Mullin's recent activity
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Comment on Luigi Mangione pleads guilty to federal stalking charges in the killing of UnitedHealthcare CEO in ~news
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Comment on Luigi Mangione pleads guilty to federal stalking charges in the killing of UnitedHealthcare CEO in ~news
Mullin Link ParentI was perhaps needlessly hostile, in retrospect. Believe me when I say that I am always malding about healthcare, it's my hobby horse everywhere. Providers love that they can push all the blame to...I was perhaps needlessly hostile, in retrospect. Believe me when I say that I am always malding about healthcare, it's my hobby horse everywhere.
Providers love that they can push all the blame to insurers, especially to patients, but they could just as easily lower costs or increase care if they wanted to. I understand that if you've been interacting with the healthcare system, especially for someone who is dual, and if it's not strict Medicare but MA, and not sure the Medicaid situation, but yes, it can be astronomically annoying when you just want to receive care, but providers made this bed. At no point in their finance meetings are they thinking "how can we treat more patients more cheaply" and I've seen what I would describe as hostile negotiations where they'll threaten not to treat Medicaid or indigent population to get better rates from the state.
Sorry I got heated, I have enough rage for everyone involved XD
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Comment on Moving US to Japan: Things to bring? Things to leave behind? in ~life
Mullin Link ParentI think, I mean any of them are fine default/Ryobi/Milwaukee/home Depot brand etc, but Milwaukee has the best of the mini sized ones, the case would be easy enough to throw in a suitcase. I'd get...I think, I mean any of them are fine default/Ryobi/Milwaukee/home Depot brand etc, but Milwaukee has the best of the mini sized ones, the case would be easy enough to throw in a suitcase. I'd get one of those to hedge and then if you need larger tools just buy them in Japan. I helped my brother move/assemble furniture and he had one he'd gotten for work and it was a godsend. It's like the Ikea gun screwdriver on steroids.
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Comment on Luigi Mangione pleads guilty to federal stalking charges in the killing of UnitedHealthcare CEO in ~news
Mullin Link ParentHow it typically works is there are criteria for anything not automatically approved, and then beyond that a doctor is tasked with being the final adjudicator of claims approval, and beyond that...How it typically works is there are criteria for anything not automatically approved, and then beyond that a doctor is tasked with being the final adjudicator of claims approval, and beyond that there is still appeals and grievances. But IME it doesn't take much to meet the threshold for medical necessity. All the doctors have access to the same information on what treatments are effective or not. It isn't so cut and dry that one avenue is better than another.
In the same vein that one doctor is paid by the insurance the other doctor is paid by the hospital, he has exactly the same perverse incentive to get that MRI approved as the medical director does to deny it, per your own admission
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Comment on Luigi Mangione pleads guilty to federal stalking charges in the killing of UnitedHealthcare CEO in ~news
Mullin Link ParentI don't want to hound you, so tell me if you'd rather just not have further discussion about it. But insurance companies exist to manage risk, and to collectively bargain. That is the service they...- Exemplary
I don't want to hound you, so tell me if you'd rather just not have further discussion about it. But insurance companies exist to manage risk, and to collectively bargain. That is the service they provide, and health insurance provides more and takes less profit than basically every other type of insurance in existence. Your bills are lower because the health insurance negotiates for you. You can afford to have a catastrophic medical event because the insurance spreads your costs over a greater risk pool. Your premiums pay for someone else's catastrophic event, so on and so forth.
Whether you believe this should be the government's job or not has no bearing on the application or value add of insurance. Also both Medicare and Medicaid are often managed by insurance companies as a health plan, and have to make the exact kinds of decisions about coverage, utilization management, etc in order to maintain profitability. That means denying care, it also means giving only certain members additional care. I worked for a Medicaid health plan in New York, when the budget bill passed, we had to reduce membership because NY was losing federal dollars and had no way to compensate. You either deny care to maintain profitability or you no longer cover unprofitable members. The dollars truly are zero sum. Health plans can only lobby, they otherwise have no bearing on the funding situation or laws at a federal level. I absolutely assure you that nobody wants patients to be sicker, everyone wants them to get high quality care, but it's a difficult problem to solve. Recently I evaluated a vendor we were paying for the sole purpose of helping patients get into their PCP, they got an extra community based healthcare worker to get them in, remove barriers, facilitate transportation, plenty of extra care and cost because getting them in and then being healthier would reduce costs. And it had zero ROI over three years of program!
Until the government gets off their ass, which they seem uninterested in doing, insurers are unfortunately a solution rather than a problem. We could also get the AMA to stop fucking restricting residency slots and reduce education requirements so we could have enough doctors to service our population, too!
I'm just tired of misinformed opinions on this. I've worked in healthcare for 17 years, I've worked at hospitals, doctor's offices, pharmacies, insurance plans, health service providers, it is insanely stupid and reductive to think you can point to any one actor as "the problem" and I would seriously consider educating yourself on the details before spouting nonsense. For the record, the CEO of UHC was not the CEO of UHG who dictated many of the overall policies around increased usage of AI in prior auth, or increase in denials without using actual clinicians, things I very much disagree with. I just think Thompson's murder..... accomplishes nothing, it changes nothing. I think it was better that CEOs take the subway or walk the streets instead of taking an armored van or flying only by helicopter anywhere, I don't think whatever this was in service of actually improved anyone's life, and I was just as incensed about the response here when it happened as I (apparently) am right now. And I never met the guy or anything, I have no personal stake in it
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Comment on Luigi Mangione pleads guilty to federal stalking charges in the killing of UnitedHealthcare CEO in ~news
Mullin Link ParentYou do realize that the people denying care at the health insurance company are also doctors right? I think in terms of denying care it doesn't matter who does it, an insurance company declining...You do realize that the people denying care at the health insurance company are also doctors right?
I think in terms of denying care it doesn't matter who does it, an insurance company declining to pay, and a doctor declining to treat without being paid. If you believe that healthcare systems and providers aren't also profit seeking then you have a very misunderstood idea of how broken US healthcare is and who the bad actors are (it's not really anyone tbh, it's just perverse incentives the whole way down)
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Comment on AI data center developers begin suing local jurisdictions behind bans and moratoriums — claims range from officials exceeding authority to violations of due process and equal protection laws in ~tech
Mullin Link ParentI think it's whether you can block specific businesses provided they meet the zoning requirements, right? It's one thing to zone something commercial but try to restrict which commercial entities...I think it's whether you can block specific businesses provided they meet the zoning requirements, right? It's one thing to zone something commercial but try to restrict which commercial entities can build there. I don't think communities themselves have carte blanche to unilaterally stop a business from building provided they bought the land and pay taxes, no?
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Comment on Moving US to Japan: Things to bring? Things to leave behind? in ~life
Mullin LinkI think power tools are pretty cheap in the US but not as available elsewhere? But if you're limited on packing may not be a good fit. But I assume if you're in a rural area having like a...I think power tools are pretty cheap in the US but not as available elsewhere? But if you're limited on packing may not be a good fit. But I assume if you're in a rural area having like a Milwaukee cordless impact may be nice, Amazon.jp doesn't seem to stock them or ship them there, but no clue on if hardware stores or anywhere else would have them. I remember not really seeing any in any electronics stores in Japan.
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Comment on Tokyo, yeast, and expectations in ~travel
Mullin Link ParentHonestly Michelin stars are a bit of a crapshoot these days, it's a bit disconcerting, but they definitely drive people to go there.Honestly Michelin stars are a bit of a crapshoot these days, it's a bit disconcerting, but they definitely drive people to go there.
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Comment on Hitoner | Chapter 11 in ~anime
Mullin LinkSpoilers Haruko is the AI(suspected) on his ship correct? So I'm guessing we are going the direction of misaligned computer, which I fear is a bit played out, but we'll see where it goes. I'm...Spoilers
Haruko is the AI(suspected) on his ship correct? So I'm guessing we are going the direction of misaligned computer, which I fear is a bit played out, but we'll see where it goes. I'm guessing the human army is just robots. I've been enjoying the mystery of this series, whether humans seeded the planet in the first place, and that's how he knew to come here. Whether Hito is a modified human beyond just being able to cryo sleep, and if the animal world is truly as war-free as it appears. I love that they went the direction they did with the "cowardly lion" trope, when he's totally right to be afraid.
Really enjoying this so far, glad to see discussion for it here on tildes
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Comment on Any significant changes to Tildes are extremely unlikely in ~tildes.official
Mullin LinkFine by me, I'm very happy with the minimalist structure. I don't need or want more than Tildes offers: users submitting and commenting, like the forums of old.Fine by me, I'm very happy with the minimalist structure. I don't need or want more than Tildes offers: users submitting and commenting, like the forums of old.
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Comment on Tokyo, yeast, and expectations in ~travel
Mullin Link ParentMaybe it's just not wanting to seem like you're only posting to be a certified hater. But no, you're right not everywhere gets the same treatment. I found NYC is a pretty mid place too, it's...Maybe it's just not wanting to seem like you're only posting to be a certified hater. But no, you're right not everywhere gets the same treatment. I found NYC is a pretty mid place too, it's dirty, cold, and expensive. The hotels suck, the traffic sucks. But people praise it to the ends of the earth.
On the reverse, anytime I mention Houston, people cannot help themselves but talk shit about it because it's car centric, or is in Texas, they will never not talk shit about those things. It's just whatever the prevailing sentiment is. For Japan, it had kind of gotten too good a rep, call it effective tourist marketing, and it became attractive to visit since the Yen is so weak.
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Comment on Tokyo, yeast, and expectations in ~travel
Mullin Link ParentNo? Do you mean me or the comments? I expected Japan apologia to an extent when I made the post. So some of it is hedging to avoid comments about how I didn't research or wasn't culturally aware...No? Do you mean me or the comments? I expected Japan apologia to an extent when I made the post. So some of it is hedging to avoid comments about how I didn't research or wasn't culturally aware enough and that's why I had the experience I did. But I don't or wasn't trying to mince words here, the brunt of what I'm saying is that Japan has a culture that needs work and shouldn't be praised, and that my travel experience was decidedly worse than the general "Japan is amazing" type posts.
Even a lot of the comments here, especially regarding the homophobia, no, it is not blatant and in your face, nor will a non-confrontational culture say something to you even if they wanted to, nor is it unsafe to travel if you're LGBT, but that isn't the point, what they wouldn't say to a foreigner or a stranger js not what they would say to a family member, or a friend, or what they would say online, or the policies they vote for.
Part of why I wrote this was to accept that the parts of their culture I did love were in the minority. Again to use the works of Nagata Kabi, it feels strange to say I relate to them, but I really enjoy them and emphasize with the situations, but that's not you know, what Japan actually is.
Sorry I wasn't more critical? I guess? I didn't coach my criticism in apologia, or wasn't trying to. It just wasn't all bad
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Comment on Tokyo, yeast, and expectations in ~travel
Mullin Link ParentI used the Japanese review site as well as a native Tokyoite and we never had anything bad. Everything was good to occasionally great, but Tokyo is actually quite expensive, and I was not...I used the Japanese review site as well as a native Tokyoite and we never had anything bad. Everything was good to occasionally great, but Tokyo is actually quite expensive, and I was not impressed with the cheaper options, whereas I've had Al Pastor in LA from a truck that was elite. I think it's a thing where there is also more bad food in the US? But the peaks are really similar, if not I'd give the edge to major US cities, LA, New Orleans, NYC, Houston, Chicago.
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Comment on Tokyo, yeast, and expectations in ~travel
Mullin Link ParentTo directly compare since it was the same vacation: I experienced zero of the issues I had in Tokyo in both Seoul and Busan, and both still had proper public transit. Obviously the beaches in...To directly compare since it was the same vacation: I experienced zero of the issues I had in Tokyo in both Seoul and Busan, and both still had proper public transit. Obviously the beaches in Busan were extremely child friendly, but that's perhaps cheating a bit. Seoul is very hilly so sometimes I'd be pushing her uphill but in general the sidewalks were wider, better maintained, and rarely if ever did I actually have to carry the stroller up stairs.
In North America: LA, NoLa, and Montreal especially were totally fine, no complaints. Granted LA and New Orleans necessitated a rental car to get between destinations, but pushing her around was completely fine otherwise. The Montreal metro was plenty and again, possibly because it's simply less crowded period, space was never an issue.
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Comment on Tokyo, yeast, and expectations in ~travel
Mullin Link ParentGlad you had a good time! I think you pointed to something particularly noteworthy, and this is the real sticking point: I don't think it's great that if I want to do certain things or go to...Glad you had a good time! I think you pointed to something particularly noteworthy, and this is the real sticking point: I don't think it's great that if I want to do certain things or go to certain areas, then it becomes more of a chore than others. Again this was not disastrous, we still had a good time. But going to pen stores or shopping in Ginza, these stores are often extremely busy, crowded, and often not very easy to navigate even with a extremely light stroller, yes Odaiba was fine, but I don't and didn't want to simply stay in Odaiba! It was much, much more difficult for my wife and I to branch out and do our own things, basically what we had no problems with in other places we've traveled, because my wife can't lift the stroller easily, or is much more concerned letting my daughter walk in a crowd. And for me as great as the climbing gyms are, they are often small and crowded, not somewhere I could bring my daughter in the stroller and have her just off the mats.....despite that always or nearly always being an option stateside. It's not a fault but it's something that is annoying.
Anyways it's NBD, I fully expected people to disagree or express a different experience, this was as I said, kind of half travelogue, half cultural observation, half word vomit ;)
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Comment on New label suggestion: a removable "One-sided" label that gradually reduces the comment's visibility in ~tildes
Mullin Link ParentI don't think it would be helpful for me to simply have some flag that said "someone disagreed with you or someone was offended by what you said" because it doesn't convey enough information. I...I don't think it would be helpful for me to simply have some flag that said "someone disagreed with you or someone was offended by what you said" because it doesn't convey enough information. I much prefer someone engaging with what I said, and telling me themselves, that's productive conversation to me. If someone doesn't want to engage, I don't think there's any benefit in giving them an out to label something. Either give me the information necessary to improve or give me nothing. I'm not saying anyone has an obligation to educate me or anything of the sort, but I am saying that just being tagged wouldn't mean anything if I didn't know why.
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Comment on New label suggestion: a removable "One-sided" label that gradually reduces the comment's visibility in ~tildes
Mullin Link ParentI don't think there is any value in trying to debunk the misinformed, they aren't the target audience then for the informed discussion. There's no reason you can't focus on having the discussion...I don't think there is any value in trying to debunk the misinformed, they aren't the target audience then for the informed discussion. There's no reason you can't focus on having the discussion you want with the people that have a similar or better level of understanding on a topic, that is the conversation you want to have, so that's the conversation to focus on. Why expend any effort at all on the comments that aren't materially adding to the actual real discussion? I understand it can be disheartening if it's a flood of them, but I don't think it takes anything away necessarily, it's not zero sum. I would say if someone isn't interested in learning telling them so isn't going to change their mind, right? Just engage with the people who are already willing, in my opinion. I don't think tagging or any of the suggestions are helpful or instrumental in increasing the overall quality of conversation.
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Comment on New label suggestion: a removable "One-sided" label that gradually reduces the comment's visibility in ~tildes
Mullin Link Parent"I'm offended you haven't educated yourself better when the information is easily attainable" is so absolutely insanely judgmental I don't think it could ever not be condescending and actively..."I'm offended you haven't educated yourself better when the information is easily attainable" is so absolutely insanely judgmental I don't think it could ever not be condescending and actively toxic to any community.
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Comment on Tokyo, yeast, and expectations in ~travel
Mullin Link ParentI avoided the tourist areas for the most part, I didn't go to Akihabara or Kabukicho for the obvious reasons you stated, I did go to Shibuya which was pretty busy but yeah nothing too bad, just...I avoided the tourist areas for the most part, I didn't go to Akihabara or Kabukicho for the obvious reasons you stated, I did go to Shibuya which was pretty busy but yeah nothing too bad, just large crowds (as one would expect). The suburbs were a lot easier, but there is fewer things to do there, as expected as well. It is just a bit sad that if you want to see the sights, so-to-speak, those are the places it's most difficult to navigate with a child, is all.
I'm well aware of lobbying, as I stated. The majority supporting something and that thing being politically likely to occur are also, unfortunately, not the same thing at all in the US. I am not even sure what would need to occur to get medicare for all, but it's extremely possible that even if we did, it would be a marketplace situation like MA/ACA/medicaid(in markets like NY). So it's not even a given that the insurance companies would even fundamentally change. Pretty grim, I try to focus myself on improving patient outcomes or at least not spending money wastefully.