The first one that comes to mind would be to invalidate all existing cookies so that the ones accessible to the other server aren't useful. I wouldn't call that the "best" since invalidating cookies can be annoying for users, but I'm sure there are other ways.
If a user has a cookie for example.com (your domain) and type in vendor.example.com in the web browser how would you invalidate these cookies before they are sent to the vendor? Or even after they are sent? I struggle a bit with seeing how this could be done in a secure manner.
I've never really had an issue with it. The data is much better than a few years ago. I don't use Google maps (I'm happy with Apple and its integration).
I've heard (anecdotally on podcasts) they're roughly even.
The one thing I've heard in the past is it really depends on where you live. Google had better data in rural areas or other countries (they've been at it for what, almost 15 years?) so Apple Maps may not be an option for some.
In the US? I'm not sure there is a big difference for streets.
(Pretty sure Apple has slightly fewer points of interest like businesses, but it's rare I run into that).
Hmm or just go to a doctor and ask for a long term EKG maybe. That's what I did. I had to wear some measuring equipment for a day and then I had the result (broken heart). I don't think this changes from day to day so you might want to get a check every few year.
No, atrial fibrillation occurs in distinct episodes (imagine your heart occasionally having an epileptic seizure that lasts a few hours) and it can be difficult to get an EKG when you suspect something is wrong.
What is sad about this? Small sizes are nice but as a consumer I don't care much. If a larger file size means that apps can be produced easier then I have zero objections.
Because for many consumers, 40MB where it could be 4MB means e.g. 5 minutes of download instead of 30 seconds, or 4% of their data plan instead of 0.4%.
And waste is kind of like honesty - if you are wasteful with this, you're probably wasteful with everything else. Like with storage usage, which is a hard constraint on anything but top-of-the-line mobile phones. Like with network usage. Like with energy usage, which accumulates over everyone making wasteful software and adds up into lots of unnecessary emissions.
As a consumer, I don't care about who is first to the market. Take extra time to make your application not suck. It doesn't take that much more.
How do you know the 40MB download wasn't aggressively optimized down from 400MB? Equating larger file size with lower quality is presumptuous. Is there any known correlation? Equating larger file size with lower honesty seems dishonest to me.
Optimizing takes time, sometimes a lot of time. I know because I've spent a lot of time optimizing file sizes to fit on game consoles, taking xbox360 games over to the Wii for example. If you optimize aggressively when there's no strong need to, when consumers like the one you replied to don't really care, and wont' change their buying habits, you are prematurely optimizing. That's a significant waste of precious time (and money) for a developer.
We (humans) waste a lot of things that are much more important than people's data plans. Gasoline and food, for examples. Why haven't we reduced those 10x? It is possible.
> How do you know the 40MB download wasn't aggressively optimized down from 400MB?
I don't; I thought the context made it clear, that I meant relatively trivial apps that do little but are bloated internally.
> Is there any known correlation
Possibly, I don't know. But I also learned that heuristic from experience. When large app sizes are justified, you usually see this in functionality.
> That's a significant waste of precious time (and money) for a developer.
OTOH from a consumer point of view, you're saving time by externalizing your waste on me. I know that "optimize everything" isn't the right answer, but so IMO isn't "optimize nothing". If you save one dev day by wasting each user's 10 minutes over their use of the app, those 10 minutes multiplied by 100k users suddenly become over two man-years of wasted time.
I know that you can't compare users' time to developers' time 1:1, but the scale at which those decisions affect people is still worth minding. Especially for other resources, as e.g. electricity usage does add up pretty much linearly, unlike small time periods.
> We (humans) waste a lot of things that are much more important than people's data plans. Gasoline and food, for examples. Why haven't we reduced those 10x? It is possible.
And many people are working on it too. I find wasting those things to be bad as well.
Applications become increasingly bloated when they need to support lots of different environments and runtimes.
To give a modern example: if I want a web app to run on a wide range of browsers, I have to include shims and polyfills to handle missing functionality, API differences, and implementation bugs.
But it's not a problem limited to the web, it exists with native applications as well. This is why Electron apps are huge energy and memory hogs. It abstracts every native layer in order for the application to run pretty much everywhere.
IMO, it's not such a horrible thing in some cases. I usually prefer native applications for anything that I'll be using regularly... But electron apps can be incredibly handy for one-off utilities. To give an example I'm personally familiar with: I occasionally use Etcher [0] to burn images to USB and SD cards. I've used it on macOS 10.12, Windows 10, and Ubuntu 17.04 without any issues! The most famous native alternative I'm familiar with is UNetbootin, which didn't seem to work on macOS when I last tried it. Of course, on macOS and Ubuntu I also have the option of using the terminal, which requires me to look up or remember the platform-specific way of listing all disks, identifying the target, unmounting it, and copying the image.
That's all fair. I don't like bloat either. I'd suggest the ecosystem is more to blame than individuals devs. Apple and Google could do more to fix this problem than anyone else. It's too easy to make a basic app that's large, and it takes too much effort to get the file sizes down. If it were easier to make a small app than a large one, apps would be smaller.
The real problem is economic, which is why I brought up food & gas. We are optimizing them slowly, but it's not happening quickly because it takes too much effort and consumers don't care enough. You're right that not optimizing is externalizing the waste onto consumers, and that user waste happens at a vastly different scale than developer waste. Which is why if consumers made a big enough stink, the problems would get fixed more quickly.
I agree with everything you wrote here. I too see the problem as primarily systemic.
The problem here is also that users are kind of "captive consumers" of software; i.e. more often than not, there's no other choice besides either using or not using a piece of software. And even if there is a choice, it's usually between two or three pieces of softare, all competing with each other on shiny features and accumulating bloat at tremendous speed.
The frustration is there though; it shows in the rare cases when there is a partial choice. For instance, I know plenty of people who refuse to use Facebook app because of the battery usage, and instead choose to go to Facebook mobile site (which is objectively more annoying and less user-friendly than the app).
> Which is why if consumers made a big enough stink, the problems would get fixed more quickly.
Which is why I do my part in making the stink, complaining about the bloat and waste in places where both users and developers can hear, besides trying to ensure my own backyard (at work and otherwise) is as bloat-free as possible. I guess that's the best I can think of without going into full advocacy mode.
Well, since the problem is economic, the stink has to be economic. For consumers to make a stink, it means they have to withhold their money and stop purchasing wasteful products, not voice their complaints after purchasing.
Despite how much time we all spend solving problems we fear we have but don't really have, most devs don't actually have the option to spend significant portions of their time optimizing, even if they want to. I've been exposed to squeezing large games down onto a Wii console because it was a requirement to ship, but not because we cared about bloat. We did care about bloat, btw, but we didn't spend anywhere near as much time reducing file sizes on the PS3 as on the Wii, even though we could. It was an organizational decision that I had almost no control over.
Gamedev plays by different rules. You guys work too hard already :). I was thinking more about regular run-of-the-mill app and webdev.
> For consumers to make a stink, it means they have to withhold their money and stop purchasing wasteful products, not voice their complaints after purchasing.
Yeah, but that's not easy to do either. I added that point in the ninja-edit to my previous comment. In my experience, in many areas consumers don't really have any real choice. I.e. you choose from what is available on the market, not from the space of all possible products. There is no good line for getting feedback from consumers to producers about options not explored, or even about the reason you refrain from buying something. Again, I currently have no idea how to approach this.
I had to upgrade my phone because it ran out of internal memory and I had to keep removing apps I valued, as they all grew in size.
So bloat cost me real money.
Just because you don't care doesn't mean others don't. This is one of my pet peeves. Developers building things on high spec machines with fantastic network connections. Your website is impossible for others to use as it is so slow and cumbersome but the devs never notice.
Software has been increasing in size over time since the beginning of software. This will never change. It goes hand in hand with why hardware keeps getting bigger capacity too. I agree that some of it is bloat, but some of it is more features and content too. When the OS adds a little, and the libraries add a little, and the apps add a little, the downloads get more than a little bigger, but it can be a side-effect of everyone adding useful features at every level.
There will always be a hardware limit, so if you install apps up to your limit, you will eventually have to delete some of them, no matter how small the apps are and no matter how big your phone's memory capacity is. You can't entirely blame that on developers, it's your budget to deal with. You can buy a bigger phone or install fewer apps. I like to keep a good 20-30% of my memory free just so things I depend on have room to grow.
You also have the option to swap out apps continually. It'd be a pain in the ass for sure, but if the least important app on your phone that you had to delete is really one you couldn't live without, you have the option to delete something else and re-install it, and then swap back later.
No, no one does. Any more than they cast nets to catch wishes, phone their mums every time they step on a crack to make sure that her back is okay etc. etc.
Yep the base price for a Iphone 7 Plus in Sweden is 1100$. Not sure it makes sense comparing prices like this though. In Sweden the cost of an iphone does not compete with your ability to get access to health care or education for example.
The Swedish price also includes 25% VAT, as well as the cost of consumer protection afforded by Swedish/EU laws (which in the US you have to pay extra to get through AppleCare - although AppleCare does go further)
Using credit cards in the US give a pretty high level of consumer protection (over and above usual consumer protection laws) although not as much as buying an explicit warranty.
That doesn't protect you against accidental breakage. Outside of that, I rely on actual consumer protection laws, which aren't so hefty in the US - hence folks using credit cards to get some extra protection. It isn't like you are taking a big risk with Apple or your phone company ripping you off anyway.
Only some of us haven't kept those in many, many years. And the one I had back then certainly didn't have such things, but it might have changed since the late 90's. For myself personally, it doesn't seem worth the hassle. Another bill every month that is non-necessary when I could just save some money to cover such things or get it repaired. It kinda sucked not having an actual card in the US, but here it isn't.
Is this sort of thing common on credit cards nowadays? I saw two replies mentioning their banks, and I'm now wondering how widespread such a thing is.
I don't see my credit card as "another bill"; in fact I use it to autopay as well as make daily purchases, so it becomes "the only bill" (or, one of the only).
Yeah, you can autopay on debit cards too, but I don't trust that as much.
Purchase protection is pretty common on good credit cards.
It's only for 120 days but, e.g. this is from one of Chase's cards: What's covered: "Eligible personal property that has been damaged, stolen, or involuntary and accidental parting with property within 120 days from the date of purchase"
This is in addition to a year of additional warranty protection and various other purchase protections.
It certainly does. Most of Chase's cards cover up to $500 per occurrence. The Sapphire Reserve, and I believe Ink Preferred, cover up to $10k per occurrence. There are plenty of accounts of people taking advantage of these benefits online.
I'm genuinely curious if credit card companies get involved with warranty-related actions, or really anything beyond the fitness and accurate representation at the time of purchase. As far as I can tell, thigs like AppleCare and EU VAT protections cover an almost entirely exclusive set of concerns, namely, the fitness of the product after initial purchase.
I'm not knowledgeable enough to compare directly to VAT, but many credit cards extend a product's existing warranty (90 days to two years, depending on the card), and some offer things like 90-day purchase protection (if the price changes or if merchant/manufacturer won't accept a return, the credit card will).
Purchase protection took care of a theft I had in my house last month. They just needed a receipt and a police report, and the purchase price was refunded a few days later.
I think there's some confusion here as to what VAT means.
VAT in the EU (or anywhere else really that has the concept of VAT) normally affords no additional consumer protections on its own. It's a tax, not dissimilar at a high level to sales tax in the US, applied to goods or services at time of sale.
Thanks for the response. This is something that's not well known to me and in the age of retailers trying to upsell the same thing for a fee, I'm not surprised that it is obscured.
In all fairness, it's not a standard thing. Most of the extended card protections that go beyond purchase dispute resolution/defective product come from various premium cards more so than basic no-charge ones.
I can only speak to my personal experience, but my Citi Premier card has pretty good coverage for theft and accidental damage, albeit with a relatively short coverage window compared to something like Apple Care. I'd have to look it up, but I think it was about 6 months post-purchase.
Well, you can buy partly subsidized or receive fully subsidized healthcare (ACA/Medicaid). That's on top of programs like COBRA and in worst case scenarios welfare from the state, county, or federal levels. We also have CHIP on the federal level which is a separate program just for children, where the parents may have insurance but for some reason cannot insure their kids. That's on top of what the states themselves offer, but that's sort of rolled into the ACA nowadays, which makes more sense.
We're at 8% uninsured, which is nothing to brag about, but its far from a free for all post-apocalypse where people keel over in their desks or in the unemployment line. Its also important to note that those numbers include illegals who can't or won't get insurance due to citizen status and 1/3rd to 2/3rd of that number actually qualify for various insurance programs, but for some reason aren't seeking it (aside from citizen status).
We absolutely have a big problem with the rural poor and insurance, which is a hefty 14-20% of that demographic. I'm not sure what the fix here is especially considering rural states are heavily conservative and fight off ACA and Medicare/Medicaid expansion regularly.
upvoted.
as far as the rural areas vs ACA are concerned - before ACA a lumberjack/construction/handyman/hunting-fishing guide etc type dude could by themselves cheap health insurance that wouldn't break the bank off-season. now it's an ordeal.
The problem there is that low rent health insurance didn't cover anything. You'd had catastrophic plans with $2,500+ deductibles and a cap at $25k. It didn't cover preventative maintenance, doctor visits, kids, drugs, etc. It only made sense in a "what if I injure myself at work, but not too seriously" kind of way.
I imagine ACA mandated insurance is a net boon here even if the monthlies are more.
Strange how the US healthcare setup is largely unchanged over many years, yet the general perception is that it's suddenly total chaos. I'm not saying the status quo is best, but we didn't suddenly plunge into a crisis.
It's been incredibly bad for at least ~3 decades. A sick person with insurance without a dedicated advocate (relative or friend) watching out for them non-stop will likely end up having several care screw-ups occur to them, and with a bill ludicrously rather than just insanely large and probably a few things in collections (even if they can pay them) if said advocate doesn't spend a couple hundred hours fighting insurance and hospital billing and mailing regulators and wrestling a mountain of paperwork and bills.
Watched this process with sick relatives in the 90s, and it was already fucked-up then. Gone through it with my wife's 3 pregnancies and a couple family illnesses in the last 5ish years. Same thing. It's a broken, evil system that ruthlessly exploits and crushes anyone without the time, wits, and wherewithal to fight it every step, and it has been for a long time. I think what changed is we have much better exposure to what it's like elsewhere, so more of us are aware that there is no reason whatsoever to keep hurting people this way.
In general, you can always skip the whole gov't funded healthcare system to get a particular private service at a full cost, and some (though not most, depends on the specialty - plastic surgery will but trauma neurosurgery won't) of the top docs will work in this manner.
Other than that, the patient-doctor match gets mostly allocated on the basis of location and narrow specialty, or with limited availability; e.g. if you want a particular popular doc, then (s)he might have a queue, so you either wait when they become available or pick someone else.
Look at what other OECD states spend per capita. Compare to how much the US spends per capita. For a real WTF look at how much public money the US already spends per capita. This is all a google away. The safe bet based on available data would be that moving our system to be more similar to any of those used by other OECD states would significantly reduce our spending while having little effect on health outcomes.
It's possible some other reforms that differ radically from those systems would improve things, and maybe even be better than anything other OECD states do, but since we have a wealth of real-world data about how the existing systems work and only speculation about most others, it's a much safer move to base reforms on the ones that are observably better than ours in the real world.
Almost everyone is politically motivated in some way to slam the healthcare system; nobody is politically motivated to defend it.
Personally I'd offer the somewhat-feeble defense that it isn't as bad as people say it is, but I'd stop far short of calling it good... because I've got my own political axes to grind too, even if they are nearly diametrically opposed to the local consensus. But it isn't actually true that the American health system requires you to sign into indentured servitude the moment you walk in the emergency room door, and injects you with strychnine and tosses you out the door if you can't pay enough to satisfy the bureaucracy this week. Ambulance crews do not prowl the street and abduct unsuspecting European tourists and force them to donate blood before they're allowed to escape. Doctors do not actually giggle with glee and make "chaching!" noises when giving you bad diagnoses.
> Ambulance crews do not prowl the street and abduct unsuspecting European tourists and force them to donate blood before they're allowed to escape.
Why would they? The US produces a surplus of blood and tissue, to the point that many other countries (particularly in Europe) have to purchase to from the US to address their own shortages.
> Strange how the US healthcare setup is largely unchanged over many years, yet the general perception is that it's suddenly total chaos.
It's been horrible for a long time (and there's been outrage for a long-time: while it got derailed and we got nothing out of it but HIPAA, the bad state of healthcare and plans to reform it were central to the Clinton campaign in 1992—and while Clinton tried for a complicated scheme involving insurance companies, polling showed majority support for single-payer even then; the ACA is often pointed out to be a copy of Romneycare in Massachusetts, but what is less commonly pointed out is that both are copies of something proposed by the insurance industry and embraced by the Republican Party as a desirable national reform direction shortly after Clinton's reform effort failed, because even then it was widely perceived that something had to be done.)
> I'm not saying the status quo is best, but we didn't suddenly plunge into a crisis.
No, we've been in a crisis for more than a generation.
> what is less commonly pointed out is that both are copies of something proposed by the insurance industry and embraced by the Republican Party as a desirable national reform direction shortly after Clinton's reform effort failed
It's less-commonly pointed out because it's not really true.
It's true that there was one bill, in 1993, that was proposed by a Republican and which happened to somewhat resemble the Affordable Care Act at a very high level. However:
a) It was proposed by a Republican senator from a very blue state (Rhode Island)
b) That Republican senator lost his next re-election bid
c) The bill never received a vote
e) The bill was only one of many GOP-sponsored healthcare bills that year
f) Conservative and moderate Republicans strongly criticized the bill
g) While it bore some resemblance to the ACA at a very high level, it was a very different bill in details and implementation, so it's misleading to suggest that supporting one and not the other would be hypocritical. There were a lot of things Democrats like about the ACA that weren't in Chafee's bill, and there are a lot of things that Republicans might like in Chafee's bill (or the ANHRA in the House) that were not present in the ACA.
Sure, there were a number of different subsidized-private-insurance schemes over the years (including the one briefly rhetorically embraced by George W. Bush but, again, that never went far legislatively) that differed from the ACA model in that only HDHP/HSA plans would be subsdized.
> so it's misleading to suggest that supporting one and not the other would be hypocritical
I wasn't suggesting that, I was illustrating that the perceived problem and many elements of the potential solution space have been part of the national dialogue for a long time.
Price of healthcare is driven by a luck of supply (medical professionals, hospitals, affordable drugs) and supply is limited by regulation (expensive and ridiculously long educational process for physicians, huge liability and regulatory burden for practitioners and hospitals, very long and expensive approval process for moving a new drug through FDA, plus again liability cost) .
Regulation in turn is driven by lobbying efforts of large professional groups (trial lawyers, AMA, large pharma etc).
In another word it is a corrupted system that manages stay afloat as people in power legally able to get their cut through lobbying.
People are getting relatively poorer in comparison to their health care costs. So yes, we have been getting worse, and at some point the character of a problem changes into a crisis, which can seem "sudden".
> People are getting relatively poorer in comparison to their health care costs.
That's not really true; total expenditures have increased, but that's largely because the treatments and care that people are choosing are different (and more expensive) than previous ones.
Put another way: today you can still get the same type and quality of care that was available in the 1960s, and it'll be cheaper than it was in the 1960s (measured in 2017 dollars). You just probably don't want it, because it's nowhere near the current expectations and standards of quality of care.
> Put another way: today you can still get the same type and quality of care that was available in the 1960s,
No, in many cases you can't because the techniques and absence of procedural and other safeguards are no longer up to the standard of care in the profession, older drugs are no longer produced, etc.
Ok, the price increased. And, let's ignore related factors such as the increased cost of medical education and advances in medical care (my aunt got a new heart a year ago!)
My view of the mainstream story is that things went from ok to chaos within the past, say, 3 years.
Instead, the costs have been steadily rising while voters have repeatedly opted not to make changes.
Thought experiment: what if gas or milk prices had increased at the same rate? Education cost has increased a lot, but that's mostly inflated by student loans that I predict will implode like subprime mortgages.
> Instead, the costs have been steadily rising while voters have repeatedly opted not to make changes.
Have voters done that, though? I mean look at the trouble Republicans are having repealing the ACA. Voters seem to not want to repeal it. It seems like only the Republican leadership actually wants it repealed. My understanding is that when you ask individual voters of all stripes, they agree that pre-existing conditions should not stop you from getting affordable healthcare, and that lifetime limits are unfair across the board. But those are the things the Republican leadership wants to axe first.
Look at all the congressional seats the Democrats lost (and the POTUS seat) after Obama pushed through his plan.
It's always harder to repeal a law, versus blocking it from passing. As soon as a law is passed, it's the new status quo. And recall how close the recent repeal vote was.
Why haven't we repealed the laws against weed and poker yet?
Yes, or worse. I'm American. I live in Norway. Most folks I talk to from other countries - not just Europe - find the American health care system to be cruel and too expensive for the common person.
And by the way, I do not buy subsidized insurance. I pay my taxes, and I have health insurance. My taxes pay for health insurance. There is nothing else to pay to get that, other than a small fee for the doctor out of pocket up to a certain amount. No doctor, no medicine = no payment. Other than taxes, assuming I'm working and paying taxes.
Nit: "everyone" pays taxes - you get healthcare even if you don't pay any taxes (eg: college student without taxable income, unemployed not receiving benefits (yes, there's income tax on unemployment benefits)).
That's a very small bit of the population, but you are right. Nearly everyone gets health care, minus some classes of immigrants. I knew there were taxes on unemployment benefits (and i'm not opposed to that). But even the folks not paying employment taxes generally pay tax through food, transportation, entertainment, and other things.
There's a point below which you can't afford any kind of even subsidized insurance. Not if you want to keep paying rent, buy food, car insurance to keep going to work, phone bill, electric bill and so on. Whereas in the part of Europe where I live, the less you have the less healthcare costs you.
I'm not really sure where you get your information. Anyone can get Heath insurance from the healthcare.gov marketplace.
Your salary requirements factor into the price. Someone making only 17k a year is capped at $54 a month premium. There are caps at certain salary intervals.
> Whereas in the part of Europe where I live, the less you have the less healthcare costs you.
100% true for the US as well. Please don't listen to news or internet comments. Verify the facts!
If you are not getting subsidized because of income, you have to pay for everyone else who is subsidized.
I was buying plans from health care exchange for 2 years and my last plan for two (parent and child) cost me 500$ per month with 6500 deductible per person - 13000$ total.
So effectively I had only a catastrophic insurance but was forced to pay for some subsidized guys who had a platinum plan with no deductible for 54$ per month. Worst situation for people like me!
That's actually not true in any of the states that didn't sign on to the ACA Medicaid expansion, which, yes, was designed so that between exchange subsidies and Medicaid eligibility there would be affordable subsidized or government provided coverage across the whole spectrum where people didn't have employer coverage or the ability to afford unsubsidized coverage.
It's also not true of extremely high cost of living areas such as NYC or the bay area where you're living beyond your means long before you qualify for government programs based on poverty levels that are calculated averaged across the nation.
The system has warts. There are good reasons to criticize it. But saying we leave the poor dying in the streets because, well, fuck 'em they're poor, is both untrue and insulting.
> But saying we leave the poor dying in the streets because, well, fuck 'em they're poor, is both untrue and insulting.
Well, except that it's exactly true that that’s why the “warts” that you acknowledge which do, in fact, deny swaths of the poor access to care are tolerated.
Subsidized insurance which still gives you costs for healthcare and sometimes doesn't cover certain tests or treatments that are considered not essential, such as birth control to treat polycystic ovaries or a blood test to diagnose functional sexual hormone levels(such a test would also detect polycystic ovaries, which untreated results in further health complications), More effective antibiotics for infection, multiple kinds of mental health medication, and dermatological medication. Not to mention confusing limitAtions of location of treatment due to network effects.
> Emergency rooms only have to stabilize you, they don't have to treat you. It's a big difference.
No, and you don't want an emergency room treating you, because emergency physicians aren't trained to provide anything other than acute care.
That said, the point is moot, because once a patient is stabilized, if they need further care, they'll be admitted, and receive care from an internist.
Afterwards, they'll receive a bill for a rather large amount, which the hospital doesn't expect them to actually pay (but for legal reasons is required to present them with). If they know about this, the uninsured patient can almost always get away with paying less than 5-10% of the total (initial) bill, and the hospital writes off the remainder so the bill is paid in full (ie, it does not get sent to collections). Of course, most patients don't know any of that.
The billing situation is 100% fucked, and the reasons for that are way too long to explain here, but it's not true to say that an unemployed person without insurance can't receive anything but acute care from a hospital, or that they would necessarily have to end up in debt for doing so.
> That said, the point is moot, because once a patient is stabilized, if they need further care, they'll be admitted, and receive care from an internist.
No, they often won't, because while ER stabilization without regard to ability to pay is mandatory, subsequent admission and treatment is not.
If the condition is not stabilized in the ER, they may be admitted for stabilization to fulfill the mandate, but there is no mandate for admission for treatment after stabilization.
> No, they often won't, because while ER stabilization without regard to ability to pay is mandatory, subsequent admission and treatment is not. If the condition is not stabilized in the ER, they may be admitted for stabilization to fulfill the mandate, but there is no mandate for admission for treatment after stabilization.
That's not really true, and it's a common misconception that arises due to the way the ER mandate is specified in law (explicitly, and via a single bill), as opposed to the confluence of a few different regulations.
In short, because of the intersection of ways in which hospitals are and are not allowed to discriminate against patients by insurance status, what ends up happening in practice is that the decision to admit a patient is rarely made with the patient's insurance status as a determining factor.
That's especially true for public hospitals, but it's true of many private hospital situations as well. (Note that this doesn't apply to the decision of which hospital to admit a patient to - a single ER which has more than one associated hospital may decide to admit a patient to the public hospital instead of the private one based on their insurance status).
My mama taught me to not talk about things I don't know anything about. I wish more people listened to their mamas.
To the curious Europeans out there, if you lose your job you can stay on your job's health plan for 18 months while you look for new work. If you're unemployed that long then you'd qualify for Medicaid after that, the government insurance program for the poor. If for whatever reason you really didn't have insurance you will nevertheless never be turned away from any hospital emergency room. This "die in he street because you have no insurance" is a myth and total hogwash.
> Put another way: today you can still get the same type and quality of care that was available in the 1960s,
If you can pay the full premiums, including the part your employer paid while you were employed.
> If unemployed that long then you'd qualify for Medicaid after that, the government insurance program for the poor.
You don't qualify for Medicaid based on duration of unemployment; whether, and in what form, you would qualify for Medicaid depends on income, assets, and state you live in (Medicaid is a state-run program with some federal standards, though even the most basic broad-strokes qualifications differ between states, especially between those participating in the expansion under the ACA and those not.)
> If for whatever reason you really didn't have insurance you will nevertheless never be turned away from any hospital emergency room.
But will be booted into the street from the ER after stabilization without treatment of the underlying condition.
> This "die in he street because you have no insurance" is a myth and total hogwash.
Except that people do, in fact, die because of lack of health insurance in the US.
Make sure mama also told you these two things... Cobra insurance after losing your job requires you to pay the full premium which can be upwards of 10k per year. Also Medicaid has a very low asset threshold that you can still qualify unless you are pregnant, have young kids, disabled or elderly. ACA subsidy is the best shot for most in this situation but who knows how long till it is dismantled.
It's not hogwash when actual, documented cases exist of people not going to the emergency room for fear of being crushed to death by the debt from an ER visit. And COBRA doesn't just give you free insurance for 18 months, you have to pay the full premium for it. If you're unemployed, how in the hell do you expect to pay the full premium as opposed to the premium that you were paying before that was subsidized by your employer?
You've clearly never, ever been in a position where money was an issue for you. Especially not to the point where you felt your life was in danger because of it.
If you had been, you wouldn't be handwaving away legitimate concerns over the system of healthcare. Considering you didn't even address any of the points I mentioned, I have a feeling you have no response.
"Like many musicians, Matheny went years with minimal health insurance, or none at all. In Germany, with no insurance, he wound up in debt of about €30,000 — roughly $35,000. That's what Matheny calculated he would have owed in the U.S. if he did have insurance."
My healthcare plan costs me $1,200/month for my family of 4. It went up nearly 30% this year and is expected to do the same next year. Give it a few years and it will be $2,000! I have a good job, but if that keeps going I won't have any choice but pay the fine/tax.
So back to the $1,000 phone. If all phones cost $1000 - I'd be more likely to go without one.
Yes! As a twenty something single I was shocked that people saw paying $200 out of pocket each month as a privilege that comes with working. Clearly, for me it was a pure waste because I used exactly zero dollars worth of health care myself. Of course, people with infants absolutely need it. I had a coworker who had basically the same story as Jimmy Kimmel (newborn with heart defect). I can't imagine how much quality care would cost if he didn't have health insurance through work. I mean at some point there were apparently dozens of specialists involved with the case... I'm sure each of them are billed at hundreds of dollars each hour.
I just want to say that at the end of the day there is no solution other than reducing the cost: be it healthcare or education or retirement...
I also skipped getting health insurance in my 20s, which I deeply regretted when I needed unexpected emergency surgery to remove a diseased organ.
The hospital that did it was religiously affiliated and knocked a huge amount off my total hospital stay, but I still paid a lot out of pocket.
What's worse is, until the ACA came along, that bout of uninsured surgery made me uninsurable from then on--I had "pre-existing condition". The ACA has made it possible for me to actually buy health insurance at all again.
Of course, I'm still hoping the Medicare for All movement starts gaining steam...
Until you have a catastrophic health issue like say total kidney failure at 18 which happed to some one I know or you need a transplant I dread to think what my recent kidney transplant would costs in the USA as opposed to the UK
> not getting healthcare as a 20-something is popular, but incredibly shortsighted.
My idea is that it is not something that you should have to think about. I mean I understand it is a difficult topic because you have these outliers that can totally destroy your life if you have a baby with a malfunctioning heart or whatever but it comes back to the question of what we think is fair. I sincerely believe that healthcare is too expensive. The problem is that nobody who is in a position to cut costs has the incentive to do so.
I mean I hear all these complaints about medicare from providers like oh there are restrictions on what you can bill and what you can't and I am just thinking "good" because otherwise the doctor will put every single patient who comes in with a stomach ache through an MRI without using any of her judgment. I mean it looks badly on her if one out of a thousand patients turns out to have something she didn't catch but it doesn't hurt her at all for all those 999 useless MRI and the cost of those. The hospital is happy because they already have the machine and the technician who is there so is drawing salary so they have an incentive to maximize the use of the machine and the technician.
I am hopeful for medicare for all but we should remember that this is not the end of the problem. There are no silver bullets. As a society, we have to constantly make difficult choices and I for one support "death panels" which to me means that certain cases where the cost is too great AND the outcome is not good enough can and should get denied.
> where the cost is too great AND the outcome is not good enough can and should get denied.
I'm not completely clear on the point you're trying to make, but this is how things work in socialised healthcare. Not everything is paid for - instead the money that is available is spent on those that return the best value-for-money balanced against not being unfair on an individual level. The question of whether to MRI everyone with tummy pain is translatable into a clinical question and can be tested in clinical studies.
In the UK we work on using a QALY - or quality-adjusted life-year to help with these sorts of decisions. They are used on boards in NICE (for general health-provisioning guidance) and the cancer drugs fund [1] which aims to give quick guidance on the fast-developing and expensive field of anti-cancer therapies.
Sure there are no silver bullets, but issues you bring up are being tackled to a relatively sophisticated degree in other countries.
I'd say for most of us in the US it's a non-issue -- you either have it, or you don't, and that hasn't changed a ton in the past few decades. I don't go around thinking "man, if I was in Sweden, I'd ALSO have health care just like I do today".
I think it's probably a proxy for talking about "discretionary income" or something. My kid may have more discretionary income than I do if he doesn't have to pay a mortgage and utility bill every month. So a higher cost may actually be more affordable if other things don't have to be paid for.
I don't really know how to compare countries like that- but I would wager somebody has tried.
Because in most of Europe, sales tax (which therefore is added onto the purchase of your new iPhone), will in some part go towards the funding of universal coverage free-at-point-of-use healthcare.
In the US you get your phone cheaper. But you buy your healthcare.
Most Europeans would prefer to pay more for their phone and know everybody in their neighbourhood gets free medical for life in return.
Before the ACA a family of 4 could get health insurance from the private market for 350 a month or 4200 a year and it's tax deductible. In Germany, a family of 4 making 75k$ a year pay 7.5% or 5,625$.
The US system was cheaper and comparable. Now it's dramatically more expensive for the same cost. All we got from the government is expense. This is why many here are not pro-single payer.
Take a look at the U.S. public healthcare expenditure per capita. It's higher than countries like the U.K. (with fully tax-funded healthcare), probably even Germany. And that's before accounting for private funds.
Again your example is a poor way of comparing things, but you didn't even factor in how much you pay towards Medicare/Medicaid.
Last time I checked, in the UK I pay less towards the NHS and the best private health insurance I could find, combined, than I'd be paying in the U.S. in taxation towards healthcare alone.
All these comparisons between the US and Europe regarding healthcare are useless. The common suggestion that the US would need a 20% VAT or higher income tax to afford universal healthcare is absolutely false.
Which is a fair, but statistically insignificant point. We had a lot of uninsured that could have afforded insurance without government aid. Now we have to get aid to afford anything.
Probably because prominent American politicians brought up iPhones in health care discussions recently. "And so maybe, rather than getting that new iPhone that they just love and they want to spend hundreds of dollars on, maybe they should invest in their own healthcare." - Actual statement by actual (now retired) American member of Congress in March.
My point was that there are other factors than price which influences whether or not someone will buy something if you look at the entire world. I just gave two example of such factors. And I'm surprised this was not obvious.
You don't think someone's ability to buy an iPhone or any other product at a certain price depends on how much money they earn/they are left with at the end of the month?
It's also the userbase or the marketing there (unsure which one). I was in Sweden few years ago, gislaved / hestra, and overall nothing else was being sold besides iPhone. It came as a shock to me.
Only one of the tech toys stores that we visited had Samsung at the time.
Looks like your view is biased by what stores you visited. All stores where I live sell a mixture of brands, with the obvious exception of the Apple store.
I think the largest stores are Elgiganten, Mediamarkt, Netonnet and all of those sell a mixture.
A quick look at price comparison site for my area shows 80 stores selling iPhone 7 and 72 sellingg Galaxy S8. And that includes the Apple stores.
Well, it is "just a game"... an innovative, highly creative game with some really interesting features.
I suspect the real creative talent behind the game got used and pressured by product-manager types to ship far before it was ready because of all the money and promises involved.
Throwing a fit because of "honesty" in game pre-marketing is sort of like asking for your money back because a movie didn't fulfill the expectations set by the trailer. Yeah, good luck with that at the multiplex, but also keep in mind that many people got their money back for the game.
And anyways, cautious folks who expect absolute honesty from their game vendors, would do better to wait for the 3rd party reviews before jumping in headfirst with their 50 bucks.
> Throwing a fit because of "honesty" in game pre-marketing is sort of like asking for your money back because a movie didn't fulfill the expectations set by the trailer. Yeah, good luck with that at the multiplex, but also keep in mind that many people got their money back for the game.
These aren't the same though. Trailers can be used to evoke a certain sense about a movie that is disingenuous such as masking a drama as a comedy by splicing together the funny parts. You'll still get those funny parts, but they just weren't what you expected. A director can say that they'll guarantee you'll laugh until you cry, but that's all subjective. What happened with No Man's Sky was just outright lying.
This would be akin to someone saying that some actor gave the performance of a lifetime in the movie, but the actor never had anything to do with the movie. Does that mean I can't enjoy the movie? Nope. I might still love it, but that person still lied to get me to see the movie. That's what they did with No Man's Sky - gave false information about a game's features that was still good for what it was.
For what it's worth, I heard that people who didn't follow the hype-train liked the game. Those accounts of the gameplay all praised it.
> For what it's worth, I heard that people who didn't follow the hype-train liked the game. Those accounts of the gameplay all praised it.
It's unfortunate (but understandable) that critique of No Man's Sky often mix what was promised with what was actually delivered. So much of the commentary focus on Sean Murray's broken promises.
There are a few reviews that cut through all the hype and focus on the gameplay and it's not a pretty picture. It's an AAA-priced game that (at the time of the launch) is at the level of an early access game. I recommend checking out Joseph Anderson's analysis on Youtube.
The people who have had the best time with this game seem to treat it as an overly complicated fidget cube. Something to keep their fingers busy while their mind is focused on something like listening to a podcast.
This is not really a game—more like a tech demo. This was the problem outlined in the article and many, many gamers.
> And anyways, cautious folks who expect absolute honesty from their game vendors, would do better to wait for the 3rd party reviews before jumping in headfirst with their 50 bucks.
100% agree, but the two are not really related. People should be cautious, but developers and publishers should not lie.
>>Well, it is "just a game"... an innovative, highly creative game with some really interesting features.
My understanding is that the developer either outright lied about the features pre-release, or they strongly hinted at them and misled people, or a mix of two.
I don't envy software developers under immense pressure to deliver a AAA title on time. Having to predict whether or not you can get that feature working flawlessly in 30 days isn't easy in a vacuum. Much less with your Marketing dept being overly optimistic with your prediction.
In this case of a small company, most of the marketing was done by lead director who was very close to the development team and obviously knew what the team was able and unable to deliver.
Yeah, but like in the case of online multiplayer, I believe they had every intention of making that a release day feature, but it just wasn't ready. I just think calling the guy a liar is a bit harsh. All marketing is lying in some form or fashion. :P
How is purposefully implying that there is multiplayer a month before release not a lie? Had it been “uhm, yeah, we are working on that but have nothing to announce at this point” would have been a lot more honest. But none of the marketing campaign was honest—it was full of half-truths, inaccuracies and insinuations of something much grander.
Also, I think the end result being as bad as it was in many’s eyes create feedback loop on the negativity. This is not the first time a game has disappointed its audience due to an overreaching marketing campaign, but this was not much of anything at the time of release.
