javadocmd

The answers bring up the topic of updatable views, which got me curious.

In what use-case are updatable views superior to updating directly on the underlying table?

Views are great for bringing together data from multiple tables, but it seems that such views cannot be updatable: (from the docs) "The view must have exactly one entry in its FROM list". Thus it seems, while it might be handy, views can't help you spread an update across tables.

Presumably, a view with `LOCAL CHECK OPTION` or `CASCADED CHECK OPTION` could be granted to a user, providing fine-grained control over the kind of data that user can update. Is this accurate?

What am I missing?

The kinds of doctors that work as "tier-1 tech support" -- that is, primary care -- are not being paid top dollar, believe me. After you account for the cost of education, delay of entry to the workforce, hours worked per week, and the fact that insurance compensation models are biased towards specialty care and procedures, and it starts to look like bad financial planning.

The average adult can be quickly and reliably trained to use bleach appropriately: "Should I drink bleach? No. Always no."

On the other hand, the average adult requires six or more years of education and training to manage warfarin appropriately.

I'm being somewhat glib for effect, but do you not see a critical distinction there?

In the interest of public health, we make all kinds of laws to protect people from things they cannot be expected to do safely. Why is it unreasonable to protect people from dangerous medications?

> But this isn't true...

You completely missed this point. To quote the article:

> Many people, especially those in marginalized groups do feel less welcome. We know because they tell us.

Hanlon doesn't claim to know why the marginalized groups feel unwelcome. He doesn't even claim that the root cause is a bias of action -- conscious or subconscious -- on the part of SO's users or staff. What he said was these groups report at a higher than average rate the feeling of being unwelcome. That is a simple fact, and can only be dismissed at the cost of saying those people's opinions are not worth addressing. Acknowledging it, saying "maybe if we get creative we can improve it", is not virtue signaling, it's the most fundamental requirement to:

> shift from “don’t be an asshole” to “be welcoming.”

Maybe the solution to this is stop requiring (or tacitly encouraging) moderators to pull weeds and block all the bad questions, but rather allow them some sort of feature to identify particularly good questions.

"But then we'll be flooded by bad content!" (I can hear SO mods screaming in the distance.) If old, low-score posts are clogging your search results, that's a problem with your search algorithms, not with moderation.

Just buy every US electrical substation and deliver the maps data via grid-wide powerline ethernet.

It is a non-trivial problem, but one common enough that I would suggest any Actor library worth its salt would include mechanisms to tackle it. (Here's Akka talking about back-pressure support in Streams, for example. https://doc.akka.io/docs/akka/2.5.11/stream/stream-flows-and...) Akka also provides infrastructure for actor pooling and routing.

I don't see the manifestation of this problem as forfeiting the point. You could on the opposite extreme write one monolithic application that does everything: web interface, application logic, and data storage. It's readily apparent that for most use-cases, the benefits of separating, say, your web and database software will more than outweigh the added complexity cost of running two applications and routing requests between them. (And we don't anymore balk at running pools of web servers in front of our databases.) Continue to chop your application into smaller segments and of course you'll see diminishing returns. The application just has to be complex enough to raise the expectation of benefit from segmentation.

Ms. Enthoven covered that point rather nicely, I thought.

And I think we would all agree that the ideal amount of abuse heaped on your team is zero.

I think anyone remotely familiar with the internet won't be surprised by these outcomes. Of course the occasional reality check is always good.

I wonder to what extent plucky startups expect abuse when they put pop-up chat dialogs in their products. I imagine it's inescapable that some percentage of your user base is going to see it as an invitation to respond poorly. Something door-to-door salespeople and telemarketers learned long ago. I suppose abuse filtering is still an unsolved problem waiting to make someone rich.

I have to imagine wallpapering over a functional power outlet is not up to code.

I'm terribly skeptical of AWS Lambda as the engine of a main-line REST API. There seems to be no way to avoid the cold-start time: not only when your function is first called from a dormant state, but also when request load rises, bringing additional workers online. (A timer that constantly pings your service only protects against the first, and I hope we all agree is a dirty hack.)

I'm hoping someone will correct me if I'm missing something. Otherwise it seems like Lambda isn't really suited to use-cases where random latency spikes would degrade user experience.

A business perfectly optimized w.r.t. waste will have zero inventory and zero sales.

> Medicare is just another insurance payer

I should have been more careful with my terminology. I used "insurance" as a shortcut for private, for-profit insurance, excluding government insurers like Medicare.

Good question. My understanding of this was based on discussions with doctors. I had a bit of trouble finding a citation, so it's possible this isn't as cut and dry as I represented. I did run across this memo from DHHS in 2004 that might shed some light (although I'm not sure this still reflects current law).

https://oig.hhs.gov/fraud/docs/alertsandbulletins/2004/fa021...

It points out a pair of laws -- the Federal Anti-Kickback Statute, and the Social Security Act -- which may have caused some confusion about discounts and waivers. Hospitals, the memo assures, are free to offer discounted services under a specific set of conditions such as methodically established patient financial need, an inability to collect on bills, and given that the waiver does not in any way entice business (i.e., you can't advertise it).

But the implication is that you can't give discounts willy-nilly, as a provider, or risk federal audit.

A separate but related issue is that under-billing may be considered fraud by CMS. A doctor cannot provide a service which they do not bill for, nor bill for a code which is lesser in magnitude than the actual service provided. I can't say if anyone has ever been investigated for under-billing.

In any case it's worth adding that aside from legalities, there are severe ethical ramifications of offering discounts to certain patients and not others unless that decision is made by some impartial measure. You could imagine all kinds of kickbacks, favors, enticement, coercion, biases, and so forth rearing their ugly head if doctors are given the freedom to bill whatever they choose (less or more).

Insurance (including Medicare and Medicaid) can and do push back against things they identify as inappropriate treatment. There are many problems with this system -- too restrictive in some places, not restrictive enough in others -- but in theory this could be improved to act as a reasonable check on rogue doctors.

Another relevant effect worth noting here is CYA medicine: doctors order tests aimed at catching highly unlikely conditions to protect themselves against the hypothetical lawsuit that asks "why didn't you test for that?" Whatever the truth is about malpractice suits, the perception in the industry seems to be that these cases are overwhelmingly biased against doctors if even one question can be raised about the course of treatment.

> When I didn't have medical insurance, doctors charged me twice what they charged the insurance companies.

You've identified the symptom but misattributed the cause. You ran afoul of the charge master system of billing, which is a byproduct of our insurance-based healthcare system and the laws which uphold it. In short, providers are "forced" to set their base rates high in the knowledge that insurance companies (their most significant revenue source) will negotiate a fraction of the posted rate. Meanwhile, federal law enforces (under very stiff penalty) that individuals cannot negotiate nor be given a discount from the base rate.

You are also correct to identify the inherent information imbalance in the doctor/patient economic exchange: you as the patient will never know for certain if the recommended course of treatment is appropriate. Realistically only a doctor has enough information to tackle that question. In a cash-based system you are indeed susceptible to abuses.

(In fact, this is one of the main arguments against concierge or "executive" medicine: they will frequently throw in wasteful and dangerous tests like full body scans which have absolutely no justification in medical science.)

But by the same token, insurance company incentives aren't aligned in your interest either, so there are even more abuses on that side.

I believe a single-payer system is the best compromise -- the government's incentives are best aligned to improve the health of the populace (securing a healthy workforce) at the least cost. ("Least cost?!", I can hear the scoffs as I type.) Only government systems have enough scope and lifetime to realize the long-horizon payoffs of preventive healthcare, and cannot so easily escape their failures (the way insurance companies could with lifetime caps). Many people are surprised to learn that Medicare is at least on par in terms of efficiency and above par in terms of patient outcomes and satisfaction.

It's a gigantic market though. (Revenue of $850 billion in 2016 according to https://www.statista.com/statistics/214544/total-revenue-of-... )

I'm not an economist, but it seems like a 5% margin on a $850 billion market is worth a 10% margin on a $425 billion market.

Historically health insurance developed around the turn of the century along-side things like fire insurance. This sort of made sense at the time, when our understanding of health and our ability to treat disease was extremely primitive.

Eventually science progressed to the point that medical care was an inevitability in people's lives; which is a surprisingly recent development due to modern medications, lab tests, improved treatments and surgeries, increasing preventive care, etc. Faced with this sea change, developed nations around the world transitioned to some form of universal health coverage.

Only the United States persists in the delusion that an insurance-based system is an efficient way to provide healthcare.

No. In order to utilize your insurance plan's out-of-network services, the insurance company has to be in the loop. A cash-based system completely circumvents insurance.

I was being casual about my phrasing. Yes, we expect there to be benefit from the general execution of science as a practice at the macro scale. My point is simply that the same expectation cannot be applied to the micro scale of an individual research effort because, as you said, the benefits are unknowable in advance.

I would be interested in a cross-cultural evaluation of the Dunning-Kruger effect. This study was performed in the US. Is the effect as prominent in Russia? Sweden? China? South Africa? Across racial boundaries? Across class boundaries? I suspect a strong cultural and environmental influence.

The benefit of any scientific paper is that is benefits science -- it is not necessary that science accomplishes anything more. (The fact that science benefits society is a nice consequence, but not necessarily an immediate one.)

While I think there are in fact useful insights that the individual can glean directly from this paper, we shouldn't forget that scientific papers exist for a larger purpose than to be the tools of self-improvement or the weapons of our social wars.

Is the high latency you mention due entirely to cold starting instances, or is there another cause?

Another way of looking at this story:

It took $8 million to take a problem that was only visible to the sales department -- empty boxes are hurting our image! -- and make it visible to the stakeholders who had the right insight to actually fix it -- the people on the production line.

That is it cost $8 million to move the pain point to the "right" spot.

That is conspicuous consumption, and digital goods can perform this function just as well. As an extreme example, the "I Am Rich" app. https://en.wikipedia.org/wiki/I_Am_Rich

If you're in a friendly competition with your friends to gain the high score, there is in fact social utility around IAPs. Also works with complete strangers if you have a particularly competitive streak.

Great points, but a bit misleading if the intent is to present this as something new under the sun. The illogical decision to buy a game boost that will not recoup its cost is not much different from buying a name-brand pair of sunglasses instead of $5 cheapies. Both cases lack any marginal utility in the purchasing decision, so the purchase is justified by marketing. That is, a story is created that the consumer either accepts or denies.

In the game, playing with the boost is more "fun", because you have more agency in the game and thus feel more powerful. You are temporarily unburdened from the artificial limitations of the game.

With sunglasses, there are (often illusory) promises of quality or imaginary utility, or participation in a social narrative that says a certain configuration of plastic is more fashionable than another. Or plain old conspicuous consumption, also a social narrative.

Simply put, IAPs did not invent this style of anti-economic behavior.

I don't doubt that you (or whoever) had additional information and made a sound decision.

Point being simply that someone reading your original comment (or such comments generally) doesn't have the full context and might not realize it. I'm not making a point about your situation, but about how the internet is often misused by people seeking to make their own decisions. A subject that fascinates me.

Your father might be dead or suffering today. It is impossible to be certain about the natural course of a disease after you intervene. I'm glad your father is doing well, of course, but we should be cautious: stories like this one tend to bias people towards treatment with what is technically a false representation of facts. I hate to seem pedantic, but accuracy is crucial in discussions like this.