patience_limited's recent activity
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Comment on New worlds, and what was your "Future Shock" moment? in ~life
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Comment on New worlds, and what was your "Future Shock" moment? in ~life
patience_limited Link ParentSince video calls for telehealth are one of the technologies I've had to support over the years, it's been less of a shock and more of a "why is this still so shitty in 2026", after a recent...Since video calls for telehealth are one of the technologies I've had to support over the years, it's been less of a shock and more of a "why is this still so shitty in 2026", after a recent doctor's appointment.
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Comment on Luigi Mangione pleads guilty to federal stalking charges in the killing of UnitedHealthcare CEO in ~news
patience_limited (edited )Link ParentDepends on how critical the denial is, doesn't it? As /u/rosco, /u/DefintelyNotAFae, and I mentioned, some of those 20% private insurance denials are disabling (physically and financially) at...Depends on how critical the denial is, doesn't it? As /u/rosco, /u/DefintelyNotAFae, and I mentioned, some of those 20% private insurance denials are disabling (physically and financially) at best, life-threatening at worst. The denials often go against medical standards of care with little if any long-term cost savings, and are completely opaque to the people receiving them.
The majority of working people in the U.S. have health insurance through contracts their employer agreed to. The quality and coverage of these contracts varies wildly - you must take whatever the job provides, and lose it if you lose employment. There are insurance marketplaces for people whose jobs don't provide any coverage (also self-employed, intermittently employed, etc.), but again, the policies are very costly and often unaffordable (moreso since the suspension of subsidies, causing millions of people to drop coverage) or insufficient.
An insurance denial doesn't actually block care except to the extent that the insuree can't pay for it. Which is nearly always, given the astronomical non-negotiated prices outside of insurance coverage, and low wages. Employers often explicitly justify relatively low wages due to the cost of health benefits... In any case, there's not much incentive to align the insuree's interests and the insurers, other than long term healthcare costs. And long term costs are buffered by the government insurance program, Medicare, which workers age into.
Policies in countries with public insurance usually include a transparent process to evaluate the cost/benefit ratio of treatments, as well as the ethics of denial. It's not great emotionally if it's your grandmother who didn't get the $2 million dollar chemo that might extend her life by 6 months, but I'd personally take that denial if it means 1,000 kids get care they wouldn't otherwise.
I do not argue that threatening the lives of insurance CEOs will improve anything - I'll let someone else make that case.
Edit: I've left out a lot of nuances that make U.S. health insurance even more complicated to explain, like preferred provider networks and denial of coverage outside them. Even Medicare isn't really a "single payer" program, since there are coverage exclusions and private insurance for those.
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Comment on What lesser-known sci-fi reads do you recommend? in ~books
patience_limited Link ParentYou beat me to it on several of these. John Brunner's Stand on Zanzibar has been repeatedly called "prescient". I'd like to add a recommendation for his The Shockwave Rider, which was profound...You beat me to it on several of these. John Brunner's Stand on Zanzibar has been repeatedly called "prescient". I'd like to add a recommendation for his The Shockwave Rider, which was profound about information technology and society given that it was written in 1975, and generally has a linear and accessible thriller plot structure. Stand on Zanzibar's style is more experimental and very much a product of the 1960's - not necessarily to everyone's taste.
As far as I'm concerned, Bellwether is some of Connie Willis' best work. It's very tightly written, and doesn't lose the Wodehouse-inspired comic intensity in the page volume.
Love the C.J. Cherryh rec - it's dense and chewy reading in all the best ways, a fully realized vision with character complexity, someone to empathize with and root for on all sides.
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Comment on New worlds, and what was your "Future Shock" moment? in ~life
patience_limited (edited )LinkFrom the article: Publicity for Get A Drip Limited The author collects a series of news article blurbs that gave him pause to think about how dramatically technology is changing life and society....From the article:
Don’t let the absence of a flying car in your garage distract you: we are definitely now living in a version of the future out of J.G. Ballard or William Gibson.
Every day I notice a news story that startles or alarms me, that feels like pure cyberpunk, nestled between reports about council bin collections and cabinet reshuffles.
“The first ever IV Drip clinic to appear in the centre of a shopping mall, our Westfield clinic is a must-stop shop when doing a bit of retail therapy. From Vitamin Drips to Instant Vitamin D Testing, Get A Drip Westfield has it all. Book your appointment today!”
Publicity for Get A Drip LimitedThis made me think of Michael Moorcock’s habit of opening stories or chapters with startling newspaper clippings that revealed the future apocalypse already underway in the present, or Ballard’s typographic collages. So I began snipping.
The author collects a series of news article blurbs that gave him pause to think about how dramatically technology is changing life and society. "Future Shock" is a reference to a 1970 book by Alvin and Heidi Toffler, which posited that the rapid and accelerating pace of technological change and scientific discovery would prove alienating and disorienting for most people, leading to societal instability.
Do you feel that you've encountered something that gave you such a "shock", and if so, what was it?
Conversely, do you feel that you've become inured or numb to new developments, or are you inclined to dismiss them as hype?
Do you feel that you have control over the presence and pace of technological or science-mediated changes in your life and/or do some of them seem like uncontrollable, undesired impositions?
I'll start off - my "Future Shock" moment was finding out in 2018 that Cambridge Analytica was actively performing political manipulation using Facebook/Meta data collection. And just how much data Facebook was gathering and exposing even for non-users. I knew propaganda was a thing, and had my suspicions. That news was my wakeup moment in realizing just how easily people would be programmable at scale through social media, in more subtle, targeted, and effective ways than via Internet, broadcast media, or print advertising. I was predisposed to view privacy as something to be protected, and the real shock is how rapidly and unconsciously we've acqiesced to its erosion.
I've been surprised and delighted, but not shocked, at the rapid development of renewable energy technologies and electrification of everything. The science and engineering behind this change reflect decades of development, and like the bicycle, the stars have finally aligned.
Same thing about longevity and immunology research - decades of inquiry and development that are now culminating in gains of understanding and new medicines. The rapid release of COVID-19 vaccines was a good surprise, but not a shock.
I find the psychology of why and how we respond to historic events interesting. There are events which pile up in tiny increments until there's a kind of phase change that feels unstoppable, like the sudden salience of LLMs. I'd been half-watching the early experiments with distant amusement, but over the course of the next five years, they became inescapably usable.
I do find it shocking how much of life is now lived online globally, from games to romance to ordinary finance and commerce. I don't pay a lot of attention to popular culture drama, and when I do poke my head into it, it's still startling how much of it is now mediated by online beefs and manufactured political posturing.
@mycketforvirrad, apologies in advance for not going deep into the tagging... this one's for you.
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New worlds, and what was your "Future Shock" moment?
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Comment on Luigi Mangione pleads guilty to federal stalking charges in the killing of UnitedHealthcare CEO in ~news
patience_limited Link ParentThat's the whole point of liberal democracy - it's supposed to enable a political response to intolerable conditions before people start picking up pitchforks and bringing back the guillotine. I...That's the whole point of liberal democracy - it's supposed to enable a political response to intolerable conditions before people start picking up pitchforks and bringing back the guillotine. I don't think there's any question the United States has been trending towards plutocracy for a while now.
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Comment on Luigi Mangione pleads guilty to federal stalking charges in the killing of UnitedHealthcare CEO in ~news
patience_limited (edited )Link ParentIf it gives any clarity, I can provide a very specific example of the absurdity of UHC's claim denials. The cartilage in my hip joints was destroyed by undiagnosed aggressive RA over the space of...If it gives any clarity, I can provide a very specific example of the absurdity of UHC's claim denials. The cartilage in my hip joints was destroyed by undiagnosed aggressive RA over the space of about 6 months. Under Humana insurance, the first hip replacement was approved immediately (like eye surgery, orthopedists don't do both legs at once even if they're in the same condition).
Under UHR, I was forced to "fail" physical therapy - painful, useless (according to the therapist - he used the time to work on my hands and shoulders instead), and expensive. My orthopedic surgeon had to attend two hours-long insurer board reviews to establish that the x-rays plainly showed no cartilage, and bone erosion with no treatment other than joint replacement, the exact same justification that resulted in approval of the first replacement. "Deny, delay", indeed.
While I waited for the surgery, the ongoing release of inflammatory joint debris was making the overall autoimmune disease worse. I had to remain on prednisone while working through UHR's required DMARD drug list before starting biologics. What should have been a six month DMARD drug trial process per the standard of care stretched out to two and a half years. That process had its own health consequences (weight gain, hypertension, bone density loss, joint damage, partial tendon detachment, other drug side effects and reactions) that are taking more years to recover from. Un- or inadequately treated RA is a life-shortening disease. I don't have any idea of what the ultimate cost of UHR's delays might be, but the rheumatologist is furious on my behalf because there's permanent joint damage that could have been avoided. The bitter joke is on UHR, because they'll be paying for more joint replacements.
As angry as I am at my own situation and that of others, I still don't believe that Luigi Mangione's action was justifiable morally, ethically, or practically (there is evidence that assassination is marginally effective in international relations, if you ignore the long-term instability it causes).
However, as others here have indicated, it's predictable that we'd get to the point of CEO murder given the frustration and powerlessness of ordinary citizens faced with this systemic behemoth of greedy gamesmanship with people's lives.
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Comment on Luigi Mangione pleads guilty to federal stalking charges in the killing of UnitedHealthcare CEO in ~news
patience_limited (edited )Link ParentThank you for the corrections/definitions, and my apologies to all for the sloppy post and any confusion it may have caused. Also, India launched a national program in 2014 to make adalimumab more...Thank you for the corrections/definitions, and my apologies to all for the sloppy post and any confusion it may have caused.
Also, India launched a national program in 2014 to make adalimumab more available and affordable for its citizens through local manufacture of Humira biosimilars. As a result, the cost of a prefilled autoinjector pen with the usual 40 mg dose in India is $49 USD, around 10% of the US price.
And as a semi-offtopic aside, I'd like an option to get non-emergency medications dispensed in vials, without the autoinjector pen, if this significantly reduces costs. Immediate-use packaging makes perfect sense for an EpiPen. Users of insulin and other drugs have been safely filling their own non-automatic syringes for a very long time. Patents on proprietary autoinjectors are just another pharma money extraction scheme.
One more correction/clarification - my employer stopped using UHG/OptumRx due to the excessive pricing. OptumRx did not require prior authorization for adalimumab, presumably because they profited from easy prescribing. I'm fighting my fight because the new pharmacy benefit manager, TrueScripts, does require prior authorization for every prescription. This is complicated by the fact that my rheumatologist's practice was absorbed by a hospital system that's horrible at overloading practitioners and managing its communication systems.
As both /u/rosco and /u/DefinitelyNotAFae's stories indicated, the system is broken and has pervasively perverse incentives.
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Comment on Luigi Mangione pleads guilty to federal stalking charges in the killing of UnitedHealthcare CEO in ~news
patience_limited (edited )Link ParentTo your point, there are systemic issues with U.S. healthcare, and I agree that Brian Thompson's murder accomplished no enduring change in that system. UHG absolutely has culpability for creating...To your point, there are systemic issues with U.S. healthcare, and I agree that Brian Thompson's murder accomplished no enduring change in that system.
UHG absolutely has culpability for creating the equivalent of a medical zaibatsu, with insurance, billing, pharmacy benefit management, clinician groups, IT services, and other entities vertically integrated, and market control greater than 50% in some of those octopus arms.
Pharmaceutical companies, hospitals, outpatient surgical practices, regulators, medical products vendors, specialist practitioners, assisted living facilities, home health companies, etc. all need a share of the blame for costs that deplete insurance funds.
Just as personal for-instance, I'm once again fighting through a UHC prior authorization requirement for a generic version of Humira (adalimumab), the wonder biologic drug that makes my life possible. I need roughly $2,000 USD/month of that medication at current prices. It's such an amazing improvement for so many people that it represents half of all pharmaceutical spending in most developed nations, whether their health systems are public or private.
You'll hear that "biologic drugs are expensive to make" by comparison with small-molecule drugs. That's true in a relative sense, but the pharmaceutical price is 140x the cost of monoclonal antibody manufacture. That's taking my prescription as an example - 160 mg/month, scaled cost of adalimumab at $91/gram for manufacturing to filled vials. With the note that commercial scale may be much cheaper.
I understand that there are research and regulatory costs for bringing a drug to market, including the amortized cost of all the failures. There are regular pharma complaints about the est. $2 billion costs of proper U.S. drug trials. However, adalimumab has had over $200 billion in sales since its introduction. U.S. pricing for this drug is 400+% higher than the global average. Due to the regulations for biosimilar drugs and pharmacy benefit management, the generic competition hasn't dropped prices as much as or as quickly as expected.
I understand why insurers will put roadblocks up for an expense of this magnitude. But the conflicting profit incentives for UHG in particular through its OptumRx subsidiary have contributed to keeping generic biosimilar prices high.
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Comment on Any significant changes to Tildes are extremely unlikely in ~tildes.official
patience_limited Link ParentAs the cliché goes, YMMV. When someone says, "this is my experience", it's not an invitation to say, "no, you're wrong", or "have you tried x, y, z" without reading the post. That's just rude and...As the cliché goes, YMMV.
When someone says, "this is my experience", it's not an invitation to say, "no, you're wrong", or "have you tried x, y, z" without reading the post. That's just rude and socially unaware, at best. It definitely feels hostile when it's repeated, or turns into a dogpile of similar denial responses. Recent example...
Maybe it's the general unfriendliness of other sites and their discourse cultures bleeding in here, maybe it's the threatening nature of (gestures at everything) current events making everyone more fearful and guarded. It's also worth considering that Tildes has selection biases due to the invite-only system and the Reddit invite source. Each wave of new users has brought some acculturation problems, with fewer active "old hands" to guide behavior in accordance with the expressed philosophy of the site. Explaining why low-effort, discourteous, or derogatory posts are unwelcome, over and over, isn't anyone's idea of a good time. Of course people just want to hit a label and make the problem go away or become someone else's (Deimos, usually) problem.
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Comment on I love Tildes in ~tildes
patience_limited Link ParentI've set my default sort to "All Activity" rather than "New", so I usually see what's getting comments even if it's an older post. I'll check "New" as a second step. I'm not contributing that much...I've set my default sort to "All Activity" rather than "New", so I usually see what's getting comments even if it's an older post. I'll check "New" as a second step.
I'm not contributing that much these days, so it's not as critical for me as it might be for more active users.
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Comment on I love Tildes in ~tildes
patience_limited LinkI've met some amazing people here, gotten support when I needed it, fascinating arguments when I've invited them, and been able to avoid most of the gross toxicity of modern social media. I'm...I've met some amazing people here, gotten support when I needed it, fascinating arguments when I've invited them, and been able to avoid most of the gross toxicity of modern social media. I'm ancient enough to have seen a few Eternal Septembers, and "Slow Social" happens to be just about right for me.
I'm deeply grateful for the technical and philosophical framework that Deimos, cfabbro, mycketforvirrad, and others have built and maintained. I'm not constantly looking over my metaphorical shoulder to figure out how I'm being surveiled, monetized, and manipulated. The people who gather here have been, on balance, kind, thoughtful, smart, emotionally mature, and willing to tolerate the rambling musings of an oddball like me.
/u/doors-cannot-stop-me, thanks for opening the door to let some light in!
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Comment on Any significant changes to Tildes are extremely unlikely in ~tildes.official
patience_limited Link ParentThough we haven't interacted much (I've limited my posting time hard), I'll definitely miss your spirited voice and perspective. It seems to me that some of the missing safety functionality...Though we haven't interacted much (I've limited my posting time hard), I'll definitely miss your spirited voice and perspective.
It seems to me that some of the missing safety functionality (legitimate asks, IMHO, under present circumstances) can be emulated through use of Tildes Re-Extended to highlight usernames and filter topics. But that's just one more layer of effort in a world of exhausting online interactions where people who behave in damaging ways are given excessive license, over and over again. I'm sorry this has been hurtful and has created a hostile environment for you, me, and others. I hope you can find a more benevolent community.
I understand the position that attempting fixes beyond what we have on Tildes now is likely to cause more issues than are resolved. Ultimately, I don't think there will ever be, or should ever be, technological solutions for all human problems. A geological age ago in Internet years, I'd suggested the "Malice" tag, under the assumption that there'd be enough people moderating to detect and evict users with consistent patterns of hostile behavior. That hasn't materialized, and Tildes' norms have drifted towards more tolerance of JAQ-ing off, sealioning, dogpiles, and all the usual online community entropy.
I've seen too many good, kind, thoughtful people leave because they've had abrasive interactions, and aren't finding enough positives to stay. It's a self-reinforcing cycle - using community standards for surfacing hostility fails as the user base becomes more generally hostile. It's a living example of the "Evolution of Trust" game.
The thing is, these are problems with humans, not just the technological affordances of Tildes. Again, I hope that you can find a place that fits, and that you can keep it for as long as you're at home there.
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Comment on Is it time to include pronouns? in ~tildes
patience_limited Link ParentThe Bio feature was added in March, 2019, and that's when I first filled it in. But it's a tiny mention in the Docs at the bottom of the "User Settings" page.The Bio feature was added in March, 2019, and that's when I first filled it in. But it's a tiny mention in the Docs at the bottom of the "User Settings" page.
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Comment on Is it time to include pronouns? in ~tildes
patience_limited Link ParentThere's always the username's "Bio" profile information, though many people seem unaware that this feature exists.There's always the username's "Bio" profile information, though many people seem unaware that this feature exists.
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Comment on Why normal people aren’t using AI agents in ~tech
patience_limited (edited )Link ParentSpeaking as one of those older folks with a modicum of IT wisdom, I won't touch AI agents for personal use with a 10-meter pole, for the foreseeable future. The glaring environmental costs,...Speaking as one of those older folks with a modicum of IT wisdom, I won't touch AI agents for personal use with a 10-meter pole, for the foreseeable future.
The glaring environmental costs, security issues, data harvesting, damage to web resources, corruption of truth, political power balance, impact on creators, and "first taste is free/cheap" risks of dependency and skill degradation, are absolutely relevant to me.
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Comment on The AI bailout could be baked into the AI bubble in ~finance
patience_limited (edited )Link ParentBeen through a private equity buy-in (not even a takeover, just board seats) and it's a horror story in healthcare. Besides the patient care and business damage, I was among the employee...Been through a private equity buy-in (not even a takeover, just board seats) and it's a horror story in healthcare. Besides the patient care and business damage, I was among the employee stockholders and didn't see a dime of the mountain of cash that was pumped out, just the 80% drop in share price. I was overinvested because I thought the company did good work and provided worthwhile services, so it was the equivalent of taking a 20% pay cut for all the years I'd worked with the company. I quit just before the massive layoffs started. Yes, I've got durable hostility to private equity shenanigans.
I'll probably add Bad Company to my reading list, thanks for the mention.
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Comment on These twenty-five artifacts explain America (gifted link) in ~life
patience_limited (edited )Link ParentMy little list... Twelve-lane highways Domed stadiums Silicone breast implants Landfills turned into ski hills Press-on nails Mickey Mouse watches Corn dogs Jeeps The oblate spheroid version of...My little list...
Twelve-lane highways
Domed stadiums
Silicone breast implants
Landfills turned into ski hills
Press-on nails
Mickey Mouse watches
Corn dogs
Jeeps
The oblate spheroid version of football
Blue jeans (especially "designer")
The Big Gulp soft drink sizeI'll think of more later.
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Comment on After decades of drought, water is rising in the African Sahel in ~enviro
patience_limited LinkFrom the article: Needed some good news, and this counts with qualifications. Climate changes are bringing back the weather regime which made much of the African continent the cradle of humanity....From the article:
Near-extinct oryx are returning. Farms are prospering as irrigation water reaches fields for the first time in decades. Farmers are even nurturing new trees on their land. Once a byword for drought and famine, the African Sahel region on the southern flank of the Sahara Desert now has more water than it has for decades. Wells are filling as water tables have risen by 13 feet or more in places. Lake Chad, which was one of Africa’s largest expanses of water before shriveling during the droughts, is recovering.
Over years of drought in the late 20th century, the sun hard baked the soils of the Sahel. Now, erratic but extreme rains are returning to this semi-arid region, causing lethal floods but also replenishing rivers, filling desert depressions, restoring water to dried riverbeds known as wadis, and sluicing rainwater off impermeable soils directly into aquifers. The process began in the 1990s but has accelerated in the past five years.
“Across the Sahel, from Ethiopia to Senegal, we have evidence of increased terrestrial water storage,” says Richard Taylor, a hydrogeologist at University College London who has led ground teams investigating the relationships between climate, land use, and groundwater recharge in the region.
Needed some good news, and this counts with qualifications. Climate changes are bringing back the weather regime which made much of the African continent the cradle of humanity. Humans are resilient, and ingenious ancestral techniques are helping to restore the groundwater tables in the Sahel now that the rainfall permits.
On the peptide front, I did feel shocked when a coworker who's a serious competitive bodybuilder tried to sell me on the benefits of randomly sourced BPC-157 for arthritis. I guess the general Internet availability of compounding pharmacy-provided unregulated Chinese research grade chemicals, and "doctors" willing to prescribe them, is one of those cultural/technological phenomena that should be shocking. That being said, if there wasn't an effective, approved treatment available for arthritis, I still wouldn't try peptides in the absence of any evidence they work, and an increasing number of stories that they're harmful.
Edit: I'm being disingenous here. I do use a compounded peptide prescribed by an online "doctor" - semaglutide from Hers. It's also well-evidenced, has an extensive safety profile and my real doctors are onboard. It's from a U.S. company big enough to sue if something goes wrong, that tried to get FDA approval for their generic until the pharma companies blocked it. Even if my doctors prescribed it themselves, I'd have to get it compounded anyway, since I've responded well to half the normal semaglutide dose for weight loss. And yes, this is the science fiction one for me, squarely back in the middle of the healthy BMI range when I can't exercise to the level I used to maintain my weight previously.