Tuesday, December 12, 2017

Health Apocalypse Now

Link

Much of my time for the past year has been spent navigating the medical maze on behalf of my mother, who has dementia.

I observe that American health care organizations can no longer operate systematically, so participants are forced to act in the communal mode, as if in the pre-modern world.

Health care is one leading edge of a general breakdown in systematicity—while, at the same time, employing sophisticated systematic technologies.[..]

For complex health care problems, I recommend hiring a consultant to provide administrative (not medical!) guidance.[..]

My mother’s mild dementia began accelerating rapidly a year ago. I’ve been picking up pieces of her life as she drops them. That has grown from a part-time job to a full-time job. In the past month, as she’s developed unrelated serious medical issues, it’s become a way-more-than-full-time job.

The most time-consuming aspect has been coordinating the dozens of different institutions involved in her care. I had read that the biggest failing of the American health care system is its fragmentation; I’ve now spent hundreds of hours observing that first-hand.

There is, in fact, no system. There are systems, but mostly they don’t talk to each other. I have to do that.[..]

This is a stark example of medical cost disease, but the post is not about that. It’s about how institutions fail to talk to each other—and what that implies about our future.[..]

My mother went into the hospital a month ago with severe pain in her hip. (It’s still undiagnosed.) After two days, she was medically ready for discharge from the hospital: whatever the pain was, it wasn’t one they could help with. Instead, she should be sent to a “skilled nursing facility” (SNF) where she’d get “physical therapy,” i.e. leg exercises.

For a SNF to agree to take her, they had to get confirmation from an insurance company that insurance would cover her stay. She has two kinds of health insurance, Medicare plus coverage through a private insurer (Anthem). Which would cover her? Or both, or neither?

SNFs have admissions officers, whose full-time job is to answer this question. Two different SNFs started working on the problem. I talked with the admissions people every day. Both claimed to be working on it more-or-less full-time. The hospital wanted to free up my mother’s bed, so their insurance person was also working on it.

Days passed. The hospital doctor on rounds said “Well, this is typical, especially with Anthem. It’s costing them several thousand dollars a day to keep her here, versus a few hundred dollars a day in a SNF, but it might take a week for them to figure out which local SNF they cover. [..]

It’s like one those post-apocalyptic science fiction novels whose characters hunt wild boars with spears in the ruins of a modern city. Surrounded by machines no one understands any longer, they have reverted to primitive technology.

Except it’s in reverse. Hospitals can still operate modern material technologies (like an MRI) just fine. It’s social technologies that have broken down and reverted to a medieval level.


One of the pervasive ways women are disadvantaged under the ACA is its reliance on employer-based coverage. In the United States, World War II–era wage freezes helped entrench a system of employer-provided health insurance, a perk meant to attract workers in a squeezed labor market

Eventually, Medicare and Medicaid were devised as a safety net for those shut out of private plans, and the ACA expanded that safety net. Still, job-based plans remain the bedrock on which our insurance system is built.

Under this system, it’s harder for women to get health insurance in the first place. The strains of childrearing and elder care make women more likely to seek more flexible employment, like part-time, remote, or freelance work. These forms of employment tend not only to pay less, but are less likely to include health insurance benefits.

Those that do provide inferior ones: companies with majority-female workforces tend to offer less generous health-care coverage than those that are majority male. And less than one-third of low-income workers receive any health insurance through work. Jobs paying at or around the minimum wage are most often occupied by women, the majority of whom are women of color. Trans women face even higher levels of poverty than cis women, and are frequently saddled with impossibly high out of pocket costs.

Wednesday, December 6, 2017

Chia

Link

[Bittorrent inventor] Cohen has just started a new company called Chia Network that will launch a cryptocurrency based on proofs of time and storage rather than bitcoin’s electricity-burning proofs of work. Essentially, Chia will harness cheap and abundant unused storage space on hard drives to verify its blockchain.

“The idea is to make a better bitcoin, to fix the centralization problems” Cohen tells me. The two main issues he sees in bitcoin are in environmental impact and the instability that arises from the few bitcoin miners with the cheapest access to electricity exerting outsized influence.

Chia aims to solve both.

Bitcoin uses proofs of work to verify the blockchain. That’s because it’s prohibitively expensive to make a fake blockchain as it wouldn’t have as much work demonstrated as the real one. But over time that’s given a massive advantage in collecting the incentives for mining bitcoin to those who operate close to low-cost electricity and naturally chill air to cool the mining rigs.

Chia instead relies on proofs of space in file storage, which people often already have and can use for no additional cost. It combines this with proofs of time that disarm a wide array of attacks to which proofs of space are susceptible.

“I’m not the first person to come up with this idea,” says Cohen, but actually implementing requires the kind of advanced computer science he specializes in.

--

Fascinating. I wonder how disk space is used as proof-of-work.. how can u make sure someone has X amount of space, reliably..? I wish I had time to dig into it.

The huge amount of CPU power spent on BC mining always bother me, hopefully Chia fixes that. "Democratizing" mining is nice too -  if mining is easy, and the currency is adopted widely, in theory this would be your UBI mechanism, ppl can mine reasonable amount of $$ on their own, no being bothered by the stigma around hand-outs.

So here is my ideal cybercurrency features - uses less CPU like Chia, is completely anonymous like Monero, supports ultra-smart contracts like Ethereum, and is as robust as Bitcoin. Mining should never end, so currency is not dis-inflationary. 

#aetna


Monday, December 4, 2017

Q&A - 4/12

James Mulvale

Welfare state programs [..] have been premised on a growing economy where everyone gets a slightly bigger piece of the pie. Those days are over, we have to think about steady-state economics, we have to think about redistribution of wealth. I think basic income gets us partway towards that goal.

Interesting point

U still need government-funded universal healthcare of course bcz citizens need govs bargaining power, but BI can do lota good.

So once the current circus is over the new political leaders can start constructing this system.

Twitter

Ha Ha

Scott Alexander

Do you think that modern colleges provide $18,000/year greater value than colleges did in your parents’ day? Would you rather graduate from a modern college, or graduate from a college more like the one your parents went to, plus get a check for $72,000?

(or, more realistically, have $72,000 less in student loans to pay off)

Was your parents’ college even noticeably worse than yours? My parents sometimes talk about their college experience, and it seems to have had all the relevant features of a college experience. Clubs. Classes. Professors. Roommates. I might have gotten something extra for my $72,000, but it’s hard to see what it was [...]

This can’t be pure price-gouging, since corporate profits haven’t increased nearly enough to be where all the money is going. But a while ago a commenter linked me to the Delta Cost Project, which scrutinizes the exact causes of increasing college tuition. Some of it is the administrative bloat that you would expect. But a lot of it is fun “student life” types of activities like clubs, festivals, and paying Milo Yiannopoulos to speak and then cleaning up after the ensuing riots. These sorts of things improve the student experience, but I’m not sure that the average student would rather go to an expensive college with clubs/festivals/Milo than a cheap college without them. More important, it doesn’t really seem like the average student is offered this choice.

Right

NYT

We need to start asking which public goods universities are producing and whether government support gets Americans more of them. Taxing graduate students is a crude, destructive mechanism for extracting goods from academia because it would diminish both scientific discovery and the size and scope of the educated public that has been improving our country for generations. The current plan for taxing endowments does not address the problems that rightly drive citizen fury: soaring costs, educational inequality and schools’ resistance to change.

To address these issues, universities must bring new proposals to the table.

Yes

News

Arcade City = decentralized #Uber via #ethereum. We built in #Austin the world's first citywide P2P rideshare network

Nicccce

We mentioned Ethereum, an alternative to Bitcoin, before, a cybercurrency more suited for distributed programs. Theoretically a lot of today's Internet based software can be ran in a distributed fashion, distributed on everyone's machine.

Software for the people, by the people, of the people.

Question

What other new coins are out there?

Monero

This currency is said to be better for individual miners requiring less compute power, and is completely anonymous perhaps mirroring today's paper money better. That can be a good thing.

Friday, December 1, 2017

#millenials


He is talking about this video


It is such a stupid video - and I love it. :)

Go easy on the millenials man.. What is millenial humor anyway? One of the same actors is in this video for ex... the shit is funny.

Wednesday, November 29, 2017

1/3

Link

In a new study that is optimistic about automation yet stark in its appraisal of the challenge ahead, McKinsey says massive government intervention will be required to hold societies together against the ravages of labor disruption over the next 13 years. Up to 800 million people—including a third of the work force in the U.S. and Germany—will be made jobless by 2030, the study says.

The bottom line: The economy of most countries will eventually replace the lost jobs, the study says, but many of the unemployed will need considerable help to shift to new work, and salaries could continue to flatline. "It's a Marshall Plan size of task," Michael Chui, lead author of the McKinsey report, tells Axios.

In the eight-month study, the McKinsey Global Institute, the firm's think tank, found that almost half of those thrown out of work—375 million people, comprising 14% of the global work force—will have to find entirely new occupations, since their old one will either no longer exist or need far fewer workers. Chinese will have the highest such absolute numbers—100 million people changing occupations, or 12% of the country's 2030 work force.

I asked Chui what surprised him the most of the findings. "The degree of transition that needs to happen over time is a real eye opener," he said.

The details:

Up to 30% of the hours worked globally may be automated by 2030.

The transition compares to the U.S. shift from a largely agricultural to an industrial-services economy in the early 1900s forward. But this time, it's not young people leaving farms, but mid-career workers who need new skills. "There are few precedents in which societies have successfully retrained such large numbers of people," the report says, and that is the key question: how do you retrain people in their 30s, 40s and 50s for entirely new professions?

Just as they are now, wages may still not be sufficient for a middle-class standard of living. But "a healthy consumer class is essential for both economic growth and social stability," the report says.

The U.S. should therefore consider income supplement programs, to establish a bottom-line standard of living.

Whether the transition to a far more automated society goes smoothly rests almost entirely "on the choices we make," Chui said. For example, wages can be exacerbated or improved. Chui recommended "more investment in infrastructure, and that those workers be paid a middle wage."

Do not attempt to slow the rollout of AI and robotization, the report urged, but instead accelerate it, because a slowdown "would curtail the contributions that these technologies make to business dynamism and economic growth."

Tuesday, November 28, 2017

Education Without Subjects

Link

The head of the Department of [Finnish] Education in Helsinki, Marjo Kyllonen, has announced that he believes that the way children are taught now is based of a style that was a benefit to students in the beginnings of the 1900s, but now is no longer relevant and beneficial to our modernised way of learning. He strongly believes that our needs have changed and so we need to adapt our teachings to match with our new way of thinking and developing.

The huge changes will involve the removal of school subjects from the curriculum, as proposed by Finnish officials, which will be replaced by the study of individual events and phenomena.

This means that students will no longer have individual classes on subjects such as maths, geography and history, but will instead study an event, such as the Second World War, from the perspectives of maths, geography and history [..].

The idea of this is to eliminate disengagement of students who have to sit through individual classes that they believe they will not need based on their future hopes and ambitions of a working future, but instead will apply those prior individual subjects to a specific topic of their choice, thereby still learning the same skills, but using them in a more productive way that is most beneficial to their individual learning.

Health Apocalypse Now

Link Much of my time for the past year has been spent navigating the medical maze on behalf of my mother, who has dementia. I obser...