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> the company’s health plan was on the hook for a million in costs

As usual, this is the craziest part of the comment to my European mind. Your healthcare system spent somewhere around an entire lifetime of effort for something that, while relatively dramatic, should still be quite routine for a sophisticated medical organization!

Which begs the question: what happens if the premature baby is born to a US family that can't afford a decent insurance plan? Does the hospital repo the baby? Is the family bankrupt and the baby's life ruined from the get go just for being born premature? I can't wrap my head around it, and it seems to suck either way.

To some degree yes everyones life is ruined. The people with nothing still get some medical care, it's the working poor who make too much to get welfare but too little to cover expenses after insurance who are really screwed.

In the US only the wealthy ( millionaires ) are safe from medical bankruptcy and even they can get taken down by some issues.

The parents are on the hook to the hospital, to the myriad physicians involved in the in-hospital care, and for non-covered post-discharge costs. Their financial lives may be crushed absent bankruptcy, which carries its own problems regarding loss of assets and mortgage availability for ex.

The infant is also financially liable but likely uncollectable. The baby's life may or may not be ruined depending on where the US goes w/r/t health insurance coverage for pre existing conditions.

How is the infant financially liable?

Maybe more civilized countries can offer them asylum. Its just incredible to what degree the US is fucking its own people and how unwarrantedly proud they all are about their country.

The hospital bills a million dollars, the health insurance says, no we'll pay you $125,000. That's it. I don't know enough to understand how this situation came about, but the bill the hospital provides is often 2x to 10x the reasonable cost and the insurance company only pays the reasonable cost. And has sort of negotiated this beforehand with the hospital. This is the situation that truly ends up screwing people without insurance, because their only negotiating power is that they literally do not have enough money to pay.

This is really screwed up. "Everything is worth what its purchaser will pay for it" is deeply immoral when applied to life and limb. I can hardly understand how a democratic society can accept a system like this.

I mean, can you even imagine other areas of life where every person you purchase from attempts to screw you over by demanding 2x-10x of the reasonable fee unless you had the information to be aware of it? It would be impossible, because everyone would just take their business somewhere else.

But you can't exactly say "oh, I'm not willing to pay my life savings for this, I'll just take this 3 months prematurely born baby to the shop across the street, or maybe get it done in six months time instead, when it's more convenient.".

It's even worse because neither you nor the people treating you actually know how much cost you are incurring. You find out a few weeks later when you get the bill. Imagine if anything else worked like that?

> As a jr employee they’ll never rise to chief architect

Considering that only few people get to the top title at a big company (I think there is ~20 Technical Fellows in Microsoft world wide), I think that is a fallacy. If you work at a small company that grows, you're far more likely to become a chief architect.

> Now tell me my experience would be better in a 12 person startup/shop. I dare you.

Only applies to the US. EU citizens don't really have to worry about that.

The thing is that in a big-co, you don't have to become chief architect or CTO to have a healthy career evolution. You can be "just" architect and impact a much bigger team than the 10-people startup.

Technical Fellow is an academic and/or research position. SMEs don't have technical fellows, although technical fellows sometimes start their own companies.

Senior/Chief Architect is an engineering/production position, with limited scope for game changing R&D. In a typical 10-20 man shop the position is usually taken by the CTO, who will be usually be in it for the long haul for both financial and technical reasons.

Very, very rarely a startup will turn into a unicorn with hundreds or thousands of employees. You can get some way up the ladder when that happens.

But the odds are against it happening in the first place. And at the higher levels you'll still be competing with talent hired from outside.

> As a jr employee they’ll never rise to chief architect

This is so important, as a relativley junior developer at a 6 person web dev shop, the owner is the only other backend developer. I have no room for climbing, even if I get a job title upgrade or a raise, my responsibilities and the level I work at won't change. I will handle the day to day backend and the owner works on strategic choices. There is only so much impact I can make in this position

> There is only so much impact I can make in this position

I'm reminded of this talk : https://www.youtube.com/watch?v=hER0Qp6QJNU around the 8m30 mark is the pertinent point, but worth to watch before that to get where his point is coming from.

Big companies will spend money on training but personally I have learned a lot more at smaller places because I was able to explore a lot more and my contributions had a lot more impact on the buisiness overall.

So in a sense, small companies are the training. You pop in, learn what you can, and jump ship.

The holy Grail of small company is to get trained and keep getting trained at the same company as your trainer(s) rise to executive level.