It's designed well, people just refuse to use it correctly and we can't force them.
"People refuse to use it correctly" sure looks like bad design from the outside.
Ever heard of "Desire paths?". You can have a beautifully engineered and designed walkway, and people will still walk through the dirt if that makes more sense to them.
Similarly, you can try to get people to use their PCP as the doorway... but if that's too complex or annoying of a process they'll skip that and use urgent care.
Maybe just maybe there's a way that accommodates people's preferences.
faceh
7hr ago
Yep.
There was a local eye doctor with big dreams when I first moved to this area 9 years back who now owns like 6 different offices in two different counties. Actually, I just checked, now its 7 in three counties. Could quite possibly be pulling in 8 digits annually.
Entrepreneurial spirit in the medical field can be rewarded heavily, and because it is gated so heavily, you generally have a built-in advantage for reaping those rewards if you have business savvy.
Of course, entrepreneurs from outside the medical field are absolutely SALIVATING to piece up the medical industry any way they can, and it all seems to trend towards consolidation, where big, established players will eventually come in to compete with you.
Most doctors I've known are happy enough to just build up a big book of patients then sell off their practice.
Urgent Cares exist because people these days refuse to use the system how its designed (and it's because of incentives, I get it and have committed this crime also) but they aren't really designed for the care people ask of them.
Sounds like a design problem.
This has a number of important effects one of which is: most of the shit that annoys you most about doctors is not their fault, they are required to do it because they aren't in charge anymore (most people in most specialties are employed now and not in independent private practice).
Sounds like a design problem.
Doctors no longer work for themselves and are now required by law and by their employer to do things that annoy the hell out of patients and we hate it but its not our fault please dont blame us thank you.
Sounds like a design problem. I'm not blaming them, definitely not individual doctors.
But doctors are theoretically in the best position to raise the issue and demand or impart adjustments. Seems like there's a large... incentive problem, who profits from keeping things as they are, and why don't they suffer consequences for failure?
Another Eliezer Yudkowsky tweet that lives rent free in my head on top of the other one is his almost certainly correct argument that completely removing all regulations currently effecting the healthcare industry would create immediate improvements compared to the status quo.
So, hope that Trump takes a chainsaw to the healthcare regs?
He also has interesting ideas on addressing the status quo.
faceh
8hr ago
Yep, we discussed that a bit not long ago, so I can't say I'm donating entirely out of altruism.
I don't know if they filter out the microplastics from the blood somehow (probably not) or if they just get passed along to become the next guy's problem.
Well conveniently I explained what happened with my primary care physician elsewhere in this thread.
i.e., he's been 99% useless to me compared to the time and money cost, so urgent care is simply the better option.
Ultimately if you say, go to your lawyer and ask for accounting help, they may charge you for it and try and help but they aren't an accountant.
Ackshully, as a practicing lawyer, I can say that that may very well be malpractice, and its for this exact reason I keep a number of trusted accountant and financial advisors in my rolodex to send clients to rather than even risk that issue.
faceh
18hr ago
Somehow they don't even have to test the drop these days. They get the iron level some other way.
faceh
18hr ago
The fact that I was able to get an issue solved by a Physical Therapist with an investment of about $50 and 30 minutes of time seems to suggest that the medical industry is overcharging for certain services.
Not sure what you'd suggest I do when I'm experiencing ongoing immense pain but no immediate danger and it'd take weeks or possibly more to get in with a specialist.
If the urgent care folks had said "oh, we aren't really geared for this, go see a physiatrist" then I'd give them credit.
That ain't what happened.
faceh
23hr ago
Far as I know it's just based on some eligibility criteria. Giving more often in theory means more blood available (for others) for emergencies. I like to think I'm banking some karma.
I had severe and persistent shoulder pain a few years back, it would radiate down my arm to the point it it became actually debilitating. Went to urgent care, they did X-rays, a doc came in and felt around, asked me some questions, and looked at the X-ray results.
Said I likely had bursitis and gave me a scrip for muscle relaxers and painkillers, that BARELY got me through the next couple weeks until the pain went away.
Last year, the pain came back. This time I spoke to one of my Physical Therapist friends who I KNEW saw tons of patients a year. She agreed to do an exam for cash, then give me her thoughts and possible options.
Took her about 10-15 minutes of prodding around to diagnose elevated first rib and a muscle imbalance causing possible shoulder impingement.
She gave me some stretches to ease the discomfort, then some exercises to remedy the imbalance once the pain subsided. Took <1 week for the pain to alleviate, and after easing into the exercises everything started working even better than before. No drugs needed.
Sort of broke my last remaining faith in Doctors as the gatekeepers of health.
Lol I think about the same thing from time to time.
Back when I moved to a new area and had to face the terrifying fear of finding a new doctor, dentists, etc. all on my own, I spent a couple hours of research to find a doctor who accepted my insurance, was located conveniently close to my home, and seemed sufficiently competent from the dubiously reliable reviews and ratings systems there are for doctors (this shouldn't be difficult? There should be some easy way to ascertain if they've ever fucked over a patient or not?). The appointment had to be made a month or so out. I saw him a grand total of twice. Each time I waited about 20 minutes to be seen. I think I spent a total of 15 minutes in his presence. The first time he asked me all the standard health screening questions, including Tobacco use. I truthfully said that I'd had a cigar earlier that year, which he marked down on my sheet and noted "that might make it harder for you to get life insurance." Sent me to go get the standard battery of tests one gets as part of a general physical exam.
Second time, X months later I came back so he could review lab test results with me. All seemed good (BMI a little high but I COULD HAVE TOLD YOU THAT), and I requested politely that he make it clear that I am not a tobacco user, and he was good enough to remove that from the sheet. Hours of research and waiting to talk to the guy for <15 minutes and be told I'm in great health, if a little heavy.
Never went back. Felt like the time investment was simply not worth the so-called 'preventative' benefits. What was the point of him and me being in the same room other than allowing him to show face and justify however much he was billing to my insurance co.? Every single measurement he took could have been done by a nurse, any information he needed to diagnose could be provided without me having to make the appointment and such. I can give a blood sample, turn my head and cough, and get X-rays done somewhere else and send them to him for review without needing to coordinate our busy schedules to coincide.
That's how lab tests work! I go to a location that has plentiful availability, they do some tests and send the results to the Doc. Surely he could have looked them over and sent back some recommendations or concerns as needed. He can presumably do that from the comfort of his home, even!
If I feel something physically wrong with me and it doesn't go away, I go to urgent care and get attention on the spot. If I want to know about some given metric about my body I can usually purchase or borrow a tool that will give me acceptable measurements, then punch those into google (or, more recently, ChatGPT). As somebody with no chronic health issues I simply don't see the value-add of having a primary doctor that will just tell me things I already know, but with the authority of an M.D.
I donate blood every few months and they do a mini-physical that allows me to have a small insight into my health going back for years, so its not like I'm just sticking my head in the sand!
Now, OTOH I kind of love my Dermatologist. Visits last <30 minutes, about 10 of those she's physically present, and the entire time she's actually doing examination of the relevant organ. I pay in cash, I get another appointment 1 year out, and that's that. If something out of the ordinary is noticed, she can write the scrip and I can usually physically see the improvement the treatments bring.
I wonder how much of the prestige for doctors is still driven by all the Primetime shows that portray doctors as various types of savants or at least dedicated, hard workers who are subject to insane pressures and generally rise to the occasion. It probably makes the layperson think its GOOD that we limit who can be a doctor. "Doctors have to be like top 10% for intelligence and capable of working insane hours, that's not something just anybody can do!!"
Nevermind that the shortage of doctors is the reason they get insane hours and plenty of people in the top 10% for intelligence would avoid the field BECAUSE of that.
faceh
3d ago
I have come to despise the proliferation of messaging apps with slightly different functionality, and each one tries to justify itself somewhat differently but end of the day the features anyone cares about are identical.
"Meta" missed a huge chance to live up to their name and build up interoperability with every major messaging app so that Facebook users could end up having a single account on one app that allows them to chat with everyone on every other app through one interface.
faceh
3d ago
After carefully curating my feed and lists I pretty much never see any content I find completely distasteful and I also get a smattering of opposing views that aren't stark raving mad.
I kind of hate the site as a general rule, but it's less bad than virtually all the competing options. Facebook is boomers and slop, LinkedIn is strivers, grifters, and awkward corporate copy, Instagram is distilled narcissism. Reddit is... reddit. Twitter is, I think, the closest to the ideal of the public square where large scale discourse actually happens.
Pick your poison.
Yeah. There used to exist forums with competent moderation that allowed quality, technical, high level discussion among members and yet random onlookers could view the discussion, and many of them were indexed by search engines so you could find them when needed as well.
Reddit sort of replaced this but shit the bed because
A) Useful subs get overwhelmed by casuals and Eternal September kicks in
B) Useful subs go private to avoid the above and can't be accessed or indexed or searched OR
C) Powermods capture the useful sub and turn it into an ideological echo chamber.
Wikipedia could probably step up and fill a massive gap here, but there's signs it is ideologically captured a swell.
I am not satisified with AI 'replacing' the open internet that we had, even if it manages to match the general quality.
Also there's a narrative that everyone is broken or suffering from trauma in some form and thus EVERYONE needs 'healing' to manage their lives. And people who deny needing healing are the most broken of all! So they work from the assumption that anyone who hasn't gone to therapy must be broken, and thus therapy will help fix things... even if that person had a perfectly normal, healthy upbringing.
I say this as somebody who used therapy to get over a bad breakup. It helped me work through some things, get my emotions out, process my own role in the events and my own personal failings and then... get back to real life quicker. Its a tool! If it works, you should eventually be able to stop using it.
But end of the day it led me to conclude that I'm doing almost everything 'right' and have an accurate world model and generally a normal response to life events... and its EVERYONE ELSE who needs to get their shit together.
This Eliezer Yudkowsky tweet lives in my head rent free.
I think a lot of people use the need for therapy or the fact that they're in therapy as an excuse to not address actual life circumstances that are holding them back.
And by the same token, if their therapist isn't pushing them to address or change their life circumstances, they're probably just there to collect a check and make the person feel like they're doing something constructive.
I don't know if LLM therapists will suggest actual proactive steps to improve life circumstances.
faceh
6d ago
A group chat that has competent people who are tied in with various industries and specialties in various fields.
And a highly curated twitter feed or set of twitter feeds for other competent people in various fields.
The first one is hard to find, for sure.
The second one takes some effort, because you have to filter out brainless pundits, grifters, kooks, and the occasional psy-op, and identify people with consistently correct analysis or at least an actual mastery of the facts.
Right now there's a LOT of people online who offers 'newsletters' and paid writing (usually via substack) where their whole game is that THEY comb through all the new of the day and analyze it and summarize it to their particular audience. If you found a good one that might suit your needs. But also consider how that person is choosing to present any given issue, and what they might be choosing to exclude.
Ultimately though, accept that you can't keep up, and your own sanity is probably better served by deliberately taking breaks from the firehose. News will happen in the interim, you will hear about it, but it won't take you long to catch up on the stories that ACTUALLY mattered later, rather than trying to identify meaningful stories as they happen.
The crazier the world gets, I assert, the more critical to ensure your own mental peace.
I'm not certain if you're arguing that she was a critical part of creating the wealth and therefore deserves a large cut (i.e. he wouldn't have succeeded if he wasn't married to her) or if you're just saying that the law states she gets a chunk as long as they were married long enough, ergo it is just dandy that she gets what the law says she gets.
The position "a woman can be married to you a long time and then leave and take a huge chunk of your wealth with her" isn't very encouraging, on its own.
faceh
10d ago
It was their money and it was divided in a divorce settlement. Losing a big chunk of the fortune you were able to accumulate because your wife was loyal enough to support you into building a business that turned into the most profitable one in the world is a fair penalty for deciding to cheat on her.
Is it, though? The law says that she is entitled to some percentage of what he earned/acquired during the marriage. But that law presumably was not written with billionaires in mind.
As far as I understand divorce law (admitting it varies between states), the goal is to ensure that the less endowed spouse is not left destitute and is given enough support to live approximately the lifestyle they enjoyed during the marriage for the foreseeable future. Punishing the other spouse is not really part of the calculation.
I think $100 mil would be more than sufficient for that purpose. Maybe you disagree.
And regardless, the message this sends to guys is that they can lose enormous chunks of wealth in a divorce (and thanks to no-fault, the cheating part is optional!) and so they probably shouldn't risk getting married if their assets are considerable.
faceh
10d ago
But there's a certain kind of boasting/hypernationalism that you can see sometimes online, a certain level of entitlement to other people's money.
I have to be circumspect, but in the course of practicing law, I've run across these types of clients who have a tendency to haggle about prices and rates from the start. And then once you've agreed on prices they will later on try to get discounts or write-offs, oftentimes by pointing out perceived flaws in the work or failures on the customer service side. And on some occasions just try to screw you over directly.
And when you notice that despite these people belonging to a group that is <10% of your clientele, they are like 80% of this specific type of problem client you encounter, it becomes bad enough that you kind of brace for it when you notice certain names associated with a certain ethnicity pop up.
Now, I have had entirely pleasant interactions and dealings with some of them, but adverse interactions are common enough that I can instantly recall the bad ones, and that can definitely feed into a bias.
"white men in the like 25-45 range" does seem to be the least bad male demographic to be in.
In terms of dating and mating success I bet this is true. But I think the sharp understated problem is that the more success they achieve, the greater their overall risk becomes, too!
That is, white men will likely have more to lose/further to fall from getting me-tooed, divorced, or arrested.
To put it bluntly, losing a few billion dollars in a divorce is a patently absurd, and extremely harsh outcome, and even if we admit that it doesn't render the guy destitute.
And that's what white males, (almost every male, really) are sensitive to. Their success built over years or decades being threatened by picking the wrong woman or running afoul of the wrong social group. Because those are the conditions everyone currently operates under.
And no this isn't a "won't somebody PLEASE think of the Wealthy WASP guys?" post. Its a "if it can happen to them, it can happen to ANYBODY" post.
So yes, I'd grant white guys are going to have it better ("less worse"), but they're not escaping the conditions that are plaguing everyone.
faceh
10d ago
If it truly is a situation of molochian hypercompetition, NOBODY is getting the "better" end of it. Everyone is working harder than ever for less reward than ever.
It's crab buckets everywhere, and any perception that it is better somewhere else is just grass is greener effect.
faceh
10d ago
What does this have to do with anything? Ron's nickname was "desanctimonious".
Yes, and as we can see running against Trump in the primaries and getting a nickname doesn't suddenly mean Trump won't turn around and treat you favorably later.
faceh
11d ago
but that's mainly because we don't think anyone under 18 (21? 25? 120?) is actually a human being
I mean, it shouldn't be controversial to say that youth is a form of 'mental disability' that most people overcome through age and experience.
I'd be in favor of there being some kind of basic test that someone can past to 'remove' that disability in a legal sense, rather than having a blanket age of consent.
faceh
11d ago
Desantis was the one who was quickest to see where the winds were blowing and endorse the guy without reservation.
By comparison, I still remember when Trump's nickname for Rubio was "Little Marco."
And it is also obvious that replacing a Senator is a much higher-leverage move than replacing a house member, in general.
Why not do this against Murkowski instead, a senator who voted to impeach Trump?
Would she accept?
faceh
11d ago
'Zactly. On the one hand I don't mind free-riding by, say, using ad-blocker on sites where I was never going to click the ads anyway.
On the other, I really don't like to think that I am getting something for free because somebody else is vastly overpaying relative to the value they're getting. It is easy to imagine they're some rich loner who has endless spare cash, but it is still a predatory model. Also, in game settings, the 'free' players are arguably there just to be easy opponents for the overpowered paid whales. Not really a fan of playing the role of disposable mook so some other guy can live out his power fantasy.
Look, all I want is to be able to buy health insurance that covers only catastrophic injuries and the attendant recovery. I want to be able to pay my doctor in cash for any other services, and be able to have medical care for any minor but debilitating injuries readily available on demand. Why is that practically impossible under the current system?
As it stands, with health insurance tied to employment, I can lose access to a doctor if I switch jobs or the my employer switches insurance plans, and I can't actually be sure how much anything costs because there's no price transparency.
So I'm 'forced' into getting health insurance that covers every little thing, which most studies show doesn't actually improve outcomes for people.
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