Hey Duff, you're right, healthcare is broken in so many places, and insurers are probably the worst in this morass. They selectively follow Milligan care guidelines, build tools that actively discourage anyone from understanding and/or fighting for fair care and bills, and basically pretend they're doing you a favor but making you pay for your services, then showing a marked down EoB that pretend like they saved you money but knocking off 80% of a bill that was prenegotiated, and you're the one footing the bill. Insurers have no incentive to make healthcare better, and though hospitals are disjointed they still make so much money, it doesn't matter how badly they are run.
But aside from the insurance companies, the first large scale emr systems (Cerner, McKesson, and even Epic) were built as operational tools to essentially give accounting access to Crystal reports. Sure, electronic charts should make the patient's life better, and assist trained medical staff in tracking, however they ultimately are used to figure out how the CBO can game the insurer financial incentive system. CPT + ICD +modifiers (oh, and 85% of those cpt codes are under copyright by the corrupt AMA - yup i have a different bone to pick with them).
I agree that operational dysfunction is the biggest problem in these behemoths, and there's so much ineptitude in administrative staffing that it's a nightmare. Doctors like to believe they're the bees knees and everyone should kowtow to them, but they usually can't run a business to save their lives. It's easy for them to simply blame an EMR than to acknowledge the truth of a dysfunctional system they are a part of.
Glad to see you're still kicking ass, better than sameday.
Most patients who are unhappy about how much they have to pay should complain to their employer, not their nominal health insurer. The majority of US consumers reading this obtain their medical coverage from self-insured employers who use "insurance" companies mostly for network management and claims administration. It's the employer who ultimately pays for treatments. An insurance company will be happy to put together a custom plan for an employer under which plan members get as much care as they want for $0 out of pocket. This will be extremely expensive for the employer.
(We can argue about whether health plans should be tied to employers at all but that's a separate issue.)
But i don't want my kids going to ivy League. I want them to study what they need to know, have fun, and explore. We aren't rich, and they know that, and that level of stuffy education would be better in graduate or post grad, when they pay you to study there.
That was my conclusion as teen too. I went to in-state to a Big-10 school with one of the automatic merit scholarships based on ACT/SAT scores. Still got a great job out of college and moved out west to work at a FAANG (they recruited at my university). Pretty much a top outcome money wise I would've gotten at MIT (where I did get in).
This is classic survivorship bias. For every student that did make it out of those schools and did make it to FAANG, there are many many many more. A much higher % of university recruiting happens at MIT/Berkeley/CMU and as you mentioned, many of the in-state schools barely get recruited.
It definitely makes things easier IF you get in and IF you use the resources of the school to their full potential. Lot of ifs, but let's not discount the objective value of those schools in making the next set of decisions easier just because they didn't benefit you.
I think this is definitely the case for certain classes of jobs but I am skeptical about the value of those jobs.
For example, I think that consulting firm McKinsey does some kind of recruitment and job interview on campus during spring and then they announce who they are hiring for the next summer internship in Autumn. A lot of people try to get in and then there is kind of a weird thing on campus where people talk about who made it in. (I never applied so idk all the specifics just observed this.)
So is working at McKinsey or being a Google director or whatever, working at the other big consulting firms/Goldman Sachs really worth it? I don't know. It seems like they pay higher but I don't feel like there is a big value play for these firms. So really you just have people who play every trick in the book to make themselves appear impressive to get in to the school, then use that to get a job at McKinsey, then they do nothing useful there but at least they can say they were in a special club?? Is this really what's considered desirable? It just feels very artificial all the way down.
On the other hand if you didn't go to an Ivy+ I think there isn't really a barrier to doing interesting and useful things which aren't involved in this weird status game. That's not to say all students at those schools are like that but the places where degree matters the most seem questionable to me. I don't like speaking in generalities either but I think it's worth questioning this economic system we have set up with admissions and the job availability after graduation.
Culture was another reason I chose state school over MIT (and didn't even consider any other fancy schools). I don't really have a good word for it, but I got a bad smell and haven't regretted it.
I bet on myself and it wasn't an uneducated bet. I figured I would end up in the same place regardless because I had been reading about research on college outcomes. I read that intelligent people tend to end up with the same level of success in life regardless of university. Made sense to me.
Given where my career has taken me since, I'm especially confident I would be in the same sort of place. If anything, going to the state school I went to is both what introduced me to my career focus (professional FP & Haskell) and first job (got a referral from a friend for FAANG. He was pretty savvy - had an older brother in SV tech - and told me tips such as job hopping for a raise every 2y or so).
> 58% of full-time undergraduates received an MIT Scholarship during the 2022–2023 academic year. Among those, the median family contribution after student term-time work was $9,926.
1. My contribution was even lower. No need to take out a single loan.
2. I (and my parents) actually did dig into the real cost. It was more than that. It was doable but with loans and/or my parents dipping into funds well beyond their college savings for me.
Not sure I would've gone even if the costs were closer tbh. Culture fit is important.
If it was not a fit, why did you apply to MIT? 99% of people who apply to MIT are people who are absolutely hungry to get into MIT. I never heard about anyone accepted at MIT and turning it down because they realized it was not a good cultural fit for them.
What exactly was the cultural issue that you didn't like? People being rich? The MIT crowd is not rich. If you travel the one mile or so from MIT to Harvard, you'll immediately see the contrast between MIT kids and Harvard kids. MIT is definitely a place for hard working people from all backgrounds, and if anything, the rich are underrepresented.
I want my kids to go where they want to go. If that happens to be Ivy, so be it. If that happens to be MIT/Caltech/Stanford, so be it.
When parents lament or worry about their kids not being able to get into Ivy League schools, I think it's less about those specific eight institutions and more about whatever selective college they might want to attend.
In my culture—which I think is right on this—individuals are subordinate to the family. I want my kids to go to an Ivy (or in the case of my eldest son, a service academy) because those are important to success in business and politics, and that’s what I want my kids to pursue—for the success of the family unit. That doesn’t mean I want to go to one, or regret not having gone to one—what I want for my kids is quite independent of what I want myself.
As someone who's yet to play with Erlang and Elixir, is the bytecode lean or fluffy? Microcontrollers often have somewhat limited Flash storage, and I see they have 512kB as bare minimum with 1MB recommended for the VM itself.
I'm not a BEAM developer, but a quick search found this [1] which was very informative. My classification would be "quite fluffy", but that's of course highly subjective and the language/platform has quite a lot of features that it needs to support so I wasn't expecting CHIP-8, exactly.
If I understand correctly, Elixir builds an Erlang syntax tree and then the erlang toolchain takes over. If it runs Erlang, it should be able to run elixir
I think you have it the other way around. Elixir is built on top of Erlang, no? So if it runs Elixir it can run Erlang in the same way React can run JavaScript, but not necessarily the other way around.
No, the GP is correct: Erlang and Elixir are 100% equivalent on the BEAM, because Elixir compiles to Erlang AST, then that is compiled with Erlang compiler to BEAM bytecode. I honestly don't know what you mean by the React example, but it's more like JavaScript and TypeScript, or Java and Kotlin. At runtime, there's no difference between the code compiled directly from Erlang and code compiled from Elixir.
But aside from the insurance companies, the first large scale emr systems (Cerner, McKesson, and even Epic) were built as operational tools to essentially give accounting access to Crystal reports. Sure, electronic charts should make the patient's life better, and assist trained medical staff in tracking, however they ultimately are used to figure out how the CBO can game the insurer financial incentive system. CPT + ICD +modifiers (oh, and 85% of those cpt codes are under copyright by the corrupt AMA - yup i have a different bone to pick with them).
I agree that operational dysfunction is the biggest problem in these behemoths, and there's so much ineptitude in administrative staffing that it's a nightmare. Doctors like to believe they're the bees knees and everyone should kowtow to them, but they usually can't run a business to save their lives. It's easy for them to simply blame an EMR than to acknowledge the truth of a dysfunctional system they are a part of.
Glad to see you're still kicking ass, better than sameday.