The U.S. could slash health-care costs with two fundamental changes - <AUTHOR> https://www.marketwatch.com/story/the-us-can-slash-health-care-costs-75-with-2-fundamental-changes-and-without-medicare-for-all-2019-08-15 <comment><USER2> What I've always found amazing is how cheap dental and eye care is in comparison to other types of medical care. The fact that you can get laser surgery in your eyes for a couple of thousand dollars is incredible, given that a diagnostic test like an MRI can often cost that much. Clearly there is room for competition to reduce costs.

Clearly that doesn't work for emergency services. But is there room to distinguish emergency from non-emergency services? I had surgery for a deviated septum. I don't know what it cost, but if I had an incentive I could've price shopped for it. There are a lot of non-emergency procedures (colonoscopies, hip replacements, knee surgery, etc.) that could be subject to competition.

Also, the comparison to Singapore's health outcomes is a bit odd:

> The result is not only 77% less spending than the United States but also, as > Bloomberg Businessweek reports, one of the healthiest populations in the > world.

Fun fact: Life expectancy for Asians in the US is 86 years (almost 90 in New Jersey!), quite a bit longer than the 82 years in Singapore.

<comment><USER3> > if I had an incentive I could've price shopped for it

In my experience hospitals and surgery centers can't or won't tell you what something will cost up front.

<comment><USER4> I'm pretty sure though they have to supply an 'itemized' list if you ask for one, which you can contest anything on the list and a lot of times take them to court over if they don't budge. Often they will because they know $35 for an ibuprofin is absurd but most people don't think they can win against a big bad hospital.

<comment><USER5> Here's how it went when I tried to do it upfront. My wife was pregnant, so we had 9 months of routine, scheduled visits. I asked "how much will this cost ignoring any unexpected costs." My insurance had a helpful PDF showing $650 as an out of pocket example with an asterisk saying not to use this number for reference. Reading up, some places offer a "package deal"\--our's didn't. I was told to call the doctor's office and write down their itemized list of procedures. Then call their billing office to get an itemized list of billing codes. Then call my insurance to get the out of pocket cost. The final cost was a few multiples of that cited value (although there were additional, unexpected costs).

</comment></comment></comment></comment><comment><USER6> I bristle when I see health savings accounts presented as a solution to the health care crisis. The median household income in the U.S. is about $64,000 a year (see [https://www.census.gov/library/publications/2019/demo/p60-26...](https://www.census.gov/library/publications/2019/demo/p60-266.html)). When a single major medical procedure can result in a six-figure bill, there's just no way that the average person could ever save enough. You end up with people who are lucky enough to never need to tap their HSAs, and people who are unlucky enough to get sick, whose HSAs just present a speed bump on their slide into bankruptcy.

There's only one thing HSAs are really good at, and that's creating a huge new tranche of money for Wall Street to suck fees out of.

<comment><USER7> HSAs are part of high deductible insurance plans with out-of-pocket maximums. No one with such a plan would ever receive a six-figure bill. (With the possible exception of surprise billing from out-of-network providers, which we ought to ban.)

<comment><USER8> Oh, people on such plans incur massive bills all the time.

Suppose you're in a bicycling accident, you're knocked unconscious, and an ambulance takes you to a hospital that isn't in your insurance network.

Boom. Out-of-network charges.

If your bicycling accident was so bad that you need surgery, a five figure bill is a certainty. A six figure one is rarer -- but absolutely possible.

What's really messed up is that, even if you end up at an in-network HOSPITAL, you might get care from an out-of-network provider.

In this bicycle surgery hypothetical, for instance, your hospital and your surgeon might be in your network - but the anesthesiologist isn't.

Boom. Another out-of-network charge.

(Thats called Surprise Billing, btw)

At median income levels, there's no amount of HSA savings money that can insulate you from costs like that.

The current US insurance system asks consumers to walk an insane tightrope of cost controls.

It's no wonder a lot of us fall.

<comment><USER9> > (Thats called Surprise Billing, btw)

Yes, and in some states, it's starting to be illegal.

[https://www.nytimes.com/2019/09/26/upshot/california- surpris...](https://www.nytimes.com/2019/09/26/upshot/california-surprise- medical-billing-law-effects.html)

</comment></comment></comment></comment><comment><USER10> As U.S. the election season warms up, it is important to recognize a political piece when you see it. This starts not with presenting the problem, but with implying that the changes proposed by Democrats aren't what is needed. And later on calls out data gathered by Republican office holders.

Even if the topic is health care, those bits of the writing should indicate the political motivations behind the article. I'm not going to tell anyone where to fall in politics, and HN is the wrong place for it anyway... but I do encourage everyone to be aware of it over the next 12 months.

<comment><USER11> It's nice of you to underscore the issue, but I suspect most readers would catch on based on the first line of the article, wouldn't you?

> As the Democratic presidential candidates argue about "Medicare for All" > versus a "public option," two simple policy changes could slash U.S. health- > care costs by 75% while increasing access and improving the quality of care.

<comment><USER10> I hope so. But HN typically shuts down political articles fairly quickly, and this one made it to the front page and had comments on it as if nobody had noticed, so I thought it was worth a mention.

</comment></comment></comment><comment><USER12> The Indiana data point for this was only two years of study, a decade ago 2007-2009, and crossing the very exceptional 2008 recession year. This is a questionable time period to claim proof of savings on health care costs.

The Singapore cost savings example is attributed to silver bullets of price tags and deductible scheme while completely ignoring that most care in Singapore are delivered via government owned corporations of hospitals & clinics that service 70-80% of the population. Drug prices for example are controlled essentially by government boards nationally negotiating prices with vendors. This too is ignored in the marketplace article and seems fundamental to making those silver bullets viable.

I would submit that the fundamental control of pricing at work here is that the 20-30% private care needs to compete with a basic competent and majority publicly provided care delivered at gov't negotiated prices. The financial structuring of how the care is priced to the user base is a far far lower contributor to Singapore care being 75% less than the US.

[https://en.wikipedia.org/wiki/Healthcare_in_Singapore](https://en.wikipedia.org/wiki/Healthcare_in_Singapore)

[https://www.vox.com/policy-and- politics/2017/4/25/15356118/s...](https://www.vox.com/policy-and- politics/2017/4/25/15356118/singapore-health-care-system-explained)

Edit: I would also say that it's a nice trick to keep some small component of private care boxed into an area where it has to compete on fundamental effectiveness. This allowance I think is a nice way to accommodate some level of private innovation maybe helping to keep a public only system from becoming too stolid.

<comment><USER13> It also totally ignores that a dollar saved by skipping on short-term care can be a thousand dollars lots five years later. Not sure how it's possible to show much of anything in a 2 year study.

</comment></comment><comment><USER14> First off, if something this large can drop by 75% in price then you're being bamboozled, extorted, or potentially both.

 _" Under our current system, it's nearly impossible for people with health insurance to find out in advance what anything covered by their insurance will end up costing."_

It's worse than that. Not only can you find or figure out how much everything will cost, most places (particularly hospitals and outpatient centers) will not even tell you how much they charge for their services. Some news outlet did a study and called the top 25 hospitals in the country and asked them how much a hip replacement would cost. Only around 3-5 actually gave a number and it varied wildly. The rest refused to pin down any number at all. That's one of the most common surgeries there are and they don't know what they will charge for it?

On the moral/philosophical side - how can a person be held financially liable for something they cannot possibly know the cost of in advance, even if they try to find out? Such practices are illegal everywhere else in this nation. And there is no legal exception for healthcare providers. How do I know that? Because a few years ago Rand Paul tried to pass a law that would exempt healthcare providers. It failed - which means it is still _currently illegal_ to be doing this. Yet not one of these providers or operations has been charged accordingly. If you went to a mechanic and they took a look at your car and you asked how much it was going to cost to fix it and they responded with "which insurance do you have?" or "I don't know until I'm done" they would get shut down and charged, and rightfully so. Because the logical conclusion is to say it costs some extravagant amount of money and then "settle" for something less. Which gee, doesn't that happen a lot in the medical industry when people can't pay their bills? People face bankruptcy and can't afford a $10,000 bill but somehow the hospital is just fine accepting $3,000 instead?

<comment><USER15> > Not only can you find or figure out how much everything will cost, most > places (particularly hospitals and outpatient centers) will not even tell > you how much they charge for their services. Some news outlet did a study > and called the top 25 hospitals in the country and asked them how much a hip > replacement would cost. Only around 3-5 actually gave a number and it varied > wildly. The rest refused to pin down any number at all. That's one of the > most common surgeries there are and they don't know what they will charge > for it?

Because in the US model the insurances negotiate with the hospitals what they pay, and you will almost always be given a number that is way higher than the highest insurance amount - as when you pay yourself the hospital has a high risk of never being able to (even partially) collect the bill. Also, it must be higher than the highest insurance amount so that if you were an undercover agent of your insurance you would still believe you pay less than others.

<comment><USER14> That's not how any other insurance works. Providers charge the same amount regardless of coverage, insurance, etc. and whatever your insurance covers (including nothing at all) you are responsible for. But they also tell you up front what they are going to charge you and you acknowledge that you accept responsibility for making sure they get paid that amount either out of your own pocket or by covering the gap of what insurance pays.

The idea that having insurance changes the cost is sort of a misdirection. There's a chance my plan doesn't cover some or all of things that will be billed. So there is always a risk of non-payment or partial payment. Yes, they sometimes do pre-approvals for specific procedures but that doesn't always translate to proper billing/coding that gets covered.

The vast majority of healthcare are not ER visits which means people have a chance to review and accept the responsibility of payment. But that would also mean they would know what the hell they would be charged. There's no _good_ reason for a hospital to say "oh you don't have insurance so we're going to basically mark your bill up 3x just to be safe. Marking the bill up 3x, for example, doesn't change the fact that they are really only seeking 1x so the people who can afford to pay 3x are legally required to do so because for some reason this is viewed as a legit practice and not fraud. And the people that can't settle for something less than 3x, usually much less. Maybe 1x...in which case the providers gets what they were after anyway and just indicates further that this is a sort of fraud and extortion.

<comment><USER16> >That's not how any other insurance works. Providers charge the same amount regardless of coverage, insurance, etc. and whatever your insurance covers (including nothing at all) you are responsible for.

This is incorrect. It's absolutely the other way around.

<comment><USER14> You're talking about something outside of healthcare charging different prices to people based on which insurance they have _and_ said practice is legal? I've never heard of such a thing.

You're not referring to the common practice of bill inflation are you? For example, a tree falls onto your house and the damage is covered by insurance but the contractor knows insurance is paying for it so he jacks up the price once he finds out what you are getting from the insurance company (they tend to ask so that they can "plan" accordingly to stay within budget, but really they just want to make sure to capture the entire insurance check). This is 100% illegal but very hard to prove, hence it goes largely unenforced. With healthcare it's well-documented but still unenforced.

If you are referring to something else I would be very interested to know what else operates in such a manner.

</comment></comment></comment></comment></comment><comment><USER17> This article misses one other potential savings — allowing patients to cross state lines to buy plans in cheaper states.

In terms of HSA's, I think they are a great idea.

But I have a more radical solution than an HSA:

Allow the first $100k of income to be contributed pretax to a unified savings plan. We would do away distinctions between 529, ira, 401k and HSA. It would just be a unified account. You could withdraw prior to 59.5 to cover health, education and first home purchases up to any amount. Anyone (employer, family member, friend, charity) could match up to 100% of whatever you contribute in a year into the account. Cash and stock contributions would be accepted. There would not be a minimum age to participate - anyone with a ss#.

Like I said, there are holes in the above - I'm sure with some thought they could be addressed. The general idea would be to turbocharge personal savings and create a unified structure that helps one build and protect a savings account with utility beyond just retirement.

<comment><USER18> _This article misses one other potential savings — allowing patients to cross state lines to buy plans in cheaper states._

Is there anything preventing people from buying plans across state lines other than the insurance companies themselves?

<comment><USER19> In order to sell insurance (basically any type) to people in say New York, you need the to follow the insurance laws of that state. This will have all sorts of weird paperwork and rules that are different from any other state in the country.

Having to jump through all those hoops will mean you need a few dozen employees minimum dedicated to compliance in that state etc.

But we can overcome that by having the federal government regulate interstate insurance, likely making these companies only needing to comply to the rules of their home state, or by having states set up agreements to allow out of state insurers sell under the rules of the other state.

Only a few states currently do that. Even then nobody is using this ability to sell health insurance interstate. And the reason why is:

You also need to develop a network in the other state, which can be a significant factor in costs. There is no way that you will get hospitals and doctors offices in New York to accept the same small amounts that you can get hospitals and doctors offices to accept in some low cost of living flyover state.

Of course if you do agree to the higher prices that New York providers would charge, well now your average costs have shot up, so you need to raise your rates, making your cheap insurance not as cheap anymore.

</comment></comment></comment><comment><USER20> Article's rubbish and (probably purposefully) misses a bunch of really important points.

1\. The biggest problem with American health care is access to coverage - publishing prices or helping pay deductables does absolutely nothing when your insurance company refuses to reimburse or refuses to cover in the first place. Deductables don't bankrupt people, uninsured cancer does.

2\. The exorbitant cost we pay is caused by a predatory, rent-seeking insurance industry extracting value from the whole process.

Only medicare for all solves both of these problems!

(Finally and hilariously, the article touches on the example of LASIK, which - free of the insurance industry, as none of them cover it! - has allowed market forces to bring up the standard of care while simultaneously lowering the price on average.)

<comment><USER21> Uninsured people don't typically foot the bill and don't go bankrupt, the hospital has to eat the costs because no one can be turned away from a hospital. They then pass that along to the insured by jacking up their prices.

Imagine if health insurance was like car insurance, with radio adds telling you how much you can save. Imagine a world where you can get MRI's or CAT scans done for cheap in a strip mall with total price transparency, something like "MRI's are us", instead of requiring people to go through a primary or a specialist. No one company could sustain predatory practice without another company lowering their price to eat their market share.

<comment><USER22> > Uninsured people don't typically foot the bill and don't go bankrupt, the > hospital has to eat the costs because no one can be turned away from a > hospital. They then pass that along to the insured by jacking up their > prices.

Too true. The few times I or a relative had to visit the ER, I got an outrageous $1,000+ bill for minor things (like suture, stuff like that). I always called them, told them to fuck off, and they basically said "If you can pay $~300 we're good".

It just feels like they're desperate to get any payment because I assume a lot of people just don't pay at all, and they have to eat the cost.

</comment></comment></comment><comment><USER23> I support universal healthcare, but fundamentally speaking there is no reason there couldn't be a free market healthcare solution that works for a large percentage of people (IE those that can afford a reasonable healthcare insurance premium). The remaining could be covered by a government welfare program.

However, rewrite laws as you want, a good free market solution would depend on the following:

\- Healthcare providers are incentivized to quickly and efficiently care for patients as necessary.

\- Every single person should be incentivized to use healthcare services regularly and as needed, without concerns such as cost.

\- Insurance providers should be incentivized to make things as easy, painless, and low cost as possible for both healthcare providers and individuals. The main purpose of the insurance provider is to pool risk and prevent fraud, not to squeeze dollars out of sick folk.

\- Regulatory bodies like congress should be concerned with regulations that can (a) ensure the above incentives exist, and (b) lower the fundamental costs associated with healthcare (e.g. prevent drug companies from price gouging and such)

Current every single incentive I've listed above is misaligned in the market today. Doctors' time is wasted with billing and insurance and risk-prevention to avoid getting sued, many many people avoid using healthcare services out of fear of unknown costs and bankruptcy (which turns untreated small issues into big ones), insurance companies optimize around fleecing customers and making billing hell for doctors, and regulatory bodies are commonly more concerned with the politics & optics of Obamacare this, affordable healthcare that.

On top of that, our current free market solution somehow revolves around _the employer_ giving some kind of subsidy and bargaining for better benefits, which makes no sense whatsoever because everybody needs healthcare, not just employees of successful corporations.

Anyways, this rambled on a bit, but my point is that any solution that doesn't have a way to align these incentives will fail to make a big dent on healthcare costs in this country. Period. This includes M4A or other universal healthcare plans.

<comment><USER21> The problem is your incentives breed more bureaucracy and its exactly that bureaucracy that leads to higher costs and a system where nobody knows the price of a procedure. Laws get passed with good intentions, but with bad overall outcomes on the system as you pile on more and more mandates. You have to back off from these requirements and let the market work. Imagine if anyone could get a MRI or a CAT scan or a blood draw anytime just by walking into a small private clinic in a strip mall. No requirements to go through a primary or a specialist, a registered nurse can and should be able to do this with minimal licensing. No insurance company forced to be involved. No over regulation mandating that "thou must do the following". Imagine next if health insurance was like car insurance, with companies blaring ads about how much you could save if you switched to them. No mandates that it must be employer provided. No hospitals being forced by law to fit the bill for the uninsured, thus driving up the cost for the insured.

My point is you need to back off the list of mandated incentives and let the market do its thing. Then, once it appears that things are stable and there is healthy price competition, you can maybe pass a few laws to take care of the edge cases and bad actors.

</comment></comment><comment><USER24> Why is price transparency not a thing already? The government should do that immediately and see what happens before doing anything extreme.

<comment><USER25> President Trump has already started that process, and has asked Congress to help: [https://www.npr.org/sections/health- shots/2019/06/24/7354323...](https://www.npr.org/sections/health- shots/2019/06/24/735432387/trump-administration-pushes-to-make-health-care- pricing-more-transparent).

For example, they've already started mandating drug pricing transparency in advertising: [https://www.nytimes.com/2019/06/14/health/drug-prices-tv- ads...](https://www.nytimes.com/2019/06/14/health/drug-prices-tv- ads.html?module=inline), but are being opposed by industry groups obviously.

</comment></comment><comment><USER26> > The second policy—deductible security—pairs an insurance policy that has an > annual deductible with a health savings account (HSA) that the policy's > sponsor funds each year with an amount equal to the annual deductible.

Yeah, people avoid care when they have those plans. Is that a good outcome ?

<comment><USER27> In many cases, I would say yes. A massive amount of ER visits are not needed for instance, and are more suitable for walk-ins and primary care. And just in my experience my Doctor will often push for various tests, which aren't needed. I've had multiple people tell me the same. Then I've gone to other doctors that wonder why such and such doctor did that other than just to gouge.

<comment><USER28> Most ERs would be well served by opening all-hour urgent care clinics directly adjacent, and triaging the roughly 70-80% of people with non-emergent and/or minor issues into that wing rather than to the ER.

<comment><USER29> How exactly? Since it would do the same thing as ER, it would cost as much to operate as ER. The patients and insurance would win if this made them pay less, but the hospital would be a loser here with reduced revenues.

<comment><USER15> > How exactly? Since it would do the same thing as ER, it would cost as much > to operate as ER.

No. The ER and its expensive specialists (e.g. trauma/accident specialists) can be reserved doing their actual specialized jobs (taking care of patients injured in car crashes, for example) without being clogged by some dude with a toothache. The ER _only_ handles the real hardcore cases that can escalate to death in a matter of seconds, and the urgent-care facility only handles the "everyday" harmless stuff, which needs less and especially less- certified/experienced and thus cheaper staff.

<comment><USER29> The ERs should already be doing this: if they have too much toothache cases for one trauma surgeon, they clearly won't add a second trauma surgeon to the shift, they will add a general practitioner. If the trauma surgeon is not busy putting car crash victims together, he can handle the toothache just fine: he is already getting paid anyway, so it doesn't make sense to keep him idle.

</comment></comment></comment></comment></comment></comment><comment><USER21> Glad to finally see someone pointing out the obvious, that simple price competition would lower prices, and that Singapore does have a private insurance system that works!

You can only have two out of three: Low Price, High Quality, Universal Access. Europe chose Price and Access. Singapore chose Price and Quality, and they have done some interesting things to make sure that at least their poorest have no-cost access with a tiered system. You will have a mass wave of doctors quiting the profession if everyone goes on medicare, the reimbursement rate is too low to make any money.

</comment><comment><USER30> Looking at Singapore is a bit disingenuous. They have both public and private systems, with the private system being vastly more expensive. The public system costs are regulated. (Other differences: adult obesity in Singapore is below 10%. In the U.S. it's 40%. 65+ population in Singapore was 9% in 2010. In the U.S. 65+ population was 13% in 2010. Singapore has a population < 6M.)

[https://en.wikipedia.org/wiki/Healthcare_in_Singapore](https://en.wikipedia.org/wiki/Healthcare_in_Singapore)

[http://assets.ce.columbia.edu/pdf/actu/actu- singapore.pdf](http://assets.ce.columbia.edu/pdf/actu/actu-singapore.pdf)

[https://www.vox.com/policy-and- politics/2017/4/25/15356118/s...](https://www.vox.com/policy-and- politics/2017/4/25/15356118/singapore-health-care-system-explained)

[https://www.nytimes.com/2017/10/02/upshot/what-makes- singapo...](https://www.nytimes.com/2017/10/02/upshot/what-makes-singapores- health-care-so-cheap.html)

If I were starting from scratch I'd go with single-payer but given where we are, it seems easier to get to a Bismarck-style regulated multi-payer system like Germany or most recently, Switzerland:

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

Still, Singapore is an interesting system. The craziest thing about the U.S. is how many different systems we have: the V.A. is effectively a Beveridge system, Medicare is an NHI model, Medicaid is a weird Federal/State hybrid, then we have private insurance, and on top-of-that, out of pocket. There are vested interests throughout. It's 18% of our GDP. It's going to be hard to fix. I think Medicare as a public option with subsidies is a good start. Doctors and hospitals are not going to be happy with the reimbursement rates though.

</comment><comment><USER31> I'm a fan of M4A, but I think something the gov't could do is allow people to earn tax credits for practicing preventative care that help lower whatever tax increase would be created to fund healthcare. That creates a financial incentive to try to be healthy while not necessarily discouraging people from going to the doctor when they really need to (which can happen with out of pocket expenses, HSA or not).

E.g. on one of my old plans I got a $300 visa gift card just for going to a checkup.

</comment><comment><USER32> This could sort-of work.

In The Netherlands, healthcare is billed according to a"diagnosis-threatment combination" (DBC, diagnose-behandel combinatie in Dutch), which is a government-mandated set of billing codes. Each code covers the whole diagnosis/threatment pipeline, for example "uncomplicated total knee replacement" which covers imaging, surgery, and a few days of revalidation until you leave the hospital. As these codes are standardized, it is relatively easy to know in advance what it's going to cost the insurance company.

The codes are sort of overlapping, for example a breast MRI has it's own code (usually 270eu, but with outliers both ways), but there's also a code for the combination of a mammography, breast MRI + lumpectomy.

Hospitals are nowadays obliged to publish these pricelists, even though insurance is mandatory etc., after some court cases involving uninsured people not knowing costs in advanced. Just having these lists could work wonders in terms of transparency.

</comment><comment><USER33> This is a critical issue that could throw the whole economy into a recession. Fixing this and the recent prevalence of foreign, disease carrying mosquitos are the two biggest policy issues, that if fixed will cause a world of good.

<comment><USER34> >the recent prevalence of foreign, disease carrying mosquitos are the two biggest policy issues

This is a weird idea. Are you arguing that native mosquitos carry fewer diseases?

Also... I can agree that health care is #1, but mosquitos are not number 2... more like number 900 or so. The amount of disease caused by them is tiny compared to e.g. smoking or obesity.

<comment><USER33> It's more of a local policy issue for southern California residents.

Of course all of this can be debated, and perhaps it's not the 2nd most important, but it's much more important to me and all my friends than most policies.

Native mosquitos on the west coast (Culex) do not carry west nile or zika.

The new Aedes species does and is extremely hard to control. [https://www.latimes.com/science/sciencenow/la-sci-sn- aedes-m...](https://www.latimes.com/science/sciencenow/la-sci-sn-aedes- mosquitoes-california-20180901-story.html)

Further, it caused everyone I know in the Los Angeles area to stay inside during this last summer. My kids and friends kids stayed inside all summer. It was like night and day compared to every other year.

Fear of Zika has spread to pregnant mothers around my neighborhood. People are literally choosing not to get pregnant because of the fear of this new mosquito in the area.

The amount of fear caused by these new mosquitos has been extreme. They are very hard to control, I think this new invasive species can only be eradicate with government intervention. There are no cost effective trapping solutions.

Nets and Deet aren't 100 percent effective and is not something we should settle for being the new normal when government intervention is possible.

The sooner it's dealt with the more realistic it can be fixed.

I would literally vote for any local politician if this were a primary policy issue for them.

<comment><USER34> Hmmm, interesting. I wonder to what level this is an actual threat vs. something the media came up with? It being such a hot button for people in that region would seem to also make it a potent way for politicians to gain support.

</comment></comment></comment></comment><comment><USER35> Health-care costs can only be slashed by somebody missing out on their current income.

Would there be strong resistance to that?? You bet!

There are too many middle-men leeching away within the US health-care system. Many poorer nations can afford single-payer health-care which covers all citizens. Why not the US too? It's just a matter of determination, and removing the 'I must have my share at the trough' mindset.

</comment><comment><USER36> Trying various proposed solutions sounds good to me, if and only if the US federal government is not the one doing it. States could be good laboratories to try things if and as those people want to, and learn from each other etc (and not make the _federal_ budget problems even worse while trying to solve everyone's _personal_ problems). If there are people in need: join nonprofits or help them personally, or at the state or local level: there are many good efforts! But charity by federal force leads to too much control over our lives and huge, controlling, wasteful bureaucracies that are hard to live with, multiply laws and consume resources so limiting ability to try anything different.

(edit: I know enough about history to know what happens when the government tries to solve every problem. We definitely do not want that.)

In fact, we fought a war in the 1770's, partly because of faraway people having too much involvement and control in our lives. Then wrote a constitution that limited federal power, because of those problems. The principles in the Declaration of Independence and US Constitution really are important.

Helping people is important! There are other, better ways to do it than increasing federal control and distracting it from its core missions.

To avoid going on and on about this, I posted more thoughts including personal experiences (with even more that I haven't posted, but can, given interest), at: [http://lukecall.net/e-9223372036854586100.html](http://lukecall.net/e-9223372036854586100.html) There is an email address in the footer for honest feedback.

</comment><comment><USER22> I don't understand how people can be liable to pay a bill they have no knowledge of upfront, like not even a rough estimate. Even a plumber will tell you "well, I bill $150/hr and I _think_ it will take 2 hours, but who knows".

Is there any other example of an industry that operates like that?

</comment><comment><USER37> From an economists perspective knowing the prices could have profound effects on things as people will likely substitute either going to the doctor at all or shopping around within or without their state for treatments until a fair market price for a procedure is found. At least that's the theory anyway.

</comment><comment><USER38> Why look at Singapore, a tiny country akin to San Francisco and try to apply it to all of US, which is infinitely larger and more rural. Why not look at Sweden, UK, France etc. like the Dem. nominees are correctly doing?

</comment><comment><USER39> The vision vs knee surgery on price comparison falls flat on my ears.

The current HSA deductible limits are $1350-$6750.

So, how does knowing a knee surgery is $20k instead of $60k make the consumer, who is out of pocket $6750 (that they still can't afford) either way, price discriminate?

<comment><USER40> Expecting price transparency to fix things without actually changing anything else doesn't solve anything, sure. The point isn't that prices aren't transparent, it's that prices are artificially high because they're opaque. Fixing the transparency and encouraging people to shop around should, in theory, help fix that inflation.

Currently, insurance premiums cost the average American family $19.5k/year[0] (yes, this includes employer contribution, and yes, the actual incidence falls nearly entirely on the employee[1]). Much of the point is that if pricing transparency were in place, costs of both care and premiums would plummet, resulting in more money in consumers' pockets to spend how they choose. What kind of medical care might you elect for if you had an extra $15k/year?

[0] [https://www.kff.org/other/state-indicator/family- coverage/?c...](https://www.kff.org/other/state-indicator/family- coverage/?currentTimeframe=0&sortModel=%7B%22colId%22:%22Location%22,%22sort%22:%22asc%22%7D)

[1] [https://www.nber.org/papers/w3557](https://www.nber.org/papers/w3557)

</comment></comment><comment><USER41> This comparison between LASIK and _actual healthcare_ is puerile. Healthcare providers make bank off the fact you can't afford to shop around. That you need that cancer operating on. That you need that chemo. That transplant. That stay in hospital. And that they —and all like them— can charge whatever the hell they like because your only alternative is a painful death.

So no, pretending that you can fix this by listing pricing things because an entirely optional industry does it, doesn't just not fix this, it's noise that confuses people.

Healthcare in the US can only be fixed by hard laws on price gouging (codified limits, etc) or astronomically altruistic competition that comes in at cost, and drives everybody else out of business.

And I don't see either of those happening in the US because _everybody_ involved in US healthcare is making obscene money from the status quo.

</comment><comment><USER42> Couldn't you do both? Provide HSA deductible Medicare for all. And force price tags on everything? Then you get government offered health care. Negotiating power of a big single bulk payer. And competition from patients trying to keep some of the insurance money to themselves by avoiding unnecessary care or hunting for a better deal.

</comment><comment><USER43> I don't get how anyone. An draw conclusions from elective treatment like Lazik, when, until we get better about proactive medicine, most treatment is reactive and fairly dire.

I don't think in our current state of poor health and disfunction ("deferred maintenance") is a market appropriate at all. The Oregon experiment makes sense. We need to get a few good years of people taking care of themselves in ways they never did before. It might mean more visits. (A side benefit is we can recalibrate all our statics with more healthier people visiting.) Only then could we experiment with some quasi market tricks.

America is too stupid unhealthy and disfunctional for some clever market tricks to work. We need some simple stupid public healthcare and only then could try some German/Swiss/Japanese/Indianan tricks. Capitalism works best when the stakes are low, as a game for rich (or healthy in this case) people. The improvished or dying will just get screwed over without aggregate benefits for the rest.

</comment><comment><USER27> This would definitely help, but the 75% number is just pulled out of the air.

<comment><USER44> It may have been in reference to Singapore's results, per TFA:

> With Singapore's citizenry empowered by deductible security and price tags, > competition has worked its magic, forcing providers to constantly figure out > ways to lower costs and improve quality. The result is not only 77% less > spending than the United States but also, as Bloomberg Businessweek reports, > one of the healthiest populations in the world.

<comment><USER45> It is mostly pulled out of a backside though, because without much evidence it attributes that 77% decrease in spending to a couple of cherry picked difference between the systems.

Overall it would plausibly help, but it's a pretty strong claim that these are the only important differences.

<comment><USER46> It ignores the 30 point gap in obesity - 6% for Singapore, 36% for the US - which is obviously a big contributor to the US healthcare cost problem. 36% obesity is an extreme elephant on the table for costs. I would be surprised if the US couldn't shave 1/5 off its healthcare costs with a 22% obesity rate (comparable to Germany, Brazil, Poland, France, Sweden, Netherlands, Finland, Norway, Austria, Spain, Russia, etc).

Singapore vs Japan and South Korea is a more interesting comparison (similarly very low obesity rates) between costs in developed health care systems, if you wanted to see which worked better. Japan for example has a spiraling healthcare cost problem related to its aging population.

</comment></comment></comment></comment><comment><USER18> _But the annual gifts do more than ensure that participants are financially secure; they give people skin in the game. Participants spend prudently because they know that any unspent HSA balances are theirs to keep. The result? Massively lower health-care spending without any decrement to health outcomes._

HSA also discourage you from doing any preventative care because that's money you can probably find a use for in other ways. Thus inflating long-term healthcare costs as people only go to the doctor when it's an emergency.

Anyone who supports HSA accounts is either an idiot or has suspect motives.

Those may be a strong opinion, but it's one I stand by in this particular case.</comment>


Taiwan is making democracy work again. It's time we paid attention - <AUTHOR> https://www.wired.co.uk/article/taiwan-democracy-social-media <comment><USER2> I like that, first you vote on the question, then the answer to the question.

</comment><comment><USER3> It will only work if people are adequate. Nowadays most people are braindead.

And I don't even say about propaganda. Media can make people think black is white and white is black on any question.

I would restrict people who has access to votes, so only people that pass tests on history of his country and some minimum iq can vote.

<comment><USER4> What if i restricted voting to people who scored perfect in those history tests and are above 140 iq?</comment></comment>


Ask HN: Who is your sounding board? - <AUTHOR>

Do you have a couple of good friends who you bounce your ideas off? Do you throw your ideas out on twitter, and see if there's a response? Do you keep a blog somewhere with all the pieces of something (possibly) that pop into your head?
I want to know who you use as your sounding board. Are they someone who 'gets you', who easily shares your vision, or someone who can quickly spot the strengths and more importantly weaknesses of your ideas?
Personally, I have a few 'trusted' friends who I know will listen to my ideas, but aren't afraid to point out when I'm being an idiot. I've been known to flood an IRC channel at times trying to get all my stupid thoughts out before I forget them.
I've tried blogging, text files, and carrying a note-pad, but being able to bounce ideas off a real person (and one who doesn't just say "yeah, that sounds great" in a disinterested tone) is by far the most effective way I've got of fleshing out ideas.
So what works for you? <comment><USER2> If you're based in London, I recommend taking up Rob Fitzpatrick (robfitz) on his offer of free 30-min office hours - [http://thestartuptoolkit.com/blog/2011/10/open-office- hours-...](http://thestartuptoolkit.com/blog/2011/10/open-office-hours-in- shoreditch-on-mondays/)

I did it last week and found it to be quite useful just talking him through my ideas and marketing strategy. Rob's been working with startups for a while, so he's got a lot of data. He is a great listener and gave me some good actionable suggestions.

Even if you're not based in London, he might be up for a skype call.

</comment><comment><USER3> I use my Geeks circle on G+, a few close friends on IRC and there are a couple of close friends I'll call in a pinch.

Although are we talking about geeky ideas or life crap?

<comment><AUTHOR> Geeky ideas, for sure.

I have recently started a few new side projects, but due to the fact that my regular sounding boards weren't available at the time (timezones... blergh), I keep getting this dread that they're not actually good ideas.

</comment></comment><comment><USER4> Stop talking about your ideas and build something.</comment>


Chladni Figures (1787) - <AUTHOR> https://publicdomainreview.org/collections/chladni-figures-1787/ <comment><USER2> This is a cool page about creating chladni patterns in code [https://thelig.ht/chladni](https://thelig.ht/chladni)

</comment><comment><USER3> Most of these figures exhibit at least two lines of symmetry, but there are a couple that only have one. What causes this behavior?

<comment><USER4> I'd be quick to guess that in those cases, the missing axis of symmetry falls beyond the field of view. That is to say, it might not be trivial to align the focus of the vibration such that the center of each axis falls on the plate, and demonstrates a pattern depicting the perfect midpoint of the figure.

</comment></comment><comment><USER5> I've noticed patterns quite like these (viz. #5, 11-13) on the surface of beer in a pint glass. I've speculated it's the result of either the different sizes of bubbles or differing rates at carbonation sites, but I hadn't noticed the similarity to Chladni patterns.

</comment><comment><USER6> Reminds me of this work : [http://newt.phys.unsw.edu.au/~jw/guitar/guitarchladni_engl.h...](http://newt.phys.unsw.edu.au/~jw/guitar/guitarchladni_engl.html)</comment>


Show HN: SocialBusinessCard – Turn Your Social Profiles into Business Cards - <AUTHOR> http://socialbusinesscard.me/

<comment><USER2> Pretty cool but the LinkedIn Card gives me the following PHP exception: Catchable fatal error: Object of class stdClass could not be converted to string in /home/stephenou/socialbusinesscard.me/card_linkedin.php on line 49

</comment><comment><USER3> The word "Cards" from the title in the page is almost hidden in (my) Chrome

</comment><comment><USER4> First ever? Moo + FB did this back in 2006? 07? A while back at least. It's nice, clean though. Any plans to branch out to IG/G+/others?

</comment><comment><USER5> Facebook app is in "sandbox" mode, so unfortunately I can't use it right now. Nice concept, though!</comment>


For Start-Ups, Sorting the Data Cloud Is the Next Big Thing - <AUTHOR> http://www.nytimes.com/2011/12/26/technology/for-start-ups-sorting-the-data-cloud-is-the-next-big-thing.html?hpw&gwh=B050ADB7647888F8E67CB1E83CFBA891 <comment><USER2> I like these fluffy articles around the holidays because the odds are good that someone you like to chat with that's smart but not in the domain is still relaxed from the day before, sitting with a coffee and actually has the aperture wide enough to have a meaningful conversation before the kids get up.

Dad's sitting there reading Economic Weekly or some such, and I make an amused cough while reading this article. "Whatcha getting into over there?" he asks, taking the bait I didn't know I set.

I tell him that the article is saying how the next thing in this cloud stuff is to start using the data, to sort it, get some signal out of the noise. He suggests that work must all be done already, must be a pretty common problem. He says he does some batch jobs at the bank he works at that sound like this.

I tell him, "Dad, how come both our basements are filled to the brim with crap?" He was coming over with a refill for my coffee but now I get a noogie at 32 years old for the jab. "I'm serious, why do you suppose that is?" He supposes I have some reason already figured out.

I tell him that I figure our basements are full of crap because it's real easy to fill a container up with crap, but it's a real pain in the butt to go sort it. Just like it's a pain in the butt for his computer core to crunch all the transactions to get his customer data for the online banking.

You can see where this went, I'm sure. I pointed out that his data is tiny and it still takes a while to crunch and sort it. I wanted, badly, to discuss NP Complete with him, but I think that "why does organizing the garage generally suck" was my Christmas metaphor, to keep the coffee cup getting refilled this morning.

</comment><comment><USER3> Funny, I remember meeting these guys at an RSA conference years ago, must have been in 2004, and thinking "this is the only innovative thing I've seen here." It was pretty cool tech at the time, interesting to see them branch out from information security.

</comment><comment><USER4> This is an article about Splunk.

<comment><USER5> I don't know who downvoted this person, but the article is in fact about Splunk. I saw the comment, was like "ah, good, don't need to click through to the article: it will just be a fluff marketing piece", but then I saw that it was /downvoted/, and so thought "huh, I guess he's wrong?".

After having clicked on the article, I will reiterate gfodor's comment: "this is an article about Splunk".</comment></comment>


Electrical Disruptions Caused by Squirrels - <AUTHOR> https://en.wikipedia.org/wiki/Electrical_disruptions_caused_by_squirrels <comment><USER2> [https://cybersquirrel1.com](https://cybersquirrel1.com)</comment>


The Art of Giving Up - <AUTHOR> http://davidadewumi.com/2008/12/14/the-art-of-giving-up/ <comment><USER2> I was actually hoping for a way to give up gracefully. Instead, he's just saying to never give up. Doing the former would have been interesting because it would have been something I have not already read.</comment>


There's Always Something (Or, Why Are Environmentalists Always Complaining) - <AUTHOR> https://medium.com/@ngottlieb/theres-always-something-1fd46d81e9f8 <comment><USER2> > " that nitpicking is actually a critically important signal telling us that > the framework with which we're approaching these problems is faulty. First, > our efforts at mitigation are rooted in the idea of harm reduction: how can > we keep doing what we're doing, but less bad?"

Unfortunately if you take this attitude you won't get anywhere, certainly not to a world with less climate destruction.

You have two options

(a) we keep doing what we're doing, just as bad or worse

(b) we keep doing what we're doing, but less bad

That's it. There is no third option where we don't keep doing what we're doing. The overwhelming preference of the humans on earth is to destroy the planet and retreat into biodome bunkers if we have to, but absolutely no option permits reducing consumption or material innovation. Extinction, wasteland, whatever, nobody cares. You've got to deal with that inarguable fact.

If you can show them a way to keep their comforts but less bad, even if they must pay more, then you _might_ be able to solve problems. But you have to take it as a constraint that people must keep doing what they are doing, come what may. That part's not changing.

<comment><USER3> > retreat into biodome bunkers if we have to

hasn't humanity consistently been able to outpace any rise in climate-related risk? i.e. greater access to energy that protects against the consequent rise in weather related disasters, etc.</comment></comment>


Stackato 1.2 Released - Includes user/group management & persistent file sharing - <AUTHOR> http://www.activestate.com/stackato/features

<comment><USER2> Request quote = out of my price range

<comment><USER3> You missed the more important "Try Stackato" button right above it. No cost, no barrier to entry for those of us on the developer level. Go check it out.</comment></comment>


Show HN: Test your computer for IPv6 Leaks - <AUTHOR> http://ipv6leak.com/

<comment><USER2> "Looks like your IPv6 is leaking"

That's how they define having full Internet access. In other news, your computer is broadcasting an IP address !!!

Private Internet Access is one of the few VPN providers to acknowledge the existence of IPv6, but it's sad that their reaction is to block the protocol and call it a "leak protection" feature, rather than provide actual dual-stack service.</comment>


I'm joining the Go team at Google - <AUTHOR> http://spf13.com/post/joining-go-team-at-google <comment><USER2> > _As I had before, I recognized that this technology had the potential to > revolutionize how software was written at a fundamental level._

Congrats and all, and I love Hugo (use it all the time).

That said, I think the kool-aid was spiked with something.

Sorry, but in what way is Go "revolutionizing"?

I'd buy "refreshing simplicity" and "yay, static builds again" but it's hardly revolutionary, even in its most touted feature (channels).

And it hardly changed how people write software. At best, it introduced some dynamic language programmers to static types and static builds.

All the rest, including creating a language that's easy for average programmers to program at scale was already the goal, and a success at that, of Java.

<comment><USER3> Go's big success, in my opinion, was to fuse the lightweight, spawn a million threads we don't care, style of programming to conventional imperative, conventional static-type programming. I know of several other runtimes that had that lightweight threading capability, I've been using them since years before Go was even a thing, but they all required programmers to learn a new paradigm. At times, a _radically_ new paradigm (Haskell).

You may complain that programmers have a professional obligation to learn those new paradigms. You may complain that programmers should consider "learning a new paradigm" a smaller strike against a language, especially if it brings other good things with it. But that won't change observed reality, in which programmers do want to not have to risk several months to a year on something they aren't sure will pay off. By contrast, if you know any of the existing manifestly-typed languages at all (Java, C, C++), which most programmers do to some extent, you'll be writing fancy concurrent code in Go next _week_. Possibly even "tomorrow". You can be shipping production code in a month.

The language nerd in me really wishes Go had isolated its goroutines from each other and only passed things by value. (While I like Rust's much finer-grained handling of that for a lot of other reasons, you can get a lot of the benefits in a language where the threads aren't supposed to be that large by isolating to small threads, and it's way easier to implement.) The pragmatist in me is forced to reluctantly admit that had it done so it probably wouldn't have succeeded as much, because while that may not have been a "full" paradigm shift if the rest of the language was still imperative, it still would have been at least half of one. That affects how you design larger programs. In a lot of good ways, I think, but still, change with an unknown prospect of payoff.

So... it depends on your point of view. It's not revolutionary in the sense that there's anything new in it. But it is a somewhat revolutionary combination of concepts.

You're even free to join me in being a bit sad that fusing your concepts to an Algol-descended language is basically mandatory for success right now. But, one step at a time. We are slowly creeping away from it. As I've often observed, programming as a profession does not move anywhere near as quickly as some people think; there's a constant surface churn of technologies and languages, but deep paradigm shifts take decades.

<comment><USER4> > I know of several other runtimes that had that lightweight threading > capability, I've been using them since years before Go was even a thing, but > they all required programmers to learn a new paradigm.

One of those runtimes is Ruby (Ruby uses lightweight threads, not OS threads), and Ruby is not a new paradigm.

<comment><USER5> Ruby (that is, the main implementation, from 1.9 on) uses OS threads with a global lock so that only one thread running Ruby code is executing at a time in a process, same as, e.g., Python.

Up through 1.8.x, Ruby used N:1 lightweight threads (multiple lightweight threads on one OS threads.)

Go uses M:N threading (multiple lightweight threads, which may be distributed among 1 or more OS threads.)

M:N threading is a different model than either the Ruby 1.9+ model (1:1 threading on OS threads with a global lock) or the older Ruby approach (N:1 threading), or even the JRuby approach (1:1 threading on OS threads with no global lock.)

</comment></comment></comment></comment><comment><USER6> Congratulations!

And never, ever, ever give up the fight for GNU-style double-dash command-line flags!

<comment><USER7> Context? Are people actually switching to single dash flags? If so I'll get my pitchfork out of the closet.

<comment><USER6> The default golang flag package ([https://golang.org/pkg/flag/](https://golang.org/pkg/flag/)) does not implement gnu-style long-with-shortcut options. Instead, one and two-dash arguments are identical. For example, -enable-pants and --enable-pants are equivalent. Compare this with the GNU style where you can have -p or --enable- pants.

Most go programs I've read use spf13's flag library, which _is_ GNU- compatible.

<comment><USER7> Is this a remnant of Plan9 or something? Ugh, this is why I don't dabble in ecosystems with overly opinionated leaders. You have to know when to have a strong opinion and when to do things the standard way, and some people can't do that.

<comment><USER8> Plan 9 doesn't have --long-options at all. In Plan 9 arguments are single letter.

</comment></comment></comment></comment></comment><comment><USER9> I interviewed at Mongo a long time ago for a Drupal developer position. It was strange, they took me through a bunch of whiteboard algorithm crap that had nothing to do with Drupal. Obviously they weren't Drupal devs and didn't know how to interview for one so they just gave me the standard CS stuff. Obviously I was a Drupal dev so I didn't know shit about actual CS topics. I failed hard and learned a lot from it.

Steve was the only one of the 3 that I interviewed with that didn't come across as a self-important asshole. He was kind and helpful and overall seemed like the perfect guy for a Developer Advocate or whatever the title was. I wish him luck.

<comment><USER10> > they took me through a bunch of whiteboard algorithm crap that had nothing > to do with Drupal.

Oh I hate that type of interview. I had a similar experience getting interviewed for a front-end dev position by two backend devs at a consumer VPN company in Toronto who asked me to write common CS algorithms while they both sat there staring at me.

Even ignoring the total lack of connection between the content of the algo with the job in question, I've never coded like that in my life. Largely because I also never took a CS course and didn't bothered to study cliche interview questions because I don't apply to big cos. But most importantly, I don't solve problems on the spot in front of other people IRL, so what aptitude are they testing for exactly?

I'm an introvert who always codes with headphones on and likes to spend time thinking through problems on my own - but can also work with other devs to solve problems when needed. I also had OSS projects, private repos I could show them, and live production apps with tens of thousands of visitors I built myself to point to my aptitude. That's been more than enough for other smart teams to hire me. It's also the content I look for most when I've hired people myself.

The non-technical founder also never told me ahead of time they were going to do this type of interview so I was surprised when they sat me down.

Also during a telephone interview with their other semi-technical founder asked me to describe how NAT works (yes asking a front-end dev to describe network implementation details). I figured he was just confused about what I would be doing for them... then I showed up to meet the two backend devs the next day.

I just walked out of the interview and told the founder his hiring process was silly, even though I liked the company (product). I'm happy I did.

I should note that I'm not against the idea of measuring aptitude during the hiring process, if companies want to be thorough. For example. during another interview process with a different company a dev team gave me a problem to solve (with ample warning before I arrived that day) and let me solve it on my own, using my own laptop in a quiet room, while they went back to work at their own desks for an hour or two (taking however long I needed). I was fine with that process and it worked out. There was also a collaborative element to it as well. That was a test better grounded in the reality of software development.

<comment><USER11> Person who interviewed you here. Our interview process may not be perfect, but surely going into a technical interview, you could expect some coding questions. You mentioned that we "asked [you] to write common CS algorithms", like we asked you to do invert a binary tree. That, indeed, would be ridiculous.

In fact, if I recall, we asked you to reverse a string. This is not an "algorithm" question, it's a basic programming aptitute test and if you can't do it on a piece of paper, this is a major red flag for us. Furthermore, you demonstrated a lack of understanding of basic JavaScript concepts like prototypes and scoping. This, and your personal attitude, were the reason why we did not hire you for the front end deveoper position.

You are no doubt a hardworking and resourceful individual, but we were looking for something more than ability to glue JavaScript libraries together. I wish you, and "other smart teams that hire [you]", all the best.

<comment><USER12> Hey, what was the acceptable answer to reverse a string in javascript?

</comment></comment></comment></comment><comment><USER13> The one request I make is, please do not give in to complexity in order to accommodate to all users' requests.

</comment><comment><USER14> I'm sorry to hear that. Go is _not_ revolutionary (unless you count "completely ignoring runtime errors" to be revolutionary). If anything, functional languages are the new, old, revolutionary thing.

<comment><USER15> How does Go completely ignore run-time errors? For all I know it forces you to deal with them by treating them as values instead of exceptions.

<comment><USER14> How does treating them as values _force_ you to deal with them (except on principle)? Does the language force you to check the return value of every line of code? And the checking would only encompass _expected_ errors, not _unexpected_ ones, no? The unexpected ones (read: bugs) would simply be swallowed up and the actual problem would finally turn up far away in some other stack scope, no?

<comment><USER15> True, you can discard errors on purpose by assigning them to "_", which is an explicit way of saying "I do not care about this error happening". If you do that and get a panic down the line, you already know where to start debugging. That's much better than having an exception bubble up from deeeeep inside your code with some context-less cryptic message or number, isn't it?

<comment><USER14> > That's much better than having an exception bubble up from deeeeep inside > your code with some context-less cryptic message or number, isn't it?

I don't see how that follows. A stack trace (as initially cryptic as it seems) is a record of all the code that would have affected the current buggy state you find yourself in. If anything, a stack trace isn't comprehensive enough, ideally it would include all known/named values at every level of the stack... a large quantity of information, to be sure, but perhaps it could be narrowed down by diffing each stack level with the previous one or something. But if you could have those 2 things, you would have literally ALL the information you needed to fix the bug. Since bugs are programmer-unexpected states, and the stack trace plus the known values at each stack level are LITERALLY the entire state.

So correct me if I'm wrong, if you don't assign an error to a variable on the same line in Go, it throws? Because it was my understanding that there were absolutely no throws at all in Go. Or is it only that certain kinds of statements are _expected_ to possibly error, and must therefore be assigned to a variable (or _)?

<comment><USER16> Any error return values in go must be assigned to a variable at call time, otherwise it's a compile error. Unused variables are also a compile error, so you are forced to do something with it.

Assigning to _ effectively ignores the error, but is considered a very bad practice.

Unavoidable runtime errors (eg divide by 0) will generate a panic, which is similar to an exception, but is uncatchable within the Go routine it originates in.

<comment><USER17> _Any error return values in go must be assigned to a variable at call time, otherwise it 's a compile error._

Nonsense.

       fmt.Println("Hello world!")

I just ignored an error and it compiles fine. Go check the return type of Println:

[https://golang.org/pkg/fmt/#Println](https://golang.org/pkg/fmt/#Println)

tl;dr, it's very easy to accidentally ignore errors in functions that are side-effecting or modify parameters. Been there, done that.

<comment><USER14> Yeah, that's what I thought. And I've _also_ been there, done that. Is there basically some willful blindness around this issue with Go fans, or something? Or a lack of experience doing code? Or am I completely missing something?

</comment></comment></comment></comment></comment></comment></comment></comment><comment><USER18> > What is missing from the Go ecosystem?

Personally, golang "IDE" experience is not as good as Java or even C++.

For example, ycmd only supports subset of functions for golang. I miss ycmd- goto-references the most.

<comment><USER19> Please do try atom with the go-plus package. It has goto def, can show "doc strings", and has decent integration with delve.

<comment><USER20> For me, using LiteIDE and Atom + go-plus was what got me comfortable with Go. Without it, I felt it was far too finicky and had lots of hidden gotchas (like no unused variables).

</comment></comment></comment><comment><USER21> * Interfaces which can have fields would be really, really great.

* A rust-style borrow checker would make dealing with channels and pointers a lot safer.

* Equality operations for slices would clean up some ugly parts of the standard net library (addresses are []byte, so a direct x == y doesn't work but seems like it should).

* Closed enum sets: some ability to setup an enum type which can be "complete" when used in a switch statement without needing a "default" and which will only panic/fail when a bad type conversion is made. Let me sanitize out a whole bunch of possible errors at one point in my code when I want to use constants (and be warned when I break the guarantees).

<comment><USER22> My two Golang pet peeves, not very important either:

-still no math.round WTF?

-make() should be syntax and not this quasi-function that takes this vast array of argument types, and while you're at it, you should just rename it `new`, because that's what it is.

<comment><USER23> [https://godoc.org/github.com/gonum/floats#Round](https://godoc.org/github.com/gonum/floats#Round)

<comment><USER22> Is gonum part of Golang? I don't think I should have to pull in an entire library just to get a working round implementation.

</comment></comment></comment></comment><comment><USER24> I'm using C# mainly because of debugger integration in Visual Studio.

Make decent visual debugger and devs will come.

<comment><USER25> What are you developing with C#? I see Go more for server-side stuff, and C# for Unity/Desktop development...

<comment><USER26> Interesting. I've used C# heavily at my last couple of jobs and it has all been server side web work - mostly back ends of web apps, but also services and microservices of various kinds.

From talks with coworkers, the impression I've gotten is that most C# in the wild is running server side, though there's obviously a lot of it in desktop apps, and on mobile with Xamarin.

</comment></comment></comment><comment><USER27> I am happy for you spf13, congratulations! And thanks again for software you wrote, like hugo!

</comment><comment><USER28> Why do people find the need to write about themselves in third person? [https://stevefrancia.com/](https://stevefrancia.com/)

<comment><USER29> As a habit it is bad, but this is actually standard for short bios. It allows it to be dropped in place directly for conferences, PR shots, news articles, etc without any rewrite.

<comment><USER30> Great to make it look like someone took the time to do a bio about you because you're important, while it's just you writing. Lack of self-confidence if you ask me.

<comment><USER31> _Lack of self-confidence if you ask me._

How do you figure? Every time I've been asked for a bio for a conference or similar, they've asked for it in third person. Reading bios in conference proceeding in first person would just come across as weird to me.

<comment><USER32> The difference is having a bio on a website _about yourself_ versus a bio on a website about a lot of people. No one thinks that your johndoe.com site was made by your official fan club.

<comment><USER22> You really named your user account after WHAM!? That's fucking awesome. Tell me you're either George Michael or Andrew Ridgey in deep disguise... please please.

<comment><USER32> Just another jitterbug, but you gotta have faith that I'm once bitten and twice shy.

</comment></comment></comment></comment></comment></comment></comment><comment><USER33> What is your favorite opening? I like the High Chinese.

<comment><USER34> If someone makes an alternative go implementation, they should name it baduk or weiqi.

<comment><USER35> At least it would make the language and ecosystem [slightly] more Google-able.

<comment><USER34> It would collide with the game. It should be worst in the beginning.

</comment></comment></comment></comment><comment><USER36> Congratulations, but what of Hugo? :)

</comment><comment><USER37> > Go has the nearly perfect balance of readability, expressibility and > simplicity

Is Go really expressive?

<comment><USER22> It is pretty readable, but really non-functional too. Eg, they still don't have math.round and you wind up writing a lot of code because it can be a little bare bones or does things in a way that isn't quit usable.

I wouldn't say it is very expressive either. Go can be very wordy and verbose at times, and some things are downright a pain or poorly thought out (e.g, while Java has finally and C++/Rust have RIAA for dealing with resource deallocation Go has defer and it doesn't work really well when you encounter an error in the dealloc logic).

Simplicity is about Java 1.0. Give Go some time to add some technical debt before you get too excited about it simplicity.

It isn't a bad language. This is my second run thought the language, and I'm neither excited nor turned off by it.

<comment><USER38> > It is pretty readable, but really non-functional too

There are projects starting to fix that: [https://github.com/asteris- llc/gofpher](https://github.com/asteris-llc/gofpher)

<comment><USER39> I think he meant non-functional in the sense of "not functioning", not functional programming. Neither of his immediately following complaints have anything to do with functional programming.

<comment><USER38> I was trying to be funny and missed the mark

</comment></comment></comment></comment></comment><comment><USER40> Generics please.

</comment><comment><USER41> How does this guy just stumble his way into Mongo and Docker. WTF am I doing with my life?

<comment><USER42> I dunno, perhaps develop very good open source projects like Viper, Hugo, etc...

</comment></comment><comment><USER43> One thing I liked the most about JavaScript was chaining methods.

One thing I liked the most about c# was the libraries in one place.

One thing I liked the most about PHP is the many array methods and easy to call methods from objects.

One thing I liked the most about Python is the readability and built in debugger into the language.

One thing I didn't like about all of them is all the libraries you have to memorize.</comment>


The buyer's envelope, please - <AUTHOR> http://blogs.law.harvard.edu/vrm/2008/08/26/toward-a-buy-side-solution-to-mwgp-or-so/ <comment><USER2> _You need better buyers, not just better sellers. You need to improve the tools available to buyers — tools that help buyers with all sellers, and not just within each seller's walled garden or silo._

Buyers already have many tools: review sites, merchants, comparison search engines, magazine sites dedicated to product verticals, daily "hot stuff" emails, price forecasting tools, etc. It's easy for them to get overwhelmed trying to navigate all this information.

With SaneShopping, our advice service aims to simplify shopping by doing some of this research for the buyers. Is anyone else here working in this space?</comment>


The Ayan Rand Institute: 'We Took PPP Funds and Would Do It Again' - <AUTHOR> https://newideal.aynrand.org/we-took-ppp-funds-and-would-do-it-again/ <comment><USER2> Counterargument: If you believe that a system is immoral, its better to minimize your participation in that system, even if you're coerced to participate to a certain degree.

<comment><USER3> But...that requires not caring about furthering yourself.

<comment><USER3> (Which is a hard sell for an overwhelming majority of the population)

</comment></comment></comment><comment><USER4> Having read their statement on taking the aid ([https://newideal.aynrand.org/to-take-or-not-to- take/](https://newideal.aynrand.org/to-take-or-not-to-take/)) their argument boils down to:

 _" we would be foolish not apply for and take a government handout and that it is OK for us to do so as we are pro-capitalists but bad for everyone else to do so."_

Rand's personal argument for this behavior and why she took government handouts including social security and medicare was:

 _" Those who support such government handouts, have no right to them; those who oppose them have"_

I personally find the hypocrisy of this stunning.</comment>


Refactoring to an Adaptive Model - <AUTHOR> http://martinfowler.com/articles/refactoring-adaptive-model.html <comment><USER2> I'm strongly against going down the rabbit hole of implementing something like this. I often encounter the situation where configuration files become complex and it would be a nice-to-have thing to embed logic in them. But then you start slow, maybe add conditions, then function calls, then loops, then variables and soon you have implemented your own Turing complete language by accident, spending countless hours re-inventing the wheel.

The demonstrated approach IMHO leads to situations where N implementations share the same code, like the "atNight" function he shows. So each new feature requires synchronous changes to N codebases.

I would probably opt to rather embed a "real" scripting language lika Lua or Groovy (or today, maybe even some JS dialect), provide it the spec object, the seasons and countries and be done with it. I instantly gain a ton of features, existing documentation for end users and no endless river of "please add condition X to the config language" tickets.

<comment><USER3> I'm astonished that Fowler presents a central LISP idea here, without even mentioning LISP by its name, let alone mentioning that this is building something that a LISP system gives you for free. (i.e. in LISP you could take the quotation of your code directly as data structure, and even have an interpreter for that right now.)</comment></comment>