This is sad, but kind of strange with all the fear and media publicity of an airplane crash. For example, 1.2million people lost their life in road traffic in 2010 alone... We rarely read or fear about this fact.
That's because most localStorage implementations are in-memory. Chrome and FF (as far as I know) have to synchronously load all your localStorage data from disk at page load and then flush changes to disk later. This increases your page load times dramatically if the user has a spinning rust hard drive. (This is part of why localStorage has a ~2.5mb cap in Chrome and a ~5mb cap in Firefox.)
So, in practice you're benchmarking actual I/O vs in-memory data structure updates.
I donated $50, but I really wish US (and other countries) would reconsider their broken healthcare systems. My dad died of cancer a few years ago and I am really glad we lived in Denmark when he got it - - with a great public healthcare system. He lived 2 years with his cancer, which is a lot when you are counting days. Not many normal people can afford these things (as each of my dads treatments cost about 20.000USD+ and he had a lot of them).
Also, just yesterday DHH posted this:
"Top income tax rate for California residents is 51.6%. Top for Danish residents is 51.7%. (Kicking at $500k+ vs $70K+, though)."
I donated $100, and yeah, our healthcare system is a goddamn travesty. I don't get it. If you're fortunate to live long enough, the one thing that's guaranteed to eventually happen is you're going to get sick in a very expensive manner. It's not an "if" question, it's a "when" question. I don't think that should mean financial ruin. People against universal healthcare must think they're just immune to ever getting sick or something.
> that's guaranteed to eventually happen is you're going to get sick in a very expensive manner.
Wrong, there's still a large part of the population who will end up dying of what we call "natural causes" such as Heart attacks and stuff like that. These are very inexpensive, because you don't see them coming, usually. So, no, not everyone on Earth dies from Cancer.
That's why I qualified it with "if you're lucky to live long enough".
So, yeah, you might be lucky enough to unexpectedly drop dead before some other scourge takes you
However if you don't happen to fortune into a sudden unexpected death, your body will inevitably decay to the point that you will become a large financial and emotional burden on someone. (Or die homeless and friendless). But we can't take care of those people, cuz socialism! They should have had the common courtesy to just hurry up and die.
If the probabilities were as bad as you suggest, there would be no such thing as health insurance. They need to bring in more than they spend on health-care costs. Most people can't end in a devastating health-cost manner.
So.. your argument is that because insurance companies can profit, it's not so bad? "Well, your legacy might be financial ruin for your children, or an early death to avoid that, but since most people die before they realize they're severely ill, ¯\_(ツ)_/¯
I'm not arguing probabilities here, I'm arguing deductive reasoning. You are a decaying meatsack. So am I. At some point something very bad will happen to that decaying meatsack. Such an event will be absurdly expensive to treat. Since I think we'd all agree that for pretty much anyone it makes sense to have health insurance, the obvious next step is: just give everyone health insurance and take it out of tax, and simplify these things 1000 fold. (Not to mention that a single payer would have WAY more leverage, and thusly could negotiate way lower prices. And that's not a hypothetical.. that's how it works in pretty much every country that isn't the US).
But the problem is also that healthcare in the US is just absurdly expensive, insurance or not. Sure, many EU countries have universal health insurance, but if you look behind those, costs (paid by the insurance or not) are quite a bit lower than the US. They're still quite hefty and you do want to be insured for them, but why is healthcare in the US so expensive in the first place?
1/3rd of US healthcare costs is administrative. Single payer (Medicare for all) fixes that.
The lowest hanging fruit, biggest bang for the buck, best ROI, the most logical common sense way to control US healthcare costs is to switch to single payer with universal coverage.
Sure, do all the other kabuki, like quality of care, healthcare insurance exchanges, price transparency, generics, whatever. Because better is better. But know that you're weeding the flower beds while the house is burning down.
I think the real problem that affects everyone in US is the cost of anything health related before insurance. This may be a consequence of the fact that everything is private, but just look at the numbers.
You may be thinking "OK, the system is not great but I'm fine because I've got a good insurance", but that's not true. Even with a good insurance you're getting ripped off before of the cost before insurance of healthcare.
Not really. Hugely ruinous medical expenses could be something that happened, say, once every hundred or two hundred person-years and still affect a massive proportion of people who lived long enough. Also, even just health insurance for critical illness and emergencies isn't exactly cheap...
Well it's not like the health insurance companies really want to pay for the bills the contracts are always phrased in such a way that the can just say... well we don't cover that when you get sick but the do expect you to pay every month when you are healthy.
They wouldn't have that ability in a European like country sponsored insurance since everything would be covered.
People against universal healthcare are just good people who are confused and/or deluded. Their arguments will never really add up because it's only about corporations making profits and to that end people will need to be deluded and manipulated into believing that we shouldn't implement a proper system. Just remember this when you say you don't get it: it's just the political power of traitors speaking through humans via propaganda.
I'm against public healthcare in the USA because there's no way (in the current political climate) it won't be massively corrupt. Did you know the insurance companies were lobbying in favor of our new system? It's still about corporations making profits.
By living in a few different countries, I found out believing that the current political climate of your own is somewhat worse than other ones where supposedly things work better is a common fallacy.
Universal healthcare exists (and works, with various degrees of success) in most countries that are otherwise very similiar to the US in terms of culture, form of government, and in some cases have worse corruption and bureocracy.
As in many things with democracy and social security, there would be inefficiencies, abuses and problems, the real issue is, in my opinion, if the people would be better off in the end, all things considered.
Public healthcare ought to be implemented at the local level for those that want it (which I don't). I'm quite fine with not seeking treatment when I get a terminal illness. If it ever gets to that point I would prefer euthanasia (illegal in the USA).
>You say that now, but I guarantee you the moment you get diagnosed you change your mind. Especially considering so many terminal illnesses can in fact be cured with (very expensive) treatments.
By definition, they aren't terminal illness then. In any case, in the US (or many other countries), those treatments are unavailable or will literally make someone homeless (and preclude them ever getting insurance again). There's also the question of if it's worth it - will the end result provide proper quality of life or not.
Breaking a leg is a specious analogy as it is neither terminal nor permanent; but if something worse did happen and it would permanently affect my quality of life, yes, I'd still feel the same.
And before you say "tort reform", single payer and universal coverage largely eliminates need for malpractice insurance. Again, because we have existence proofs (every country that has single payer) that discerning people can use to inform their opinions.
Tort reform also has no bearing on cost outcomes, according to the data. Texas is one example. It's solely designed to prevent human beings from holding corporations accountable for their actions.
The reason people bring it up is because it's just straight up propaganda preventing them from thinking. Single payer is inarguably more effective, efficient, and cheaper. Also, "I'm against a public system because it's corrupt"? But this private system is a-ok, no corruption at all! FFS.
Markets are not always the most efficient way to determine price information.
Further, most transactions are private or semi private, meaning not conducted via an open market. The amount one business unit (or agency) charges another for goods and services may be informed by a market price, but not necessarily.
Tragedy of the commons type problems. Concrete example: CFC Regulations.
Prisoners Dilema type problems. Concrete example: Cigarette advertising bans. (I'll clarify that this is better for the companies involved on a competition between company basis and "better" for the public in the form of a shrinking tobacco market)
More to the point a real concrete example is healthcare costs. Per person they are cheaper in comparable countries to the US such as UK, Australia, Canada all countries with public healthcare systems (this is including the tax money spent). I would also point out that if you are going to argue that health outcomes are better in the US than those other systems (Maybe that's true, I couldn't say) you are missing the key point of what these non free market systems can be good at (that is capturing externalities, like in this instance bankruptcy or inability to afford service).
You claim cigarate bans helped tobacco industry? CFC helped grow corporations? Because if all you are saying is that regulation is destroying industries, well that's actually my point.
And yes the US Government involvement and regulation in the Healthcare industry in the US destroyed it too. Up till 1960s and invention of Government intervention into US healthcare system, the healthcare in the US was cheap, affordable and the US kept #1 spot for longevity in the world. After medicare, medicaid and all the other Government involvement and regulation in healthcare in the US (i.e. 10% of GDP in the US goes to healthcare) we have #50 in longevity and nobody can afford it. Blaming capitalism for that just shows your ignorance.
Firstly the entire point of my comment was that capitalism is not the best system in all cases and that there are situations especially those involving externalities where an approach involving regulation is the better solution. I repeat it here so you realise what I'm arguing and what statement you made earlier.
Secondly you grossly misrepresent what I say with the first few sentences of your reply which makes me worry about whether you paused to give any thought to what I said or just decided to be argumentative and pick out random words you disliked. Nonetheless I'll go through your points.
>You claim cigarate bans helped tobacco industry?
No I claimed ADVERTISING bans on cigarettes helped the companies by reducing expenses related to competition between cigarette companies. I also claimed that outside of the industry it had other positive effects. However you will have noticed the quotes around "better" in ' "better" for the public' because I felt I should qualify that a non smoker generally costs the health system more by living longer.
> CFC helped grow corporations?
I'm sorry, perhaps I shouldn't have assumed you knew what CFCs are and why they are relevant to the conversation. CFC are a widely useful range of chemical compounds that were used in a great many products, they also deplete the ozone layer. The regulation of CFCs which phased out their use is an example where government intervention was required and the free market solution of localized profits failed. I have no data on whether it helped grow corporations, it is however known that the requlations reduced the amount of CFCs in the atmosphere which led to the shrinking of the hole in the ozone layer.
>Because if all you are saying is that regulation is destroying industries, well that's actually my point.
You're the one that's taken the hardline position of saying that centralized solutions never work better than pure free market and as I reject your reframing of better to be only industry, I am pointing out that centralized/regulated solutions do work better in some cases. Even if I didn't reject your definition of industrial production as the basis for better, wartime america with centralized planing on production was a 'better' idea than the free market system it had before it, being much more productive.
>And yes the...
It may have been cheap and affordable but that doesn't mean everyone was getting it, in fact that's the reason the government stepped in. So sure the system got screwed up by regulation, because it was the wrong regulation, they should have gone whole hog on the nationilization like the other countries and then the US would have a better system. (And by better I mean has a positive effect on the the most peoples lives, not maximises the money spent on basic healthcare, or the total wealth of the "healthcare industry")
I'm sure I've persuaded you that your original statement about the free market system always being the best system is an untenable position. If you still disagree could you explain to me how a system without regulation deals with atomic weapons. (Now a flippant question because I really would believe it to be absurd to hold to the unregulated premise at this point (I hope you realise I'm poking fun at the premise not you)) Do they always go to the highest bidder cash wise or do they only sell them if there's a sales contract not to blow up the seller... and whatever court the breach of contract trial would be held in?
Free markets means that stupid/wrong decisions (i.e. Google hurting people) result in competitive advantage to companies that don't do those stupid things. I'm sure CEO of DuckDuckGo.com just can't wait for Google to start hurting its customers.
And then I take corporations competition every day over Government regulation.
I'm continually amazed at the number of ways the current US system is centralized, usually in an arcane manner e.g. prices that hospitals can charge for things being set by a committee.
You've got all the bad parts of centralized bureaucracy without any of the good bits.
(edit: also, it's hard to tell how many layers of sarcasm your post has, but economists generally agree on centralising certain aspects of healthcare. Insurance is a fairly well studied topic in general.
You can't, and should not, ever; spoke about corruption on a media were a south american/african could read you. US got corruption? We got it worst! Much much much worst. Worst in a level were the King of Soccer (Pelé) can say on national television that the money that would be stealed during the construction of the stadiums for the world cup would came back as tourists money.
And, beside that... we have universal health care. (It's not fancy nor without big lines of people or up to 5 hours waiting to a doctor but it exists, and works. Specially for serious illnes like cancer, HIV or Hepatitis).
My mom just got diagnosed with extensive small cell lung cancer (thats spread to her brain) and I am fucking terrified about whats going to happen to us financially. I can't even focus completely on my mother as a person because I'm wondering about the bills, then I feel bad for worrying. It fucking sucks.
Very sorry. Speaking from experience, this is exactly how it is. When there's a serious medical situation, the focus is necessarily on the bills. They even send you separate envelopes for every little line item and provider, staggered over time, even more than a year after the service, so you can never stop thinking about it. Always fearing opening the mailbox, having to deal with confusing hard to reconcile charges, trying to catch double-billing, dealing with payments to multiple providers. The stress of the bills can easily make the illness worse. The US is truly a barbaric system. But it has this small bubble of well-off people, who have a disproportionate platform for their propaganda, so you can get this public picture that everything is great. Everyone beams smiles in the commercials, consuming the miracle products. The well-off only associate with others who are well-off, so they can pat each other on the back and say "What a country! All this opportunity for those with the right sort of character, like us!"
> "you can get this public picture that everything is great"
I'm not aware of anyone, from any political background, who thinks the US system is anything above "pretty crappy". I've heard some people express positive sentiments regarding small parts of the system -- the quality of certain types of care, for example -- but never for the system as a whole.
The primary disagreements I'm aware of concern how to fix the current worst-of-both-worlds system. Do we put it entirely in government hands? Do we enact more regulations to try to force down costs? Do we remove or relax regulations that appear to drive up costs? How do we create transparency in pricing? How do we respond to innovative groups like Qliance? How should we balance the role of government, individuals, families, employers, and charity in health care?
Do not mistake disagreement on how to answer those questions as support for the current system.
You would be surprised. It wasn't long ago when I met an intelligent and otherwise very well informed American who truly believed that the "socialized" Canadian healthcare system was a 3rd rate disaster and feared any change to the precious US system would lead to a similar situation.
Don't get me wrong he acknowledged it wasn't great, but there is more than sufficient doubt and confusion amongst most Americans with regards to what the actual problem is an how to fix it to prevent any kind of attempt and changing things.
I'm from the UK. The NHS is shambles and is spread very, very thin. Doctors are pissed off. Patients are pissed off. The government seems to be too. However I would prefer the 3 hour A&E (ER) waiting times, being spoken to like shit if it isn't as serious as originally thought and epic waiting lists for outpatient services than having companies profit from my health and the massive vulnerability that puts me in (on top of just bad health). Even for all the bad of the NHS, when things really to hit the fan, I can be sure I get seen to ASAP when it is deadly serious.
Just last month my pregnant fiancée was very ill with an infection and she was examined straight away at A&E, bypassing the 3 hour waiting time. It's for cases like here that the 3 hour wait is in place. There was no cost to me for any of that, perhaps except national insurance which is very small payments out of my pay packet each month a d the £7 for the course of anti-biotics
The real problem is how do we adequately reward doctors who spend such a massive amount of effort and time not just in school but in work? The NYS cannot do this, there are targets like "15 mins per patient on ward rounds". Each doctor needs to spend 10 years in the NHS before private practice. How is a system like this sustainable with a massive budget deficit to boot and government that would like to see its end?
In 2013 my son received treatment from NHS Scotland for a very serious eye infection and, later on, a nasty shoulder injury - in both cases the care was fantastic and even though I have private health insurance I never thought about using it.
I know lots of people have problems with the NHS (a few years back my wife got some care that was less than "caring" - but that seemed to be a staff problem) but generally the experiences of our family has been excellent.
In my experience the location matters. I sprained my ankle in Edinburgh once, and the hospital visit was almost enjoyable. The staff were great. Where I live in London, it's not so great. They have to deal with a lot of annoying drunks and are overworked, but also the place was just not very clean. Our local A&E is closing down too.
As a patient, I'm not really arsed. As a patient, I actively discourage putting strain on the system when unnecessary. I'm really moaning about how doctors are treated, and they are spread thin and are not rewarded by the system fairly by the effort they put in. The targets in place mean they cannot give patients the care they want to give, meaning there is little intrinsic motivation too.
I care, many people care. When you're feeling like shit, you don't want to be made to feel worse. It's simple.
I don't mind a 3 hour wait. The 3 hour wait just shows how thin doctors are spread. Lets face it, a 3 hour wait for any sick person in an uncomfortable chair is NOT going to do them any good.
I just had a baby daughter. The care was excellent at a hospital a couple of miles from home. At one point we had 3 midwives helping, then the anaesthetist and for the delivery we had 3 doctors at one point. After-birth care was great too and we were encouraged to stay at the hospital until we felt comfortable going home all the while with adequate food and a private room.
We had to go to A and E with our daughter a couple of weeks ago. We were seen before I even had time to park my car after dropping off the wife and baby! The doctor and nurse were both very supportive and were happy to see us even reassuring us that we were absolutely right to come in even though no treatment was required in the end.
Around 10 years ago I had months of physio on the NHS and a series of consultant appointments. I was very happy with the service.
Yes, the NHS is struggling like all public services, but the media seem keen to trash the NHS and force us into privacy to keep the (mainly conservative) MP's happy and help their friends get the big contracts. It makes mistakes and isn't perfect but in general I've had good experiences.
I've also had surgery and a lengthy hospital stay in California. An excellent standard of service but at a massive cost (fortunately fully paid by my travel insurance).
I'd prefer the service as it is in the UK where everyone is equal insurance or not even if the quality is not quite as high as places where the end user is paying for the service.
My girlfriend just had a major operation on the NHS.
The pre-op preparation was really impressive, the operation itself was astonishingly quick and well-performed (I was not expecting her to be conscious and talking 2 hours after having a non-trivial part of her body replaced), the post-operative care was pretty decent but certainly not terrible, and the physiotherapy support and general aftercare was good to great. They provided the equipment she'd need to get about the house and keep up her normal life whilst she was recovering, and in general, the whole experience was good to excellent.
"The best health care system in the world" is a pretty common refrain among American right wingers. Many of them truly think that we are #1 in this area and that the great tragedy of socialization will be destroying that.
> ""The best health care system in the world" is a pretty common refrain among American right wingers"
In my experience, the right wing perspective is more like "some of the best health care procedures, embedded in a payment/distribution/insurance system that sucks". One of the biggest fears is that the few things American healthcare does well will be sacrificed, and the things that are wrong with the system won't actually be fixed, the costs will just be shuffled around and hidden a bit better.
My experience is that the system outside of payments and such is seen as superb (when it's actually average), and the rest is seen as OKish (when it's terrifyingly bad).
I was discussing health care reform with one fellow who was under the mistaken impression that outcomes in the US were significantly better. After I explained that people in countries with socialized medicine get care that's just as good as ours, he asked me, "OK, but then why do we need to change anything?" He really thought that the current system, if not great, was still perfectly fine. I've seen that a lot.
There is, no doubt, a wide spectrum of beliefs. But don't underestimate the number of people who think the system is pretty good overall. Really, just look at the total lack of any credible alternative reform put forth by the right wing. They talk big, but they don't seem to come up with anything beyond "leave it alone". They're stuck in kind of a tough position, because they've been advocating government non-interference and free-market solutions for so long, yet they're not in a place where it's acceptable to say that poor people should die in the streets from treatable conditions, even though that's what a free market solution gives you. As a result, there's a huge incentive to convince people that the way things are right now is just fine.
I'm not sure what you base the statement "that's what a free market solution gives you" on, since as far as I know we've never had anything remotely resembling a free market solution. In my experience, one of the most common refrains from that side is "the current solution is bad precisely in the ways that it's not free market". Granted, they're just guessing what will happen, but I don't see that as meaningfully different from your guess about people dying in the streets etc.
Also, I have no doubt that you've talked to people with strange ideas, but your conception of what conservatives advocate (or fail to advocate) is very far from my conception of what conservatives advocate. Your statements make me think you know someone like one of my friends, but you're missing the whole rest of the spectrum of conservative/libertarian/capitalist thoughts, memes, and ideas.
Sorry to hear that. I lost my mother to that exact same thing ten years ago. Her husband had barely OK union insurance (which he was forced to purchase even though it sucked, as a kick-back to the union), that quickly got tapped out (couple hundred thousand dollars worth). She was randomly fortunate enough that the state she was living in had a mandated twice per year, take any patient with an existing condition, requirement for insurance providers in the state, and she was able to pick up a new policy. I don't know about your state, but you might look into that, a lot of states have programs of that sort apparently (the cost was a little high relatively speaking, around $600 per month, but it gave her another million plus in coverage).
While I could only donate $50, I feel everything you said is absolutely true. We must learn to live within our means and be content with a less materialistic (higher quality of) life. Universal healthcare makes this a reality. Not having to worry about increasing premiums as one gets older is a reason in itself to justify for higher taxes that come with it.
We need to educate the youth to start thinking about life holistically and not just in terms of vacations and latest toys.
I can't tell if this is snark or not, but the "ACA" does provide subsidies on a sliding scale based on income, however, I can't comment on his situation. More likely though, it would be Medicaid, not subsidized private insurance at lower incomes, and the ACA expanded eligibility to 125% of the poverty level.
But single-payer it is not.
(edit: Medicaid is very limited in recurring residential care and support, so this potentially be a contributing factor).
I don't particularly see this as being a strong problem with American healthcare. You can buy health insurance to pay for any and all medical expenses. The healthcare system is broken if you do an honest day's work and can't afford insurance, but that's not what we're talking about here. There is a reason that most of the best hospitals in the world are American, and the way we fund our healthcare is that reason. Yes there are plenty of efficiencies to be improved, and much in the way of helping everyone access affordable care. However, you're never going to have Americans shifting away from exchanging dollars for doctors.
You can buy insurance which covers home health care and doesn't cost a cent after a deductible of a few thousand dollars. You can buy insurance which provides income if you can't work because of an illness... there are also several government programs that help the disabled.
You can also save money for emergencies and not live in debt beyond your means your whole life as too many Americans do. Sometimes bad luck strikes and you'll need to ask for help from friends, family, and the community and there's no shame in that.
If you get sick and can't work, is the health care system supposed to pay your mortgage too?
The American system is based on choice, and Americans will not give up that choice no matter how many discussions are had calling the system broken. It is not a broken system in which a person with appropriate means choses risk over safety.
If we were talking about people without the means to pay for insurance then this would be an entirely different discussion.
> If you get sick and can't work, is the health care system supposed to pay your mortgage too?
In lots of countries, if you get too sick to work, the government will assist you in paying for housing. In lots of countries, they'll do it if you're just unemployed, too.
There's no righteousness to the fend-for-yourself ideals of the USA. It doesn't have to work that way. You can choose, as a society, to sacrifice extreme wealth for greater equality. It doesn't make those countries better, but nor does it make them worse.
The widespread and persistent belief in the USA that whatever the USA does is the best way, and all other countries are dumber and weaker, is one of the most distasteful things about living here as an immigrant. It doesn't have to work this way. The American way is not automatically the best one.
The problem with your Rand-esque proposal that if we all saved and lived below our means would be rolling in it, is that we don't all have the privilege of living in state or region that provides reasonable healthcare.
Any guesses what a family policy with a $10,000 (?!) deductible goes for in Maine? $1,400. Say what? That's if you don't get insurance through your employer, which is becoming more rare everyday as insurance negotiations for employers gets stupid expensive everyday too. That's approaching 30% of my annual salary, and we'd have to pay up to $10,000 before anything kicks in.
Oh, and routine medical visits aren't covered either, so that just encourages you to not see a doctor unless you really need to. Who honestly wants to drop $200 annually to have someone with 5 years of med school tell you you're fine, but could lose a little weight.
The system is broken. If you're covered by insurance you have no right to speak to any of this. If you live in a state where individual policy pools are cost effective, you have no right to speak to any of this.
The state of the matter is that the rest of the world has figured this out. And while there will always be challenges figuring out when $84,000 for open heart surgery on a 90 year old man is warranted, we can do better than right now.
TLDR; Health care that's twice as expensive and general health that's not even in the top 25 in the world anymore. And no, people go to Thailand for really expensive experimental surgeries (done by American doctors, granted), these days.
That's new in the past 45 days. For what it's worth, under the ADA the insurance subsidy I get from taxes is enough that I actually am insured, but it doesn't bring the monthly cost of an insurance plan down any ... just pushes the cost off to taxpayers.
The miserable irony of this is that then the government winds up making a deal with FOR PROFIT insurance companies. Companies which would be failing their investors if they weren't wringing every cent out of the policy holders to pad their own pockets and generate wealth off the suffering of others.
My personal opinion is that the ACA is a stepping stone to a single payer or something close to it in the USA. Meanwhile it is absolutely the worst of both government spending and private corporations. Now we just have to wait a whole other oscillation of the liberal-conservative pendulum, which tends to take 10-20 years.
Insurance companies generally have to spend 80% of premiums on medical expenses. The profit and marketing expenses aren't that much of your premiums. What you seem to be asking for is price fixing the way much of the rest of the world handles healthcare, which will reduce the incentives to advance medicine. I prefer our current approach, where those who can afford to pay are left to pay as much as they're willing to, which increases the number of smart people who are willing to solve everyone's medical problems.
I grew up in Houston, where people from around the world go when they want to be treated for cancer at M.D. Anderson Cancer Center. It's not cheap, but the best doctors in the world head there because they can make the most money.
Single-payer healthcare is worse than the Affordable Care Act.
But 90% of the world doesn't die from exotic cancers, at least not below the age of 50 (or 60 ... keeps creeping up). The idea that advanced medicine is an justification for for-profit medicine is a straw man argument.
The reality is that there are many more nuanced single-payer healthcare systems in the world than the one where the government tells you who gets to live and who gets to die. In the U.K. for example, there are still for-profit health care insurers and if you're wealthy enough you can buy their policy and have quadruple by-pass surgery when your 75.
I'm not going to pretend we don't live in a capitalist world and that at some point rich people are going to live better than poor people. That would a fool's dream. But to argue pure Smith-style market economics will help keep people healthy is a joke.
Even worse than that, while you laud the MDA Cancer Center in Houston now, wait 20 years and the cost of operating it will have sent it out of the country. In a globalized world you are competing with everyone, and while the USA has been sleeping the rest of the world has been getting very good at what we believe makes us special.
I don't fear the rest of the world getting better than us at medicine. Money motivates most people. The best doctors will go where they can get the most money. That is here.
If I had to pick between the UK's system, where price controls help pay for healthcare for those who can't afford it, and the Affordable Care Act, where wealthy people pay for healthcare for those who can't afford it, I'd choose the Affordable Care Act.
Price controls have such a terrible track record that we should prove why healthcare is different from the failures we've seen in housing, food and gas before trying again. Price controls give us less of what we desired so much in the first place.
"...the UK's system, where price controls help pay for healthcare for those who can't afford it..."
I'm not sure how much you know about the UK system, but it doesn't use "price controls". Its funded by National Insurance Contributions , which are a form of payroll tax. The more you earn, the more you pay. People on low incomes pay nothing but still receive health care.
The vast majority of the UK's health expenses flow through the NHS. This gives NHS the power to demand prices that are lower than they would be if there were many competing insurers. That is effectively a price control. If you don't agree to accept the NHS's price, you're left with few, if any customers.
No, but if your theory of healthcare is that private healthcare produces the best, most advanced treatments, then by all rights you should fear the world getting better than us at medicine. Healthcare is by it's nature a social issue as well as an economic issue. And a draining of doctors in the USA would have a devastating effect on general health.
Even more important is pointing out that medicine is already not a perfect capitalist economy. Insurance companies negotiate crazy deals with hospitals and doctors to avoid paying out, and the hospitals and docs are driven to post prices as high as humanly possible because the insurers are so ruthless in undercutting every single expense. What would Ayn Rand have made of a world where generic Advil in a hospital setting cost 1000% of what the drug store is charging? That's not a Smith economy. That's a gross perversion of free economics.
That's the snake eating it's tail on the other end of price control. $25 per pill for pain killers ? It's a joke.
> Money motivates most people. The best doctors will go where they can get the most money.
Except that most doctors already make plenty and that most doctors are in fact also strongly motivated by the desire to help and treat people. That's why they became doctors, and the latter desire helps them achieve becoming better doctors much more than a desire for money.
I'm not saying they're not motivated by money. Just that "the best doctors" are probably driven by a couple of other motivations too.
There is a private health care sector in the UK - doctors can choose to work there exclusively or share their time with the NHS. You aren't forced to use or work for the NHS - although everyone does have to pay for it.
Also in the report: "The majority of the uninsured are in low-income working families. Reflecting the more limited availability of public coverage, adults are more likely to be uninsured than children. People of color are at higher risk of being uninsured than non-Hispanic Whites."
If you have an especially difficult medical problem or you have the money and want the best possible care, your hospital of best choice is probably American.
If you're talking about average medical conditions and the average outcomes... maybe not, but those statistics are usually about the medical systems as a whole which is much more difficult to compare in a country without universal health care.
If you have an especially difficult medical problem or you have the money and want the best possible care, your hospital of best choice is probably American.
Again, do you have anything to back this up? My question isn't about there not being good hospitals in the US, but rather the assumption that the best ones in the world must be American.
Also, I think you definitely mean "and" rather than "or" in that sentence. If you have a difficult medical problem and no money, then your best hospital is going to be one that will treat you rather than turn you away for having no money.
> The healthcare system isn't broken if you do an honest day's work...
And how about all those people that can't work, because they're sick, or disabled, or mentally ill, or too young, or too old, or they just need 3 months think time to get their head in the right place.
"The healthcare system is broken if you do an honest day's work and can't afford insurance, but that's not what we're talking about here."
But that IS what we are talking about here. Millions of americans do a hard days work and can't afford insurance. You know where they get their care now? At the country (public) hospital emergency room. Don't believe me? Go and have a look. Most of the people waiting in the waiting room are not emergencies. Their waiting for standard care. And they got no place else to go.
And this impacts us all. As in property taxes going up to pay for the public hospitals. Oh wait.. don't tell me - we don't need public hospitals either right? I mean you got yours... fuck the rest right? Until you get sick and facing cymo treatments that cost $75,000 a pop. And your insurance company only covers 75% of the bill.
Then you're complaining "where's my medicare disability?"
It saddens me that some people look at travesties like this and think "fuck him, the system is great, three cheers for the status quo."
This despite the fact that any honest reading of our medical outcomes shows that America gets very average medical care, and that we pay about twice per capita what the best care in the world costs.
I mean, I know there's a lot of propaganda out there, and I know there are a lot of sociopaths who are eager to believe it... but I'd think you'd keep your dishonest pro-status-quo, anti-efficiency nonsense out of a thread like this one. Especially since your post implies an utterly nonsensical (and clearly grossly uninformed) dichotomy that the only options are pure state control or the status quo, when any informed survey of developed nations would show many other models, some of which would work well in the US.
Sadly, progress is stalled and we all suffer because there are obstructionist assholes like you, willing to ignorantly pretend that the status quo is the best in the world.
The top can get the best care for the right price, the bottom has been inadequately supported though much progress has been made with ACA, and lots of people in the middle are inadequately prepared, because given the choice, they choose a higher standard of living instead of more safety for the future. To be given that choice is engrained in a lot of American culture.
You won't find much sympathy for the middle class who choose a nicer house in a more expensive city, a newer car, or a bigger family instead of safety and security for the future.
Sure especially bad circumstances happen, and then you have the government, friends, and family to fall back on... and maybe some of these public services could be improved, but a significant positive change certainly has happened with the ACA.
Progress isn't necessarily taking choice away from the population, because ultimately health care will cost the same whether you can choose your coverage or the government chooses it for you... if there are inefficiencies and cost problems, don't think that forcing everyone to have the same health coverage will fix them... there are plenty of other problems.
"You won't find much sympathy for the middle class who choose a nicer house in a more expensive city, a newer car, or a bigger family instead of safety and security for the future."
The average cymo treatment is about $75,000 a hit. So, you know anyone who is prepared for that? The top 1% are, of course. But the rest of us? Those who don't have insurance are fucked. Those that do are ok until they get a bill for services not covered by their insurance. And god help you if you want a non-standard treatment. Then it's ALL on you. And then the house is up for sale. Then the cars. Then you are applying for medicare disability. Only to be dined because you made too much money last year.
This happens all the time. My hope is that Obamacare deals this. But I have my doubts.
Tell you what.. get cancer then come back and comment. I bet you change your mind. ;) No offense of course. Just don't come to my county hospital for care.. my property taxes are high enough. ;)
The thing that seems to be missing from most people's argument is that the cost doesn't go away if you move to a single-payer healthcare system. You still pay for that $75k in the form of higher taxes and higher prices... it doesn't get erased. Wanting a non-standard treatment and not being approved won't change with single-payer... you'll still have to sell everything you own to pay for it.
Saying the cost doesn't 'go away' is deflecting from the fact that it does reduce overall, because of a number of reasons. Administrative costs are vastly reduced. Employers no longer have to negotiate individual contracts with insurers. Hospitals don't need huge administrative staff for deals with different insurers and paperwork for each one. On the whole, the cost savings from moving to single-payer take a huge bite out of the increased taxes.
They are HUGE. I work in the field (writing software). Every insurance company has it's own forms and payments requirements. So do governments, local, state and federal. Not to mention reporting requirements. Throw in other insurances such as schools, the VA (and TriCare), Medicare, Medicare Disability (they are different by the way) and Medicaid - and the hundreds of other sources I've missed. This all equals to a administrative nightmare. A cluster-fuck. A huge expense the hospitals and doctors have to deal with. And you'd think moving to electronic medical systems would fix this.
And this is one of the big reasons healtcare.gov failed the first time out.
My god you're a privileged, elitist, self centred... calm, be calm. The fact that you keep posting this crap on a thread about some I look up to who is DYING OF BRAIN CANCER is really upsetting. So please stop.
If you don't like discussing the costs and methods of delivering health care, downvote the parent comment which mentioned it initially, not a person whom you disagree with.
If you can't handle an opposing viewpoint without becoming extremely upset and resorting to petty insults, you are part of the broken political system that has led to many of the problems we face, not me.
Europe is ~800million people with very different cultures. You can find geniuses here. You can find entrepreneurs. You can also find people that are sloppy. You can find people that have built billion dollar tech companies. Stop generalizing.
>Europe is ~800million people with very different cultures. You can find geniuses here. You can find entrepreneurs. You can also find people that are sloppy. You can find people that have built billion dollar tech companies.
But you can't find a Silicon Valley or a similar economic and/or cultural spot. He's trying to explain why.
Generalizing is the (literal and historical) start of science -- putting things in general categories and taxonomies is essential in understanding them.
There are categories of things -- and different places have different characteristics in aggregate, not just because "there are various kinds of people in general".
Nobody is saying that generalizing is wrong in the general sense. It's just that sometimes advantages can be had to being particular. For example, I have a feeling that the culture in Estonia (including one's attitudes towards entrepreneurship) is quite different from the culture in France.
I think what the post is trying to say, if you look at Earth, you'd say, look at those bunch of whiners, on average they don't do squat. I mean most of them are just plagiarizing and barely make ends meet. Or just starving to death...
Taken into average VC spirit is pretty dead in most places on Earth. Can VC in Africa, India and China be compared to USA?
USA shares common history, language, state system. Europe is waaay more diverse. Treating it like a singular entity is much like treating all human states on Earth as a single entity.
I for one think it's amazing that I see so many globetrotters (well, continent-trotters) that have experienced and gotten to know so many different European cultures. At least that's the kind of credentials that I assume when they talk about Europe as one homogeneous group of people...
I don't agree with the premise. Software isn't a static thing, it's something that is constantly evolving and creating great software, like creating great anything, requires a lot of effort, a lot of time and a lot of dedication. This is what you pay for when you pay for software. You don't pay for the actual copying of software, you pay for the effort that went into creating it.
Also, designing software and features by "crow-sourcing" is a terrible approach. Why? Henry Ford said it best “If I had asked people what they wanted, they would have said faster horses.”
I don't really think you need to solve this problem using crypto. I think a simpler solution would be to use the "hash it" solution, but restrict how many lookups each client can do. You can either do this by the using the client's phone number, IP or other unique information etc. This way an attacker would have a very hard time brute forcing this.
Additionally you could use captchas (or other humanity tests, such as SMS verification) to limit hackers creating automated accounts (in order to fight automated bots spamming and polluting the network).
While Twitter a is cool service I can't imagine what 1000 engineers can do all day long? Based on this maybe they are building their organization wrongly and following their footsteps isn't the correct way to follow.
Come on. We're supposed to doubt the merits of this entire article about Twitter's philosophy and general large-organization engineering practices because someone outside can't imagine how so many people fill their day? Because maybe a thing which we can't hope to gain an accurate perspective of indicates they're doing everything wrong?
This reminds me of the story of a walk from SF to LA illustrating why software estimates are always so wrong:
Look at e.g. Instagram or imgur or reddit or HN for a lean team. It's hard to compare without intimate knowledge of what either team faces, but without considering alternatives, many things that shouldn't look plausible actually do, e.g. The $5,000 hammers the army supposedly bought, the (incorrect, but oft repeated) space pen story, or the clusterfuck that is US healthcare.
If you've worked on online software you might have some appreciation of the masses of unseen services that are essential for running the system. All web apps, except in the early days, are icebergs. Payments, analytics, control panels, monitoring, deployment etc. -- there is just a huge amount of stuff that goes on that the user typically doesn't see.
I have actually built and scaled a system similar to Twitter called Plurk (which has millions of users, billions of data items and similar use cases as Twitter). We built this with a team of a few developers and one sys-admin. While Twitter is at a much larger scale, I really doubt you need 1000 engineers to solve that problem, because even at Plurk's scale we built automated systems for scaling, monitoring, backups etc. (e.g. sharded the databases, used master-master MySQL setups that supported auto-failovers, nagios for alerts etc.)
You may say: but they have mobile apps? But so do a lot of other companies that don't have 1000 engineers. You need a few really great mobile devs to build great mobile apps, again based on my experience.
I think what has happened for them is that their structure isn't that good and they have scaled too fast (and in this process they have hired a lot of B and C people that aren't that good). It's a least my conclusion based on the limited information I know about them.
If Plurk has 5 developers serving 1 million daily users, and Twitter has 1000 developers serving 100 million daily active users, you only have to believe that scaling by 2 orders of magnitude is twice as hard for it to be a tie in terms of developer:user ratio.
(I suspect the write load is rather different - the figures I can find for Plurk suggest 8 billion messages in total - Twitter writes half a billion a day.)
I don't think there's a huge differences serving 1 million daily users or serving 100 million. In both cases you need highly scaleable systems. In 100 million case you need a lot more computers, but I think the overall structure of the systems could be very similar (e.g. sharded databases, auto fail-overs, extensive monitoring etc.) Of course you need a larger team serving 100million users, but I don't think you need to scale the team as much as Twitter has done.
The big advantage of software though is that you don't have to maintain a fixed ratio of developer:user like that, though. Sure, your employee count should increase as user count does, but far less than linearly.
I'm not sure this is in practice true. Twitter have to start writing or tuning their own scale-specific software, need more analytics, application security, developer productivity, partner and sales engineering etc. proportionally than they would do at 1% of their size. Certainly they could run 100 Plurks with many fewer than 1000 engineers but I'm not sure that's the best way to characterize Twitter.
one of the problems there is that everything is extremely convoluted.... every single thing is a huge rat's nest of cross team dependencies. I found it an extremely frustrating environment to try and work in.
This is pretty common in the growth phase of a company, especially one with easily scalable demand such as a software company.
As others have pointed out, a lot of projects have been built from 'scratch' due to Twitter's needs and/or culture. This alone has a heavy carrying cost, as they now have the burden of having at least two maintainers for mission critical applications and services. It doesn't mean the engineer-tuples are bijective onto the various projects, but there are only so many tickets a person can resolve.
At Amazon, we grew to what we then thought was an insane size in IT (and across the company – we had horrid little offices all over the place in Seattle). This was boosted by a number of acquisitions, such as drugstore.com and homegrocer.com. In 2000, we had a small round of layoffs, then they had another round in 2001.
I would expect something similar at Twitter if they don't move horizontally. I would say that, given the competitive HR landscape, it's quite possible they intentionally overhired to secure strong engineers and will rank and yank those who have not turned out to be performers.
They're still in an annealing phase, but, honestly, I'm unqualified to speculate on their internal alignment, growth plans, or any RIFs they have planned in the near future.
For OT to work you would need the ability to track all the changes and mirror them to the other users. React appears to have the ability to track changes, but I am unsure how easy it would be to mirror them over the network.
React internals support being used in a web worker. It should be easy to send it via XHR.
This would be a pretty exciting thing to be able to do, i'd love to see a demo :)
Yeah, I was really impressed with the way goyo.vim works. And I absolutely agree about the sad state of hackery we have to go through for such plugins.
A big part of why most such plugins fail is that they don't take into account user settings and the fact that it is their responsibility to "hide" other plugins. If you look through the source of goyo.vim, you'll find tons of lines dedicated to working around other plugins. Similarly, LiteDFM has a good chunk of code dedicated to remembering and restoring previous user settings.