Preparing for and runing a Design Thinking, Gamestorming and Creative workshop - <AUTHOR> http://eurydice13.com/2019/01/how-to-prepare-for-and-run-a-design-thinking-gamestorming-creative-workshop-and-what-to-do-with-the-outputs-too/ <comment><USER2> To everyone who thinks design thinking is just the obvious way to do things, I think you need something to contrast it with. In the same way that we cannot see anything innovative about "agile" without understanding the standard that was "waterfall."

Suppose we wanted to come up with a new product in the "old days". Or you ask an unenlightened person to come up with a product. What might they do?

Brainstorm, would be my first guess. You would brainstorm various products. So let's take the latest thought from @boredelonmusk:

"Eye tracking software that engages turn signals automatically when the driver (who has no regard for other humans and shouldn't legally be allowed to be on the road or really be part of any modern society) doesn't."

So there is an idea, and then maybe someone else will come up with another one and another. After that maybe we'll all vote on the best idea.

After that someone start implementing an early version to test. So let's say they mount a helmet on a person and they try to get the eye tracker to work properly. Once they have that working, they will try to get it hooked up to the blinkers.

Once the prototype is out, we'll see if we can mass produce it, and also start market testing.

With "design thinking", you would not start with brainstorming "ideas". You would brainstorm problems to solve. (People not putting on their turn signals). Then you would go out and see if that really is a problem, and maybe interview people. If its not a problem, you would discard it without anyone voting on it.

If you did discover its a problem, you would then test to see if people were interested in an eye tracker. You would do interviews and mockup a product to see if people would even bother to wear it.

Its not "just" thinking. Its a particular habit (a "discipline") of thinking.

<comment><USER3> > To everyone who thinks design thinking is just the obvious way to do things

Things always seem obvious as someone explains them, but not when you're wondering what to do without prior experience or knowledge of what works.

I have an idea of designs I like, I have no idea how to go through and replicate those designs necessarily and they may not be what my boss or the client wants. I've been led down paths of building awful designs by clients, but they're paying so... I just do what they say, till they realize what we realized long before the design was implemented (and trust me, no amount of telling them works).

</comment></comment><comment><USER4> I took a design thinking course in college, and it was something the people in charge were pushing really hard.

Tbh, I'm not sure what the big deal was. To me, without any prior "formal" (read: academic) entrepreneurship knowledge, it all felt extremely obvious. It's the basic process that pretty much everyone uses to solve some unknown problem

Find a need -> define the need further -> brainstorm solutions -> pick a favorite, start building and prototyping -> test - iterate -> present final prototype - GOTO start if needed.

I guess it's decent learning for people that are stuck on creating solutions for unknown problems (i.e "solution waiting for a problem to solve")

<comment><USER5> Every time "design thinking" comes up the responses around here are similar: That's it's an obvious and somewhat natural process.

I think that's part of the point. It's a natural process for creative people with development experience and critical thinking skills. But those people are often not in charge of projects. Those people in charge need these concepts formalised into a process to even consider it. In my experience, many development frameworks come from developers trying to get average managers to sort their shit out.

</comment></comment><comment><USER6> When I was working for a large consultancy, I hosted a couple of DT workshops. The whole thing is no magic. But one thing for what it is great for: it forces people to think from the customer perspective. Sounds trivial but especially for large and old companies that is a huge thing.

</comment><comment><USER7> Stanford's dSchool primer on design thinking:[https://dschool.stanford.edu/resources- collections/a-virtual...](https://dschool.stanford.edu/resources- collections/a-virtual-crash-course-in-design-thinking)

Design Thinking MOOCS:

        https://www.edx.org/course?search_query=design+thinking
        https://www.coursera.org/courses?query=design%20thinking

</comment><comment><USER8> Someone I know was at a big 4 consultancy was taking the internal class on "Design Thinking".

At one point a lady turned whispered to the rest of the class:

"Design Thinking is just thinking!"

And actually this is simply the case. How did "having a think about things" get its own proper noun?

<comment><USER9> I witnessed time and time again that if you can give something a catchy name and somehow promise that doing / having that thing gives you an edge over someone else, you can make a lot of money.

I should try to make a course out of this single realisation (by repeating the same thing over and over) and call it " __brand thinking __, the most usefull skill a product manager can learn in the digital age ". Or something.

It probably already exists.

<comment><USER10> [https://www.brainpickings.org/2013/05/01/brand-thinking- debb...](https://www.brainpickings.org/2013/05/01/brand-thinking-debbie- millman/)

The name seems to be taken, and their Markov Chain results (something about identity) seem to fit the name better than the one you are planning to run :)

Maybe with another name. Maybe you can create the research field of metabranding!

</comment></comment></comment><comment><USER11> For workshops like this, you should consider using Diggle (diggle.com/trial). We're still in beta, but this is the type of thing we use it for.

<comment><USER11> (No mobile friendly backoffice yet)</comment></comment>


JQuery UI Bootstrap: A New Bootstrap-inspired Theme For Your Widgets - <AUTHOR> http://addyosmani.com/blog/jquery-ui-bootstrap/

<comment><AUTHOR> Project page: <http://addyosmani.github.com/jquery-ui-bootstrap/></comment>


Medicare will require hospitals to post prices online - <AUTHOR> https://www.msn.com/en-us/news/us/medicare-will-require-hospitals-to-post-prices-online/ar-AAwiccI <comment><USER2> I really like this push towards transparency but hopefully people who use the data / develop will make sure to understand the system and the data they're dealing with. Like list prices are often incredibly far removed from the actual dollars paid, and the actual amount paid is all dependent on insurer contracts

I'd imagine hospitals hate this. Many of them are paranoid at what will happen if there is more transparency -- there's a union fighting Stanford hospital now and playing radio ads about high infection rates at Stanford. Other hospitals are worried about whether similar things could happen to them -- and hold their data tight to make sure no one has ammunition to do similar things. Hospitals in many cases market based on brand value rather than quality. In a closed world, hospitals can define quality any way they want. Everyone is #1 in something. If there's an objective standard for quality based on integrated data from hospitals nationwide, many brands will be tarnished. I'd be interested to see how hospitals respond to this push towards openness

<comment><USER3> How this isn't already mandated by law is baffling. We like to champion the "free market" but then completely fail to implement policies that make that even remotely possible.

When people talk about the free market and today's healthcare in the US I'm always like, "What are you even talking about?" You've got a situation where there is typically no competition and little or no information available to the consumer. Free market economics simply don't apply.

One of the reasons I like Kaiser is because the price for just about everything is posted. I know an CT scan of stomach area, with dye is $608. Every healthcare provider should be required by law to give you an estimate price on the spot. If it's too complicated because of multiple insurance providers and their contracts they should be forced to renegotiate in a way that make this possible. "It depends" or "we can't tell you until after we bill you" is not acceptable. Can you imagine any other market working that way? How much is this car? Can you imagine if the response was, "Well, it depends. We can't tell until after you agree to take possession. It's somewhere between $40 and $40,000. But it might actually be free if you submit form X, but you have to go back in time and submit it before you walked in the door and get it approved."

If the option was universal healthcare vs a free market system there would at least be a discussion. Instead it's universal healthcare vs the roll-of-the- dice healthcare system we have now.

<comment><USER4> I'm glad to see someone else shares this view. I've been saying for years that both a single payer health system _and_ an actual free market system would be preferable to the heavily-yet-poorly-regulated mess of a "market" we have now.

If we don't go the single payer route, it seems one of the #1 things we could do is to help move "insurance" back to being actual insurance (i.e., we'll keep you from being bankrupted by your medical bills) rather than a system that highly subsidizes your regular medical care but then may not actually be there for you when the bills really pile up... If consumers had to actually shop for procedures (as opposed to knowing the out-of-pocket is $250 and who knows what happens beyond that), I think you'd start to see people screaming for transparency, and medical providers would have to get their acts together.

Only one of many problems, I know.

<comment><USER5> Resetting the expectation that insurance is for unusual procedures, not for yearly checkups and the common cold would be a great start. It's also necessary to focus on the supply side. Just two examples: the AMA limits the number of doctors and new hospitals can't be opened without the approval of the existing hospitals in the area. There is far from a free market in health care in the US.

[http://reason.com/archives/2017/10/25/this-one-weird- trick-c...](http://reason.com/archives/2017/10/25/this-one-weird-trick-could- improve-medic)

<comment><USER6> Except checkups and preventative care are usually far, far more effective than emergency care. So it would be to the benefit of all for insurance to cover it.

<comment><USER7> This is intuitive, but turns out to be false.

That is, for any one particular patient who's found to have a disease down the road - say, cancer - it would have been cheaper for him if that problem had been found very early, so _for his individual case_ the checkups and tests would have been a big savings.

But when you account for all the people that do not turn out to have the problem at all, and the cost of checkups and tests, and then especially the costs of the followups due to false positives that are a risk in every test, the overall cost of test and prevention is actually worse.

<comment><USER8> Your statement is poorly thought out on several fronts.

Firstly putting a bullet in the head of anyone with non trivial cancer would probably be a financial savings for the insurer but the real equation is the human/societal benefit of treatment vs costs to best make use of a finite resource.

A simple cost of treatment analysis even misses out on the income that a person would have earned had they not died and the money that could have been paid in taxes and used to fund more treatment.

Drilling down into just the cost of treatment your statement isn't even wrong its a category error like saying that adding 2 integers always yields a number greater than 42.

For any given test and set of circumstances under which it is administered there can be a cost benefit analysis.

Example if you spend a thousand dollars on each false positive result and save 10k for each and have a 1% false positive rate and test a million people with a 1 in a million true positive rate. You will find one true positive saving 10k unfortunately you will also find 10k false positives and waste 10 million dollars.

In actuality you wouldn't do this you would test people whose symptoms or circumstances suggest they are likely to have it.

It seems fantastic to suggest that preventative medicine is always financially negative when people who actually study health care say otherwise.

<comment><USER7> Still, you've got your facts wrong. Consider:

 _Mr. Gruber_ [yes, it's THAT Jonathan Gruber] _found that when retirees in California began visiting their doctor less often and filling fewer prescriptions, overall medical spending fell. People did get sick more often, but treating their illnesses was still less costly than widespread basic care — in the form of doctors visits and drugs. ... As Dr. Mark R. Chassin, a former New York state health commissioner, says, preventive care "reduces costs, yes, for the individual who didn't get sick."_ [1]

You go on to state that the additional productivity of the person we saved also nets us additional savings. But the same article contradicts this notion as well:

 _The actual savings are also not as large as might at first seem. Even if you don't develop diabetes, your lifetime medical costs won't drop to zero. You might live longer and better and yet still ultimately run up almost as big a lifetime medical bill, because you'll eventually have other problems. That would be an undeniably better outcome, but it wouldn't produce a financial windfall for society._

You go on to suggest that medical professionals would not be wasting money on doing too many tests: "For any given test and set of circumstances under which it is administered there can be a cost benefit analysis."

That seems logical, but it's not how the real world works. People get emotional about the potential risks, and demand the tests even when there's not a clear indication. You might remember the hubbub a couple of years ago when it was suggested, based on historical evidence, that regular mammograms should be delayed a few years later than was currently the practice. But women's health advocacy groups raised such a hue and cry that the actual medical guidelines were not changed to follow the evidence.

[1] [https://www.nytimes.com/2007/08/08/business/08leonhardt.html](https://www.nytimes.com/2007/08/08/business/08leonhardt.html)

<comment> your-nanny I think that it is very hard to do a proper accounting. It is difficult to forsee all the consequences of an intervention; if a parent is sick, they do not work. The other parent may need to stay home too to help out. A double whammy on productivity. The firm employing them takes a hit too, as well as the municipalities and other levels of government depending on tax revenue. Such hits can lead to declines in necessary investment. And this doesn't even account for possible epidemiological effects, which can be highly nonlinear, as infection Cascades can be frequency dependant.

</comment></comment></comment></comment></comment></comment></comment></comment></comment><comment><USER9> One of the biggest problems with US health care is that it's usually impossible to find out what treatments will cost before having them.

This makes "shopping around" and being an informed consumer near impossible.

If this actually happens in a meaningful way, hospitals will have to be competitive on price, and I can easily see a 30% cost reduction across the industry just from that.

...which is why I'd be surprised if that actually happened. Such a big restructuring of such a politically powerful industry doesn't just happen in our system.

<comment><USER10> Where as other high income/developed countries, citizens don't have to shop around because everyone is insured by the State and pays the same prices.

The biggest problem with the US health care system is that it's decades behind every one of our counterparts in Europe, Australia/NZ, Japan, Canada, et. al.

People in other developed nation don't have to worry when they're sick. They know they can see a doctor and it either won't cost them anything, or it will always cost the same amount. If they lose their jobs, they don't have to worry about their health as well. People can chose to quit their jobs, or take long unpaid periods to work on their own projects, without having to worry about how they're going to pay for health care. In America, we're required to pay for private insurance, even if you leave the workforce.

There is a huge cognitive load when health is in the background of your mind. In America, we have to work. If you don't work, you don't get services; not until you're old enough to get Medicare. In other words, you don't get medical services until you're too old to be a working member of society; until the country bleeds you dry as a resource.

That is America.

<comment><USER11> > Where as other high income/developed countries, citizens don't have to shop > around because everyone is insured by the State and pays the same prices.

Exactly. Everyone praising this is doing so because they think it's great that this will allow Americans to "shop around" when it comes to healthcare, but they seem to be missing the fact that even the very concept of "shopping around" for healthcare is _absurd_.

If you're having a heart attack, or just have a broken bone, or even if you just have a stomach ache, the last thing that you are going to want to have to spend time doing is "shopping around" before getting your problems fixed. Being able to shop around isn't something that should be praised, it's something that should be relentlessly mocked and is evidence of a failing healthcare system.

<comment><USER12> _very concept of "shopping around" for healthcare is absurd_

No it's not. A very large percentage of medical care is planned, not urgent. There is no reason why price comparison can't happen for those.

A great example of a highly functional healthcare market is vision correction laser surgery. Every time I look around some deal is being offered. Competition is what drove those prices down.

Can you do that with everything? Of course not. But you can do it with a lot of planned medical care.

<comment><USER13> >No it's not. A very large percentage of medical care is planned, not urgent.

And for those procedures, a hybrid system should suffice. All Americans, should, at minimum, be able to get urgent, surprise medical issues addressed in a way that doesn't completely destroy them financially.

Of course, nothing is black and white. Issues that could have been treated in a planned way become urgent if they're left to fester. Obamacare started shifting the incentives to make preventative measures more palatable, and healthcare cost growth has come down as a result. ACA is a /conservative/ set of policies. Even still, it elicits extreme reactions from loud people on the fringes.

<comment><USER14> I'd suggest a slight addition:

> _All Americans should, at minimum, be able to get routine and urgent, > surprise medical issues addressed in a way that doesn 't completely destroy > them financially._

Elective procedures are obviously a thorny issue people will debate over where to draw the lines. But standard checkups, routine wellness procedures, and covering the unexpected ought to be the bare minimum—the healthcare floor of social decency beneath which we do not allow _any_ member of society to fall without recognizing we are failing as a society.

</comment></comment></comment></comment></comment></comment><comment><USER15> I went to the emergency room with a horrid ear infection because no local urgent cares were open and after I called the phone # on my insurance card thats what they told me to do.

The receptionist literally, and I am using this word correctly, LITERALLY laughed in my face when I asked how much the visit that had just ended would cost.

For me it's not about "shopping around" before I go to a hospital. Its having a transparent and up front bill for what services were rendered before I leave. It's preventing that shock unbelievable bill that shows up in the mail three months later, and giving the patient a chance to dispute fraudulent or excessive costs while they are still in the building.

Hospital billing needs to be open and transparent. It's the most manipulative and predatory industry on the planet. If only the goal was to help people, it seems like the companies that own hospitals only care about shareholders.

<comment><USER16> I had a similar situation about 5 years ago. Even though the hospital had my insurance info, they sent a bill / demand letter for the full amount anyway. Of course insurance eventually paid for most of it, and I was finally reimbursed by the hospital about six months later. This was from an "award winning" hospital in Oregon. Scum suckers.

</comment></comment><comment><USER17> I would like to see a stronger law:

Hospitals and doctors must post their price list online.

Hospitals and doctors must disclose to each patient before any non-emergency service how much that service will cost. The disclosed cost must be consistent with the price list and must not depend on what insurance is involved.

Hospitals and doctors must not give any non-charitable discount to anyone that lowers the total amount that they charge below the listed price. (With the possible exception of Medicare.)

Hospitals and doctors must not attempt to collect more than the listed and disclosed price from any patient for any service.

In other words, if a doctor is willing to see a patient with some particular insurance plan for $100 (split between the insurer and patient however the insurer sees fit), then that doctor cannot bill a patient $300 for the same service becaues they have a different insurer.

Yes, a law like this would thoroughly invalidate the entire way that insurance contracts work right now in the US.

<comment><USER18> Interesting that many states have laws mandating this for auto care.

I'm hoping we reach consensus soon that healthcare isn't somehow "special". It's just an industry, with incumbent interests, fighting to earn as much profit as possible, just like any other industry.

<comment><USER19> What do you mean by "auto care"?

<comment><USER20> In the U.S., "auto care" means automobile (car) maintenance. In other words, car repair shops must list or quote you a price before service.

</comment></comment></comment></comment><comment> shaki-dora People are mocking this policy here, but it's obviously better than nothing.

A large number of hospital procedures are likely planned, and can therefore be subject to comparison shopping. Giving birth is an obvious one. But even for many fractures there is a day or two before the procedure, and you could transfer.

Maybe more importantly, public price information allows independent research into price disparities, and public shaming of the worst offenders. That's data only insurance companies currently have access to.

<comment><USER11> I don't really think it is "better than nothing", though.

If we start 'publicly shaming' hospitals for high prices, then that will encourage hospitals to aim for low prices. That of course sounds _great_ on its face, but my concern is that this is going to encourage hospitals to achieve lower prices through cost cutting, (aka cutting corners, in the industry where corners need to be cut the least: healthcare).

Trying to rein in healthcare costs is great, but I fear that trying to do it by encouraging focus on narrow metrics like these could do more harm than good.

Also, these publicly-available prices will be almost meaningless to the average person, as they are just 'list prices' and won't match what insurance or any individual actually pays.

<comment><USER21> Isn't pressuring them to lower prices (at least a bit) what the insurance companies do themselves?

<comment><USER22> Not really. It is much more common and much easier from a business operations perspective to simply increase premiums or deny coverage, especially because a lack of competition means that consumers will have to pay the premiums no matter what. If a price hike causes the premiums to become unaffordable the insurance company actually benefits because they no longer have to endure the cost of providing benefits but they get to keep all the money that was paid before raising the rate to a level that the consumer could no longer afford. This is in contrast to healthcare providers which have a much better negotiating position because they're the ones actually providing the service that the consumer actually wants for the money that they're paying, so trying to get them to lower prices ends up being a much more difficult and risky negotiation.

</comment></comment></comment></comment><comment><USER23> Next step is to make them actually charge those prices to all patients/insurers. It's not appropriate for insurers to pay less because they made a deal with the hospital.

From TFA: It may still prove to be confusing to consumers, since standard rates are like list prices and don't reflect what insurers and government programs pay.

Just because your insurance doesn't cover something doesn't mean they should make more money. This is one of the root problems driving healthcare costs. No deals for government or insurance companies. Post prices. Standard procedures should end up with lower pricing due to competition.

</comment><comment><USER24> I've worked in medical finance as a consultant, and a huge problem that I've seen is that although private insurance was originally intended to encourage competition, it has made prices much more complicated and opaque for the end consumer (patient).

Generally speaking, each hospital/practice/clinical lab has to negotiate with individual insurance companies to get reimbursed at a given rate minus "contractual adjustments" \- this negotiation process is highly inefficient, given that each payer may do things differently (a contract with BCBS of NC may be different than one with Florida Blue), and smaller providers simply don't have the bandwidth or resources to have any leverage in this process.

The complexity of this ecosystem only hurts consumers and providers (and helps the payers, of course), and although many insurance entities call themselves "non-profit", I seriously question their motives.

It's almost reminiscent of the era leading up to the financial crisis of 2008, where complex derivatives, mortgage-backed securities, and other overly sophisticated financial instruments made those that worked in the industry fantastically wealthy, while the common people were left holding the bag when the stock market finally plummeted.

I hope we can find ways to simplify this system - the single payer system, for all of its flaws, seems like a step forward in the right direction.

<comment><USER25> Why hospital even need to negotiate with insurance company? Can't they just set the price they deem reasonable and then let the patient and insurance to work out the payment within themselves .

<comment><USER26> It works that way for 'out of network' facilities and doctors, and there are higher deductibles and lower limits on payouts for those as the insurance copany has no fiscal control.

The negotiations happen for 'in network' systems, and it's in the hospital's interests to be 'in network' for as many insurance companies as possible, as most people choose 'in network' care providers.

<comment><USER24> Yes, this is also true.

</comment></comment></comment></comment><comment><USER27> > Hospitals are required to disclose prices publicly, but the latest change > would put that information online in _machine-readable format_ that can be > easily processed by computers.

This is great news and step zero on the long road to transparency in the voodoo that is USA medical billing.

What would be really awesome is if someone can get non-Medicare versions of these prices and somehow marry that with the co-pay / co-insurance of common insurance plans to give people an idea of what they'd be on the hook for. At the moment nothing short of going through with the medical service and then taking a time machine will get you the true answer. And even then they can retroactively change it!

<comment><USER28> This is exactly what my company's solution does! We get prices from multiple sources, one of them being claims data (which is basically your time machine).

<comment><USER27> What's your company? (Your HN profile is empty).

Shameless self-promotion is encouraged in this type of reply so don't be shy!

</comment></comment></comment><comment><USER29> Anecdote: along with the public health care system in Italy, there's a parallel, private system if you want something a bit fancier, or a bit faster for non-urgent things. One of the things that made me laugh was when I went through that to see a local ear-nose-throat doctor. I was able to call and ask for prices on the phone.

In other words, along with covering everyone via the public system, Italy's private system is a better functioning market than the US system.

</comment><comment><USER30> >Hospitals are required to disclose prices publicly, but the latest change would put that information online in machine-readable format that can be easily processed by computers.

Apparently the hospitals have already been required to do this but now it will be online. Also this number will only give the upper bound of the cost since it is considerably negotiated down. What good does it do if they say mending a broken bone costs up to $20k when in reality it is somewhere between 0-$20k depending on insurance and other factors.

</comment><comment><USER31> I like this.

Last year I went to my dermatologist for a routine check up and they frooze 1 mole on my leg:

$ 600 for the visit

$ 600 for freezing the mole

<comment><USER32> Wow, that would cover 2 years worth membership at the clinic I run. We charge $49 / month for unlimited visits, freezing the mole would've been around 10 bucks. You likely could have gotten a plane ticket, flown to our clinic, gotten the procedure, and flown back for less money

<comment><USER33> I'm curious to learn more about your clinic. Mind sharing any information?

<comment><USER32> Sure, my email is in my profile. Send me a message with what you would like to know and I will get back to you.

<comment><USER33> I'm unable to see that in your profile (looks blank to me). Do you mind updating it?

<comment><USER32> Whoops, sorry for lying I've updated my about section.

<comment><USER33> Thank you!

</comment></comment></comment></comment></comment></comment></comment><comment><USER34> Who wants to start the Uber for ambulances? It will have a list of prices for the nearest hospitals and drop you off where the costs are cheapest and the waiting times the shortest? (I'm a mobile/backend dev B) )

<comment><USER35> Ambulance services are generally extremely tightly regulated, and often exclusive area contracts. You probably couldn't operate an ambulance company with the policy you describe in most places, and you certainly couldn't legally do an Uber-style middleman service with independent ambulances that used that policy.

And, unlike taxi laws, the laws on operating thingd that pretend to be legally-mandated emergency vehicles are going to be vigorously enforced.

</comment></comment><comment><USER36> Useless. Consumers don't care about how much something costs when it's life or death and they may not even know enough to understand what price they should be looking for. Medicare must have the power to negotiate prices for the benefit of the population full stop. Also, medical service must be free at the point of service for all US residents to ensure everyone gets essential care and preventative care.

Here's the healthcare plan we should have: [https://medicareforall.dsausa.org/](https://medicareforall.dsausa.org/)

<comment><USER37> Multiple the medicare spending for the amount of population it serves and rejoice in a 40% GDP spending on healthcare.

<comment><USER38> > Multiple the medicare spending for the amount of population it serves and > rejoice in a 40% GDP spending on healthcare.

Don't forget to account for the fact that Medicare's reimbursement rates are not self-sufficient - they're implicitly subsidized by private insurers. So it's actually much higher than that.

<comment><USER37> That effect goes both ways: medicare gets patients that are old and have more expensive and chronic diseases, thus their spending per service might be very efficient. Which leans on which is hard to know without some rigorous analysis.

<comment><USER38> > That effect goes both ways: medicare gets patients that are old and have > more expensive and chronic diseases, thus their spending per service might > be very efficient.

It doesn't really matter, if they're reimbursing below COGS (which they are). If the expected value of a set of numbers is negative, you can't make it positive by adding a bunch of other numbers which are also negative (even if they might be closer to zero, which in this case they oftentimes are _not_ ).

<comment><USER37> I don't follow your reasoning. Private insurance pays physicians more than medicare, producing the implied subsidy you mention (as they pay less). But once patients get onto medicare, they dont go to private insurance anymore so there is no subsidy: almost all the money is spent by the state at that stage.

This has the incentive that private markets have incentives to do disease treatment and prevention before the patient goes to medicare, potentially offloading care onto the later stages.

I would surely like some formal study and analysis on this, i feel this is very theoretical.

<comment><USER38> > I don't follow your reasoning. Private insurance pays physicians more than > medicare, producing the implied subsidy you mention (as they pay less). But > once patients get onto medicare, they dont go to private insurance anymore > so there is no subsidy: almost all the money is spent by the state at that > stage.

As a provider, let's say 40% of your patients are on Medicare, and 60% are on private insurance. On average, you're losing money on a per-patient basis for 40% of your patient base, since Medicare's reimbursement rates are below COGS. You stay in the black by charging the remaining 60% enough to make up the difference.

Without the privately-insured patient base to subsidize the Medicare patients, the provider would go out of business immediately, because they wouldn't even have enough revenue to cover the direct, marginal costs of supplies for each treatment, let alone anything to pay for staff wages, office space, overhead, etc.

> I would surely like some formal study and analysis on this, i feel this is > very theoretical.

This isn't theoretical at all. It's no secret that Medicare's reimbursement rates are below sustainable levels. Medicare itself admits as much. For providers that see a high enough percentage of Medicare patients that they can't effectively distribute the costs among their privately-insured patients (because there aren't enough of them), Medicare actually runs special stipend programs, where they provide you with extra money to stay afloat (separately from the regular reimbursements).

<comment><USER37> I dont agree with this analysis, but Im more than willing to read up on it.

> Medicare does not reimburse below sustainable levels > On average, you're > losing money on a per-patient basis for 40% of your patient basis..

I disagree with this conception of sustainable: at any point if you have two suppliers with price differenciation yes, one of them 'subsidizes' the other, but that doesnt make it so the latter doesnt bring revenue. If by law airlines could not sell coach anymore, they would all drastically go out of business, even though they dont make money on coach. Medicare does lower reimbursement but it only matters in so far they take the spot of a private insurer.

Furthermore, sustainable implies that there would be no providers at medicares rates but that is not true: there would be less because they pay less, but you would still have providers.

Second, accepting medicare is a hassle for providers but I assure you they dont do it out of charity. They give you infinite demand which means you can fill your non-private insurers slots with medicare and provide lots of revenue.

<comment><USER38> > Furthermore, sustainable implies that there would be no providers at > medicares rates but that is not true: there would be less because they pay > less, but you would still have providers.

In most regions, Medicare reimburses rates that are less than COGS. If you have to pay $100 wholesale just for the supplies to perform a procedure, and you're only allowed to charge $93 for the procedure, you're going to go out of business very quickly.

Your assertion that "there would still be providers" is wrong, because unless Medicare dramatically raised its reimbursement rates[0], most providers would go out of business overnight. Even if it _were_ true that there would still be providers, just fewer of them (which is not true), you're at best arguing for something which, in your own words, would exacerbate the current shortage of practicing clinicians, which would drive up prices for self-paying patients even further and dramatically lower the quality of care for the entire country.

> Second, accepting medicare is a hassle for providers but I assure you they > dont do it out of charity. They give you infinite demand which means you can > fill your non-private insurers slots with medicare and provide lots of > revenue.

Medicare doesn't give you "infinite" demand. But furthermore, having more patients doesn't help you if you're literally losing money on a per-patient basis. You can't lose money on margin but "make it up in volume".

This is exactly why Medicare has to provide separate stipend programs to providers who aren't able to overcharge privately-insured patients and make up for their losses on Medicare patients that way.

[0] which is the entire point of the comment that began this whole thread - Medicare would _have_ to dramatically raise its reimbursement rates if it covered all patients

</comment></comment></comment></comment></comment></comment></comment></comment></comment><comment><USER39> This is great.

Article in The Atlantic back in 2009: [https://www.theatlantic.com/magazine/archive/2009/09/how- ame...](https://www.theatlantic.com/magazine/archive/2009/09/how-american- health-care-killed-my-father/307617/)

My mother-in-law died of brain cancer over the course of about five days. We received a "Statement of Benefits". She received ~$130,000 of care. Medicare paid ~$30,000. That's bullshit. Per James Fallows' article, medical price transparency is CRITICAL. You can't improve something if you can't see it and can't measure it until after you experience it.

I'm an anti-Trump (and anti-Republican) Republican but I have to admit that, with this Medicare transparency action, sometimes this administration takes surprisingly sensible actions.

<comment><USER40> Were you responsible for that debt? Why did Medicare cover so little?

<comment><USER39> Great question. We were not responsible for the difference. The "Statement of Benefits" is a very confusing US healthcare tradition in which you're told how much you _should_ have paid before being told what you owe. In our case, there was a corresponding "Medicare discount" (or something; it's been 8 years) and the final bill was $0.

The situation is _terribly_ regressive: people with the least money and the least likely to be able to afford healthcare and are therefore most likely to suffer high hospital costs. People with the most money get healthcare "insurance" and so get the lowest prices.

</comment></comment></comment><comment><USER41> Understanding the root cause of how our healthcare system developed is both crucial and completely lacking from most of these discussions.

It is a tale of federally mandated wage control and specialized tax breaks. A quick google will show many articles outlining how we got here.

Why is car insurance not tied to employers? In general how much better does car insurance work than health? Are the prices not much more straightforward and is it easy to shop around? If you are treated poorly by your car insurance company, can you easily tell all your friends and change companies?

This is the real problem here. Most folks have no choice and no skin in the game, which leads to all these crazy stories about zero pricing information and no ability to change companies.

If the tax breaks simply got removed, and people had to actually pay directly for their insurance and could switch companies, the vast majority of these problems would go away.

<comment><USER42> Car insurance is not comparable to health insurance. It's apples to oranges. Car insurance reduces risk, by exchanging the cost of an unpredictable potentially costly event (an accident) for a regular much reduced cost event (monthly payment). The benefit is predictable expenses and budget.

Health insurance only works this way for the healthy. For the chronically ill, it's flat out cost reduction to have it and a profit loss for the insurer.

My insurance pays out more than I pay into it every year. I had one year it paid out ~$250k.

Unless we stop mandating care for the sick unable to pay for it, healthcare is socialized; it's just a matter of how efficiently socialized it is.

Insurance companies overcharge the healthy to make up for their losses with the chronically ill, and hospitals overcharge those who can pay to make up for their losses with those who can't.

Really just need to cut out the middle men.

</comment></comment><comment><USER43> Medicare reimbursement is generally fixed price based on diagnosis (DRG == diagnostic related groups)

Table 5 here shows a "weight" . That's the number of units of reimbursement a hospital gets for each particular diagnosis / procedure / whatever. (LOS is length of stay) (CC is complications) (MCC is major complications)

[https://www.cms.gov/Medicare/Medicare-Fee-for-Service- Paymen...](https://www.cms.gov/Medicare/Medicare-Fee-for-Service- Payment/AcuteInpatientPPS/FY2018-IPPS-Final-Rule-Home-Page-Items/FY2018-IPPS- Final-Rule-Tables.html)

Hospitals negotiate with CMS the number of dollars per unit of weight. Sometimes aggressively. It would be good to have that number of dollars posted publicly and explained. Does the hospital hate serving Medicare patients because they don't make enough?

</comment><comment><USER44> Good. They also need to improve the appeal processes for private insurance and crack down on improper denials.

</comment><comment><USER45> Hospital billing is incredibly murky.

1 - I'd imagine the price they will post is similar to an airline's full fare, refundable ticket price. The price actually paid is quite different and related to the negotiated rates with your insurer and your deductible.

2 - Hospital billing is often separated from physician billing. Does price transparency extend to all physician groups?

3 - Patients care about total out of pocket expense. How much is it going to cost me? Hospitals can't know this because they are not privy to your health plan structure/details - they only know their negotiated rates. Your health plan doesn't know it, because it hasn't received the full details of your treatment.

</comment><comment><USER46> Still have to change consumers of health care to have a consumer mentality for health care. Whatever the age, you really should actually shop around for non- emergency medical procedures. This is one area you can really save money because a lot of places are severely overcharging for simple procedures.

Call the facility, get a quote (they will probably have to do a bunch of work on their end), document quoted price (if I were to do this I would probably have the hospital email me a document), and don't pay more than the agreed upon price.

Receiving non-emergency medical care should be like shopping for cars, pizza, iPads, houses, etc. So, yeah, start doing that. Be the change you want to see.

</comment><comment><USER47> I'm in favor of this, and not just for Medicare. Medicare pricing is extremely low because doctors can't turn down Medicare patients. Medicare pays like $8 for a physician visit, which is, quite obviously, not sustainable for the physician. I want to be able to comparison shop at the very least for routine stuff that's not customized patient to patient: yearly physical, blood tests, chronic disease care, etc. Combined with ratings this should reduce the current extreme information imbalance and drive the prices down.

</comment><comment><USER48> How much of my money are you willing to spend to save your own life?

Read an article that talked about insurance companies providing tools to consumers about pricing, turns out they don't use them because people are price conscience when it comes to their current healthcare needs. And my guess they're probably too price/time conscience when it comes to preventive care. Aka, they would need to be compensated to stop eating cheeseburgers.

<comment><USER49> Cheeseburgers are cheaper than healthy eating

</comment></comment><comment><USER50> Hotels are required in most jurisdictions to post their rack rate for hotel rooms. Look on the inside of your hotel room next time, you'll find the rack rate is usually 4X what you actually pay.

You'll find they comply with this, just like California Prop 65.

They'll continue to give discounts just like Rockefeller gave rebates and subsidies.

</comment><comment><USER51> The next interesting question. Say you needed some surgery, would you choose the cheapest one or the most expensive one?

</comment><comment><USER52> I never understood why doctors, hospitals, etc never do this. They know their prices but they never want to let you know until too late. Heck doctors have often told me they take my insurance then say "woops you gotta pay me cash!". Medical billing needs some serious fixing or consumer protections.

</comment><comment><USER53> Great read on this topic

[https://www.theatlantic.com/magazine/archive/2009/09/how- ame...](https://www.theatlantic.com/magazine/archive/2009/09/how-american- health-care-killed-my-father/307617/)

And his book of course

</comment><comment><USER8> How about we take this a step further and require hospitals to have one price for each service to all comers.

Then we can trivially pick a plan independently of backroom deals that are impossible to evaluate ahead of time and easily pick the provider that provides the combination of service and price.

</comment><comment><USER54> Even if it was just "this is the cash price for item X" this would be a huge benefit for he consumer.

</comment><comment><USER9> Here is an article about one of the few US hospitals with a fixed public price list:

[http://time.com/4649914/why-the-doctor-takes-only- cash/](http://time.com/4649914/why-the-doctor-takes-only-cash/)

</comment><comment><USER55> This is a step in the right direction. I hope they push all medical services and drugs to publilsh their prices. This way, customers can have the option to pay cash or go through insurance.

</comment><comment><USER56> Good! It should have been done a long time ago.

</comment><comment><USER57> We will have to see how this will be implemented but I like that they acknowledge that price transparency is a big problem.

</comment><comment><USER58> I don't want just prices, I want to know actual costs and then the prices, and breakdown of what goes where.

</comment><comment> King-Aaron This discussion makes me appreciate the healthcare system here in Australia much more.

</comment><comment><USER59> This would be a halfway decent way to fight back a hospital's insane chargemaster.

</comment><comment><USER60> I wonder what will happen when an important hospital opts out of Medicare over this?

<comment><USER61> It's not going to happen, hospitals mostly get revenue from Medicare/Medicaid.

</comment></comment><comment><USER62> Singapore does this. Their health care costs are significantly lower than the USA.

</comment><comment><USER63> how about taking it one step further and aggregate the database of all hospital prices so we can filter and compare. better yet, single payer system overall

</comment><comment><USER64> Will hospitals decide to just not take medicare any longer?

</comment><comment><USER65> Current U.S. healthcare: NIH syndrome writ large.

</comment><comment><USER66> The big question is which set of prices IMO...

</comment><comment><USER67> This would take effect in 2019 if passed.

</comment><comment><USER68> Feels like a step in the right direction. But we've already got geographic monopolies in many cases - you can't just decide to go ten more miles in an emergency because you know the prices are 15% lower.

However, if a new hospital opens close-ish to an existing one, offers a temporary discount, then the two just keep an eye on each other's websites to maintain the status quo in pricing will offering "competition," now we have a duopoly.

Capitalism will find a way to keep screwing consumers.

</comment><comment><USER69> Removing any of the information asymmetry in health care is useful. Providers in clinics usually don't know what procedures costs, especially with various insurance negotiations. This empowers patients and additionally medical providers themselves. It is a real conversation (in non-emergent situations) that should be happening with patients and providers about what the patient can afford.

If you do not like that this exposes publicly the capitalist nature of US health care, then I encourage you to support a universal/government health care option, rather than trying to prove this information isn't helpful.

<comment><USER70> Honestly the biggest pain in the ass when it comes to trying to price healthcare comes outside office visits. Want to go in for a surgical procedure? You think it's going to cost $X but it ends up costing $X+Y because some complication caused the operation to run 10-15 minutes over the estimated time and now you have an extra unit of time for the anesthesiologist getting billed.

Price transparency is great, but office visits are basically the only thing you can estimate well upfront (there's five CPT codes for the visit, 99211-99215 and it's easy to estimate which one will apply based on whether it's a new/existing patient and the level of history/examination you anticipate requiring). I will stand by my belief that the only way to "fix" healthcare in our country is going full single-payer so citizens don't have to worry about whether they can afford to get treated or not.

<comment><USER71> A few years back my son got his tonsils taken out at a private hospital in the UK (my employer at the time provided it) - after the operation the anesthesiologist and apologized and said that due to a billing mistake I'd have to pay an additional amount directly and handed me a bill.

Having read horror stories about medical billing in the US I was prepared for a shock. However the bill was for something like £4.50... :-)

</comment></comment></comment><comment><USER72> Finally the first good news from the Trump administration.

</comment><comment><USER73> As long as they assign a variance to that mean price. Even then it woukdn't fit any known distribution.

</comment><comment><USER74> A delusional wishful thinking that a patient, while in pain and in need to care, will be shopping and browsing around to see prices, and that would drive prices down. Even if that was true, it requires that you could predict how much your treatment or visit would cost, and anyone who have actually used and paid bills in the health system in US knows how it goes.

<comment><USER75> There are some facilities which already post basically accurate prices online: [https://surgerycenterok.com/](https://surgerycenterok.com/) is a great example.

If I needed some kind of elective or non-emergency procedure, they would be high on my list (along with medical tourism to foreign countries where procedures are also clearly priced, and even cheaper)

I've recently been having pretty good luck going to medical providers and offering cash (I have Kaiser insurance now, which I basically treat as emergency/catastrophic only, since they never cover any providers I'd want to see, so I basically end up paying cash.). I was able to get a dermatologist to go from $600+ to $95 because cash.

<comment><USER76> > (along with medical tourism to foreign countries where procedures are also > clearly priced, and even cheaper)

The thing that is _really_ bizarre to me is that I've more than once seen people quite prices for non-emergency procedures in the US that are more expensive than taking a business class flight to London, checking into a high end hotel and getting treated at a top private hospital targeting mostly rich people... Of course it's less convenient than being treated near your home, but the difference can be significant.

<comment><USER77> Do such hospitals actually accept non-resident patients from outside the EU for elective stuff? I'm not sure about the UK setup, but in Ireland, private hospitals are able to save costs on the basis that if something goes badly wrong, they can just shunt the patient over to the larger and generally better equipped public hospital, which is often literally next door, at which point the patient become's the state system's problem. For instance, many of them don't have an ICU.

This works okay if the patient is resident or is an EU citizen, and so is entitled to be treated by the public system (though it's arguably an effective subsidy of the private system by the public system), but I wouldn't have thought it'd be feasible for non-resident foreign citizens.

<comment><USER78> England has a mix of private hospitals and NHS hospitals. Some private surgeons work from NHS hospitals - in that case you'd have a private surgeon, a private anaesthetist, and probably NHS nurses / OD techs, and then a private room.

The cost to visitors of NHS treatment is 1.5x the NHS rate. Some stuff is exempt.

Here's the official guidance: [https://www.gov.uk/government/publications/guidance-on- overs...](https://www.gov.uk/government/publications/guidance-on-overseas- visitors-hospital-charging-regulations)

[https://www.gov.uk/government/publications/guidance-on- overs...](https://www.gov.uk/government/publications/guidance-on-overseas- visitors-hospital-charging-regulations/summary-of-changes-made-to-the-way-the- nhs-charges-overseas-visitors-for-nhs-hospital-care)

<comment><USER77> Huh, interesting. I wonder if that's allowed here, too; the Irish system is a dual public-private system fairly similar to the UK one. I just assumed it wouldn't be allowed because it seems like it'd be an undue burden on the public system.

</comment></comment></comment></comment></comment></comment><comment><USER79> This is a terrible idea.

Which is better, a CT Scan for $1000 or one for $10,000?

You probably guessed the cheaper one, right? Thinking "all CT Scans are the same," right? I happen to know that's not remotely true, but it's easy to think that saving money on a test would make sense, right?

Okay, now which is better, open-heart surgery for $20,000 or $200,000?

That's a lot harder to answer, isn't it?

You need to know the outcomes of those procedures at that facility, compared to other facilities, to have any possible way to judge them.

<comment><USER80> This is free market working correctly. Transparency is important. You should have information about the price AND outcome. It is not mutually exclusive.

<comment><USER79> Healthcare should not be a market.

If you need a heart transplant, and I know you need a heart transplant, you're in kind of a lousy position to negotiate, aren't you?

I don't buy some Defense tokens or insurance on some market. I pay taxes for National Defense.

Don't get me wrong, capitalism is awesome. And I worked in healthcare software for about 13 years. But applying capitalism to basic, necessary healthcare is no good.</comment></comment></comment>


Cramming Software with Thousands of Fake Bugs Could Make It More Secure - <AUTHOR> https://motherboard.vice.com/en_us/article/43p7dm/software-chaff-bugs-could-make-it-more-secure <comment><USER2> 1\. Not just bad guys look for vulns. What about White hats?

2\. Your adversary maybe has an endless supply of said resource you want them to run out of: time. A state-sponsored attack can have a dimension so mind- boggling that it's laughable to try and use cheap "security tricks" to stop them. Remember Stuxnet?

3\. Since when is obscurity a valid security measure?

See also [https://twitter.com/polytomous/status/1025869511004577792](https://twitter.com/polytomous/status/1025869511004577792)</comment>


The Perils of Outsourcing Your MVP - <AUTHOR> https://mtlynch.io/outsourcing-mvp/ <comment><AUTHOR> Author here. Happy to answer any questions or hear feedback you may have.</comment>


Private schools, painful secrets - <AUTHOR> http://www.bostonglobe.com/metro/2016/05/06/private-schools-painful-secrets/OaRI9PFpRnCTJxCzko5hkN/story.html <comment><USER2> "There is no research available on the prevalence of abuse at private schools and whether it is more common than in public schools, where one federal study found nearly 10 percent of students are targets of unwanted sexual attention by educators in grades K-12."

Isn't it a moral obligation to look into that before making an article like this?

It's like the end of Spotlight where the ending contradicts the title by listing every place where priest sexual abuse was found, which is pretty much everywhere. Shouldn't the spotlight be shined on wherever sexual abuse never occurs so that such a place may be emulated? Or is there such a place? If not, then research there should be starting point for fundamental change.

<comment><USER3> Sounds like they looked into it... and found that there was no research. They're certainly not morally obligated to _conduct_ research on the matter. This is a story about events that allegedly did happen, it is their journalistic obligation to ensure the information they're reporting is correct, but not to follow all possible research avenues.

<comment><USER4> The whole _point_ of the article is that private schools get away with things because they're private. If they want to make that claim, then they _do_ have a responsibility to make sure that the facts back it up.

<comment><USER5> _> The whole point of the article is that private schools get away with things because they're private_

You've built a fine straw man. But in fact, the authors explicitly identify several hypotheses that aren't inherent to (but do correlate with) private schools:

1\. _" boarding schools, in particular, present unique opportunities for educators to have close contact with students"_ (yes, public boarding schools exist.)

2\. _" The schools, many with rich histories and famed alumni, have often struggled to balance the need to respond robustly to abuse allegations with a desire to guard their reputations."_ (yes, public schools with rich histories and famed alumni exist.)

So the authors specifically _aren 't_ saying that the schools "get away with things" _soley because_ they're private. They're simply saying that abuse happens at private schools. Which, _regardless_ of how it compares to abuse happening at public schools, is worth reporting on.

 _> If they want to make that claim, then they do have a responsibility to make sure that the facts back it up._

1\. Your strawman aside, The _actual_ claims made in the article are all well- substantiated or else are clearly presented as hypotheses, not facts.

2\. Following this principle would effectively censor a lot of important investigative journalism.

As far as journalism these days goes, this article is excellent. The writing is nuanced but clear, the reporters report back hypotheses about underlying causes that relate to the human side of the story but with minimal editorializing, and the article is even accompanied by a hand-curated data set.

</comment></comment></comment></comment><comment><USER6> Alas, there is this problem at public schools too. What helps over the long term is for families to have the power to shop, so each family can look for a school that is affordable for their family with characteristics that are safe for that family's children.

<comment><USER7> How do you shop for a safe school? It's not like schools advertise that they only have a 12% molestation rate.

</comment></comment><comment><USER8> Not limited to New England. There's a massive scandal in one of Manhattan's priciest and most exclusive schools.

[http://mobile.nytimes.com/2012/06/10/magazine/the-horace- man...](http://mobile.nytimes.com/2012/06/10/magazine/the-horace-mann-schools- secret-history-of-sexual-abuse.html?referer=)

The advisor at my temple's youth group went to jail for pedophilia. (He was also a teacher) The predators hang out near the victims.

</comment><comment><USER9> I'm getting kind of tired of seeing 'outrage' stories here. They're kind of like politics: a bunch of kids being abused is way more important than the javascript framework du jour, or the latest startup. However, there are so many horrible, outrageous things in the world that it'd be easy to keep the front page of this site full of them.

<comment><USER10> flag them and move on.</comment></comment>


Very Long Proofs - <AUTHOR> https://johncarlosbaez.wordpress.com/2016/05/28/very-long-proofs/ <comment><USER2> From the linked post [https://johncarlosbaez.wordpress.com/2012/10/19/insanely- lon...](https://johncarlosbaez.wordpress.com/2012/10/19/insanely-long-proofs/)

>The method is called 'proof by exhaustion', because it involves reducing the problem to 10,000 special cases and then settling each one with detailed calculations… thus exhausting anybody who tries to check the proof by hand.

Ha.

</comment><comment><USER3> It should be noted that there is some reason to aesthetically dislike computer-generated proofs.

It's not mentioned by Baez, but one of the first breakthroughs in the Erdos discrepancy problem was a very verbose (running into a few GBs if I remember right), computer generated proof, for a subcase. Terry Tao later presented a general proof which was far far shorter.

Obviously there are cases like the 4-color theorem which have withstood the test of time and prejudice, but there is something sad about not being able to make sense of such math.

<comment><USER4> "… some reason …"

Name one? I think I understand that it's unsatisfying that there are instances where mathematics cannot be done with just pencil and paper. However, it's a reproducible proof. And folks in science have long gotten over the fact that there are important results that can only be achieved with lots of computing power, and not just pencil and paper.

<comment><USER5> A reason to dislike computer-generated proofs:

The point of mathematics is not just to know whether some proposition is true, it's to understand the mathematical objects under study. A beautiful proof sheds light, it explains _why_.

<comment><USER6> That's your view on the point of math. I would be perfectly content to have a long, computer generated proof of P ?= NP. Of course I prefer beauty and elegance in proofs, but I think leveraging the computer as a tool to prove things for us is quite an elegant thing by itself.

<comment><USER7> It would be horrible if we had an impossible to understand, but correct, proof of P = NP that gave no hint of how to actually construct polynomial algorithms for those problems.

<comment><USER8> Interestingly, there are algorithms for solving NP-complete problems which are provably polynomial time iff P = NP. So the moment P = NP is proven, we immediately know of polynomial-time algorithms for NP-complete problems. We have the algorithms today, we just don't know if they are in P.

[https://en.wikipedia.org/wiki/P_versus_NP_problem#Polynomial...](https://en.wikipedia.org/wiki/P_versus_NP_problem#Polynomial- time_algorithms)

<comment><USER7> Huh, thanks! That's completely surprising to me.

Edit: ah ok, a semi-algorithm that just tries all possible programs...

</comment></comment></comment></comment></comment></comment></comment><comment><USER9> It seems to be part of our habit in mathematics to first make many discoveries using brute-force and large enumerations, and then later extend the results with more sophisticated methods if we can find them. For one practical example, if you were doing a lot of computation in the 1960's you might carry around a book of trig functions, or a slide rule, but after microprocessors came about a pocket calculator could do all those functions with better precision. With proofs, many questions are proven up to some number n, which is only further extended by feeding the algorithm into a powerful computer. But occasionally we discover a way of reframing the problem so that it can be solved with relatively little computation.

I believe programming has some analogous quality to it: It's much easier to solve just one problem and gradually find ways to generalize it.

<comment><USER10> > _if you were doing a lot of computation in the 1960 's you might carry > around a book of trig functions, or a slide rule, but after microprocessors > came about a pocket calculator could do all those functions with better > precision_

The pocket calculator is doing a huge amount of computation to find those results, an amount which would be impractical for the human to do (hence the use of slide rules instead of laborious pen-and-paper arithmetic). It's just a different flavor of brute force. The calculator is basically going back to the pre-logarithm method, carrying out elementary school arithmetic algorithms very fast.

To be honest, the slide rule method – converting multiplication problems to addition problems via a logarithm lookup table encoded on a stick – is quite a bit more "elegant" than what the calculators are doing. The invention of logarithms in ~1600 was one of the most important advances in the history of science and technology.

* * *

The same is true in many other kinds of mathematical problem solving. In the past, we only had access to manual effort and limited human time/attention, so the available brute computation was quite limited and many problems were entirely intractable, and great cleverness was required to solve others. The goal of symbolic reasoning was to reframe problems to eliminate as much manual computation as possible. For that reason, it was necessary to learn how to manipulate trigonometric identities, solve nasty integrals by hand, etc. We had to be able to rewrite any problem in a form where each concrete computation only required a few simple arithmetic steps plus as few table lookups as possible. Despite such simplifications, actually performing computations often required teams of people mechanically performing arithmetic algorithms all day. [https://en.wikipedia.org/wiki/Human_computer](https://en.wikipedia.org/wiki/Human_computer)

Now that computation is cheap, we can dispense with many of the clever/elegant methods of the past, and just throw silicon at our problems instead. This lets us treat a wider variety of problems in a uniform way, and get away from doing nearly so much tricky algebra.

<comment><USER11> Your mention of "invention of logarithms" raises a couple of questions.

First: is there a good, _accessible_ (college calculus, some diff eq, some linear algebra) history of mathematics you might recommend?

Second: I've been kicking around an ontology of technological dynamics (or mechanisms) for a few months. In it I classify mathematics under symbolic representation and manipulation, along with what I see as related tools of speech, language, writing, logic, programming, and AI. If that sets off any lights, bells, or whistles, I'd be happy to hear ideas or references.

[https://ello.co/dredmorbius/post/klsjjjzzl9plqxz- ms8nww](https://ello.co/dredmorbius/post/klsjjjzzl9plqxz-ms8nww)

<comment><USER10> Stillwell's book is pretty good. [http://www.springer.com/us/book/9781441960528](http://www.springer.com/us/book/9781441960528) [https://amzn.com/144196052X](https://amzn.com/144196052X) (Unfortunately recent Springer books are printed on demand, and printing/binding quality can be iffy; in particular quality of books bought via Amazon seems to be quite poor.)

<comment><USER11> Thanks. Fortunately there are local library copies:

[https://www.worldcat.org/title/mathematics-and-its- history/o...](https://www.worldcat.org/title/mathematics-and-its- history/oclc/19269766&referer=space_alien_cat)

</comment></comment></comment></comment></comment><comment><USER12> > This is one of the world's biggest proofs: it's 200 terabytes long! That's > about equal to all the digitized text held by the US Library of Congress. > There's also a 68-gigabyte digital signature—sort of a proof that a proof > exists—if you want to skim it.

This sort of comparisons always bothers me, they make no sense.

Also according to the Nature post linked, the 68G "digital signature" is just the 200T compressed, just another sign that talking about the file sizes is meaningless.

</comment><comment><USER13> OK look, running a^2 + b^2 = c^2 a few trillion times and calling that a "long proof" is disingenuous - it's really long if you include every single operation, but must you? I just described it here in a few sentences. I guess what's more interesting is a sort of kolmogorov complexity of the proof, perhaps.

<comment><USER14> Yes, in fact every single mathematical proof can be reduced to a few lines of code! You just write a program that verifies a proof, and another program that brute forces through the space of all possible proofs. It should fit onto a page or two. So the kolmogorov complexity of any proof has a pretty small upper bound.

<comment><USER15> That isn't a proof, it's a procedure for finding a proof. The procedure might _fail_ , and whether it will fail or not cannot be checked without running it - which is not guaranteed to halt! Of course, to guarantee that it halts, you could include an upper bound on the size of the proofs it searches in your program. So then at least your "proof" is checkable. However, it is not in general _efficiently_ checkable - that is, checkable in polynomial time. If it were, it could only produce polynomial compression!

(Though admittedly, polynomial compression is pretty good, practically speaking.)

As for Kolmogorov complexity, there are infinitely many distinct proofs, so their Kolmogorov complexity cannot possibly be bounded.

<comment><USER14> > That isn't a proof, it's a procedure for finding a proof.

That's exactly my point. I wasn't being serious.

<comment><USER16> I think you're missing an important point though. The article's proof is guaranteed to be verifiable in a known finite amount of time. Your example does not so it's hard to take commentary from it onto the article's subject.

<comment><USER17> I think you're missing the important point that Houshalter was being sarcastically critical of makmanalp's dismissive top-level comment, not the proof in the article.

<comment><USER16> I don't see how Houshalter's post can possibly be read as sarcastic, it looks like a technical comment that makes an interesting point that is slightly tangential. I simply don't know how to read that comment as if there were a /s at the end. And I don't see how the top level comment can be considered dismissive, it too is making an interesting point that we should use another metric.

<comment><USER18> > it looks like a technical comment that makes an interesting point that is > slightly tangential

That's why I love Math.

But hey, I hope your post is sarcastic too. But don't mind, there's no procedure you could use to convince me it isn't.</comment></comment></comment></comment></comment></comment></comment></comment>


Ask HN: First tech talk I give, any tips? - <AUTHOR>

I am giving my first tech talk with Frontenders Valencia ( http://valencia.frontenders.me/ ) about a project that I made and debuted here in HN, Picnic CSS ( http://picnicss.com/ ).
Mainly, I'm really nervous and insecure right now and would love to boost my confidence. HN looks like the proper place for me to ask: any tips? I know to:
1. Review, review, review the presentation 2. Arrive early to get to know the people <comment><USER2> > "1\. Review, review, review the presentation"

Not just review, but give it. Talk to the mirror or a chair, and picture yourself actually giving the talk. Reading it to yourself is not as good as actually saying it out loud.

Practice good body language. It's been well studied that having confident body language will actually improve your confidence. When you arrive early: Stand tall, walk around with your hands clasped behind you (a very confident position) and get to know the space. I used to do this before interviews, while other candidates sat frozen in the reception room.

Think of 1-3 main points you want the listeners to come away with. No matter how good your presentation, nobody will remember the entire thing, so be realistic... Focus on a few central points that you want to get across.

Consider acknowledging in the very beginning that it's your first talk and you're a bit nervous. This has the dual benefit of making the crowd less critical and relieving you of some stress.

If you can arrange it somehow, film the talk. (Ask a friend in the audience or the organizer.) Then you'll be able to watch yourself present (it'll be unbearable, but do it!) and learn from your mistakes.

After the talk, approach a few people from the audience (or the organizer) and ask for some constructive criticism. "This was my first talk, actually. What do you think I could do better next time?"

<comment><AUTHOR> You made some great points. While there are some that I thought (constructive criticism), there are others that are really valuable, like body language and 1-3 main points.

It's filmed so I'll review it when they upload it, thank you

</comment></comment><comment><USER3> Whenever I give a talk, I show up wearing fancy lingerie underneath my business clothes. That way I get the feeling that I know something absolutely nobody else in the room knows... and that little fact gives me confidence.

If you're a guy and/or not into wearing lingerie you can always wear a ridiculous shirt underneath your presentation clothes that has something outrageous on it. Or (if you're crazy enough) put a printout of something random, like a banana or a hamster or Oscar the Grouch in your pocket. Just thinking in the first ten seconds that you did something so nonsensical make you kind of wonder if you are losing your mind- in which case you may have a little chuckle to yourself, causing the tension to dissolve. Also, you will know something the audience absolutely doesn't.

I realize this is exceptionally unorthodox advice, but it works so don't knock it 'til you've tried it.

Another tip is to pretend that you are talking to a room full of friends, that you have been accepted by all of the audience members already and they support you. Takes the edge off...

jsonne is absolutely right the lead up is always worse and after 10 to 20 seconds it starts to feel normal.

Knock 'em dead, you're gonna kill it.

</comment><comment><USER4> There is a load of great advice here: [http://speaking.io/](http://speaking.io/)

Practice is the main thing, you are speaking about your own project so you know your content well which is a great start.

Make sure that you know the main points you want to get across and make them clearly.

It's very tempting to rush a talk when you are nervous. I used to put BREATH in my speaker notes when I first started speaking to remind myself to pause, breath, think about the next point.

Practice your opening so you know it really well, as many have said the first few minutes are the hardest, so if you really know what you are going to start out with you can get over that bit and into the main talk.

I speak at loads of events, am still always a bit nervous, but it does get easier the more you do it.

</comment><comment><USER5> I've always felt better when I pick out individuals in the audience, and imagine myself speaking to a series of individuals instead of a large audience. I like to pick out different people around the room throughout the presentation, so I'm not staring in one direction the whole time.

Also, keep in mind that most people in the audience are truly interested in what you have to say. Some people will attend to other things during the talk, but most people are pretty focused on what you have to say, and want to see you do well.

Good luck, and it just gets better with practice!

</comment><comment><USER6> Not a talk specific tip, but just for presentations in general, the more you want the talk to come off as casual and not rehearsed the more you need to rehearse. Don't just read it over and over, but give the talk to the mirror, a chair, your dog, etc.

Best of luck. I've found that the lead up is actual worse than actually presenting. 10 to 20 seconds in, you'll feel fine.

</comment><comment><USER7> Don't get overly technical. Many speakers feel like they have to show every technical detail in order to prove their worth. It's more effective and helpful to focus on concepts and applications rather than details.

</comment><comment><USER8> Relax. Have fun with it. You're going to do great.

</comment><comment><USER9> You can be fully relaxed when you enjoy the talk. Yes, not all the audience will be interested in our project, but so what. focus on the points that your first backers will be interested in, and make friends with them after your talk.</comment>


Are You Really Gluten-Intolerant? Maybe Not - <AUTHOR> http://www.realclearscience.com/blog/2014/05/are_you_really_gluten-sensitive.html

<comment><USER2> Regardless of whether or not gluten-intolerance is as widespread as some claim it is, I'd like to see a simple change to food labeling to make it easier for those who want to know what they are eating to find out: versioning on labels.

The way it works now, I go to the supermarket. I see, say, a frozen spaghetti and meatball entree. I carefully read the long label to see if it has anything that makes me want to avoid it [1]. It passes. I buy it. I like it. Can I now just buy it again, without reading the label?

Nope! Food companies like to tinker with their products to improve consumer satisfaction and to cut their costs and increase their profits, so I need to read the label again.

If they put version information, such as a last change date, on the ingredient list I could then just glance at the date and see if it has changed since I last bought the item.

This should be doable at almost zero cost to the food producers if it is phased in by making the switch to versioning on a given product the next time they are changing the label.

[1] I have no known foods that I must avoid for medical reasons, but I have some admittedly irrational requirements. Some time when I was a kid, I decided for some reason to stop eating meats other than beef and pork. I have sometimes described myself as a lacto-ovo-bovo-porco vegetarian.

</comment><comment><USER3> > The ingestion of gluten, a protein found in grains like wheat, rye, and > barley, gives rise to antibodies that attack the small intestine.

Is this something new? Growing up in a different country I don't remember _ever_ hearing about this. And here is a huge "Gluten free X" market, where X is just about everything.

Does this sound odd or strange? Isn't gluten something people have been eating for a very long time now? And now we've evolved this strange sensitivity to it. So the idea is that it is these FODMAPs. Do we today end up eating more products with FODMAPs while before when baking bread it just didn't have that many of those?

I feel the same is happening with allergies. I don't remember hearing much about allergies. I only knew one kid in my high-school who had asthma. But now I know a lot of people in this country that are allergic to all kind of things. Heck my wife is. I have become allergic to pollen in the spring (and it never bothered me as a kid).

Anyway, it just seems very puzzling.

<comment><USER4> I've been having terrible stomach issues for about a year now. I went to a nutritionist who suggested a FODMAP elimination phase to try to identify the problem. Nothing seemed to help. I don't really know what to do now.

<comment><USER3> I am sorry to hear that. That sounds very frustrating.

Maybe try a different doctor. Maybe keep a diary of what you eat. See if there is something in particular the make it worse.

We had to do it for our kid to see if they are allergic to certain foods (since my wife is).

<comment><USER5> Sometimes that doesn't work, allergens don't always trigger the same response, or the same severity of response with each exposure. It's sometimes just better to cut out a class of foods for a few weeks and see if that solves it. The reintroduce it to see if the symptoms return. Then cut out another (overlapping) class of foods and monitor symptoms. Start to narrow down. Sometimes the classes of food that, when cut out, eliminate the symptoms can be false positives as it's one particular food in the class, or one ingredient in the food. My sister-in-law is allergic to peach skins, but can eat peaches just fine.

It took quite a few years to figure that out.

</comment></comment></comment></comment><comment><USER6> I love the anti-science bias of people against the gluten-free trend. You're telling me if an article came out that showed a study with a sample size of 37 people found that marijuana was incredibly harmful we would see the same "Marijuana confirmed to be incredibly harmful!" all over the internet? With the same certainty and intensity? Give me a break. There is a lot of nonsense in the gluten-free movement, there is no doubt about it. However I don't understand the hate it generates out of otherwise skeptical and rational people.

<comment><USER7> It is perpetually surprising to me how much other people feel it's their business what other people choose to eat.

<comment><USER8> It is frustrating as someone who prepares food for others to have to deal with bullshit "food intolerances" like the current gluten-free fad. I could prepare a delicious meal for you, but I guess you've decided you're gluten intolerant (unless you've been diagnosed with Celiac by a doctor, you're not), so nevermind. Or the tasteless sorghum beer these types bring to parties.

Food's a social thing. Placing nonsense limitations on what's allowed can really cramp social settings.

<comment><USER9> Receiving an official diagnosis by a doctor for celiac is not always possible. Although my wife's doctor considered it a possibility that she was celiac, he did not do anything with that idea until she had tried being gluten free already for a few months and found that it helped her intense pain.

The test for celiac _requires_ a person to have been eating regular amounts of gluten for _3 months_ before the test is done. When my wife is in a position such that a crumb of normal bread in her meal can cause her pain afterwards, there is no way she can eat gluten for 3 months in order to get a diagnosis by a doctor. The best she can get now is a statement that she is sensitive to gluten - but that sensitivity is enough that she can't have food cooked in the same pan as your food when you don't give any consideration to her.

So don't say this is "bullshit food intolerances" \- just because you don't have to deal with it does not mean that it is not real.

</comment></comment></comment></comment><comment><USER10> While gluten itself may or may not produce any ill effects for non-celiacs (likely not, it seems), it may regardless be a helpful signal of which foods to avoid for other reasons. Even if only adhered to leniently, a bias against gluten has been a great help in reducing the quantity of processed food I consume, the benefit of which I don't think anyone currently denies.

<comment><USER11> Yes, but you could certainly make an attempt to reduce processed foods instead of indirectly by avoiding gluten. There is plenty of processed food out there that doesn't rely on wheat, and the gluten free section of the grocery store is starting to look more and more processed every day.

<comment><USER10> Absolutely -- you're spot on.

</comment></comment></comment><comment><USER12> I went gluten-free 2 years ago and all my symptoms went away, I feel better, have lots of energy, etc.

I did not take a test, but my (non-alternative) internal medicine doctor told me to go on the gluten free-diet after I explained (in gory details) my symptoms.

Is the test really necessary then? Really?

<comment><USER13> On your gluten free diet, do you eat (in no particular order): apples, pears, peaches, milk, sugar, asparagus, Brussels sprouts, broccoli, garlic, avocado, cauliflower, mushrooms, and soft / fresh cheeses?

Do you have any issues with them? They are identified as high FODMAP foods.

[http://onlinelibrary.wiley.com/doi/10.1111/j.1440-1746.2009....](http://onlinelibrary.wiley.com/doi/10.1111/j.1440-1746.2009.06149.x/pdf)

<comment><USER12> I do, and I have no issue with them. I eat lots of apples, sugar, broccoli, mushroom, and cheese. Daily. I eat goat yogurt (I like the taste better) but I eat some regular yogurt too. I typically don't drink milk (taste again) and eat almond and coconut milk instead. (Trader Joe's gets lots of my business)

I eat very few processed food, canned food.

I eat all fruit (except kiwi--i get irritable bumps on my tongue), meats, cheeses, vegetables, rice, potatoes, dairy products, wine, and non-beer, non whiskey alcohol. (Also, some Shoju is made from wheat, so I only drink those from sugar cane, potato, sweet potato, etc).

I eat very little fried foods. (Although I won't pass up french fries on occasion).

<comment><USER13> That's what I kinda suspected. It would be hard for me to imagine someone mistaking sensitivity to the listed foods with a gluten problem.

</comment></comment></comment></comment><comment><AUTHOR> FWIW, I submitted this article with the title "Gluten intolerance is likely FODMAP intolerance" because I wanted to avoid the condescending, linkbait title of the original article.

</comment><comment><USER14> Shameless plug for my iPhone/ios app: [http://isthatglutenfree.com](http://isthatglutenfree.com)

The marketing website is way out of date, but the app is current, regularly updated (dedicated staff) and has the largest database of gluten-free brands and products available. The next release (out as soon as I can get it past the Apple gatekeepers) adds the ability to easily find NEW brands/products.

If you've chosen to eat gluten-free you know that finding tasty gluten-free products can be a real challenge. I'm trying to help people that have already made the decision to eat gluten-free; I'm not trying to 'promote' the diet itself - any significant diet and health decisions really should be made in consultation with professionals.

Would love to feel some HN love for my app :)

</comment><comment><USER15> Carbs just can't catch a break lately. I wonder if we finally pinpointed the problems with modern western diet or will our kids in a few decades see this as another fad, same way we start to view low fat recommendations.

<comment><USER16> The modern western diet is the fad, if you look at what it is, how long its been around, and what our biologically identical ancestors ate for a huge multiple of time longer than the modern western diet.

<comment><USER17> >what our biologically identical ancestors ate for a huge multiple of time longer than the modern western diet.

Why is there a belief that our ancestors had a singularly common diet? Humans have lived in all areas of the earth with vastly different diets. Some were high in fat, some were high in protein, some relied on plants/fruit, others were more balanced, etc.

Yes we probably on average have a higher carb intake than most humans in the past. But that doesn't mean there was some standardized diet that all pre- historic humans ate. They ate whatever was around to survive.

<comment><USER16> Its more of an exclusionary process.

The modern western diet is mostly made of vegetable oils, caffeine containing leaves and beans, huge amounts of refined sugar, ridiculous quantities of grains, antibiotic infused meats, fruit juices, milks, fermented products, huge amounts of corn syrup. Its no great challenge to go to the store for groceries and come home with nothing not on the list above, yet almost none of it existed more than a couple centuries ago. I realize this is considered an incredibly controversial opinion; I assume "most people" strongly believe our ancestors in 8000 BC mostly ate McDonalds and drank MtDew for every meal.

<comment><USER18> Tea, coffee, fruit juices, milk, and fermented products have all been around for much, much more than "a couple centuries."</comment></comment></comment></comment></comment>


A Million People Are Jailed at China's Gulags - <AUTHOR> https://www.haaretz.com/world-news/.premium.MAGAZINE-a-million-people-are-jailed-at-china-s-gulags-i-escaped-here-s-what-goes-on-inside-1.7994216 <comment><USER2> How many are in US ones? We should be talking about those too.

(This is not what-aboutism. Two evils are worse than one.)

<comment><USER3> And when we talk about that, someone asks "but what about China", rinse, repeat.

A million evils are worse than several ten thousand. And last time I checked, companies aren't folding to pressure by the US govt left and right to silence any mention of the ICE camps and other things, which isn't a minor detail, either.

From the article: (click the "print article" icon to get the full thing)

> _Why were people tortured?_

> "They would punish inmates for everything. Anyone who didn't follow the > rules was punished. Those who didn't learn Chinese properly or who didn't > sing the songs were also punished."

> _And everyday things like these were punished with torture?_

> "I will give you an example. There was an old woman in the camp who had been > a shepherd before she was arrested. She was taken to the camp because she > was accused of speaking with someone from abroad by phone. This was a woman > who not only did not have a phone, she didn't even know how to use one. On > the page of sins the inmates were forced to fill out, she wrote that the > call she had been accused of making never took place. In response she was > immediately punished. I saw her when she returned. She was covered with > blood, she had no fingernails and her skin was flayed."

> On one occasion, Sauytbay herself was punished. "One night, about 70 new > prisoners were brought to the camp," she recalls. "One of them was an > elderly Kazakh woman who hadn't even had time to take her shoes. She spotted > me as being Kazakh and asked for my help. She begged me to get her out of > there and she embraced me. I did not reciprocate her embrace, but I was > punished anyway. I was beaten and deprived of food for two days."

> Sauytbay says she witnessed medical procedures being carried out on inmates > with no justification. She thinks it was done as part of human experiments > that were carried out in the camp systematically. "The inmates would be > given pills or injections. They were told it was to prevent diseases, but > the nurses told me secretly that the pills were dangerous and that I should > not take them."

But (in addition to it getting penalized by flags apparently) even when a witness gives such details, we can't talk about this before we talked about the ICE camps, about which there are many reports? What can I say, I disagree, I think such discussions are orthogonal.</comment></comment>