidia starts selling fewer units year-over-year, that could be problematic.
Well, for starters, they definitively passed the Turing test a few years ago. The fact that many regard them as equivalent in skill to a junior dev is also, IMO, the stuff of science fiction.
how do you market that as a product that is needed by other people?
there are already companies that advertise Ai date partners, Ai therapists and Ai friends - and that gets a lot of flame about being manipulative and harmful
I've been pushing Opus pretty hard on my personal projects. While repeatability is very hard to do, I'm seeing glimpses of Opus being well beyond human capabilities.
I'm increasingly convinced that the core mechanism of AGI is already here. We just need to figure out how to tie it together.
Generating 3000 lines of esoteric rendering code within minutes, to raster generative graphics of anything you can imagine and it just works? From natural language instructions. Seriously think about that my dude.
Actually the surgeon analogy is really good. Saying AI will replace programming is like saying an electric saw will replace surgeons because the hospital director can use it to cut into flesh.
While I find your frequent use of 'it turns out' to remind me of https://jsomers.net/blog/it-turns-out .. I do think there may be supportive logic to be had. A lot of software previously wasn't simply hand done, it was done along with implementing libraries of code or using snippet libraries. So, software engineers had already abstracted away coding a lot of the reusable parts between projects they will be now in-house developing with AI.
If so, it might be true that in many cases writing code wasn't as big of the story as some people think for some other people in the industry. I imagine there were many people though who toiled by hand a lot of code they didn't need to before for lack of experience or awareness, and so for them this a big increase in speed.
As it turns out - "just make this button green" - is not the majority of what people at FAANG are doing...
As it turns out - 4 years before LLMs - at least one of the FAANGs already had auto-complete so good it could do most of what LLMs can practically do in a gigantic context.
Contrary to popular opinion - the majority of engineers are not working at companies that have no revenue.
Anywhere the risk of something going wrong is high, a lot of what you're paying engineers for is to minimize that risk while getting shit done - not to "just do the thing" you might think you're paying for.
Wherever "this sort of works" is good enough, LLMs will excel. Wherever it doesn't, you'll still be paying a lot of money for humans.
Mostly because non-engineers cannot define what "working" is most of the time it's important.
You don't go to a surgeon and tell him to replace your heart in some way. You go to a surgeon to "fix" your heart. You wouldn't even know what that meant. No amount of WebMD LLM summarization is going to help the average person.
Almost 20 years ago, IBM was famous for the average engineer writing ONE line of code per day...
It's not like IBM was paying people to do nothing, contrary to what most people thought who worked there for 15 years.
It's almost as if lines of code don't have value and a working product and the ability to change it reliably does.
Everyone has its own set of novel problems. And they use libraries and framework for things that are outside it. The average SaaS provider will not write its own OS, database, network protocols,... But it will have its own features and while it may be similar to others, they're evolving in different environments and encounter different issues that need different solutions.
Health care is so broken that I think it will unbreak itself.
You can eliminate most of the problem by mandating true cost billing by hospitals (get rid of their insurance mandated 500%+ markups to make it look like your insurance does anything at all besides make your care as costly as possible).
As you said, it's oftentimes cheaper to buy drugs without insurance.
The average person would quickly find out that insurance doesn't pay for anything at the hospital (most of the time).
~80% of healthcare spending is already at the tail end, and the state already covers most of that through Medicare and Medicaid.
The bottom ~50% of spenders (healthy people) only spend ~3% in total of healthcare (~$900 per year per person, about 1 month's PREMIUM).
Health insurance is a MASSIVE tax on the bottom ~3% of spenders (~50% of the population), when the state ALREADY covers the vast majority of people that need covered for tail end expenses.
Think about this: the MEDIAN adult in the US pays <$1k in personal income tax! Yearly health care premiums (that do nothing) are 3x that! 75%+ of the median person's true tax is going to health insurance that does NOTHING for them.
We already have the European model. Health insurance as it is is a tax. It just could not be designed to function more poorly than it does for the average healthy worker.
It benefits literally no one besides the health insurance industry which does not employ that many people, and is not strategically important for national security.
If the state completely covered the tail, and we had true billing at hospitals, almost no one would need or want insurance besides people that already have it through Medicare and Medicaid.
You are extremely close to arriving at the solution, which is medicare for all. Cover everyone, then almost noone uses the insurance except when they need it, which is when they get old.
If the US had the equivalence of Canadian health insurance, the spending reduction would be so big, that as a working person, your health insurance bill would go to zero, out of pocket costs to zero, and everyone would have health insurance.
> You are extremely close to arriving at the solution, which is medicare for all. Cover everyone, then almost noone uses the insurance except when they need it
Most Medicare recipients do get supplementary private insurance though? It's called "Medigap."
Medicare pays for 80% of patients' costs, but even the remaining 20% is a lot. (You get a $100,000 procedure -- you're on the hook for $20,000.) That's why people get Medigap coverage.
By "the insurance" I was referring to Medicare. I'm a working, healthy person and rarely use healthcare outside of preventative care. You could raise my Medicare taxes by hundreds monthly and still be less than what I pay for private insurance.
In a Medicare-for-all scenario, the individual price of a given procedure doesn't need to be so high, because the reimbursement is guaranteed. Right now, the "list"
price of the procedure has to be high to subsidize the uninsured and Medicaid who lose money.
I'm sure there are single payer health insurance countries in which people still purchase insurance, which should inspire debate about the universal insurance cost-sharing.
Regardless, the only viable solution in the US is a single payer insurance model.
Your private insurance isn't there (ideally) to pay for your preventative care, which you can easily pay for out of pocket. It's there to pay for the low-probability but very expensive scenarios, such as cancer, major accident/injury, etc. that would otherwise bankrupt you.
I understand how insurance is supposed to work. The problem is that private insurance captures all of the value I pay in during my working life, and doesn't have to pick up the tab when I inevitably get old and sick.
To use car insurance as an example, it would be like if we had a government program for cars over 150k miles. You have to pay for both private and government insurance. The private company collects more money than the government, but the government pays for all the expensive stuff because that's when cars break down. It's completely pointless.
If you want a medicare-for-all scheme where working people have a higher cost-share than children/retirees, fine, that's reasonable. Having private companies rake in profits from a system that has no business being a profit enterprise is insane.
The value is that it is there. Most insurance isn't used, or ever pays back what you paid into it. That's the point; that's how it's a viable product. There's no way to insure old, sick people, that's why the government does it. It would be like selling automobile insurance only to drunk drivers, or selling homeowners insurance to people whose houses are already on fire.
There's a way to insure old, sick people (who were once young and healthy) and it's how every other developed nation does so at lower cost. How is it lower cost? the profits from the young and sick don't get shoveled to private corporations for performing the exact same function at higher cost.
Paying for the preventative is because it's been demonstrated that doing so reduces costs overall. The amount involved isn't all that much, it's not the driver of the costs.
> You are extremely close to arriving at the solution, which is medicare for all. Cover everyone, then almost noone uses the insurance except when they need it, which is when they get old.
I strongly think that covering everyone in the existing system is not the best way to go.
The existing system is designed to cost as much as possible, and we have way too much demand for treatment (as is) and not enough supply. ER wait-times aren't 2-4 hours just because.
First, that needs to break.
Then, you can cover everyone.
We simply do not have enough doctors for how many old and unhealthy people we have. We should be thinking about how to keep people from going to the hospital that don't really need to be there. Do you really need to go to the ER because you stubbed your toe? If you didn't have insurance, you'd go to a low-cost clinic and get the same treatment for 1/10th the price.
We are slowly getting there already. Low cost clinics weren't widely available, but they are becoming more and more available as the cost of health care even WITH insurance is too high for most people.
The infrastructure for the bottom ~50% of people needs to exist to break free from a system that is not designed for them BEFORE they can move off it.
It's almost there.
Since One Medical became widely available, I basically have not gone to the hospital in 5+ years. Before, you kind of needed to go even for routine things (or at least I didn't know of a viable alternative). More and more places like this are springing up all over the US.
ER wait times are long because ERs are the only place in the country where we effectively have medicare for all, albeit in a particularly perverse and dysfunctional form. Everyone gets treated at the ER even if they're broke & uninsured as long as they're willing to wait long enough. Now imagine if those folks could go to any primary care doc or even use One Medical, CVS walk-in clinic etc. That would go a long way toward fixing our overloaded ERs. We've legislated quazi-medicare for all but only in the most inappropriate part of the system.
Agreed. We all collectively understand that we can't allow people to die in the streets because of their lack of health insurance. We already have universal healthcare, we just have the worlds dumbest way to pay for it.
> Do you really need to go to the ER because you stubbed your toe?
Where else are some people supposed to go? Maybe that toe is starting to change colors… is it broken? Do I need to have it set? Is that possible for toes?
People have valid medical questions and don’t want to wait weeks to see their primary care. They might not live near an urgent care. The urgent care may have terrible hours, or they made the mistake of mentioning chest pain for their heartburn incident and now they are forced to the ER.
It’s a chicken and egg problem. Faster medical answers will lead to reduced ER wait times. Reducing ER wait times lead to faster medical answers.
I hate to break it to you but insurance is meant to be a tax on the entire risk pool. What changed after the ACA is we couldn’t kick anyone out of the risk pool for getting sick.
The sick are mostly the old (if you're looking at total spending), and they are already covered by Medicare.
The sick young are a minority, and are often times covered by Medicaid.
If the state covers the tail end and assuming they aren't covered already by Medicaid, there just isn't that much spending remaining.
They can get private insurance to cover the under $10k per year - but there's not really a product that covers that effectively - so unless a new insurance evolves, it still wouldn't make much sense.
The sick, young, non-medicaid tail is VERY small compared to the rest of the tail the state already covers. Just add it in. A 1% global tariff could easily cover it. You've still got 9-14% left to spend on more bombs, tax breaks for the rich, paying people to get underwater basket weaving degrees, whatever.
The premium charged for the sick, young is high enough that your math doesn't make sense. ACA plans have to pay out 80%. Since I'm paying $11k/yr for my ACA plan they are clearly paying out at least an average of $9k in claims for the average member of my cohort. (And the reality is worse as they are limited in the ratio between young and not so young, this effectively makes the young subsidize us not so young.)
I’m not understanding how this is better than just putting everyone in one risk pool and having the young and healthy subsidize the old and sick? You’re basically saying if you’re healthy don’t carry any insurance and just rely on the government and taxes for catastrophic coverage. And then as soon as you get sick you’re supposed to apply for this coverage that only applies when you’re sick? The biggest problem with Medicaid is that you have to prove you can’t get the means to pay for healthcare which is essentially impossible without paying for healthcare.
So now you have this huge apparatus for intake and for rejecting people who are not sick enough or old enough but who can’t conventionally afford care. And you have to pay for that apparatus. Why would that be any better for the young people, other than seemingly using their taxes to make cruel decisions about a portion of the old and sick instead of simply providing care?
And what’s worse is a lot of those sick people wouldn’t have gotten that sick if they could pay for preventative care. So now in your system you have this huge group of people who have through lack of means let their illnesses and maladies get so severe that they can’t afford to treat. The whole point of preventative care is to keep people healthy so they don’t become a cost burden to the insurer. That’s why we pay more relative to what it costs. And it’s a hedge for us. We might find ourselves among the desperate ill some day without the means to pay for treatment.
Breaking the existing system will be extremely difficult. I have decade-long relationships with all of my doctors. The thought of a health plan that forces me to change all my doctor relationships is anger-provoking and exhausting. New doctors don't know me, they don't know my history, and haven't seen the medical shit show you've been through and why your treatment is the way it is. Then they think they can change your treatment to something that has already failed because "I didn't give it a long enough trial" or "That's a rare side effect," it won't happen to you.
I highly recommend you read the book "We've Got You Covered." It's an economist's view of health systems and how we can rearrange government spending to provide coverage for everybody and prevent medical bankruptcies.
One Medical looks interesting, but I wonder how they keep the price that low. Is it subsidized? Are they putting constraints on physicians and what they can do in the same way BetterHelp messes with the therapists? Are they servicing only the young and healthy?
Their senior care plans tell an interesting story. They only work with Medicare Advantage plans, specifically those known for up-coding, excessive pre-authorization requirements, and high rates of care denials. Medicare Advantage is an interesting failure in the marketplace in that it costs the government significantly more than classic Medicare and provides worse-quality care.
For the rest of us, we can skip the ER by going to an urgent care. But around here, urgent care offices are owned by private equity, have deceptive billing and are part of the reason why medical care costs so much.
> I have decade-long relationships with all of my doctors. The thought of a health plan that forces me to change all my doctor relationships is anger-provoking and exhausting.
You are clearly not in the bottom 50% of health care spenders. You would be in the group that would keep private insurance and be happy.
> One Medical looks interesting, but I wonder how they keep the price that low. Is it subsidized?
No.
> Are they putting constraints on physicians and what they can do in the same way BetterHelp messes with the therapists?
The vast majority of their "doctors" are Physician's Assistants. You can see whoever you want for whatever you want (that they provide).
> Are they servicing only the young and healthy?
Mainly. It's a clinic. You can't go there for Open Heart Surgery and cancer treatments. They'll just (cheaply) refer you to a specialist (who will be expensive and require insurance).
What you can do is avoid huge wait times and get good enough treatment for ~90% of what the mostly healthy group of ~50% of the population needs for fair up-front prices - which previously did not exist.
That's a mighty big assumption you're making. I've had private insurance for years, and I've always been unhappy with it because of treatment delays, Treatment denials, pre-approvals, and unrealistic copay limitations.
Many of my health needs are not expensive, but my body's reaction to treatments is. Frequently, cheap drugs are all side effects and no benefit. Also, private insurance has bizarre coverage gaps. For example, ambulance costs. When I had a heart attack, I drove myself for 45 minutes to the nearest hospital with a cath lab rather than take an ambulance and end up with God knows how many thousands of dollars in uncovered ambulance fees. Then there are things like cardiac rehab, which go a long way toward restoring cardiac health. 12 weeks, three times a week at $50 copays, was an expense I wasn't counting on. When I qualified for Medicare, the quality of care improved significantly. Usually, wait times for service are much lower than with private insurance.
I also resent private insurance because my premium dollars go toward enriching stockholders rather than providing care for all policyholders.
Okay - so you could keep your private insurance and not be happy, or move to Medicare and also not be happy.
I think you want a third solution - but that seems highly unlikely to be available in the mid term - and it doesn't look like anything is changing in the short term.
Who knows, my crystal ball doesn't work any better than anyone else's.
We're going to need to make more doctors. To do that we'll need to identify kids in high school that would be good candidates and offer full-ride scholarships where needed. And we need to improve science education at the high school level to help with all of this.
> To do that we'll need to identify kids in high school that would be good candidates and offer full-ride scholarships where needed. And we need to improve science education at the high school level to help with all of this.
We could import them.
We have tons of options. But the medical industry likes a shortage, because they like high wages, so I won't hold my breath.
They pick the rules. The rules favor them.
That's going to remain true for the foreseeable future, and on the list of problems, that's at the absolute bottom of things to fix that would actually move the needle.
The cost you spend on DIRECT HEALTHCARE is only ~20-30% of all spending. The rest is administration, drugs, insurance overhead, profits, ACTUAL insurance costs, cost overruns due to insurance making everything as expensive as possible to scrape 15% off the top, fraud, legal fees, etc.
The biggest benefit to moving to a centralized insurer is that fraud is centralized.
If you're a Republican and skeptical of government, you might assume the government will let massive fraud slip through to insiders, and you don't like that.
If you're a Democrat, and think the government can generally be good, you think the government can catch a lot of the fraud and cut total costs by 10% to get to fraud levels that are similar to other advanced countries (with similar systems).
Or, like, not haze kids in their 20s for residency and make them take hundreds of thousands of dollars in debt. Whereas in Europe and other countries, residents work something like 50 hours per week and graduate with zero debt.
I've watched friends go through it here in the US and I have zero interest in working 24 hour shifts and sleeping in break rooms, working 80+ hour weeks for years. There just is no need other than hazing and keeping artificial scarcity of doctors for inflated wages. There are plenty of brilliant, scientifically minded, hard working people that care about others that probably could be great doctors, but the US training system is just hostile towards most people.
The United States will never have universal healthcare because a subset of the population would rather pay more for worse health outcomes than participate in a system the provides abortions, HRT, or PreP, or any healthcare at all to Black people.
See, for example, “Dying of Whiteness: How the Politics of Racial Resentment Is Killing America’s Heartland” by Jonathan Metzl
> The United States will never have universal healthcare because a subset of the population would rather pay more for worse health outcomes than participate in a system the provides abortions, HRT, or PreP, or any healthcare at all to Black people.
This subset does exist, but is smaller than the percentage of people who think the system is broken - and the solution is not to just open up the floodgates and make it even more broken and even more expensive.
You FIRST have to fix the system before you open up the floodgates.
I am on your side that I think it would actually cost LESS to move all high-cost patients off of the ER and onto Medicaid.
But that's not a big enough problem to actually move the needle. In the rosiest scenario, you might save 2% per year. That's still like $20-40B, so nothing to scoff at - but in realistic scenarios, I'm doubtful it would save >$10B.
Even if they had Medicaid, they're so conditioned on going to the ER for everything, a lot of them might still go there instead of somewhere cheaper. For one, they might be convinced they get better care there (and maybe they would).
>You FIRST have to fix the system before you open up the floodgates.
I don't see any reason to fix the system on a nationwide level. Let the individual states figure it out. There's things that the top 5 US states for healthcare have in common, and there's things that the bottom 5 US states have in common [0]. They know how to talk to each other if they want to know more.
The more critical, and yet smaller, subset is the people making bank from the current system. Get their money out of politics and watch resistance crumble.
Yes, precisely. The smaller subset that make bank from the current system directly benefit from us poors (aka non-billionaires) from blaming the person lower on the ladder.
I think that some_random is saying sarcastically, "46493168, keep doing libel on people of white blood by stating that they vote against health insurance reform because they are racist, and maybe it will solve the problem."
That's good, love how you're co-opting anti-semitism for your own political ends.
"Blood libel" refers to a specifically anti-Jewish trope of alleging that Jews murder Christians, especially children, to use their blood for religious rituals. Grandparent comment is 100% not blood libel.
Medicare's admin cost is around 5%, private insurance is around 33% of claim dollars. There are around 27-28% uninsured. The money is already there who pays needs to be moved to the Billionaire and Multimillionaire class to reduce the annual costs for those who work for a living.
> private insurance is around 33% of claim dollars.
The Medical Loss Ratio (MLR) requirement established by the Affordable Care Act (ACA) is 20%.
Typically it's closer to 15%.
As these are private companies, some percentage of that is obviously profit.
It doesn't cost that much more to run private insurance than Medicare.
The problem is the incentive of insurance to drive up cost to get a larger fixed cut, and the lack of a public option (which would require private insurance to actually be worth it).
Those figures are in the right range, and the full picture is larger. The CMS NHE 2023 data puts total US healthcare administration at roughly $1.1-1.7T annually (depending on methodology), building on Woolhandler and Himmelstein's 2020 Annals paper ($812B in 2017 dollars). The per-capita comparison against 10 OECD peers: US $4,983 vs. a peer average of $884. That 5.6x gap is the number Issue #5 of this series will examine in detail, covering three separate computation methodologies and why the estimates range so widely. All source code will be in the repo: https://github.com/rexrodeo/american-healthcare-conundrum
The policy lever that addresses this is billing standardization, not just insurer reform. Countries like Germany and Switzerland run much lower admin under private insurance through standardized claims formats and all-payer rate setting.
The actual true problem is that there is a mismatch between the value the average person generates in their life, and the value of them staying alive. A handful of SOTA treatments can easily blast through a year of someone's total earnings. And this isn't even some kind of gouging or scam, anything SOTA tends to be the most expensive.
Insurance is the natural solution to this, but to be effective it requires most people to not need it while still paying into it. This is what Obamacare tried to fix by mandating insurance, but healthy/young people got sticker shock and bailed.
> Insurance is the natural solution to this, but to be effective it requires most people to not need it while still paying into it.
Yes, and you can fix it by the state covering ONLY tails - which it ALREADY essentially does, just as expensively as humanly possible.
Democrats and Republicans spend all their time arguing about whether to have sweeping changes that won't drive down costs or do nothing (which obviously won't bring down costs).
You could spend less money and get better outcomes by officially covering the tails instead of un-officially.
Instead of ~50% of young, healthy people paying a MASSIVE tax for "insurance for all" which doesn't really do what it says - you could just officially cover the tails, use the existing tax dollars, and accept that instead of ~30% of people "not having coverage" everyone would have tail coverage and ~50% of people wouldn't have "coverage".
You get a better, fairer system - that costs less overall, and that I think the American people could actually vote for.
Republicans would like it because it costs less and doesn't cover abortions or whatever they bitch about.
Democrats would like it because it officially covers everyone and prevents medically bankruptcies, and it doesn't FORCE anyone off insurance, and it would bring down private insurance costs significantly. They'd bitch that we should just do Universal Healthcare instead, but it's hard to argue it's a step in the wrong direction.
Pipe dreams don't pass. Reality does. You're never getting anything passed that massively fucks over a huge relatively popular special interest (like doctors).
You might be able to pass things that piss off unpopular powerful special interest like Health Insurance (or, previously, Fossil Fuel companies).
1) In many cases you are paying that high "markup" for the handling rather than the product.
2) Hospitals are typically not making much money. Available 24/365 costs. Deadbeats cost.
3) Yes, most people don't pay much healthcare in any given year. But you don't know what year they are going to.
4) I like the idea of it as a tax--but in the real world this always ends up with the fox guarding the henhouse. Because most people don't need much care in a given year it's easy to satisfy the majority of the population with poor quality care. The ones that see the failure aren't enough to change the outcome of the ballot box.
You theoretically lose yield compared to the S&P average - but if you're hedging your bets against the US possibly going to shit - the S&P is unlikely to perform as well as its historic average IFF that scenario unfolds.
Seems like a better hedge than gold, but my crystal ball isn't working.
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