Cancer Complications: Confusing Bills, Maddening Errors And Endless Phone Calls - <AUTHOR> https://www.npr.org/sections/health-shots/2019/02/26/696321475/cancer-complications-confusing-bills-maddening-errors-and-endless-phone-calls <comment><USER2> In Australia the Leftist government of Gough Whitlam introduced health- coverage-for-all in 1975 with a scheme called Medibank. In 1984 after a couple of governments, Bob Hawke's Leftist government created the Medicare scheme (Medibank became a government provider of private health insurance), which exists to this day.

The most interesting stat I ever heard about Medicare was this: prior to Medicare the number one cause of personal bankruptcy in Australia was medical bills.

So I'm with Bernie on this: health coverage for all is an incredibly important goal.

While we're at it, let's end the monopoly given to drug companies on the sale of pharmaceuticals in the US. You should be able to legally import them from, at the very least, any NAFTA country and any EU member.

<comment><USER3> I'm all for universal coverage too. But reducing the profits of pharmaceutical companies well reduce the money they have for r&d dramatically.

This will slow down the speed of pharmaceutical development. So I think it needs to be paired with reforms to the FDA to reduce the go to market costs for drugs.

<comment><USER2> Pharmaceutical companies spend way more on marketing than research.

If drug companies are willing to sell the exact same drug in Canada or the UK or Germany or France for less than a percent (in some cases) of what they sell it here for then why can't US insurance companies, hospitals and consumers buy it for that price? There's no reason other than an artificial monopoly.

You'll note that I didn't say "anywhere" and that was deliberate. India, for example, has decided that drug companies largely (it's complicated) don't get monopolies from patents and thus you can buy a lot of low-cost high-quality generics in India because no drug company is getting paid.

Obviously this is untenable at the global scale.

And before anyone lambasts India for not respecting patents here, countries do this sort of thing all the time. In the US, for example, you can't patent nuclear technology as a matter of national security.

<comment><USER4> > If drug companies are willing to sell the exact same drug in Canada or the > UK or Germany or France for less than a percent (in some cases) of what they > sell it here for then why can't US insurance companies, hospitals and > consumers buy it for that price? There's no reason other than an artificial > monopoly.

They're willing to do that because the US is a much larger market than any of those countries. Most pharmaceutical companies - including European companies - make the lion's share of their profits from the US market. If they couldn't, you'd certainly see the costs for essential medicines increase in European countries.

> You'll note that I didn't say "anywhere" and that was deliberate. India, for > example, has decided that drug companies largely (it's complicated) don't > get monopolies from patents and thus you can buy a lot of low-cost high- > quality generics in India because no drug company is getting paid.

India has pretty solid reasons for not honoring drug patents that don't apply to the US or Europe.

<comment><USER5> _They 're willing to do that because the US is a much larger market than any of those countries. Most pharmaceutical companies - including European companies - make the lion's share of their profits from the US market. If they couldn't, you'd certainly see the costs for essential medicines increase in European countries._

"Willing" is a broken way to look at it. The drug prices are negotiated by the government in the single-payer systems.

<comment><USER4> > "Willing" is a broken way to look at it. The drug prices are negotiated by > the government in the single-payer systems.

Most countries don't have single-payer systems, and even where that's the case, "negotiated" is the broken term. For essential medications, the supplier always has greater leverage than the purchaser.

</comment></comment></comment></comment></comment></comment><comment><USER6> I think that's just a corollary of "63% Of Americans Don't Have Enough Savings To Cover A $500 Emergency":

[https://www.forbes.com/sites/maggiemcgrath/2016/01/06/63-of-...](https://www.forbes.com/sites/maggiemcgrath/2016/01/06/63-of- americans-dont-have-enough-savings-to-cover-a-500-emergency/#14c251a34e0d)

EDIT: My comment is in reference to the old thread title, which was something like "More than 42 percent of the 9.5 million people diagnosed with cancer from 2000 to 2012 drained their life's assets within two years"

<comment><USER7> Even with insurance, folks often wind up with six figures of bills out of pocket treating cancer. That's a huge amount for the even most frugal of the lower or middle class.

<comment><USER8> When my son was born he fit in my hand and spent his first three months in NICU. I guess the nurses thought his survival was questionable so they entered in his name into the computer as "Baby Boy". A few months later I started getting bills (eventually around $3 million) because there was nobody named "Baby Boy" on my insurance. Calling the insurance to try and correct was a nightmare - wait on hold for an hour, get 3rd degree interrogation about my identity, wait on hold, explain that son was on insurance but not called literally "Baby Boy", wait on hold, get interrogated for his details on son's identity, wait on hold, long series of questions to determine Baby Boy isn't real and let me know about penalties for fraud. Three hours later done, that covers the first $50. Decided I would never do that again, let it go to collections and explain it to the judge. Turns out that before it goes to collections it goes to someone with a brain who realizes "Baby Boy" is in-fact the infant boy with identical birth date on my policy, notices stop coming. No telling how much money they spent sending me all the nasty payment due letters in the mean time.

<comment><USER9> As someone who works in healthcare software, I wouldn't interpret "Baby Boy" that way. Different hospitals process information in different ways and it is very common for newborns to all be entered under the same, generic name. Sometimes different departments within the same hospital have different systems, especially as they get more specialized (see: NICU). Maybe the birth name you chose got entered in one place and not the other.

Just thought I'd shed some light on the issue.

</comment></comment></comment></comment><comment><USER10> It's such an absurd expense that I wonder if I get diagnosed with cancer, I would just deny treatment, accept death, and hand my assets to loved ones. Not sure if anyone else thinks the same way.

<comment><USER11> I don't think anyone can think about it realistically until they are in that situation. How much is another year of your life worth to you? And to your loved ones for that matter? (assuming we're talking terminal cancer here, which it might not be)

I have family that suffered from cancer and spent a good lot of money prolonging their life by about eighteen months. They were not pleasant months, but I don't think for a second that the family would have preferred to take the lump sum instead.

In short, every decision is horrible.

<comment><USER12> I'm on the downward side of 50. My best years (physically) are in the past. My kids are nearly adults. I'd rather pass on my assets to them and set them up for a better life than piss it away on medical treatments that don't have much hope of working.

<comment><USER11> My point is that your kids might not agree with you, and it is difficult, to say the least, to negotiate that situation. I'm not saying you're wrong, just that everyone has a different answer.

</comment></comment></comment></comment><comment><USER13> It always seems any American that is against Universal Healthcare quickly changes their tune as soon as they or their loved ones are hit with bankruptingly large bills for things they have no control over.

What a shame they can't see outsides themselves and realize they're only an inch away from financial ruin.

<comment><USER14> That's how it is in other aspects too: unemployed? Must be lazy. Homeless? Must be mentally I'll or a druggy. Lost the houses? Must have been living paycheck to paycheck. People are quick to judge others until that thing happens to them and all of a sudden the tune changes.

</comment></comment><comment><USER15> This is honestly one of the things that most stresses me out as I get older. I don't use my insurance much now because I'm pretty healthy, but I know my cancer risk will just go up over time.

I've considered that if something like this ever did happen, I'd move to Lithuania and do it there paying in cash over trying to do it in the US system. Universal health care can't come fast enough.

<comment><USER16> When you get old you presumably qualify for Medicare.

<comment><USER17> Why not just make it so that you always qualify for Medicare?

<comment><USER16> Because it would go bankrupt and then no one would get Medicare.

<comment><USER17> But why not make it not go bankrupt?

<comment><USER18> Because "I got mine", or maybe not yet, but someday I hope to get mine and you better keep your grubby hands off my imaginary money.

</comment></comment></comment></comment></comment></comment><comment><USER19> I'd like to know where the patient with the $870 MRI bill was seen. My last MRI was billed at over $7500. Before I started treatment for my brain tumor I got divorced for purely financial reasons and gave all my remaining money to my children. USA is so fucked.

<comment><USER20> Other than cash, how do you give money over $15k without being nailed by the gift tax? Keeping as much money in retirement savings seems wise as those are exempt from liens.

<comment><USER9> On top of the yearly exemption, you have a lifetime exemption in the US of $11.18M.

<comment><USER21> Currently you do. At a recent visit to my estate planning attorney he said it's likely that will be cut in half in the next few years. I don't recall whether it was because there's a time limit on that particular part of the law that's going to run out, or because it was likely the ruling parties would switch and they would vote it back down. But either way just remember that it can change in either direction at just about any time.

</comment></comment></comment></comment><comment><USER22> 57% of Americans cant handle a surprise bill of $500 without going into debt. [1]

I don't doubt cancer is probably the most expensive hit that we have a good chance of receiving, but I'd be inclined to point to the lack of "life's assets" being fluid as the first problem to tackle.

[1] [https://www.cbsnews.com/news/most-americans-cant- afford-a-50...](https://www.cbsnews.com/news/most-americans-cant- afford-a-500-emergency-expense/)

<comment><USER23> It's amazing that you got down voted so much. Do people not like facing reality or something?

</comment></comment><comment><USER24> Well I can't speak for all countries, but here in the UK I haven't paid a penny toward my cancer treatments.

I also kept my job despite being off work for nearly a year going through chemo, and I even got sick pay for all of that time. (Not at full wage, but still a very generous proportion of it).

Post-treatment I went back to my same workplace, doing the same job, and found out that I had even acrued annual leave at full rate during the 9 months I was off sick, so had 25 "extra" vacation days that I wasn't expecting.

Yes, this is more than the legal baseline, but even the legal baseline would let me keep my job, acrue leave, get some sick pay (although the statuatory sick pay isn't huge), but most importantly, have completely free treatment, so I wasn't spending the little energy I had worrying about medical bills or insurance.

</comment><comment><USER25> I wonder what the downstream effects of this are on building generational wealth. 100 years ago, when your parents died, you might inherit a home or a small amount of money. That then helped uplift the next generation. Now, if your assets are drained, you have a reverse mortgage, etc, there's nothing to pass on except for the very wealthy.

Cancer sucks.

<comment><USER26> This was definitely the case with my grandparents, but it wasn't even cancer it was just the long term cost of care for people who live well into their 90s.

</comment></comment><comment><USER27> >Cancer Complications: Confusing Bills, Maddening Errors And Endless Phone Calls

Hell that's just insurance in America... if you just use it.

I've been dealing with a bill where the insurance company decided that my kid's pediatrician was out of network all of a sudden. All the other visits to the same pediatrician have been covered, but they can't seem to fix this one bill....

There's no incentive for the company to be helpful as what am I going to do? Change insurance companies? That's not my choice.

<comment> xkcd-sucks A cynical viewpoint might add that if the patient has a terminal illness, and if they are overcharged, then the process can be dragged out past the patient's lifespan and their estate just might not get around to it.

<comment><USER27> I think they just expect I'll get tired of it and pay.

</comment></comment></comment><comment><USER28> This is a 2019 article covering a study that covers 2000 to 2012 and doesn't mention the Affordable Care Act signed into law in 2010. Insurance landscape has changed quite a bit in the USA since ACA, which makes this not very interesting. What I would be interested in is repeating the study now and comparing results.

<comment><USER29> I would expect the results to be no different - the article was talking about people who already have insurance. I've been through the incredible medical- bill maze that results from cancer treatment since then; it's just the same. The ACA was explicitly designed to perpetuate the current insurance system, why would you expect the situation to have improved?

<comment><USER30> Before ACA, there were lifetime benefit limits. After ACA, there is no limit, so it will have greatly changed the situation that people facing years of very expensive treatment faced. Now, you are spending a max of $10k per year on in network providers, or whatever your annual out of pocket max is. Before the insurance company had the option of telling you that you've maxed out your benefits and you're on your own, and/or not offering health insurance coverage for you in the future period.

The removal of lifetime benefits, ability to deny pre-existing conditions, and setting a maximum range between the lowest premium that can be offered and highest premium that can be offered greatly improved access to health insurance benefits for everyone. At the expense of making it more expensive for the young and healthy, but obviously someone has to pay, and we as a nation don't want it to be via taxes.

</comment></comment></comment><comment><USER31> This came up last year when it was discovered that Leon Lederman had to sell his Nobel Prize to pay for cancer treatments. But there is more moral complexity to this issue than people appreciate. Cancer treatment is inherently expensive; it just doesn't seem that way in some other countries because the government pays from the outset.

But I don't think that's necessarily moral, compared to something like Medicaid, which requires people to spend down their assets first before the government will pay. The median net worth for someone between 65-74 is $225,000. Why should the government spend tax dollars to protect those savings for people unfortunate enough to get cancer, when there are many people unfortunate enough to never enter the middle class and be in a position to save that kind of money in the first place? Isn't it unfair to spend tax dollars protecting the inheritance of an upper-middle-class kid when that money could be given to a kid that never had a hope of an inheritance?

Put differently, there is a huge moral difference between the government ensuring that everyone can get cancer treatment, and the government intervening to protect the financial and social status of people fortunate enough to have significant assets.

<comment><USER32> I would think the average person would feel slimy/predatory buying someone else's Nobel prize. Unless it's the case of a friend offering to help out, but then why not just lend the money without the collateral?

<comment><USER33> Could have been a museum or something.

</comment></comment></comment><comment><USER34> I _cannot_ even imagine the toll this would take.

I have a _very simple_ set of recurring claims against my healthcare provider that I'm handling myself (out of network, no problem, I thought). Due to job changes I had successfully had my charges reimbursed by my previous 2 insurance companies over the past year.

The current one has taken _6 months_ to finally start reimbursing me -- and actually, they're almost caught up! Every goddamned time, the helpful phone persons sees the problem: "Your provider was entered as an XYZ type of provider instead of a ZYX provider, so it was being sent to the wrong unit. I'll re-enter him correctly, delete the old entry, and resubmit your claims marked as urgent. They should be processed within 7-10 days..." Very helpful staff. They seem to get it. They seem to figure it out. They seem to fix it. And it's never. fucking. fixed. And so you wait 7 days. You want 10 days. Still in process (if the horrible online system even allows you to login today). You wait 14 days, thinking maybe that was 10 BUSINESS days. Then you call back. Again, and it's the same thing. Over and over again.

My reimbursements came totally out of sequence. The claim numbers don't match. The dates on the claim number don't match the dates on the EOB, they're paying me back for the wrong visits!

But somehow, somewhere, on the backend, someone is reconciling it. Amazingly, the amounts are adding up. I think the processors are REALLY GOOD at not accidentally double-paying, so even though they're paying me for the wrong dates here, the next time they avoid double-paying, and find ANOTHER date to pay for (properly). It actually looks like it'll somehow all get paid back. Again, all one insurance company and one health care provider. And it's my insurance. And it's top tier private tech company employer PPO type stuff.

My wife was in the hospital after a car crash. The first EOB I got for $200,000 saying "Denied", and that number didn't even include the surgery. I just laughed. It went to the wrong insurance, a simple call and it was sorted.

But I can't fathom having less than perfect insurance (and I don't even know how to manage to maintain good insurance while having cancer and potentially being out of work and having a partner who might not be able to work while they're helping you), and having millions of dollars in bills, and having them come in from countless different providers.. sheer misery.

</comment><comment><USER35> Moving to Switzerland, you'll be compelled by law to get health insurance and you will be covered no matter what for roughly 500 bucks a month with a 300$ deductible.

</comment><comment><USER36> When I was in my early 20s, I got myself a beefy life insurance policy that covers suicide after some waiting period that has expired many years ago. I know that in case of crippling illness I can always take the easy way out while preserving my assets plus the life insurance payout. My family would be taken care of.

<comment><USER17> >My family would be taken care of.

And possibly traumatized that you killed yourself so they could have money.

<comment><USER36> In case of being stricken by an incurable disease, I'm going to die anyway. I'm sure my people will understand my choice to make a graceful exit before illness takes away any shred of my dignity.

</comment></comment></comment><comment><USER37> It's not just the billing that sucks. It's also the care, or lack thereof, in the health care system.

I remember taking my friend to a Dr. visit when he had a brain tumor. The parking was confusing, with signs threatening fines of hundreds of dollars for parking anywhere near the building(this was at UCSD in La Jolla). This was at a cancer center, where you'd expect they'd prioritize access for patients. He went in for an eye exam, and the doctor was getting extremely agitated because my friend had problems communicating and performing a few tasks as quickly as the doctor wanted. Very few people in the hospitals seemed equipped to handle someone who had problems seeing, walking and communicating.

</comment><comment><USER38> "But none of these is her most gnawing, ever present concern.

That would be the convoluted medical bills that fill multiple binders, depleted savings accounts that destroy early retirement plans and so, so many phone calls with insurers and medical providers."

Is it like this in other OECD countries? I ask because I'm told that we in America have "the best health care system in the world."

<comment><USER30> No, my family in Canada and UK don't deal with any of this. In the US, it's not even worth your time figuring out how much your treatment will cost, other than whether or not the provider is in network or not. Assume it's the out of pocket maximum for your insurance, because when you go to a provider, you sign a blank check that says you will be responsible for whatever chargers they make up during the course of your treatment. So your only ally is the insurance company, who has the power to deny payment for things like $15 worth of linens (which was actually a few pieces of paper towel).

<comment><USER19> You can't figure out whether your provider is in or out. Just yesterday I got a bill from someone I've never heard of who turns out to be a "Medication Safety Specialist" who allegedly rendered services to me worth $392. You'd think such a person would just be a functionary of the hospital who in any case bill me $27k every day, but actually they are some kind of mercenary who bill patients directly.

<comment><USER30> Yes, it's crazy how difficult these little things are.

During birth, should one stand outside their wife's delivery room and ask each provider to wait outside while you look up if they are in network or not on your insurance company's app? At least we have apps to do that nowadays.

<comment><USER19> Yes, you should. When my wife gave birth the first time there was an endless parade of idiots who uselessly entered the room for a moment and then left and later sent a huge bill. We also got a bill from the anesthesiologist who was not present because my wife didn't want it and for the supposed attending obstetrician who, although they were paged, never showed up. We had to go through disputes of all those things and even though we prevailed on all of them, my attorney had to get paid.

<comment><USER30> I would definitely recommend actually doing that, but I kind of meant "should we do that" in a sense of "should we be behaving like this in a civilized society"?

</comment></comment></comment></comment></comment></comment><comment><USER39> > " _Their high-deductible insurance policy meant they had to spend $6,000 > before their insurance started covering her treatment expenses. They hit > their annual out-of-pocket maximum of $10,000 well before the year was > over._ "

The article mentions a variety of causes but I'm having a hard time figuring out which ones are most important. In the example above with a $10k out-of- pocket maximum, how much money did these patients actually end up paying? Is that the main reason for their bankruptcy, or is it their loss of income? Does disability insurance cover things like cancer, and if not, are there similar programs that do?

</comment><comment><USER40> I published a piece on debt in America last week and touched in the subject of medical debt. When you look at it from a broader perspective, most Americans are in a financially dire situation. 42% sounds lower than I would have expected.

Americans are Drowning in Debt: [https://thenib.com/americans-are-drowning-in- debt](https://thenib.com/americans-are-drowning-in-debt)

<comment><USER41> Yep, paying off my debt (except mortgage, which is affordable and only 15-year term) has been the most liberating thing I've done. Learning to live below my means was difficult (still is), but absolutely worth it.

</comment></comment><comment><USER42> I remember the radiolab episode on worth[0]. Is another month of life with cancer worth x amount of dollars? Who should pay 100k for a medication that might let you live a month longer with pancreatic cancer. I imagine most Americans don't look at it that way.

[0][https://www.wnycstudios.org/story/worth](https://www.wnycstudios.org/story/worth)

</comment><comment><USER43> Has anyone tried flying to another country for more affordable treatment after the diagnosis?

Countries like Germany and some south american countries have much more affordable treatment even factoring in the lodging and flying.

<comment><USER44> Having to fly to receive treatment seems like it might significantly affect the likelihood of a full recovery. Cancer patients tend to have compromised immune systems and airplanes are filthy.

<comment><USER45> As a cancer patient, wear a mask. I travel for work all the time, even right after chemo. I'm not older, which makes for a stronger immune system in the first place, but planes just require hand sanitizer and a face mask. The real problem would be you would have to be able to pay out of pocket for lodging, translation services, treatment, etc. and in most cases overall survival is better in the US for late stage cancer.

</comment></comment></comment><comment><USER46> This same issue exists for autoimmune disease as well as many other diseases. My understanding is that the hospitals were going to post the costs for treatments and make the process more transparent. Has this happened?

</comment><comment><USER47> I'm confused. If you have medical insurance, shouldn't you only pay up to your deductible? Is this saying people's life assets don't cover the deductible? Or, people are uninsured?

<comment><USER17> The deductible might be huge, and there's also this magic new thing I've just discovered (or United invented out of nowhere) called "co-insurance" and "maximum out of pocket" which I call "deductible #2."

Then when you actually try to use the insurance you pay monthly for (but don't get to use until you reach the deductible #1 and #2?) they may just send the bill to you with a lot of legalese that amounts to "we don't cover this, or we do but we have better lawyers, get fucked peasant."

Luckily the debt collection industry is incompetent so all you gotta do is keep replying with "please mail proof of debt" and you're golden!

<comment><USER30> All of the terms you listed are easily understandable concepts clearly explained on healthcare.gov or any health insurance company's website, and they've been a thing for decades.

How much clearer can maximum out of pocket be?

Edit: I do think in network and out of network should be easier/faster to figure out though.

<comment><USER48> There are plenty of times when in/out network is an impossible thing to determine or plan for.

I had an out patient surgery about a year ago and while my doctor and every admin I talked said that everything would be in network, I still had someone sneak in who was supposedly out of network.

Then came the bill of what should have been ~$300 was around $2500. I got that BS waived only by called my doctor's office and talking with them about it. Once we talked it all through, the nurses called the _head management of company that ran the out patient surgery clinic_ in order to get it removed. It feels like people have to do you favors in order to get your actual correct billing.

Our health care system is so royally f'ed in the U.S. It desperately needs fixing and I hope it does before something serious happens to myself or my wife because it's currently feels like gambling with ruination. No $2.5k isn't ruination but health care is the only thing in this country where I go in knowing NOTHING about what my final bill will actually be.

<comment><USER49> If you tell everyone who admits you "I don't consent to any procedures or care from out of network providers", could you sue any out-of-network providers who operate anyway for malpractice?

Or I wonder if a similar "HIPAA trap" could be constructed by categorically revoking consent to share your PMI with any out-of-network individuals and companies?

<comment><USER45> Typically the people performing the operations don't know if they are out of network. That's handled by a separate billing department.

</comment></comment></comment></comment></comment></comment><comment><USER30> My plan in a situation that would burn up all of my assets for little guarantee of meaningful gains is to off myself to prevent using up my family's assets. I wouldn't want to sacrifice the future of the rest of my family to milk a couple more years, especially with reduced quality of life. Assuming I'm mentally strong enough to, anyway. Although, nowadays with mandatory out of pocket maximums, if you have insurance, this shouldn't be as widespread of a problem.

<comment><USER17> >off myself to prevent using up my family's assets

I'd give 90% of my income if it meant my friend that "offed herself" could still be alive.

Decisions like that have consequences beyond you...

<comment><USER30> I agree, and I think one consequence of using up my family's assets would be a decrease in the probability of my kids' having secure futures, which I wouldn't want either.

</comment></comment></comment><comment><USER50> Maybe it will not be easy to read this: In this particular case the US can learn something from past socialist regimes - or from Germany and many other western countries, which already learned, that OBLIGATORY state medical insurance solves such issues. It is not the ideal solution, but the best compromise available. Who would like to get cancer and fight with private insurance company while being ill?

<comment><USER51> > past socialist regimes

Ok, I agree with the spirit of your post, but don't ever hold up the USSR or Venezuela or any of the others. It's obvious you don't know how shit actually worked back then, so let me tell you. It was a prime example of an underfunded system that was forced to meet bullshit metrics and shit was falling apart. If you wanted treatment for anything more major than the flu you basically had to bribe the doctors. Otherwise you could e.g. go to the ER bleeding out, be left to bleed out and just be written off as "well he died outside the operating room, nothing we could do guv'nor, metric for people surviving the OR = met". Mixups were constant, corruption was rampant and the doctors who were in this mess were all day-drinking to cope with it. To this day government healthcare back home is underfunded and oversubscribed and you need to pass doctors bribes to get priority treatment. Or you can go to a private clinic that openly just takes money on top of your standard insurance, thank god.

Previous socialist regimes are what NOT to do when you're implementing government services. Look at what they did and do the opposite.

</comment></comment><comment><USER49> It would be cool if you could sue for emotional damages and timecost of resolving the issue when someone fraudulently bills you.

</comment><comment><USER52> Our healthcare system is wildly inefficient. A major overhaul would need to take place --- for me, as long as biotech and pharma innovation/production is not negatively affected (because I actually want to cure cancer) then I'm all for hearing options.

</comment><comment><USER53> At some point a lot of us will have to make the decision if we want to go through this type of nightmare, physically and financially. When do you say, I've had a good run, time to not participate in these horrendous medical systems.

</comment><comment><USER54> I have good healthcare through employer, but god forbid - i have no idea what'd happen even with the insurance.

Unexpected health problems are the only reasons i'd go back to my home country to get treatment. US healthcare is nuts.

</comment><comment><USER55> In the US.

</comment><comment><USER56> Recent discussion on "U.S. Health Care Spending Highest Among Developed Countries" (50 days ago, 698 points, 522 comments):

[https://news.ycombinator.com/item?id=18851823](https://news.ycombinator.com/item?id=18851823)

Opinion – "A Better Path to Universal Health Care: The United States should look to Germany, not Canada, for the best model.":

[https://www.nytimes.com/2019/02/20/opinion/health-care- germa...](https://www.nytimes.com/2019/02/20/opinion/health-care-germany.html)

Decade old Frontline episode – "Sick Around The World: Five Capitalist Democracies and How They Do It":

[https://www.pbs.org/wgbh/pages/frontline/sickaroundtheworld/](https://www.pbs.org/wgbh/pages/frontline/sickaroundtheworld/)

What I don't know is how we get from here to there. The health insurance companies are already gearing up to fight MFA – "Health Care and Insurance Industries Mobilize to Kill 'Medicare for All'":

[https://www.nytimes.com/2019/02/23/us/politics/medicare- for-...](https://www.nytimes.com/2019/02/23/us/politics/medicare-for-all- lobbyists.html)

</comment><comment><USER57> Canadian version of Breaking Bad:

"You have cancer. Treatment starts next week."

The end.

<comment><USER58> A real Canadian version is the following:

\- You've got a backpain? Here is your ibuprofen peal.

\- But I have very severe back pain.

\- Here is your bigger ibuprofen peal, come back in 6 month to see the specialist.

6 month later in US:

\- Congratulations, you've got cancer.

3 years and more than $1M in bills later:

\- This is the end.

</comment></comment><comment><USER59> More than 42% of 9.5M people with cancer drained life's assets within 2 years _in the US_.

<comment><USER60> Yes, but bankruptcy due to health reasons is actually quite common in Canada as well.

Why? If you're sick enough you can't work or pay your bills so you go bankrupt.

It's not just healthcare costs.

 _Survey research commissioned by the Canadian government found that despite having a government-run health system, medical reasons (including uninsured expenses), were cited as the primary cause of bankruptcy by approximately 15 percent of bankrupt Canadian seniors (55 years of age and older)._

<comment><USER61> Not sure for Canada, but in many EU countries, if you are employed, you will keep receiving a large percentage of your salary when on extended sick leave, mostly paid by social security after the first few days.

[https://www.researchgate.net/figure/Paid-sick-days-and- sick-...](https://www.researchgate.net/figure/Paid-sick-days-and-sick-leave- in-22-countries-worker-at-median-earnings-full-time_fig1_41720650)

My mother was on sick leave for many months for breast cancer and the illness had a relatively small impact in terms of family finances.

</comment></comment></comment><comment><USER62> GDPR-friendly: [https://text.npr.org/s.php?sId=696321475](https://text.npr.org/s.php?sId=696321475)

<comment><USER63> Thanks!

</comment></comment><comment><USER64> I hate to be political, but anyone who looks at these numbers, and believe that the system is working properly as intended is absolutely an enemy of American Prosperity.

<comment><USER65> I would argue that the system is working as intended, it's just not to your or my or most other people's benefit.

<comment><USER66> I would say both your comments are true.

</comment></comment></comment><comment><USER67> This is unfortunate, but what do you want to do, have the government pay for it? Maybe there are a lot of people with cancer who will get better and live for X number of years. But many people are going to die in a year or two and we would just end up spending millions of dollars on them, essentially wasting the government's money. How much money would you spend to increase someone's life by a minute, an hour, a day, a month, etc?

And if there was a maximum amount the government was willing to pay, then people would just be talking about how the government is deciding the price of life. Maybe you could devise a fair system in which every individual has a certain dollar amount allocated to all the healthcare in their life, and then if they go over that, they would have to pay it themselves. But I think people would be upset about that as well.

At the end of the day, every system we create (bridges, power plants, cars, etc) is implicitly or explicitly deciding the price of a human life. People are uncomfortable with that idea, so they try to think of things in different terms.

Our healthcare system is broken, but not for the reason people think. It's broken because it's this public-private Frankenstein monster of rent-seeking, self-dealing, and corruption. It was terrible to begin with, but Obamacare made it so much worse. The system has become so complex that the government can't properly model or anticipate how legislation would affect the long-term stability of the system. Over the years, the government has legislated bug fixes over bug fixes, patches over patches.

What needs to be done is replace this horrible and inefficient beast with a completely free market system. Just get rid of all of the laws and start anew. I guarantee you that the free market would be able to offer reasonably priced insurance plans that would service a variety of needs.

The solution isn't free healthcare for everyone. The US government does not have the money to even begin to do something like that.

<comment><USER68> What do other wealthy states with populations who generally prefer their healthcare system to one like ours (the US) do? That'd be a good place to start looking. Plenty of examples. Like, all of them, pretty much.

> The solution isn't free healthcare for everyone.

I mean....

<comment><USER67> it's not a coincidence that the US is much wealthier and home to much more innovation than socialist European countries.

Clearly our system is bad, but there are multiple ways to skin a cat.

<comment><USER68> Color me skeptical that our healthcare system contributes to our being more innovative than our peers. Looking at the way it distributes risk (bumpily and with little certainty) and the immense cost of it, I'd expect precisely the opposite.

> Clearly our system is bad, but there are multiple ways to skin a cat.

I'd love to see a hyper-free-market system work for this. It'd be great. So much simpler. I'd like to see it happen somewhere else first, though. Meanwhile all our best examples are _not that_ and I'll take something working in practice over working in theory any day.</comment></comment></comment></comment>


Madden Puts Concussions in New Light in His Game - <AUTHOR> http://www.nytimes.com/2011/04/03/sports/football/03madden.html?hpw&gwh=0BCD941C30F88FF14ABD80B8D6E3A68A

<comment><USER2> I salute Madden for this move-- particularly not showing defenseless head-to- head hits and other risky plays. The recent science on football concussions and long-term neurological damage is very concerning.

The thing that is lost in the debate about NFL concussions is that a million American youth and college football players emulate the way the pros play. So enforcing responsible rules at the top of the game will ripple down through the entire sport. I'm glad that Madden realizes that their simulation game probably has a similar impact, and cheers for doing the right thing.

(I played football for 11 years including at the college level, so I love the game and am not some hand-wringing observer.)

</comment><comment><USER3> I think it's great that this is being addressed in a video game. If a game's going to be realistic, it should take realistic consequences in this sort of thing. Concussions are a problem which have a growing awareness; this kind of action only helps awareness and understanding, leading towards a better life for athletes.

Massive kudos.</comment>


Asteroid that narrowly missed Earth 'slipped through the net' - <AUTHOR> https://www.independent.co.uk/news/science/asteroid-nasa-near-miss-earth-emails-2019-ok-a9113846.html <comment><AUTHOR> _The emails showed space agency employees rushing to discover how the asteroid avoided detection, after a colleague alerted them to the near-miss "because there may be media coverage tomorrow"._</comment>


Starbucks Commitment to the UK | Starbucks Coffee Company - <AUTHOR> http://starbucks.co.uk/blog/starbucks-commitment-to-the-uk/1240 <comment><USER2> The three things that stood out for me were:

1 Starbucks lumped National Insurance into their tax bill

2 They pay "branding rights" to the parent corporation

3 They make almost no profit in the UK

The first point is that NI is pretty much unavoidable anyway, so including it doesn't really make you look great. Only really low-level tax evaders try to get out of NI and PAYE.

The branding rights is an obvious avoidance measure. They don't _have_ to pay this, since Starbucks UK is wholly-owned by their US headquarters (and if they're not, they may as well be).

The final point actually follows from the second: they don't report high profit because it's all syphoned off via branding rights. Do they seriously expect people to believe they operate in the UK purely out of the goodness of their hearts?

<comment><USER3> > The first point is that NI is pretty much unavoidable anyway, so including > it doesn't really make you look great. Only really low-level tax evaders try > to get out of NI and PAYE.

IANATL but do Starbucks even have any PAYE or NI tax to pay? Isn't it their employees that pay that? Just because Starbucks happen to take the money off of your pay cheque for you doesn't mean that it's not your tax liability that's being paid for.

Not having your employees systematically avoiding tax (e.g. like what happens at some levels in the civil service) is great and all but it's not like Starbucks are out there preaching to their employees about how awesome it is to be a tax payer.

<comment><USER4> In the UK, PAYE and NI are deducted from your headline wage, but then the employer has to pay an additional NI contribution on top of that, which is what Starbucks are presumably referring to. Employers aren't allowed to deduct this from staff wages, so instead they simply pay staff a lower wage to start with.

</comment></comment></comment><comment><USER5> People stumbling upon this: please make sure you read the comments on that blog post.

Apparently Starbucks changed the original writing; with huge semantic differences. It seems they divulged something they shouldn't have…

<comment><USER6> They didn't 'divulge something they shouldn't have' what they did was say that in the £160m in taxes they are saying they paid they include PAYE. PAYE is the portion of an employee's salary that is automatically taken by the taxman; so Starbucks were saying they paid taxes that in fact their employees paid.

It would be interesting to know what other taxes they include in that figure (such as VAT which a company would merely collect from customers and pass onto the government).

<comment><USER5> "so Starbucks were saying they paid taxes that in fact their employees paid."

That's what I meant by divulging something they shouldn't have. Them considering taxes their employees paid as taxes they (Starbucks) paid is obviously something that won't be received favorably.

</comment></comment></comment><comment><USER7> > _Following a number of stories in the media over the last day about > Starbucks and the amount of tax we pay each year, I believe it's important > that we share the facts with you on this important issue._

I know that anything they say after this is going to be sleazy lies and distortions. It is baffling to me how they think they can churn out vapid puffery and expect people to believe it.

The comments on the blog are delicious, and I really hope parliamentary researchers are reading and passing information onto the select committee.

</comment><comment><USER8> It's simple really... vote with your wallet and don't buy Starbucks coffee

<comment><AUTHOR> vote with your wallet and your taste buds and your health. All three suffer when you buy Starbucks coffee.

</comment></comment><comment><AUTHOR> Ha ha absolute meltdown in the comments. Methinks this won't go well for Starbucks.

<comment><USER9> brilliant, one blog post not to have comments on if ever there was.

</comment></comment><comment><USER10> You'd have thought for all that effort they could have made some decent coffee.

</comment><comment><USER11> I prefer this article: <http://news.ycombinator.com/item?id=4777423> (Starbucks, Google and Amazon: the tax crash of Monday afternoon)

</comment><comment><USER4> I'm really curious. Did anybody here read that and think that it in anyway painted Starbucks in a better light, even if taken with a pinch of salt?

A lot of press-releases are often aimed at investors or the business markets etc., which is why they sometimes appear strange to the general public. But even (perhaps especially) those types of audience are even more able to see through this kind of BS and understand how the "system" works, so I'm really not sure why they released it at all. Any thoughts?

<comment><USER12> I think it's aimed at consumers, trying to patch up their public relations. Taken at face value (and overlooking the comments), it does sound vaguely comforting - they quote a big number for taxes paid, protest that they're not making much money, and talk about the local things they source (so caring of them, not to fly sandwiches in from China!). If you were unsure, but kind of liked going to Starbucks, I imagine you could well go away thinking that maybe the allegations were overblown.

<comment><USER4> Maybe. Most customers having heard the allegations though I would have thought that it would take a lot more than this to pull the wool over their eyes. Maybe I misjudge some of their customers though...

</comment></comment></comment><comment><USER13> <http://pastebin.com/UGdPnaDb> mirror of the comments</comment>


Ask HN: What's the ratio of people clicking forgot my password on a login form? - <AUTHOR> We are working on making login easier for non tech people, and we want to open the discussion/feedbacks about password issues on websites/mobile app targeted to nontech visitors and users. <comment><USER2> Depends on frequency of use and if there are any weird requirements like no symbols.</comment>


A study on human behavior has identified four basic personality types - T-A http://www.uc3m.es/ss/Satellite/UC3MInstitucional/en/Detalle/Comunicacion_C/1371223155576/1371215537949/A_study_on_human_behavior_has_identified_four_basic_personality_types <comment><AUTHOR> A friend of mine who's quite into philosophy once told me that a good number of philosophers did little but try to categorize things. Rather than draw meaningful insights, say, or squeeze every drop out of some experience, they'd simply say, here's nature, here's a grid I've drawn, let's see what falls into what square. Ok, good job; but what have you actually accomplished? (So my friend said.)

I don't know if this is true of the history of philosophy (or if it's a meaningful indictment of these philosophers), but I can't help but be reminded of it when I see strenuous efforts being made to bucket various phenomena, and human ones at that. What are we going to do with these categories? Not to put too fine a point on it, these things are complex. Any differentiating scheme simple enough will be insufficient to be the basis of any important decision, and any sophisticated enough won't be neat enough for us to be talking about it like this.

I say this as someone who spent more years than I'd care to admit obsessed with MBTI. Wow, look, there are all these different people with their strengths and weaknesses. I even get a cool framework—a _stack_ —to aid me in psychoanalysis. And then of course you have Socionics, which shamelessly tries, using just sixteen categories, to produce a catalog of human interaction. I am not saying it isn't _fun._

Actually, MBTI did help me in one way: by showing me how diverse humans are. In my most advanced, intelligent state, I'm still not going to get along with or be compelling to all of them. That was an important idea for me growing up, and still is.

But beyond that, and running the risk of sounding unsophisticated: who cares?

<comment><USER2> Eleven years ago Kaiser Permanente hired me to help roll out new software to all their hospitals in Northern California. We had like 3 months of training before going in and one of the things they had us do was some personality type thing with some psychologist.

It felt like this lady was trying to shoe horn me into some category, telling me I am some 4 letter acronym and here are my strengths and weaknesses. I just kept arguing with her pointing out events and situations in my life that refuted everything she was trying to say I was.

It seems like an overly complicated horoscope thing where people love to read descriptions of themselves and others to make sense of the world, even though by looking at someone's face for a few seconds you can make way more judgements about the character of someone.

<comment><USER3> The "horoscopieness" of almost anything related to personality labeling causes me to feel deeply rebellious. You can't pigeon hole me! Irrational or not, I reject that my personality is fixed.

<comment><USER4> Sounds like you fit into the "Rebellious" personality type.

</comment></comment></comment></comment><comment><USER5> I look at these things more like "check out our classification scheme which is broken down into 4 categories", as opposed to "there are 4 different kinds of people" (which the headline kinda sorta implies).

<comment><USER6> Depends on what your methods are for finding your classifications. For example, if all you're doing is recording a bunch of data over some feature set and then throwing it at an unsupervised clustering algorithm like DBSCAN or single-linkage clustering, It's not unlikely that you can say that your data can be partitioned into N distinct clusters.

Granted, that depends heavily on your features and your data set. It's just as easy to end up with one big undifferentiated blob, even after running PCA.

<comment><USER7> I mean, that's still "who cares"? It just sounds fancier.

"It's not unlikely that you can say that your data can be partitioned into N distinct clusters."

Of course not...that's tautological. You can say it because that's what it means. DBSCAN isn't some wizardry that peers into the nature of the universe...its just a clump finder. Whether those clumps have any connection to anything interesting is a coincidence. You could roll a six sided die six times and run dbscan on the results and be like "holy shit! I've discovered how to partition the natural numbers 1 2 3 4 5 and 6!!"

<comment><USER8> This is an unfair and anti-scientific characterization of descriptive research.

Correlation does not imply causation, but you (generally) can't have causation without correlation. Finding natural patterns of associations in data is our only reasonable starting point for finding patterns of causation.

Also, developing reliable and well-researched ontologies can help other researchers when building models, making sense of other data, etc.

<comment><USER7> It's not anti-scientific at all. Looking for correlations to uncover causations in data is important, and it can certainly be the beginning in a scientific effort to build a model of the world (especially, I would argue but I guess this gets rather philosophical, when it's motivated by a belief in an underlying mechanic that drives the correlated observations, perhaps developed so fully as to be considered a 'hypothesis'). Finding natural patterns of associations in data is a totally reasonable starting point for finding a causation _when a causation exists_.

Feeding arbitrary sequences of samples into dbscan and deciding that because dbscan produces output, there _is_ causation (or, that there is an underlying phenomena that can be captured in some type of model), is ridiculous. And there are tons and tons and tons of natural phenomena that will be happy to produce clumpable inputs all the time, with no underlying behavior (including noise).

I'm sure there are also tons of interesting models of human behavior that you can make out of some set of observations of human behavior via clustering. But just because you feed some data to an unsupervised learning algorithm and it discovers features doesn't imply that those features have any useful descriptive power to help us make sense of the natural world. THAT's anti- scientific thinking.

<comment><USER9> > Finding natural patterns of associations in data is a totally reasonable > starting point for finding a causation _when a causation exists_.

So if a causation turns out not to exist then finding natural patterns was an unreasonable starting point? What would have been a reasonable starting point in that circumstance?

</comment></comment></comment></comment></comment></comment><comment><USER10> As a correction to the title, they said four, but then said, "There is a fifth, undefined group, representing 10%, which the algorithm is unable to classify in relation to a clear type of behavior. The researchers argue that this allows them to infer the existence of a wide range of subgroups made up of individuals who do not respond in a determined way to any of the outlined models."

So based on the study: [http://advances.sciencemag.org/content/2/8/e1600451.full](http://advances.sciencemag.org/content/2/8/e1600451.full)

and looking at the results in: [http://d3a5ak6v9sb99l.cloudfront.net/content/advances/2/8/e1...](http://d3a5ak6v9sb99l.cloudfront.net/content/advances/2/8/e1600451/F2.large.jpg)

the summarization of "Undefined" as "Decides randomly" seems a little wrong- there's an obvious tendency in PD (Prisoner's Dilemma) for some results: [http://d3a5ak6v9sb99l.cloudfront.net/content/advances/2/8/e1...](http://d3a5ak6v9sb99l.cloudfront.net/content/advances/2/8/e1600451/F3.large.jpg)

Also, I can't help but wonder whether there is bias effect, as humans seem to tend to use a small number of groups or factors for personalities. For example, in literature, J.K. Rowling's sorting hat chose between Gryffindor, Hufflepuff, Ravenclaw, and Slytherin, and Veronica Roth had citizens of Chicago choose between Abnegation, Amity, Candor, Dauntless, and Erudite. Even though there is a mix between races in humans, we tend to categorize- like in the U.S., typically you must choose from Caucausian, Asian-american, African- american, Pacific-islander, or Hispanic, even though color and genetic makeup vary. Then MBTI has four factors (E/I, S/N, T/F, J/P). Friedman and Rosenman came up with A and B types then later Denollet added the D type. We tend to categorize like this.

Also, they chose just four games for the study. That could have affected the outcome.

<comment><USER11> > Abnegation, Amity, Candor, Dauntless, and Erudite.

She tried so hard for ABCDE, but couldn't find the word "Benevolence" ?

</comment></comment><comment><USER12> The article's description of the research is unhelpful, and almost certainly wrong. This doesn't sound like an attempt to identify four basic personality types. It's an attempt to categorise behaviour in a single, very precisely defined economic experiment. We already know the five basic dimensions of personality: openness, conscientiousness, extroversion, agreeableness and neuroticism (OCEAN).

It's sad that there is so much good social/psychological science out there, but people know so little about it and fall for this kind of ignorant reporting.

<comment><USER13> " We already know the five basic dimensions of personality"

That model present five dimensions, to which the personality traits are mapped. It does not mean they are the basic dimensions of personality. Similarly I can map the world into 2 dimensions as in a photograph.

But I cannot say I've mapped the world to it's basic dimensions. I've lost quite a lot of data already - I'm missing 4 dimensions of data. The 3.rd coordinate, and 3 for momentum.

<comment><USER12> It's a fair point. People can't be reduced to a 5-D vector of traits. (Otherwise novelists would be out of a job.) But OCEAN does capture a lot of human variability.

<comment><USER14> Can you provide citations please? All the correlations I've seen have been in the 0.3 range, which doesn't equate to a lot of human variability.

I actually think this study is pretty interesting. Full text here: [http://advances.sciencemag.org/content/2/8/e1600451.full](http://advances.sciencemag.org/content/2/8/e1600451.full)

I don't believe in their clustering, but then I rarely believe the output of any unsupervised learning methods.

Its an interesting approach, the real question is whether or not it captures incremental variance relative to an OCEAN (or the six factor one they like in medicine) baseline.

<comment><USER12> Heh, so now I had to read the actual study.

I agree it's interesting, but my original impression was also true: this isn't about discovering basic personality types. It's about correlating play across four 2 x 2 experimental games. This is a very, very narrow domain of social behaviour. Standard personality psychology, by contrast, aims to predict behaviour across a much wider range of situations. (I still think that is true, even if individual correlations are low in any one situation. But, if you know better and personality measures actually a crock of crap, feel free to correct me!)

Of course, it's possible that there really are four deep types of human personality, that you can capture them in these four games, and that they predict behaviour in lots and lots of domains. But I doubt it, and this article provides no evidence for it.

What's more interesting is the comparison between this unsupervised clustering method, and more theory-driven ways of categorising play in games, like inequality aversion models. I think there is an interesting race between psychologists, who pay greater attention to internal validity, and experimental economists who focus on theory consistency. I'd like to know which kind of models does better at predicting out of sample.

</comment></comment></comment></comment></comment><comment><USER15> Oh, come off it. Of course the study "identified four basic personality types". They set out to identify four personality types to begin with:

 _After carrying out this kind of social experiment, the researchers developed a computer algorithm which set out to classify people according to their behavior. The computer algorith organized 90% of people into four groups:_

It's not magic, innit. If you choose a bunch of features and run some classifier on them you'll get some grouping accoring to the distribution of values of those features in your sample. If you choose a different bunch of features, you'll get a different grouping. What did you learn? That your features have a distribution- well done.

Trying to clasisfy peoples' personalities is futile: what constitutes "behaviour" or "personality attributes" is very, very arbitrary and there's nothing to say it's not all in the eye of the beholder to begin with.

</comment><comment><USER16> _" There is a fifth, undefined group, representing 10%, which the algorithm is unable to classify in relation to a clear type of behavior."_

They are _divergent_ :-). I found the characterization of "Envious" as people who always want to win a bit more charged than "Competitive" would have been.

</comment><comment> d--b Based on 541 interviews of Spanish people living in Barcelona, a study is able to classify 7bn human beings into 4 very distinct categories, and guess what, most of them fall in the 'bastards' category.

</comment><comment><USER17> "Optimistic, Pessimistic, Trusting and Envious" in case you missed the obvious like myself.

</comment><comment><USER18> I am checking to see if this is a joke :) This is not the first time for psychologists to come up with divisions like this. Not really sure how relevant this is, thoughts?

<comment><USER19> It is not the categorization itself that particularly caught my attention so much as the observation that many people would rather be envious than, say, optimistic:

> _the latter of the four types, Envious, is the most common, with 30% > compared to 20% for each of the other groups._

See also: Why are Adults so busy? [https://news.ycombinator.com/item?id=12494999](https://news.ycombinator.com/item?id=12494999)

</comment></comment><comment><USER20> This looks about as useful and sophsticated as the MBTI (ie, not very): 'A study on human behavior has revealed that 90% of the population can be classified into four basic personality types: Optimistic, Pessimistic, Trusting and Envious.' I can't see how this contingent typing, apparently done for the purposes of being able to group people to do game theory experiments, can have much external validity, especially as there will be so many edge cases and double- or even triple-class members. This just doesn't look worthwhile, from this article.

<comment><USER21> When I read about my MBTI type, I can reasonably say "Yes, I am exactly like that, and no, I'm nothing like the others." When I read about these categories, my reaction was "I'm all of these."

<comment><USER22> That's because MBTI is about as scientific as astrology. Frankly, when I studied psychology in college ( _real_ psychology, not e.g. some Scientology 'psychologists are evil space aliens' claptrap), I came to the conclusion that most of it is equally unscientific. It has the form but not the substance.

</comment></comment></comment><comment><USER23>
      1. The Envious (anything to get ahead of everyone)

      2. The Optimists (everyone else is basically good, have faith)

      3. The Pessimists (most others are evil, favor the lesser of evils)

      4. Trusting Collaborators (will go along with anything to just be included)

      5. Unclassifiable (no common archtype correlating decisions, strategic decision making demonstrates conflicting tendencies)

<comment><USER11> 4 simplistic patterns, and one group of creative thoughtful people. I wonder how well "Unclassifiables" are represented among the most accomplished and powerful people in society.

</comment></comment><comment><USER24> I have found another one with 6 which seems far less crude and has also statistic "proofs": [http://www.comcolors.com/en/](http://www.comcolors.com/en/)

</comment><comment><USER25> Wrong. My hand is in a splint after arthritis surgery, so I can't type much here, but see any reliable online source about the "Big Five" theory of human personality to find out better information.

</comment><comment><USER26> Sounds like 5 personality types IN game theory. Not in personality ? It mean it doesn't include how nervous / relaxed the person is. Which impacts a lot.

</comment><comment><USER27> Sounds like bunk. Optimistic<\--->pessimistic is obviously a complete axis, which can have envious and trusting people on it all over the place.

<comment><USER28> Not to mention these may change upon circumstances.

</comment></comment><comment><USER29> Meyers-Briggs are gonna be suing these guys for sure.

</comment><comment><USER30> I remember looking at the distributions for Meyers-Briggs quizzes on OKCupid...

They were not Gaussian distributions :)

</comment><comment><USER31> Oooh, I can break it down to just 2 personality types: men and women!

</comment><comment><USER32> How is the image related to the article?</comment>


EU innovation deficit?? - <AUTHOR> http://www.washingtonpost.com/blogs/innovations/wp/2015/06/08/europes-innovation-deficit-isnt-disappearing-any-time-soon/

<comment><AUTHOR> I read the article, but am not from the EU. I remember that ZenDesk for started in Denmark. Also, I hear that the startup scene in Berlin is good. What do people from the EU think?</comment>


Show HN: FamilyOKJobs, jobs with a chance to be with your family - <AUTHOR> https://familyokjobs.com <comment><USER2> First observation: In Post a Job, there is a typo for Job Desciption (should be Job Description) Second observation: Under How to apply, I think there should be a link to the apply page (example: [http://careers.hotjar.com/o/full-stack-developer- europe](http://careers.hotjar.com/o/full-stack-developer-europe)), maybe a button to indicate Call to Action. Currently, I need to select it, copy, paste it in the url to get to the page.

<comment><AUTHOR> Tnx for this. I will fix that typo and implement a link to apply page. Not immediately, but in the evening, after kids go to bed and wife is satisfied ;)</comment></comment>


Show HN: A Lichess Team for HNers - 1-KB-OK https://lichess.org/team/hacker-news <comment><AUTHOR> The second HN chess tournament: [https://lichess.org/tournament/Wg6CHtmp](https://lichess.org/tournament/Wg6CHtmp)

I'm pretty pumped to the idea of losing some games :)

</comment><comment><USER2> Thanks for this. Lichess is pretty great in terms of features. If you see the guy playing the bong cloud, that's probably me.</comment>


Turbocharging web sites with new PageSpeed Service optimizations - <AUTHOR> http://googledevelopers.blogspot.com/2012/08/turbocharging-web-sites-with-new.html

<comment><USER2> The single biggest drag on page speed for the user right now is social buttons (which act more like tracking tags) from G, FB and T - and tags for 3rd party payment systems or affiliate tracking.

The payloads on these tags can be enormous. Stepping through one recently - the tag was pulling down 12 additional scripts including two different versions of jquery - in addition to the jquery version used on the site.

A couple of these tags can make a 400ms page take 4s+.

<comment><USER3> I made sure to setup my G/FB/T tags to load async. They show up on the page when they are done loading and don't prevent the rest of the page from loading as quickly as possible.

That said, I agree, they are slow to load and it is crazy how much extra stuff they load into the DOM.

<comment><USER4> I'm taking the approach of putting an image in their place of social buttons, than when a user hovers near the element replacing the image with the working javascript one.

That said, I think PageSpeed Service will only benefit really poorly coded sites who's webmasters aren't tech confident enough to optimise a site correctly.

<comment><USER3> What happens if someone hovers or clicks on the image and the underlying JS hasn't loaded yet? Also, how will you show the 'count' of Likes? You may wish to reconsider that approach as it sounds like it adds complexity without really benefiting the end user.

PageSpeed is more than just optimization of JS/HTML. It is also about only sending the data which has changed. And really... why should all developers have to worry about doing that optimization as part of their build step when they can get it for 'free' with services like CloudFlare/PageSpeed? Sure, it isn't for everyone, but I can see it being of value for a lot of different sites out there. I love keeping an open mind on stuff like this.

</comment></comment></comment></comment><comment><USER5> It's unfortunate PageSpeed is still a semi-closed beta; I've been trying to get access for some time now.

You'd think a year would be enough to launch a product (or at least accept everyone that enters the beta, if you want to keep things quiet).</comment>


Unequal Pay: The Worst and Best Cities for Women in Tech - <AUTHOR> http://www.xconomy.com/national/2016/03/01/unequal-pay-the-worst-and-best-cities-for-women-in-tech/ <comment><AUTHOR> This study adds a little more color than the Dice study (which has been reposted from multiple sources at least 3 times now).

If you adjust for the same basic factors as the Dice study but also factor in location and some cost of living factors, it matters quite a bit where you are geographically when comparing tech salaries.

But never thought I'd see a study that ranked it better to be in tech in Detroit than in SF, so either this is very interesting or also flawed in some key ways.</comment>


Ask HN: Best Open-Source Monitoring? - <AUTHOR> I maintain a bunch of small things: little web sites, a Twitter bot, a couple of home servers, etc. Currently I'm getting rid of my colocated server and moving a bunch of stuff to the cloud. (Yay terraform!) 7 years ago, I ended up with Nagios for monitoring and alerting, but I've never really liked it. What are folks using these days? What do you like about it? <comment><USER2> What do you mean by best?

What features are you looking for?

What is your comfortable tech expertise to configure, organize, and maintain monitoring tools?

There are a few good OSS monitoring tools out there.

Alerta - Distributed, scaleable and flexible monitoring system.

Canopsis - Opensource Hypervision and Data Aggregation Software

Cacti - Web-based network monitoring and graphing tool.

Cabot - Monitoring and alerts, similar to PagerDuty.

Centreon - IT infrastructure and application monitoring for service performance.

check_mk - Collection of extensions for Nagios.

Flapjack - Monitoring notification routing & event processing system.

Icinga - Fork of Nagios.

LibreNMS - fork of Observium.

Monit - Small Open Source utility for managing and monitoring Unix systems.

Munin - Networked resource monitoring tool.

Naemon - Network monitoring tool based on the Nagios 4 core with performance enhancements and new features.

Nagios - Computer system, network and infrastructure monitoring software application.

Node-Bell - Real-time anomalies detection for periodic time series, metrics monitor.

Observium - SNMP monitoring for servers and networking devices. Runs on linux.

Opsview - Based on Nagios 4, Opsview Core is ideal for small IT and test environments.

Riemann - Flexible and fast events processor allowing complex events/metrics analysis.

Sensu - Open source monitoring framework.

Sentry - Application monitoring, event logging and aggregation.

Serverstats - A simple tool for creating graphs using rrdtool. (source on github)

Seyren - An alerting dashboard for Graphite.

Shinken - Another monitoring framework.

Xymon - Network monitoring inspired by Big Brother.

Zabbix - Enterprise-class software for monitoring of networks and applications.

Zenoss - Application, server, and network management platform based on Zope

</comment><comment><USER3> I've only ever seen/used OpenNMS ([https://opennms.org](https://opennms.org)) and Nagios (which you've already got)

<comment><USER4> There are others, far more respected. Have never heard of this, looks like it can't hold it's water compared to the most commonly used systems.

Looks more like self promotion than a useful suggestion

<comment><USER3> >Looks more like self promotion than a useful suggestion

If I worked there, it might be

But I don't

Thanks for making a false assumption, though

<comment><USER4> It was a speculation, which implies I don't know the actual answer. How do we know you have no affiliation?

It's a poor suggestion either way.

<comment><USER3> >It's a poor suggestion either way.

Why?

Close to 2000 paying customers, and 20 years of history isn't good enough for you?

<comment><USER4> 2000 is a small number and says nothing about trajectory, time is less important, 20 years sounds like a zombie project if it's not a brand name by now.

It's about adoption, skillsets available, industry standards. Never heard of this, the landing page does not instill confidence.

Hence poor choice

It really seems like you have an attachment to this project, at least na emotional one. How do you know how many paying customers there are?

Are you sure this was not a promotion of the project originally?

<comment><USER3> LOL

Keep spazzing on others' success if you want

</comment></comment></comment></comment></comment></comment></comment><comment><USER4> Prometheus + EFK + Graphana.

</comment><comment><USER5> Grafana</comment>


Apply HN: Spendwell – A fitness tracker for your money - <AUTHOR> Spendwell is a productivity tool for your finances. We pull data from across your credit cards and bank accounts and give you tools to play around with it. This mainly takes the form of Gmail-style, filter-based labels for your transactions. That one simple mechanic enables a bunch interesting things, like seeing a list of monthly bills with paid/unpaid state clearly indicated, tracking your average vs. current spend in a label without having to create a budget, and much more.
We also summarize income vs. spending from across all accounts giving a really clear picture of how much money you have to spend without breaking the bank.
This is a scratch your own itch idea. After trying many of the existing tools like Mint, YNAB, Level etc. we felt no one was tackling the problem the way we wanted. We wanted a simple and powerful tool that let us manage our finances in our own unique way.
My partner Matt and I have been working together for years. We've worked on several projects, including a previous startup. We're extremely excited about the potential for this one, and we'd love to know what you think.
https://www.spendwell.co <comment><USER2> Hey HN, I'm the other Co-Founder of Spendwell. We'd love to hear what you think and we're here to answer any questions you may have.

[https://www.spendwell.co/](https://www.spendwell.co/)

</comment><comment><USER3> Love this. Interested to hear about the underlying technology used. Sounds like building this might be a bit of a nightmare.

<comment><AUTHOR> It's a React+Relay single page app talking to a Django-backed GraphQL endpoint.

Django's ORM helps a lot with cleanly serializing the filters. Though we denormalize the label/transaction relationship, since live-filtering everywhere in the app kills performance.</comment></comment>


A 21 Year Old Software Engineers 260K Salary and How She Spends It - <AUTHOR> https://www.businessinsider.com/software-engineer-with-260k-salary-how-spend-my-money-2018-6 <comment><USER2> 6 hour days? Fire her.</comment>


The Evolution of V8 and the Challenges of Research in a Billion User VM [video] - <AUTHOR> https://www.youtube.com/watch?v=z92Xm9VlPjM

<comment><USER2> I wonder how many of these techniques could be/are applied in other VMs such as the JVM or .NET?</comment>


Game Mechanics - the new black - <AUTHOR> http://joncarder.com/post/549498751/game-mechanics-the-new-black

<comment><USER2> I like to read these kinds of articles because it is interesting to see how other people choose to categorize their game mechanics philosophies.

In my mind, a game is comprised of a goal and methods for reaching that goal. You can manipulate the more subjective concept of "fun" by changing the goal's attributes/complexity or adjusting the methods (adding, subtracting, manipulating challenge).

The point to reaching the goal is for reward, which is why I do not list it separately. Reward is often a gateway to more games. For example, the scoreboard is actually a metagame, where the goal is to get the highest score in a competition with other people. The game of "catch" is time-honored and does not involve much more reward than the gateway to the metagame of becoming more dextrous.

By methods, I refer to all the tools at your disposal to try to reach your goal. These can include tools outside the parameters of the game; after all, many people can have fun by cheating the game, and in some games, cheating is part of the point (reneging in Uno).

The point is, as far as I can tell, there are just the two parts to a unit game definition, and the interesting stuff involves all the tweaks you make to those two parts. A typical fun game will be comprised of many minigames.

So I do not agree with this --

 _Unlike video games, company games need to be simple and focused._

We just need to be clever about shaping motivations and limitations for the audience, be it video game players or "company game" players. The video game industry is seeing greater successes when the games are simple/accessible, too.

<comment><USER3> Winning a game can be a reward in itself. (Or rather, the sense of smug superiority over your peers you get out of it--of course this only works if everyone's playing to win.)

</comment></comment><comment><USER4> Roll 5 d10 and take the median. You get a bell-shaped distribution, but you don't have to do any addition-- the result is immediately visible.

<comment><USER3> You have to do comparisons, though.

Anyway, what's the connection to the article?

<comment><USER4> It's a good game mechanic for RPGs. In high school when all the cool kids were writing their own role-playing systems, I wrote one based on m5d10.

I feel like the computational (and, worse, legalistic) overhead for RPGs can detract from the fun of playing. So I wrote a simpler system that was based on that. Finding the middle of 5 d10s is something you can do (once you're used to it) in 0.25 seconds, so it's "immediately obvious" what the dice say. Adding 5 d10s takes about 1-2 seconds for most people, which is enough of a pause to break flow.

However, the real flow-breaker of RPGs isn't computation, but looking up rules in a rulebook to figure out how many dice of damage you take from a third- story fall before deciding whether to leap. This is one of the problems with formal role-playing systems... but, as always, the quality of the session has a lot more to do with the GM and players than the system itself.

But if I were to do a role-playing system now, it'd be based on Tarot cards (the 22 trumps). RPGs are more about interactive storytelling than about combat and number-crunching.

<comment><USER3> Fair enough. That's interesting.

The article seems more concerned with goals and incentives, than with nuts and bolts.

By the way, how would your Tarot card system work? They could make for an interesting qualitative instead of quantitative system. Say, you try to do an action, draw a card and interpret "The Fool" as fumbling.

<comment><USER4> The cards have a ranking that is on the card (Judgment is 21, World is 20, Fool can be 0 or 22) if you need a quantitative result, but it would be a mostly qualitative system. How it would work would be based largely on the GM, since you can't write rule books for qualitative systems.</comment></comment></comment></comment></comment>


Print your own handcuff key? - <AUTHOR> http://blackbag.nl/?p=940

<comment><USER2> This brought up some traumatic memories from very long ago.

To make a long story short, such a key would have come in fairly handy at some point in my life (only we didn't have 3D printers then).

The longer story:

In Amsterdam, in the early 70's they were building a subway. This led to all kinds of bad feeling between the people and the municipal government culminating in riots on the 'Nieuwmarkt' where a bunch of houses would have to be torn down.

My dad was there when it happened and spotted a police issue pair of handcuffs on the ground after the melee.

He picked them up and took them home as a 'souvenir'. A little while later he had to go on a trip and an uncle came to look after us.

I found the handcuffs and tried them on my one hand first 'crrrrclick', ok, that was fun. Then - of course - the other arm. I showed my uncle who thought it was funny but told me to take them off.

Slight problem, they were on pretty solid, I'd pushed the ratchets as far as they would go. Now panic set in, causing my wrists to swell. My uncle freaked out too, searched everywhere for a key (which wasn't there) and finally had to call the police to get me 'liberated'.

They were definitely not pleased and after releasing me took their handcuffs with them and issued a fairly stern warning and had my dad report to the station for another lecture upon his return.

<comment><USER3> In case someone gets into such a situation:

I've seen that many handcuffs can be opened with a strong, thin wire by pushing the hook, which keeps the ratchets from going back, back and pulling the ratchet out. Source was some documentation about a certain military operation where someone explained how he got out of a police station.

<comment><USER4> I'm interested in how getting out of handcuffs would help you out of a police station. Isn't it like saying that picking the locks on the door to the White House will get you in to see the President?

<comment><USER3> I'd call it a 'necessary requirement', or even a 'requirement that is good to have'.

Certainly, if I -- as a pretty untrained computer science student -- pick my lock in the largest new yorker police station, well... who cares? Similarly, if you pick the lock of the white house, you probably won't see the president.

On the other hand, if a highly trained marine wants to get out of some police station, he will probably get out of there, and he can raise his chances a lot if his hands are not constrained by handcuffs. (And similar, if a highly trained specialist wants to see the president, he has some chance to do so, and if he can pick any lock in the white house, his chances rise pretty much)

</comment></comment></comment></comment><comment><USER5> It is worth pointing out that the key is made of plastic, which means that metal detectors won't get it. This is going to be a fun century.</comment>