Related: ProPublica investigation on doctors performing unnecessary amputations on poor black diabetes patients, because they don't pay enough attention to the patients and also get paid more to amputate.
Frontline did an episode a while back were dentists were performing unnecessary major dental work on poor people when the government had a program to pay the dentists for such work. Frontline was outraged at the dentists, but did not seem to recognize that this is the inevitable result of incentives the government set up.
Whoa whoa whoa, I'm the first one to call out perverse incentives in government programs, but even I would assume that dentists had meaningful ethics codes and enforcement that would largely mitigate this kind of abuse.
OTOH, if the "unnecessary" there just means "not satisfying the platonically correct cost/benefit analysis", and there's still some net benefit to the patient, and the government program didn't ask the dentists to use such CBA, then I wouldn't consider that abusive.
(I can imagine Frontline being equally outraged at dentists denying government-subsidized dental care on grounds of failing the platonic CBA too...)
Dentists do have an ethical code, government payers do look for patterns of abuse, and state licensing boards do investigate complaints of unnecessary procedures (to some extent). But many of these cases really fall into gray areas. Dentistry is still more an art than a science, and different dentists treating the same patient in good faith will often come up with completely different treatment plans. It's tough to really prove abuse. Financial incentives absolutely do encourage healthcare providers to err on the side of doing more procedures.
When the government provides a vending machine that dispenses gold coins at the push of a button, how many of us could resist pushing that button as much as possible?
A society cannot be run on expecting people to resist the powerful incentives set up for them.
You can see this effect in every aspect of government operations.
If too many of us would literally cut off the limbs of others unnecessarily to acquire said gold coins than we're done here. Let's just burn it all down and start over.
> Frontline did an episode a while back were dentists were performing unnecessary major dental work on poor people when the government had a program to pay the dentists for such work
I haven't seen this episode and so don't know what qualifies as "major dental work." However, as someone who has had government dental insurance, I wanted to chime in with a possibly irrelevant anecdote.
This dental insurance covered few things, one of which was having teeth pulled. When I was having major pain and other issues with a molar, the only covered treatment was to have the tooth pulled. Anything else would have to be paid 100% out of my own pocket. So the only viable option for most people in my situation would have been to have the tooth pulled, which certainly seems like "unnecessary major dental work on poor people", through no fault of the dentist.
Hitler claimed to have taken inspiration from how America treats its undesireables.
A doctor who grew up in the heyday of eugenics could still be practicing medicine into the 70s. We literally gave black people syphilis behind their backs, and now we wonder why they are vaccine shy. We spent over two centuries with at least half the country openly espousing as policy that black people were a lesser race and the south screamed from the hills that it was God's intention that white people control black people.
The children of these people were still politically relevant recently.
"Seventy-nine out of the 100 counties with the highest levels of medical debt are in states that have not expanded Medicaid under the ACA"
Who benefits in these 10 states that have still failed to expand Medicaid? What is the upside, to either the populations of these states or the politicians who run these states and make those decisions? Because the downsides are obvious and seem to directly harm a lot of people.
The Federal Government covers 90% of the Medicaid expansion costs. Which means that there is a some cost in terms of state taxes.
But that's not the reason I usually see expressed. It usually comes expressed like this:
“The health care industrial complex made up of hospitals, medical device manufacturers and pharmaceutical companies are the great robber barons of our time,” Oliva said. “The term robber baron is defined by government manipulation, monopolizing industry and price gouging.”
“We must reform Medicaid and double down on pursuing common-sense policy reforms to unleash innovation and increase access that can all lead to lowering costs,” Zander said.
A lot of these states have big problems with gerry-mandering and there tends to be huge wealth disparity between the few small wealth centers in the state and the rest of the state is extremely poor. The money just isn't being distributed with any sense of equity.
I don’t know about gerrymandering. In the most recent Texas house election (Texas being one of the major ACA holdouts) republicans won a 12-point seat margin with a 7-point popular vote margin. The governor, which is elected by statewide popular vote, won by an 11 point margin. In the 2022 Tennessee House elections, meanwhile, republicans won 75% of seats with 70% of the popular vote, which is as lopsided as some heavily skewed states like California and New York. (At a certain point, winning more seats than popular votes isn’t due to gerrymandering but just normal population distribution effects.)
I suspect the real issue is that, in red states, the democrats tend to be low propensity and younger voters. In Tennessee, Trump beat Biden by 24 points. But the GOP beat democrats by almost 50 points in the popular vote in the 2022 Tennessee House elections.
Income inequality isn't an issue, wealth inequality is.
I find it perfectly fine to earn 8 time as much as my artist best friend does as long as we are in a market-based system. What bothers me is that I do not pay enough taxes, and could pay even less by declaring my donations.
Well yes, since others not paying enough taxes is part of the tax system being unfair, someone who actually cares about fairness would be bothered by it and them personally paying more doesn't fix that. Do you not care about fairness? "You could pay more yourself" has always been more of a snide low-effort attempt to shut down conversation than to engage in it. Please try to do (and be) better.
It's not about who benefits. It's about fucked up cultural priorities. It's not just the politicians who are the problem. The voters who keep electing these people over and over are asking for this too.
> Debates raged in Tennessee around the same time about the state’s participation in the Affordable Care Act and the related expansion of Medicaid coverage. Had Trevor lived a thirty-nine-minute drive away in neighboring Kentucky, he might have topped the list of candidates for expensive medications called polymerase inhibitors, a lifesaving liver transplant, or other forms of treatment and support. Kentucky adopted the ACA and began the expansion in 2013, while Tennessee’s legislature repeatedly blocked Obama-era health care reforms.
> Even on death’s doorstep, Trevor was not angry. In fact, he staunchly supported the stance promoted by his elected officials. “Ain’t no way I would ever support Obamacare or sign up for it,” he told me. “I would rather die.” When I asked him why he felt this way even as he faced severe illness, he explained: “We don’t need any more government in our lives. And in any case, no way I want my tax dollars paying for Mexicans or welfare queens.”
> At the most basic level, Trevor died of the toxic effects of liver damage caused by hepatitis C. Yet Trevor’s deteriorating condition resulted also from the toxic effects of dogma. Dogma that told him that governmental assistance in any form was evil and not to be trusted, even when the assistance came in the form of federal contracts with private health insurance or pharmaceutical companies, or from expanded communal safety nets. Dogma that, as he made abundantly clear, aligned with beliefs about a racial hierarchy that overtly and implicitly aimed to keep white Americans hovering above Mexicans, welfare queens, and nonwhite others. Dogma suggesting to Trevor that minority groups received lavish benefits from the state, even though he himself lived and died on a low-income budget with state assistance. Trevor voiced a literal willingness to die for his place in this hierarchy, rather than participate in a system that might put him on the same plane as immigrants or racial minorities.
Some guesses:
- It benefits corporations and the wealthy (whom the government actually work for) in some way
- Politicians think running on "rugged individualism" works
- Same politicians truly believe in trickle-down economics and austerity.
Medicaid expansion under the ACA isn't "free" for state budgets. The Federal government only puts in part of the funding. So by forgoing expansion the state politicians can keep taxes low or continue funding other priorities. Some politicians also have ideological objections to expanding government control over the healthcare system.
(I am not endorsing these policies, just explaining some of the reasoning behind them.)
Given how often I see the argument that “blue states subsidize red states” I can see why folks who want to maintain their dignity wouldn’t want to expand their reliance on blue state largesse. That money comes with no strings attached.
Also, even if it’s true that blue states may bear the brunt of taxes, inflation hits everyone equally.
Inflation literally doesn't hit everyone equally, prices are set in local markets, not fixed at a national scale.
Things like federal mortgage subsidies probably cause more inflation in less affluent regions where housing is less competitive than they do in affluent regions (where the competitors for housing aren't particularly pricing their offers to the largest payment they can afford).
That's not a policy. That's indulging in a fantasy world. A policy might be ending subsidies for sugar, or creating subsidies for healthier foods, etc.
Things are not that black and white. There are many places in both urban and rural America where access to healthy food is much further away and more expensive. If you're relying on food stamps unhealthy foods will often make your dollar go further. This is especially important when you're trying to feed a whole family. The corner mcdonalds or bodega is easier to access food when you don't have a car and work double shifts. Food preferences are also learned early in life and harder to break as you get older. This is a far more nuanced problem than people choosing unhealthy foods because that's what they want.
To combat this NY state, for example, has a whole program around getting additional benefits on top of SNAP for produce at local farmers markets which has been very successful. So yes, while no one is holding a gun to their head your hyperbole is not really adding anything useful to the discussion.
I've been poor. I've been in situations where the only lunch option was McDonalds. Didn't get fat. Didn't get diabetes. How come? Ordered a cheeseburger, small fries, water, while all of my co-workers "super-sized" their orders. My bill and my BMI were always far lower than theirs. People here can blame corporations, "red staters", "food deserts", and whatever other divisive new york times nonsense they want. Ultimately, you've only got one pancreas, and instead of pointing fingers, you should take care of it.
I didn't get pre-diabetic until I was wealthy--eating out, non-stop sushi and Thai. Unfortunately for me, rice has a very high glycemic index. It is not suited to the genetics of my people.
T2D doesn't arise from a moment of bad luck or inattention. T2D arises from a long stream of sub-optimal choices and ignored warning signs. I am not here to argue for or against socialized medicine. I am here to tell people that they should fix the actual problem instead of opting for the quick fix. I encountered this problem a couple years ago. If I trusted those damn doctors, I'd be stuck, sticking myself several times a day, and keeping an eye on my insulin supply, but I didn't, so I'm not.
Type 2 diabetes doesn't really wreck the pancreas, at least no more than other tissues. The problem is that cells throughout the body become insulin resistant. While it is obviously better to avoid the condition in the first place, most cases if caught early enough can be put into remission by eliminating carbohydrate consumption. (Adherence to such a diet can be difficult for many patients due to economic and cultural issues.)
In North Carolina, before Uber and stuff like that, there was this driver a few of us knew and would call to taxi us around. He was a skinny fellow but through the years we knew him, he'd tell us about how he keeps telling his brothers not to eat as much because they're going to get in trouble and how he was a fat dude but managed to lose weight.
No happy ending. One of the brothers died just before I moved away, of an obesity and diabetes related illness.
Interesting tale. Mostly a question of junk food and portion sizes.
This is as much a cultural problem as a financial one. Somehow we've convinced ourselves that in spite of the fact that we can afford to provide everyone with good food and access to medical care, that we'd rather give you bad food which causes health care issues and then treat those because it contributes to GDP.
> This is as much a cultural problem as a financial one.
I live in one of these Diabetes Belt counties. I'd like to add another aspect to the "cultural problem", which is that the median person here eats absolutely horrendously and doesn't exercise at all.
> we'd rather give you bad food
I'd like to believe that people have the agency of choosing what they eat.
> I'd like to believe that people have the agency of choosing what they eat.
They do, but they need to know how to eat a healthy diet. I don't know about you, but I've never once seen a commercial about eating whole foods with vegetables. I am however bombarded on a daily basis with adds for fried chicken and burgers. Some people just don't have the access and education.
I don't think it's an advertising thing though it could play into it.
- Eating a varied healthy diet is a lot more expensive than eating a varied unhealthy diet (if you can eat kale, rice, and beans all day then good for you but most can't)
- We're creatures of habit, if we grow up eating unhealthy we are more likely to continue to as adults. Eating healthy for most people requires cooking for yourself, many never learn this skill or see their parents putting daily effort into meals when they are children.
- Lack of public education around the topic, lack funding for free healthy lunches for school children
I had a friend when I was in school who had the most messed up disgusting teeth I'd ever seen. He had dental insurance, a decent job, decent pay. Turns out he never grew up learning that you're supposed to brush your teeth regularly so he just never made a habit out of it.
> Eating a varied healthy diet is a lot more expensive than eating a varied unhealthy diet (if you can eat kale, rice, and beans all day then good for you but most can't)
Eating healthy is not more expensive. Potatoes, rice, beans, carrots, etc. are all inexpensive. I was in the store today, and a can of Nalley chili with meat and beans is $2.19. It's more than enough for a meal.
I also buy whatever's on sale, including the day older steak which is around half off. A half gallon of milk is $1.99.
Kale, rice, and beans are notoriously cheap! When I worked in a restaurant 20 years ago we put kale out as decoration because no one wanted to eat it. Times change, I suppose.
Fried chicken and burgers really aren't that bad from a diabetes standpoint. You will sustain more metabolic damage from drinking a regular Coca Cola with that fried chicken than from the fried chicken itself.
Broccoli sauteed with garlic and black pepper is awesome. Then served over rice with a cheddar cheese sauce and I'm pretty sure you can get up there in calories if you want to.
As someone who regularly eats several pounds of broccoli (I love it so much), I can only describe the outcome as a cleanse, of both the colon, and if you survive, the mind.
Is the median person there dumber than the median person in the rest of the world?
Or are they eating shit, because eating shit is the path of least resistance, and median person travels down the path of least resistance, and if you set up your society such that the path of least resistance results in horrible outcomes, you're going to get horrible outcomes?
Industry caters to consumer demand. If consumers wanted white meat, fruit and vegetables, they would have been provided as cheaply and abundantly as red meat and corn syrup.
Global advertising spending is around $750 billion. Assuming advertisers believe most of their money is well-spent, can I infer the percentage of human beings that actually do ignore advertising is small?
If you like this, you might enjoy The Price We Pay[0] by Marty Makary. It talks about the incentives in the US health system, and how they combine to create a system where even people with insurance can end up with unmanageable medical debt.
The book points out both genuinely bad actors (e.g. companies that pay kickbacks to medical staff for pushing patients into unnecessary helicopter rides) and also problems that happen due to the design of the system, despite the best intentions of individual actors.
I don't think it helps to call them "degenerate." They're human beings. Some of them, more clever than you. Who are trapped in lives of quiet desperation.
We think we are civilized, but we are just as barbarous as the world of Hugo's Les Misérables. We live in a world filled with Inspector Javert's spending their lives chasing their Valjeans.
Changing labels doesn’t change the underlying reality. Spend some time talking to some old stock Yankees. Their attitude towards food is different. A phrase you’ll often hear is “eat to live.” It’s not a wonder that Alabama has an obesity rate that’s over 60% higher than Massachusetts.
This is a very extreme claim that requires a lot of evidence. If we're just throwing out ideas, I'll make a claim that "attitude" is a lot less of a factor than having only dollar stores and no grocery stores within an hour's drive.
Also, I've lived in Massachusetts my entire life and I've never heard anyone say "eat to live".
I seriously doubt that in Alabama there are many people who don’t have a grocery store within an hour drive. Almost certainly less than 10% of population. Even if you said 20 minutes instead of an hour, it wouldn’t be a lot of people either. The thing with areas this remote is that few people live there.
I did exaggerate a little, I apologize. It's not just rural areas though, there are plenty of small towns without any grocery stores, and urban areas where the nearest grocery store is very far away, especially if you don't have regular access to a car. Here's one source that says 1.8 million Alabama residents don't have a grocery store within 45 minutes: http://humsci.auburn.edu/news/hunger_solutions_institute_awa...
Are these people more or less obese than the ones who have easy access to grocery store? You are suggesting that this is a major driver of obesity, so you must be basing this on some data, no?
Also, that link doesn’t say whether this is 45 minutes drive, and since it does not reference any source, it’s hard to look that up.
Well the driving part doesn't matter, the thing we care about is how hard it is for someone to get to a place with affordable healthy food, however they get there. If it's an urban area where a significant portion of people don't have easy access to a car, then you wouldn't look at driving times.
These are called food deserts, and there is a ton of research on them. From what I've read there is not a direct line between food deserts and higher obesity rates, but it is a relevant factor, especially when abundant dollar stores and fast food places are offering cheaper and more accessible food than the nearest grocery stores (if there are any). I've also seen this described as a "food swamp".
I've never seen any research or data showing disparities in American obesity rates are influenced by cultural attitudes toward food.
> Well the driving part doesn't matter, the thing we care about is how hard it is for someone to get to a place with affordable healthy food, however they get there.
Can’t be much harder than it was 100 years ago, when everyone was extremely poor by today standards, and visiting a grocery store was often a whole day trip, no? Obesity didn’t seem to have been a problem at that time. Seems like it really is not about lack of access to affordable healthy food, which today, by any historical standard, is very easy even in most deprived places in US.
> If it's an urban area where a significant portion of people don't have easy access to a car, then you wouldn't look at driving times.
Most poor people in urban areas do have easy access to a car. Cars are extremely cheap in US, poor Americans enjoy high consumption levels by global standards, which typically entails access to cars.
In any case, for this to support your argument, which that lack of access to affordable healthy food drives obesity, we’d need to have that in urban areas, carless people are significantly more obese than people with cars. To reiterate, your argument is that drivers are less obese than people who are too poor to drive. Is it actually the case? I seriously doubt it, but you’re welcome to show data supporting your theory.
> These are called food deserts, and there is a ton of research on them. From what I've read there is not a direct line between food deserts and higher obesity rates, but it is a relevant factor, especially when abundant dollar stores and fast food places are offering cheaper and more accessible food than the nearest grocery stores (if there are any).
Yes, I’ve heard about this stuff, and most of this stuff is highly motivated logic with extremely meager support in facts. Even you admit that the whole food desert thing has little actual observed causal impact on obesity rates. Instead, the poor just go to convenience stores and buy crap, and they do this even if they have healthy options easily available (this is true, because otherwise you’d see clear correlation that people close to grocery stores with cheap and healthy food are not obese, which you don’t).
Here, let me propose an alternative theory, which matches facts on the ground much better: many poor people in US are low in conscientiousness and long term thinking, and so instead of engaging in relatively complex activity of buying bulk staples and cooking simple and healthy meals, prefer to spend extra for convenience of unhealthy foods from dollar stores and fast food. This is possible, because their “poverty” is not an absolute level, but rather relative measure. By this I mean the fact that by global standard, American poor enjoy quite high consumption levels, so they can easily afford these unhealthy habits. Making healthy food easier to obtain for them will, as you admit, not change much, because people will just not take advantage of it, instead preferring easy and unhealthy food instead. Instead, what you’d need to do is to immiserate them even more by either taking away convenient and unhealthy options nearby, or reduce their purchasing power to make them unaffordable. This is, of course, seen as immoral, so it will not happen.
> visiting a grocery store was often a whole day trip, no?
I mean, no. 100 years ago was the 1920s. Not really sure what you're referring to and this is not a useful comparison anyway, obviously many many aspects of the US food system and economy have changed in 100 years. I don't really know how to respond to this.
> To reiterate, your argument is that drivers are less obese than people who are too poor to drive. Is it actually the case?
> Not really sure what you're referring to and this is not a useful comparison anyway, obviously many many aspects of the US food system and economy have changed in 100 years. I don't really know how to respond to this.
It is extremely useful comparison, and this is why you don’t really know how to respond to it. Your theory hinges on the fact that worse access to fresh food makes people more obese, but 100 years ago (and 150 years ago, even more so) most people had even worse access to fresh, healthy foods, but nevertheless obesity was not a problem at all. This is a problem to your argument, which is why you are lost for words.
> Rich people tend to have more cars and eat healthier food because it's more accessible. Here's a study:
The graph you linked shows that men with a car have higher BMI than men with no cars. Thanks for supporting my argument with evidence, I guess? In any case, this is just purely correlational study, which does not even attempt to answer whether access to car causes lower obesity. You might as well show me a graph of square footage per person against BMI and argue that small houses make people fat. On the other hand, it is perfectly consistent with the theory I elucidated above, which is that conscientiousness causes people to both be wealthier, and less fat.
What makes things so bleak? My small county is somewhat below the national median income (so doing fine but not wildly wealthy) and like half of the people that live here live within 10 miles of 3 large grocers and multiple other grocers. The most concentrated population is within a couple miles, and the people that live further away are doing so because they want to live outside of town, they mostly aren't stuck there or whatever.
Small stores out in the county mostly don't have much fresh stuff, but probably a few things.
No, I think "different American subcultures having different attitudes towards food is the primary factor causing a 60% difference in obesity rate" is an extreme claim.
The nearly universal trend among nations is that they get fatter as they get richer. So it would be quite bizarre to see affluence, in and of itself, suddenly causing the opposite effect.
Maryland has comparable median income to Massachusetts, but much higher obesity rates. Vermont and Kansas have similar incomes, but Vermont has much lower obesity rates. (Same is true for Virginia versus Colorado, Montana versus South Carolina, etc.)
The majority of people with T2D who are also overweight would be asymptomatic if they lost weight. So there’s a free treatment available to a large subset of these people.
Most health insurance doesn't cover weight loss treatment without a condition like T2D, heart issues, etc. If you're fat enough that it's damaging your health you're extremely unlikely to be able to lose it without significant support through medicine, nutritionists, etc.
No, it just requires constantly feeling hunger pains. Along with bouts of lightheadedness, distraction, and things of that nature.
There are a variety of reasons people get fat, and a variety of reasons people stay fat. Treating the specific reasons for the specific people is a lot safer, and easier, than just having people eat less.
For me, I'm a stress eater. I need more money, and better credentials, and then I can get career tracked in a way that will reduce my stress enough to eat better.
Exercise does help, and I should be doing more. I exercise best (most consistently) with machines, but don't have the cash flow for a gym membership anymore. I also exercised great with rollerblading, but the serious accidents I had doing that make it a bad idea without an indoor rink, and the nearest indoor rink is both expensive and a ways away. I have to drive to work, so I try parking about a 10 minute walk away and walking uphill. It's something, at least.
> No, it just requires constantly feeling hunger pains.
No it doesn't, just eat more filling foods with lots of fiber. Veggies are cheaper than dirt, far cheaper than junk food, and far more sating. Junk food is engineered to leave you feeling hungry, to encourage you to buy more. Stop buying junk food completely; no more chips, colas or frozen pizzas. Buy vegetables, particularly the leafy ones, and eat as much as it takes to make yourself feel full. You'll lose weight and save money at the same time.
I eat "double fiber" bread and take 4 tablespoons of whole psyllium husk per day.
The chips are a good idea, but my diet is already so limited to PB&J, hummus and cheese and mixed green sandwiches, and the occasional whole grain rotini + prego chunky garden (and mixed greens), oatmeal, apples, frozen blueberries, bananas, and the occasional frozen quinoa dish that chips and occasional ice cream or Italian ice are a nice change of pace.
I haven't had a soda or the like since, I think pre-COVID.
I just eat too much, and don't exercise enough. I could probably use more water, too, but I don't like using the restroom at work. I do find that when I'm working I can often not eat without feeling and hunger pains, but I usually make up for that by eating a lot at night when I get home.
I'mma tell you as an avid veggie eater: veggies are not cheap. The amount of leafy greens that will make someone full (and properly nourishing leafy veg: spinach, kale, dandelion and beet greens, etc.) isn't cheaper.
Poor people aren't living high on spinach and kale. They're eating butter sandwiches for lunch because they're too poor for nut spreads and jam. They're eating 5 boxes for 2$ mac dinners. They're checking which of the soup cans they bought on a 10 dollar for 10 cans sale years ago are still good (aka not puffy) even though they're long expired. The cheap vegetables are starchy roots, but even the 50c/lb carrots don't hold up to processed food prices.
You can spread out 1 cup of rice with 9 cups of water as a soup. I was stirfrying cabbage with almost no seasoning. And it would still be cheaper and more filling to indulge in mac dinners and hamburger helper.
If you're that fat you're statistically unlikely to lose weight without medical intervention of some sort, even something as basic as talking to a fucking nutritionist about portion sizes.
When you're that obese you're well beyond personal responsibility. Personal responsibility is enjoying a big thanksgiving dinner and then eating light for the next week or so, or eating some salads for a bit to have a hot girl summer. Obesity is increasingly looking more like a hormone disorder (the latest "miracle" weight loss drugs are all hormone-regulating) or an eating disorder of some sort and should be addressed as such.
Personal responsibility is great, but we're all paying for patients with type-2 diabetes (and other lifestyle related chronic conditions). We pay in terms of higher taxes for Medicare/Medicaid, higher premiums for private commercial insurance, and higher charges from providers trying to cover losses from indigent patients who default on medical debt. People are unlikely to suddenly become more responsible so what is your solution?
Statistically, if a person is so obese for so long they get T2D, they are not going to go into remission just from googling weight loss or following whatever they find on the internet (doubly so if they fall into some crank Liver King style nonsense). That's just the facts. It's been studied over and over again for many years at this point.
I honestly don't understand responses like this. We're presented with systemic issues, and your "solution" is just "personal responsibility"? Something which has demonstrably failed and lead us to the situation we're in today? Do you often think that doing more of the same thing will lead to different results?
Since we're in a technology forum. Let's say you're a product owner and your app is suffering from severe performance issues. Would a "solution" of telling the developers of the app "just write code more efficiently! Use Google if you have to!" be acceptable to you? Do you think it would produce the results you want?
I think a better analogy to use would be a very slow loading app.
Say your app takes 5 minutes to load the first page and 1 minute to switch between pages after that. Instead of blaming the developers, blame the users for expecting too much of the app. Personal responsibility and all that.
It's the users fault they are using the app during peak times. If they really needed access to X part of the app they should have done it before it got busy.
I used the app dev side because I think it's more illustrative. There are various teams with various competing priorities who have collectively developed a product which is horribly slow. No individual developer is at fault. Some are efficient with their code, and some are less so. But there is no architecture team or mature SDLC to handle cross cutting concerns or a foundational platform for everyone to build from. Everyone is free to do their own thing and write code the way they want use whatever standards they can find on Google. In that world, just telling the devs to write more efficient code is insufficient to correct the course. The systemic problems that have developed require systemic solutions. A blanket "just do better" has never been useful to anyone.
And your "solution" is completely meaningless because it's been proven to not work across societies. It's like saying the solution to world hunger is easy. Everyone should just feed themselves! Want world peace? Everyone should just be more peaceful! It's completely useless rhetoric with absolutely no value in the conversation. Are you actually incapable of looking at these things as systems with a large number of variables and broad societal impact?
They use the internet and find people who tell them that it's not their fault. It's the fault of vegetables for being so expensive, even though vegetables are cheaper than junkfood. It's the fault of food deserts, even though they live in walking/driving range of half a dozen full-sized super markets. It's the fault of their genes, even all 8 of their great grandparents were fit. It's anybody/anything's fault, except their own. And so they stay fat, and join the ranks of those who perpetuate these fat-excusing myths (on full display throughout this discussion section.)
> USDA’s Economic Research Service previously identified more than 6,500 food desert tracts in the United States based on 2000 Census and 2006 data on locations of supermar- kets, supercenters, and large grocery stores. In this report, we examine the socioeconomic and demographic characteristics of these tracts to see how they differ from other census tracts and the extent to which these differences influence food desert status. Relative to all other census tracts, food desert tracts tend to have smaller populations, higher rates of abandoned or vacant homes, and residents who have lower levels of education, lower incomes, and higher unemployment. Census tracts with higher poverty rates are more likely to be food deserts than otherwise similar low-income census tracts in rural and in very dense (highly populated) urban areas. For less dense urban areas, census tracts with higher concentrations of minority populations are more likely to be food deserts, while tracts with substantial decreases in minority populations between 1990 and 2000 were less likely to be identified as food deserts in 2000.
But it requires massive willpower to overcome those first few days of cravings, pain and mental anguish and then extended willpower to keep it going for at least 30 days so you can build some tolerance to the new reality of clean eating and exercise...and then even more willpower after losing all the weight not to fall back into a bad habit and refill all those dormant empty fat cells that your body does not destroy for at least 7 years. Combine that with the fact that a lot of people are living paycheck to paycheck/working multiple jobs to survive and may not have access to clean nutritious foods without extended effort and you see how we ended up in this situation.
If you look at recent layoff numbers, their coastal brethren will be joining them soon. It's America! One man copes with food, another with money, another with sex. You are all degenerate!
Hey, I understand how frustrating it is when people casually insult a group that you belong to or care about (or when it feels like they are doing that). But please don't lash back like this on HN, for two reasons. First, it's against the site guidelines and we have to ban accounts that post like this (see https://news.ycombinator.com/newsguidelines.html).
Second, it's not in your interest. Fulminating may bring temporary relief but at the cost of discrediting your own position. That's not a good trade. It will only harden the other side in its views, giving people a fresh reason to be convinced they're right and righteous. Worse, by doing this you give the larger, neutral audience a reason to side against you, putting you in even more of minority than you already were (or feel you were).
Not frustration. Astonishment, at such low levels of self-awareness. People who will neg an entire region one minute, then get so hurt and offended by the advice of "don't wreck your pancreas" that they flag and report it.
This was not me venting, or being angry. This was me being entirely serious. For the sake of the country and their own well being, they should go down there, and compare what they see at WalMart with what they see in the mirror.
Ok, I believe you about your subjective state (obviously!). Just please don't post more comments like the GP to HN. It's not what this site is for, and destroys what it is for.
https://features.propublica.org/diabetes-amputations/black-a...
Another link if you are skeptical there is a racial issue: page 12 of https://data.dartmouthatlas.org/downloads/reports/Diabetes_r.... Among Medicare beneficiaries with diabetes, black people are still way more likely to have a leg amputated.