polygotdomain

> if a private business with all the incentive in the world can't figure out how to lower healthcare costs

What if their incentives aren't to lower cost? Insurance companies make more when the obfusicate pricing and payout less. That's the opposite of incentive, it's a way to cover up your profits.

> Everyone that proposes a single payer can't explain who makes less money.

If you think the healthcare industry is just doctor-insurance-you, then you're nuts. Look up pharmacy benefit managers. They're basically third parties that are in place to jack up prices.

> Even if you're able to do everything the health insurance company does and capture 100% of their margin with equal efficiency, you'll capture a profit margin of around 2-6%.

Insurance companies have had their profits capped via the ACA for more than a decade now. Where they're making their money is by using more third parties in the middle to jack up pricing and increase costs so that A) their 2-6% is bigger, and B) their "investments" in the third parties are not regulated by the ACA so they can get their massive profits their.

> The only argument I hear is "other countries do it", which is just unpersuasive. It's not a serious argument. Propose something better

Its a very serious argument, you're just happy to dismiss it for some reason. If the entire developed world uses a different system than us, gets better results and for less money, then you'd have to be insane to insist that mimic those systems is not a serious alternative.

Competition based on benefits really comes in at the low end and the top end of employment.

If you're a tradesperson, just having insurance coverage is a big thing. It doesn't matter if it's not great, it's better than nothing. Leaving a job with insurance for one without insurance is likely going to cost you thousands of dollars out of pocket for the same coverage.

At the top end, companies will have plans that cover so many things at very high percentages, meaning that your out of pocket for health insurance will be surprisingly small. Less competitive companies simply can't offer that.

It's only in the middle where the details of a plan matter, and those are going to be the hardest details to find.

I completely agree. While it's counter intuitive, many businesses want to maintain control of employee's healthcare. Some companies look at it as a way to compete by offering better benefits than their competitors. A lot of companies like controlling healthcare because it keeps employees tied to their employer. If you temporarily lose your insurance when you switch a job, all of the sudden switching doesn't look as good. When you get to really larger companies, then they have the ability to self-insure, which means they can control the costs a hell of a lot more.

Of course, since many companies prefer less regulation, the last thing they'd want to do is hand over the keys to what they do for the healthcare for their employees over to the government. With things how they are now, they can always cut or pair back their plans if they want to cut costs. That lever would be gone with single payer.

Like many things, the system is set up to benefit those in charge rather than those who it's meant to serve. You can look just about anywhere outside the US and see that universal healthcare is a much better system, but better for who? Not much of a benefit for those who make the decisions, so we keep the flawed system we have.

To start, it was clear that many were Musk fan boys. I don't think "bright" was a driving force, but "young, with no prior experience" would be great if you wanted people to make decisions that have the potential to negatively impact millions of lives. You need people with a lack of context to realize those are the stakes at hand. Since it was also clear they were going to "throw AI at it", I also doubt they were looking for anyone who acknowledged the shortcomings and pitfalls of an all AI approach.

I think this approach got them exactly what they wanted. Musk clearly wanted access to as much data as he could get his hands onto; legally or not. There were contracts and investigations into Musk's interest that he wanted control over, and got. Overall, chaos is not seen as an issue for those in this administration. The attitude from the top was clearly that these agencies and contractors "deserved it" for some reason, even though they have no idea what they really do or why they're doing it.

Psychopath? No. But it's also not insulting their intelligence by having that little catch up. You're asking someone for something that they don't have to do for you. Showing up in their inbox saying "Give me something" might seem to you like you're being concise and to the point, but to the person reading it, there's not much motivation for why they should give you that thing you need.

The catchup, as mundane and obvious as it is, at least signals to the person that you see some value in them and value your relationship, even if it's transactional in nature. Does it need to go on for paragraphs or multiple emails back and forth? Absolutely not, but having some lead in makes it less like you're only concerned about what you can get from the person.

Would you rather a waiter just come up to your table and say "Order!?" or have a little bit of pleasantries before asking what you'd like to eat. There's no more transactional relationship than a diner and a waiter, but most people would prefer the latter.

> Fixing healthcare costs will require a lot of people losing their job, and that wont be popular.

Agreed, but I also don't think it _has_ to be this way. First and foremost, a switch to single payer would mean that a lot of the infrastructure that's currently in medical insurance industry would need to shift towards being government employees. While there'd be massive administrative savings with single payer, there wouldn't be zero administration at all.

I'd also posture that the US would never go full single payer, and that there'd be supplemental plans similar to the German model (and Medicare, to be fair), so while private insurers would still exist, the administrative burden would significantly lower.

In the end, you'd still end up with a lot of people losing their job, but it wouldn't be a complete wipe out of the industry. Certain areas would get hit harder than others with the insurance brokers likely getting cut out big time.

> In truth I think about 20% of US workers are involved with the healthcare industry and the surrounding insurance and other supporting industries

That seems pretty high to me. I wonder what made you come up with those numbers.

But why did the US lose their AAA rating? It has nothing to do with how much debt we have. It has far more to do with a non-functioning congress that simply decided it wasn't going to pay it. As has been said several times in this thread, it's political, not about the numbers themselves.

This story is incredibly frustrating because it seems to throw a lot of numbers at things (which isn't a bad thing, it's just not super useful) as if that's going to change things politically. Debt is political and the fundamentals of government debt have not changed at all.

Government debt is a red herring that many fiscal conservatives wave to say we're spending too much. Unfortunately those same conservatives don't actually want "fiscal responsibility", they want to cut programs they don't agree with and continue handing out lucrative military contracts that we arguably don't need.

Government debt has always been about borrowing today to fund growth for tomorrow. However, that's not what we're actually doing at all. Much of our current debt is due to COVID stimulous, which was an incredibly exceptional event. Of course that was more to "keeping things going" than fund growth initiatives. That's not to say that debt was "bad" or that we shouldn't have done it, but that much of the debt we're taking on is not going to fund infrastructure, education, or health which are all things that have significant long term benefits to society.

Lastly, debt only matters in comparison to rates. If you're borrowing lower than growth of GDP, then that borrowing is generally considered a net positive. Artificially deflating rates in the late 2010s and the rapid increase in rates post-COVID is not going to do well for government debt because we can't shift our budgets quickly enough to adjust. Of course that also assumes a functioning congress, which we certainly don't have.

Since it is a political issue, it will be a football and a dog whistle. Cut programs for minorities from the right, and raise taxes on the rich from the left. While one party is likely to be more irresponsible with this than the other, it's still not going to go away because it's never supposed to. Government debt is all about the cost to borrow compared to growth. The challenge we're at is that the cost is no longer cheap and we haven't been truly focusing on growth as much as we should. Instead we've just had political distractions.

I think this quote misses that there can (and arguably should) be differences between your persistence model and your actual data structures. I'd argue that keeping things 1:1 with your underlying tables is incredibly restrictive and leads to models that miss out on the expressiveness that's available in modern languages.

To give a slightly more technical answer, at a large insurance company I used to work for, the legal department had provided definitions on what conditions we would consider various components of PII a match. So between SSN, DoB, First Name, Last Name, and a couple others, there were potential combinations that our system would say, "yes this is the same person". Note that we didn't necessarily need exact matches on things like names, but "close enough" matches were sometimes sufficient.

This misses the mark for me completely.

>My theory is that neither individuals nor organizations feel comfortable being frivolous or indulgent with their wealth anymore.

I guess the author hasn't paid attention to the rise of the mega-yacht or having personal jets. If you also don't think that the wealthy live in opulent real estate, then I've I'm not sure what rock you've been living under.

What I assume the author is really referencing is how skyscrapers and other buildings are no longer as "beautiful" as they used to be. Beyond the survivor bias of the older buildings that we perceive as "beautiful", a real explanation probably ties more to corporate accounting and business practices than anything else.

The big grand skyscraper for a company HQ pre-dates the exodus of city centers in the 70s and 80s. In the meantime, the construction of these types of buildings is now being pursued by developers, rather than corporations. Those developers have a much different approach to building, which is much more about making profitable real estate, rather than something that's a statement or a symbol. Corporation also needs more flexibility in their office space that makes renting vs owning a much more viable approach to meeting space needs. We no longer need all employees working under one big roof, and corporations are far more likely to have far more office locations than they did.

I also think that the definition of what this author and the one they're responding to consider "beautiful" is largely missing. We still build fantastic buildings, but they likely don't look like they were built in the 1920s or 1930s and may not align with everyone's preferred aesthetic.

>It's hard to really understand why it matters that the previous rounds occurred at all

It's not hard at all. Humans are not perfectly rational beings. It's not purely about odds, it's about emotions and psychology. In a version where there's no previous selection and it's 50:50, than I pick one and live with it. In the canonical example, the previous selection means that the contestant has already staked their claim, and changing it to the loosing door would have a different emotional response than a simple 50:50 shot with no previous selection. There's a reason why Roulette shows you the last X spins and whether they're odd/even, red/black... because humans make the assumption that the last disconnected data point somehow impacts the current one.

You're also glossing over the fact that there was a 1:3 chance you picked the right door to begin with, and 2:3 chance the "other" door was right. The last round isn't 50:50, as you so claim, because there was prior information

This is the same reason why the 1000 door example helps explain things; because the math is fundamentally the same, yet significantly more imbalanced. We can also think about how we'd feel about our selection in the 1000 door version, which is likely significantly less confidence, and therefore more likelihood of switching. Whether it's 3 doors, or 1000, the math still say switching is optimal, and our psychology and emotions deal with the choice of switching different in each case.