NaraVara's recent activity
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Comment on Why US health insurance reform is difficult in ~society
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Comment on Why US health insurance reform is difficult in ~society
NaraVara Link ParentIf you don’t deny care, which is to say, say “no” from time to time when a doctor, nurse, patient or whomever wants to charge for something, costs will spiral out of control. You will have created...If you don’t deny care, which is to say, say “no” from time to time when a doctor, nurse, patient or whomever wants to charge for something, costs will spiral out of control. You will have created incentives for the healthcare system, including for profit hospital networks, medical practices, and big pharmaceutical companies, to jack up prices as high as the market can bear. It’s not unethical to set up standard practices and limits it’s just bad for patients to have that done through a paperwork ridden 3 way arbitration process where the one with the most on the line (the patient) is the least informed about what’s going on and the other two are for profit entities deciding how much of the pie to eat.
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Comment on Why US health insurance reform is difficult in ~society
NaraVara Link ParentThis was basically Buttigieg’s “Medicare for all who want it” plan, and that essentially became the root of Kamala Harris’ plan in 2024. Over the long term this would create ground for single...This was basically Buttigieg’s “Medicare for all who want it” plan, and that essentially became the root of Kamala Harris’ plan in 2024.
Over the long term this would create ground for single payer because you’d be able to outcompete private insurers on price, especially if you make political hay around no longer subsidizing millionaires and their “Cadillac healthcare plans.”
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Comment on Why US health insurance reform is difficult in ~society
NaraVara LinkHe’s right about healthcare and has been all along. He also doesn’t mention that there is literally no other way it can be if you have private companies in the mix. They can’t make a profit if...He’s right about healthcare and has been all along. He also doesn’t mention that there is literally no other way it can be if you have private companies in the mix. They can’t make a profit if they don’t deny care, and their every incentive is to not have to pay out.
Also, unrelated to the article itself but I’m very disappointed that Paul Krugman decided to host his blog via substack. Krugman came to speak at my college once and, when asked where he got his news and commentary because the media was so reflexively conservative (this was right before he became a Time columnist) he suggested trying the, then nascent, blogs and rattled off a list of blogs he read that included DailyKos and Atrios.
This plugged me into a whole world of the political blogosphere, up until then I only knew of blogs as basically open personal diaries. This also had a significant impact on my politics, and took me from being a generally politically disaffected person to an ardent progressive Democrat. So seeing him on Substack, while I assume is something of a path of least resistance, feels disappointing being as how it’s yet another of the platform monopolist, blitzscaling, value-sucking vampires that adds nothing to the ecology of online discourse but the promise of discovery and simplified hosting. There’s gotta be a better way to get the latter on an open platform.
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Comment on Man suspected of killing UnitedHealthcare CEO is ordered held without bail after brief court appearance in Pennsylvania in ~news
NaraVara Link ParentI think the uber wealthy are very good are redirecting populist anger away from them. This is why capitalism and communism very quickly become “Jews” or “Immigrants” or whatever else the target is...I think the uber wealthy are very good are redirecting populist anger away from them. This is why capitalism and communism very quickly become “Jews” or “Immigrants” or whatever else the target is this month.
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Comment on You can now put an expandable, cost-effective solar roof rack on your EV for off-grid charging in ~enviro
NaraVara (edited )Link ParentI don’t think this is realistic for people without home charging. If even their higher end promised future product can get you about 30 miles of range after a full day of charging that’s barely...I don’t think this is realistic for people without home charging. If even their higher end promised future product can get you about 30 miles of range after a full day of charging that’s barely any range. And that’s assuming you’re keeping the panels clean of dust and debris and pollen. You’d need to be someone who doesn’t use their car very much, less than daily, at which point you probably don’t want to buy $3k worth of extra kit. You’d be better served with a zipcar type of car sharing service or have some sort of battery trailer that you charge at home and then carry/wheel out to plug into your car instead.
Where this may find popularity is with off-roaders/overlanders who make a bit of a fetish out of being over-prepared. Though even then, 30 miles (less if you’re on unpaved roads and weighed down with cargo) means you’re basically spending multiple days camping to get enough charge to go anywhere. If you’re doing that, then again you might as well have a really big solar array that can sprawl over more area so you can get more charge out of your daylight hours. There’s no reason to be constrained by engineering considerations around being roof mounted and aerodynamic.
It could also be useful for micromobility type vehicles (think golf carts and e-bikes) since their battery packs are a lot smaller and, if it’s a shared service, you can have them deployed out there for longer with less charging downtime. But the design would be different if you were mounting it in the back of a bike or golf cart.
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Comment on Inside the war against excessive headlight brightness in ~transport
NaraVara Link ParentThis would make a hell of a hood ornamentThis would make a hell of a hood ornament
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Comment on Anthem Blue Cross Blue Shield reverses US policy that would have limited anesthesia periods in ~health
NaraVara (edited )Link ParentThat’s how a business works. If there’s competition what policy holders get in return is lower premiums, and less administrative load will mean less paperwork and bills trickling down.Again: why should they get any benefit without giving something in return to policy-holders?
That’s how a business works. If there’s competition what policy holders get in return is lower premiums, and less administrative load will mean less paperwork and bills trickling down.
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Comment on Anthem Blue Cross Blue Shield reverses US policy that would have limited anesthesia periods in ~health
NaraVara Link ParentThe upside for them is they get to pay anesthesiologists less money. A single payer system is also interested in paying highly compensated specialists less money, because if you let them dictate...The upside for them is they get to pay anesthesiologists less money. A single payer system is also interested in paying highly compensated specialists less money, because if you let them dictate whatever rate they want they will end up demanding infinite money. This logic doesn’t change just because it’s a for profit payer rather than a state run one.
Cost control is a necessary part of a healthcare system, regardless of how it’s structured.It also makes the whole thing less administratively complicated, which is why CMS is pressuring payers to adopt more standardized conventions.
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Comment on Anthem Blue Cross Blue Shield reverses US policy that would have limited anesthesia periods in ~health
NaraVara Link ParentIt’s bringing the process in line with what the standards would be in a single payer system. CMS is defining the standard based on how they pay out for Medicare and Medicaid. It’s actually one of...It’s bringing the process in line with what the standards would be in a single payer system. CMS is defining the standard based on how they pay out for Medicare and Medicaid. It’s actually one of the parts of the system that isn’t rotten.
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Comment on Anthem Blue Cross Blue Shield reverses US policy that would have limited anesthesia periods in ~health
NaraVara (edited )Link ParentThe averages in the US are heavily skewed by the owners of large medical practices, which kind of work like a law firm where the partners make bank but the junior associates are doing a lot of the...The averages in the US are heavily skewed by the owners of large medical practices, which kind of work like a law firm where the partners make bank but the junior associates are doing a lot of the work, seeing only a portion of their billable rate, and aren’t as out of line from other countries. Also American doctors tend to have more rigorous training before they start practicing and our residency programs are insanely selective, so your average doc is probably a decent bit better. (I’d argue it’s probably not necessary to have that level of training and education for much of the care that’s needed but that’s a separate issue).
Of course from the payer/patient perspective that money is still bleeding out of our pocketbooks so it’s irrelevant.
But if we were to have a single payer system or some other kind of socialized healthcare we’d definitely be doing things like this to control costs or physicians and hospital networks would end up absorbing 100% of GDP. Far be it for me to defend health insurance companies, they’re very culpable for the state of things, but we’ve also structured the system such that the payers are responsible for all the decisions that might make people mad. Basically they’re structurally required to be the bad guys. It’s terrible to have profit motive be the North Star around those, sure, but rationing care and cost control is something any healthcare system needs to do and we can’t just blame all of it on “capitalism” or greed. Some of it is just plain scarcity.
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Comment on Anthem Blue Cross Blue Shield reverses US policy that would have limited anesthesia periods in ~health
NaraVara Link ParentThe corporate entities are large medical practices, the owners of which are usually doctors.ETA: To be fair, approximately 80% of todays practicing physicians are simply employees of a corporate entity, so it's not exactly "the doctors" that are charging multiples of allowable reimbursement. It's mainly the corporate owners. This question is simplified if the focus is on physician's charges rather than adding the complexity of hospital charges.
The corporate entities are large medical practices, the owners of which are usually doctors.
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Comment on Anthem Blue Cross Blue Shield reverses US policy that would have limited anesthesia periods in ~health
NaraVara (edited )Link ParentThey weren’t floating some random scheme, they were trying to bring reimbursements for anesthesiologist procedures in line with CMS standards, which is to bill by procedure instead of billing by...They weren’t floating some random scheme, they were trying to bring reimbursements for anesthesiologist procedures in line with CMS standards, which is to bill by procedure instead of billing by hour. The only losers from this would be anesthesiologists.
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Comment on The CEO of UnitedHealthcare (insurance company) has been assassinated in NYC in ~news
NaraVara Link ParentI actually do think fascism should be considered a sort of “failure state” for a democracy whose institutions have broken down, and this theory is at least as old as Plato. The thing is though,...I actually do think fascism should be considered a sort of “failure state” for a democracy whose institutions have broken down, and this theory is at least as old as Plato. The thing is though, that it’s a consequence of a breakdown of the core democratic institutions due to lack of maintenance/stress. Everything succumbs to entropy eventually, but it’s a question of how resilient and capable of renewal it is.
Yes, specifically because they are continually undermined and have excessive violent dictators placed at their helms by the US.
Like I said though, it’s not as if the USSR and PRC weren’t also throwing their weight around to prop up violent and bloody dictators. North Korea wasn’t propped up by the US. The various Maoist guerrilla militias throughout the Global South weren’t either. This just seems to a straightforward consequence of great power conflict more than anything else, and I don’t see the Maoist/Marxist paramilitary units being appreciably better or worse for society than the ultranationalist ones. The only consistent pattern seems to be that they both tend to be better than the religious fundamentalists (that other, underappreciated, variety of high-modernist extremism).
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Comment on The CEO of UnitedHealthcare (insurance company) has been assassinated in NYC in ~news
NaraVara Link ParentIf an ideological position is unable to outcompete an adversarial ideology then what good is it? Like part of the job of a political/state system is to protect the people under it and advance its...If an ideological position is unable to outcompete an adversarial ideology then what good is it? Like part of the job of a political/state system is to protect the people under it and advance its state/national interests.
Put another way, if I’m a regular dude in a country deciding what kind of political and economic system I want to run. I see the ones that have been tried and notice that one set seems to keep collapsing into narco-terrorist guerrilla movements and autocracies, and another tends to equilibrate into relatively stable, but unequal, institutions. What am I supposed to pick out? It’s not as if the PRC and the USSR weren’t also trying to throw their weight around. Do we imagine North Korea could have just stayed that way on its own?
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Comment on The CEO of UnitedHealthcare (insurance company) has been assassinated in NYC in ~news
NaraVara (edited )Link ParentEven successful revolutions have tended to collapse into autarkies that only vaguely grope towards their ostensible ideological moorings. This is because the key element in a “violent revolution”...Even successful revolutions have tended to collapse into autarkies that only vaguely grope towards their ostensible ideological moorings. This is because the key element in a “violent revolution” is the violence and what determines success is your effectiveness at applying violence rather than how well you adhere to your moral or ideological objectives. It just ends up collapsing into an amoral situation where justice is the will of the stronger and wisdom or compassion don’t enter into discussions about how things ought to work.
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Comment on Inside the war against excessive headlight brightness in ~transport
NaraVara Link ParentThat reflective back windshield mentioned in the article was a cool idea and I’d like to invest in some sort of active countermeasure that mirrors the headlights right back at the eyeballs of the...That reflective back windshield mentioned in the article was a cool idea and I’d like to invest in some sort of active countermeasure that mirrors the headlights right back at the eyeballs of the driver. Fuck it, apparently we live in a world where civic responsibility is for cucks so if it’s gonna be a war of all against all let me arm up.
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Comment on Inside the war against excessive headlight brightness in ~transport
NaraVara Link ParentA lot of the autism spectrum things aren’t solely experienced by people on the spectrum, they’re just more sensitive to them and/or have more difficulty suppressing or ignoring their discomfort...A lot of the autism spectrum things aren’t solely experienced by people on the spectrum, they’re just more sensitive to them and/or have more difficulty suppressing or ignoring their discomfort than a neurotypical person. But it’s probably more useful to think of it as a sort of canary-in-the-coal-mine indicator that something is amiss that the rest of us are overlooking rather than a thing where if you’re in the spectrum you’re like this and if you’re not you’re like that.
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Comment on Inside the war against excessive headlight brightness in ~transport
NaraVara LinkYeah I’ve noticed over the past few years I’ve gone from not really minding night driving to actually worrying about it and it’s largely due to the amount of headlight glare out there now. It’s...Yeah I’ve noticed over the past few years I’ve gone from not really minding night driving to actually worrying about it and it’s largely due to the amount of headlight glare out there now. It’s bad enough for highway traffic, but for city driving it makes it so I literally just cannot see cyclists or pedestrians on dark clothing. My night vision is completely shot and my own car’s headlights don’t light up the periphery enough to see people at intersections. (Let’s not even get into the fat fucking A and B pillars giving drivers giant blind spots right where people or cyclists are likely to be.)
It’s also why I’m leery about getting a sedan despite preferring them to suvs and crossovers. Those lifted truck headlights will blast straight into your retinas at that height, so it’s a real arms race to avoid it.
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Comment on Social media algorithms can change your views in just a single day in ~tech
NaraVara Link ParentThere is no “Fire in a theater” test in American jurisprudence. This was a vague argument Oliver Wendell Holmes made in order to justify imprisoning conscientious objectors to World War I that has...The hard part in the US is equating the danger in AAPA speech to the danger in yelling "Fire!" in a crowded theater.
There is no “Fire in a theater” test in American jurisprudence. This was a vague argument Oliver Wendell Holmes made in order to justify imprisoning conscientious objectors to World War I that has since been discredited as a bad argument.
The only real exception to free speech protections we have are very vague “fighting words” qualifications for if you are trying to incite immediate and probable lawless action (e.g. Let’s go burn down that house over there!)
The way they’d do this is just give the doctor’s a flat amount of money per patient and it’s up to them to make the most of it. But then you get the problem of doctor’s preferentially stacking their patient roster with healthy people and leave the unhealthy (expensive) people for others to deal with.
Yeah more supply of anything would be ideal, but you’d have to pay for it. MRI machines are expensive, and you need to make sure they’re put where they’re needed.