Scientists may have solved a mystery about sea-level rise - <AUTHOR> https://www.washingtonpost.com/news/energy-environment/wp/2015/12/11/scientists-may-have-just-solved-one-of-the-most-troubling-mysteries-about-sea-level-rise/ <comment><USER2> So the mystery was because the original paper had flaws in it's methodology? That's anticlimactic.

<comment><USER3> Welcome to science!

Also, not just flaws in methodology, but also flaws in its model, which is a more significant issue. Making better models & checking them against reality is a big part of science. It's not necessarily that the original author fucked up; it's that our knowledge of the world improves (we hope) over time.

<comment><USER2> Ah, okay, that seems like an important distinction.

</comment></comment></comment><comment><USER4> So they mention that the asymmetrical melting of glaciers contribute to "wobble". Do commute patterns with millions of vehicles exerting force on the earth along non cancelling routes, contribute to additional wobble?

<comment> semi-extrinsic The total mass of all cars in the world is on the order of 2e12 kilograms. Since most routes cancel, drop that by an order of magnitude or two. The mass of the ice melting just from Greenland in a year is 2e14 kilograms.

(Edit: the car mass number was 1e3 too small, thanks to mikeash for correction.)

Edit2: the car mass number was right, but both numbers should have been in tonnes. Now it's right. I should sleep now.

<comment> semi-extrinsic So this is quite interesting: could it be that the total volume of ore excavated per year is comparable to the total volume of new seawater from melting ice? It looks like 5e13 kilograms of ore are excavated per year [1]. At an average density of <5 kg/l, that is the same volume as 1e13 kg of water, or 1/20 times the meltwater from Greenland. No solution to rising oceans :(

[1] [http://www.ilocis.org/documents/chpt74e.htm](http://www.ilocis.org/documents/chpt74e.htm)

<comment><USER5> OK, I read this and I had some disbelief. It starts with a total of 23 billion tonnes of ore, and ends with a volume equivalent to 1.5 meters of the whole country of Switzerland being excavated per year.

That seemed high, but it turns out that independent estimates of just _coal_ excavation are 8 billion tonnes per year. So my disbelief was wrong.

And then, looking at it the other way, this makes it evident how much burning all that coal could change global CO2.

</comment></comment></comment></comment><comment><USER6> [http://talkorigins.org](http://talkorigins.org) is an amazing resource for the scientific perspective on Creationism vs. Evolution. It details neatly all the creationist arguments then thoroughly debunks them with overwhelming scientific evidence, complete with references. Is there a similar site that does the same for climate change?

<comment><USER7> [http://creationwiki.org/Index_to_Creationist_Claims](http://creationwiki.org/Index_to_Creationist_Claims) responds to arguments by Talk Origins. Is there a similar site that does the same for climate change?

Better, is there any site that lists all arguments from all sides and reach a conclusion? If they don't reach a conclusion, do they have a issue tracking system and leave the issue open for anyone to find easily and respond?

Debates should have a programming language, have CI for new arguments, have unit tests to check logic, have issues tracked and collaborated on GitHub.

<comment><USER8> I would love a site that categorized each argument and the supporting evidence pro and con for a given topic. Would be a wonderful resource.

<comment><USER9> How would that work? For creationism/evolution would it be one column with facts and another with a lot of bunk? What's the point?

<comment><USER10> Sadly it would probably never work. Your comment is a good illustration of why.

</comment></comment></comment></comment></comment><comment><USER11> The comments in the article from the climate change skeptics hurt to read.....

"Are you suggesting that the oscillating ice ages are caused by a slowing and speeding up at the earth's core?"

<comment><USER12> Always interesting to hear people who openly deny science attempt to reason about science.

<comment><USER13> I used to work with a young-earth creationist pharmacist who spent a lot of time talking about how evolution was impossible since the second law of thermodynamics says that entropy increases over time -- so it's impossible for evolutionary complexity to increase.

Wasn't sure how to respond to that one.

<comment><USER14> This is one of the old standbys. Deleting the clause "in a closed system" and pretending the 2nd law is still valid without it. I wonder what this person would say if you asked them why you needed a different flu vaccine each year.

<comment><USER15> Probably "I don't need a vaccine"

<comment><USER14> Well, given that the person a pharmacist, I would hope that's not the advice they give.

</comment></comment></comment></comment></comment></comment><comment><USER16> so basically we're all going to die.

<comment><AUTHOR> Yeah. But that's true anyway. "Death and taxes" \-- we were all born under sentence of death. Ain't none of us getting out of here alive.

<comment><USER17> Funny to see you downvoted, have an upvote instead. Reality is a harsh mistress apparently. Makes you wonder if the same people that are harping on promoting science and only trusting in the facts are the ones that would downvote a comment that is about as factually true as possible. Uploading and resurrection are - for now - hard SF and well over the horizon of the final sunset for everybody living today.

<comment><USER18> Yeah maybe 'tis the season. I got nailed on a (true) Jesus comment earlier. Made me LOL.

</comment></comment></comment></comment><comment><USER19> I thought this may be regarding the effect of ground water extraction causing coastal cities to sink 10+ times faster than sea level rise.

[http://meetingorganizer.copernicus.org/EGU2014/EGU2014-14606...](http://meetingorganizer.copernicus.org/EGU2014/EGU2014-14606.pdf)

Still interesting though.</comment>


ShowHN: HackerNews Plus - Chrome Extension for Keyboard Shortcuts - <AUTHOR> http://halfaclick.blogspot.com/2011/12/hackernews-plus.html

<comment><AUTHOR> Quick Github Link: <https://github.com/mayanksinghal/HackerNews-Plus>

I will try to add more features tomorrow. Hope this is useful for others as well.</comment>


MapReduce and Spark - <AUTHOR> http://vision.cloudera.com/mapreduce-spark

<comment><USER2> I like Spark over Hadoop just from an interface point of view, particularly the ability to just start up a (Scala) shell and start playing around. Hadoop can be very effective, but even getting "hello world" to run requires an intimidating array of setup.

<comment><USER3> Have you tried Apache Hive? I believe it was meant to make Hadoop easier to use by way of SQL-like commands. Something like Qubole might be able to help too.

<comment><USER4> Pig is another option. It allows using SQL like commands on the grunt shell, making using Hadoop a lot easier.

<comment><AUTHOR> Going from Hive/Pig to Spark enables substantial improvement in developers' productivity (for non-reporting/BI workloads). You can properly unit test your program, use a debugger, and have all your code in the same place in the same language (rather than in the case of Pig, write UDFs in Java and then use a pseudo-scripting language for workflow specification).

All of these are just productivity gains; not to mention the performance gains you get when you go from MapReduce to Spark.

</comment></comment></comment></comment><comment><USER5> I often read that spark avoids the costly synchronization required in mapreduce, since it uses DAG's. Can someone explain how is that achieved. If the application so demands that you can launch jobs together, that can be done even with hadoop/mapreduce. If one job requires the output of another, then the job has to wait for synchronization whether its mapreduce or DAG.

<comment><USER6> Spark's major benefit comes from storing the intermediate results in-memory instead of storing it in HDFS as Hadoop does. Let's say a certain query needs to run 3 mapreduce jobs A, B, C one after another. In Hadoop, there will be 3 hdfs reads and writes. With spark, there will be only 1 hdfs read (before launching A) and 1 write (after C is completed). In spark, the output of A gets stored in RAM which is read by B and so on until the final write.

The DAG used by spark represents how one job/partition of data depends on another job/partition and what methods (e.g. filter) need to be applied on the parent data to get the child data. This is useful when a node goes down and that portion of data has to be recomputed. Note that users can choose to persist some intermediate results to hdfs to avoid recomputation in case of failure.

</comment></comment><comment><USER7> Some interesting use cases are also described on Cloudera's developer blog, at [http://blog.cloudera.com/blog/2013/11/putting-spark-to- use-f...](http://blog.cloudera.com/blog/2013/11/putting-spark-to-use-fast-in- memory-computing-for-your-big-data-applications/).

</comment><comment><USER8> Although spark is nice, I'm also looking forward to mpi/orted integration with hadoop...

"Performance: Launches ~1000x faster, runs ~10x faster"

"Launch scaling: Hadoop (~N), MR+ (~logN)"

"Wireup: Hadoop (~N2), MR+ (~logN)"

[http://slurm.schedmd.com/slurm_ug_2012/MapRedSLURM.pdf](http://slurm.schedmd.com/slurm_ug_2012/MapRedSLURM.pdf)

</comment><comment><USER9> What I would love to know is if Mahout works out of the box with Spark or if there's a third party library that bridges the two.

<comment><USER10> No. See MLbase [http://mlbase.org](http://mlbase.org)</comment></comment>


Show HN: Lightweight SFTP Server for Windows - <AUTHOR> https://buruserver.com <comment><USER2> no gui ,use command.

so,don't waste your time to try it.

<comment><AUTHOR> There is an optional (web) gui. However the primary audience is for those who prefer scriptability (or console/config files in general) over GUIs.

<comment><USER3> details are here: [https://buruserver.com/docs/web- administration](https://buruserver.com/docs/web-administration)</comment></comment></comment>


Ask HN: any suggestions for a Lisp project to start with? - <AUTHOR>

I am just about starting to learn LISP.  I am not expert in programming. I was thinking of a one month project(1-2 hours per day) for introduction.
I am not interested in anything internet-related, and the less graphics the better.
Any reasonable suggestions? <comment><USER2> Don't do long ambitious projects in Lisp. Instead, implement a small library everyday. Do something that itches you _now_ , and be done with it the moment you get bored.

It's more fun and educational that way.

If you cut yourself a "project", the remaining 10% will suck the life out of you and it's not fun.

Try not to close your Emacs. You need to be able to find lisp on an impulse. Do all your arithmetic calculations with it, first. And gradually write your shell scripts in it and other admin types. Download libraries and read their sources; you can get to the definition points by typing M-. in Slime mode.

I encourage you to indulge yourself, have fun, and feel free to jump from project to another. In fact, you will do just fine having multiple "projects" in one source file; I had scratch-buffers tens of pages long.

Hedonistic, irresponsible programming :-)

<comment><AUTHOR> Thank you very much

</comment></comment><comment><USER3> Both these books walk you through creating various interesting applications in Lisp, from servers and databases to games:

<http://gigamonkeys.com/book/>

<http://landoflisp.com/>

<comment><AUTHOR> Thanks. I've got already the ANSI common LISP to have as first reference and after seeing some posts here I am considering getting the landoflisp some time soon.

<comment><USER2> ANSI Common Lisp is good. I did _all_ the exercises.

You might consider playing with GUI stuff with LTK:

<http://www.peter-herth.de/ltk/>

</comment></comment></comment><comment><USER4> Project Euler is nice because Lisp (Common Lisp anyway) is good at dealing with large numbers. It's also reasonably fast.

</comment><comment><USER5> Anything you find interesting. You will be more motivated to work on something that you truly care about.

<comment><AUTHOR> I have recently decided learn a bit beyond the basics of two programming languages: Python and Lisp

I have already started using Python for something that I truly care about: simple phyics simulations

Lisp is for me something that I want to learn for the fun of it. And because I trust people saying that lisp programming is very rewarding experience. I have not some side project that I truly care about, I am just thinking that following the little examples that the Lisp books suggest is not the path that I want to take at the moment.</comment></comment>


VMware wants SuSE because of Mono - <AUTHOR> http://www.sdtimes.com/blog/post/2010/09/17/VMware-2b-SuSE-Microsoft.aspx It's not about the Linux. It's about squeezing Microsoft the fuck out of the picture. <comment><USER2> That's an excellent point. What I want to know if Microsoft have made an offer to bu Mono themselves - if they're serious about selling platforms other than Windows (like .net) it would be a massive boon to MS.</comment>


Can you connect to AWS (us-east) from Europe? - <AUTHOR>

I have connectivity problems with AWS. Web management console, my ec2 instance (in us-east region) and https://status.aws.amazon.com is unavailable. Heroku seems to work fine. Do you also experience any such issues? <comment><USER2> Mine's working like a champ (The Netherlands - US-East)!</comment>


Australia's Economy Is a House of Cards - <AUTHOR> https://www.linkedin.com/pulse/australias-economy-house-cards-matt-barrie <comment><USER2> The writing has been on the wall for a long time in Australia but vested interests and the status quo means no meaningful change is actually going to happen.

Take Australia National Broadband Network (NBN) strategy as an example. Connecting every house and business to a fibre optic line would have "future- proofed" the nation for generations. Instead it was destroyed by the conservative government, along with investments in renewable energy, a resources super tax and a range of other progressive ideas.

This country is run by dinosaurs. While there are intellectuals, theres also a proud culture of ignorance and weird working class arrogance. Instead of having pride in working class jobs and pride in working class people who put food on their families tables and support their community it seems theres been a concerted effort to warp it into and "us vs them" attitude of "true blue" working class Australians against white collar "know it alls". This is plain to see when the current Prime Minister and former investment banker goes into rural towns wearing his untarnished Akubra and adopts his fake working class accent to stoke tension between rural and city people.

Australia often has bushfires every 7 years or so that have historically cleared out a lot of dead wood and given the bushland an opportunity to breath and grow again. New policies to prevent bushfires meant woodlands accumulated fuel which led to cataclysmic-ally large bushfires like black saturday, ash wednesday etc.

Its hard not to think that Australias approach towards governance is similiar and that the only way for us to re-set the agenda is through a huge depression.

</comment><comment><USER3> > In Australia, the average person in the street might think that the way that > you get into the Prime Minister's office is by being elected by the people. > Since 1966, this has only been true about 40% of the time.

Well not only are they wrong. Matt Barrie (the author) is wrong too. No Prime Minister has ever been elected by the people. All of them have been elected by their party room. Australia elects Representatives and Parties. Mr. Barrie seems to be wading into topics that he doesn't have the chops for...

<comment><USER4> screwed my face up at this, I'm willing to give him the benefit of the doubt and and assume he chose his words poorly and meant that 6 were not the party leader at the time of the election.

It's a shame because there is some interesting opinions in this that wind off into almost stream of consciousness.

If he had stuck to making his point with data and scrapped the anecdotes it would have made it an easier read.

It really need an editor and fact checking.

</comment></comment><comment><USER5> > Indeed Digital Finance Analytics estimated in a October 2017 report that > 910,000 households are now estimated to be in mortgage stress where net > income does not covering ongoing costs. This has skyrocketed up 50% in less > than a year and now represents 29.2% of all households in Australia.

As of 2011 there were 7.7 million households in Australia (according to the ABS) so how does 910,000 (or 888,207 in the table) become "29.2% of all households in Australia"?

(I may well be missing something...)

<comment><USER5> The more I read this article, the less I'm convinced... Another "odd" bit (imo).

> This brings me onto Australia's third largest export which is $22 billion in > "education-related travel services". Ask the average person in the street, > and they would have no idea what that is and, at least in some part, it is > an $18.8 billion dollar immigration industry dressed up as "education".

> While some of these students are studying technical degrees that are vitally > needed to power the future of the economy, a cynic would say that the > majority of this program is designed as a crutch to prop up housing prices > and government revenue from taxation in a flagging economy. After all, it > doesn't look that hard to borrow 90% of a property's value from Australian > lenders on a 457 visa.

A 457 visa doesn't have anything to do with a student visa... This comment feels like intentional misdirection, because those two things are not at all related. (A 457 visa is a skilled worker visa - although as with all skilled work visas, it has got it's own controversy and, as the article points out (in an underhanded way I would say, again...), until recently had some very odd "skills" (and probably still does...))

> How much the banks will be left to carry when the market turns and these > students flee the burden of negative equity is anyone's guess.

AFAIK, if you're a temporary resident in Australia getting a 90% loan (and even if you're not a temporary resident in some (many?) cases) there's a requirement to get Lenders Mortgage Insurance. So... The insurer will be left to carry said burden, not the bank? Unless my understanding of LMIs is off. And again, they're not a student if they're on a 457 visa, so this is all a bit inaccurate anyway...

Back to the "education-related travel services" side of that quoting, friends of mine work in the Higher Education industry and it actually is huge business for them getting international students. And their respective organisations make a lot of money from it. (And it's not just higher education, even schools in Australia make a lot of money from international students.)

And, in my opinion more importantly, this is an export industry, so it doesn't matter that only "some of these students are studying technical degrees that are vitally needed to power the future of the economy". It's not about those degrees being vitally important to Australia's economy, because it's an export... (And the underhanded nature of that line is a bit much for me...)

> You now know what all these tinpot "english", "IT" and "business colleges" > that have popped up downtown are about. They're not about providing quality > education, they are about gaming the immigration system.

Sure, I mean, I don't know how technically accurate this statement is so taking it at face value, just because there are some dodgy education providers, the whole 18 billion dollar industry is now denigrated to an "immigration industry"? Apparently there are 6 Australian Universities in the top 100 worldwide [0], but no, the whole show is actually _mostly_ just an "immigration industry"?

("Ask the average person in the street, and they would have no idea what that is" \- a huge number of my friends know that the Australian economy makes a heap of money from foreign students studying here, maybe they don't know it's the third biggest export, but still... Again with the underhanded language...)

This article is quite grating...

[0]: [https://www.timeshighereducation.com/world-university- rankin...](https://www.timeshighereducation.com/world-university- rankings/2017/world-ranking)

<comment><USER3> You're right that there are a couple of odd, basic inaccuracies.

> As if the Australian economy needed further headwinds, the developer- > enamoured evangelical right have crucified NSW's night time economy. > Reactionary puritans and opportunists alike seized on some unfortunate > incidents involving violence to simply close the economy at night.

In the last couple of years, the only lockout laws I have heard about apply to the CBD of Sydney, and nowhere else. But here, the author conflates the Entertainment district of the CBD with the entire NSW night-time economy.

Perhaps, by the numbers, it's fair enough to conflate those things. But a strongly suspect he's just very wrong.

<comment><USER6> They trialled (and kept) lockout laws in Newcastle, 2nd biggest city. Killed our nightlife too.

</comment></comment></comment></comment><comment><USER7> Another bubble is agricultural land prices in the United States. This was such a foreign thing to me when I first heard it, but it's so overvalued. If you look at a 20 year graph you'll see it barely even dipped during the 2008 recession.

That, combined with any downturn is going to see a bunch of Baby Boomers sell their houses to make up for their lost 401k money only to find that no millennials (and certainly no millennials without jobs) can or want to buy their houses.

Keep in mind, unlike the stock market which has dozens of safeguards and controls, the housing market has exactly zero safeguards. Think about that for a second. The housing market is operating off the same system Wall Street basically had in 1873.

Bubbles certainly do come and go, but the larger issue here, the one that will compound the bubble greatly, is the lack of political resolve to tackle it. A bailout is a political no-go. It looks like the full force of this bubble will have to be ridden out.

If anything 2008 was WWI, and the bubble coming up will be WWII.

tip: Start a local facebook group. The amount you can save in borrowing power tools is amazing...

</comment><comment><USER8> Their real estate development boom is largely supported by Chinese investors. That is, buying into a Development Co. in AUS and having an Aussie run it.

In Sydney I counted 50+ cranes earlier this year. Will the demand for X amount of new towers continue? Will buyers support it or become Miami 2.0? How many empty condos are there in Miami right now?

They are also very prideful about the state of their economy.

<comment><USER9> Because Sydney barely had apartments until recently. Cross the bridge and it looks like a country village 3km from the city. Not many development sites and houses are very tightly held so it's tough to acquire houses for demolition and agglomeration into a development site. If Sydney is going to be a real city it needs the development that's happening now.

I've also noticed cranes here are used for midrise apartment block construction which I'd never see for comparable building in the US. There's a lot of safety rules and a strict building code so maybe that's why.

</comment></comment><comment><USER10> A much simpler way to look at the same argument is simply to describe Australia as a Chinese mining province. There's no shame in that -- my native Australia has only a bit more than half of the population of my current home, California.

The widely reported "104 quarters of growth" is indeed impressive but it's ironic that the achievement was breaking the record of the Netherlands -- who set _their_ record through extractive industries (oil in their case). And in fact Australia suffers some of the "Dutch disease": a loss of other primary industries, like manufacturing, wage and property inflation, and a sectoral imbalance.

None of this means the sky is falling (or doesn't) -- the economy is flexible, and China's economy, being huge, has a lot of inertia. But people should be honest in how they characterize it.

<comment><USER11> Yes, population of Australia at ~24m is about the same as Shanghai.

</comment></comment><comment><USER12> A long and perhaps terrifying article. With all the statistics, a strong case is made that Australia is in deep, deep trouble. What I'm having trouble with is understanding why this is not talked about more in more main stream avenues?

<comment><USER9> Barrie's company Freelancer.com was just outed as a bunch of scam artists on HN front page yesterday, now he's an economic mastermind?

This whole article is basically "the entire world economy is a house of cards wtf!" Yeah, no shit. We've known that for a decade now. Australia rises and falls with the world economy and if/when China crashes things will be ugly everywhere.

<comment><USER13> Could you please give a link.

I have searched for the article using 'Freelancer.com' and the earliest one is from 10 days ago titled 'Freelancer.com has ruined my life'. I also see similar articles to this from longer ago. Definitely seems like a site to avoid.

Searching for 'Matt Barrie' only gave this story.

I would love to see the article about them being scam artists.

</comment></comment></comment><comment><USER3> [https://medium.com/@matt_11659/matt-barrie-australias- econom...](https://medium.com/@matt_11659/matt-barrie-australias-economy-is-a- house-of-cards-6877adb3fb2f)

This is a link to this story, but with the original references and links.

</comment><comment><USER14> People have been crying "bubble" my entire life, and I'm yet to see one actually "burst".

The only things close to bubble bursts were scam driven things like the sub- prime mortgage collapse in the USA.

<comment><USER15>
        People have been crying "bubble" my entire life, and
        I'm yet to see one actually "burst".

I gather you didn't work in tech in 2000?

<comment><USER14> This is a fine example of what I was saying, this is people cramming money into something with the hope of getting rich in a short period of time. People getting in knew it was a high risk gamble. Not to mention that the tech industry is now one of the biggest on the planet. Is it still a bubble?

Edit: attempt to add clarity.

The core of what I'm trying to say is almost any increasing asset is labelled as a bubble now days. I'm not denying that there aren't shady investments that appear and collapse all the time, some are enormous, like the tech bubble.

But it requires further classification. There are gambling bubbles built by thousands of agents where some have seen astronomical profit, but then there seems to be more stable "bubbles" like all of the bubbles mentioned in the article.

A bubble isn't a bubble, not without further clarification.</comment></comment></comment>


How to get the best out of your Yubikey with GPG - <AUTHOR> https://callanbryant.co.uk/blog/how-to-get-the-best-out-of-your-yubikey-with-gpg/ <comment><AUTHOR> Hu, I recently wrote an article about using a Yubikey and GPG after it was quite a saga to set up correctly. I hope this is useful to someone.

I'd appreciate corrections/feedback etc!

Callan</comment>


How to tell your mother and bosses why they should protest surveillance - <AUTHOR> http://www.slate.com/blogs/future_tense/2013/09/20/how_to_tell_your_mother_and_bosses_why_they_should_protest_surveillance.html <comment><USER2> * It undermines the freedom of the press because journalists need to protect their sources.

* It undermines the rule of law because the government should not know what you discuss with your lawyer.

* It sabotages the health system because you should be able to talk to your doctor in privacy.

<comment><USER3> I think those examples are begging the question. Many people would say they don't care if a Government agency knows any of that info. Why should they care? Personally I'm not worried if GCHQ know that I went to the doctor about a rash.

I find a more convincing argument is that the data can be abused for purposes beyond that for which it was gathered; for example, the disclosures about the DEA and 'parallel construction' shocked many people with whom I work. People respond more to the risk that their misdeeds will be discovered ( be it simple cash-in-hand tax evasion or more nefarious activities ).

<comment><USER4> >Personally I'm not worried if GCHQ know that I went to the doctor about a rash.

Except it can leave you vulnerable to blackmail. Say your rash is a symptom of a STD which was caused by a drunken one night stand with a x/y person you met at a bar. "Now you wouldn't your partner to find out would you?" says the guy in guy in the suit...

Other ways health records can be abused if your partner or child needs a transplant and they are way down the waiting list...

<comment><USER5> More ways your health records can be abused:

* 70% of Americans are currently using some form of prescription drug. Would you be comfortable if this information was given to, say, the next employer you interview with?

* Many health issues can be embarrassing for people, even relatively benign ones. This isn't always obvious until you've experienced it.

* Mental health issues often carry a social stigma. Yet 11% of the American population currently take antidepressants.

* Health records, by necessity, include vast amounts of personal information that isn't directly medical. Addresses. Phone numbers. Social security numbers.

<comment><USER6> Are you sure those statistics are right? Do you have a source for them? They just sound quite surprising to me (although I'm from the UK rather than the USA).

<comment><USER5> "Eleven percent of Americans aged 12 years and over take antidepressant medication."

from CDC/NCHS Data Brief: "Antidepressant Use in Persons Aged 12 and Over: United States, 2005–2008": [http://www.cdc.gov/nchs/data/databriefs/db76.htm](http://www.cdc.gov/nchs/data/databriefs/db76.htm)

"Nearly 70 percent of Americans are on at least one prescription drug, and more than half take two, Mayo Clinic and Olmsted Medical Center researchers say."

from Mayo Clinic, "Nearly 7 in 10 Americans Take Prescription Drugs, Mayo Clinic, Olmsted Medical Center Find": [http://www.mayoclinic.org/news2013-rst/7543.html](http://www.mayoclinic.org/news2013-rst/7543.html)

<comment><USER6> Thank you. It's great to have sources and they seem very good.

I would never have guessed that the number of people taking antidepressant drugs would be so high.

</comment></comment></comment></comment></comment></comment></comment><comment><USER7> I think this is important, but abstract arguments aren't really going to fly with grandma. Tell them that atheist Obama is reading her church emails. That'll get them fired up. Or if your grandma voted for Obama, tell her that can you imagine if Dick Cheney were reading your DNC emails?

You have to make political issues personal. Personify them. That's why "welfare queen" was such a smashing success. Privacy advocates have to figure out how to put a face on NSA spying.

<comment><USER8> What if your grandma is an atheist?

<comment><USER9> You can trust FDR with this, but what happens in twenty years when Nixon gets it?

(Or something similarly hyper-political and specific. I'm sure the comments below can come up with something witty and visceral.)

</comment></comment></comment><comment><USER10> I say: Never give truth to the power.

To make people understand what I mean I tell them about Martin Luther King and how the FBI concerned him as a threat to the public, he was kept under strict surveillance to collect information that would be used to blackmail him. The FBI collected information about Dr. King's plans and activities through and extensive surveillance program, from wiretapped telephones to hidden microphones in hotels and motel rooms.

Then aI ask: What if your kid is the next dissident, can you guarantee she/he won't have to step up and fight some absurdities? What will happen with she/he under the surveillance state we live today?

The problem with "normal people", those who have nothing to hide, is mainly one: you are telling the power what is important for you. I know this seems silly if we only think about ourselves (micro view), but it became a real problem when we realise the whole society is doing the same at the same time (macro view), telling the power what is important, where they should invest, make money, find/manipulate our geniuses, blackmail, incarcerate or kill our dissidents is just non-sense.

</comment><comment><USER11> A shorter response to "I have nothing to hide" is "Why do living room windows have curtains?" (It's not because of crimes or orgies.)

Another good response is, "Then would you mind if I inspect your wallet, nightstand, medicine cabinet, and tax return?"

</comment><comment><USER5> Everyone has information they would rather not be public, but many people don't realize that until it happens. Remember, most people aren't the focus of mass attention; we don't care if the information gets out because we can't imagine other people actually caring about us en masse until it happens.

Bruce Schneier has responded to "I have nothing to hide" with "tell me your salary." We all have things that we'd rather not have specific other people know, but privacy is usually thought of as protection against the anonymous crowds, and our social taboos haven't caught up to the new world.

<comment><USER9> >Bruce Schneier has responded to "I have nothing to hide" with "tell me your salary."

A friend in high school showed me a web page that had the salaries for all the instructors at our school. So many things made sense after that.

</comment></comment><comment><USER12> I believe one of the most compelling arguments for mainstream individuals is to appeal to their sense of fairness. People don't always understand privacy - but they tend to understand fairness.

A simple, relatable example would be exploiting insider information to use in the stock market for huge financial gain. Access to confidential business communications gives individuals an unfair advantage to exploit that information for personal gain.

Now, there's no proof that this has taken place, but one has to assume that given the scope of what's collected, it easily could - and eventually will, if it hasn't already.

</comment><comment><USER13> If you want to explain why surveillance is creepy, show your mother or boss this video and ask how they'd feel:

[https://www.youtube.com/watch?v=Uz8PdALdQDI](https://www.youtube.com/watch?v=Uz8PdALdQDI)

To give some background, it's a man who simply walks up to people and starts taking video. It's amazing how many people get annoyed with it.

I think this runs close to performance art, and is the best demonstration possible, because it's so easy to empathise with those under scrutiny.

</comment><comment><USER14> For the longest time, I combatted my conspiracy theorist friends who were sure the government was out to steal our freedoms by saying that such a conspiracy would require collusion by far too any people, and that since the advent of the internet, that kind of thing would be near impossible. The only thing that concerned me was the possibility of controlling communications (under guise of internet censorship). I asserted that if such censorship ever got passed, our brilliant cryptologist and internet freedom fighters would step up with larger efforts such as TOR to defeat such measures, and preserve our communication freedom and privacy. Someone would start a new network, trying to resolve some of those vulnerabilities that governments and criminals had found exploitable in the past. I am no longer comfortable with that answer. It seems this has all transpired, and we have been left unprepared. Perhaps the internet is too big to fail, and people will lay down and accept the abuse we suffer, because it is too difficult to find another way? More upsetting is, perhaps those friends and relatives weren't so crazy after all?

</comment><comment><USER15> Remember Minority Report? What happens when "big data" applied to the dragnet flags you as dangerous because of a false positive. Let's start by comparing patterns in the data of known terrorists to everyone else and put the closest matches on a no-fly list.

</comment><comment><USER16> The nothing to hide idea is interesting because it works both ways. If I have nothing to hide then I shouldn't worry about the NSA, according to them. On the other hand, if I have nothing to hide then they should have no reason to surveil me and shouldn't do so.

</comment><comment><USER17> How about give the reasons why you believe something, rather than invent reasons after the fact that are tailored to other people's values? In fact, despite working in tech I don't think my values are very different to my Mother's or my Bosses (well actually my boss is an engineer too...). I don't agree with the idea of first finding the truth, and then formulating arguments to convince others. Exactly the same arguments that cause you to believe X are what you should be conveying to others. boi_v2 has a very good summary in this page of the reasons why I oppose mass surveillance.

</comment><comment><USER18> Wish I had a quick link to the reddit post I read from a guy who lived in an active police state. He explained what it's like to be contacted by the government asking for a "favor". And, "btw, we noticed some questionable items in your uncle's file."

It's not just about you. It's about everyone you've ever cared about being used against you. Now imagine anyone considering doing anything the govt might not appreciate in that environment...

</comment><comment><USER19> Too much text. If anyone want to have at least some slim success conveying these ideas the message has to be impactful and short. That's why "think of the children" and "if you have nothing to hide you have nothing to fear" work so well.

<comment><USER20> I explain it in four words: "We are all guilty of something."

And then I explain that a corrupt power can use this nearly perfect intelligence machine can use this to find something that they hold over our heads.

From there its a pretty easy explanation to get to a Hitler like figure being in charge.

<comment><USER21> Except that many people believe they are - and will always be - "guilty" of _nothing_. (I have nothing to hide. . .). So that argument won't fly with huge numbers of people.

It's like the huge number of people who believe the police department/judicial system/system of choice is infallible until they personally know someone who was treated unfairly or see some egregious example of unfairness in the media. And even then, they still often believe that they never would have done XX and never would have found themselves in that situation.

<comment><USER22> If you interpret "guilty" as meaning "an action one is responsible for" then we really are all guilty of something. You are guilty of waking up this morning, you are guilty of making that post, you are guilty of expressing your opinion. The point is that a government that is tyrannical enough can in the future make anything you would normally think is totally innocent a crime and then use that against you to put you away.

</comment></comment></comment></comment><comment><USER23> Something occurred to me that might help drive intuition:

Everyone gets nervous when there's a cop behind them on the highway.

</comment><comment><USER23> A playful response to "I have nothing to hide" is "... are you really that boring?"

</comment><comment><USER24> Could somebody post this on pastebin for people who don't like to visit Slate?

<comment><USER10> [http://pastebin.com/Aw2SG4Qf](http://pastebin.com/Aw2SG4Qf)

I am curious, why not Slate?

<comment><USER24> They recently published an article suggesting people surrepticiously feed animal products to vegans, so I don't read their site anymore. I realize that not everybody will agree with that, but I'm not comfortable giving a site like that page views and ad impressions.

Thanks very much for providing the link!

<comment><USER25> Do you mean that the author at Slate seemed to approve of the practice, or just that they talked about it in general?

(I assume the former, and I assume that this is the article: [http://www.slate.com/articles/life/food/2013/09/chicken_stoc...](http://www.slate.com/articles/life/food/2013/09/chicken_stock_vegetarians_need_to_compromise_and_stop_pretending_it_counts.html))

<comment><USER24> Your assumptions are correct!</comment></comment></comment></comment></comment>


Justbeamit.com - file transfers made easy - <AUTHOR> http://justbeamit.com

<comment><USER2> Am I right in guessing that the file is streamed to the server and the server streams it to the other end? It's not actually a direct transfer with some flash-based NAT punch-through or anything?

</comment><comment><USER3> How will you guys make money?

<comment><USER4> by working day jobs. =)

</comment></comment><comment><USER5> So can I upload 50GB of files and will they stay there forever?

<comment><USER6> Hey there, so the point of the service is to stream the file from one computer to another. The transfer will work once between two computers. Also, the file size limit is determined by the limits of http (~2gb). Thanks.</comment></comment>


AFIncrementalStore: Core Data with AFNetworking, Done Right  - <AUTHOR> https://github.com/AFNetworking/AFIncrementalStore

<comment><USER2> Woah, who knew NSIncrementalStore has been exactly what so many of us have been looking for. After a quick scan through, this looks like it completely replaces, not wraps, the default SQLLite store, yes? In other words, if the network is down, you can't save anything that would be synched later or request any queries that weren't cached? Or maybe I'm just not reading things right.

Full offline functionality is pretty important to us so I wonder if there is a nice way to make the NSIncrementalStore wrap a regular old SQLLite CoreData store and fault out to the network if something isn't found locally and conversely, store any new calls that need to be made until network is available.

<comment><USER3> In addition to AFIncrementalStore and the other suggestions in this thread, you should check out Simperium (<http://simperium.com>). Our iOS/OSX library watches your existing Core Data context and handles syncing transparently, with full support for offline use. Unlike other solutions, we use persistent connections and operational transforms to send only the data that changes, allowing many conflicts to be resolved automatically.

We've already been down the path of using a more traditional RESTful approach to syncing data with earlier versions of our app Simplenote. I agree it seems like it should be easy to just cache some offline data locally and send it up to a server at first opportunity. And you can write a prototype of that system pretty quickly. But in our experience at least, conflicts, errors, duplicates, etc. arise a lot more often than you might think and it's very hard to make a system like that reliable, not to mention scaling and maintaining it.

<comment><USER2> Hi Mike, I went to your talk at CocoaHeads a month or so ago - I'm a big fan.

Correct me if I'm wrong, but, a big part of the point of NSIncrementalStore is that you don't need the entire database locally to perform queries against it (hence, Incremental and not Atomic). If somebody wanted to go parading around someone else's data (imagine clicking around through a bunch of YouTube videos) that would require interfacing with Simperium's query API's on other people's buckets, and then maybe saving that to your own local CoreData store, right? As I understand it Simperium hooks into context change notifications to figure out locally performed OT and then periodically pulls from the network to find OT on the bucket performed elsewhere. Maybe a good next step for you guys would be to build in a NSIncrementalStore for querying outside of the synchronized bucket to other people's stuff.

<comment><USER3> Oh, hey!

Your analysis is accurate. Actually, one of the features we're preparing to launch is sharing/collaboration/groups, which will allow data in Simperium to flow across users the same way it currently flows across devices. But you're right in that having more ways to perform queries outside of a known data set would be useful too.

</comment></comment></comment></comment><comment><USER4> As a long time Obj-C/iOS dev, web service interaction frameworks and/or best practices have been lacking for some time now. While RestKit works, it's learning curve is a tad steep and the sheer size of it can be a tad frightening in terms of 3rd party component reliance. If AFIncrementalStore is as great to work with as AFNetworking itself devs may have found themselves a new standard.

<comment><USER5> is there any good central repository for these kinds of frameworks / best practices?

<comment><AUTHOR> All of the best Objective-C libraries can be found on CocoaPods (<https://github.com/CocoaPods/specs/>)</comment></comment></comment>


The Company Behind Many Surprise Emergency Room Bills - <AUTHOR> https://www.nytimes.com/2017/07/24/upshot/the-company-behind-many-surprise-emergency-room-bills.html <comment><USER5> I am having problems with my insurer at this very moment. I went to an in- network hospital for an ER visit, which turned into an 8-day stay (yes, it was serious). Evidently, _none_ of the doctors at the hospital are in-network, however, (claims from various technicians are still "in processing", so I don't know how they will turn out) despite the fact that the hospital itself is definitely in-network. I had no choice as to what doctors came in, and, yes, I can now see them billing $600 for a 1-minute visit ($600 per visit, & they came every morning).

This is ludicrous! I have insurance, & still this will completely drain me financially. I'm at the point where I almost think it would be easier to declare bankruptcy and start over!

<comment><USER6> When I had back surgery, there were all these therapists coming in the moment I got out of surgery trying to get their 1 minute in. It was throughly ridiculous. One of them was attempting to do physical therapy and pulled on my leg a little and put me into so much pain I went into shock. She probably got her $600 bucks.

I am with Kaiser now and it is the most BS free medical experience I have ever had. To fix healthcare without single payer the government should just make a law that medical insurance can only be offered by hospital chains and the doctors and specialists cannot bill insurance separately, but must be paid by the hospitals. This is how Kaiser works. That way the hospitals can pay a fair market rate to doctors and not have them demanding a surprise emergency room rate from distressed patients.

<comment><USER7> I work in investment banking and cover hospital facilities (i.e. the "hospital chains"). You are right that the Kaiser model, or what the industry calls fully integrated systems, can often produce more efficient healthcare. For people that aren't as familiar with the healthcare system, I thought it might be helpful to provide a brief overview of why that is the case.

Since the ACA, there has been an emphasis on shifting from a fee-for-service model (FFS) to a value-based care model (VBC). Under a FFS model, doctors and hospitals are paid for each service they provide and make their profit from the margins built into the prices they charge for their services. In an ideal VBC world, doctors and hospitals are paid a certain amount for each patient they cover, and don't make additional revenue when they provide services to patients.

You can immediately see the incentives in each model. In a FFS world, doctors and hospitals are incentivized to give you the most care possible at the highest possible prices. For example, you could see how a doctor could be motivated to give a patient an unnecessary MRI. In a VBC world, the best-case scenario for the doctor is that he never sees you, and that you never enter the hospital. Each time you receive care, he spends time and money providing that care, but doesn't get paid any additional money for it. In other words, his margins decrease when he provides care (or, as those in the industry think about it, his medical loss ratio increases). When you become sick, the doctor would prefer that you seek care in a setting that is as low-cost as possible - via telemedicine, an urgent care center, or his office. That way, he keeps more of the monthly premium.

Practically, though, in the VBC world, the doctor probably wants to see you once or twice a year, to make sure you are healthy and that you are taking preventative measures to avoid becoming sick and utilizing healthcare. That investment of resources can help reduce your need for healthcare in the future, protecting his profit margin going forward.

So in a perfect VBC world, everyone's incentives line up. You spend as little time in the hospital or at the doctor as possible, and check in every once in a while to make sure you are healthy. Doctors and hospitals make more money when they don't have to treat you, and want to keep you out of the healthcare system.

The problem is, the current system is a mix of FFS and VBC. Most hospitals and doctors aren't compensated on a fully capitated basis (capitation is a concept that, in layman's terms, measures how close the system is to VBC vs FFS - <USER2> highly capitated = closer to VBC). Under FFS, doctors don't make much money providing preventative care, so there is no incentive to keep people away from the hospital. Unless you are a member of a system like Kaiser, you are most likely covered by a plan that is partially capitated - your insurer may share profits over a certain % with your doctor as a reward for keeping you healthy, but still pays for services on a FFS basis. Often, this profit sharing does not compare with the potential revenue from providing additional acute care services, so the old FFS incentives are still at play. (Hence the $600 1-minute consultation.)

Now, wouldn't it be great if every health system operated like Kaiser, where all the incentives are aligned and the objective is to keep people out of the healthcare system? Yes, but the answer is not as simple as requiring healthcare systems to provide insurance. In fact, Kaiser is one of the only success stories involving provider-sponsored health plans (Presbyterian in New Mexico is another).

The reason why many of these provider-sponsored health plans fail is twofold:

First, most healthcare in the US (70% I believe - but that is from memory) is provided by regional or community healthcare systems. These systems only serve certain communities (their primary service area, or PSA) and therefore certain populations. These populations are often not of significant enough size to provide adequate risk diversification for healthcare systems that provide insurance plans. One of the key reasons insurance works is risk diversification - but these hospitals can't diversify their coverage beyond their community's population. In fact, one of the most common criticisms of Kaiser from the investor community is that its membership is too concentrated in California - and Kaiser has over 10 million members on the East and West coasts.

Second, these systems often don't have the capability to price their insurance and healthcare services correctly to account for the levels of risk embedded in their insurance plans. Sometimes that is due to lack of actuarial experience, sometimes that is due to lack of risk diversification causing risk to exceed estimates, and sometimes that is due to existing healthcare prices driving up costs to a level beyond where they can reasonably charge premiums. Also, it is hard for these systems to predict who will enroll in their health plan, and what their overall risk level will be after enrollment season. There are companies dedicated to helping systems operate provider-sponsored health plans (e.g. Evolent), but this has proved to be a difficult problem. For examples of premier systems getting this wrong, look up Partners (they own Mass Gen), Catholic Health Initiatives, Northwell, Banner Health.

While this is a hard problem to solve, and I don't have the answer, you are right that the Kaiser model has in many ways proven to be more cost effective than FFS or other capitated models. It might be a good intermediate step for some of the larger systems. But there is still a lot of work to do to fix the system, and even solutions that sound good on paper have unintended consequences (for example, if you move to a single payer system to reduce prices, would lower drug prices disincentivize pharma R&D, hurting development in the US and the rest of the world? Would medical device companies making prosthetics go out of business if prices decreased below their cost levels? etc.).

Hopefully this was helpful to people who aren't as familiar with the way the system works. A less-than-perfect analogy I often use is:

The old FFS model is a "supermarket" model: the supermarket makes money by selling you as many gallons of milk as possible, and pricing the milk at a premium to their cost. The higher they can price the milk, or the more milk they can convince you to buy, the better off they are.

The current model is a "Costco" model: you pay a recurring membership fee to Costco, and can buy their products at a lower price, but (let's assume) you still pay a slight margin on those products to Costco. So, Costco would love to have as many members as possible paying membership fees - and, in fact, could offer its products close to cost if there were enough members who didn't use the store. But, they would still prefer that members use the store as much as possible, and buy as much product as possible at the highest allowable margin for Costco.

The "ideal" VBC model is a "Netflix" model: you pay a recurring membership fee to Netflix, and can stream any of their videos for free. Netflix starts out the month with its $10 of revenue from your membership, and each video you stream causes them to incur streaming costs and royalty payments, reducing their margin on your $10 throughout the month. From a pure profit perspective, Netflix would love to have millions of members who never used the service, allowing Netflix to keep 100% of their membership fees. However, in order to grow and be successful, Netflix needs members to use and love the service, so it "invests" some of its membership fee by streaming videos to users. If users are going to stream, Netflix would prefer that users stream its proprietary content, which is lower-cost for them to provide. (That last part of the analogy is stretching it a bit, but meant to demonstrate that for the health of the system, some utilization is required, and the provider would prefer that utilization to be as low-cost as possible.)

<comment><USER8> I appreciate the time it took you to explain all that. You did a good job.

I am in the opposite camp and don't have the time to write out my position to the extent you did. However, I'd just like to take a moment to point out the ludicrousness of calling something that isn't Fee For Service "Value Based", as if there's anything in the world more "value based" than paying someone for the value rendered in a specific service.

<comment><USER7> Thanks. I would be interested to hear your perspective.

I agree that "value based care" is probably not the best name for a fully capitated system. (Population health might be closer, but still not perfect.) By definition the "value" of something is whatever someone is willing to pay for it. A doctor's reimbursement rate is negotiated with the insurer, so there is an explicit agreement to pay that rate for that service. And by being a member of that health plan, the patient explicitly agrees to pay whatever deductible or copay is required by the plan, based on the rate the insurer negotiated with the doctor. So in a FFS system everyone has actually agreed to pay the price that is charged.

The problem is that as a patient, it is hard to tell how much a medical service will cost before receiving it. In a grocery store, you can look at the price of milk and decide whether it is worth buying. But there are all sorts of reasons why price consciousness is harder with healthcare (for example: emergency care, lack of price transparency, agency issues). And so the idea of value is harder to measure from the patient's perspective, which is why value and price paid may not exactly match.

</comment></comment></comment></comment></comment><comment><USER9> Over here (in Europe) we get the impression that US has such a crazy healthcare system. Why aren't people marching in the streets? Is it not as crazy as it sounds for most users? If you're taken to ER how are you supposed to know if the doctors are all part of "your network" (whatever that even means)?

<comment><USER10> Because those in the middle and upper class have employer-paid health insurance which protects from the worst of bills. You only go bankrupt if you're uninsured and usually only those in the lower-middle or lower class are uninsured.

And those in the lower echelon of society economically are those least able to have the time or money to march or lobby for change.

<comment><USER11> I went to ER a couple of months ago for a relatively minor issue and stayed for a few hours total. This was in-network hospital, doctors and so on. Purely by co-pays this ended up being a ~$800 bill after all the insurance kicked in.

If I didn't have a comfy software engineer salary, and instead lived paycheck to paycheck, this would've been devastating, even with insurance.

<comment><USER12> Which is ridiculous. We're at the point where the insurance is just covering the cost of the overhead that necessitates having insurance in the first place. There's no way the real charge should be $800, let alone co-pay.

<comment><USER13> > Which is ridiculous. We're at the point where the insurance is just covering > the cost of the overhead that necessitates having insurance in the first > place. There's no way the real charge should be $800, let alone co-pay.

You're right. Of course the private insurance premiums have a negative expected value. Aside from insurance always having a negative expected cash value by definition, private insurance premiums are literally used to subsidize care of Medicare, Medicaid, and uninsured patients.

</comment></comment></comment></comment></comment><comment><USER14> In a past life, I worked in health insurance fraud detection.

Everybody should know, the health insurance system in the US is fundamentally broken and has been almost since its inception in the early 20th century. The lack of adequate consumer protection, transparency, health systems and appropriate government regulation, in addition to organizational oversight, has lead to a situation where we have poor systems that can easily be exploited. And they are exploited.

What the third party care outsourcing/billing company mentioned in the article (Emcare) was doing sounds like upcoding. They bill the highest cost service they legitimately can to maximize profit. In this case, as a third party billing organization, they both want to maximize the profit for their customer (the hospital system), but also for themselves, as they surely take a cut as a middle man.

Likely, they were operating within the gray area where illegal upcoding has to be proven in a court of law. It is an expensive process, that requires review and comparison of huge amounts of medical records with claims to determine whether the more expensive procedure billed was medically necessary/appropriate, or if it was egregious. That legal process does pan out sometimes in the end, but it can take years and just adds even more overhead.

Coding correctly, fairly and getting reimbursed correctly and fairly is incredibly complex. There are an enormous number of combinations of services (usually represented by codes called HCPCs and CPT codes) and diagnoses (ICD-10... which has 100,000s of codes), as well as all different regulations and scenarios for settings of care (inpatient, outpatient, doctor's office, etc.).

Props go to the hospital system for taking back their coding after they realized what the third party was doing, but the reality is, it was probably financially benefiting the hospital system too.

Every technology that I know of has been tried to address these issues, such as data mining, machine learning, rule-based expert systems, etc. and none of them has addressed the root cause, which is the basic system is fundamentally flawed.

All the politics you see about US healthcare in the news are, in a way, representative of the root problem - how big and complex the systems are now, how much money they represent, and how many interests are involved. We have a tangled web.

I don't know the solution (and many have been proposed).

<comment><USER15> > Props go to the hospital system for taking back their coding after they > realized what the third party was doing, but the reality is, it was probably > financially benefiting the hospital system too.

I doubt the hospital system got anything from it, physician groups usually keep all their revenue from professional services claims - the hospital gets paid whatever they do for their facility claim regardless of what the professional claim pays.

<comment><USER14> It's possible you're right. Without knowing the details of the relationship, you never know.

The reason I say that is the article points out another glaring issue - <USER4> shortage of ER docs that we are currently facing. I know this first-hand, as I have a family member who is one and is working harder than ever.

Some of these arrangements are to make up for the shortage, and the hospital systems and physician groups are often working in partnership... so it could be there was benefit for both since the hospital system needed coverage for their ER (due to physician shortages), and Emcare is providing the physicians. Without the physicians doing the services in the hospital, there would be no facility claim either...

<comment><USER15> > It's possible you're right. Without knowing the details of the relationship, > you never know.

This is true, and being a mere software developer I'm in the dark on the contents of any of the contracts my parent company has with facilities either.

> The reason I say that is the article points out another glaring issue - <USER4> > shortage of ER docs that we are currently facing. I know this first-hand, as > I have a family member who is one and is working harder than ever.

Insert my standard rant about restricted med-school/residency admissions and cost of tuition here.

<comment><USER14> It's sad but true that we are getting to a point where all we have are standard rants about these topics, but can't find the solution. I'm guilty of the same too.

Stalemate.

We need to go through Kurt Lewin's change model process - "unfreezing, change, and refreezing" and find something better. It's like, we need agile healthcare or something - fail fast and iterate faster... without costing people their lives or their savings. [https://en.wikipedia.org/wiki/Kurt_Lewin#Change_process](https://en.wikipedia.org/wiki/Kurt_Lewin#Change_process)

</comment></comment></comment></comment></comment><comment><USER16> So, basically, if you visit any emergency room then your handing them a blank Check and they can write whatever number on there they want. That's egregious beyond belief. I'm never one to call for legislation and price controls, but in the face of such adversity, I think it may be our last hope. I think they should either provide a quote before they offer the services or there should be a law limiting the amount that can be billed per service.

<comment><USER17> Yep. Took my wife to the ER last week for suspect appendicitis or diverticulitis. Last time this happened a CT scan alone was $3k ($11k prior to insurance reduction). My HDP is $4,500 OOP max per family member; $8,500 for family.

What really pisses me off is that the HSA max contribution has not kept up with family OOP max. I contribute the max every year and can't end up with $8,500 saved.

I had a decent insurance plan prior to Obamacare. Now it's 3x as much and a HDP. Don't even have dental insurance anymore; use the HSA for that. Work for a Fortune 100 Company too.

<comment><USER18> _Work for a Fortune 100 Company too._

Your HR department is shit. I manage a 30 person company and our benefits are better than what you've mentioned.

<comment><USER17> Yes, no argument there. I work for Fortune #75 (hint; it's probably hanging on your wall). Lost dental insurance last year, vision the previous year, and switched to an HDP the year before (with massive premium increases every year). But hey, the stock price was at an all-time high on Friday.

Funny thing about HR directors is that they don't last more than 1 year before rotating out. Don't want them to become too attached to the people they are there to screw.

<comment><USER19> >I work for Fortune #75 (hint; it's probably hanging on your wall).

Honeywell; thermostats?

<comment><USER20> HON stock did just hit an all time high.

</comment></comment></comment></comment></comment></comment><comment><USER21> Canadian here. Had a pain in my right side for about 3 weeks (thinking muscle pull). Called Doctor's office at 10am had appointment at 11am, had exam and referred electronically to local hospital for X-Ray, had X-Ray at 11:45am, out the door at 12pm. Doctor called me personally the next day to say it's probably a muscle pull and call back in a couple of weeks if still sore.

$0 out of pocket, just showed my government issued card everywhere.

Couple of years ago my father was in an ICU for two weeks with Parkinson's related complications. That one had a $0 out of pocket bill as well. The ICU was in a world class university teaching hospital.

System works here. Sure people can cite edge cases, but they are relatively rare. The single payer, $0 out of pocket system also encourages pro-active care as opposed to waiting until the problem is severe, which in turn keeps costs down.

Wouldn't trade our single payer, socialized medicine for anything. There's reason why Tommy Douglas, the father of Canadian socialized medicare, was voted the greatest Canadian of all time by the public in a recent CBC poll.

(Shameless plug: software industry is booming in Toronto and there's lots of jobs. Just sayin'...)

<comment><USER22> _System works here. Sure people can cite edge cases, but they are relatively rare._

Not sure these are just "edge cases"...

[http://www.cbc.ca/news/canada/british-columbia/patients- live...](http://www.cbc.ca/news/canada/british-columbia/patients-lives-ruined- as-hip-surgery-waits-grow-1.2976196)

<comment><USER23> Lets compare the 'horrible edge case' rate of the USA compared to Canada now.

<comment><USER22> How about we compare Canada's edge cases to countries other than the US. How does it stack up?

<comment><USER21> I would suspect not too badly.

</comment></comment></comment></comment></comment><comment><USER13> If you want to understand how medical billing works and _why_ these ridiculously high bills get created, there's a lot of important context that this article unfortunately leaves out.

Large hospital systems accept patients who have a range of payers (Original Medicare, Medicare Advantage, various Medicaid plans, private insurance, and uninsured patients). On the aggregate, they want to make sure that their entire system is cashflow-positive - however, they do that in a rather roundabout way, because they only have the ability to negotiate with some of their payers, whereas the others are able to set their rates at whatever price they want.

Medicare and Medicaid set their reimbursement rates by fiat, and providers have essentially no ability to negotiate those. Except in critical access areas, Medicare actually reimburses much less than the marginal costs of care for its patients (7% in the aggregate)[0]. These rates are so low that Medicare actually has a separate program to pay extra money to hospitals that treat a lot of Medicare patients - otherwise, they would literally go under. The reason they provide this money as a separate program and _don 't_ count it in claims is entirely political.

As a result, providers present very large bills to everyone else (privately insured and uninsured patients) to make up for this loss - you can't stay in business if you're literally making a loss on every patient! Uninsured patients see the large bill and assume they have to pay the entire amount (they don't!), and private insurers end up negotiating that down to some multiple of what Medicare pays.

A typical insurer will negotiate an agreement like, "we'll pay 350% of what Medicare pays for this category of services".

[0] This is not looking at any markup that the hospital provides - we're talking about how much the hospital has to pay _its_ suppliers. So, for a hypothetical vaccine that costs $100 wholesale, Medicare might reimburse $93, which doesn't even cover the cost of the equipment, let alone the entire hospital infrastructure (wages, etc.).

<comment><USER24> _We 're talking about how much the hospital has to pay its suppliers_

Except suppliers can engage in their own fiat prices, as the OP demonstrates.

But your narrative does show the basic situation - where you have an elaborate _digraph_ of buyers and sellers, most of which have a more or less monopolistic position. These monopolistic suppliers initially/formally set their prices based on "what they could possibly imagine getting", expecting regulators/down-stream-buyer to be the ones who will push things back into sanity (or not).

American health care, of course, has bounced from regulatory regime to another, with all of the players having to adjust. And moreover, all the players are now adept at adjusting, able to switch gears to leverage whatever ad-hoc cost reductions might go with any new system (cautious enough to lay- low when the new system comes since they know the politicians need to point to gains but will move on - see the way Obamacare worker great for two years, etc, etc).

And with all the bouncing, the situation has gotten only broadly more catastrophic. Health care was ~18% of GDP a year or two ago and no doubt is higher still.

Not only does health care have a problem but the four or eight cycle of ad-hoc fixes to health care has itself broken. Which might relate to the general breakdown of the countries political system, and so-on. I assume when (part of) Rome fell apart, no had seen an empire disintegrate on quite those terms (where a lot of civilization still remained on higher terms than Rome's neighbors). Perhaps our descendants will look back on this era in similar terms.

<comment><USER13> > Except suppliers can engage in their own fiat prices, as the OP > demonstrates.

Those aren't fiat prices by any stretch. Aside from the fact that there is a competitive market of providers, patients don't have the obligation to pay the entire billed price (a key point which this article does not mention). That's neither a monopsony nor a monopoly.

Medicare, on the other hand, _is_ a legal monopsony over its patient population and _does_ set its prices by fiat. (There is no competitive market; patients can opt to receive their Medicare benefits privately, but they cannot opt out of Original Medicare entirely. Similarly, most providers cannot legally opt out of accepting Medicare, in practice).

</comment></comment></comment><comment><USER25> Start with the fact that even the hospitals _themselves_ do not even know the cost/price of their procedures and goods.

Notice here, in 2013, an article about how "For the very first time, the federal government is publicly releasing the "rate card" (the full charge before insurance company discounts) prices hospitals throughout the nation charge for the one hundred most common procedures and services." [https://www.forbes.com/sites/rickungar/2013/05/08/the- great-...](https://www.forbes.com/sites/rickungar/2013/05/08/the-great- american-hospital-pricing-scam-exposed-we-now-know-why-healthcare-costs-are- so-artificially-high/#3a56feb53bff)

Yet two years later, a CEO of a hospital cannot even get the costs at the hospital of which she is CEO: [https://www.nytimes.com/2015/09/08/health/what- are-a-hospita...](https://www.nytimes.com/2015/09/08/health/what-are-a- hospitals-costs-utah-system-is-trying-to-learn.html)

Price discovery, the most basic element of a free market, is literally impossible, even for expert executives within their own organizations. Vast price discrepancies exist for procedures just a few towns apart. Discovery for consumers in advance is impossible, and of course absurd in the situation where you are being rushed to the nearest hospital in an emergency.

Do not let anyone get away with claiming that this is somehow a "Free Market" until reliable prices, and outcome rates (with case difficulty information) are as easily available as prices and reviews on Amazon.

</comment><comment><USER26> The entire pricing scheme is an elaborate sham if you ask me. My wife had to have surgery. A outpatient laparoscopic procedure that required cutting a tendon. The time she spent at the facility (from the when they took her back and discharged her) was about 3 hours. A month later we got a statement showing they tried to charge $67k and were denied… followed by a separate bill for $7.5k We ignored the bill and contacted Anthem who said the hospital didn't code it correctly. Anthem said they would resolve it. A month later… another attempt to charge $67k another separate bill for $7.5k. Again we repeated the same process. This time it appears it went through. Final total when they "coded it correctly" was $74k.

I have a friend who had to have an emergency appendectomy this year. She paid $1500 for it after insurance. My father had knee surgery he says they tried to charge the insurance company $64k for it.

At this point I think the pricing is all arbitrary. It's about them trying to charge what they think they can get away with and sticking you for the rest. Kind of like raising the price so you can offer a deep discount later on. I think the real price of the surgery (without insurance) was probably the $7.5k.

I can think of no other business where you agree to have work done without an agreed upon price. The insurance company will tell you it's covered but the hospital you go to may decide to play games with you. At the very least I suppose they are just hopping you pay so they can collect interest on your money on it before sending it back.

<comment><USER27> > I can think of no other business where you agree to have work done without > an agreed upon price.

You can't really compare this with other businesses. Unless you want the doctors to stop the moment they hit your negotiated price (like lets say a building constructor would).

However you should be able to get a rough quote for the procedure (assuming no unexpected complications).

And I agree with you in general, US health care is a total scam (very high- quality to be fair).

<comment><USER26> That's good point. I wouldn't expect pricing to function like that, especially in life or death situations. In our case, this was a surgery that was planned and scheduled a month in advance and at no time was a price ever mentioned. Just a letter from Anthem saying it was covered. We didn't start to see anything on the monetary side until after it was all said and done with. In advance of the procedure I tried to find some pricing data on the surgery but struck out. Apart from some articles about hospitals in California publishing prices for procedures, I could find nothing for the east cost.

</comment></comment></comment><comment><USER28> Does anyone know if a lawsuit has been lodged questioning these practices?

I've always thought that my informed consent should also apply to cost of procedure - I have a right to say "NO" to something in the medical establishment. And had I known the price and the success rate, I would have said "No".

Now, I'm not asking "What is my exact rate?", although that would indeed be nice. But given minimal complications, I should be able to get a range of what to expect.

<comment><USER29> Price transparency is pretty meaningless for ER care. Anything that is serious enough for an ER visit probably distracts you from making good economic choices, plus it's likely impractical to change ER (plus you'll pay for that ambulance ride!)

Further, it shouldn't be necessary for people to be making financial decisions in the middle of medical emergencies, even if it was easy.

<comment><USER30> > Anything that is serious enough for an ER visit probably distracts you from > making good economic choices, plus it's likely impractical to change ER > (plus you'll pay for that ambulance ride!)

there are all sorts of folks using ERs for non-emergency issues, simply because ERs are required to treat everyone.

both of my trips to the ER (subluxed knee; particulate matter lodged in my eye) would've been amenable to at least a few moments of financial consideration, had any information been available to me.

</comment></comment></comment><comment><USER31> Every time I read a story about ER-billing I have to fight the urge to spend a few hundred bucks on the materials and equipment required to produce "official enough looking" forms of ID.

Seems like getting a hospital to think they treated someone who doesn't exist is a better bet and no more stressful than getting your insurance to cover things to the extent you are lead to believe they would be covered

<comment><USER23> They do check IDs at hospitals. I remember sitting in one and the person next door having a conversation about how their ID was fake / not theirs.

</comment></comment><comment><USER32> Similar experience where I went to an ER and like six people interacted with me for less than 1-2 minutes apiece plus scans and an unneeded IV which came with a generous offer of Opioid pain meds when I specifically said, multiple times, I wasn't in pain. I got like seven different bills, each for randomint(0,1000). Worse, after wasting a day there - all they could do is just refer me to a specialist. The bills didn't even really explain what they were for, they just kept coming for almost a year after - apparently one for every person who may have looked in my direction plus each scan or test.

So I switched to Kaiser which is slightly better from the billing side but feels pretty mediocre care-wise. I don't hear back from the GP about questions/tests ordered and I've waited literally all night just to get something for a bad cough.

Healthcare in America is truly and thoroughly fucked.

</comment><comment><USER33> This is no longer legal in some states, including California... [http://www.huffingtonpost.com/entry/surprise-no-more- balance...](http://www.huffingtonpost.com/entry/surprise-no-more-balance- billing-from-docs-in-california_us_59567da0e4b0da2c73232bd7)

Im curious how many supporters of GOP's free market rhetoric would support regulations around these practices once they are hit with a surprise bill like that

</comment><comment><USER34> We will have our universal healthcare, eventually. More and more people are scorned every day by the perils of our system. The Democrats couldn't manage to pass a public option during Obama's honeymoon period but the country might be ready for it once the pendulum swings back in 2020. Even my somewhat economically-conservative father admits that it is inevitable.

These next two to four years are going to suck, though.

I am a New Jerseyan and the medical industry is going to fight tooth and nail on this. My district swung (!) and even the Democrat won't endorse single- player.

Hopefully we can effect change as the Boomer leaders die off, at the very latest.

</comment><comment><USER35> What are the specific benefits to having an immensely expensive administrative bureaucracy lodged between the actual patient and actual health care provider?

This should be easy to answer and explain.

<comment><USER36> Shifting costs from the hospitals and insurance to the patients, plain and simple.

This is merely the tip of the iceberg for what for-profit healthcare is developing into. You cannot have sound medical decisions being made when money is so deeply intertwined in the process.

<comment><USER35> I would highly recommend every patient asks their doctor(s) about health insurance and their opinions of it. You will get an interesting earful.

</comment></comment></comment><comment><USER37> Seriously, America: how is _ANYONE_ still arguing against universal, single- payer health care?

<comment><USER38> Healthcare is 1/6 of the US GDP, and they have good lobbyists.

</comment></comment><comment><USER39> In any other field all of these billing scams would be a federal crimes.

Congress could solve this issue overnight by passing a 1 line law:

If a patient is using services that is not covered by their insurance, or if they have no insurance, no medical service provider can change more than the official medicare standard rate for any services rendered.

Problem solved.

<comment><USER23> That quickly becomes single payer, since prices will be set to a price ceiling of whatever medicare (the gov't) sets it at. Good luck!

</comment></comment><comment><USER40> I feel like there must be something I'm missing here. Isn't providing health care the core purpose of a hospital? Why are they outsourcing that? Outsourcing might make sense for ancillary stuff (e.g. running the cafeteria), but I'm confused why they'd look to outsource their core job. And if the outsourcing company can do it so much more efficiently, why don't they just open their own hospitals and take all of the profit?

<comment><USER41> Think of a doctor as being an specialist independent contractor affiliated with the primary business.

Imagine if you would, a small hospital. They probably don't see enough patients with diagnosis X to keep staff specialized for X busy year round. There is a doctor in town that specializes in X. This doctor needs a place to get their patients stabilized and where the doctor can see the patients periodically. When one of the patients needs hospitalization, the doctor can write an admission order telling the hospital to take care of a patient in a certain way. When somebody comes into the ER and the generalist/hospitalist discovers that person has condition X, then the hospital knows they can call on the doctor to consult with them on how to treat X.

A historical artifact of the hospital/physician relationship is that there are separate billing streams for each side. There is just enough information sharing so that the doctor's billing system knows who the patient is and it is up to the doctor to claim that certain actions were performed for a valid medical reason and documented.

The current state ranges from very arms length relationships to total economic integration, which is rare enough to have a term for it, Single Billing Office.

[http://healthaffairs.org/blog/2016/05/09/the-tangled- hospita...](http://healthaffairs.org/blog/2016/05/09/the-tangled-hospital- physician-relationship/)

</comment></comment><comment><USER42> I have learned, directly from people that would know, that even in affluent cities in the US one-third of the people having surgery do not have insurance and simply refuse to pay any of their hospital bills. In some cities, hospitals have virtually no paying patients.

This surprised me, but I suppose it makes sense that cost have to be born by those of us that have the means to do so.

</comment><comment><USER43> One thing to keep in mind: when you go to the emergency room as a relatively well-off individual who has insurance and pays their bills, you're not only paying for your emergency room visit - you're also paying for the visits of people who don't have insurance and can't afford to pay their medical bills.

</comment><comment><USER44> My name is Ricky, I applied for a house and a car loan about a couple of months ago and it was rejected because my score was in a low 412 with a couple of negative items (including eviction, bankruptcy and a judgment), I was really devastated and perplexed. i ran into an old friend, I explained everything to him and he eventually introduced me to a hacker who happen to be a former FICO agent. Just in 5 days, he had my credit score raised to 788, wiping out the entire negative items with the addition of some good tradelines. I swore to reveal the hacker's proficiency to the world if he should fix my credit. Well here I am recommending CYBER DON (email@example.com; +1 912 388 3132) for your credit score & credit report issues, he is a true credit specialist. Just drop him a mail or text him on the above contact and be happy you did.

</comment><comment><USER45> Some out of network providers send bills to patients but don't collect. Some even tell the patients not to worry about it, although I believe this may be illegal.

In theory, the high reimbursements are so out of network doctors can get paid market rates. There's also a fair amount of propaganda from insurance companies on this issue which makes the reality hard to discern. Yet they pay 10-20% on average of the bills they receive, so it's just another way to punish the patient while both the insurance company and doctor are taken care of.

</comment><comment><USER46> Dear NYT, Spokane is not rural. It may not be the metropolis you're accustomed to, but rural it is not.

</comment><comment><USER47> At least the hospital in Newport took back their coding/billing into their own hands.

<comment><USER48> What was the result?</comment></comment>


When good assumptions go bad - <AUTHOR> http://blog.businessofsoftware.org/2009/01/bos-digest---when-good-assumptions-go-bad.html <comment><AUTHOR> >> Like the punchline to the how many philosophers does it take to change a light-bulb joke, I have no answers, only questions.

hah.</comment>


Poll: Why do you use free antivirus? - <AUTHOR> https://blog.kaspersky.com/poll-why-do-you-use-free-antivirus/3208/ <comment><USER2> The answer is in the question - FREE. Nothing beats free. Unless the real price is hidden / bundled in the price of the hardware, making it seem free.

</comment><comment><USER3> Because a) why pay for something that should not be necessary in the first place, and b) why pay for something that is generally ineffective?

</comment><comment><USER4> Because my seldom-used Windows box sits on a zvol with snapshots.</comment>


Woobius - a taste of magic - tomh- http://www.vodafonemobileclicks.com/blog/uk/104/woobius_-_a_taste_of_magic/

<comment><AUTHOR> Nice job swombat. Have you considered making screencasts of your own for the 'Tour' section of the site?

Edit: apparently those guys work for Woobius. Have you considered using screen recording software?</comment>


The Ivy Bridge and Haswell BTB - <AUTHOR> http://xania.org/201602/haswell-and-ivy-btb <comment><USER3> Cool article, but if I may say, rainbow graphs are hard for me (and many other people) to parse.

[http://betterfigures.org/2014/11/18/end-of-the- rainbow/](http://betterfigures.org/2014/11/18/end-of-the-rainbow/)

[https://eagereyes.org/basics/rainbow-color- map](https://eagereyes.org/basics/rainbow-color-map)

Not that it makes the article significantly weaker though, but yeah.

<comment><USER4> Thanks for the feedback! I must say graphs and whatnot are not my forté - <USER2> spent nearly two evenings trying to get them half-decent. Patches welcome, of course :)

</comment></comment><comment><USER5> That was an interesting and insightful article about CPU branch target buffers. Learned something new about Haswell and Intel BTBs in general.

Haswell's branch prediction seems to be pretty nice. I bet that makes quite a bit of difference in branchy code. No need to care so much about arcane rules about branching as in the past.

Haswell+ Xeons will likely be good with branchy code, especially avoiding those old pathological cases. Predicting 4096 branch targets with such an accuracy is very good.

<comment><USER6> Yes the Haswell branch prediction is so good that it obsoleted previous "best strategies" for fast interpreter loops.

See [https://hal.inria.fr/hal-01100647/document](https://hal.inria.fr/hal-01100647/document)

But unfortunately a lot of real code is so big these days that it thrashes all caches, including branch prediction.

Big is slow.

<comment><USER5> There are just 512 cache lines in both L1 code and L1 data cache.

512 * 64 = 32 kB. 512 is 8 * 8 * 8, I'd guess if they add more (up to 4096) L1 cache lines that access would take 1 clock longer. Which is very likely a net performance loss.

Maybe it's time to increase cache line size to 128 bytes. That could of course break a lot of old code performance wise. It'd cause more false sharing [1] and double memory bandwidth requirements for random access. Maybe we should start to organize shared data to have 128 byte alignment.

It'd also break some read bandwidth-saving code that assumes 64 byte streaming (non-temporal) stores eliminate need for RFO [2] access.

Writing a _single byte_ to RAM would require CPU core to first read a 128 byte cache line (RFO [2]) and then eventually write that cache line back. Currently "only" 64 bytes need to be read and written in the same scenario.

128 byte cache lines would mean L1C and L1D caches are both 64 kB, up from current 32 kB. That'd definitely help with monstrous codebases.

CPU design is full of compromises...

[1]: Atomic ops unintentionally touching same cache line cause performance loss through false sharing. The effect can be very significant, up to 2 orders of magnitude. [https://en.wikipedia.org/wiki/False_sharing](https://en.wikipedia.org/wiki/False_sharing)

[2]: Read for Ownership. [https://en.wikipedia.org/wiki/MESI_protocol#Read_For_Ownersh...](https://en.wikipedia.org/wiki/MESI_protocol#Read_For_Ownership)

<comment><USER7> For dram reads, to my knowledge you can't read only 64kb anyway. You get much larger pages from dram.

<comment><USER5> > For dram reads, to my knowledge you can't read only 64kb anyway. You get > much larger pages from dram.

I didn't say 64 kB, I said 64 bytes is the read and store transaction size.

I think DRAM page sizes are 2^n * 512 bytes, where n is a positive small integer. Typical DRAM bank sizes are 512 bytes, 1 kB or 2 kB.

So, with interleaved memory channels DRAM page changes every (DRAM page size) * (number of memory channels).

I think typical bank switch intervals for a laptop with 2 memory channels is every 1 (DDR4 minimum), 2 (DDR3 minimum, probably typical) or 4 kB.

Although DRAM bank sizes are irrelevant in this context.

I was talking about the smallest possible _cached_ DRAM transaction -- read or store. Which is the same as the cache line size, 64 bytes.

Simplified:

Read 1 byte from memory and the CPU will fetch 64 bytes.

Write 1 byte to memory and the CPU will first fetch 64 bytes (RFO), modify the cache line and eventually when the cache line is evicted (which can be quite a while) write 64 bytes back.</comment></comment></comment></comment></comment>


SHA-3 in x86 assembly – 761 bytes - <AUTHOR> https://odzhan.wordpress.com/2015/11/03/tiny-sha-3/ <comment><USER2> The number of magic numbers in that code makes me a bit nervous.</comment>


Non-programmer wants to build functioning prototype - <AUTHOR>

I want to learn one language that will enable me to patch together a functioning crowdsourced platform that works sort of like Airbnb.  I know Dev Bootcamp focuses on Ruby, but can that do what I need or should I learn PHP, Python, or something else? Suggestions on best books/tutorials, etc. please. edw519 likes the Rhino book on Java Script by Flanagan. Thank you. <comment><USER2> If you'r a non-programmer, I'd suggest WordPress. There's a ton you can do w/ it [ <http://tommcfarlin.com/web-applications-with-wordpress/> is a great read ].

<comment><AUTHOR> Thanks Flash. Interesting...didn't know you could do that in WP. I will have to research this more. So do you like WP better than Bootstrap for a mission specific tool? Also, I would like to have at least one language that I can learn as a long term foundation that I can build on. Appreciate the feedback, TJ</comment></comment>