"Federal funding typically covers 80% of bus purchases, with agencies responsible for the remainder."
Well, there is your answer. The one making the purchase isn't the one primarily paying for the purchase. This makes them less sensitive to pricing.
Kinda like how expensive healthcare is since it is paid for by insurance.
Or how you don't care how much you put on your plate or what you choose to eat at an all you can eat buffet.
The second you detach the consumer from the price of something, even through an intermediary such as health insurance, that is when they stop caring about how much something costs, and so the price jumps.
I'm convinced that a great majority of problems in the US these days fundamentally boils down to principal agent problems. The 2008 financial crisis is a great example. Once banks no longer kept mortgages on their own books, it just became a matter of time until that was going to blow up. The incentives change.
Your personal life is abundant with meaningful human activity that cannot at all be explained by money incentives. The principal agent problem has this same problem: once we stop talking about money, “interests” can be vague and overlapping, making the problem disappear with scrutiny.
To me, a great majority of problems in the US fundamentally boils down to people looking for markets and money where there aren’t any. Great examples include rising healthcare costs (what is the right price to pay for saving a child’s life, for example? Culturally, it’s basically unlimited!) whereas rising legal costs are NOT seen as a crisis (suing other people over BS grievances, unlike saving lives, is not compulsory); infrastructure investment (cars don’t make financial sense everywhere and everything all the time, but they’re REALLY cozy, so we will spend exorbitant amounts of money on infrastructure for them compared to everything else); the obesity crisis (eating feels GOOD, even if it costs EXORBITANT amounts of money); worsening education outcomes; lack of growth of alternatives to single family homes…
> To me, a great majority of problems in the US fundamentally boils down to people looking for markets and money where there aren’t any.
Your examples are mostly things where there are, though, e.g.:
> rising healthcare costs (what is the right price to pay for saving a child’s life, for example? Culturally, it’s basically unlimited!)
This is confusing value with cost. If you had to pay a million dollars to save a child's life, maybe that's worth it, but that's not the problem. The problem is that so often we could have saved the child's life for $100 but for various bad reasons it ends up being $100,000 instead, and the people getting the other $99,900 want to keep it that way.
> whereas rising legal costs are NOT seen as a crisis (suing other people over BS grievances, unlike saving lives, is not compulsory)
Isn't the problem with the rising legal costs mostly on the defense side? You can't prevent someone from filing an unmeritorious lawsuit against you, or avoid hiring compliance lawyers to tell you what to do to prevent that from happening, so it matters when those things get more expensive. But then the compliance lawyers and their lobbyists like it to get more expensive because they're the ones getting the money.
> infrastructure investment (cars don’t make financial sense everywhere and everything all the time, but they’re REALLY cozy, so we will spend exorbitant amounts of money on infrastructure for them compared to everything else)
People who hate cars say this but we mostly spend money on cars because everything is too spread out for mass transit, which brings us to this one:
> lack of growth of alternatives to single family homes
Markets are great at solving this. If it wasn't literally banned in most of the relevant places, developers would be replacing single family homes with higher density housing all over and people would be buying it.
> the obesity crisis (eating feels GOOD, even if it costs EXORBITANT amounts of money)
Government subsidizes the production of high fructose corn syrup, which does this:
I don't think I do. Are you going to run a bus every 15 minutes down a road that would have one passenger an hour? Mass transit isn't viable at the density of the suburbs but building higher density there is banned.
We've incentivized cities to develop around highways and the automobile infrastructure instead of building them for mass transit. You need cars because we build for cars.
It's not that we've incentivized cities to develop around highways, it's that we've prohibited them from doing anything other than that.
Zoning boards put a tiny little strip of commercial and high density residential in the downtown and then require the whole rest of the map to be single-family homes. At that point it doesn't even matter what the downtown actually looks like, people are still going to be in cars because it's the only way to get there from the suburbs.
These zoning board decisions were made largely to accommodate cars. For example, in many places, we can't have dense urban housing or commercial unless the developer pays to park all of the cars associated with the new development (so the cars don't consume public street parking). But this means we end up surrounding buildings with these giant parking lots which creates more space between each building, putting downward pressure on walking/transit and upward pressure on driving. This also means you need more lanes to accommodate the cars (the additional lanes also create more space between buildings and make pedestrian traffic considerably less desirable, putting more upward pressure on driving).
Tangentially, the additional length and width of roads as well as the traffic lights all constitute an increase in infrastructure costs while also reducing the amount of revenue generated per unit space (because so much more of the space is for streets and parking).
The space between buildings thing is a red herring. If you want an area full of tall buildings, there must be a significant amount of space between them to let in light and fresh air. You could hypothetically use that space for greenery or something instead of lanes and parking but you can't get rid of it and use it to increase density. Moreover, it isn't actually a density limit anyway because you can make the buildings taller instead of wider, and you can build a parking garage under the building rather than beside it.
The real thing minimum parking requirements do is increase cost, because building parking floors costs money. But that isn't nearly as much as the cost increase from zoning most of the map exclusively for single family homes, because that's the thing that makes the land expensive, and on top of that requires you to use 15+ story buildings in the limited area that allows them when you could have the same average density by using 3-5 story buildings over a wider area.
Moreover, you can't put the cart before the horse. If people currently live in the suburbs and arrive in cars, you can't expect them to walk before you allow anyone to build them housing within walking distance.
> The space between buildings thing is a red herring. If you want an area full of tall buildings, there must be a significant amount of space between them to let in light and fresh air.
First of all, I don't think anyone's goal is "an area full of tall buildings"; that's certainly not what I mean by "density" (although it is _one kind_ of density). Secondly, even in urban areas full of tall buildings, there's frequently much less space between buildings than a CostCo parking lot.
> Moreover, it isn't actually a density limit anyway because you can make the buildings taller instead of wider, and you can build a parking garage under the building rather than beside it.
Building vertically is expensive, and in many places land is cheaper, so it's easier to meet the legal requirement by surrounding the building with pavement than it is to build a parking garage beneath the structure. This is why you rarely see a Walmart with an underground parking garage (and when you do, it's usually in a dense city with more lax parking regulations).
> Moreover, you can't put the cart before the horse. If people currently live in the suburbs and arrive in cars, you can't expect them to walk before you allow anyone to build them housing within walking distance.
I think you're confused about what is being advocated. No one is suggesting we make everyone walk to work. I don't think that's a realistic outcome, and probably not a desirable one for many people (who wants to work close to a factory, airport, etc)? More importantly, relaxing parking requirements on developers doesn't make the existing parking lots go away, so it doesn't really affect the current crop of commuters; it just means that future suburban commuters will lean more on public transit to get to work.
You are right but in a roundabout way. It’s true that most problems in US can be explained by this but it’s also true that the west and US particularly are successful because they can bypass the principal agent problem to an extent.
You just have to look at India or Africa a bit to understand the severity to which this problem permeates day to day in these countries.
No matter how poorly one thinks of westerners and their leaders, it is clear that in general they can look beyond themselves and their immediate surroundings when optimising their impact.
The same cannot be said about Indians and other poor people from poor countries. Their optimisation lies solely on themselves or immediate family. This has consequences at every level and even at the political level.
It is just the case that the west and its leaders have had the luxury of choice and have only seen relative poverty but not absolute poverty for various reasons.
When your are poor and basic necessities are difficult to meet, its natural to optimize for self and not care about the big picture.
This is not correct. First, in crisis situations people tend to cooperate more, even though naive model predicts that people would act in self-interest. Second, there have been cases of countries that collectively decided not to be poor, and they stopped being poor once external pressure has been removed. Case in point is a huge part of Eastern Europe after the fall of communism.
“America’s sophistication is reflected in the depth of its financial markets. It is unusually good at creating tradeable claims on the profits and revenues that its economy generates. In a more primitive system, these spoils would mostly accrue to the state or tycoons; in America, they back a vast range of financial assets.”
It takes more than just misaligned incentives to get a banking crisis -- you have to have structural corruption preventing the transfer of
the loss gradient back to the "misaligned" decision makers. It's somewhat disingenuous (or overly innocent) to reimagine the pathways which power structural corruption as "innocent ignorance in the face of bad incentives".
The real world has "actually bad" actors -- not just misaligned incentives.
> It takes more than just misaligned incentives to get a banking crisis -- you have to have structural corruption preventing the transfer of the loss gradient back to the "misaligned" decision makers.
Nah, you can do it just on the basis of information asymmetries.
Banks can sell mortgages. People think buying mortgages is safe, because banks don't loan money to people they don't think can pay it back, and even if they did, the mortgage is backed by the house so in the worst case you can foreclose and get back your principal. So lots of people buy mortgages.
Then banks figure out that it's easy to sell mortgages, and that if they sell them it doesn't matter that much if the people they loan the money to can pay it back. Plus, the less creditworthy people pay higher interest rates, and you can still foreclose if they default. So banks make a lot of loans to people who can't afford them, and then sell the mortgages, and people still buy them.
Except that if this happens at scale, the people taking out mortgages they can't afford bid up the price of houses. And then when they start to default and you want to foreclose, you'd have to sell the house to get back the money, which at scale means that the prices would go back down to where they were before they got bid up, which means you wouldn't even recover your principal.
If everybody realizes that this is what's going to happen then people wouldn't buy bad mortgages from banks and then banks wouldn't issue them. But if enough people don't notice until after the bubble is inflated...
You can sit them down and explain precisely why buying something, like a new car, is a bad financial decision and that they cannot afford it anyway, and then watch them go buy it anyway. To the point where I have seen people laugh about how dumb of an idea it is, while in the act of doing it.
The "I wish someone explained to me..." that comes later when it all falls apart is largely just licking the wounds of their damaged ego.
> You can sit them down and explain precisely why buying something, like a new car, is a bad financial decision and that they cannot afford it anyway, and then watch them go buy it anyway. To the point where I have seen people laugh about how dumb of an idea it is, while in the act of doing it.
And this is actually fine because it comes with its own integrated stupidity penalty. We only need the government to impose a penalty if the person who needs the disincentive when making a decision is different than the person being affected by it.
This is a big "hell yes" for me! Some seem to think that mortgaging themselves up to their eyebrows with huge houses and the latest vehicles is a good idea. As an example: I needed a pickup truck back in 2021. I settled on a ram and purchased the base model. The only options were a towing package and the medium level smart audio/display system for a cost of $27K. I could have easily spent $50K and got a whole lot of other options, but determined the extra cost was too much and the options weren't needed. (The only reason I purchase a new one is people tend to drive like maniacs in trucks where I live, so I didn't trust a used one.)
I digress, the numbers alone are the reason for the base model, because I could use the extra money somewhere else. And yes, new vehicles do depreciate too much. However, if you keep the vehicle for it's entire lifespan, the hit isn't so bad.
You skip over a very important step here, where people keep buying the MBSes because the ratings agencies are knowingly rating the securities incorrectly. If that didn't happen, the market would be too small to blow up in the way that it did, all of the safe money can't invest if the MBSes aren't AAA.
It's not that no-one noticed in time, it's that the people responsible for noticing were paid to pretend they hadn't. That is the corrupt part.
What they were doing was, they'd take a bucket of high risk mortgages and apply a contract to them to retroactively sort them. So, if you bought the 30th percentile of the bucket and then anything more than 70% of the people in the bucket paid their mortgages you would get paid, and if fewer than that did then you wouldn't.
Then they were rating the highest percentiles in the bucket as AAA because even for borrowers with bad credit, the probability that such a high percentage of them would default was considered very low. Even for people with bad credit, default rates are usually only something like 10%.
But that doesn't work out if you haven't noticed that banks have stopped caring about the default rate when issuing mortgages.
I disagree with the characterization of structural corruption. Every rationale actor will seek to capture all the benefits and pass on the risks. The real corruption is when decision makers know that they can’t be held responsible through corporate or political structures. See also [moral hazard](https://en.m.wikipedia.org/wiki/Moral_hazard)
Throw in confirmation bias https://en.wikipedia.org/wiki/Confirmation_bias and you have a lot of inertia from changing. Not only do they not have the right info, but because they have invested in the ongoing solution, it is difficult to get any change going because humans tend to simply see everything as supporting their current viewpoint.
> The second you detach the consumer from the
> price of something, even through an
> intermediary such as health insurance, that
> is when they stop caring about how much
> something costs, and so the price jumps.
In reality, this claim doesn't survive a cursory glance at the OECD's numbers for health expenditure per capita[1].
You'll find that (even ignoring the outlier that is the US health care system) that in some countries where consumers bear at least some of the cost directly via mandatory insurance and deductibles, the spending per capita (and which survives a comparison with overall life expectancy etc.) is higher than in some countries where the consumer is even further detached from spending, via single-payer universal healthcare systems.
Or, the other way around, it's almost like it's a very complex issue that resists reducing the problem to an Econ 101 parable.
If consumers actually directly paid the whole cost for health services (as opposed to a fixed price, like a $20 copay, etc.), the prices charged would become far more regular.
An easy way to examine this is to compare the price of over-the-counter versus pharmaceuticals. If a third party weren't paying for them, the price would have to either come down to something affordable to the average person, or else the market for it would shrink to only the wealthy.
I'm aware of your and the GP's claim, I'm saying it doesn't survive contact with reality.
If you look at e.g. the per-dose price of insulin it's as low or lower in countries with single-payer universal systems, where someone requiring insulin is never going to have any idea what it even costs, because it's just something that's provided for them should they need it.
In that case it's usually some centralized state purchaser that has an incentive to bring prices down, or a government that has an overall incentive to keep the inflation of its budgetary items down, which ultimately comes down to public elections etc.
In any case, a much more indirect mechanism than someone who'd be directly affected paying the costs associated with the product, which directly contradicts this particular argument.
Why do you even argue against someone that doesn't think "insurance" should exist? Its a troll, not even most serious libertarian freaks are that idiotic. Our goal should be to make sure these freaks have no power.
OF COURSE single-payer means lower prices, the government has a shit ton of power in negotiating prices if they want to. They don't want to because they are corrupt, freaks like the above are only there to rationalize the theft. They need to be defeated politically.
The original argument wasn't against public healthcare per se, but against the US system in which it really is run as insurance, with multiple competing providers, who therefore don't have the power to negotiate down prices.
It's very easy to find examples of abuse in this system. For example, in modern "factory towns" around corporate campuses, somehow, routine dental maintenance costs exactly the maximum amount provided for this purpose by the employee health plan.
> If consumers actually directly paid the whole cost for health services, the prices charged would become far more regular.
Which is arguing against the very idea of insurance which distributes risk, its an absurd argument not even libertarians make. The problem for literarians/neoliberals is that we already have exactly the system they think should work great, it just doesn't, but they completely refuse to ever recognize that the reason it doesn't work is systemic and it will never be fixed by more literarianism/neoliberalism, we need to shove it. Whats needed is a single-payer, universal, zero(!!!)-private, public health care system.
Why insist on single payer? It's not even dominant in Europe, and it makes the whole thing a much harder sell politically, yet there are no clear evidence that single payer is superior to other public healthcare arrangements.
> OECD's numbers for health expenditure per capita[1].
Interesting that the graphs use PPP, but that the age-adjusted graph still shows the richer OECD countries spend more than the poorer ones. I wonder what's up with that.
These reports tend to ignore how fast you can get a specific service or test done. There is plenty of anecdotal data out there that in US you can get CT or MeI the next day, while in many countries in the EU you have to wait months.
I think looking only on the spending per capita tells us nothing about accessibility of service, and its quality. Once you start to consider those things, imo, the whole thing is not as a clear cut as it looks.
It's also a mechanism for some governments to cheat, because medicine is R&D-intensive.
Suppose that to devise some treatment for 10 million people worldwide, it costs a billion dollars once for R&D, i.e. $100 each, and then $10 more per person to actually manufacture it. So the average person will have to pay no less than $110.
Then some countries say "that costs you $10 to manufacture, we won't pay more than $40" and if you don't take the $40 you can't sell there at all. So, if you don't recover $30 of your R&D per person there then you recover $0, even though you need to average $100.
If everybody does that it doesn't work; they go out of business. But suppose that half the patients live in those countries and the rest live somewhere that the company can charge enough to sustain themselves, i.e. in those countries people have to pay an average of $180 instead of $40 so the total average can stay $110. Then they don't go out of business, but the countries not paying their share are cheating the people in the other ones.
And to add insult to injury, you then hear the people in the countries paying $40 saying "why are you paying $180 instead of doing it like we do"?
Yeah that’s the story people tell. On the other hand, I need to take a brand name version of a medicine that was patented in the early 20th century, and in the US the co-pay alone costs me $200/mo or more (not including what insurance pays) while I can buy it from Canada for $30 without insurance. (The generics cost a similar amount, but don’t work as well due to bioavailability issues.) So while I appreciate the idea that high US prices are all about R&D, I also have pretty visible evidence that US pharma will just charge whatever the market will bear, even for drugs that are long out of patent and inexpensive to manufacture.
The trouble is that it's both things at the same time. Countries that fix prices are paying less than their share of the R&D and the US market has bad regulations that unnecessarily limit competition.
The situation you're describing can happen in one of two ways. The first is that the more bioavailable version wasn't patented in the early 20th century, only the less bioavailable version, and then the version you like is still under patent and that's exactly what's supposed to happen. They get to charge a lot until the patent expires as the incentive to invent the more bioavailable version to begin with, and then Canada isn't paying their share and the US will be paying less when the patent expires, and if you don't like what they're charging then you can use the old version until the patent expires.
The second is that nobody is making a generic of the more bioavailable version even though the patent is expired. The US could and ought to fix that by remediating whatever regulation is impeding other companies from entering the market even though they should be able to. But then we're into a different problem because it can't be other countries not paying their share for something still under patent if it isn't still under patent.
>The second is that nobody is making a generic of the more bioavailable version even though the patent is expired.
I've been taking this drug since 1995 and the brand-name version has been in production (in its current format) since 1938. I don't think there have been any substantial improvements in the formulation in decades (as evidenced by my dosage, at least.) It certainly isn't expensive due to patents.
What's happening here is that in the US generic alternatives are supposed to demonstrate bioequivalence (meaning the same bioavailability), but the standards are lax and not well-enforced. Insurance formularies aren't going to spring for a brand-name drug formulation that costs 10x when the government has certified the cheap generic as bioequivalent. Manufacturers of the unpatented (but more bioavailable) brand-name drugs know that in reality some subset of their patients will need their formulation to keep blood levels stable, which means that in the US they can crank their prices way up and soak a bunch of sick people. In Canada they can't do this. Nothing about this is really defensible.
Which brings me back to the larger issue. High US drug prices can be due to both (1) recouping R&D costs and (2) greed, but the greed is enough to render our current system unworkable. You can't just assign manufacturers a monopoly and the right to charge whatever they want, and expect that they won't abuse this to soak desperate sick people with prices far in excess of their costs (as they are clearly doing.) So yes, you can point to the cost of R&D as one reason we should all (globally) pay more for some drugs, but you can't really use the need for R&D to justify the US system, which is inefficient and dangerous.
Here's the part where it seems like we're still missing some information. There is an unpatented formulation of the drug which is better enough that patients are willing to pay a large premium for it, but there is only one company making it. It can't be that the other companies don't like money, so what's the actual reason?
I think you misunderstand how US drug purchases work. There is very little competitive market whatsoever anywhere in the prescription med system; there are simply "brands" and "patented meds" and "generics" plus various underserved niches where pharma companies can extract high prices from desperate patients (see e.g., Martin Shkreli and Daraprim.)
With respect to generics, there's little incentive to make a better formulation. If patients have insurance, they'll get whatever "bioequivalent" generic is available from the pharmacy if it matches the insurance provider's formulary price requirements. That manufacturer can change any time, since by law they're all deemed equivalent. It's like buying generic store-brand ibuprofen: you have no idea which factory is actually making the stuff, and it can change from package to package.
There's also very little benefit to having a "brand name" generic that has better bioavailability since you really can't charge more for it: insurance companies and pharmacies will just switch to another generic brand with lower costs. Trying to argue better bioavailability could also involve admitting that your existing bioequivalence studies are bunk, which would require an expensive new certification process. Plus, even in a functioning and truly competitive market, trying to experiment with different formulations to figure out which "gets better results" is a dangerous game for individuals; it's not like buying different Kleenex and deciding which holds together better. You have to do a lot of risky trial and error and get frequent blood tests.
So basically we have a system that ensures a completely non-functioning non-competitive market, and then we throw in an exclusive term where new medication can be sold at any price and we expect market forces to somehow constrain manufacturers. But the market forces are very weak and limited here. When we clearly end up paying dozens of times more than other countries (even for unpatented medicine) people raise the R&D issue to justify the costs. But that's sort of like saying "hey, the Mafia spends a lot on churches, so their extractive business model is fine." If you really want churches (or R&D) we should find a more rational way to come up with those funds.
I was kind of curious if there was some specific failure with this outside of the general brokenness of US healthcare competition, but it's starting to sound like the classic one:
The biggest problem with US health insurance is that it's not actually insurance. The purpose of insurance is to cover major claims. If a storm does $30,000 in damage to your house, you file an insurance claim. If it does $30 in damage, you go to the hardware store and pay $30. But we expect health "insurance" to cover the little stuff. Health insurance should be for if you get cancer or need major surgery, not for a generic drug that ought to cost $30.
Which in turn is what messes up what could otherwise be a competitive market. Instead of picking who you want to buy the drug from, most people have insurance, and the insurance company picks. And then most people get insurance from their employer so they also don't get to pick their insurance which makes the insurance company unresponsive because the patient can't easily switch.
And then it sounds like what happened is that the manufacturers make nearly all of their sales through insurance, who only care about regulatory compliance, and there aren't enough people paying out of pocket to get them to compete on actual quality.
But the other problems shouldn't be there if we could get people actually buying what ought to be cheap generics themselves instead of through insurance:
> Plus, even in a functioning and truly competitive market, trying to experiment with different formulations to figure out which "gets better results" is a dangerous game for individuals; it's not like buying different Kleenex and deciding which holds together better. You have to do a lot of risky trial and error and get frequent blood tests.
This wouldn't be something most people would have to do themselves. If there are five companies making the same drug then forums for people with the condition it treats would have people already taking each of them, and if some of them are actually not right then aggregate data should show that, and then everybody would find out without each person having to do their own trials.
And somebody needs to be doing that anyway or you're going to have a lot of people whose medication is wrong who don't realize that it's because they're not getting what they paid for while the one that works is available from someone else.
> When we clearly end up paying dozens of times more than other countries (even for unpatented medicine) people raise the R&D issue to justify the costs.
But then we're back to, the trouble is that it's both.
And then people propose to have the government set prices, which is only trading one problem for another. Whereas what we ought to do is address the things causing the markets that are supposed to be competitive to not.
Well, US health insurance is insurance. That’s one function. But it’s also managed healthcare. The management is being performed by a series of large corporations with somewhat broken incentives, with the government backstopping and certifying everything and filling in all the gaps. That’s why other countries achieve such better results with government-managed healthcare, because our system genuinely has very little relationship with the free market and already is a kind of planned system; it’s just an exceedingly inefficient planned system.
But the lesson you should take from this is not “we should just deregulate it a bit and hope the free market takes hold.” This is the planned system we designed in one of the most capitalist countries on earth: it got to the state of being a planned system because the truly competitive market systems kept failing. I’m not sure where you can go to find a truly competitive system that isn’t in some way underpinned and supported by the government (and the US government specifically.) People often point to third world countries where they can pay cash, but I think that’s mostly just rich US people buying luxury healthcare at lower prices, not a real working free-market health system that delivers broadly-shared results.
You have to entertain the hypothesis that when the ideal “free market system” exists nowhere, the reason is because the free market system was tried (here in the US, even) and it worked so poorly that it was replaced with one of the systems that survived. Because that’s the pattern we see everywhere with healthcare (and with roads and fire departments, too, outside of a few exceptions.)
The pharma investment problem is a problem, but just to be clear: it’s a question of financial allocation. There are many ways to solve it that aren’t what we have right now.
> This is the planned system we designed in one of the most capitalist countries on earth: it got to the state of being a planned system because the truly competitive market systems kept failing.
We didn't really "design" it though, it emerged organically out of the various constraints, many of them historical.
For example, why is quality health insurance in US tied to employers? Because during WW2, when federal government froze salaries, companies started to use various benefits to attract employees instead, and one of the most lucrative benefits turned out to be health insurance. And, since companies were large customers negotiating on behalf of all their employees, they could get more out of insurers for the same amount of money. And so gradually it evolved into what things have been before ACA, and ACA is basically a crutch that preserves this historical nonsense.
FWIW I don't think that free market is the answer here, but that doesn't mean that it can't produce significantly better results than what we currently have (it's not hard because our existing system essentially combines the downsides of free market with the downsides of centralized healthcare - you don't get the choice and you get fleeced).
It should also be noted that there are many different ways in which less-than-free market can be implemented. Single payer is a fairly extreme take with no clear evidence that it works better than more market-friendly approaches as seen across Europe. The one model that I'm really curious about and that doesn't seem to exist anywhere, though, is one where the government simply provides healthcare at a certain level as a non-profit public service, thereby setting the baseline, but doesn't try to heavily regulate private healthcare, and doesn't require citizens to participate in the public plan. Germany has some similarities but I don't think it's quite there yet.
I have a $6500 deductible. I definitely care what things cost because my insurance almost never actually helps pay for anything unless I have an unbelievably bad year.
The problem is that literally nobody can tell me how much anything is going to cost until I get the bill in a month. Not even because they don't want to tell me. Nobody at the desk even knows what my price is going to be because it's all numberwang.
Not defending insurance but theoretically you do also get a better rate than the uninsured rate just by having it go through the health insurance.
I say “theoretically” because I’ve also heard they’re often willing to cut some pretty good deals if you don’t have insurance and pay cash. And I mean “good” relative to the initially billed amount, not “good” relative to what it should actually cost.
Yeah, I suspect this is very country and region specific.
In my country I don't have health insurance. I've noticed that medical providers charge me less on discovering that. Party (I suspect) because I'll pay immediately so there's no financial cost (ie cost of delayed cash flow) and much lower admin cost (ie they don't need to deal with insurers.)
In some places I've seen signs advertising 30% discount if you "pay now, claim back from your insurance yourself". This informs my hypothesis that providers see the insurance system as a major overhead.
No, it’s the opposite actually. There are a couple of reasons why:
1. You have a deductible. Insurance is incentivized to make things more expensive so you don’t use it. With a $10,000 deductible, are you going to pay $500 for a service outside insurance or $2,000 with insurance?
2. Hospitals really have no idea what anything costs. Nobody does. There is a maze if agreements between providers, contractors, hospitals and insurance companies. If you have insurance, hospitals are more likely to throw out a higher random number;
3. There is more process and paperwork for the hospital with insurance; and
4. You are more likely to be able to negotiate down a bill without insurance.
I was told it's also illegal in the US for a hospital to bill you as uninsured if you have insurance.
You won't get in trouble but the hospital will, but if they ask if you have insurance and you say no when you do, that could change the situation.
Again, I'm not a lawyer but this was they told me once a few years ago because I got charged a ridiculous amount for something and wanted to see if it would be cheaper if I just paid without insurance considering my deductible was many thousands of dollars.
This is correct. I have been in situations where I am told the cash price and then "I cant tell you how much it will be with your insurance". Come to find out cash was A LOT cheaper. They cant undo it.
I have also been in a situation where insurance price was cheaper.
Thereinlies the problem..without know the price people CANNOT make an informed decision. There is no freemarket. This done on purpose and only happens in America.
I always view the initial billed amount as the MSRP for a really shady industry.
While it’s often 2x-3x the allowed amount, I’ve even seen it closer to 20x-40x one — an amount for a simple outpatient procedure the would lead to financial ruin if it had to be paid in full.
I really don’t understand why there is any math in the initial amounts.
Why don’t they just bill $1M for every single item and then see what they get?
Every time I’ve gotten a large bill that hit my deductible, going back to the provider and asking to pay cash without insurance has resulted in a lower bill.
You care about small costs but not the large ones. Even with a relatively large deductible it’s irrelevant to you if your hospital charges $50k or $90k for a surgery.
$6500 is nothing once surgery, radiation, and/or anesthesiology enters the picture.
Absolutely, there is room for price shopping for a subset of medical treatments. https://surgerycenterok.com is a well-known cash-pay surgery center. If you look through the procedure list, you can see the types of things that lend themselves to this model: lots of orthopedic surgeries, things that are fixes for chronic issues that don't really need to be dealt with on any specific timeframe.
But when you get into the really big, serious, time-sensitive things. Cancer treatment, heart disease, anything that starts with an ER visit... you don't really have an ability or time to "shop around". The demand is inelastic.
The funny thing is there are only a few insurance companies (BCBS, Aetna, United, …) and types of plans (PPO, HMO, EPO).
I could be misinformed but I feel like there are only a few possible combinations of one’s actual coverage.
A simple spreadsheet could easily track everything. The providers even know how much they get from each company, so they know the allowed in-network cost for a patient.
My understanding is that this is only really true for straightforward things like, say, a therapist. If they only have a couple of codes that they bill and they accept a limited number of insurance providers, then they can probably tell you what you'll pay (although I believe there are still a lot of edge cases).
However, if it's something like a surgery at a major health system, then it's way more complicated. The health system can't be as selective about what insurance they take, so they're dealing with medicare, medicaid, plans sold on the individual/small business market, and employer-sponsored plans. So way more than a few providers and a few types of plans. I checked the stats for my state and just the individual/small business market is 12 providers and 250+ plans. Medicare Advantage is at least 14 providers. A major hospital system probably accepts thousands, if not tens of thousands of different types of plans. Then you have to consider that the anesthesiologist, the surgeon, and the facility are all separate providers who may not all take the same insurance.
Different plans from the same company, even of the same type, don't always cover the same things at the same rates. This is especially true of self-insured plans for large employers - there's certain mandatory things they legally have to cover, but anything beyond that is all up to the individual employers' discretion (since they're paying all the claims directly, as opposed to paying a monthly per-participant fee).
> Kinda like how expensive healthcare is since it is paid for by insurance.
If your argument were correct, socialized medicine would lead to higher costs, but it usually does the opposite. Insurance profit margins are a small portion of the overall cost in the US. In inelastic markets, when profit is removed, often you can see lower costs because profit by itself is purely extractive and in an inelastic market competitive forces are weaker.
One of the controlling factors for socialized healthcare is that prices are negotiated down by the people paying for the medicine. In countries where private healthcare is extremely rare, pharmaceutical companies can choose between "less profit" or "no sales in that country at all". Sometimes they bluff and in rare cases that means public healthcare has to go without certain medication or certain vendors, but on the whole the price is kept under control (until corruption kicks in, at least).
When the people handing out cheques don't get a chance or don't bother to demand lower prices, things become incredibly expensive. Even if a party like a private insurer tries to negotiate the price down, the healthcare provider can always say "tough shit, guess your customers aren't insured then" as long as there's at least one insurance company willing to pay the full price.
You also see this with electric vehicle incentives. Governments incentivising people to buy electric cars by giving money directly to the consumer just end up with electric vehicles rising in cost because the money is essentially free anyway.
Subsidies, depending on the market, often produce some degree of the effect you’re talking about, but it’s not black and white. The term is pass-through and full pass-through is rare with partial pass-through being typical. Often with subsidies (like for EVs) prices rise (showing pass-through) but it rarely cancels out, for example this study showing every $1000 of subsidy in California lowering the post-subsidy cost by around $800 - https://www.sciencedirect.com/science/article/abs/pii/S00472... - so only around $200 pass-through.
But this is a more elastic market than healthcare. To your point about negotiating power - it’s elasticity that gives negotiating power to consumers vs not.
I don't know. I live in a country with excellent healthcare, excellent public transport, overall excellent quality of life - yeah, and so much of it is funded from our taxes. Granted, the country was rich to begin with, but it seems to be perfectly sustainable.
Posts like these on Hacker News are quite interesting bc if this scenario comes up in any "left vs right" debate, it's always shot down as a terrible concept and idea to keep the government out of it.
Even when it's not the insurer, it's at least a hospital. Many a doctor around me that used to have a private practice sold to one of the hospital chains, as they promised more money than by owning, solely due to superior collective action advantages. A large insurer can bully a private practice into cutting costs, but a hospital network that handles 40% of ERs in the metro area? The insurance company can lose. So everyone makes more money but the people paying insurance.
To be fair, this is because there's long-standing [but disputed] evidence that healthcare providers drive up costs/utilization when they can refer to hospitals they have equity stakes in.
Not quite true. If you own the providers, getting people to pay deductibles and copays (i.e. getting treated) will yield way more money than just having them pay premiums.
Correct, which is another reason why they are buying the healthcare providers. It allows the insurers (“pay-viders”) to strong arm independent doctors and smaller insurers out of the market.
The insurers are legally obligated to pay out 80-95% of their premiums for treatment. So the only way to grow profits is to spend 2x and much and charge 2x as much. Sure you only make the same 5-20% margin, but it's on 2x the revenue so it's 2x the gross profits.
Uh, no… they want to deny claims. The best situation for insurers is that you are healthy for a while, then abruptly die of something that cannot be treated.
Uh no, they don't. Not if they're also the ones who provide healthcare. Simply denying claims isn't even remotely close to the financially (and obviously not the politically) optimal strategy.
The optimal strategy if you own both the insurer and the provider is a combination of premiums, copays, deductibles, and maybe even some totally unnecessary care to drive up volume.
Lower margin on dramatically higher volume is still dramatically more money. Lower margin actually provides political cover for your $400 billion revenue years.
You first have to agree on a definition of free in this context. When Adam Smith was writing the Wealth of Nations most of the transactions in the market were between entities with more or less comparable power. Local people bought stuff from local suppliers. This is very much not the case any more when it comes to transactions involving private individuals on one side and corporations on the other.
This is true but beside the point. I don't care either way what you count as a "free" market or whether such a thing exists, you can just say that health insurance is less free than almost any other market.
It makes a ton of sense in theory. In a fair market, you would want to prevent the insurer from charging super high premiums that let them make a large profit relative to the cost of care provided.
The problem is that it doesn't stop there. There is a second order effect.
As noted by sibling comments, the arm of the Healthcare company that wons the doctor's office wants to collect as much as possible, while the insurance arms are anyway capped at how much they can make. Incentives (conflict of interest) are towards paying more.
Governments of countries that have public health care generally are price sensitive. The competition is from other governmental functions that need the budget.
That's less a matter of price sensitively and more that other countries usually have price controls on healthcare. That's why doctors make so much less and drugs are so much cheaper outside the US: it's literally illegal to charge more.
If the feds are mandating USA manufacture in order to secure the funding for the muni.. then it just really amounts to welfare for the bus manufacturer.
Which is probably the right way to support american manufacturing.
Isnt it a little onesided to put blame on the payers for price insensitivity?
> The second you detach the consumer from the price of something, that is when they stop caring about how much something costs, and so the price jumps.
Why should nobody care about prices? The customer gets subsidizes by another payer, in this case governments that have to authorize budgets.
The reverse could be true too, companies raise their prices in lock step because they want to 'detach' more profits off of production and so, the government steps in to subsidize. So what is the causality chain here? Still the government not caring?
IMO you are putting blame onesidedly on payers and not on the ones in charge of price policy, which would include companies too. I dont understand why people dont apply their critizism of large organisations, like a government, to other large organisations, like a company.
Companies are incentivised to keep costs low and the feedback loop for this incentive is much smaller. What I mean by feedback loop is: the cost of running the company directly affects the stake-holders in a meaningful way. The CEO is probably has stock options and has to hit a target so that they can be paid well. To do so they need to be more sensitive with prices or shareholders or the board will be on the CEO’s behind. There is a direct monetary incentive relation here.
There is one for the government too but the feedback loop is much bigger. If some one in the government makes a suboptimal decision, what incentives exist to penalise them?
> Kinda like how expensive healthcare is since it is paid for by insurance.
This seems different. A healthcare consumer (in the US) is overpaying in large part because (1) they need the coverage (2) they lack the expertise to distinguish between offerings and (3) there simply aren't more affordable offerings.
Single payer healthcare systems feature significantly lower costs and better quality despite that the payer is not the consumer.
It could also be like health care, where the cost goes down when the government is paying for it. In fact my knee jerk reaction to the title of the thread was: Let the government buy generic buses in volume and give them to the localities.
- Govt beaureucreats spending taxpayer money
- Availability of cheap credit for the US govt (the spender is other countries buying the debt)
- Availabiulity of cheap student loans
> The second you detach the consumer from the price of something, even through an intermediary such as health insurance, that is when they stop caring about how much something costs, and so the price jumps.
That's not the only problem with health. It's a very inelastic resource.
If you and your neighbor's have cancer, and I promise to treat whoever pays most, I can safely assume I'm going to be filthy rich. After all, money is pointless if you die, so barring money for descendants, the logical thing is to give me as much money as you can.
It's not just about not caring. It's a system that is wide open for grift. For example, the mayor awards the contract to X, and X in return donates to his campaign reelection.
Fairly accurate assumption to make in this case. Incentives around government spending are structured against close scrutiny of how much gets spent on what and why.
Politicians love splashing their names on papers on how they got a bill passed to spend $X on $GOOD_SOUNDING_PROJECT, and the bigger the X, the better. Government employees are strongly incentivized against the reduction of their own employment should that spending go away. Lobbyists and service providers obviously have a direct interest in ensuring those contracts continue.
Nobody but the taxpayer has any interest at all in ensuring that money gets spent on things worth spending on and, moreover, that the spent money actually achieves the outcomes desired and intended behind those projects. And how much influence does the average taxpayer have on any of that? It rounds to zero.
We need to shut down the government until buses and other wasteful borrowing and spending is eliminated. Local governments should pay for 100% of their buses rather than 20%.
It's even worse, I will use my healthcare just because it is free. I would feel like a moron not get my free physical, bloodwork and other labs every year. If it was $20 I wouldn't bother but its almost obligatory to take something "because its free".
Once I learn something is free it is like I already own it, so now I don't get it if I take it, I lose it if I don't.
Preventative care is free because it saves a tremendous amount of money for the insurance company and physical and emotional hardship for yourself by catching bad things early.
Your view is a commonly-held one, and makes a lot of sense; unfortunately there is very little support for it. One data point to the contrary is the Oregon Health Care Study, which showed that 'free' preventative care increased healthcare spending, but did not improve lifespan or reduce long-term cost.
> On average, Medicaid coverage increased annual medical spending by approximately $1,172 relative to spending in the control group. The researchers looked at mortality rates, but they could not reach any conclusions because of the extremely low death rate of the general population of able-bodied Oregon adults aged 19 to 64.
> In the first year after the lottery, Medicaid coverage was associated with higher rates of health care use, a lower probability of having medical debts sent to a collection agency, and higher self-reported mental and physical health. In the 18 months following the lottery, researchers found that Medicaid increased emergency department visits.
> Approximately two years after the lottery, researchers found that Medicaid had no statistically significant impact on physical health measures, but "it did increase use of health care services, raise rates of diabetes detection and management, lower rates of depression, and reduce financial strain."
But it only looked at two year outcomes, yet you made a claim about long-term health and cost outcomes.
For example, it found that diagnoses and medication increased. If you are diagnosed with heart disease and you begin an intervention, you probably see no change in mortality in two years especially since it took decades for you to progress to that point in the first place.
Anecdotally, if I hadn't gotten tested as part of a long term physical I wouldn't know about stuff that would cause my body to fail much younger than it would otherwise and lead to an early death.
So hey, at least in my case, it worked as the commonly held belief states.
And that study doesn't look at multi-decade long term effects like diabetes, etc. where you need it for a decade (or longer!) untreated (or poorly managed) before it kills ya. But it still kills ya years early.
So even the "raising rates of diabetes detection" in combination with your belief from that study proves you incorrect when people talk long term.
Such a counterintuitive study, when there are highly motivated political actors trying to deprive people of social benefits, makes me highly skeptical. Catching bad things early is almost always better. Diabetes, cancer, heart disease, etc, cost hundreds of thousands to millions of dollars to treat caught late and prevent people from working or doing things they like to do, and mere thousands to treat early while preserving their quality of life.
Cancer, in particular, can be practically free to insurance if caught early. Colon and skin cancer are the poster children. Colon cancer can be treated in the process of doing the screening when caught early. And skin cancer is a pretty minor "just lop off that mole" procedure that also ends up being the treatment.
Letting it grow and catching it when symptoms arise is terribly expensive. The chemo, surgery, scans, and frequent doctors visits are all crazy expensive.
About the only way I could see preventative care not costing less is if you just let the people die and call it god's will rather than calling it a death that could have been prevented.
The challenge is that we have a rapidly evolving GLP/GIP/Other landscape being developed. In other words, you take a risk that the government buys the wrong thing. However, I think with a little push, you could have a highly competitive field to lower the federal cost, and the ROI should be easy to plot.
Actually, you don't need to do everybody all at once. Target the biggest (no pun intended) opportunities first.
The study is looking only at healthcare spending and two-year outcomes, so it doesn't really address people's intuition that healthcare spending is lower in the long term with preventative care.
That said preventative probably does result in more dollars being spent on healthcare; presumably significantly, if not completely, offset by economic benefits like increased productivity and quality-of-life benefits. Analyses that only look at the cost side of the equation IMO are unhelpful.
The Oregon Health Care Study followed patients for 2 years initially, then it was expanded out to 3 years. That's an absurdly short interval.
The idea is that increased primary care services will have benefits 10 or 15 years down the line by preventing chronic disease from reaching a critical state. For example, preventing prediabetes from reaching diabetes and then diabetic end stage renal disease (which would require dialysis at a cost of 5 figures per person per month). You're not going to see that over 2 to 3 years.
Only if nobody does anything to help you. Truly LBJ's "Great Society" That also completely discounts the value (economic, social, and moral) of human life and all the attendant problems a dying person creates.
These free things are preventative. If you take them, the insurance company expects you to need less healthcare in the future, so actually this is a good thing (and not a problem as in the op)!
I looked into somehow hedging against the Mag 7 in my portfolio (which is otherwise almost entirely in an S&P 500 index fund), but it seemed surprisingly difficult for something that is probably quite widely desired.
Though maybe I'm just unsophisticated. And it feels a little hopeless because there's no telling how long the smoke and mirrors will continue working, and whenever it stops, undoubtedly the rest of the economy is going to suffer, too. Bleh.
Investments can never be identical for everyone, but in my case I switched my assets from an MSCI World to an MSCI World ex USA.
For the U.S. market portion I adopted a more complex strategy based on factor / smart-beta investing (making sure that none of the top holdings include AI-related companies).
I'm not completely divested but I'm buying some VFVA as my non-tech fund.
Top holdings are CVS, Verizon and FedEx all at 0.8%. Basically normal companies.
It's amazing how traditional companies have done in comparison to the top of the S&P500 (or really the top S&P10). So I feel the need to buy the other stuff in case the top S&P10 is a bubble.
I’ll add to this, no politician is on your side unless it means getting your vote to keep them in power. It’s hard to be an actual good person and get too far up in politics, especially in today’s environment.
So, yes, I believe they both want tracking to exist, because they both benefit massively from it.
I would add, some politicians are on your side on select matters, most are not.
Sad thing is people ignore a politician's actions and keep applying Yes or No to their marketing statements. They use social engineering wording just to get votes and then they will ignore that standing to support their own action of legislation crafting and voting.
By block and limiting access to information, such as Wikipedia, they are advocating for a dumb populous. Irony is that in order to have a strong national security, an educated populous is needed. They are the ones see beyond the easily deployed social engineering tactics and are better at filtering out misinformation.
So, this cut out the least fit for work. One group heavily cut out would be those without work experience such as kids and other first entering the marketplace.
Fast food is a stepping stone job, and if employeers have to pay more for labor then they will be pickier about it.
Let's think about the reverse. If we cut minimum wage, the sector would be much more loose about hiring first time workers, convicts, or people just not fit for other jobs. The people could grow their skills and contribute more to society, a society where low end business constantly complain about how hard it is to find skilled workers.
High minimum wage contributes to more people on social safety nets living on low fixed incomes because the gulf between that and paid employment becomes too great and there is no low wage on ramp for them.
This is a good attempt at a thought experiment but it doesn’t bear out at all in the evidence.
You need a fixed number of people to run a restaurant, there’s only so many positions to be filled. You aren’t hiring on extra people and spending a certain amount on labor, they’ll just pocket any excess.
You can invest in automation but today that’s at a cost higher than paying a living wage and with lower service quality.
> You need a fixed number of people to run a restaurant
What? Just varying restaurant hours changes labour requirements. Menu complexity adds another dimension. Quality of service another. Restaurants are highly variable-cost businesses.
Yep, I feel you. Let me just explain what I want in detail and one little piece at a time, and AI, make my words become code and I will watch you do it to make sure you don't mess up.
I cut out drinks with sugar in them, eating after dinner, and in general just eating healthy meals.
I lift weights about 3 days a week, and am fairly fit strengthwise.
All this lowered my fat levels down to a reasonable level, but still left me with about 23% body fat and a bit of a belly, and that remained consistent. Trying to diet didn't really cause any maintainable change.
What I found has helped is doing a 24 hour fast once a week. This really means just eating one dinner a little earlier (4:30pm) and then skipping breakfast and lunch and drinking water with electrolytes added.
With keeping the rest of the days calorie intake the same, I have shaved off consistently 1 pound a week and 1/2" from my waistline.
This has been going for 5 weeks now, and I have gone from 23% to 19.7% based on navy body fat formula.
What is great is I have no cravings or feelings that I am depriving myself except for the last 8 hrs of the weekly fast. The rest of the week, I eat well.
My plan is to bring myself down to 15% and then continuing to measure. If I get above 15% I fast that week, if I don't then I don't fast, so it basically becomes like a controllable throttle.
> Trying to diet didn't really cause any maintainable change.
That's not a surprise. Changing diet composition can in the short-run lead to lower caloric intake than what preceeded (e.g. SAD diet), but doesn't guarantee a sustained caloric deficit, which is why controlling for macros like fat or carbs eventually hits a wall. What are you going to do when there are no more carbs to cut? If you have a lot of excess to lose, you can't "intuitively" eat your way down to your target.
The fasts work similarly owing to deficit: a fasted day lowers the average caloric intake for the week (assuming you don't overcompensate other days). As with macros, here again, what are you going to do to increase deficit further? Fast for 48 hours? If with a fast your caloric intake isn't dropping further week-to-week, weight loss will stagnate.
Whichever approach, one of the pitfalls is steep deficit followed by metabolic adaptation i.e. crashing metabolism. This is why it's helpful to keep a small caloric deficit, and incrementally change your intake target. That is only reliably achieved by tracking calories.
I use Cursor as an agent and sometimes I use autocomplete. Both tools are dependent on what you are doing at the moment. I like autocomplete when I am focused in tight on one file. I spell things out in depth in file and start out code and hand pick completions. It brings my mind in sharp on what I am doing. Agent is when I am doing big but simple stuff where I am crafting less in detail. Refactoring and setting up tests and basic shallow framework code.
But this article is on point. All of things listed are more impactful than LLMs
I've been using vim forever, and often use "advanced" editing techniques: macros, .-repeat, :g/.../norm ..., occasional templates.
For certain projects I'd used `vscode` (with the vim plugin!), and there's definitely some helpful bits. The biggest helper for me is/was the `F2-rename-symbol` capability. Being able to "rename" securely in the whole file (or function), and across the project is super-useful.
Working with Cursor and the autocomplete is (often) pretty shockingly good. eg: when I go to rename `someVar` to `someOtherVar`, it'll prompt to `<tab>` and:
* rename the function call
* edit the log lines
* rename the return object value
* ...etc...
In vim, I'd `*` to automatically search for `someVar`, then `cwsomeOtherVar`, (change-word), then `n.n.n.` (next, repeat, etc.)
...so my overhead (by keystrokes) is `*` (search), `cw` (change word), (`n.`) next-and-change. Five "vim" characters, and I mentally get to (or have to) review each change place.
In straight `vscode`, I can do `F2-rename` and that'll get me replace _some_ of the variables (then I still have to rename the log lines, etc).
With Cursor, I make the `cw...` and it's 90%+ accurate in "doing what I probably also want to do" with the single `<tab>` character.
It gets even more intriguing where you'll say `s/foo/fooSorted/` and it automatically inserts the `\*.sort()` call, or changes it to call `this.getFooSorted()` or `this.getSorted( foo )` or whatever.
For "cromulent" code, cursor autocomplete is "faster than vim". For people that can't type that good, or even that can't program that good, it's a freaking god-send. Adding in the `Agent...` capabilities (again, for "cromulent" code)... if you're just guiding it along: "Now, add more tests" => "Now 50% more cowbell!" => "Whoops, that section would be more efficient if you cached stuff outside the loop."
Even then, I have to have some empathy with the AI/Agent coding, "Hey... you messed up that part (btw, I probably would have messed up that part the first time through as well...)". We can't hold them to gold standards that we wouldn't meet either, but treating them as "helpful partners" really reduces the mental burden of typing in EVERY SINGLE CHARACTER by yourself.
I'd describe myself the same as you did in your first paragraph here, and wanted to say that with LSP, your "rename function call" example in vim (well, I switched to neovim some years ago) is (mostly) `<Leader>rn` (default in my LSP setup, I'll paste the relevant line below) when the cursor is on the symbol. That will change the name in all open buffers. Annoying thing is that it doesn't (ofc) change the name in "log lines", so it's helpful to pre-`*` on the symbol name so you can go back and `n.n.n.`. (I've always wanted to "wire up" something to also detect those log lines and change them at the same time, but... ya know.)
The line in my nvim config that sets up the LSP "rename" is:
I mention this because in spite of using vim/neovim for over 20 years, I still learn new things (from HN comments and elsewhere) -- which is part of why I love it.
I don't know if you've ever messed with `ctags`, but I used that a long while back with a crufty, large, PERL codebase.
It was super nice to have "jump-to-definition", but the vim plugin in vscode is very nice (missing a few things, but even `<c-w>hjkl` "does the right thing(!) so they're really trying).
I haven't leaped to nvim (yet?), and the fact that vscode kindof "just works" has prevented me from chasing LSP support or setting up the more "advanced" features, but thanks for sharing!
I'd be fantastical if something similar to that cursor autocomplete were available in a "real" cli-vim. There's things that really bug me about the "hover suggestions" (eg: can't always tell which characters/lines are "real" or "suggested", especially with auto-closing double-quotes suggestions), but when I occasionally drop to a terminal vim for "accurate" editing, I really do find myself missing like "I should just be able to tab-complete the rest of these edits..." and I don't know how to express that in an appropriate "editor" context?
Maybe lean on like a `vimdiff` representation, where you could `:vsplit $ASSISTANT` and accept suggested diffs? (Hmmmmm....)
Probably some super fuzzy thesaurus that will take your words, and create a weighted list of words that are similar to them and so some search matching going down the weighted lists.
Maybe also, they take those queries that needed lots of fuzziness to get to the answer, and track what people click to relate the fuzzy searches to actual results. Keep in mind, what you might think is a super unique "tip of tongue" question, across billions of searches, might not be that unique.
Building a search system to find things can be much more optimized than making an AI to return an answer, especially when you have humans in the loop that can tweak things based on analytics data.
Well, there is your answer. The one making the purchase isn't the one primarily paying for the purchase. This makes them less sensitive to pricing.
Kinda like how expensive healthcare is since it is paid for by insurance.
Or how you don't care how much you put on your plate or what you choose to eat at an all you can eat buffet.
The second you detach the consumer from the price of something, even through an intermediary such as health insurance, that is when they stop caring about how much something costs, and so the price jumps.
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