Sounds exactly like fine as price in the making.
150 karma · joined November 15, 2016
Many good refs define both but [1] is free. As far as how you might think of them [2,3] give context. The exact extent of merit can be debated but these do have merit.
[1] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5903119/ [2] https://ebm.bmj.com/content/21/4/125 [3] https://jamanetwork.com/journals/jama/fullarticle/1895230
Context for those who missed it:
http://www.aaronsw.com/weblog/rewritingreddit
https://www.wbur.org/news/2013/02/20/carmen-ortiz-investigat...
I think of Sci-hub and Alexandra are the continuation of Aarons fatal push:
https://en.wikipedia.org/wiki/Alexandra_Elbakyan
Ongoing attention on the circumstances:
https://theintercept.com/2021/02/15/marty-walsh-aaron-swartz...
The solution - to the extent one exists - is pre registration. I see no evidence that this study was pre registered and thus the usual assumption that it has no meaningful protection from publication bias applies.
Here’s one of the very well known reports of potential impact in a well studied area (fda approval): https://www.nejm.org/doi/full/10.1056/nejmsa065779
E.g., https://psycnet.apa.org/record/1937-00266-001
The sign is changed to escape folk connotations but in time reality asserts itself the signed subsumes the new sign and the cycle repeats.
The walrus has branched out.
TL;DR: consumption of healthcare on a gold plated health plan meant that my total comp was more than I've ever gotten in salary on the FAANG RSU train and whereas its easy to talk about RSUs its hard to talk about 'golden EOBs'.
The eye opening has roughly two versions all of which you can see in a peer group when babies start landing:
1. The tail event
Lets say you're a SWE making $500k/yr then you have a child and run up a $2m NICU bill and then a $2m cochlear implant bill after that... most people look at your $500k in 'salary' (base + bonus + stock) and say 'wow you're well paid' in reality what they should look at is your $5 copay and $1k total annual and say 'wow you're well paid' (an extra $1,999k in consumption enabled by your work). Remember it's even more extreme than raw numbers b/c your $1m in wages over these two consumption events gets squeezed through an income tax that (in CA) is ~50% vs. your employer sponsored plan paying the $4m in bills (granted crazy hospital Monopoly dollars) without that tax drag.
2. The ordinary frustration
boplicity and I consumed the same service (OB ER triage) and boplicity ended up unhappy to be out 'multi thousand dollars' in user fees whereas I was happy to be out $5. When a peer groups starts having children this first - for many - substantial engagement with the healthcare system shows just how different 'good' employer sponsored plans are. In my peer group share of cost, network of options, extent of benefits were all meaningfully different even among prestige employer plans. The fear of infinity $ as an upper limit paired with the loss of agency involved in infirmity causes a lot of consternation about the money and choice. It's hard to price the absence of that worry and feeling you got the short straw in the relative buying power game devalues your prestige employment.
For my part, I felt fortunate to be on a plan that exposed me to ~zero financial risk or sense of network loss during a healthcare consumption event. This was not always so. As a healthy single 25 y/o with that first package I ignored 'fringe.' It didn't even make the xls doc from the HR people a free gym you use with your boss's boss is hard to price anyway. Now having worked through the GFC / COVID & consumed some healthcare the RSUs are harder to budget and health insurance reads like a deranged lottery ticket that could asymptotically approach 100% of total comp.
Finally, whether any of this 'ought' to be is a separate question. As a practical matter, today, it is so - my employer can buy things I cannot and can do so with dollars I cannot match 1:1. Sometimes I value them and sometimes I do not. If the person sitting next to me values these more than I do then I am are being under compensated. If HR tried to close that gab with salary we'd have pay equity problem. As such, I believe the present tax / insurance system means we can have any two of diversity of employee preference, pay equity, comp equity (in theory ... in practice it seems we can have zero of three).
Anyway, hopefully that clarifies my thinking a bit. As I said, wouldn't put much weight on it.
*the third trip, like you, was passing through the OB ER on the way to delivery and I’d never count it normally… then again unlike you my total cost out of pocket was $5. The financial experience of childbirth has been one of the most useful tools in reframing my understanding of total comp as something very different than salary.
For the many who have shown the impulse here, a bit of context: Apple global revenue in 2020 was 274B[0] and US healthcare spend was $4T[1]. If you can capture just 6% of just the US you've got an Apple sized (in one sense) operation. Six percent isn't so big, Google is at 90%[2]. Little old United Airlines picks up twice that 6% target for 13% share[3]. If you pulled in 13% of US healthcare you'd have a Walmart sized operation[4].
Apple, Google, Amazon, Microsoft have made a multiple runs at it. Maybe Apple Watch and PillPack count as successes, maybe.
The world is waiting for, dying for, someone who actually knows _____.
[0] https://www.statista.com/statistics/265125/total-net-sales-o...
[1] https://www.cms.gov/Research-Statistics-Data-and-Systems/Sta...
[2] https://gs.statcounter.com/search-engine-market-share/all/un...
[3] https://www.statista.com/statistics/250577/domestic-market-s...
[4] https://www.macrotrends.net/stocks/charts/WMT/walmart/revenu...
(obviously the math is approximate, the sourcing iffy, and the comparisons flaky ... particularly Walmart which is a big player in healthcare so is getting double counted).
An unlicensed space is a business with all the usual obligations and the doctor is a doctor with all the usual obligations. When you move to the practice of medicine to a “hospital” (again as a licensing and finance idea which is separable from a sort of basic idea of building X) all that comes along but now with an additional regulatory overlay.
Big picture this doesn’t change much about the Ada except to say that many medical practices are happening in spaces where the Ada is just the beginning.
HN is filled with people bemoaning subscription software. Subscriptions, whether to software or news, shift power toward sellers and invite dark patterns for its abuse.
That abuse is well enough recognized to be the subject of an often celebrated (on HN) CA law attempting to make subscription less odious.
https://leginfo.legislature.ca.gov/faces/billTextClient.xhtm...
Can’t speak for parent but I’d be slow to conflate unwillingness to subscribe and unwillingness to pay.
The best documentation of this I know of is from Chicago about 10 years ago. The above was the first article by the journalist I associate with it.
“In a fully developed bureaucracy there is nobody left with whom one could argue, to whom one could present grievances, on whom the pressures of power could be exerted. Bureaucracy is the form of government in which everybody is deprived of political freedom, of the power to act; for the rule by Nobody is not no-rule, and where all are equally powerless we have a tyranny without a tyrant.”
Hannah Arendt
At core, my job is arithmetic on 3D arrays of approx 10x1000x100,000,000.
The rub is that for every LOC of written manipulating those structures I’ve got 100 LOCs doing IO (broadly defined) and then 1,000-10,000 doing some form of ETL, QC, normalization (I.e. find and validate the correctness of the magic numbers that go in the cells of the big array).
Do you think J/APL would be of any use to me and if so where in your similar projects’ life cycle does it crop up?
https://en.wikipedia.org/wiki/Goodhart%27s_law
All else equal, easy to capture proxies make good metrics; however, the point is that all else will not be equal.
Also, the CYAed version of web of trust is a “360 review”. Going all in on 360s is a good way to unleashing reality tv dynamics in a previously banal workplace.
Perhaps the extent to which one cares about the nonsensical composition of the word irregardless speaks to the same latent disposition that drive preferences among type systems.
Whether “it works but is wrong” is nonsensical is debatable. My grandfather had a llama who duck typed his sexual partners. He was not, in a Darwinian sense, a successful animal but was beloved for his easy going disposition.
Anyway, word are fun.