Is it the case that UnitedHealth and Cigna each own (or control) one of the "big three" PBMs? If so, that is a just crazy - the control insurance premium pricing, benefit decisions, AND the pricing of covered medications?
yadaebo wrote below "Medical Loss Ratio (MLR) is capped at 85% in the US which means 85% of revenue must go to patients". Does controlling a big PBM allow an insurance company a loophole?
> It’s no secret that UnitedHealth is a colossus: It’s the country’s largest health insurer and the fourth-largest company of any type by revenue, just behind Apple. And thanks to a series of stealthy deals, almost 1 in 10 U.S. doctors — some 90,000 clinicians — now either work for UnitedHealth or are under its influence, more than any major clinic chain or hospital system.
>They purchase physician groups... and then pay themselves higher rates.
> UnitedHealth Group is paying many of its own physician practices significantly more than it pays other doctor groups in the same markets for similar services, undermining competition and driving up costs for consumers and businesses, a STAT investigation reveals.
For better or worse, the incentives created by federal legislation since the 1940s make this healthcare industry consolidation and vertical integration inevitable. Payers (insurers) have been merging to gain more negotiating power over provider rates and hold down medical costs. So provider organizations have reacted by consolidating themselves to maintain their negotiating power and keep rates high. Increased costs to comply with federal and state rules around security and interoperability also drive provider consolidation to achieve economy of scale. Many areas are now dominated by only one or two large health systems. So, the logical next step is for payers to vertically integrate and bring more care in house where they can better control cost and quality.
UnitedHealth Group is hardly unique in this regard. They're the largest but all the major commercial payers (including the non-profit ones) are pursuing similar strategies. Essentially they're copying the existing Kaiser-Permanente model of having a payer and provider organization under one roof.
I'm not defending this system, just explaining why the current structure exists. Any major improvements will require an Act of Congress to better align the incentives with the interests of patients / consumers / taxpayers.
>the logical next step is for payers to vertically integrate and bring more care in house where they can better control cost and quality.
…except you skipped over the part where UHC billed at higher rates for the clinics they own so they could screw customers with premium hikes, take a bigger percentage of of the inflated bills, as well as profit from whatever costs they didn’t cover and people were forced to pay.
From a strict legal perspective it's not at all clear that UHG or any of the other large payers meets the definition of a trust. Any attempt to apply antitrust law would likely be tied up in the courts for many years, and even if UHG were eventually forced to divest some parts of their Optum business it wouldn't solve any of the systemic problems. If we want to bring down costs and improve access to care it will require a major realignment of incentives that impact all the participants.
Decent article, why the need for someone to pick up the pitchfork and emphasize their moral compass publicly like this? The comment and ensuing discussion is so pointless.
Why do we pretend that these things don’t matter? Why should we?
Why in the norm to ignore these issues - there by perpetuating them because they face no consequences - rather than pointing them out?
Justine did write openly on the web about their prejudices and never even apologized let alone showed in anyway evolution away from fascist leaning and prejudiced politics
I didn't know about Justine's politics and I'm glad I do now. She is definitely not someone I would want to be associated with, unless she clearly distanced herself from these - in my opinion - deeply problematic and disturbing views.
EDIT: That being said, I think it should still be possible to discuss her technical contributions in some form. It's basically the old question as to which extend you can separate the work from the author.
I fail to see anything of substance here, seems to be some person with a chip on their shoulder. Apparently the word cosmopolitan is a derogatory dog whistle for Jewish person, but why would an antisemite name their own work after something they do not like?
Just to be clear I'm not talking about Justine here and I consider the project to be well within the normal meaning of "cosmopolitan", but dogwhistle names are absolutely a thing antisemites do.
The spirit of this and its practicality in every case isn’t the same thing at all.
I don’t think a supposedly meritocratic community would want to associate with racist or prejudiced ideas that by their very nature fly in the face of this
What are you arguing here? Should no one use APE? Should people use APE but just feel bad every time they do? Should people use APE but never write about it for fear of aggrandizing the author?
This makes sense in the case of, for example, a bestselling author who kicks puppies. Purchasing books by this author means you are giving them money, if indirectly, and thus to some degree subsidizing their puppy kicking habit.
That I can determine using APE gives the original author nothing.
Ahh, never encountered Poe’s Law, thanks for that. I like it, however I’m not entirely sure that mock bewilderment at the implication that SS-Sturmbannführer Werner von Braun (PBUH) kicked puppies represents an extreme view.
In general, I've noticed that people like to kick the people with least power or privilege, which often means women are targeted as they tend to have the least power and privilege.
Oh, a BigTech company is evil, with CO2 demands that will kill the planet, support for genocide, and developing mass surveillance to improve their bottom line? Not a problem! Look at all the cool tech toys they have!
Someone develops cool tech toys but has horrible personal opinions? Keep him around as the Chief GNUissance and invite him to all the conferences because he didn't do anything except express opinions, but pounce on her whenever people mention her toys, because of her opinions.
Did you even read that post of mine that you searched up for some reason?
What do you imagine you found there?
And keep who around as cheif gnussance? Doesn't that usually refer to Stallman?
Do you think Stallman is the same as either Reiser or Tunney?
And who is pouncing on anyone exacly? No one is doing violence on Tunney, nor advocating it. They just opt out of lionizing her, and for a reason she creates herself.
Why do you seem to be so scandalized at holding someone accountable for their opinions? Did you not know that some opinions are not neutral or harmless? No one cares about her opinion about tea vs coffee.
Personally I don't actually even hate her. She says so many different conflicting things that you can't take anything quite fully seriously, including the worst bits, because 10 minutes earlier on some other site she probably said something opposite, and I frankly agree with about half of it.
But you can't ignore the worst bits either because some things you don't get to say without consequence.
And one thing that IS consistent is that she does it on purpose and explicitly, by her own admission, gets off on making everyone else crazy. Not just gets off on being smarter or righter, but specifically on making someone else upset for no other purpose than to laugh at that.
I've known a hundred people like that. Most were 12-22 year old boys, and at least half of those eventually outgrew that phase, and even those that never did are mostly harmless. So I say she's not evil, she's just a garden variety douchebag.
Someone who explicitly prides herself on violating everyone else's feelings, and who explicitly preaches that everyone else needs to grow a thicker skin, cannot possibly at the same time have any problem with something as insignificant as being called an asshole.
I think you both make valid points, but I also get the sense that the article is articulating insights gained from pure math explorations into the theoretical limitations of learning, which in the article can sound "turboencabulator-speak" when compressed into words.
Maybe I should have just linked to the research paper:
Yes, I should have made that clear in my first comment. Thanks for doing so. I used the quote in my title because I found it a fascinating way to start a technical blog post, and it made me want to read the article to understand what the author was planning to write from such a beginning.
I found the opening quote of this article to be intriguing, especially since it was from a 1992 research lab:
“One year of research in neural networks is sufficient to believe in God.” The writing on the wall of John Hopfield’s lab at Caltech made no sense to me in 1992. Three decades later, and after years of building large language models, I see its sense if one replaces sufficiency with necessity: understanding neural networks as we teach them today requires believing in an immanent entity.
Basically, as LLMs scale up, the author (Soatto, VP at AWS) suggests they're beginning to resemble Solomonoff inference: hypothetically optimal but computationally infinite approach that executes all possible programs to match observed data. Repeating this approach for any given question by definition gives the best answer, yet requires no learning, since the entire process can be repeated for any query (thanks to infinite computation).
The article develops a theoretical framework contrasting traditional inductive learning (which emphasizes generalization over memorization) with transductive inference (which embraces memorization and reasoning). Here's a quote:
"What matters is that LLMs are inductively trained transductive-inference engines and can therefore support both forms of inference.[2] They are capable of performing inference by inductive learning, like any trained classifier, akin to Daniel Kahneman’s “system 1” behavior — the fast thinking of his book title Thinking Fast and Slow. But LLMs are also capable of rudimentary forms of transduction, such as in-context-learning and chain of thought, which we may call system 2 — slow-thinking — behavior. The more sophisticated among us have even taught LLMs to do deduction — the ultimate test for their emergent abilities."
reminds me of the anthropic's recent work on identifying the neuron sets that correlate to various semantic concepts in Claude: https://news.ycombinator.com/item?id=40429540 "Scaling Monosemanticity: Extracting Interpretable Features from Claude 3 Sonnet"
Ditto. The larger question is how does the linear sequence of DNA (primary sequence) ultimately drive the spatio-temporal development program that leads to mature differentiated cells working together at the organoid / organ / organism scale. How do cells know what to do in time and space as the organism grows? How is that logic encoded in the genome?
Eric Davidson did a bunch of pioneering work meticulously "debugging" this spatiotemporal genomic logic in the sea urchin. Pretty amazing. Eukaryotes like us have control elements directly upstream of our genes (trans-acting aka close acting) and also 100,000's of base pairs distant (cis-acting). The region of DNA directly preceding the beginning of an open reading frame at the start of a gene usually has a sequence of DNA motifs that bind proteins that can increase or decrease expression of the gene. Davidson and others showed that the transcription factor proteins that bind to these control motifs actually have additional other proteins that bind to them, in literally a layer on top, and that the sequences of proteins in this second layer recruit a tertiary layer of proteins that conditionally cause more or less gene expression, depending on their identities. You could say the secondary and tertiary layers are a form of "abstraction" in a literal sense, since they encode a hierarchy of logical operations.
Here's an open-access overview of Davidson's work which incidentally illuminates a lot of these concepts in more detail for a lay audience: "ERIC DAVIDSON: STEPS TO A GENE REGULATORY NETWORK FOR DEVELOPMENT" by Ellen Rothenberg, 2016; doi: 10.1016/j.ydbio.2016.01.020 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4828313/
to see the decoded logic in pseudocode and with a diagram, see "cis-Regulatory control circuits in development", Howard and Davidson, 2004, Developmental Biology, vol 271, https://doi.org/10.1016/j.ydbio.2004.03.031 (open access)
