281–290 of 403 posts
I'm as surprised as anyone to see this #1 on HN. Glad y'all like it. AMA. Feedback, criticism, comments, directions to go, whatever.
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> Especially our government. Spending. Salaries. It all needs to be public. This is especially useful for valuable gov't employees that want to negotiate a higher salary :) Totally fine by me, but just be aware you may not realize the second order effects. The primary people that care may actually just be the employees for pay fairness
The US government is the last entity that should be playing games with salary negotiations. The G payment schedules are well established and can be updated. If they need to figure out other ways of providing a salary, they can update the existing schedules or make a new set that is also publicly available. If I’m paying taxes to provide a salary for a federal employee, I want that to be recorded, publicly accessible,…
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There are annual out of pocket maximums. Mine is something like $7000 last I checked. Its a lot of money, but not an amount that would bankrupt most people.
I always wonder about those. Are they real? Or will insurance companies find exclusions or ways to mark things as out of network and the maximums don't apply?
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Fun fact, your pharmacist is allowed to change your prescription in some states! Try asking them if there are cheaper generics.
In France, the pharmacist is legally obliged to offer the cheaper generic. If the doctor wants the primary brand specifically, he has to write "non-substitutable" on the prescription and a shorthand mention of the reason.
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Yes, the fact that literally all health care goes through insurance is a big part of the problem. As my dad says, if you had to get all car maintenance done through your car insurance, changing your oil would cost $5,000.
It is not like that at all in countries like Germany and France, where really literally all health care (for a lot of people) is covered (mostly) by general medical insurance. The pricing explosion is exclusively an US problem. (Germany has private insurance and France as well in parallel, but the main system is "sozialised")
The healthcare systems in Canada, the UK, France, Germany and Switzerland are all distinctive (they’re main commonality I suppose is that they somehow deliver quality healthcare at a fraction of the US cost.). But to hear Americans say we should “do it the way it’s done in Europe” is to understand that the person likely don’t know how the healthcare systems operate in different countries.
The other frustration in talking about this is the tendency to “It’s just” the problems. If this were a simple problem with an obvious solution it likely would have been solved. We are where we are because of a century of organic, and often idiosyncratic, growth. Well intentioned policies of decades ago have come back to bite us with unintended consequences as likely are our best ideas today.
I don’t say we should throw up our hands and give up, but when anyone says there is an easy solution - we just need the political will to let them do what they want - I do see snake oil.
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Interesting, thank you. One remark: > Modernization is hard, time consuming and very expensive. These regulations are a good driver for all that, but it takes time. Having been in some of these boardrooms there is not typically a cartel of evil executives figuring out how to screw patients. A lot of the time it is a group of relatively normal people trying to hold up a technological and business process house of card…
The problem is that it was built by the last 50+ years of technology and regulations. The system is a product of its upbringing. A company could starts out with noble goals of doing better and slowly year by year sink into this morass and become just another “part of the problem” before it becomes obvious to everyone that it’s now just another entity making things worse. These kinds of reforms would have had to begin…
So... perhaps if we'd had a better goal 50 years ago - single payer or universal medicare or whatever you want to call it - we'd have decades of technical debt that propped up a fairer system, instead of an unfairer one?
Perhaps we need to change our goals today so that 20-30 years from now things will be better then?
I analyzed Italian hospital costs so you don't have to: it's 0.
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The difficulty of fixing and improving these systems is frankly overrated. It has more to do with penny pinching and profiteering that they haven't modernized. I don't mean a rewrite in JavaScript either, I mean sensible engineering, which many people are ready to do but not paid to do, because it weakens the upwards money vacuum the finance cabal wants to maintain. Progress isn't profitable enough according to the E…
I was in the physical therapy space for over 15 years. The penny pinching that comes from healthcare giants towards their software vendors are dreadful. It prevents any serious software engineering from happening. One customer billed over a billion dollars in a year to Medicare through our software and paid us $1M that year. I'm still not certain that we didn't take a loss to take that client. Passing around financia…
I see this a moderate amount in fintech, or perhaps at least older fintech?
Had a colleague tell me about a new financial info provider he was supposed to connect with for data. "Oh this one will be easy" he was told. "They use oauth". OK... well... you oauth in, then you hit an endpoint that triggers a data build which then puts your data file in to an FTP account of your configuration. But you can't even configure it via hitting the endpoint behind the oauth. You have to log in to a web app to configure the FTP account for your account.
You hit the API endpoint and get 'OK'. But... that's it. You might get a file in your FTP account 5 minutes later. Or an hour later. It's just whenever it gets processed on their end. And... if it doesn't show up - you have no indication whether something broke, or perhaps the data service "just doesn't have any data for you today - you can't expect data every single day".
It's insanely crazy how across-the-board poor so many of these mid-level data vendors are. Colleague is currently supporting 8 different integration ingests like this - some deliver FTP daily, some you have to pull down, etc.
One delivers data which is only ever a delta. You have to continually request previous daily info from them to get to the 'first record' for that account, which can sometimes go back years, but... you don't know that up front. So you have to loop and request "day before", pull down data, parse it, then check the day before, until you don't get anything for that customer, then presume the previous was "initial balance". But you also can't just do that once, because... there may not have been any data the day before because... holiday? system down? So in practice you need to go back 3-4 days at least to verify. Oh... and don't keep looping and requesting too fast... you'll exceed the low rate limit ("we don't want people abusing our API").
I can only barely imagine how systems evolve like this, because they don't really seem to serve anyone's interest fully.
[1] https://github.com/pola-rs/polars
Wrote Hacking Healthcare for O'Reilly, created ClearHealth/HealthCloud open source EMR, managed health systems for 15+ years, blah, blah, blah. It is very good there is are the transparency regulations. It is worth briefly explaining some of the reasons why many facitilities are having a hard time complying. There are some bad actors, absolutely true. However "Hanlons Razor" -- never attribute to malice that which is…
Interesting, thank you. One remark: > Modernization is hard, time consuming and very expensive. These regulations are a good driver for all that, but it takes time. Having been in some of these boardrooms there is not typically a cartel of evil executives figuring out how to screw patients. A lot of the time it is a group of relatively normal people trying to hold up a technological and business process house of card…
This statistic is misleading. The US is only the richest country on Earth if you consider the mean wealth. By median wealth, the US is ranked 26th. The wealth gap is enormous, and if you're in the upper echelons of the pyramid your health outcomes are vastly better than the clownshoes shitshow that the rest of the country is subjected to.