Mullin's recent activity
-
Comment on The American suburbs are better than you think in ~life
-
Comment on The American suburbs are better than you think in ~life
Mullin LinkGreat article, I'm glad more people are seriously considering the "Why's" of American suburbanization. It's very often because people want the SFH, they want the big yard, they don't care that...Great article, I'm glad more people are seriously considering the "Why's" of American suburbanization. It's very often because people want the SFH, they want the big yard, they don't care that they have to drive everywhere. There really isn't as huge an advantage to high density especially once you are older, married, and with children.
I grew up in the suburbs, and because I went to a local university, I never moved on campus, so I never got used to being in a dense, walkable area, so didn't really think of it as something worth spending money on in terms of rent costs. Ultimately my wife and I decided it made more sense to live in the suburbs if we wanted to eventually start a family, so we sort of bucked the trend this article points to of early 20s going city and then back, but it was....fine? My social circle has always been strong, I'd just drive all over the city, I still do. But people slowly moved to various parts of the city, it would be impossible now in our late 30s to imagine all our friends living in once place, they all had to move for work or jobs etc.
Having visited very dense places like Tokyo, Seoul, and NYC... it's nice there are so many things and choices nearby. So many restaurants, it's definitely a boon, but I wouldn't want to live there all the time. I don't actually like people that much, and having small kids cars are just super helpful, otherwise I'd have to basically always carry a backpack full of their stuff vs putting it in a car. Maybe in a hypothetical where the cost of living is the same I'd prefer the density, but that's never going to be the case, and I'll always choose to have more money in my pocket or bank account vs paying it in rent, or spending it on a car that I at least can enjoy (or sell eventually).
-
Comment on The American suburbs are better than you think in ~life
Mullin Link ParentIm fairly certain the author meant they are a sign of wealth specifically because they are expensive, not cheap. And many people do not buy the cheapest car to fit their needs, especially out in...Im fairly certain the author meant they are a sign of wealth specifically because they are expensive, not cheap. And many people do not buy the cheapest car to fit their needs, especially out in the suburbs.
I cannot go to breakfast on a Saturday or Sunday without at least one G wagon parked outside, in addition to probably several other >100,000 SUVs or Trucks, and I see an exotic fairly frequently (Ferrari, Lamborghini, McLarens) in the suburbs I live in. There is a definite feel of, people spend their money, they might make the choice on a cheaper house in the burbs and turn around and spend it on a loaded truck.... because they actually want to. It's the same with people owning boats or similar, it's not about it being a sensible financial decision, they do it because they have the money and can.
-
Comment on Electronic Arts to cut 400 jobs, shut down BioWare in ~games
Mullin Link ParentI don't think it's a given that EA caused this, I think very likely it's more that bad management or bad decisions or generally poor execution (or turnover/burnout/etc) ended up creating a bad...I don't think it's a given that EA caused this, I think very likely it's more that bad management or bad decisions or generally poor execution (or turnover/burnout/etc) ended up creating a bad product that didn't meet sales expectations.
Mass Effect Andromeda wasn't well received, Anthem was more or less DOA (Even though I actually played it a lot and thought it was a very good game), and the latest Dragon Age was also relatively lukewarmly reviewed.
I specifically remember that in the huge ass article about Anthem's development, they didn't have a clear vision+lots of indecision in direction. If I recall correctly, it was one of the higher ups, management types, that actually told them to prioritize the flying, that was something they added late, but it really made the game. It didn't save it, but it'd have been a WAY WORSE game without that, and if they'd made that decision sooner, maybe it'd have been better.
Other studios have simply made better games over the past decade or so, and a lot of the love and goodwill people had for BioWare's games......they lost, because they stopped making good games.
-
Comment on Non-queer men of Tildes: PLEASE consider before commenting on ~life.women and ~lgbt without careful consideration. We are losing members over this issue. in ~tildes
Mullin Link ParentThe flip side should be think carefully before starting the topic. There is zero world where someone couldn't predict the exact scenario that happened, again I'm not entirely sure what the purpose...The flip side should be think carefully before starting the topic. There is zero world where someone couldn't predict the exact scenario that happened, again I'm not entirely sure what the purpose of conversations like that are. If you use inflammatory language you get inflammatory results, no? Framing sexism or sexual assault as a thing only men do to women is going to cause people to be defensive and hostile, and it's obvious that it would do that because it does that every time.
I've commented before in other topics before I gave up: I don't like gender essentialism or any other essentialism or reductionism of people's characteristics, whether those be ones they were born with or ones they chose. When I see topics that are "calling out men" I read them as "calling out black people" or "calling out the poor" as if the attributes someone is born with or into opt them into some obligation.
They also often exclude how intersectional and universal sexism is and the contributors that cause and reinforce it. Women participate in rape culture. Men participate in toxic masculinity. Women hurt women, men hurt men. Because people are the problem. Structural issues come about from bad incentives. Cultural issues are not resolved with othering, with awful rhetoric, with assumptions of discharity or malice.
Even on this topic, it's fucked up because things like that topic also reinforce transphobia, that trans women will always be suspect if they don't pass well enough that women won't think of them as men, that men will be guarded against trans men because they were socialized as women, or will judge them in a way a cis man wouldn't. It's fucked up, and it bothers me when these topics don't have room to discuss it. Accusations of whataboutism, or sealioning, or any other meta discussion on people's motives or intentions or privilege become 90% of the thread. It's horrible and it's not helping anyone that I can sea. Pour one out for whoever left over it I guess, is all I can say
-
Comment on Non-queer men of Tildes: PLEASE consider before commenting on ~life.women and ~lgbt without careful consideration. We are losing members over this issue. in ~tildes
Mullin LinkI don't engage with the topics because they are toxic. The fact there is a topic with "yesallmen" that's just a-ok is literally cancer. I think that real world issues of sexism can be discussed...I don't engage with the topics because they are toxic. The fact there is a topic with "yesallmen" that's just a-ok is literally cancer. I think that real world issues of sexism can be discussed without trying to be aggressively patronizing. I've consistently seen the topics the last few months about how tildes is losing members over these shit fights or how it needs to be more inclusive or sensitive or what have you really obnoxious. I would much rather people simply leave, I find it extremely tedious to see posts like this that an ambiguous user has left the site over an argument in a topic I wasn't even a participant of.
It's not that I don't think the topic is important, obviously it is, and obviously people do take steps in their life to be better, or to adhere to professional standards, it's good business. I find it demeaning when, after this post, glancing through that thread, there was quite a bit of blatant sexism, basically that any man can't know women's experience because women don't trust them? That's an insane thing to say, it makes sexism worse, not better. If you're crowding out voices on the basis of someone's gender, or orientation, or ethnicity, then you are part of the problem.
I don't need to be told to think carefully before commenting, I just don't comment because historically on this site the conversations are unproductive. Clearly they are unproductive, based on this post. I'm not certain then who the audience was for, almost as if it were rage bait specifically for this purpose. Maybe people should fork the site or make their own place if they want to police who comments on what but it's not something I want tildes to be.
-
Comment on How has your career changed you? in ~life
Mullin Link ParentThis also tends to happen even with universal and single payer systems, unless the hospitals are also state owned, you just see less of it because it's more streamlined. I would be shocked if the...This also tends to happen even with universal and single payer systems, unless the hospitals are also state owned, you just see less of it because it's more streamlined. I would be shocked if the NHS for example didn't have length of stay or levels of care standards complete with threats of non-payment if facilities are incapable of following them.
Treatments don't always have such a clear cut efficacy, especially in complex conditions, I assure you that someone, somewhere, is making an executive judgement on who gets what, whether that be a transplant, a knee or hip replacement, how long a patient should stay inpatient after surgery etc. You need standards otherwise cost overrun and over-utilization(to speak nothing of fraud) runs amok.
Also, doctors make mistakes, and if not mistakes they may have their own independent ideas of what treatment for a condition should look like, even if that doesn't align with current best practices, or there is a comorbidity or risk they didn't consider. I have myself, as the absolute last line, stopped a pediatric IV order that was egregiously wrong, when I was about to make it under the hood. The MD ordered it wrong, the pharmacist approved the order when they shouldn't have, the compounding pharmacist didn't notice grabbing the drugs and it came to me to say something was up. That was 16 years ago, and that was only one I'm aware that I caught. A single doctor shouldn't be (and often isn't) the sole point of failure for a patient.
There's no free lunch. A single payer system would save us money on administrative bloat and is the right solution, but it doesn't preclude the types of problems that people tend to have with insurance, and it won't stop there ever being a denial of care or a prior authorization or a preferred treatment or facility.
-
Comment on How has your career changed you? in ~life
Mullin Link ParentIt's not surprising, if you're only working on denials then you'd expect to be on the cases where it occurred not because it wasn't or isn't medically necessary but that either administrative or...It's not surprising, if you're only working on denials then you'd expect to be on the cases where it occurred not because it wasn't or isn't medically necessary but that either administrative or prior authorization or utilization management or some other reason occurred. The point I always try to make, and what that commenter doesn't say: hospitals could always treat if they wanted to, they could out of the goodness of their hearts deliver care on these denials. An insurance company doesn't stop a medical treatment from happening, it only stops payment. There's an underlying thought that insurance companies should be financially liable for all of this but none of that financial burden should fall on the providers, who are equally money seeking. There's no way to cheat the economics on this.
When I worked for a Medicaid plan, the goal of CM/UM all of this was to save money, yes, but it's because if you don't save money you will have to cut services, it's a misconception that every health plan runs in the black. There's also significant work (this is my domain really) around patient outcomes. The patient is not actually better served being at acute care for 20+ days, they have better outcomes if you moved them to a SNF or an LTC or an AIR...so you deny the extension of the LOS for acute care, it isn't going to help the patient but then you're the bad guy, and the hospital loves to paint you as the bad guy. All the while if you're the patient your risk of adverse outcomes might be increasing despite it costing more.
My main point is you'll find very few people who have worked on all sides of it offering nuanced opinions, it's always black and white. I've mentioned in other threads that people fundamentally misunderstand why insurance exists and what the value add even is, again, why I'm so jaded about the whole thing
-
Comment on How has your career changed you? in ~life
Mullin Link ParentRealistic pricing and a shift away from networks and charge masters that change on a contract to contract basis. I think patients should know what they (or their insurance) is paying for up front.Realistic pricing and a shift away from networks and charge masters that change on a contract to contract basis. I think patients should know what they (or their insurance) is paying for up front.
-
Comment on How has your career changed you? in ~life
Mullin LinkPresently, I work for a health insurance company (sort of) and have for the past 11 years, before that I worked 6 years at hospitals and providers. You will get a sense here that health insurance...Presently, I work for a health insurance company (sort of) and have for the past 11 years, before that I worked 6 years at hospitals and providers.
You will get a sense here that health insurance are always the bad guys, that really isn't true. There are bad guys everywhere, and nowhere, in the US health apparatus. One of the biggest changes over my career is being involved in something everyone both cares about, has opinions of, is highly political, and everyone knows someone who has a story. To a certain extent, I am empathetic and try to convey and assist where I can, but it also makes me jaded when people don't want to learn or accept reality of the situation, or are quick to point blame or expect solutions that aren't realistic (financially or politically or practically).
I really can't even begin to describe all my thoughts on my career. I started out and still abide by trying to help people. I saw the waste and cost disease at hospitals and providers, and I see it as well here. It's also very...complex, I have held 7 different positions in 6 departments, which has been across medicaid pharmacy, medicare care delivery, finance, state health plan, and now I'm in our consultancy wing, working with providers once more. Genuinely, the people working at a health insurance company spreads a pretty broad spectrum, and most people are not evil or malicious, but the US system and literal financial reality means that there's always some ghoulish scenario someone has encountered. And it's always the fault of the insurance. Despite the majority of cost drivers being from the provider side, which is increasing with AI tools.
It just feels mostly hopeless that I'll ever see any meaningful change in my lifetime to how healthcare in the US is structured so I just do what I can to at least push things in a positive direction. Sometimes that's expanding programs to populations that need it, sometimes it's cutting off vendors that aren't actually helping, sometimes it's reducing fraud. Right now I'm working on a cancer project as well as some provider scoring pieces. Nobody here wants a patient to have a bad time, but it's almost impossible to have nuanced discussions about it in any online space, since as I mentioned it's such an inflammatory topic.
-
Comment on Our AI midwife in ~health
Mullin Link ParentAs someone who has been through the IVF process (and have a healthy 3yo) as well, it's absolutely insane to me they never got a hysteroscopy, at least with us, even without a history of cysts or...As someone who has been through the IVF process (and have a healthy 3yo) as well, it's absolutely insane to me they never got a hysteroscopy, at least with us, even without a history of cysts or fibroids or similar, our fertility doctor wanted to make sure that the uterine wall was ideal prior to transfer. I think all in all we had two hysteroscopies done, one before our first transfer, and one as well as some removal of scar tissue years after in preparation for another transfer, I cannot believe they wouldn't have done one in 6 years of fertility treatment when it was one of the first things they looked towards in idk, maybe the first 6 mo of the process?
Incidentally, it was after the second hysteroscopy, that whoops! my wife got pregnant naturally. Turns out she mostly had "sticky" fallopian tubes. So our son(3mo now) jumped queue.
All in all I'm happy this couple got the child they wanted. Fertility struggles are really, really really really stressful and costly and generally a lot of sadness and disappointment, I'd have been gutted if we'd done 5 transfers without a live birth....we didn't even have 5 viable embryos.
-
Comment on Deciding whether (or not) to have a child in ~life
Mullin LinkYou've already gotten a lot of advice, but I'll still add my own experience to give another data point. We have two kids now, 3 and 2mos, and the only thing I regret is not having them sooner, as...You've already gotten a lot of advice, but I'll still add my own experience to give another data point.
We have two kids now, 3 and 2mos, and the only thing I regret is not having them sooner, as others have already stated, having kids is a unique joy that's incredibly rewarding every single day, I won't rehash.
Something I want to say is that having kids isn't just for you, but it's so much for your family/community that people don't realize. I can see how much it impacts my own parents, how much better it makes their life. My mom's had a tough time the last few years with a lot of her siblings dying, and honestly, I had this thought at the last funeral that if nobody has kids, you only ever have deaths, you're only ever at funerals and it's depressing as fuck. Not to mention losing a partner, if you don't have kids, sure you have family but they have their own lives, so that sense of loneliness is just astronomical. With kids you still have your partner with you, in a way. I know it doesn't have to be biological, but it's that you raised someone with them. We had our daughter first in our friend group and having her around quickly encouraged my other friends to get off the fence and have kids themselves, and I'm automatically closer to them because we have this shared experience, and our kids will see each other, likely their whole lives. The efforts I spent cultivating friends and community that share my values get reinforced in our kids, that's the most hopeful I can be about the world.
I think I'm rambling a bit, let me clarify:kids are also a lot of work, and you will be tired, and stressed, but! People will be accommodating, you will experience so much goodwill just from being a parent because well, other parents have been there, they see it, they've lived it. At work if you have to pick up a kiddo from daycare, or take them to an appt, everybody understands. Everyone gets it, and that feels both relieving and validating.
So yeah, I think it's fine to be optimistic, and even though life may be harder for my kids than it was for me, and my parents had an easier time than I did, at no point did I think I shouldn't have been born or that I'd wished they didn't have me. Maybe the climate or political instability or whatever else isn't fixable now, but it'll be fixable eventually, and we'll need humans who care to do that, so I try to do my small part, and honestly I get rewarded for it far more than I'm inconvenienced
-
Comment on What are the genuinely worst films of all time? in ~movies
Mullin LinkJesus Christ Vampire Hunter Yes, it's a B movie, it might be satire idk, I couldn't get through even 30mins. It's obviously low budget, like college project level, but I could not find any...Jesus Christ Vampire Hunter
Yes, it's a B movie, it might be satire idk, I couldn't get through even 30mins. It's obviously low budget, like college project level, but I could not find any redeeming qualities and we quickly turned it off, my cousin had gotten it out of some bargain bin based on the name alone and even campy-ness could not save it.
-
Comment on What are the genuinely worst films of all time? in ~movies
Mullin Link ParentOk, but battlefield Earth is kind of great as a comedy. I regularly quote the "we've decided not to keep you here for a other 5 cycles.......but for another Fifty cycles! With endless options for...Ok, but battlefield Earth is kind of great as a comedy. I regularly quote the "we've decided not to keep you here for a other 5 cycles.......but for another Fifty cycles! With endless options for renewal endless options for renewal endless options for renewal..................................hahahahahahha" it's just so goddamn goofy
-
Comment on Help me choose a small electric car in ~transport
Mullin LinkOk so, the biggest constraint problem you have here is size, but it's not insurmountable. If something like a Hyundai Ioniq 5 is too big, then that kind of leaves I think the Volvo EX30? Which...Ok so, the biggest constraint problem you have here is size, but it's not insurmountable. If something like a Hyundai Ioniq 5 is too big, then that kind of leaves I think the Volvo EX30? Which have their own weirdness being basically a Chinese EV, but also, Chinese EVs are pretty reliable hey, so I think that's probably your best bet. You can find deals on the weird Nissan/Honda/Toyota crossover EVs, because they sold like shit, but I'm sure they are fine cars, there's also the similar Suburu version or whatever, the Japanese manufacturers kind of half-assed crossover EVs, but I've not heard anything particularly bad about them, just that the Hyundais were better equipped. I think it will be tough to find anything smaller.
As far as PHEVs, yeah there are a few options that are still small, prius namely, or the Ford C-max before it was discontinued (I have a 2015 chugging along just fine), but I agree with you. I think in 2026 you can commit to full EV and be happy
-
Comment on Luigi Mangione pleads guilty to federal stalking charges in the killing of UnitedHealthcare CEO in ~news
Mullin Link ParentI'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...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.
-
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
-
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.
-
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
-
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
What exactly do you propose? Isn't it a boon to cities if people visit it? Even from the suburbs? If people move to suburbs further and further out in order to avoid city taxes, isn't that their prerogative? I'm trying to understand what isn't sustainable necessarily, if they are paying the local taxes and that is responsible for the infrastructure they use that's kind of on them, the city need not worry about the suburbs infrastructure issues. As far as roads go etc. That's both city/state/federal, so I think it gets a bit muddy to tie tax revenue directly to infrastructure costs, but I think economically you'd expect it to sort itself out eventually.
The thing I mostly see is that more (cheap) housing is built in suburbs so long as there is cheap land for them to build them on. I've seen Houston expand ever more outwards with new construction for 30 years, but they tend to use toll roads and high property taxes to offset the increased costs of less dense infrastructure, but it's still net positive because the land is so cheap. It's also not a given that infrastructure can't be astronomically expensive in dense places. NYC has spent how many billions adding marginally more subway miles. And NYPD costs an insane amount, I'm actually fairly certain that NYC as a city is partially subsidized itself by the state, so it can go both ways (just to say I don't think it's so cut and dry)