PISA : Diligent Asia, indolent West  - <AUTHOR> http://www.economist.com/blogs/graphicdetail/2013/12/daily-chart-1?fsrc=scn/fb/wl/tr/diligentasiaindolentwest <comment><USER2> Steve Sailer's PISA analysis is indispensable in any discussion of PISA scores[1][2]

[1] [http://isteve.blogspot.com/2013/12/pisa-which-countries- not-...](http://isteve.blogspot.com/2013/12/pisa-which-countries-not-to- trust.html)

[2] [http://www.vdare.com/articles/pisa-scores-show-demography- is...](http://www.vdare.com/articles/pisa-scores-show-demography-is-destiny- in-education-too-but-washington-doesnt-want-you-to-k)

<comment><USER3> The second link [2] is very interesting - it breaks down some past USA results by ethnicity.

It also seems the underlying PISA data is a closely guarded secret. No doubt a political tinderbox.

> Why does my second graph have to compare reading scores from 2009 to science > scores from 2006 and math scores from 2003?

<comment><USER4> You can't really compare different data sets like that.

</comment></comment></comment><comment><USER5> Hmph, It seems that there are only two countries on that list for Mathematics with the same degree of cardinality to the U.S... Russia and Japan. These I would find to be more appropriate a comparison than say, a city to a country. It seems disingenuous to label Shanghai as China, as if it was representative of the whole, and then compare it to the U.S... They are supposedly comparing states, but I think there are more appropriate comparisons that could be made.

</comment><comment><USER6> I would take this measure of comparison with a large grain of salt; the Chinese scores especially are almost meaningless:

[http://www.brookings.edu/blogs/brown-center- chalkboard/posts...](http://www.brookings.edu/blogs/brown-center- chalkboard/posts/2013/10/09-pisa-china-problem-loveless)

</comment><comment><USER7> If we apply the "D people will be boss to A people" rules, then US can be relieve as they will still be the leader to asians.

I believe that the "not so good in exam" type is excellent in another thing aside academic, and that thing usually make them leader.

</comment><comment><USER8> My teachers have been telling me this since 2000.

</comment><comment><USER9> The degree to which the United States continues to be successful even though people here, on average, don't work as hard as people in east Asia, on average, is a puzzlement to east Asians. My take on the situation is that the founders of the United States were largely people who worked very hard indeed, and they were probably in the top rank in the world of that time in how hard they worked. Thus the United States still has accumulated resources (not just capital resources, but a society structured on the basis of sounder rule by law) that gives it a long-term advantage, allowing many Americans now to become complacent. It is a fact that most east Asian countries have been growing economically and improving socially at a faster rate than the United States has during my adult lifetime, so they could catch up[1] (and then, perhaps, have many inhabitants decide to take it easy).

I shared this link, after reading it, with my Facebook friends as I waited to see if it would bubble up to the front page of Hacker News. Sure enough, several of my American-born, American-raised friends thought that the article describes a situation of east Asian toil that they don't desire to emulate. A south Asian friend of mine gave the post a thumbs up, and went back to work without commenting further. The stored-up wealth of the United States also prompted a comment from another Facebook friend, also brought up and born in the United States:

"I believe the following: 1\. America enjoys success today largely because of immigrant labor, not American labor. 2\. American universities are still far and away the best in the world, but they are getting worse rapidly. 3\. American universities increasingly serve foreign students, not American students. 4\. Investing in America is far safer than anywhere else in the world because of such organizations as the SEC. 5\. People hate the SEC rules and are looking for ways around them with increasing success, in large part because the investors are foreign and not used to such rules.

"I am reminded of the fall of Sparta."

One observation of this phenomenon I heard around the most recent turn of the century was from Christians in Taiwan: "It looks like God is blessing Americans for observing the Sabbath, as they surely don't work as hard as we do here." People grasp for all kinds of easy explanations for the difference in recent outcomes between the United States and east Asia (I refute another too frequently heard, too simple and just plain flat wrong explanation below another comment in this thread), but surely the explanation for this phenomenon, as for plenty of other phenomena of differences between countries, is multifactorial and subject to change over time.

[1] [http://www.globalpost.com/globalpost-blogs/southeast- asia/si...](http://www.globalpost.com/globalpost-blogs/southeast- asia/singapore-richest-country)

<comment><USER10> The fall of Sparta? Sparta relied neither on Spartan nor immigrant labor, but on helot labor.</comment></comment>


Startup tsunami in silicon valley - <AUTHOR>

Recently, I started scoping out the job landscape in Silicon valley. And holy cow!!! it's startups everywhere. Every tom, dick and harry is doing a startup! Which makes me skeptical of 99% of these startups, including some of those 'decacorns'.<p>What's going on in silicon valley? Are startups really making that much of money or just getting a free ride on investor's expense? Or is valley deluded with young-20-something-programmers who are just starting pet.com variations? <comment><USER2> I think it's important to separate out two things -- the startup boom vs the housing boom.

The startup boom in some sense has always been there. There is a bubble-like environment but I don't think it equates to 1999 -- most of the high-value companies are doing fairly well, having either good exits (Whatsapp, Tumblr, Etsy), or raking in decent revenue (AirBnB) or having marketing executives fight over the chance to advertise (Snapchat, Pinterest).

As other folks have pointed out, VC firms have gotten rich and there is money to go around so the amount firms are being offered is a little higher than normal especially for late-stage rounds when it looks fairly sure that the company is on solid ground.

The housing boom on the other hand is simply an effect of not enough housing. Startups aren't the major employer in Silicon Valley. The major employers are Google, Facebook, Apple, Microsoft, LinkedIn etc -- all employing thousands of people, all generating loads of profit and they aren't shutting down anytime soon; nor are they going to relocate anywhere in the near term. These people need places to live, but SV suburbs don't want to authorize extra housing, leading to the spike in prices. Even San Francisco they city has had way lower housing built than a city like Seattle over the last few years, though the demand has been far higher.

The housing boom / bubble will burst if there is a sudden, huge surge of new housing projects; but I doubt it.

</comment><comment><USER3> I'm in New York, not in SV but there's a lot startups over here too. I am a contract developer and have worked with startups for about three years. I can honestly say there are founders that are getting a "free ride" on investor expense - taking long vacations over the summer, building product forever and not releasing (this gives founders an excuse not to be out talking to customers - after all, the product isn't ready), and so on. It's a scam. It's a great way to avoid getting a real job while being able to say to friends and parents that you're doing something exciting - just on the beach on Montauk.

<comment><USER4> There's a perception that raising money is "easy" in the current climate. The reality though is that it's simply not that easy and that there most certainly isn't many founders coasting on beaches. I know a lot of entrepreneurs and founders here in SF/Bay, and every one of them is working much more than 9-5 5 days a week. And none of them got a "free ride" from an investor - but rather went through the slog of building product / traction to raise every penny. Sure, there's more capital floating around - but there's a lot more competition too.

<comment><AUTHOR> Frankly, given the number of startups, I too think it must be easy to raise money. May be not from A16Z, YC, LSV or other experienced ones but I see so many new VC firms now days.

<comment><USER5> Trust me, as a startup founder raising money is never easy.

</comment></comment></comment></comment><comment><USER6> Yeah it's 1998 all over again.

I wish I had the gab to cash in on it some... as it stands, I just make and sell my hardware. It's a good living, I paid off my mortgage at 32 and have enough money to not streess and enough free time to write.

</comment><comment><USER7> It can be a shock to come to SV/SF and realize how many startups there are here. It's probably unique on the planet. Sure, most startups fail. That's been said over and over. And in this economy, it's not really a problem. The risks for each individual tech worker are fairly low, because if your present employer fails, there are many others desperate for software engineers, designers, marketers, etc.

There are lots of good ideas and lots of bad ideas getting built here. Some founders are deluded, others are ambitious, and

Startups get founded in the Bay area because there's a lot of talent to draw on, a lot of experienced investors, and a lot of services that support young companies.

More generally, startups don't make money, they make promises. And the promise they make is that if VCs invest X amount of money, they will get back 5X in a few years. Or something like that.

Most startups end up not returning 5X, and a few return a 100X, and them's the breaks.

<comment><AUTHOR> I have been in SV since 2008, so not shocked by startup culture. What shocks me is so many startups with very trivial product/service which could easily be just a feature in their competing product. May be I'm questioning their value and overhead involved in developing that 'feature'. But again, there are some really good startups, and totally worth trying whatever they are trying to build. It's just their number is still no better than it was in 1999 or earlier. I wonder if there are any hard numbers of startups - how many? how many employees? their average experience/age? rate of 'success'? etc.

</comment></comment><comment><USER8> This is called a bubble. Where a lot of these start-ups are getting their funds is from the Bank of Mom&Dad, regular old credit cards, or they are 'bootstrapping' out of their jobs at places like Starbucks. Not many investors are actually doing this, it just seems like it because most of the people are lying, trying their best not to lie _per se_ , really good at saying their cousin is a big time investor because he gave them 20$ for pizza and they got too stoned to buy pizza.

Do not believe the hype out of SV, this is going to crash no sooner than 4 months from now and no later than 16 months from now. Evidence: Housing prices. The property bubble is back, because people think they can flip houses again and make a quick buck. Why is it back? Because people think that other people are actually buying houses to live in for that price because they think there are 100,000 people that FB employs because they are, like, as big as Boeing, right? And, like, they all have like bucco bucks from all the stocks, right?

Surprisingly, Mark Twain has written a lot about this kind of stuff. His "Roughin' It" talks about his time in Virginia City, Nevada and all the leeds that folks would buy and sell from adventures in the silver country. The lessons there are very good.

<comment><AUTHOR> > most of the people are lying, That's bit harsh. There was a report few days > back on HN, where a company claimed that while typical VC are slowing down > in investing, private hedge funds and such are pumping unprecedented amount > of money in tech startups. Although, I might have to agree about SV being in > 'bubble'. I live there and see shacks being listed for $1mn.

</comment></comment><comment><USER9> Why does no one think it odd that there are several large tech companies with 100k+ employees each, but think something is wrong if there are thousands of small five person companies? Tech workers don't need the resources of large tech companies anymore and they certainly can't pay for huge management overhead.

</comment><comment><USER10> I think it's perfectly normal to have so many startups nowadays, the cost of starting one has gone way down and it's a much better environment (but highly competitive) than late 90s to try out an idea. You can slap some code together or get it over the counter/plug&play and rent some cheap server power and you're good to go. The question is how many will be able to make money? US stats say 95% of them fail, but you could have 1% making some serious money, VCs/investors are not dumb to repeat late 90s mistake and they now gamble with smaller bets, pool money & collaborate alot.

You should go out and try out your idea. It's fun but hard work as I'm in middle of one, taking a break writing this :)

</comment><comment><USER11> I don't think investors are that ignorant to give away money without seeing any value in person or his idea. Its a good thing when people are trying to build business, many of those might fail, but someone of those tom, dick or harry might leave a mark.

</comment><comment><USER12> I have very recently switched from 'startupping' (bootstrapping for over 5 years) to doing more contracting and consulting.

There is 200 million Euro of government subsidies (+ private capital) going out to startups in my (rural!) area and I'm taking everybody in. It's crazy right now.

</comment><comment><USER13> The answer is that there's a lot of passive capital in the world in pension funds for teachers and police officers. Much of that passive capital is invested in bonds and equities, but some of it gets invested into private equity, of which VC is a subset.

Now, what happens is that a large proportion of the passive capital ends up in Northern California. It has to be invested somewhere. In VC, it has to chase ideas. The problem is: most ideas are lame, and most people don't have the ability to tell which ones are lame (and lame ideas can succeed in the short term: see Pets.com and Snapchat).

The passive capitalists are people like retired teachers in Ohio. If they voted, they wouldn't want all of that passive capital (and the job-creating power of it) going to a small geographic area. They'd rather have it spread out more: this would mean a greater number of jobs in Ohio, and it would take the rent/housing pressure off of the Valley. Of course, what passive capitalists care the most about is returns on investment. If VC were a successful investment vehicle, then passive capitalists would favor the California concentration, and what is happening would be the right thing. The problem, of course, is that it's _not_ a successful investment vehicle. VC works for the careers of the venture capitalists, and the cronies they can place in high positions, but the passive capitalists whose funds are being invested in it get utterly screwed.

This may answer your question and, yes, many of the startups being funded right now are bogus. However, there are some that aren't. It's not all bullshit. I'd say that it's right to be skeptical, but there are companies with genuine products and strong cultures and plausible futures. It takes a lot of time to get a sense of which are which, though.</comment>


Show HN: my first mockup, biglumber.com listings on a Leaflet.js map - <AUTHOR> http://filosottile.github.com/Biglumber-map/

<comment><AUTHOR> Biglumber is a site for coordinating GPG keys signing. People who are available to sign other people keys put a listing there.

This map makes it easier to find listings near you.

Tip: everybody should get his key into the strong set.</comment>


What You Need to Know about Progressive Web Applications (PWAs) - <AUTHOR> https://www.outsystems.com/blog/posts/progressive-web-apps-pwa/# <comment><USER2> PWAs strike me as the next step in the rush to the bottom that software seems to be on.

I don't have data, but subjectively speaking, I've never seen a web-based application that wasn't inferior to a native application. PWAs just promise to increase the amount of substandard software.

<comment><AUTHOR> There are proved benefits of using PWAs in specific situations, but it's not near the wonderland that companies like Google are making it seem.

I believe that they have secured a place in mobile development and are very worth considering at this point, but it's very soon to say they're a good solution for everyone.

<comment><USER2> Yes, I didn't mean to imply that there is no role for PWAs at all, although I think the main beneficiary is what the article is talking about -- for marketers.</comment></comment></comment>


UK Proposes All Paychecks Go to the State First - <AUTHOR> http://deadlinelive.info/2010/09/20/uk-proposes-all-paychecks-go-to-the-state-first/

<comment><USER2> The title is somewhat misleading.

Under the current PAYE system, the employer gathers the tax information on behalf of the employee and files it with the HMRC at the tax year end.

Under the proposed new system, details of the payment are sent to HMRC electronically on each paycheck. Which makes sense when you consider that most payrolls are electronic. The idea is that this will reduce bureaucracy and also makes it easier for contractors and for people who switch jobs a lot (and the companies that employ them).

If your company doesn't have a compatible electronic payroll system then you would still be able to file at the year end as you can now, except it would be an online-only filing with no paper forms.

</comment><comment><USER3> Nice timing given 6 million people had their tax records stuffed up last year (<http://www.bbc.co.uk/news/uk-11186397>). Still waiting to see if I'm due a windfall or a shake down.

I seriously doubt the wages -> government -> employee thing would come to pass. This sounds awfully like what they call "blue sky thinking".</comment>


What happens to the SF Bay area when the next major earthquake strikes? - <AUTHOR> https://www.bloomberg.com/news/articles/2017-05-26/waiting-for-the-big-one-to-shake-san-francisco-quicktake-q-a <comment><USER2> I hate to say it, but an earthquake is probably San Francisco's best bet at getting more housing built.

<comment><USER3> Also, it would take care of the homeless problem.

2 birds, one stone.

<comment><USER4> I'm curious. How? Isn't homelessness a social symptom? Homelessness doesn't just disappear because the current homeless are displaced, I thought.

That being said, I'm certainly not learned on the subject.

<comment> d-sc An earthquake would open up new ground that is currently prohibitively expensive by regulation (the 'social' part of the problem ) to allow enough housing to be built to reduce cost significantly.

<comment><USER5> Homeless people still exist where housing is dirt cheap. It doesn't matter whether the rent is $2500 or $500 when you don't have the skills or mental health to be employed at all.

</comment></comment></comment></comment></comment><comment><USER6> I have been looking for a house to buy in SF for the last 6 months. What's been very interesting is that most of the houses we have reviewed, did not have solid foundations (many being 2-unit condos). They are all located in liquefaction zones and the disclosure packages mentioned the foundations had cracks (or needed retrofitting). Still, buyers did not care and bid huge amount of money. Our estate agent told us the average buyer does not take that into consideration nor care to retrofit the foundation. Scary.

<comment><USER7> What is retrofitting? News to me from the Midwest.

<comment><USER8> In this case, it means increasing a structure's ability to survive an earthquake.

</comment></comment></comment><comment><USER9> Could be a decent way to solve the current zoning / housing crysis. The only disruption not welcome in the Bay seems to be from Mother Nature.

<comment><USER10> And concurrently, may rattle the echo chamber a bit

</comment></comment><comment><USER11> Foster city real estate is an enigma. Had anecdotally heard from a lot of people that houses close to the bay are sinking very gradually. Nothing seems to affect the prices though :-)

</comment><comment><USER12> Bart delays probably won't be any longer than usual ;)

</comment><comment><USER13> Full telecommuting becomes more widely accepted?

</comment><comment><USER14> I know one building in particular that may be problematic. It also happens to be sinking.

</comment><comment><USER15> There will be a movie about it and it'll be called "Disrupt: 2019"</comment>


Closing the Door to Microsoft Vista - <AUTHOR> http://www.businessweek.com/technology/content/may2008/tc20080512_157155.htm?campaign_id=rss_topStories

<comment><USER2> Vista is problematic and I have suffered greatly, personally, because of its flaws, so I am certainly a vocal critic of it, but I don't understand the whining about systems requirements. Most machines you can buy these days are Core 2 Duo with 2 GB of RAM or better, and in my obviously limited experience that's sufficient. A $600 laptop from Dell gets you that much.

Yes, you can't run Vista on a really old machine, which lots of people still have. It doesn't strike me as a valid criticism unless Microsoft fails to make clear that a given machine will not have an enjoyable experience due to performance problems.

I still choose to run XP, but then again I run Xubuntu on a quad-core machine just because it appeals to my neuroses.

<comment><USER3> That's the increasingly fragile business model though. MSFT and generic PC makers are like siamese twins who can't be separated. The makers depend on MSFT to create new versions which require new hardware. In turn, MSFT gets exclusive distribution licenses from the makers.

If MSFT screws the product, as with Vista, the makers suffer the fallout because the market doesn't buy their latest generic plastic. Apple managed to identify this rotating gimmick early on, and went down the proprietary hardware path because it was their only choice. And look who has the market attention now.

So I'd say that the makers are a bit pissed right now that MSFT didn't hold up their end of the deal. They know that all the crap they sell is generally indistinguishable, but that didn't matter because MSFT would provide them with a mechanism for recurring income that was better than just waiting for the plastic to simply wear out.

And with MSFT depending on thousands of licenses just to keep the lights on, I'd say the next few years are going to be interesting for the siamese twins.

With my MacBook Pro, and my dual Dec Alpha box that I plan to put Genera on, I think I'll just sit back and watch.

</comment></comment><comment><USER4> This new resistance to higher system requirements is interesting in the context of ESR's "World Domination 201" ([http://www.catb.org/~esr/writings/world-domination/world- dom...](http://www.catb.org/~esr/writings/world-domination/world- domination-201.html#id286667)), which looked at the 16-bit and 32-bit transitions and predicted that the 64-bit transition would shake up the computer industry again, in 2008. In theory, the middle of the bell curve of computer users would be buying 64-bit systems with 4+ GB of RAM this year, and if Windows cracked under this requirement, Linux or Apple would have a chance to break into the mainstream.

But we're halfway through the year, and 4GB of RAM still doesn't seem to be the median for new computers. Is it because we're finally satisfied with what a desktop computer does? Are smaller, lighter laptops changing the market? Or are retailers and hardware manufacturers deliberately hitting the brakes, having watched Vista go sailing off a cliff ahead of them?

<comment><USER5> Maybe ESR was making numbers out of thin air?

<comment><USER6> ESR writes small (but useful) UNIX tools. He ain't no analyst (for a big thing).

</comment></comment></comment><comment><USER7> Vista reflects the time: all surface, no content improvement. We get the flashy interface, but no new filesystem etc.

ReactOS might replace Windows in the future.</comment>


Ask HN: Business to Consumer vs. Business to Business startups - <AUTHOR>

After seeing many VC and Angel investment  portfolios and requirements I somehow got an impression than B2C type of startups are more welcome than B2B.
My question is: is it true? And if yes what are the reasons for that?
Right now the Google (corr. from Facebook) capitalization is bigger than SAP or IBM cap., but that can't be the only reason?
Renat <comment><USER2> B2C startups have bigger caps because the network externalities allow for bigger bubble valuations (1MM users who never pay for anything, because the internet is free = $1B valuation). As PG has said- the value of such a firm is basically the chance they're the next google; therefore, no need to be profitable.

B2B businesses are much more defined, much more down-to-earth, and make good money. Whilst it won't be as sexy, it will make you money- possibly even without ever needing an investor.

</comment><comment><USER3> facebook capitalization is NOT bigger than SAP or IBM</comment>


We lost tremendous amount of short term memory thus chimps can do this, we can't - <AUTHOR> https://twitter.com/brianroemmele/status/1213860120058220546 <comment><USER3> I'm getting tired of these "chain of tweets each ending in a pithy scientific claim that sounds really impressive but is probably wrong for technical reasons".

<comment><AUTHOR> I agree with your annoyance at these types of threads. The contrast in this chain is the animated discussion between the originator and various scientists including neuroscientists, primatologists, etc.

<comment><USER3> Maybe I'm not seeing the responses properly but it looks like nobody on the thread is an expert scientist. Within several tweets, the main claim of the OP was more or less put into strong doubt.

<comment><AUTHOR> Some of those involved in the discussion:

Brad Wyble [1, 2]

[1] [https://psych.la.psu.edu/directory/bpw10](https://psych.la.psu.edu/directory/bpw10)

[2] [http://wyblelab.com/](http://wyblelab.com/)

Sharon Rodobre OBE [3, 4]

[3] [https://lafeber.com/vet/redrobe/](https://lafeber.com/vet/redrobe/)

[4] [https://blooloop.com/features/twycross-zoo-sharon-redrobe- on...](https://blooloop.com/features/twycross-zoo-sharon-redrobe-one-world/)

Claudio Tennie [5, 6, 7]

[5] [https://sites.google.com/view/claudiotennie/cv](https://sites.google.com/view/claudiotennie/cv)

[6] [https://sites.google.com/view/claudiotennie](https://sites.google.com/view/claudiotennie)

[7] [https://uni-tuebingen.de/fakultaeten/mathematisch- naturwisse...](https://uni-tuebingen.de/fakultaeten/mathematisch- naturwissenschaftliche- fakultaet/fachbereiche/geowissenschaften/arbeitsgruppen/urgeschichte- naturwissenschaftliche-archaeologie/forschungsbereich/aeltere-urgeschichte- quartaeroekologie/mitarbeiter/akademische-mitarbeiterinnen-und-mitarbeiter/dr- claudio-tennie/)

Tom Roth [8]

[8] [https://www.universiteitleiden.nl/en/staffmembers/1/tom- roth](https://www.universiteitleiden.nl/en/staffmembers/1/tom-roth)

Patrick A. Jansen [9]

[9] [https://www.wur.nl/en/Persons/Patrickdr.ir.-PA-Patrick- Janse...](https://www.wur.nl/en/Persons/Patrickdr.ir.-PA-Patrick-Jansen.htm)

<comment><USER3> checked out all your links; really not seeing how an animal vet qualifies. The people I agree with are the ones on this list who are disagreeing with the original poster, and have the greatest qualifications in the area of interest (wyble and tennie).

<comment><AUTHOR> I took your statement, "it looks like nobody on the thread is an expert scientist," literally. It could be that I'm confused by what you mean with "expert scientist." You qualified two from the list but questioned Sharon Redobre's (I misspelled her name in my comment) inclusion as merely being a veterinarian. When I read her curriculum vitae [1], I can't help but conclude that she is both, an expert in her field, primates and exotic animals, and a scientist based on the definitions I consulted [2, 3, 4].

I will not discuss the others you excluded; it would be tedious and belaboring the point.

Finally, I agree with those who refuted the original poster despite his answers to their counterpoint. Someone posted a claim that was argued with civility over the chain of comments, not unlike what happens in HN. How such a discussion is tiresome, I leave to individual preference. :-)

[1] [https://uk.linkedin.com/in/sharon-redrobe- obe-11139912](https://uk.linkedin.com/in/sharon-redrobe-obe-11139912)

[2] [https://www.collinsdictionary.com/us/dictionary/english/scie...](https://www.collinsdictionary.com/us/dictionary/english/scientist)

[3] [https://en.wiktionary.org/wiki/scientist](https://en.wiktionary.org/wiki/scientist)

[4] [https://sciencecouncil.org/about-science/10-types-of- scienti...](https://sciencecouncil.org/about-science/10-types-of-scientist/)

</comment></comment></comment></comment></comment></comment><comment><USER4> I noticed something really interesting around the 2:09 mark in the video - <USER2> chimp taps a box, and goes on to the next one very quickly, but realizes that the initial tap didn't register properly and goes back to fix it.

I definitely commit a "mistap" error like that at least once a week on my phone / iPad. I'm not sure I can spot and fix them that quickly!

</comment><comment><USER5> I didn't see anything in the article that supported this conclusion.

We did not evolve from chimps, we share a common ancestor, but we evolved (and continue to evolve) independently. We may have lost this ability or we may have never had it. Chimps could have developed it after branching off.

</comment><comment><USER6> There is some discusión about how much training did the monkeys had and how much did the humans had. Which paper is has the best comparison?

Is there any evidence that this is present in the common ancestor an is not a new development of the chimpanzees/bonobos?

<comment><USER7> May I point out that it's racist to call them monkeys? The correct term is "ape".

Just kidding, btw, but I recall having heard something along this.

<comment><USER6> It is not racist to call them monkeys, but it is wrong. They are apes.

[I can blame my native language that is Spanish, where the words apes and monkeys are equivalent. Anyway, in the recent times it's more common to try to use each word for the different kinds of animals like in English. It's a good excuse, but the reality is that I was wrong.]</comment></comment></comment>


Employees Start to Feel the Squeeze of High-Deductible Health Plans - <AUTHOR> https://www.npr.org/sections/health-shots/2019/05/03/719519579/employees-start-to-feel-the-squeeze-of-high-deductible-health-plans <comment><USER2> You can argue that the ACA improved the healthcare system overall. But it's been tough for people who were already covered by employer insurance.

I think people fail to appreciate that prior to the ACA, when the healthcare system worked, it actually worked really well. I got very sick at the age of 20 while I was still on my parents very modest insurance (pre-ACA). Within 48 hours I had an appointment at the best oncology hospital within 500 miles, and I was able to get scans, tests, etc on a very short turnarounds. Ultimately I had two major surgeries in 4 months, and the whole thing probably cost the insurance company a couple hundred thousand dollars. Since my parents had already hit their out-of-pocket maximum, the marginal cost to us was 0.

Now, the "when it worked" caveat is a big one. The story would be very different if my parents didn't have insurance at all or if I hadn't been eligible to be on it. But the same story today on my insurance would cost me _a lot_ more money out of pocket due to a much higher deductible and a higher out-of-pocket maximum.

My perspective is that the ACA made things significantly better for a small group and modestly worse for most people. I'm open to moral arguments that the tradeoff was worth it (although that's not what I believe.) But I dislike rhetoric that pretends there's no tradeoff at all.

Edit: Added substance to a one-liner.

<comment><USER3> Pre ACA, pre-existing conditions could disqualify you from insurance. People with pre-existing conditions are the people that need health care coverage the most. We can't under-weigh the moral obligation we have to this previously marginalized group, when considering service may be slightly worse for people who have employer coverage.

How I see it: if you were in the pre-ACA pre-existing condition pool, your perspective would be vastly biased in a different direction. And nobody wants to end up in that pool. Nobody chooses that. That's why it's a net win overall.

People died because they don't have coverage (unfortunately, still happens, but substantially decreased by ACA). If things are slightly worse for people who already had access, It's such a small price to pay.

<comment><USER4> I don't like the entire concept of "pre-existing conditions". It goes against the entire concept of caring for sick people.

We are all people. We all get sick sometimes. Sicknesses can last a long time, or a short time. Sick people need help. Help the sick people. Pay what you can (a reasonable amount) into a common pool and take what you need (only as much as you need)

<comment><USER5> _> I don't like the entire concept of "pre-existing conditions"._

If you have an elective health insurance system where people choose whether or not and when to participate, it implies this restriction.

Say you have private health insurance companies but don't allow them to prohibit members based on pre-existing conditions. Everyone will simply not get health insurance to avoid paying the premiums until the day they need it. That would make health insurance companies completely unviable financially.

This is why Obamacare both eliminated the pre-existing condition restriction _and_ mandated people get health coverage. You can't have one without the other or you get the free-rider problem.

This is another reason why healthcare should just be universal. It doesn't work _at all_ like an actual efficient market product.

<comment><USER6> Would a wait limit, like with hurricane insurance, help to mitigate this problem? You can't wait until the NWS declares a Category 4 storm is barreling towards you to buy coverage. I mean you can, but the coverage doesn't kick in until 30 days later.

</comment></comment></comment></comment></comment><comment><USER7> Every discussion on healthcare payment structures in this country is completely asinine.

Healthcare is best managed as a risk pool. The bigger the pool, the cheaper to be in it. The biggest risk pool is everyone. Therefore, we should put everyone in a single pool.

How we manage this is a separate discussion. Private, public, maybe a federally chartered non-profit like the Fed.

But as long as we keep ourselves fractured into thousands of different risk pools, all these discussions about deductibles and HSAs and whatnot are just chasing our own tails.

<comment><USER8> _> Healthcare is best managed as a risk pool._

No, health _insurance_ is best managed as a risk pool, which, as you say, should obviously be everyone.

But much of health _care_ is not health _insurance_ because it doesn't deal with insurable risks. Your need to get an annual physical isn't an insurable risk. Neither is a one-time appointment with a doctor to see if your headache and runny nose is just a cold or an infection that requires antibiotics. The first isn't insurable because it's a predictable recurring cost; the second isn't because it's a routine service that shouldn't be so expensive that you can't pay it out of pocket.

Health _insurance_ should be focused on the things that _are_ insurable risks: emergency care, hospitalization, etc. Things that aren't insurable risks, like the above, should be handled differently. But our health care system insists on treating these very different things the same, which of course is going to lead to huge inefficiencies and high costs.

<comment><USER9> I might be mistaken, but here (Germany), regular checkups are paid by the insurance on purpose.

The alternative being people not doing the checkups and thereby delaying diagnosis until treatment get's really expensive as things get life threatening.

In the end insurance has an interest in people taking regular checkups resulting in early (cheap) action.

<comment><USER8> Are people _required_ by the insurance companies to get regular checkups?

<comment><USER9> No. But insurances are (to different degrees) heavily promoting checkups and health/fitness improvement programs.

Some are even handing out coupons and benefits for those joining fitness studies or sports clubs etc.

<comment><USER10> It would also be pretty easy to incentivize. Have an annual physical and save $X a month on your premium. We do it for other things like smoking already. Plus many examples in the car insurance world.

</comment></comment></comment></comment></comment></comment><comment><USER11> If you were designing a society starting from scratch today and said, "I think we should make having health insurance largely dependent on having an employer.", you would be laughed out of the room.

I think we are running along some tracks that were laid long ago, and rather than all jumping off, some people in comfy Pullman cars are content with letting the train run off a cliff.

<comment><USER12> I find it odd that some executive gets to pick which 401k and health insurance plans you get, and that you must pick from their few choices that allow you to have. I can see why the providers love it, they can target all their advertising, marketing, etc, at a few key people at large employers, but not sure how that benefits the average worker..

<comment><USER13> You can get an individual 401K or IRA and make all your own choices. If you're talking about an employer matched 401K, I don't think it's unreasonable at all for them to select it.

<comment><USER14> > If you're talking about an employer matched 401K, I don't think it's > unreasonable at all for them to select it.

What's special about 401k matching that requires the employer to choose plans? My employer doesn't force me to have a checking account with a particular bank they chose if I want to receive my salary. They should be able to match contributions to any account anywhere.

<comment><USER13> I don't know if you understand how 401K matching works on the backend.

A lot of times the employers are capped on their own plans at a percentage rate that matches their employee's participating. So matching is often in their best interest, esp at smaller companies.

But, easier version is this is a perk, not your base salary. They are paying you with legal tender and there are freedoms associated to that. There is no such thing for perks.

You aren't entitled to make the administration choices for something they are gifting you.

<comment><USER14> > I don't know if you understand how 401K matching works on the backend. A lot > of times the employers are capped on their own plans at a percentage rate > that matches their employee's participating.

I actually do not understand this. Could you please explain more? What does an employer being "capped on their own plans" mean?

> But, easier version is this is a perk, not your base salary

When I make a decision on a job offer, the 401k match, health insurance premium, free lunch and snacks etc. all factor in and they're all worth a certain amount of money. Money is money and how it's labeled, "perk" or "base", is irrelevant. If my employer ends 401k matching, I'll treat it as a pay cut mentally.

My ultimate "fantasy" is to eliminate 401k altogether and instead let everyone contribute whatever the 401k annual limit is to an IRA. The employer can simply add matching funds to your IRA and you're free to have your retirement accounts anywhere you please.

</comment></comment></comment></comment></comment></comment><comment><USER15> High-deductible health plans were always designed to benefit employers. My company switched us to one with a big PR campaign highlighting how everything would be better (contributions to HSA - free money!). The only "advantage" is that companies have to pay smaller premiums and employees are greatly discouraged from getting care due to high costs.

Funny enough, employers are rethinking this now since employees not getting basic preventive care is actually more expensive for them in the long run - [https://www.insurancejournal.com/news/national/2018/06/26/49...](https://www.insurancejournal.com/news/national/2018/06/26/493273.htm).

<comment><USER16> > The only "advantage" is that companies have to pay smaller premiums and > employees are greatly discouraged from getting care due to high costs.

In principle the advantage is that employees are greatly discouraged from _paying too much_ for care. If the insurance pays for everything then what do you care if your doctor is charging $1000 for a physical instead of $50? If you're paying out of pocket, now you care.

The problem is we also have a lack of price transparency, so it's arduous to actually determine the price you'll be charged for routine care and avoid the places who are overcharging, which correspondingly becomes nearly everyone. The states would do everyone a favor to pass and enforce some price transparency laws.

And the advantage of lower premiums is that it allows you to receive that money. If your employer is raising your plan's deductible and giving the balance saved in premiums to you, that's the advantage -- you get the money. If they're not, go ask for a raise or find another employer who will pay you more, in the same way you would if they lowered your compensation in any other way.

<comment><USER17> > price transparency

And even list prices themselves are typically starting points for negotiations when a provider is dealing with a large payor whereas an unwell individual (y'know, one who is about to spend a lot of money on healthcare) is not in a great position to bargain with her caregivers, and so is forced to negotiate after the fact, from an artificially inflated starting point, under the guise of bill reduction, or worse, debt relief.

<comment><USER18> A lot of the issues with pushing price negotiation to the individual also seem to be assuming (or worse, lying about) that most medical professionals, procedures, facilities, et al are entirely fungible. Even if individuals had full price transparency, that doesn't change the fact that certain facilities will always be closer to home, certain procedures inescapable, certain medical professionals decades or life-long relationships to build, etc. Medical services aren't just interchangeable factory goods on a retail store shelf that you can easily pick based on price alone and then slot it right into its widget shaped hole, and never will be.

<comment><USER16> > Medical services aren't just interchangeable factory goods on a retail store > shelf that you can easily pick based on price alone and then slot it right > into its widget shaped hole, and never will be.

Almost nothing actually works that way. Walmart doesn't stock exactly the same goods as Target. One of them may be closer to where you live than the other.

Which is why price isn't the _only_ criteria. If the office closest to your home charges $250 and one which is fifty miles away charges $200, you can perfectly well choose to pay the extra $50 for the convenience.

The issue is that when the nearest office decides to charge $1000 and the one fifty miles away is still charging $200, that should maybe change the outcome. But not if you aren't aware of the price difference to begin with.

And this even applies to the beloved family doctor -- there is a limit to the amount of price gouging that a familiar face is worth.

</comment></comment></comment></comment></comment><comment><USER19> Healthcare simply does not line up with the incentive structure of the free market.

People can't opt-out if they're getting a bad deal.

Risk outliers get turned down as bad business decisions, or the drugs they need to stay alive are impossible to afford because of "low" demand.

It's left up to employers to choose the product that's best for their employees (and ensure that market competition functions), but that assumes they actually care about their employees' well-being, which most don't.

Denying care to the unemployed is a strong force deepening the poverty cycle, preventing people from working their way back up to being productive members of society.

Healthcare doesn't even really fit the model of insurance, because it isn't just a guard against unlikely catastrophe, it's an ongoing, chronic, inevitable cost of being a human being.

<comment><USER20> Yet here we are. Remember when Obama fought to have healthcare prices made transparent so that we could shop for the cheapest medical treatment, and that was beaten back severely by the lobby? The compromises the ACA made to bend over backward for for-profit insurance companies were an example of how much power the lobby has. I think if we've learned anything is that we need to go all in on single payer and completely remove for-profit insurance, IMHO, because of exactly what you're saying about the free market: it doesn't work for certain things (if anything, really): military, education, healthcare all the three classic failures of the freemarket. I think this is why all the dems are embracing Healthcare for All: everyone is getting screwed by healthcare except the 1%.

<comment><USER19> I think the free market does a good job of _solving_ problems, just not of deciding which ones are worth solving. The military follows a hybrid model that (mostly) works, where a semi-free market is created and guided exclusively through governmental leverage, theoretically giving the best of both worlds. Utility companies work a similar way, as do (I think) some first- world government-run healthcare systems. I think the ACA was aiming for this type of thing, but was so hamstrung by compromises and by the sheer complexity of the system it was trying to reshape, that it ended up being a pretty mixed bag.

Maybe in the case of American healthcare, the current state of things is just such a horrible rat's nest of problems that we really do need to burn it all down and start over.

</comment></comment></comment><comment><USER21> Isn't the point of an HDHP that you're supposed to set up an HSA to go with it? Premiums for HDHPs are significantly lower than for normal health plans; the idea is that you're supposed to use the premium savings to fund the HSA, which is then money that carries over year over year, right?

<comment><USER22> Not all employers offer HSAs to go along with their HDHPs. Mine doesn't and it's very frustrating. I want to save pretax money in an HSA but I can't.

<comment><USER23> There is no requirement for your employer to provide the HSA. Frequently the employer can get better deals on the HSA than you can individually (like no waived maintenance fees and the like) but you can for sure open your own.

In fact once you have enough money in there that you are moving out of liquid investments then you definitely want to shop around for HSA much like you would for an investment account.

<comment><USER24> Can you actually fund a non-employer HSA with tax-deductible funds, or is that a benefit that only applies to payroll HSA contributions? If not, a lot of the benefit of an employer HSA disappears.

(FWIW, I have an HDHP, employer HSA, _and_ an individual HSA that I roll my employer funds to annually for lower-fee investing.)

<comment><USER25> Where do you have your individual HSA? I have an employer-provided one and I'm looking for a place to move it.

<comment><USER23> Fidelity has a pretty compelling offering: [https://www.fidelity.com/go/hsa/why-hsa](https://www.fidelity.com/go/hsa/why- hsa)

<comment><USER24> Yeah, that looks competitive. It doesn't have the one highly specific fund I wanted at HSA authority but it's got everything you really need.

</comment></comment></comment></comment></comment></comment></comment><comment><USER26> I really like the idea of high deductible plans. The idea for me is that insurance shouldn't cover regular costs that most people pay every year. Insurance should just be for unusual events, like car insurance is only used if you have an accident.

So now I got a $2k bill from ER for something that wasn't really an emergency. It makes me think carefully about next time this happens where before the cost didn't really affect me. Changing people's behavior is important part of reducing costs of the health care industry.

EDIT: Yes I'm not happy with how expensive prices are now. That is the problem that HD plans have.

<comment><USER27> I like it too, except that my (bronze level in the marketplace) high deductible plan is ~$1300 a month for my family, that is not sustainable. A recent ER visit with 1 night stay cost us about 8k out of pocket, the family deductible for the plan is $13k a year.

<comment><USER28> Be glad that "recent" wasn't in December, prior to the deductible reset.

Fun fact - my company (who sells Health Benefits Management software) added functionality so an insurer could do a "rolling window" for deductible / out of pocket management, i.e. "In any given 12 month period, your costs will not exceed $x" (where given unfortunate timing, your out of pocket could actually be 2x).

Except it was less profitable to the insurers, so no-one was interested. But spun as "will be too complicated for consumers".

</comment></comment></comment><comment><USER29> Insurance is not suited for health care. It's suited for emergencies. Sometimes health care is that, although preferably not often, and less often if proper care is given when due.

But general health care—the practice of keeping people healthy, rather than fixing them when ill—is not suited to the insurance model, and the insurance industry is too powerful to let control who gets which treatment.

A proper model pays the actual healthcare provider to keep you healthy on the regular, and then it costs you nothing in the event of sickness or emergency (like you need more stress at that moment).

The very idea of mutual indemnity is out the window with modern insurance, it's all about squeezing stats for margins, at which point there is not real mutuality, only competing risk profiles. Of course, a group of people might want to pool for emergencies, or even general health, but is there any benefit to the current scale of insurers? It only makes them more powerful.

<comment><USER30> I wholeheartedly agree. That and employer-based access to health insurance. Imagine if you had to change auto/life/home/rental insurance every time you changed jobs.

</comment></comment><comment><USER31> I have a HDHP with an HSA. When my company first rolled it out I barely gave it a glance (why would anyone want a high deductible?) and stayed on the low deductible plan. However, the next year I looked at it closer. I ran the numbers and realized that I could have x dollars come out of my paycheck to the insurance company under the low deductible plan, or I could have y dollars go to the insurance company and z dollars go into my HSA. And y + z = x (within a $100 or so).

So I could give all the money to the insurance company and that money would disappear at the end of the year, or I could give a portion of the money to my own HSA and I would get to keep any leftover at the end of the year. Well, now I had instant regret that I didn't sign up the first year.

The first year was rather rough because we had to pay all health care expenses out of pocket until we met the deductible, but we couldn't reimburse ourselves out of the HSA until the money was in the HSA. But, we met the deductible by April and after that our health care costs were equivalent to what they would have been under the low deductible plan.

By the end of the year we had $4000 left in the account which we then used to pay health care costs in the new year until the deductible was met. Now our HSA is growing year over year.

</comment><comment><USER32> I have not seen mental health mentioned here yet as a factor in rising healthcare costs. My HSA/HD Plan has almost ZERO mental health doctors in network. Providers have been fleeing in droves (especially from UHC) because the insurance companies continue to lower payouts.

I went from spending a co-pay for mental health care for 3 of my kids to paying out of pocket until I reach my out-of-network deductible, which I never do because it's 10K. I spend thousands of dollars per year on this and there is not much I can do about it.

In some cases I've reduced frequencies of visits but the value of these types of doctors cannot be overstated in some cases. I credit my son's psychologist for his ability to function in society today. But she told me she can't take UHC because after costs she was making 10/hour.

Lack of in-network mental health coverage is a huge travesty.

<comment><USER33> By all accounts we have a good PPO available but this is exactly why I haven't even evaluated leaving Kaiser's HMO. Not that I don't like them. It does have positives and negatives but I've been happy so far. I just can't even consider it.

</comment></comment><comment><USER34> I've been trying for a while to figure out what would be a good metric to judge the ACA by. Most of the time it's success is talked about in terms of number of people insured, but that doesn't really capture how well insured they are. Life expectancy seems to be the only well known (at least to me) stat that begins to capture the health of the nation. We've now had 3 straight years of declining life expectancy in the US [0], a single year is virtually unheard of in developed nations. Now there are lots of confounding variables, and it's certainly not possible to say the ACA is the cause. And 3 years of downward trend, isn't historically unprecedented. However, it certainly makes it hard to paint the ACA as a success, I'd want to see some compelling evidence that the ACA had made America healthier, which doesn't exist right now. The question to me is how long we can accept a downward life expectancy trend before we start looking at the ACA as a potential cause.

[0] [https://www.smithsonianmag.com/smart-news/us-life- expectancy...](https://www.smithsonianmag.com/smart-news/us-life-expectancy- drops-third-year-row-reflecting-rising-drug-overdose-suicide-rates-180970942/)

<comment><USER11> I hate on the ACA as much as the next guy, but the article you linked blames drug overdoses and suicides. For that I would blame the for-profit health care system pushing opioids and the (Great Recession + inadequacy of our mental health care system). To blame that on a law that sought to eliminate preexisting conditions and to establish a baseline as to what a health insurance plan ought to provide seems like a stretch. Having a free yearly physical isn't going to help your crushing depression and economic anxieties.

<comment><USER34> I was just linking that as a reference for the declining life expectancy. I don't think they even come close to establishing opioid and suicide deaths as the cause, that's just journalistic conjecture. If you look at the number of opioid and suicide related deaths it's very small compared to the total population of the US, so the math just doesn't seem to work out for me. I remember an HN comment a while ago that worked out how many deaths you'd need from those causes to lower the life expectancy as much as we're seeing and it was a lot higher than what we're seeing now. Unfortunately I can't seem to unearth the comment.

<comment><USER28> Apropos of anything else, as of 2019, you are more likely to die of an opiate overdose (accidental or deliberate) than you are in an MVA. That's staggering.

Of course, not unexpected in a country that has 3% of the world populace but 81% of the world's opiate use.

</comment></comment></comment></comment><comment><USER35> For those of us who are self-employed, I'll mention that low or no deductible health plans may provide better value.

When they sort of work, health deductible health plans are nice because: (1) monthly premiums are low and (2) they give access to a health savings account (HSA) where some amount of money can be stored pre-tax and then used for health related expenses. Of course, none of this saves someone that gets hammered with a $5000 bill like those in the article.

Anyway, the pre-tax HSA account seems to be an attractive to many, and it may be benefit some. However, if you're self-employed, you can deduct your premiums off your income through the self-employed health insurance deduction:

[https://www.irs.gov/taxtopics/tc502](https://www.irs.gov/taxtopics/tc502)

This means that there may be higher tax benefit for a high-premium, but low or no-deductible plan. Personally, I find it much easier to handle than going through the trouble of an HSA.

All that said, it's pretty much all the same in a catastrophic case. Just take the premiums x 12 + out-of-pocket max to figure out the "maximum" yearly liability. At least on the ACA exchanges, this number is typically $11-15k on what I've seen from either high or low-deductible plans. If you can't make this number, you're not fully covered for catastrophic. Alternatively, if the hospital sends a bill to an out-of-network operator, you're probably screwed as well.

Anyway, this is not to detract from the article. This is a huge problem. Mostly, I wanted to pass on some information that I had to sort through when picking and choosing plans over the years.

<comment><USER36> The tax savings on the difference in premium between high deductible health plans and low deductible health plans is probably $2k at most ($6k in extra premiums @30% tax rate). That's for single coverage, but even for family total year tax savings can't be more than $5k.

In either case, triple tax advantage of HSA is far more, especially due to compound growth.

If you have the cash to be able to deal with $10k of medical expenses in an emergency, HDHP + HSA is a no brainer

<comment><USER35> This is not to say that you're wrong, but I don't completely understand your numbers. My understanding of the triple-tax advantage of HSAs are that

1\. Money going into the HSA is pre-tax

2\. Investment gains from the HSA are not taxed

3\. Money used from the HSA for qualifying health expenses is not taxed

That said, there are many restrictions and two of these benefits seem to be included for self-employed individuals. For example, an HSA can not be used for over the counter drugs unless there's a prescription:

[https://www.irs.gov/newsroom/affordable-care-act- questions-a...](https://www.irs.gov/newsroom/affordable-care-act-questions- and-answers-on-over-the-counter-medicines-and-drugs)

However, prescriptions can already be deducted without an HSA if one is itemizing:

[https://www.irs.gov/taxtopics/tc502](https://www.irs.gov/taxtopics/tc502)

Alternatively, the above link also states that things like office visits to a physician can be deducted, which are things normally an HSA are used for.

Basically, the one benefit that seems unique to an HSA is that the investment gains from the money in the account are not taxed, which is great assuming that this money is used for medical expenses or you make it to 65.

Again, I'm not saying you're incorrect, but it looks like self-employed individuals automatically benefit from 1 and 3 above, assuming itemization. As such, it's seems like the trade off is whether the higher premium, which is less high due to the tax write-off, is worth lower the lower cost of a physician visit. Assuming, of course, we haven't gone catastrophic. What am I missing?

<comment><USER36> If you save your receipts for any medical care you or anyone else has received that you paid for, you can withdraw from your HSA to "reimburse" yourself at any point in time, including the future.

Q39 at bottom of page 18 of following IRS document:

[https://www.irs.gov/pub/irs-drop/n-04-50.pdf](https://www.irs.gov/pub/irs- drop/n-04-50.pdf)

Have a baby? Save that receipt showing payment for $5k from your post tax dollars, and let the money in your HSA grow tax free for however long you can, and then when you need it (e.g. in retirement), reimburse yourself for the birthing expenses.

It's the first place your savings should go. It's easiest to just model the HSA as a triple tax advantage savings account as long as you pdf receipts for payments for medical expenses. Which you might not in 20s and 30s, but surely will into 40s and definitely 50s, and you can use it for payments you made for other people's medical expenses too. And even if you need to withdraw from it for an emergency, the penalty is only 10%.

<comment><USER35> Alright, if I understand you correctly, you're essentially using the HSA kind of like a Roth IRA, except that

1\. Money contributed is tax free

2\. There is a $3.5k contribution limit

3\. Money can be withdraw tax free prior to 65, at any time, as long as there's a receipt for the qualifying medical expense that occurs after the HSA was established

Then, from what I can tell, the drawback to this approach is that there needs to be enough cash flow to cover for medical expenses. Certainly, money could be withdrawn from the HSA, but the real tax benefit comes from pretax contributions and that capital gains, interest, and dividends are tax free. Overtime these can provide a huge amount of savings, but they need time to develop. Sound about right?

<comment><USER36> Correct. There's a higher contribution limit ($7k in 2019) if you have family HDHP coverage. Also, after retirement, money can be withdrawn without paying the 10% penalty and just paying the regular income tax, in case you don't have receipts for medical payments from the past.

I wonder how the IRS would prevent a tax evader using the same receipts for payments for medical expenses for different withdrawals in different years.

<comment><USER37> I would assume if you got audited, you would have to justify all withdraws. I doubt they would be impressed with multiple copies of the same receipt.

<comment><USER36> How many years do you get audited for? I thought it was just 7. So if you use it every decade, I presume they're not going through every year and it wouldn't be seen. Unless they're keeping a database.

</comment></comment></comment></comment></comment></comment></comment></comment><comment><USER38> Of my past 3 employers over the past 8 years (all family plans):

$3000 deductible, no HSA

$6000 deductible, HSA

$9000 deductible, HSA

I pay $370/month in premiums... $100 of that a fee because my spouse is eligible through her employer but the plans are even worse, so we declined it.

So we pay $4,500/year in premiums. Which equates to roughly a 20% effective income tax instead of ~15% normally.

This is ridiculous. Whomever seems best to get a single-payer plan in place is who I'll vote for. Absolutely no reason it should matter who my employer is for what doctor I can go see or how much I pay in private, personal medical bills.

Retirement accounts I feel the same way, but that's a long way off for the US.

Other countries have solved this fucking problem, I'm tired of elected congressmen firing back with "BUT VENEZUALA" quips every time someone mentions "Medicare for all".

And the proper response to that is "So we should eliminate Medicare altogether then, right? Where's your bill for that?"

</comment><comment><USER39> One of our company's primary products "helps employees make an informed decision when choosing their health insurance plan". Basically, during open enrollment they are presented with their choices of plans and the "expected total cost" of each plan over the course of the year as calculate based on either, if we have their consent, their historic data or, if we don't have their consent, the historic data of a representative cohort.

The product wasn't getting traction based on employer's wanting to provide such a service to their employees, so the sales pitch was changed. The sales pitch became, "You can save your company money by moving your employees to High Deductible Health Plans. Our product presents data that encourages employees to choose HDHPs over other plans." I'm not sure if that is currently the sales pitch, but it was the primary one for two-ish years. Our customer base is now non-trivial.

I've overheard some of the conversations as to how the "representative cohort" is determined and about our data sources. It wouldn't pass a peer review. Additionally, in the past we have re-worked the numbers because our customer didn't like the results. That is, feedback from the company, not the company's employees. They did, after all, hire us to get their employees to move to a HDHP.

And to top it off, the product hasn't been a great revenue source. So we're effectively compromising real people's health care coverage, for our company's business interests, and it hasn't even been that profitable.

Our health insurance plan at this company is a HDHP...

<comment><USER39> I tell you all that my company works with employers to move their employees to HDHPs based on sketchy data, sketchy calculations, no transparency, and based on profit motive, and,,,, nothing.

Interesting.

Side note: The chances that some HN readers have used our software are, very good.

</comment></comment><comment><USER40> I currently have a high deductible health care plan because it is all that is offered by my wife's employer. The deductible is $4,500 per year.

If we just have normal well checkups, normal dental cleanings, normal eye glasses, and a few recurring prescriptions we would never hit the $4,500 deductible.

It is insane going to the pharmacy and having them tell you that the cost is $180 per month and have no choice but to pay it.

I went for a normal diabetes check and the lab work was over $600. No choice but to pay it.

I needed new glasses and no choice but to pay the $150 eye exam and then many hundreds of dollars for new frames and lenses (and I had no choice to get new frames or be without my glasses completely for 1-2 weeks).

To make it worse, we don't have any other choice of plan.

</comment><comment><USER41> If you're taking a high deductible plan-- which you should be-- you should be contributing the (often substantial) savings on your premium to an HSA. In fact theres very little reason not to max out the HSA for the year. Once your HSA is at the IRS annual maximum, you have an enormous buffer between the often 20% rate post deductible and the Out of Pocket Maximum-- which the HSA will usually cover most of. You should also participate in an FSA, which being frontloaded can absorb early-year shocks.

An HSA is among one of the most tax-advantaged programs you can participate in; I would argue that it is better to contribute just enough to your 401k to get the full employer match and stick all the rest into an HSA.

</comment><comment><USER42> While I am satisfied with my HDHP + HSA, I'd be a lot more worried if it were my only option (I'm only young for now) or if I didn't make/save as much.

People are getting hit with HDHP only and no HSA? That's rough.

<comment><USER43> Anyone with an HDHP plan can get an HSA. Whether it's through your employer or through another plan provider like Fidelity or Vanguard.

<comment><USER44> An HSA with no employer contribution, or even administrative assistance, is like throwing money into a trash can, except at least if you throw money into a trash can, you can wheel it down to any hospital and they'll probably accept it.

<comment><USER36> What? It takes 5 minutes to open a free HSA account at Fidelity and transfer funds to it.

<comment><USER26> I didn't know they were available. I thought it could be open to everyone, but employer ones do have advantages.

[https://www.fidelity.com/go/hsa/why-hsa](https://www.fidelity.com/go/hsa/why- hsa) > You could also use it in place of an employer HSA. If you do this, you may miss out on opportunities like pre-tax payroll or employer contributions, so check with your employer to see what they offer.

<comment><USER36> You can still deduct contributions from income taxes, and you can also transfer funds after contributing to your employer sponsored HSA to your individual one.

</comment></comment></comment></comment></comment></comment><comment><USER45> I was recently introduced to the idea of gluing and/or stitching one's own body parts or open wounds in case of a severe injury due to the costs associated with US healthcare. I found the nonchalant discussion of such horrible suffering absolutely incredible and would advise everyone to try some medical tourism. Here in Bosnia&Herzegovina, abdominal ultrasound is 20€, colonoscopy is 100€, one tooth filling 15€ and a tooth implant 600€. Nearly all my friends have settled outside B&H but I stayed simply because healthcare is so cheap compared to other, wealthier countries.

</comment><comment><USER46> The ACA hasn't been what it was supposed to be since 2015. Republicans in Congress gutted the market when they took away risk corridor payments. Small health plans priced with the payments in place, then when they didn't come through, everyone in a loss position went under. The big plans could weather the storm, market consolidates, prices rise.

</comment><comment><USER47> There was an interesting EconTalk recently that covered some reasons for the rising costs

"Robin Feldman on Drugs, Money, and Secret Handshakes"

[http://www.econtalk.org/robin-feldman-on-drugs-money-and- sec...](http://www.econtalk.org/robin-feldman-on-drugs-money-and-secret- handshakes/)

</comment><comment><USER48> At Mess (my agency), we were sort of forced into going with a HDCP, but we found a way for it to be a win for everyone.

Our absolutely-perfect no-deductible no-coinsurance plan was retired, and every year, for five years, the cost of our reasonable-deductible no- coinsurance plan kept going up.

Eventually, our broker convinced us that HDCP was the only way.

But I absolutely hated it.

We have quite a few employees with chronic, expensive conditions. Moving a HDCP (in our case 2K/6K family), effectively meant we were cutting their salaries. They were absolutely going to be paying that deductible.

We also employ a LOT of younger people, who just don't go to the doctor more than once a year, maybe. The HDCP wasn't that big a deal for them.

We looked into HSAs – the thing our broker recommended. These are garbage. In theory, we'd put in some amount of money each month, and eventually, over time, the entire premium would be sitting in an account for the employee. For the young and healthy, this was free money. The move to HCDP+HSA was basically a raise for them.

For the chronically-ill, the rate we'd contribute to their HSA was never going to be fast enough to keep pace with their expenses. And for most people, with most savings levels (near $0), a $1500 bill you'll "eventually get back" is just as unaffordable as one they'd never get bet.

I hate HSAs.

"Look, we know most of our folks are NEVER going to hit their deductible. We know a few folks will. Can't we just give everyone a credit card with a 2K limit that they can use to pay for stuff?"

Meet HRAs.

HRAs are like HSAs, but they're not incrementally funded. Instead, it's basically a credit card whose balance I, the employer, pay. It has an annual limit, which matches each employees annual deductible.

These things are amazing.

1\. The employee never has to worry about out of pocket cost. They go to the doctor, the doctor charges their HRA.

2\. The company has MUCH lower premiums, because we're on an HCDP. I think we saved like 30% or something moving to it.

3\. We have a maximum annual additional cost each employee can ring up in medical costs. Worst case scenario (every employee hitting their deductible) isn't fantastic, but we can plan for it.

4\. The normal-case scenario is a that a handful of employees hit their deductible very quickly at the beginning of the year, and the rest barely use their HRA at all.

I do not understand why more companies don't do HRAs given the above.

<comment><USER44> Taxes. HRAs can be a huge headache for employees (never employers). SEHRAs also have a bad reputation for being the worst of both HSA and more traditional insurance plans: underfunded, high overhead for employees, all for severely limited provider choice.

ICHRAs (individual-coverage) are the real bridge between HSAs and traditional insurance—you can use them as an HRA-style account _or_ use the money to buy an insurance plan off a marketplace. While it still pushes the burden of choosing and managing health care onto the employee, they at least have flexibility in coverage as well as tax benefits for both employees and employers.

They, uh, also don't exist until 1 Jan 2020, and they give total control to the employer. If you're a good employer, that's great. If you're a shitty one, the employee is easily fucked over.

<comment><USER48> I don't get how they'd be headaches for employees? HRA contributions are 100% tax-free and aren't treated as income. It's a pain for my co-founder and I, or would be, if we didn't have someone else doing our taxes.

</comment></comment></comment><comment><USER49> I live in The Netherlands. Single person.

I pay ~$2100 (converted) a year for healthcare.

This includes insurance and the first $430 worth of medical cost you have to pay yourself. Any additional costs are covered by insurance.

</comment><comment><USER50> I believe that ACA was partially designed just to get everyone in the same sinking boat. That way one day you could actually fix fundamental structural problems when the real crisis hit.

</comment><comment><USER51> NET::ERR_CERT_DATE_INVALID - it's interesting as it's May 3rd and the cert seems valid until May 3rd as well?

<comment><USER52> This error message from Google Chrome Browser is one of the most common problems that everyone faces in our day to day life. Google Chrome warns you whenever it finds out any abnormal tracks taken while you browse things on the web. If you are getting the SSL error in chrome, it means your Internet connection or your computer is preventing Chrome from loading the page securely and privately. However, there are few changes or settings which help you to get rid you of this error.

        Check System Date and Time
        Disable Antivirus SSL Connection
        Clear Cookies and Cached Files
        Reset Chrome Browser
        Open Chrome in Incognito Mode
        Expired SSL Certificates
        Update Chrome Browser

[http://net-informations.com/q/mis/ssl.html](http://net- informations.com/q/mis/ssl.html)

</comment></comment><comment><USER53> This is the point of high-deductable... to cast more spend on the average healthcare consumer. Also to make them price sensitive. Wellness programs are designed around making unhealthy people pay more and not trigger any of the non-discrimination issues as well. Single payer is best model proven at scale in modern countries, but it probably will take a couple decades of watching loved ones not get care before it escalates to action.</comment>


The Unix and the Echo (2001) - <AUTHOR> https://everything2.com/title/The+UNIX+and+the+Echo <comment><USER2> If you have a file consisting of some text, the file might or might not end with a \n

If you have a file consisting of some lines of text, the file will end with a \n because a line of text (unlike text generally) is typically defined by matching ^[^\n]*\n

Therefore, `echo` with no arguments returns a line of text which contains nothing.

<comment><AUTHOR> I think you are right, it is a matter of convenience, to type less, as the story hints, but not only for writing to files, also for displaying messages on the console.

According to the book quoted in the link:

 _Since a command should by default execute its most commonly used function, ... echo appends the final newline automatically._

It may seem insignificant, but this story highlights, in nerd humour, some of the design philosophy behind Unix.

Classic Kernighan (as the book's co-author).

</comment></comment><comment><USER3> "echo -n" will omit the trailing newline, on both Linux and BSD. echo -n with no other arguments therefore outputs literally nothing.

(Except for the "echo" builtin in /bin/sh, which does not recognise -n.)

<comment><USER4> Debian GNU/Linux guarantees that the echo builtin, even in /bin/sh, supports the -n option:

[https://www.debian.org/doc/debian-policy/ch- files.html#scrip...](https://www.debian.org/doc/debian-policy/ch- files.html#scripts)

</comment></comment><comment><USER5> > f u cn rd ths u mst uz unix

I thought this was cursing at me at first!

By the way, if you actually care about your newlines use printf.

</comment><comment><USER6> Everything2 rocks. I used to be a somewhat prolific noder.

</comment><comment><USER7> I'd say they overthought the behavior of echo... just a little bit.</comment>


Why the Price of Oil Is Doomed - <AUTHOR> http://wolfstreet.com/2015/11/23/why-the-price-of-oil-is-doomed-for-longer-than-expected/#comment-24278 <comment><AUTHOR> The submission points to a comment since it articulates pretty well the relation between fossil fuel prices, renewable energy and energy storage.</comment>


Companies valued at $1B or more by venture-capital firms - <AUTHOR> http://graphics.wsj.com/billion-dollar-club/ <comment><USER2> There is so many of them there i had no idea they existed</comment>