domain:academic.oup.com
Throwaway05
3m ago
I mean it's like comparing ships from the age of sail to modern battleships. Do they both suck and are too expensive? Quite possibly.
Are they totally different things? Also true.
The population is completely different in terms of age and health. What we can do for patients is also totally different - more patients are on more medications that are more effective.
If a given type of health plan increases the chance that patients actually take their diabetes medication that alone will have a radical impact on outcomes.
Those things didn't exist 40 years ago. Nor did the diabetes rates...
Apple to oranges, maybe the conclusion is the same, but still apples to oranges.
faceh
19m ago
Do you have a more recent study to cite because every factor that's changed since that one was published would have made the problem worse. Fewer doctors per capita, more regs, Obamacare, and an older, sicker population.
What's the current status of the situation, according to your research?
Throwaway05
20m ago
Huh, interesting - definitely missed how much things have changed on this front, thank you for the update.
I don't support catastrophic plans anyway so it makes sense, yeah some of it is the healthy need to subsidize the sick, but also people struggle to understand if they are healthy or sick, and how quickly that can change and so on.
The young always think they are invincible and then you get diabetes and sit on it unmanaged for a decade and end up with a heart attack and bilateral knee amputations or no kidneys.
Preventative care saves people and money in the long run and is cheap as hell but people will refuse.
ABigGuy4U
24m ago
Vance is a writer who later became a politician. Hillbilly Elegy is what made him famous and jump started a potential political career. It’s not a political memoir written for a sitting politician like Dreams From My Father
This may be nonresponsive and a tangent to your guys' dialogue, which was fun to read, but thought I would add it since I looked some of this stuff up.
Catastrophic plans are available on the marketplace
Interesting! I was sure this had been banned and it looks like it pretty much was banned. You have to qualify for an exemption to even be eligible (<30 or poor enough to likely qualify for near total subsidy of another plan anyway) and also still covers the minimum requirements under the ACA like some preventative care and pregnancy.
This is a far cry from what "catastrophic" plans were not even 10 years ago. I got a grandfathered catastrophic plan from my health insurer when I graduated school. My max out-of-pocket was $5,000 and I paid $67 a mo and that included a sort of pre-purchase plan for eye and dental for another $20 or so. That plan kept getting enforcement waivers under Obamacare until it was finally banned as a parting gift of the Obama administration to the next one.
My "catastrophic plan" was better than a current bronze plan except the bronze plan covers a bunch of things I'll never need, and the current "catastrophic plan" now also costs over 6X+ ($420 was the quote I just got using the same age I was in the catastrophic plan) what my grandfathered, ACA noncompliant catastrophic plan, and the max out-of-pocket is now >30% higher than the inflation adjusted max-out-of-pocket. The current bronze plan quote is almost 10X what I paid for a catastrophic plan, the deductible is ~30% cheaper than the inflation adjusted max-out-pocket, and the out-of-pocket max is also >30% higher.
Wow! Hard to think this was in the medical wild west of yesteryear, 2016.
The_Nybbler
Does not have a yacht
37m ago
I live in NYC, and I've never heard of anyone living like that.
You're about 30 years too late for NYC. There still are cities like that, though.
Titus_1_16
44m ago
It depends whether you're modelling the increased demand for doctors as coming from pure population growth, in which case the point by @Quantumfreakonomics stands, or having greater demand for doctoring from the same total population in area, in which case your point stands and there's a natural cap
JulianRota
44m ago
I live in NYC, and I've never heard of anyone living like that. I've lived here for about 8 years, and I know of exactly 1 instance of somebody I personally know being affected by street crime, and that was just a phone snatching. Maybe some women carry pepper spray, but I've never noticed it. IMO, carrying pepper spray indicates that things are pretty safe because it's not very effective against much. I do know lots of people, men and women, young and old, who have no concerns at all about walking around alone late at night, even drunk. I've never heard of anybody telling people everything they're doing in case "something happens".
I'm not really sure if car break-ins are much of a problem honestly, mostly because very few people have them, and if they do, they mostly park them in expensive private parking garages. It does seem a little surprising I guess, but I would think I would have heard of it happening at least some if it was actually common.
It is fairly common for people who want to have kids to move out, but that's more because it's quite expensive to get a large enough space, not because of concerns about crime. There definitely are a lot of kids of all ages around, including in strollers and being walked around. Enough that it's reasonably common to be mildly annoyed by someone wheeling a baby stroller around in a place that seems kind of inappropriate, like inside a crowded store.
TwiceHuman
50m ago
Here's the initiation ceremony for Saiva Tantrikas, for example.
Interesting, thanks! By the way, if you want a modern take on possession, read "Impro: Improvisation and the Theatre". It has a section on masks and letting yourself getting possessed by characters. Psychologically, they probably have a lot in common. There's also some research on how virtual avatars and characters, and even ones social rules, affect ones identity and behaviour. As for the ceremony, is the bell and incense used? For that would affect the senses. The whole divinity/godly aspects are almost required in order for one to take something seriously. Things have the weight we give them, so we use rituals in order to legitimize them. Praying, for instance, is likely a form of visualization, but we envoke the idea of god because we cannot believe in our own power. Tarot cards and Rorschach tests help you read yourself without filter, but in order to believe in the power of their subconsciousness, people need to believe that a diety is present (The oracle). People can barely meet a wise character in a dream without thinking that some external being helped them. It seems like we need to believe in something higher than ourselves, or even in something higher within ourselves (being made in the image of god, the transcendental function, being connected to a higher power, etc). Not that we should take all the credit for ourselves, making ourselves out to be gods (at least not the ego or the self we identify with). Nietzsche kind of tried with the ubermensch thing, he regards the human body as divine because all of this is hidden within it.
Anyway, that was a bit of a tangent. I will try various breathing techniques, but only when I feel certain that I won't be giving myself brain-damage (I'm a bit high in neuroticism).
metaphysical truths on the one hand, and perceptive shifts on the other
We experience life through ourselves, so truths about ourselves are truths about the world as we experience it, or truths about our relation to the world (not the agent nor the environment, but the agent-environment interaction). But the truth simply is, right? Figuring our a profound truth feels good, and results in viewing the world differently, but it doesn't change anything. By the way, I do believe that these ancient sages did figure out important things. The hermetic principles and modern physics have a lot in common. Can you understand the world just by thinking? Probably to an extent, Einstein seemed to manage this, and Tesla also ran physics experiments in his working memory (which was huge, likely due to anesthesia with his visual field or spatial intuition).
The fact it wasn't supposed to be this way!
This is a huge factor in what's called enlightenment. But isn't this just a function of the ego? It thinks it can control reality by rejecting parts of it. It even thinks that having negative thoughts against something helps protect against it or weaken it. That worrying about a family member helps in keeping them safe. But you can "let go" of all of this tension and just let things happen, and everything will continue as it did before, because you never controlled anything. The river flows all the same, and all your resistance amounted to was exhausting yourself. The truth is always bearable for you're already enduring it. What's false can ever harm you, as it cannot exist. It's realizations like this which helps people relax and approach the mindset of a sage. The brain wants to be correct, and to have what it already believes confirmed. It's like your memories and beliefs themselves are afraid of death, or like the brain sees the loss of a belief as the loss of a part of yourself, and reacts as if somebody tried to cut off your hand when somebody attacks a belief or a value you have.
And to generalize these contradictions: All splitting, multiple personality disorders, internal conflicts, etc. are caused by internal contradictions. Nietzsche wrote a lot about this, especially about how willpower affects our ability to control these fragments rather than getting swept away from them. But he also spoke of the positives of contradictions: "Because we forget that valuation is always from a perspective, a single individual contains within him a vast confusion of contradictory valuations and consequently of contradictory drives. This is the expression of the diseased condition in man, in contrast to the animals in which all existing instincts answer to quite definite tasks. This contradictory creature has in his nature, however, a great method of acquiring knowledge: he feels many pros and cons, he raises himself to justice-to comprehension beyond esteeming things good and evil. The wisest man would be the one richest in contradictions, who has, as it were, antennae for all types of men - as well as his great moments of grand harmony - a rare accident even in us!" By the way, if you try to solve all contradictions by taking the intersection of all beliefs and knowledge, you will likely end up with the empty set. Like I said in another comment, there's no one true worldview, you simply need to choose one.
I also want to point out that contrast between two things are required in order to feel much of anything. To feel your strength at the gym, you need to lift a weight which makes you use this power. To feel heroic, you need to feel like you're facing a great difficulty. Even the flow state requires a task with sufficient stimulation and resistance. Some people feel a lot of hate, but they don't want to point it at other people, so they ultimately point it at themselves. If they could just point this at a safe target, like "Poverty", then they could allow themselves to feel this emotion and even use it towards a constructive goal. In other words, be careful of removing any Yins as the Yangs will disappear as well. As I got less lonely, I found myself caring about other people less. As I got more confident, I started valuing compliments less. My Youtube feed is recommending a video called "How to never feel shy again", but it's considered bad to be "shameless" for a reason. Shyness is cute, I don't want to destroy it. I agree with everything you wrote here, though!
where your thoughts connect and everything naturally clicks into place
Haha, I might try this!
I mentioned Krishnamurti downthread
Looked him up now. His "insanity", so to speak, of letting go of memories is actually just letting go of the map and living in the territory, no? To live in pure experience, rather than living in cognitive models of the world. I found a quote saying "To live in the eternal present there must be death to the past, to memory. In this death there is timeless renewal". Earlier I wrote that the ego just wants its memories validated, and like you said, for its models to be correct, and to feel bad when there's a conflict between reality and ones model of it (the experience of cognitive dissonance). I too wish to experience life like I experienced as a child, and if possible, experience things as if experiencing them for the first time - but this means to erase ones memory, at least in a sense. I don't think this is "insanity". Do you know how some people lose faith in love because they deconstruct it to being mere chemicals? That is to overwrite life and experience by creating lifeless mental models and making them out to be actual reality. What sages tells us to do is merely the opposite of that. To deem reality and experience as real, and mental models as false, rather than doing the opposite and becoming excessively objective and robotic.
With the amount of thinking you do during the state
Interesting idea. I don't think it's false, but we have two models of thinking, system 1 and 2, in other words, conscious and unconscious processing. Ever felt down and then suddenly felt better with no explanation? I think that's what happens when subconscious processing resolves a conflict. So "thinking" is still taking place doing this, unless even the subconsciousness is calmed.
Tantra and Tibetan practices are the most confusing side of Buddhism
I found a book on libgen called "Mahamudra and Related Instructions: Core Teachings of the Kagyu Schools". Page 31 starts out by mentioning impermanence, but we already know that "Change is the only constant" and why getting stuck in the past is not a good idea. The book recomments letting go of this life (as it's not permanent anyway). By the way, this is probably for the same reason that one can't think clearly on topics that they're biased about. In order to see things as they are, you must not have beliefs about how they ought to be (resulting in that cognitive dissonance) so it makes sense that understanding these teachings is helped by being alright with any conclusion and implication, even when they suggest something that most people feel threatened by. Then it mentions the "ultimate bodhicitta" which is basically just letting your mind do its thing, letting things be like they are, and accepting what comes, as it's all there is. In the words of Werner Erhard: "Take what you get, for its all you get".
What's new to me is how Buddhism practices good and morality, rather than just complete indifference. This seems a little inconsistent of them, but I suppose they just assume that morality and altruism the true default which is corrupted by the ego and the brains self-survival medhanisms. There's 780 more pages than this, but I believe that I already got the general point of Buddhism, and I've come to like Samsara, and since I've learned to enjoy life despite my suffering, escaping Samsara would be a loss for me. If you can modify your perception as much as the Buddhists recommend, then you can certainly learn how to enjoy imperfection, in which case there's no need to escape anything. This worldview would probably offend a lot of gurus though.. If they're still capable of being offended, I'm not sure. And there may be more interesting ideas covering psychology that I don't yet know, I'm just very unconscientious/lazy. And sorry about my arrogance, I hope the information makes up for it.
Absox
50m ago
I would say right now that there is in fact broad variation in competence in the medical profession. You can see from the average medical licensing exam scores of different specialties that the best MDs tend to go into opthalmology, dermatology, and neurosurgery, whereas the worst ones go into family medicine and psychiatry.
About a year ago I had a rather severe case of mononucleosis, and was sick for about a month. I went to my primary care provider after having a 102F fever for about five days straight, but all the tests they ordered were negative, including the test for Epstein-Barr (though that particular test has like a 30% false negative rate), and they weren't able to give me a diagnosis. After the fever dragged on for ten days I went to the ER, where the resident suspected a cyst in my liver due to elevated enzymes and ordered a CT, along with a huge number of other tests. The next day I was seen by an infectious disease specialist, who suspected mono. Eventually a more accurate blood test confirmed the diagnosis. My health insurance covered everything, but in total my ER visit and 1 night stay in the hospital cost the insurance company about $18,000. There was no intervention except to rest, so I chose to go home. The fever went away like two days later.
Hilariously, my friend who's an anesthesiologist and medical school professor gave me the correct diagnosis before I went to the hospital. He advised me to go to the ER just to be safe but suspected mono, despite the initial negative test result. We've collaborated on research and I know him to be exceedingly competent, but this episode just reinforces in my mind that there are significant differences in the competence of physicians.
There definitely need to be more residency openings to keep up with demand, but part of that problem is that Americans are just so unhealthy compared to other developed countries. Japan has an older population, about 3/4 as many doctors per capita, yet they seem to be doing somewhat better.
What's the best body temperature?
Bryan Johnson, anti-aging zealot, recently raised eyebrows on X when he claimed to have a body temperature of just 93.4 °F (34.1 °C). He claimed that this was evidence of superior health. To me, his claim seems immediately suspicious and more likely to be a faulty measurement. Others pointed out that it would be very difficult for his body to fight infection at such low temperatures.
Nevertheless, body temperatures do vary between people and, interesting, over time.
We all "know" that the normal temperature is 98.6° F (37 °C). As it turns out, this was true once, but no longer. Body temperatures have been consistently falling. Today, the average temperature is closer to 97.9. My temperature is typically around 97.
Why is this happening? No one knows. Of course, many people blame measurement error. Other theories are that 1) people today have lower infection load 2) people today have lower metabolisms. #2 does seem likely. When we look at historical records, we often see even relatively sedentary men ate 3000, 5000, or even more kCals per day. Now, many men (myself included) will maintain their weight at 2000–2500 kCals, even with exercise.
The good news? There does seem to be some indication that lower temperatures correlate with longer life spans (in mice, of course). This is likely to be similar to caloric restriction where it might help humans, although not nearly as much as mice.
But what if I don't want to live forever, I just want to look good naked and have tons of energy? It turns out that there are people who take the opposite approach as Bryan Johnson and say that we need to increase our body temperature. For one, it will help prevent illness. But it will also increase one's metabolism, giving a person boundless energy, and allowing him to eat like a hummingbird while looking lean and ripped. Here's a guy who invented a diet where you can eat unlimited sugar before 3pm. There was another guy on Twitter who posted about his sugar maxxing diet and bragged about his body temp of 99.5. He looked pretty ripped. (Curse you, Twitter search).
These high-temperature guys all seem to follow an obscure Oregon dietician named Ray Peat who doesn't have a Wikipedia article, and is indeed only mentioned in Wikipedia on the article for Bronze Age Pervert. From the best I can tell, Ray Peat ate something like 3500 calories a day, half coming from simple sugars. He died in 2022 at age 86.
So, what's your body temp? What should it be?
SlowBoy
53m ago
All three of these articles about "cranks" on the right parse as: People who disagree with right-wingers think right-wingers are wrong. I am not a crank -- I'm right about everything!
SlowBoy
58m ago
These same Republicans voted for Merrick Garland, who proceeded to try to throw Trump in jail. They have completely different standards from what constitutes "unfit" from the mainstream Republican voter. It's a two-party system, you vote for your guy and against the other. Talking about vetting candidates for being "fundamentally unfit" is missing the point: that's why Republicans continue to lose! Trump wins specifically because he's not the party of Murkowski, McConnell, Collins, et al. Republicans would have lost without Trump, and instead of going along with what Trump wants to do, they sabotage his cabinet. That's "defecting".
Literally any combination of picks could be rationalised in this way.
Describing cabinet appointments as managing factions is basically a truism. Calling cabinet appointments fundamentally random, as OP did, is an anti-explanation.
Her only political experience is as a backbencher and later twitter poster
Tulsi served in Hawaii and was the heir to a minor Hawaiian political throne. She served in the military and was at one point No. 2 at the DNC. She's not some grizzled veteran, but come on: She has more experience in politics than Obama or Trump did when they assumed office.
MaiqTheTrue
Renrijra Krin
1hr ago
I’m not sure I’m following you here. I’m not talking about someone who doesn’t get into med school. I’m talking about a typical medical office visit in a family practice where the doctor doing much more than backstopping the NP or PA is in fact a waste of time simply because you don’t need 8 years of college and a couple years of residency to read blood pressure, heart rate, or oxygen levels. You don’t need that level of education for minor issues. I had a spider bite and needed to get an antibiotic for it. Nothing about that visit required a full fledged doctor to personally see me or prescribe antibiotics (other than liability issues and legal stuff) for a fairly minor complaint.
As such, I don’t see why it’s a problem that someone who didn’t go to medical school goes into software. It’s not going to make much of a difference in terms of the kind of care that I’m talking about. Probably 90% of medical care is pretty routine.
OliveTapenade
1hr ago
We have left-wing musings that the failure to reach low-propensity voters comes from a “lack” of a left-wing media ecosystem, which makes me scratch my head somewhat, given the disproportionate skew of media to the left. There doesn’t appear to be any introspection or soul-searching here. The issue might not be a lack of left-wing media, but a lack of trust in that media; becoming more online creates a healthy level of skepticism about what we consume, especially as AI becomes more prevalent.
People who seriously identify as left-wing would often dispute this. Many on the left see the Democrats as a right-wing party, and the mainstream media as centrist, liberal, centre-right, or something else other than left. There is a sense among dedicated left-wing partisans that they are a tiny minority.
Like most of the narratives that people tell themselves about their own political tribes, this is probably false or at least illusionary, but the point is that when people complain about the absence of a left-wing media ecosystem, those probably are not people who regard most of the media as currently on the left.
Throwaway05
1hr ago
I would hesitate to use a study from that far back because the American health landscape is so different now (in terms of population health, costs, and availability of interventions). Diabetes alone could fuck up the results (and almost certainly does).
I mean what you are asking for is available. Catastrophic plans are available on the marketplace and plenty of family practice doctors offer a practice sort of what you are suggesting. It is expensive but that's primarily because this model is a thing of independent practice which is dying outside of high tax brackets. Doctors aren't in charge when they are employed so they have to do what the employer says. Although my PCP is boring and they can do that (minus cash pay).
Ultimately nearly everything most people hate about healthcare is stuff that doctors don't have any control over and also hate, but we get blamed and people want to make our lives more miserable. It is very frustrating.
jeroboam
1hr ago
Wow, where do you even live? I live in Seattle, which is probably also 80D-15R and while there was a conspicuous lack of Trump signs (thanks Antifa!) there were not a lot of Harris signs either.
Putting up a Harris sign is a pretty cringe move in a place like Seattle, which is probably why so few people did it. Who puts up a sign to say "Yay Regime"?
TitaniumButterfly
1hr ago
Well there's teaching basic literacy, and then there's sending to school for years and years. If those are the same thing I'm not convinced it's worthwhile.
Throwaway05
1hr ago
If I were in charge of VA, I would make a rule that any doctor who got their license in any OECD country can work unsupervised (provisional on training on HIPPA or whatever other US-specific medical laws). Then get a whole bunch of H1 Visas for any doctor who wants to come work for VA for five years.
What do you gain from this? If the goal to decrease healthcare costs this doesn't do much. If it's to solve the shortage it also doesn't help that much.
Throwaway05
1hr ago
I think people in other fields fail to understand how egregiously poor a lot of NPs are. Most settings they are still supervised or deliberately have low complexity cases sent their way or have some other aspect of the environment that protects them (for instance inpatient NPs just consult specialists for everything and those specialists manage the patient even though the NP is on charge on paper).
Surely they must have some training, and they can't be that bad, right? Like who would let them practice if they are that bad?
They are that bad.
It's been hard to extract the data about this because of financial interests in NPs, and the general difficulty of doing medical research.
So much of medicine is opaque to those outside the field and even inside of it (I know nurses who have been working for 40 years and go "huh" when you tell them the resident has been working 24 hours in a row).
Fundamentally I see midlevels every week who make decisions that would make me go "holy shit you are the worst doctor in your specialty I've ever met," it's near constant.
It sounds histrionic and unbelievable but that's how so much nonsense in healthcare is.
Amazon, google, apple, tons of finances firms have all come into medicine and gone "damn that shit is run so poorly surely we can do better" and then run away screaming.
JulianRota
1hr ago
Reading JD Vance's Hillbilly Elegy. It's a much shorter book, I'm halfway through already.
I'm not sure if there was much in the way of ghostwriting or assistance on this, but if it's not much, then it's remarkably good writing for a sitting politician.
It reminds me a little of Sowell's Black Rednecks, White Liberals, which put forth the idea that quite a few of the dysfunctions affecting black culture were actually copied from the white hillbilly culture.
faceh
1hr ago
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.
Ben___Garrison
Voltaire's Viceroy
1hr ago
People have at least discussed this, although I don't know how much it's been internalized yet. Matt Yglesias had an article about the crank realignment, Hanania had an article about voters who see conspiracies everywhere, and Meskhout had this article.
In short, both sides have become dominated by delusional partisans screaming in echo chambers. The left have become experts in infiltrating institutions and corrupting them to woke ends, while the right have become eternal dissidents who are great at critiquing the left but terrible at actually building better replacement institutions. The left was a bit ahead of the right when it came to radicalizing, but it's also deradicalizing now in a way that will likely happen to the right in a few years. Around 2020 was "peak woke" after which things slowly calmed down. Now we're approaching the summit of "peak crank" on the right, which will also hopefully calm down.
Throwaway05
1hr ago
If you want us to redesign the system you need to sacrifice something else, most likely increased paternalism - is that what you want?
There are no penalties for misusing the system now, inducing penalties for bad behavior is the primary way we correct things and make systems function.
Or do you want Urgent Care to be staffed by ED and FM? That would certainly address the issue but would dramatically increase expense.
Ya have a bunch of setups like this on aquilo, and now maybe starting to do them on gleba
More options
Context Copy link