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Why is healthcare so uniquely expensive in the USA, but nowhere else?

US healthcare is very expensive because it's horribly inefficient. There's lots of insurers, lots of providers, and lots of treatments. The intersections of all of that are complex and requires huge amount of overhead to resolve.

Not to mention, the entire point of insurance is to provide that overhead. They want to deny coverage, obviously, so they're going to waste doctor's time on peer-to-peer and force their own customers to aggressively advocate for their own care. It's a huge waste of time for everyone involved, but the insurance company wants that waste of time, that's what they're optimizing for. They've gotten really good at both calling all the shots and wasting time.

Your doctor is more or less a vessel for the insurance company. The insurance company is your doctor: they decide how long visits are, what you can visit for, what medications you can take, which procedures you can get, when you can get those procedures, how much they will cost, and how you will have to pay. Your doctor gets a tiny bit of freedom. Maybe they can prescribe you a medicine out of, like, 3 predetermined choices. After, of course, you've completed all the testing. And after you've tried medicines A through C. And after you've been monitored for whatever time period the insurance decides.

Yes, that's all very expensive.


One answer is it is more expensive compared to most of the rest of the first world countries because it was more expensive compared to them 50 years ago, and over that time the growth rates in health costs have been fairly similar for us and them.

The question then is why was it more expensive then? I've not seen much on that.


It is expensive in every developed country. USA just have made everyone involved to try to maximise their profits by shadiest possible practises.

Other places are less expensive. But it does not mean they are cheap. At least in as far as you think of general cost of living. The cost might not be directly visible, but it is there in some way.


Are there really employers who negotiate this? Every job I've ever had in tech had a single "medical benefit" package that everyone just got. You couldn't negotiate your particular health insurance premium or what portion the employer paid for. Everyone gets the same thing. The only choice I've ever seen was a menu of two options: PPO or high-deductible plan.

So it's good to know the details of the plan (so you know your doctor isn't going to suddenly be out-of-network) but there's not much you can do with this info besides "take the job or leave it."

I'm sure when it comes to executive compensation, everything is open to negotiation, but not for us worker bees.


They don't negotiate the terms of your health insurance.

It's presented as part of the negotiation for total compensation.

You have to know the benefits to be able to understand the total compensation, which is what you're negotiating.


Wow, talk about a comment that starts out solid, with good points, and making a lot of sense, and ends up in an insane asylum!

It would be nice if AI turned out to not be yet another winner-take-all technology "race" that had to be won by one company.

This is a great question. Unless OP works for one of the big AI companies, the "we" is actually just "they." He would rather they not lose the AI race so idiotically. If we are not in the race, we're losers-by-default as those in the race reap all the benefits.

> And yet... the resulting posters put me off. I'm trying to figure out why that is. I think the best explanation I have is the lack of intention behind them - knowing that none of the visual details - the illustrations, the typographic flair - had anyone thinking about them while they were constructed.

I think that's exactly it, and it's not really hard to articulate. You are simply noticing the lack of effort, lack of care, and lack of craftsmanship that is inherent in AI-produced slop. This isn't mysticism and it doesn't take a sixth sense to detect. When someone puts no effort into creating something, that lack of effort carries through the entire work, and is (or should be) obvious and easy to spot.

Ask a schoolteacher. They can spot when someone half-asses a term paper, and, at least I hope, they can spot AI slop term papers.


I agree. For most people I've talked to, when this topic comes up, they'll tell me they don't like AI, but then cannot really identify it. Especially the elderly folks in my neighborhood. You look at their facebook feeds and it's 100% slop. No joke. Every. Single. Post. Is. AI. Slop. And for the most part they can't tell.

The problem is in 2026 I work in this space and it's getting to the point where I can no longer tell sometimes. By next year we're probably all cooked. My first go-to now on an image is TinEye.. if it first appeared before AI then I know it's safe.

Yea, I worked for a competitor to ATI back in the day and we were definitely Quakemaxxing. We were not so unethical as to try to detect the .EXE name so to put the GPU into a "cheating" mode only when that benchmark was run, but we did run Quake 3 pretty much constantly while trying to eke out a few more FPS...

Wasn’t that almost the norm for both new OS drivers and subsequently GPU SoC firmware of ‘gamer cards’ to literally optimize for the latest AAA titles? I feel in that case, the interests aligned - in a world where I had a chance to actually play Crysis, I wouldn’t care why the frame rate was decent, no?

Some applications provide a "paste without formatting" that is distinct from "paste" but often that one removes things like hyperlinks, which you generally want to keep.

The "paste" idiom has been thoroughly stressed to the limit. Should "paste" paste just text? Should it include text color? Should it in crude text background color? Should it include typeface? Should it include text size? Should it include attached metadata like hyperlinks? Should it include other stuff around and peripheral to the text?


"paste as markdown" would be interesting but no I don't actually want to keep hyperlinks when I'm pasting without formatting.

I resent that I need a special app to "manage" them. I want to know where this key is on my filesystem so I can back it up and edit it myself, not have to use some app to access it. My ssh authorized_keys is just a text file. I can "manage" it with something as simple as vim. Maybe KeePassXC and BitWarden give you that simplicity, if so great!

KeePassXC "supports passkeys" but the website/app that offers the passkey needs to offer it in the correct way for KeePassXC to ingest it. I've found a fair amount of scenarios where they don't correctly let you drop it into them.

Until I can have all my keys as cleartext in a text file, I won't use passkeys.

KeepassXC gave users this choice. And was threatened to be blocked for it.[1]

[1] https://github.com/keepassxreboot/keepassxc/issues/10407#iss...


Yuck. Look closely at the wording: He is trying to counter a "user choice" feature by saying it doesn't have "protection". "File protection." "Protection of the key." Protection from who? From the user, that's who!

This mentality that the user is an attacker, and the software must protect its data from the user. Isn't a passkey ultimately supposed to be my data?


This is simply the mentality. Everyone who's worth anything (as in money) has it. Everyone who makes anything you own has it. They do everything based on this mentality and will not give it up. Every new specification or policy has provisions to ensure the device is protected from its user. Whether it's age verification (non-California-style), passkeys, or CSAM scanning.

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