1,294 karma · joined February 5, 2010
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I read that same review a couple of weeks ago and it made a deep impression. It's one thing to know "the Aztecs practiced human sacrifice", and another to be confronted with the scale, sadism and calculation with which it was practiced.
As Hitchens' Razor puts it: "what can be asserted without evidence can also be dismissed without evidence." u/petesergeant was pointing that out to you, fairly gently if slightly obliquely.
I'm into rockets, and clicked the link earlier today. I shared the suggestor's view, but didn't bother to post. I came back now, saw the comment thread had updated significantly, noticed that OP had addressed the suggestion, clicked again -- and noticed, hey wow, there are cool screenshots now, these are a lot more interesting, this is better than I thought!
Yes, that's the whole point of tech used by law enforcement: to enable the enforcement of law. If we don't like the law (and I don't), we should change it!
But focusing on the ALPR here is just silly, as a quick glance of this partial list of other technologies used by law enforcement officers in the course of enforcing the law will show: * cars * guns * phones * handcuffs * computers * the internet * notebook and pen
All of these can be used to "enable authoritarianism", and indeed, any authoritarian regime would be hard pressed to run without them. Some of them are more important than others, and ALPRs are definitely a major improvement in the "who is going where" part of law enforcement -- but the problem is the bad law, not the enforcement thereof.
Your argument reduces to "some laws are bad, so we should have weak enforcement mechanisms, because otherwise people will be unable to evade prosecution for breaking bad laws, and that is bad, because the laws are bad and therefore those who break them should not be subject to prosecution." This is not as helpful a move as it might seem, since it just sends us back to the original question, which is "ok, what laws should we have?"
For better or worse, we have a setup in which we have one branch charged with answering that question, and another charged with enforcing whatever laws we happen to have. Trying to undermine one branch in order to compensate for the stupidity of another is unlikely to help.
If the humans are in fact more expensive than the chatbots, it's not like the shareholders just say "oh, ok, I guess we'll just take lower compensation for slightly more risk". Instead, they'll pressure management to pass the higher cost on to the customer.
If you want to "protect workers" by making sure they get paid x amount regardless of whether they're the most efficient way to achieve y goal, why not just do that through taxes? You're basically taxing bank shareholders and subsidizing employees, but with a lot of extra steps. Plus, the employees have to actually show up to work every day, which I understand can be kind of a drag.
Can you elaborate on this point? What is it about the union that makes their on the job training so effective? Veteran carpenters with 15-20 yrs of exp have, in general, a very strong skill set -- what is the union doing that makes people catch up so fast? And if that's true, why do more people not defect from the union?
The quality of instruction is very high, with a focus on safety and building a strong foundation of knowledge. Especially if you ever might want to charter in remote locations or sail across oceans, it's really an excellent foundation.
[1]https://www.clubnautique.net/school/introduction-to-sailing/
That letter from his wife, Naomi, contains a link to her website[1], which is itself fascinating. Its About page contains the following, which made me think her particular brand of value-add in the world is of the kind that will survive:
> I fill-in the details of the couple in each Ketubah by hand, with ink and pen, as Jewish scribes have done for thousands of years. Nowadays, most Ketubah artists use fonts and fill-in the texts by computer rather than by hand, because many have not studied calligraphy, an art which takes much time and practice to master. I, personally, like writing the details by hand, though it is not easy work, because it is traditional, and because it connects me in a personal way with my clients and my prints.
This is a popular view but I think it is wrong. Yes, we have problems on Earth. But if you compare Earth today, in terms of "carrying capacity for human beings", or "utils generated per day" or some other metric you like, vs pre-human Earth, I don't think it's a close contest.
The few early humans were hungry, naked and vulnerable to all manner of dangers. Now there are billions of us, and most live in relative safety, comfort and material luxury. If we can do for Mars what we did for Earth, that will be the best thing that has ever happened to Mars.
I don't know if that's right (anybody with more info care to comment?), but it's at least enough to give me pause on the "dealers will hate nonnegotiable pricing" claim.
Disclosure/source: I'm a former lawyer and the founder/owner of ClearCare[0], a price transparency compliance platform for hospitals that's purpose-built to help them solve exactly the requirements of this rule.
I'm actively seeking someone to take it over, as I recently got a once-in-a-lifetime opportunity to join a plant-based bacon company as a cofounder, and I'm taking it. I don't want to shut ClearCare down, but I don't have time to focus on it since the bacon company is growing so quickly.
I was actually pretty shocked to find so few HN-crowd startups tackling this. There's some competition in the market but it isn't very strong, and the distance to, at the minimum, a nice lifestyle-business that does a few hundred $k to a few million in ARR is pretty low. It took about a year to get ClearCare where it is today. The platform is written in React, uses Auth0 for auth, and is currently on Netlify. If you're interested in running with it, please reach out - jared.hansen [ at ] clearcare dot io.
Also one other disclaimer: the following is an oversimplification. Obviously.
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Background
The Affordable Care Act[1] (aka "Obamacare"), passed by Congress and signed by Pres Obama in 2010, required hospitals to “make public... a list of the hospital’s standard charges for items and services provided by the hospital,” and to update this list annually. The standard way hospitals met this rule was, for many years, to simply post a link to their chargemasters[2] - which you can think of as, essentially, an almost aggressively user-hostile data dump of opaque billing codes and amounts that didn't actually mean anything for patients.
In June of 2019, Pres Trump signed an executive order[3] requiring the Dept of HHS to create new regulations that would more clearly codify the requirement. HHS' sub-agency CMS created a draft rule in September of 2019, which became final around 14 months later.
The AHA sued to block the rule but lost, and the compliance requirement has been live since January 1 of this year.
There are many reasons the Chargemaster rate bears little resemblance to the rate paid by any actual patients, medicare reimbursement rules chief among them. Too much to go into here.
So what does the rule actually require?
The Rule
In short, hospitals must post two things:
(1) a list of Standard Charges (i.e., the chargemaster), for everything. This has to include negotiated rates with each payer (E.g.: Blue Cross pays 7500 for a given kind of knee surgery; Aetna pays 562; United Health pays 812), and the cash discount rate, if any. One thing that's interesting about this list (and overlooked, frankly, by most of the providers in the space) is that it is described by CMS as a "machine-readable file" - and they give examples as CSV, JSON and XML. Historically, hospitals would post chargemasters often as PDF(!), sometimes XLS, txt, csv, god knows what all -- but CMS is trying to move toward a world where you can create an API on top of all of the data and build more of the "kayak for healthcare" tools that the industry has been trying (and failing) to build for so long.
(2) for 300 procedures designated as "shoppable services" (meaning: can be scheduled in advance, and patients might want to shop around), a "user-friendly", "searchable" and generally better-designed disclosure of prices and various other information about the services. CMS designated 70 of these, and hospitals choose the other 230.
*THAT'S IT.* Contrary to popular belief, especially elsewhere ITT, the rule does not require hospitals to provide the kind of price transparency you see elsewhere in life. You just have to post certain kinds of data in certain formats. It's not actually that hard, but it's pretty hard for hospital IT departments to do on their own -- especially IT departments that don't really exist, because they're at small hospitals with small budgets.
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Misunderstandings ITT
Myth: "The price transparency rule requires hospitals to explain what things cost for patients"
Reality: The price transparency rule requires hospitals to list the "standard", or "chargemaster" price, along with the "negotiated rate" the hospital has reached with each payer.
Myth: $300/day is nothing to hospitals
Reality: that's true for large hospital systems maybe, but there are >2k small, rural hospitals that the rule still applies to, regardless of their tiny budgets. For these hospitals, 109k/year is a lot of money (incidentally: this also means that spending say 10k/yr on price transparency saas is a lot more attractive than doing nothing and paying the fine). Moreover:
Myth: the fine is the only penalty for noncompliance
Reality: CMS has indicated stronger penalties will come if compliance does not increase, including impact on the medicare reimbursement rate, which is a core driver of hospital revenue. Hospitals do have good reason to try to comply, and many of the larger ones are already doing so. In fact, the data show that the larger hospitals are much more likely than smaller ones to be compliant at this time.
Myth: this is way too hard
Reality: If complying with the rule meant you had to figure out what every patient was going to pay in advance, then yeah, it would be largely impossible right now, for reasons adequately documented elsewhere in this thread. But that's not what it requires. You can comply by posting a very specific, pretty well-understood set of information, which consists largely of a transform on information that each hospital absolutely already has.
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I started ClearCare basically the day I read the Trump executive order, because within an hour of hearing about it, it was obvious to me that either 6k+ hospitals would have to do a bunch of bespoke web design to comply, OR there would be a pretty straightforward SaaS platform that would do it for them, and that there was good opportunity in building that platform. I still believe this, and if I weren't busy taking orders for plant-based bacon I'd be recruiting instead of looking for someone to hand it off to. Call me if you want to talk.
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[0] https://www.clearcare.io -- and there's a corporate deck here: https://www.beautiful.ai/player/-McFhWCjOS_FBay_aAy3
[1] https://en.wikipedia.org/wiki/Affordable_Care_Act
[2] https://en.wikipedia.org/wiki/Chargemaster
[3] https://nationalhealthcouncil.org/blog/blog-president-trumps... - note the text of the order is no longer available on the whitehouse site, but this is a decent summary.
Sad to say, it's terrible. Mostly what it did was remind me how much I appreciate stuff that actually works well (e.g., wrist position sensing, so that it turns on when it's supposed to, a reliable touch interface, etc). I ended up buying a Fitbit Sense when they came out a month or so later. I don't regret it, even at >10x the price. I have my gripes with the sense but most of the time it is vastly more usable.
The median and modal ARR for SaaS businesses 7 years after founding is zero.
2. No. Google around for this; there's plenty of info on how this can be done more quickly. Also, "even if we find a vaccine it will take a year or more to produce it at scale" is no reason not to develop one or to celebrate progress in such development.
3. Possible? Uh, sure, yeah, most things are possible. Probable? I'm not aware of any evidence suggesting that "early vaccine trials result in super virus" is a remotely probable scenario. If you are aware of any such evidence, please post it here because I'd like to read it and update my view accordingly.
[1] https://www.thelancet.com/journals/lancet/article/PIIS0140-6...
[2] https://www.biorxiv.org/content/10.1101/2020.05.13.093195v1
For those not familiar: https://en.wikipedia.org/wiki/Freeman_Dyson
Well of course it isn't, but that's like saying "I'm a fighter pilot (trained in the air force), but when I try to use Flight Simulator X, it feels like the experience isn't good enough for me." The DL experience isn't really for you at all. It's for people would a little bit like to learn a new language. Not people who want to do it so badly that they'll invest substantial time in school and "life choices" to make it happen.