The open source aspect seems worthy of attention if nothing else. Even if this is a middle-of-the-road scanner - the community being able to customize, improve and support it would be incredible. Especially considering your scanner is considered one of the best despite being over 20 years old.
The way I talk about is is that the value you deliver as a software "engineer" is: taste and good guesses. Anyone can bang out code given enough time. Anyone can read docs on how to implement an algorithm and implement it eventually. The way you deliver value is by having a feel for the service and good instincts about where to look first and how to approach problems. The only way to develop that taste and familiarity is to work on stuff yourself.
Once you can show, without doubt, what you should do software engineers have very little value. The reason they are still essential is that product choices are generally made under very ambiguous conditions. John Carmack said "If you aren't sure which way to do something, do it both ways and see which works better."[1] This might seem like it goes against what I am saying but actually narrowing "everything possible" to two options is huge value! That is a lot of what you provide as an engineer and the only way you are going to hone that sense is by working on your company's' product in production.
I mean, if you click on the first link you will open the paper they are summarizing[1]. It's a meta analysis of 64 studies, so you could certainly go through the studies and look at each population.
However, the actual answer is that all population studies are only gross generalizations that may not apply to you. They are often quite useful because the odds are generally good that they do apply...but it's never certain. Even if you are a member of the studied population your specific circumstances may overwhelm your populations norms.
Yeah, but I am at the tail end of these statistical curves and my life was absolute hell and doctors (but one) did nothing for me. And they kept telling me to eat fiber cause my cholesterol was so high and HDL was too low (30)!
If the meta analysis showed population differences, why did the article not bring it up? This is what is wrong with nutrition research, then never account fro genetics despite the huge about of evidence that it is extremely importnat.
The truth is that fiber does not reduce mortality for everyone by 23%. I would rather not be guessing with science and health. I lived through that and it took me years to get out of it.
I think this is worth considering for younger folks, but I wanna point out how low the numbers in the "medical expense" column are. They're similar (if low) for routine care but if you have an actual emergency you'd have much higher bills. IIRC when my mom had breast cancer she was getting a weekly shot to inhibit the HER2/neu mechanism of her cancer that had a list of $10,000 a shot. As an uninsured person you won't pay list but you are rolling the dice pretty hard. Insurance costs are highway robbery - and also the part of their prices that aren't driven by greed are driven by absurd underlying costs.
It seems like the AIs role was in applying lengthy and complex medicare billing rules - it did not do negotiating and it doesn't seem like the accuracy of its understanding of medicare practices was actually checked. The author reasonably accused the hospital of gouging and the hospital came back with a much lower offer.
I'd be interested to hear from a charge coding expert about Claude's analysis here and if it was accurate or not. There's also some free mixing of "medicare" v.s. "insurance" which often have very different billing rates. The author says they don't want to pay more than insurance would pay - but insurance pays a lot more than medicare in most cases.
It's pretty clear that even access to a potentially buggy and unreliable expert is very helpful. Whatever else AI does I hope it chips away at how institutions use lengthy standards and expertise barriers to make it difficult for people to contest unfair charges.
having hired an expert in this field, I can tell you they aren't really that sophisticated. I found myself with an absolute mountain of cash after an accident as part of a settlement. My medical insurance won't pay claims until I've exhausted that cash. The claims I had were much higher than even the mountain of cash. The lawyer I hired use a pretty effective strategy: he contacted all of the claims against me and told them we could engage in N-way negotiations amongst all the parties until we came to a settlement so everyone got their nibble of the pie. Or they could get X today, where X was some amount that was a bit less than the rate the industry actually gets paid for those services. They all accepted.
The discounts he negotiated left me with tons of cash & were in excess of the fee he charged me.
Yeah, US hospital billing is based on the idea that the patient has insurance and won't really care about what their insurer gets charged. (The wider implications of this are left to the reader.)
For the uninsured this sort of thing is actually really common. Had an online friend who had to get emergency treatment and they sent him a bill for $20k. His response was, "lol I'm uninsured and don't give a fuck about my credit score, so, fuck you basically." The bill was revised to $500, which he paid just to not have that debt on his record.
>The wider implications of this are left to the reader.
IMHO, it's actually worse than we realize. The Medical Loss Ratio requirement is good because it requires insurance companies to spend 80% or 85% of premiums on health care. It's bad because one way for insurance companies to make more money is to have inflated health care prices to justify increasing premiums so they can get 80% of a bigger pie. It also gives them incentives to provide care themselves so they can capture some of that 80% spend.
> For the uninsured this sort of thing is actually really common. Had an online friend who had to get emergency treatment and they sent him a bill for $20k.
I experienced this personally with my own insurance. My bill was over $20k, and it took a year to convince the insurance company that removing a few feet of my intestines was actually emergency surgery. I ended up paying $800. My roommate in the hospital had no insurance and ended up not paying anything (which I did not begrudge them at all, since the reason for no insurance was debilitating back pain that led to unemployment)
Or, the likelier explanation, is that health insurance prices are highly regulated and have to get their prices approved by a government official(s), and B) they don't have a lot of pricing power due to the competition and they are not colluding.
See almost any of the proxy filings and you will see much of the compensation is based on hitting targets other than just revenue, and most of the compensation itself is equity:
> since another insurance company would just steal their customers by having lower
LOL. Meanwhile, in real-life America, there are only four or five major carriers that control the market, and none of them are incentivized to do this "competition" thing you speak of by engaging in damaging price wars. Why would they when continuing to be part of the problem makes them more and more profits each year? See also: military contracting. Do you see them constantly undercutting each other? No, they buy each other, reducing the number of bidders on every contract.
And in real-life America, the only people health insurance companies engage in price wars with is the state insurance regulator who gets to deny requested price increases.
Fascinating observation, thanks for challenging my assumptions here. Just seems to further point out how useless health insurers are, even to their shareholders.
My most sincere wish is that all insurers would be nationalized, every last employee summarily fired, and their HQs all imploded and replaced with memorials to all the people whose lives they have cut short over the years. Not a thing of value would be lost IMO. Worse than paying people to dig holes and fill them in again.
Four or five competitors is plenty for a healthy market.
Where I live, they do compete on price - prices vary by about 30% for similar coverage. They can't engage in the kind of price war you're thinking of since insurance companies, by law, have to maintain a fund able to cover costs, have to get rate changes approved by regulators and are largely banned from price discrimination.
I understand the desire to shift blame entirely onto insurance companies rather than providers. After all, one is all about money and the other is seemingly all about healing.
Heck, when a provider does bill people directly because an insurance company refused to pay, we blame insurance companies - even when the charges on those bills are highway robbery - like those in the article itself.
The fact is, the net cost of health insurance was about $279 billion in 2022. Meanwhile, $3.7 trillion went to healthcare providers, pharmacies and the like for care. The ones who stand the most to gain from higher prices are providers.
Frankly, decades of lobbying from the healthcare provider lobby to enrich themselves should have made it this obvious, but sadly, people see doctors as selfless angels and it blinds them.
Aren't they doing some kind of turf non compete agreement like isps do?
I had read that comcast won't go into century link territory and viceversa, and something along those lines for the major isps, in order be local monopolies and set prices as they like.
I used to live with a guy from Guatemala, who at some point or another wound up at the ER. At the time his insurance apparently had some huge deductible for ER visits so he got the whole bill in excess of $1000. He was going to pay it, so I suggested he just call and tell them he was planning to leave the country and not come back. I told him to tell them there was no way he could pay the full amount, but didn't want to leave a debt out there like this. They lowered the bill to $150 after a few minutes on the phone.
Many years ago, I managed to stab my face with a screwdriver (not my proudest moment), and had to go to the ER. After the stitches, I was asked whether I wanted to pay with insurance. If I did, it was something like $2,000. If I didn't, there was a 75% discount off MSRP. My deductible was like 25%, so it ended up basically being the same out of pocket either way.
The fact that there seems to be a 4x markup means makes me think insurance companies are in bed with these hospitals. If you can mark up prices arbitrarily high, the insurance "discount" is fake.
From what I heard, doctors’ bonuses rates per unit of work are entirely calculated based on the specific hospital’s revenue from medical insurance claims; smaller hospitals can’t get as many patient payouts so their rates are lower and so are not as attractive to doctors compared to hospitals that can scalp well. So the prices do relate somewhat to what the hospital must spend on personnel, even if it’s arbitrarily engineered in the first place.
At Costco Pharmacy I stopped using my insurance plan as the co-pay was more than the no claim cash price. I learned later that my health insurance company owns its own pharmacy and they design the claims process to bias you toward their own pharmacy. Since medical loss ratio must exceed 85% on employer health plans they realize their excess profits by jacking up prices at their pharmacy subsidiary and using their pharmacy benefit manager subsidiary and insurance product to steer you toward overpaying if you just take their suggestion (e.g. $100 if you use OptumRX mail order Pharmacy for the "savings" versus $20 cash price from Costco).
> Yeah, US hospital billing is based on the idea that the patient has insurance and won't really care about what their insurer gets charged. (The wider implications of this are left to the reader.)
Don't leave out the part where the consumer doesn't even shop (or sometimes pay) for the insurance policy either, it is determined by their place of work.
So the consumer of healthcare is doubly shielded from any price signals the market might supply.
I know a couple that avoided marriage so she could negotiate the childbirth bill on the basis that she was an uninsured single mom who didn't own property, etc, etc.
Health Care Sharing Ministries (HCSMs) are an interesting loophole in healthcare regulations that excepts uninsured people that participate in an HCSM from paying the tax penalty.
HCSMs are membership organizations in which people with common religious or ethical beliefs share medical expenses with one another. They are not the same as traditional health insurance.
Because patients are considered "self-pay", they negotiate their own prices with providers and they are likely to get an 80% or more discount on "list price" for the service. They are reimbursed by the HCSM if the HCSM approves the reimbursement.
As of 2025, approximately 1.7 million Americans participate in Health Care Sharing Ministries (HCSMs), which amounts to about 0.5% of the U.S. population. In Colorado alone, HCSM enrollment (at least 68k) is equivalent to 30 percent of Obamacare enrollment.
Because HCSMs often exclude essential health services and are therefore more attractive to people who are relatively healthy, enrollment of this size, relative to marketplace enrollment, may increase premiums for marketplace plans.
I am not promoting HCSMs but I did research it when I lost my COBRA coverage a few years ago. I do find it an interesting alternative approach to paying for healthcare. We really do need to explore options in this country.
I can definitely see AI being applied in the HCSM context.
Warning! As grotesque as health insurance companies are, in theory they are obligated to pay valid claims under your policy. Health sharing ministries can exercise discretion to deny payment because they disagree with your lifestyle choices. Or for any reason or no reason given at all. They are subject to far fewer regulations and audits and in some extreme cases the administrators just pocketed the money.
More and more states are auditing them. But yes it's a faith thing. And definitely not insurance. Works better for tight-knit communities where there is trust.
> Yeah, US hospital billing is based on the idea that the patient has insurance and won't really care about what their insurer gets charged.
Not quite: US hospital billing is based on the idea that the insurance company does the haggling for you.
Insurance companies negotiate (cough) "the best rate that the hospital has to offer," therefore: What the insurance company pays is confidential, and the official unnegotiated price is highly inflated. That's why hospitals will always negotiate with uninsured patients, because they're deliberately inflating their fees.
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In 2011 I had surgery. The first bill was for $100,000, which was sent to the insurance company. Then the insurance company got a letter (cough) "reminding" the hospital of the negotiated rates. The next bill was $20,000. On a follow-up visit, they did an X-ray, and sent me the bill. I sat on it, and then called my insurance company. The insurance company called the hospital to (cough) "remind" them that the negotiated rate for that kind of X-ray was $0.
A large portion of the US economy is based on this entire grift pipeline (settling before getting to court). And it's very costly and pushes up insurance costs and costs in general for everyone else.
When people talk about government inefficiency, I always think of how prevalent these kinds of shenanigans really are. I think they are more costly than inefficient government.
It's incredibly costly, and I think it's also incredibly costly in difficult to measure ways. The main method that the average American (read as: not incredibly wealthy person who has lawyers retained) uses to deal with the early stages of this pipeline is engaging in interminably long phone calls, going back and forth between multiple stakeholders, and trying to negotiate as to what actually needs to be paid or done individually. The incentives are aligned for various members of this process to make it a complicated and frustrating experience for customers, because they often benefit from increasing friction for the insured party. I think if you measured working hours lost or impacted by this it would be startlingly high.
Pretty much every 4+ figure civil violation, fine, etc, etc, is assessed on the basis of "what's the most we can get away with that won't have them taking us to court where it'll get knocked down or cause a public outcry if they tell the news"
Having to settle because court cases take too long to resolve is due to inefficient government.
Not only does the actual court case and appeals process take years, but even after you “win”, the collection process takes years after it has already been determined who owes what.
See Alex Jones for a ridiculous example. He should have been homeless and shirtless a long time ago.
While you're not wrong that most "justice" processes are expensive, I think the parent-poster is referring to a different kind of "government inefficiency", things like:
1. Single-payer health insurance.
2. Laws that insurance-companies must actually use X% of their premiums on payouts.
3. Laws requiring disclosure of negotiated prices, to encourage competition via free-market forces.
this looks like shopping in Moroccan bazaar with no price labels. But here you bargaining not for couple fruits but for your health and price range is in thousands. WTF :)
Yeah at this point this is more like a cultural ritual. You know like howin some cultures you have to refuse a gift 5 times with increasingly stubborn facial expressions, and the gift giver has to insist through it all, and then accept and say thanks. As the default.
Or where you as a guest announce that you now go home, and the hosts have to insist you stay for some more tea or whatever and then you have to again and again say you're now going really and they insist you stay so you chat more in the hallway etc. And it's just how it always is and it would be super rude to just leave or if the host didn't demand that you stay.
Similarly the US developed this traditional ritual that the first bill is outrageously expensive and everyone knows that everyone know, but the ritual protocol say you gotta start with that, we are civilized people, we say hello, so in Healthcare the hello is the huge price, and the interaction always ends in a lowered rate, because that's also part of the protocol.
It’s worse than that. In a bazaar there are only 2 participants and they are looking out for their own interests. Most Americans don’t choose their own insurance their _employers_ do.
The insurance company has no reason to make the health recipient happy and the health recipient has little agency in pricing.
In a bazaar you can examine the fruit or rug yourself.
An average person cannot call up $750K in a year to pay for cancer treatment. But for-profit businesses (and any organization for that matter) treat you much better if keep the carrot of another payment in front of their face. If you've forked over the whole wad of cash upfront they immediately de-prioritize keeping you satisfied.
We are self-employed in the US and buy our own high deductible plan on our state's marketplace. One of my family members needed a fairly routine planned surgery, so I went through the effort to try to determine in advance how much I would be billed. What a waste of time. My favorite was the hospital who told me the fee for a one night stay would be 73k. But, good news! Your insurance has a contracted discount that brings it down to 13k. So what does the 73k price even mean? At this point I shelved the effort as I correctly concluded we would hit our household max out of pocket for the year, so anything above that would not affect us.
And hey! Silver lining: in a year when we max the out of pocket limit, no more cost-sharing on any other services for that calendar year! Time to pack in some care we have been deferring mostly due to cost. Except the care providers and insurance company are well aware of this, so they don't bill you for up to a year from the date of service, so you can't be sure you "hit your max" until the subsequent year.
The “full” prices are basically just made up. If this was like the insurance company negotiates a 15% discount than OK. But the reality is crazy stuff like the “full price” is $7,623 but “your insurance company paid” $34.12. It’s totally bonkers and should be illegal.
But that’s expected. Even in a restaurant it’s not like each dish is priced as cost to make plus a markup. It varies widely, what matters is that the prices make sense in the market and over a week/month the overall numbers work out.
A hospital is vastly more complex. They have huge costs (for things they must have) that can’t be recovered 1:1 with services.
What the author calls criminal is the way hospitals typically bill Medicare and private insurance providers.
If the OPs brother-in-law had had insurance, the hospital would have billed the insurance company the same $195k (albeit with CPT codes in the first place).
The insurance company would have come back and said, "Ok, great, thanks for the bill. We've analyzed it, and you're authorized to received $37k (or whatever the number was) based off our contract/rules."
That number would typically be a bit higher for private insurance (Blue Cross, Blue Shield, United Healthcare, etc), a little lower for Medicare, and even lower for than that for Medicaid.
Then the insurance would have made their calculations relative to the brother-in-law's deductible/coinsurance/etc., made an electronic payment to the hospital, and said, "Ok, you can collect the $X,XXX balance from the patient." ($37k - the Insurers responsability = Patient Responsibility)
Likely by this point in a chronic and fatal disease, the patient would have hit their out-of-pocket maximum previously, so the $37k would have been covered at 100% by the insurance provider.
That's basically the way all medical billing to private and government insurance providers in this country works.
"Put in everything we did and see what we can get paid for by insurance" isn't criminal behavior, it's the way essentially every pay-for-service healthcare organization in the country bills for its services.
I don't say that to either defend the system, or to defend the actions of the hospital in this instance. It certainly feels criminal for the hospital to send an individual an inflated bill they would never expect to pay.
Yes. Though I think technically none of that happened here.
If I sound like I'm defending the morality of the hospital for billing a private individual $190k for services they'd expect to be paid $37k for, please know that I'm not. But it helps to understand WHY the hospital billed that much, and whether it's legal for the hospital to bill that much.
The biggest semantic "mistake" the author makes in their thread is saying, "Claude figured out that the biggest rule for Medicare was that one of the codes meant all other procedures and supplies during the encounter were unbillable."
The Medicare rule does not make those codes "unbillable" - it makes them unreimburseable.
The hospital can both bill Medicare for a bigger procedure code, and the individual components of that procedure, but Medicare is gonna say, "Thanks for the bill, you're only entitled to be paid for the bigger procedure code, not the stuff in there."
Neither the FBI nor Medicare is gonna go after the hospital for submitting covered procedure codes and individual codes that are unreimbursable under those procedure codes. That's not crime, that's just medical billing.
Actual double billing would occur if, say, your insurnace paid the hospital for a procedure, and then they came after you for more money, or billed a secondary insurance for the same procedure. Or if they'd said, "Oh no, the OP's brother in law wasn't here for just 4-hours, they were here overnight so now we're billing for that as well."
NOW - a much better way for the hospital to handle this scenario would be to see that the patient is cash-pay, and then have separate cash-pay rates that they get billed that essentially mirror Medicare reimbursement. That's essentially what the author got them to do, and it absolutely sucks that's what he had to do.
I briefly worked in adjacent space. While I hate the way it works, it makes a lot more sense when you understand that the billed amount is essentially just a negotiation tactic that represents a price well above what they ever expect to be paid (and a bit added to that for safety).
Then, they negotiate with all of the in-network providers for some number that’s well below the billed amount. That number varies a bit based on how effective various negotiations are.
Realistically, OP simply found the number that insurance was going to pay out anyways.
I think the argument is that it’s criminal to take advantage of the patient without insurance and ask them to ruin their life trying to come up with 195k when your system is setup to reasonably profit off the 37k you get from the insured patients. I firmly believe that even in a capitalist society the idea of profiting off of anything let alone healthcare in the thousands of percentage points is criminal.
The hospital double billed for over $100k worth of services on the original invoice.
At a certain point a pattern of issuing inaccurate invoices crosses the line into negligence.
If a business just have a habit of blasting out invoices that bill for services never received, and they know that they keep doing this, and only correct it when the customer points it out, at a certain point it turns into a crime.
From a quick Google query, it says that ~%90 of Americans have health insurance (which seems higher to me than I'd expected). I'd be very interested in knowing the number of uninsured, negligent/nefarious, and exorbitant invoices that are issued as a percentage of all invoices, for the purpose of determining the scale of criminality with respect to your description.
Exactly. You can do this with anything where the racket is based around the layman not being able to take in the amount of arcane subject matter info they'd need to argue their case, not just medical.
Tons of institutions that specialize in screwing people are built this way because it's pretty hard to "overtly" build an institution to screw people.
This! People underestimate the extent to which lawyers are negotiable also. “I’m not paying that” is a surprisingly effective method; they’re often willing to compromise on payment terms, work at-risk subject to a successful outcome, significantly reduce their rates, etc.
In my experience, most people underestimate what's negotiable across the board. Especially those making enough to do most of their business with mass-market operations, like big-box stores and retail service providers, that profit by doing many, many standardized transactions every day, with minimal discretion or even personal involvement.
Below that, lots of haggling and informal trade often help people get by. The costs of that process can be another burden on the poor. At the high end, it's worth involving people with discretion on the sell side. Additionally, sales are often one-off and customized. They may also bundle a bunch of different items and benefits without clear line-item breakdowns.
When hiring a lawyer, I'd nearly always recommend getting terms down in a written and signed engagement letter before work starts. That is very much a negotiation, but it's fine to ask questions and comparison shop.
If you're starting with a call, it's perfectly normal to start by asking whether initial consultation will be billed or not. If it will be, ask the rate. If it won't be, expect some limits on what can be discussed. The best lawyers I know aren't cheap or easily tricked into giving free advice on consultation calls with speedrunners, but they are up-front about what they charge for and how.
Not just arcane subject matter, but numbers so high any sane person panics.
Hospital: "Here's your bill for $1,000,000." (a figure which is 100% fictional)
Patient: <panic> "Oh shit, I don't have $1,000,000!"
Hospital: "Oh, we'll reduce it to $30,000. Aren't we nice!"
Patient: <slightly less panic> "I don't have $30,000 either, but it might not bankrupt me immediately, so I guess that'll do..."
Never mind that the same procedure in most of the EU was either "free" (to consumer at time of care) or a fraction of the cost.
In the EU you can also generally look up the cost, even in cases where the patient doesn't pay, there is a bill and fixed costs. The costs are what the government pays or what a foreigner with no medical coverage and insurance would pay. It's also generally a tiny fraction of the cost in the US.
> it did not do negotiating and it doesn't seem like the accuracy of its understanding of medicare practices was actually checked. The author reasonably accused the hospital of gouging and the hospital came back with a much lower offer.
Im increasingly of the opinion that AI gives people more confidence than insight. The author probably could have just thought of the same or similar things to assert to the hospital and gotten the same result. However, he wouldn't have necessarily though his assertions would be convincing, since he has no idea whats going on. AI doesn't either, but it seems like it does.
I've found LLMs helpful for figuring out what I don't know, then I can go and look up how those things work, again together with an LLM.
But in the past, once I got to the point where I know I could maybe do something about it, but not exactly what, and I don't know any of the domain words used, you got pretty much stuck unless you asked other people, either locally or on the internet.
At least now I can explore what I don't know, and decide if it's relevant or not. It's really helpful when diving into new topics, because it gives you a starting point.
I would never send something to a real human that a LLM composed without me, I still want to write and decide everything 100% myself, but I use more LLMs as a powerful search engine where you can put synonyms or questions and get somewhat fine answers from it.
Absolutely. It's cheap (as far as the user is concerned) to just fire off a question. And it can even be really fuzzy/ambiguous/ill-defined sometimes. It's a great starting point.
"But fight with knowledge. My $20/month subscription to Claude more than paid for itself. Yes, AI assistants can hallucinate and give you garbage. So I didn’t rely on it. I spot checked by looking up its big findings myself and found it was right. I also had ChatGPT, to which I subscribed for one month just to do this, read the letter and fact check it. No notes."
> The author reasonably accused the hospital of gouging and the hospital came back with a much lower offer.
This will always happen, especially if you don't have health insurance. I had to have surgery without insurance in the early 2000s, and I was able to knock off a large percentage of the bill (don't remember how much, it's been decades) by literally just writing back to the hospital and asking them to double check and verify the line items I was being charged.
Oh wow, I had independently formulated that as the duality/parallel between corruption and cheat codes: "The more out-of-band information you need in order to be treated normally/fairly, the more corrupt the system is."
Adding complexity is just one aspect. Everywhere there is someone whose job is to ensure the bottom line never changes and status quo for the powerful is preserved. Insurance, taxes, rents.. in the absence of effective regulation, the average number of successful appeals will simply get factored in and average costs go up so that profit stays the same and grows at the same rate as before. Similar to how chains factor in losses due to spoilage or theft.. of course they don't actually take a profit loss, they just price it in.
I really don't get people who see this kind of thing as empowering because in the end your (now strictly necessary) appeal with lawyers or AI to get a more fair deal just becomes a new tax on your time/money; you are worse off than before. A good capitalist will notice these dynamics, and invest in AI once it's as required for life as healthcare is, and then work on driving up the costs of AI. Big win for someone but not the downtrodden.
>It's like auditting tax returns of the rich - of course they didn't cheat, they already lobbied for the loopholes making their shenanigans legal.
The IRS disagrees every single year.
They say they can easily recover significant revenue from tax cheats if they were staffed and funded enough, to the point that every dollar you fund the IRS recovers 1.6 dollars.
The rich people who say they are just getting their fair deductions then refuse to fund the IRS.
If they weren't cheating, they wouldn't have to kneecap the IRS.
I suppose a saving grace there is that Medicare is incentivized to help people or at least not incentivized to provide the minimum amount of value for maximum profit.
So what you're saying is we've injected a whole smorgasbord of electrical dumbasses into a system already rife with corruption, greed and exploitation that provides services no person can do without and is frustrating to use at every juncture.
> Yes, AI assistants can hallucinate and give you garbage. So I didn’t rely on it. I spot checked by looking up its big findings myself and found it was right.
The funniest bit about all this is that this is all just laziness all the way down. People complain about AI-written articles. When the article is written about a human, they fall over themselves to point out potential flaws, like "well it looks like AI hallucinated" and it gets voted to the top. Then it turns out that they themselves did not read the article. Just a damning indictment of the quality of online discourse in year 2025.
Often with these kinds of things it's not even as much about being specifically accurate as it is about presenting yourself in a way that makes the other party believe that have sufficient understanding of the issue at hand and the escalation paths available that you won't just go away if they don't play ball. That is, make yourself credibly as a Dangerous Professional, in patio11 parlance.
I just did this with a pet insurance bill, and ChatGPT was very helpful. They denied based on the pre-existing condition exclusion even where it was obviously not valid (my dog chipped her tooth severely enough to need a root canal, and they denied because years before when she wasn't covered under the policy, she had chipped the same tooth in a minor, completely cosmetic way).
I was sure they were in the wrong and would've written a demand letter even in the pre-AI days, but ChatGPT helped me articulate it in a way that made me sound vastly more competent than the average consumer threatening a lawsuit. It helped make my language as legally formal as possible, and it gave me specific statutes around what comprises a pre-existing condition in CA as well as case law that placed very high standards on insurers seeking to decline coverage by invoking an exclusion (yes I checked, and they were real cases that said what it thought they said).
Gave them fourteen days to reverse the denial before I filed in small claims court, and on day fourteen got a letter informing me that the claim would be paid in full. It's of basically no cost to them to deny even remotely borderline cases, so you have to make them believe that you will use the court system or whatever other escalation paths there are to impose costs, and LLMs are great for that.
>It seems like the AIs role was in applying lengthy and complex medicare billing rules - it did not do negotiating and it doesn't seem like the accuracy of its understanding of medicare practices was actually checked. The author reasonably accused the hospital of gouging and the hospital came back with a much lower offer.
What exactly do you think negotiating is? Real negotiation in business transactions is more often based on agreements around certain facts than emotional manipulation.
I guess I would think that negotiating at least involves communicating with your counter-party. Its role here feels more similar to being a billing consultant. There are plenty of people (and systems) that pass messaging over to the actual AI - which was my expectation from the title and why I noted it didn't happen.
People want so badly that AI won't be useful that I feel like they will diminish everything they do. I also get that they probably feel like it's all hype, but there are plenty of examples of real value that AI brings to the table.
Yes, because, there is an entire department _dedicated_ to this function. You just call them and say "I can't pay this" and you'll get the same result.
The author mentioned in a reply in threads that most of the fees was Facility Fees. That might be just wrapped up in a code for cardiology sure, but its just profit chasing hospitals because that practice can wildly inflate the cost and billing and that can be fought.
> I'd be interested to hear from a charge coding expert about Claude's analysis here and if it was accurate or not. There's also some free mixing of "medicare" v.s. "insurance" which often have very different billing rates. The author says they don't want to pay more than insurance would pay - but insurance pays a lot more than medicare in most cases.
I'm a cofounder of Turquoise Health and this is all we do, all day. Our purpose is to make it really easy to know the entire, all-in, upfront cost of a complex healthcare encounter under any insurance plan. You can see upfront bills for many procedures paid by various healthcare plans on our website.
The information posted in the thread is generally correct. Hospitals have fictional list prices and they on average only expect to collect ~30% of that list price from commercial insurance plans. For Medicare patients, they collect around 15%. The amount the user finally settled for was ~15% of the billed amount, so it all checks out.
The reason for fictional list prices (like everything in US healthcare) is historical, but that doesn't make it any more logical. Many hospital insurance contracts are written as "insurer will pay X% of hospital's billed charges for Y treatment" where X% is a number like 30. No one is 'supposed' to pay anywhere near the list price. Yes, this is a terrible way to do things. Yes, there are shenanigans with logging expected price reductions are 'charity' for tax purposes. But there isn't a single bad guy here. The whole system that is a mess on all sides.
Part of the problem is that the US healthcare billing system is incredibly complex. Billing is as granular as possible. It's like paying for a burger at a restaurant by paying for separate line items like the sesame seeds on the bun, the flour in the bun, the employee time to set the bun on the burger, the level of experience of the bun-setter (was it a Dr. Bun Setter or an RN bun setter?), etc. But like the user said, some of these granular charges get rolled up into a fixed rate for the main service.
However, the roll-up rules are different for every insurance contract. So saying the hospital 'billed them twice' is only maybe true. The answer would be different based on the patient's specific insurance plan and how that insurance company negotiated it. Hospitals often have little idea how much they will get paid to do X service before it happens. They just bill the insurance company and see what comes back. When a patient comes in without insurance, they don't know how to estimate the bill since there is no insurance agreement to follow. So they start from the imaginary list prices and send the patient an astronomically high bill, expecting it to be negotiated down. In some areas, there are now laws like 'you can't charge an uninsured patient more than your highest negotiated insurance rate' but these are not universal.
If you find yourself in this situation, there are good charities like 'Dollar For' that can help patients negotiate this bill down for you. We are trying to address this complexity with software and have made a lot of progress, but there is much more to do. The government has legislation (the No Surprises Act) that requires hospitals to provide upfront estimates and enter mediation if the bill varies more than $400 from that amount. But some parts of the law don't have an enforcement date set yet, which we hope changes soon.
I was going to say please use and donate to 'Dollar For' [1] which provides this service, which is likely a better choice for this type of problem than trying DIY.
I have been eagerly sharing my location with as many people as possible for years. I have not been very discerning about it - and in fact if anyone in this thread wants my location feel free to message me on signal (drex.64) and I'll share on google maps. No need to share back (though I don't mind)!
The simple reason for this is that we are all already sharing our locations with many corporations all of the time. I just shared my location with home depot a few days ago so it could locate which store I am in. Google knows my location constantly. There is an urgent, obvious need for us to develop social practices around location sharing. We must build these practices and preferences within our communities so that as the wide scale tracking develops we can understand what we would consider reasonable. The demarcation of pen registers to track phone calls came out of a sense of what is a reasonable invasion of privacy - we must socially develop that sense around this form of sensing.
I now have a pretty healthy community of location sharing and the stories in this piece are familiar. When I was in the ICU for a few days (thankfully due to medical confusion and not a real condition) people reached out to see if I was ok and needed anything. I know people who discovered that a mutual friend died unexpectedly when their phone had been at the morgue for several days. There is no question, in my mind, that "always on" sharing is probably too much for most people. But the only way we will develop a detailed sense of what we want instead (and what we should insist on when it comes to corporate tracking) is to engage with it and reflect.
So far my thoughts on how to do it better involve a series of contextual elements to increase or decrease the specificity of sharing. I.e. if you are out doing errands there's no need for a precise location - show a few blocks. However, if you are close to a friend, show a precise location and notify both parties. Consider creating tiers of sharing where when you enter an area of concern (hospital, morgue, etc) your location is visible and flagged for people close to you but otherwise appears generally to others (as if you are shopping as above). Etc, etc. There is much work to do here and I hope others are thinking about how to do it.
> There is an urgent, obvious need for us to develop social practices around location sharing
Indeed, such as "don't, tf is wrong with you?" People don't need to know where I am at all times. I don't need to know where anyone is at all times. Stop normalizing this insane practice.
That's certainly one of the options! However I generally disagree with your point of view. You are welcome to hold to it, but many people already know where you are at all times and I suspect if you ask your community they will have little reflection on what level of sharing feels appropriate. I personally do not want to put the genie all the way back into the bottle.
I've never once allowed a company like Home Depot to know my location with Location Sharing. If their site needs to know what store is "my store", then I use zip code searching and manually setting the store.
There is no way to prevent cell providers from knowing the location of the device connected to their network. We can regulate the industry from selling that location. I don't necessarily mind allowing law enforcement to learn the location of a device with a proper warrant. Them selling the data to any interested 3rd party should be banned punishable by imprisonment of the the entire C-suite.
Sharing your location with family/friends is not even in the same ballpark as sharing with corporate entities. To conflate the two in your mind just shows how fucked we've allowed ourselves to become. Sharing your location with family/friends through social platforms is also not the same thing as sharing directly through the devices. Again, thinking it is just shows how numb we've become to theSocials
The people at google or apple. Perhaps your phone manufacturer if you don't use a first party phone. The cell phone companies (approximately but they can triangulate pretty well). Potentially any retail establishment[1]. As facial recognition technology becomes more mature it won't even require a phone.
[1] This one is a little uncertain because it relies on tracking bluetooth / wifi radios and you have to do a pretty complex setup. Simply establishing presence is harder (and ofc the whole thing can be blocked by secure operating systems).
Well, I happen to use a phone without Google's or Apple's services in my personal life. And if I were to go out for something the authorities would not agree with, I most certainly would not carry any phone, smartwatch or whatever while doing so. Maybe an iPod Classic or something to listen to some tunes while I get myself a bloody nose at the Fight Club, collect rich people's body fat from beauty clinics to blow up capitalism or whatever else I might get up to on a quiet evening out.
Seriously though, if I understand you correctly, you want people to be critical of stuff like location sharing and whatnot but your way there somehow involves to normalize said whatnot completely. I don't really follow.
> When I was in the ICU for a few days (thankfully due to medical confusion and not a real condition) people reached out to see if I was ok and needed anything. I know people who discovered that a mutual friend died unexpectedly when their phone had been at the morgue for several days.
I feel like this kind of information can be found out by just naturally talking with others. Viewing your friend's and family's location all the time is just so unnecessary and overkill. If something is wrong, you simply reach out to others, they don't need to be actively checking your location to determine that. Yeah obviously the exception is crazy emergencies, but I think most people would take their chances than be this open to location sharing. Kids too make sense. Other than that, I don't believe location sharing to this degree should be normalized at all.
Of course it can be found out other ways. The people I was closest to did not need the location sharing to figure out what happened to me. I do not have the impression that people obsessively check location - I certainly do not. But sometimes you see that someone is somewhere and you might reach out to them. Again - you are welcome to only have corporations know your location, but to me that seems silly.
> I just shared my location with home depot a few days ago so it could locate which store I am in.
There is a huge difference between giving Home Depot permissions to know your location while you are in a Home Depot vs giving Home Depot permissions to know your location 100% of the time.
If I was using a Home Depot app and I wanted the app to know my location, I would share location data using the "Allow While Using App" option instead of the "Always" option. I can't imagine a scenario in which I would want Home Depot to a continuous stream of my location data.
To speak bluntly, I'm not sure you're considering that many people want to hide or to be able to hide activities like adultery, gambling, prostitution, unhealthy food, spending too much time in bars, leaving their wife and kids at home to just go park and sit in a parking lot to get away, etc.
When you're mentally or morally or -whatever term you want- strong, you might miss that some people have things they want to hide that might not be burglary or trespass or murder, but nonetheless they don't want to be broadcast to their social circle.
Maybe we need a term for the Overton window applied to morality (in social terms). If your lifestyle doesn't fit neatly into the thickest part of that window, you might object to always on location sharing but be unable to honestly and openly admit why, leading to people like yourself being puzzled why others might be resistant.
I know! I am not sure you are considering that at the moment full sharing is the default and, in many cases, not optional. It seems like you're under the impression that I want us to share location all of the time when I've just said that's too much. It's just the option we have at the moment. We need to figure out when and how to share location and how to develop expectations around when people can know things.
> and how to develop expectations around when people can know things
is that most people will become paranoid when their romantic partner goes "off grid" at 7pm on a Friday, or their spouse on a work trip turns off location on Saturday, or their child goes off grid after school one day.
if humans could trust other humans "going dark" then that would be great, but it seems so far the only way to be able to be offline that is socially acceptable is to be 100% offline/unmapped all the time socially.
If you're correct then there's no hope. People will realize they can have the data and will take refusal to provide it as a proxy for misbehavior. For some that time is already here. If we can build alternatives that provide important location information in the proper circumstances without fully tracking people we can advocate for a less dystopian use of the technology.
Under what state are you living, where you can expect it to never turn on you? Where corporations aren't exploitative and manipulative?
It can't be the US or EU, that's for sure.
I commonly leave the phone behind and switch to cheap walkie-talkies to lessen the tracking data I produce without giving up the ability to communicate with people nearby but not adjacent.
I would also love to know how OP integrated logging these! I'm interested in this kind of tracking but I haven't found an ergonomic way to use it (not that I've tried hard).
Not my site and I couldn't figure out who the author is. Some of it could definitely be automated but I know I would have a very hard time recording food consistently like this.
LuaJIT has ~85k lines of code. Chromium and Firefox have somewhere in the neighborhood of ~30 million. If you need ~1 developer for "a LuaJIT" then you need ~350 developers for a browser.
I think this is just incorrect. You are not obligated to seek treatment for most medical problems[1]. The point of medicalizing something is to draw a line between situations where it would be too soon for medical professionals to step in and when people enter a situation where they may need external help. One of the diagnostic criteria, which this article mentions, is that your grief is disrupting your life - but despite what this article claims they have misunderstood that criteria. Of course grief changes your routines and life. That change only becomes "disruptive" if you feel the change has somehow gone too far or you are struggling to undo it. This writer is doing neither and therefor does not meet the diagnostic criteria for disordered grief. They are grieving normally and the medical literate supports that understanding.
There are of course medical professionals who use diagnostic criteria as cudgels. Trying to force people to become patients in order to enforce their idea of what someone "should" want. This is a problem but it is a problem that the official diagnostic guidelines try to avoid. For those who are interested in this kind of problem with our medical system might look into the professional philosophy of doctors (generally arrayed around identifying and curing disease) and nursing (generally arrayed around making the patient comfortable as possible). I tend to think the nursing model is the more useful and sensible of the two - even though, of course, if one wants to cure a disease a doctor is helpful.
[1] There are very few diseases, such as tuberculosis, where you can be forced to treat the disease.
> The point of medicalizing something is to draw a line between situations where it would be too soon for medical professionals to step in
The problem is that medical diagnoses and therapy speak have spilled over into common language where they’re so diluted that they’re not accurate any more. For many there is no line drawn anywhere because they are self-diagnosing based on flawed understandings as soon as any feeling or symptom arrives.
This is scarily obvious when I’ve worked with college students and early 20s juniors lately: A subset of them speak of everything human nature in medical and therapy speak. Common human experiences like being sad about something or having a tough day are immediately amplified into full-blown medical terms like “I’m having a depressive episode today” (which is gone by tomorrow). Being a little nervous about something is “I’m having a panic attack”. Remembering an unpleasant disagreement at work “gives me PTSD”. When they’re procrastinating a task that is fun “my ADHD is flaring up today”.
This is only a subset of people, but it’s a rapidly growing percentage of younger people I work with. When someone falls into this mindset it only grows: The same people using these terms usually accumulate a lot of different self-diagnoses to cover every element of common human experience: They will claim ADHD, social anxiety, often some variation of Autism despite showing none of the signs, PTSD due to a previous relationship/boss/professor they didn’t get along with, and insomnia or delayed sleep phase syndrome. Many will have no formal diagnosis at all or even proudly claim that they don’t trust the medical system, they’re just diagnosing themselves.
I’ve been offered helpful links to TikTok ADHD influencers to help me understand them, because that’s where they think the best information comes from. 20-something engineers confidently tell me they know more than their doctors about ADHD and how to treat it (usually after their doctor refuses to increase their dose of Adderall again or denies them some other controlled substance they think they need like ketamine or perpetual daily Xanax). There’s also a growing culture of casual drug abuse and misuse that gets justified as self-medication, but that’s a topic for another post.
I'm sure the numbers of people wrongly using those terms has risen at least a bit, but I think the anecdotal evidence you have is likely to be a mixture of that and also not that.
Similar to how some people look at raw stats of autism diagnoses and think hugely more people are becoming autistic when in reality it's that we've got better at diagnosing autism; I think we (society, in at least some countries) have got better at being honest about mental health conditions. Meaning that more people, especially younger people who've grown up around less mental health stigma, will talk about having an actual genuine problem even without more diagnoses or more exaggeration. I think studies would be needed (that I'm not aware of) to figure out how many more people are using labels that don't really fit, vs how many more people are being honest about actual serious conditions.
When I was in my 20s, if I needed a day off work because of depression I would always use a bullshit excuse to avoid mentioning the actual reason. I don't any more, most of my colleagues know what issues I do or don't have. And the younger generations are starting from that place, rather than having to grow into it.
Assuming the days you took off from work because of depression were unexpected and not planned in advance, why did you feel you had to explain anything?
Why couldn't you say: "I'm sick and won't be at work today."
This is a very american trend in my experience. Americans are quite happy to tell you their long list of diagnoses, how that some how gives them some kind of exception to the rule, and how this is some how part of their identity. This kind of oversharing is common across topics from Americans but in particular oversharing of and obsession with psychological conditions seem to be a common modern stereotype of americans amongst my friends who interact with americans regularly.
I mean, I have no data for this, but I think it's a combination of two factors:
- Access to mental healthcare here is HEAVILY gate-kept by a combination of it often costing quite a lot of money, generally having longer waits than most healthcare services, heavy variability in availability by location, and insurance coverage runs the gamut between great or utterly absent, sometimes even in the same policy depending on what you need. Self-diagnosis is for many people the only diagnosis they have access to, and even if it's wrong, you can often use whatever diagnosis it is to find coping mechanisms that help you, or substances that will help you self medicate.
- Naming something medically is the only way to get institutions to pay attention to it, which can mean a number of things by itself, from getting appropriate accommodations at work or school, to getting certain kinds of coworkers or authority figures to treat you in a way that's more amenable to your mental state.
And I don't think its wrong to make it part of your identity either. Some definitely take it to a weird, unhealthy place, and also most of those people are teenagers. Teenagers do tons of stupid shit, I did tons of stupid shit. It's just part of growing up. But ultimately... it is part of you that you're going to be dealing with probably forever, so, some amount of identifying with it is probably healthy.
Edit: Also not sure how to read you calling this "oversharing?" Like I guess it could be depending what it is, but I dunno, my wife has BPD and a touch of Autism, she doesn't announce it when we meet someone but it isn't a secret either.
Everybody wants to be the one who overcame the odds or struggled bravely on. Everybody wants their story to be special because of how hard it was for them compared to everyone else.
I think some of it comes from the value the culture places on underdog stories and some of it comes from the oversaturation of everything in modern life.
I think some of it also is an overcorrection from how taboo it used to be to discuss mental health previously... so now oversharing is encouraged vs suffering in silence.
Americans, and I am speaking in stereotypes and not about a particular person, don't respect personal boundaries on topics that other cultures would not discuss openly with someone they don't know well. Like for example, you tell me, a stranger on the internet, that your wife has borderline personality disorder. That would be oversharing if we had just met in a social setting and were discussing this topic together.
I've seen this too among some younger folks and I wonder how much of this is simply standard, run-of-the-mill teenage attention-seeking and exaggeration that's not fully outgrown yet.
I guess we'll know when they turn 40 and are still saying things like "I had a panic attack" and "I'm literally shaking rn".
There’s also that linguistic phenomenon where you have to use stronger and stronger language to signify the same thing. Maybe we just think it’s ridiculous because we’re the older generation. Or at least that could be part of it.
> Many will have no formal diagnosis at all or even proudly claim that they don’t trust the medical system, they’re just diagnosing themselves.
The thing is, many people have valid reasons not to trust the medical system. Not so long ago:
1. Homosexuality was considered a mental disease
2. Forced sterilization of minorities was good medical practice
3. FDA ignored warnings about pesticides being potentially harmful because that would be bad for business
4. FDA ignored warnings about pesticides being potentially harmful because that would be bad for international politics
5. Entire field of psychiatry was just basically random shit, it's not until very recently that we have any actual scientific knowledge
6. Pregnant women were presribed medicine that fucked up their fetuses
Not to mention that most likely when you go to a doctor you're not getting state-of-the-art diasgnosis, most likely the doctor is just a random guy doing his job, sometimes better sometimes worse. Personally I don't trust medical system with my mental health because medical system is a product of a society that made me have mental problems in the first place.
I mean I live in Germany where Hans Asperger oversaw the mass killing of autistic children. He decided which one were to be murdered or which had the "right kind of autism" i.e. Asperger syndrome and could serve the fatherland. (Just to be clear, the differentiation between autism and Asperger has not and had never any scientific leg to stand on.)
The term Asperger syndrome was only removed from the DSM in 2013.
For autistic children something called Applied Behavior Therapy is still the most common treatment. It is the same thing they use in gay conversation camps. Yes, literally. It can be super traumatizing to autistic children.
The way we treat neurodivergent people is absolutely abhorrent.
That said, the main issue people don't get a diagnosis is not lack of trust but lack of access. Most people can't afford it or are not able to jump over the bureaucratic hurdles to get it.
Germany is notorious for being shitty to people with mental illness. Even people with something as common as ADHD struggle to get the care they need there!
On the subject of Asperger syndrome, after learning about the history I was surprised that there are people previously diagnosed with Asperger's syndrome who were (and still are) very angry about the term being removed resulting in them being lumped in with everyone else diagnosed as autistic.
Being labeled as "autistic" could mean anything from seeming a bit strange but being highly intelligent and perfectly capable, to being totally non-communicative, being drastically intellectually and emotionally underdeveloped and being unable to function requiring 24 hour care. Some "Aspies" saw Asperger's as a very convenient way to differentiate their particular flavor of autism. Convenient enough that the usefulness of that distinction far outweighed the shadow of the terrible origin of the name itself and also the fact that it hilariously sounds like "ass burgers".
Personally, I'm glad that Asperger's was removed but I have to agree with the Aspie crowd that they got screwed over when no new term was given to replace what they had. The still grossly overbroad "3 level" system is trash. The spectrum of autism is so wide that the term is nearly useless.
> could mean anything from seeming a bit strange but being highly intelligent and perfectly capable
No, everyone that is diagnosed under ASD has some sort of care needs. If you are just a bit strange and it is not disabling in any form, then you are just strange.
People see autistic people on the internet and seem to miss that video editing exists and that the they are seeing just a very specific and carefully chosen part of this person. They are seeing the highlight reel not daily life that can look very differently.
One of the fears with removing Aspergers was indeed that some people diagnosed under Asperger might not be diagnose under ASD as it is arguably stricter.
> to being totally non-communicative, being drastically intellectually and emotionally underdeveloped and being unable to function requiring 24 hour care.
The problem is that many people see things as single line from low care needs to high care when in reality it is multi dimensional. Just being non-verbal does not mean that one is not intelligent, that is a huge stigma that non-verbal autistic people suffer. Many autistic people struggle with sensory issues but some don't. You might struggle heavily in one area but not so much in another.
If you know one autistic person, you know one autistic person.
> The still grossly overbroad "3 level" system is trash.
It is a step in the right direction because it realizes that care needs can change over the course of a persons life. You are born autistic but how disabling it is for you can change depending on how much help you get. It can get better or worse depending on your life situation.
Otherwise you have a current situation where people assume it isn't worth giving a non-verbal autistic child a proper education because they they think that they will never be able to life on their own anyway, acting like their outcomes are already predetermined. Or when someone with Asperger is assumed to never have serious care needs.
That said, people that have been diagnosed as Asperger, I don't correct them if they cling to their diagnosis. It is the diagnosis they have identified with for years or decades and if it what works for them then that is fine.
Still the new system is a good step in the right direction. Not perfect but better.
The dilution by people with no formal diagnosis become more common is scary because of how it normalizes not seeking help, which is the hardest part of actually having these issues. It creates this illusion that one should be able to treat themselves and that things like sitting at your desk all day thinking it wouldn't be that bad if you died in a car accident, or having your heartrate spike and sweating profusely while you thoughts are paralyzed are normal things that happens regularly to everyone so your inability to deal with them is a personal failing. They are not and if you do feel this way try and seek assistance from a experienced professional.
Standard among previous generation was to not seek help, stigmatize those who do, mock the issues and generally not even have vocabulary to talk about them.
This is very true, we are in a better place than the previous generation but there is still room for improve and a over abundance of something can be a problem just as easily as the absence of something.
What you're describing is a big problem [edit: for the people who get sucked into it] and, to me, is kind of the "other side" of the overmedicalization issue that this blog is complaining about. One way medicalization harms is is when people are forced into conditions they don't agree with (as the author feels they have been). The other way is when people who aren't medical professionals (and wouldn't be in a position to diagnose even if they were) adopt medical language to describe experiences.
I guess my thoughts on the trend you're critiquing is that it happens almost entirely outside of the medical community. As you describe the people who are most impacted by this often find actual medical treatment unhelpful and un-validating and turn to self-medication or other "medically inspired" coping techniques. I think the people who actually don't have these conditions and are applying medicalized treatments and explanations are opportunistically drawing on medical language because people often respect it socially. But also there are lots of people who engage in self-deception (or just normal deception) for social advantage and I don't know that people who use medical language are better or worse? A word is just a word and unless that word is actually on a medical record somewhere it only has the power you give it.
The flip side of this is of course that the medical establishment has many well-studied and documented biases. They offer poor treatment to overweight people, black people, people with mental health diagnoses, basically every vulnerable population that's been studied gets worse service from medical professionals. That very reasonably leads to people distrusting "the system" and searching for coping mechanism outside of it. I think that is generally pretty harmless and helpful - as long as it doesn't get into the realm of serious self-medication like you describe. Basically if you like using a medical term to describe your experience ("I'm being really OCD today") I don't think there's much harm in it and you may find coping mechanisms for people with ODC helpful as a bonus.
>Basically if you like using a medical term to describe your experience ("I'm being really OCD today") I don't think there's much harm in it and you may find coping mechanisms for people with ODC helpful as a bonus.
I was with you up until this point. My wife has C-PTSD, Bipolar type 2 and ADHD, along with what her psychologist describes as "Social OCD". I can't tell you how many times I've had to explain to other people that her mental illnesses are real and some days she and I just can't hang out because she smelled a smell that gave her flashbacks. Because people have normalized the language, they think "triggered" just means upset. For someone with real PTSD, it doesn't mean upset, it means their mind has come unstuck in time and they don't know who to trust or sometimes even what is real. Sometimes this lasts 5 minutes, sometimes it lasts almost all day. She just loses that time, and all I can do is try to calm her down and try to get her to take medication to re-stabilize her.
My wife has been in therapy with a PhD psychologist for 11 years, and only just this year has gotten to the point where it seems like she could probably hold down a job and keep her trauma compartmentalized like most people do all the time. People normalize the language for these debilitating full-blown disabilities and then don't understand the gravity of the situation when somebody with a legitimate mental illness of that sort of degree comes along.
Co-opting medical language for sub-disorder level dysfunctions is bullshit. And that's fine, when you're just bullshitting with your friends or whatever, but how is someone like my wife supposed to be seen or understood, let alone properly accommodated for when everybody thinks they know what a panic attack is but has never in their adult life been so panicked they became nonverbal?
I would posit your issue is not in co-option of terminology but in that ableism is still rampant and these are people who wouldn't take your wife seriously even if you described her symptoms. I have conditions that people do not uwu cutesy about on tiktok and people still illegitimate me when it inconveniences them slightly like canceling plans. People playing down disabilities the disabilities of others is extremely common. Being able to be flexible and accommodating to any degree I can to someone's disability has nothing to do with whether or not I think it is legitimate, and gating my flexibility to whether or not I personally judge someone's disability as legitimate is ableism plain and simple.
I upvoted your comment because this is also a huge issue. I just find that the co-opted terminology does worsen the quality of dialogues about the co-opted terms. People need to have the symptoms fully described for them in detail and sometimes don't believe me or think I'm exaggerating because it doesn't match their preconceived notions of what those words mean.
I'm not saying that the problem isn't ableism, it absolutely is, just that the co-opting of the terms is still harmful in that it uses up spoons and makes it harder to communicate clearly, especially with those who are stuck on the pop-culture meanings instead of actual medical meanings.
I flagrantly disagree that disbelieving someone's disability or believe someone is exaggerating because it doesn't mean their preconceived notions is something that can be helped if the culturally known depictions were specific to your wife's depictions. This is the mental health equivalent of yelling at someone in a wheelchair who can stand for short periods of time. Disbelieving someone about a disability assumes I am even capable of telling who is "really" disabled, which is an ableist belief that will not go away even if all the TikToks that say they were triggered by a minor toe stub disappeared.
In fairness, I believe that people who make jokes and light of disability suck in that I also believe this is an ableist activity. And I fully believe you that this kind of uwu-ification of disability is used as justification for ableist people to behave shittility towards your loved one.
It's not really a matter of it entirely solving the issue. As the other commenter is trying to stress, these are 2 separate issues, even if 1 underpins the other. We can and should try to solve for both. The thing is, 1 is a heck of a lot easier to solve. So why wouldn't we?
I don't think the position of "Having more accurate pop culture depictions of mental health issues and disabilities would enable better understanding from non-disabled people" is an entirely crazy one, and you haven't really made any arguments as to why we shouldn't do that.
I am so sorry to hear about what you and your wife have gone through. It sounds extremely frustrating and aggravating. I also suspect that when it comes up the people who downplay your wifes' conditions often act as if they are the insulted party.
We have an epidemic of not taking psychological conditions seriously. As my depression has worsened I've understood better the depth to which someone can fall and re-thought when it makes sense to say that I'm having a "depressive episode." I think there's a real issue of people mis-understanding diagnoses (in the way the comment I was replying to spoke about) and describing themselves as having them when their symptoms would not rise to the level of a diagnosis. Un-restrained by medicine and popularized by social media, watered-down understandings of disorders proliferate.
> Co-opting medical language for sub-disorder level dysfunctions is bullshit.
However, this I disagree with. Someone invoking PTSD or Bipolar to characterize their experience is not the same as claiming that label for themselves. I am not bipolar, but I mention the condition to talk about cyclic moods that I do experience (that are neither major depressive or manic but impact me). I think it's common to talk about a disease condition with the understanding that the condition has a range of severity.
I have a friend who was institutionalized for depression for a time. I don't think I am co-opting them to talk about my much less serious case - even though there's a similar "flattening" effect. If people hear my mental health journey first they might assume my friend is putting on airs about their situation. My friend has constantly had people imply or accuse them of overplaying their condition to get special treatment, which is gross.
> how is someone like my wife supposed to be seen or understood, let alone properly accommodated for when everybody thinks they know what a panic attack is but has never in their adult life been so panicked they became nonverbal?
My hope - and it is just a hope - is that on balance the social spread of broad and vague understandings of mental disorders is a net positive overall. The alternative feels like locking these terms away in the medical field - where when your wife (or anyone) says they're having a panic attack and the person who's there to help her has never heard of it. People are often shitty when you are going through a serious illness through ignorance and selfishness and I think medical conditions are the same as physical[1] in this case. I do not think that talking or identifying less with disorders is a net-positive.
All of these conditions have a spectrum of severity and, I believe, many people have sub-diagnostic versions of medical conditions. Those people will often improve their lives by recognizing patterns in their lives and using coping mechanisms developed for people with more severe cases. On balance I think that practice increases empathy for more severe conditions - because once people recognize a trend outside normative experience I think they often can extend it. I've also known far too many people who had life-changing adult diagnoses of conditions ("you mean this isn't what everyone is dealing with") to be set against the popularization of considering if you have a diagnosis.
[1] Mental conditions are, of course, also physical conditions but the dichotomy is widespread.
Someone can see their cyclic moods resemble bipolar disorder, use coping mechanisms developed for bipolar disorder, and gain empathy for people with bipolar disorder. Or someone can see their normal post traumatic stress resembles PTSD, use coping mechanisms developed for normal post traumatic stress, and lose empathy for people with PTSD.
I'm not sure if this is "human nature" or if it's a specific cultural problem in the modern west. It's certainly true here in Canada too -- everyone uses terms that are really quite heavy duty to describe quite minor things.
I'm deaf. When I tell people this, one of the most common response is "Oh, don't worry. I'm a little bit deaf too." Now not to go policing people on their identities but -- no you're not.
Like what do I need to say? Clinically deaf. Severe-profoundly deaf. Cannot hear a fire alarm without hearing aids?
It's one thing when it's an elderly person. Yes maybe they are in fact a bit deaf too. But for all the people in their 30s or 40s who have said it to me -- the odds they all have moderate or worse hearing loss is nil! Most of the people who are saying it presumably have normal hearing. I understand that they're trying to identify with and not alienate me. But it's such a strange dynamic.
>When I tell people this, one of the most common response is "Oh, don't worry. I'm a little bit deaf too."
I think that is just people being people, and that's the first "acceptable" thing that pops into their mind when they hear that. They are just trying to relate to you. They are socially conditioned to not say things like, "that's too bad", or "I'm sorry", etc.. They were probably prepping to say something about the latest weather trends or something equally banal, and now you've hit them with something out of left field that they've never encountered before. How would you like people to respond? I am a migraine sufferer, and get the same types of responses, like "oh, I get headaches too", and "my sister in-law cured her migraines with mint oil!". I mean, most of the things that most people say are rather dopey.
Conversations are rarely about saying truthful things, and mostly about societal theatre that is supposed to leave both parties feeling better. Nobody cares that you're deaf, what you're expected to do is to react in a way that makes the other person feel good. I don't like this either, but that's how, for the lack of better word, "normies" function.
This is an excellent summary of the issues I have faced, where if you inform someone in the middle of a conversation of an experience you had in the past where someone else has done something bad, they tell me I am being negative... But it wasn't me who did the bad deed. It is completely baffling to me, and you summarised very well how people just want to effectively be tickled instead of dealing with facts. It is very isolating.
> When they’re procrastinating a task that is fun “my ADHD is flaring up today”.
I mean, our industry is filled with people of all ages with ADHD (arguably because it’s one of the few industries where you can succeed while having severe ADHD), GenZ folks are just more likely to admit it in public where older millennials are more likely to either be quiet about it or ignore the fact that they are subject to it.
You’re right and it’s actually wild how many people lack the ability to just deal with it. I think they do it because having a medicalized identity gives you a kind of framework or structure to lean on in social situations. You don’t need to learn the complex social rules to get grace from other people, instead you can do this easy thing and demand it. I think it is downstream of social media displacing face-to-face social interactions.
I know people like to blame social media and just "the kids these days" in general - but I think there's another reasonable, far more charitable explanation: it's a sort of overcorrection after those illnesses being very heavily stigmatized for practically ever. It's perhaps not ideal, but if a symptom of more people who truly have those illnesses being able to get help is a small portion of people using it as a fashion statement, that's a price I think we can pay. And I'm confident it will correct itself over time.
> This is scarily obvious when I’ve worked with college students and early 20s juniors lately: A subset of them speak of everything human nature in medical and therapy speak. Common human experiences like being sad about something or having a tough day are immediately amplified into full-blown medical terms like “I’m having a depressive episode today” (which is gone by tomorrow). Being a little nervous about something is “I’m having a panic attack”. Remembering an unpleasant disagreement at work “gives me PTSD”. When they’re procrastinating a task that is fun “my ADHD is flaring up today”.
Somewhat unrelated, but I complain about the same thing in software parlance. Our work gets divided up into "sprints". A SPRINT is traditionally something you do a handful of times in your life, like when you're fleeing for your life, pursued by a bear. And then when you're a safe distance away and the adrenaline wears off, you collapse from exhaustion and rest. The idea that your employer would use that term to describe how they envision their employees structuring every day of the rest of their lives is either painfully tone-deaf, or even worse, is a brutally honest view of how they regard employee burnout.
Some of us do sprint workouts every week or two as part of sports training. Those are exhausting and require some recovery but you won't get faster unless you put in work.
But your point about misleading terminology is correct. That's why modern methodologies such as Scaled Agile Framework (SAFe) have adopted the more neutral term "iterations" which doesn't imply anything about velocity.
Those folks are the ones who refuse to acknowledge and accept the fact that they were abused by family members while growing up, where those personality 'symptoms' are common. It is very well known that ADD and ADHD comes from abusive households. Nobody except psychologists and anyone in the mental health field would ever admit such failures in life. They will not accept the fact, and exaggeration and deflection of character faults into false medical diagnosis is what happens. Not very many doctors want to get screamed at by their patients (which would prove the doctor right) for telling them the truth of their own past, and besides, they're not even paid to tell them.
"Truth hurts, don't it" is a very true phrase. It's a very sick trend affecting Millennials and Gen Z alike, and contributes to other worse mental health and criminal outcomes.
ADHD is something you are born with it. If one biological parent has ADHD there is a 40% chance the child will have it as well. We already know there is a strong genetic link. It is NOT caused by trauma.
There is a huge overlap in symptoms between ADHD and complex PTSD. Yes, one needs to be careful to not confuse the two. That is why when I was diagnosed with ADHD, I was also checked for trauma or any other conditions that could explain my symptoms better. This is the recommended and required procedure for diagnosis.
Furthermore many ADHD people also often have (C)PTSD because living with ADHD can in itself be very traumatic, especially when undiagnosed. And neurodivergent people are also more likely to be victims of abuse.
ADHD is not caused by "abusive households" because again, you are born with it. Also getting an ADHD diagnosis is probably harder to get than an PTSD diagnosis because most psychologists will expect trauma and is quite normal and expected to talk about trauma in therapy. In fact the whole field of Psychoanalysis that is the second most common therapy method after behavior therapy is based on working through childhood experiences.
Yes! While I really like the article as an expression and exploration of the authors grief, a professional would not pathologize based on DSM criteria alone. If a person does not feel sick or want‘s not to be diagnosed for psychological illness, then they won‘t be (some limitations may apply).
That said, the writing really resonated with me and i wish Bess well.
I think when the author says "we medicalize grief because we fear it," she's not arguing that clinicians are eager to diagnose grief, but that society at large wants a clean, manageable container for something inherently messy and terrifying
Agreed. I think the word "disorder" in DSM terminology is commonly misunderstood/trvialized by lay people. Being forgetful, sad, or tired is just part of life. If it becomes your whole life then you likely need help but an orderly life will contain pain, joy, pride, shame, boredom...
We are always at risk of medicalizing discomfort. Allowing oneself to be miserable for a while can be therapeutic alongside patience, forgiveness, and compassion.
Edit: after a re-read I noticed that she says she feels most of the symptoms daily a year later. That does feel pretty disruptive on its own but the definition is a bit tautological in that case.
Regardless, what she's going through sounds really hard.
I have a friend who was hospitalized recently. He tried to take his own life multiple times. Before reaching this point, he was struggling for months, but he thought it was ok bc he was working. So it's hard to draw the line for some people. Obviously, everything in life is a tradeoff and can be risky. But seeking medical advice is probably the best thing you can do bc you can reach a point of no return, and you will not accept treatment. How to draw the line? Like you said, disruptive changes and also disruptive behaviors. It's a complex problem.
I would posit that you are reading this too literally. I didn't get the impression that the author was trying to rail against the medical establishment but rather to process her own experience in relation to professional guidance on the topic. I took it much more as a personal reflective essay than a professional medical critique.
Sure - it's an expansive essay on the authors' experience around their grief. I never said that this was their thesis, but I do think the way they talk about medicalization is worth critiquing. They put their experience in tension with medicalization in a way that I don't quite see.
Edit: I specifically think it's wrong to say we medicalize grief because we fear it. We medicalize it because some people would like a medical intervention with their grief. It's great and right that the author does not want that - but also they shouldn't write in a way that suggest that medical interventions in grief are wrongheaded.
Ok fair enough. I read her sentence as more of a figurative reflection on social attitudes towards grief, but if it's taken at face value then I see your point.
Further: by defining the criteria under which a condition becomes medically treatable, other parts of the healthcare system, such as insurance (private or government-funded), treatment protocols, and the like, come into play. Individuals should they choose to seek treatment are then able to do so within a much larger system.
By making the criteria reasonably loose and readily met, such a definition also minimises the number of individuals who would benefit from treatment who are excluded from being able to do so. This would include those who are very much unable to function or face larger grief-related risks.
We medicalise grief not because we fear it, but because there are genuinely useful therapies which may be of use to some, and denying them that merely compounds suffering.
And yes, absolutely, grief ultimately is a lifelong experience. You never stop missing that which you've lost, so long as you have the capacities of memory, reason, and feeling. That is not what the clinical definition is about.
I think you are misinterpreting what the author means with "medicalize". They aren't saying "require to be treated by a medical professional".
What they're saying is that as a culture, we reason about grief using the tools and concepts of the medical industry. Because it's part of our culture, this is so automatic that it's almost hard to conceive of any other way. But it is indeed a choice to describe grief as a sort of labeled pain which can be explored using falsifiable scientific experiments, is amenable to treatment by medical professionals, is a problem representing a delta between a "normal healthy human" and their current state, etc.
We could just as well have a culture that treats grief as a normal part of the human experience. We could consider a person currently grieving as exactly as healthy and normal as someone playing the saxophone. We could (and some do) consider that the most appropriate people to offer help for grief be spiritual counsellors.
I'm not saying we should handle grief differently. I'm just trying to point out that what the author's saying is that it's a cultural choice the way we present and work through it socially. (But, for what it's worth, I do think we should handle it in a less medical way.)
I think what you are talking about is a problem. Having a medical diagnosis gives personal experience an extra weight in the social realm that's quite problematic. We should all get to say how impactful something for us and the medical folks can have their own standards for when they feel comfortable intervening.
That said, if that's what the author was trying to talk about, I think they are doing so in a way that unfairly indicts the medical system for assertions it doesn't make. They say "Apparently, that’s a disease", but as I said I do not think it is. I think they've misunderstood what makes a disease under the diagnostic criteria they list.
> We could just as well have a culture that treats grief as a normal part of the human experience.
That culture does exist. Even in this article there is an experience of grief that's considered normative in the medical community. Including, I would argue, the authors' grief. I would argue that the medical approach to grief is actually better than other western treatments of grief.
I agree that western cultures (and US culture in particular) is horrible about grief. We want people to be robotic and predictable and not make us think about loss and be sad in private and a whole mess of awful, inhuman things. But I don't think that pressure either comes from the medical community or is furthered by how the medical community talks about grief.
A piece of paper from a medical professional stating that you have some medical need is extremely powerful against the cold machine of corporate and state bureaucracy. You may want to handle grief through general compassion or something but lawyers and managers don't run on that fuel, but medical documents work on them like garlic on Dracula. That's just how it is.
