• 0 Posts
  • 22 Comments
Joined 1 year ago
cake
Cake day: July 4th, 2023

help-circle
rss






  • If I was guessing, in general, I think people who advocate for a pure meritocracy in the USA feel the world should be evaluated in more black and white, objective terms. The financial impact and analytic nature of STEM and finance make it much easier to stratify practitioners “objectively” in comparison to finding, for instance, the “best” photographer. I think there is also a subset of US culture that thinks that STEM is the only “real” academic group of fields worth pursuing, and knowledge in liberal arts is pointless -> not contributing to society -> not a meaningful part of the meritocracy. But I’m no expert.


  • As a general rule, yes. People who are able to better perform a task should be preferentially allocated towards those tasks. That being said, I think this should be a guiding rule, not a law upon which a society is built.

    For one, there should be some accounting for personal preference. No one should be forced to do something by society just because they’re adept at something. I think there is also space within the acceptable performance level of a society for initiatives to relax a meritocracy to some degree to help account for/make up for socioeconomic influences and historical/ongoing systemic discrimination. Meritocracy’s also have to make sure they avoid the application of standardized evaluations at a young age completely determining an individual’s future career prospects. Lastly, and I think this is one of common meritocracy retorhic’s biggest flaws, a person’s intrinsic value and overall value to society is not determined by their contributions to STEM fields and finance, which is where I think a lot of people who advocate for a more meritocracy-based society stand.




  • A lot of the really prestigious medical schools/residency programs have a reputation for a toxic culture, and this means by and large they attract a larger share of toxic applicants. Their programs are really focused not on training great bedside clinicians, but on training people who will attempt to change fields through research and public policy. Unfortunately, the toxic nature of these programs, and their immense emphasis on publishable output and reputation, likely attract a larger fraction of narcissists with the skills necessary to mask their inappropriate behaviors when needed in comparison to other programs. That is not to say that all Harvard trained physicians are horrible people, I’m sure the vast majority of them are fantastic, but I would be money that Harvard attracts a greater fraction of the kookes than your average midtier medical school.



  • All remote based typing is awful, T9 included. I can’t speak for everyone, but I can type with swipe gestures on a virtual keyboard via remote faster than I can input T9 text. I’m unaware of any stock remote for a device with a full keyboard. I would argue Apple has text entry perfected at least as well as any other major manufacturer. You have virtual keyboard entry, solid voice-to-text, and it can be configured to push a notification to your iOS device when you enter a search bar which will auto-open to the remote app and pull up the keyboard. Because of this feature passwords can also be autofilled from Keychain to make logins easier.

    You may personally prefer T9, but I’ve never seen anyone in the last decade input anything into a TV via T9. And you’re asking why it doesn’t have voice input, when it does. You admit to having never used an Apple TV yourself. I hate the idea of app-only interfaces features, but this isn’t a case like that. Maybe you should understand the features of a product before you call it “fucking stupid”.


  • You’ll have to strike a balance between security and ease. Your two major options are reverse proxy and VPN (Tailscale is one option for VPN)

    For reverse proxy, you functionally open the app to the internet. Anyone with the correct web address can access the login page. This is inherently less secure than VPN, but not irresponsibly so. Beyond the reverse proxy itself, you’ll also have to learn how to configure an HTTPS certificate to increase security since it will be open to the internet.

    For VPN, every user you want to be able to access the service has to be tied into the VPN and have the VPN running throughout their access. Tailscale is arguably the easiest way to configure a VPN right now, as you won’t have to manually deal with VPN configuration files for every device. VPN use will functionally make it like you’re on your home network. VPN access to your network should not be given to tons of people if at all possible.



  • I’m aware that those costs do not magically disappear and are absorbed into other billing/passed on to society. However that is not why healthcare is so ludicrously expensive in the United States. It is the substantial and unnecessary administrative costs, predominantly driven by for-profit insurance companies, for-profit hospital systems, and pharmacy benefits managers. The continued exploitation of the ill for shareholder benefit is a uniquely American take on health care, and coupled with our incredibly individualistic tendencies bring about a huge fraction of the poor health outcomes we have in comparison to other developed nations, despite spending generally more than double per person.

    Some of this is certainly driven by system inefficiencies such as forcing people into a situation where they have to use the ER for primary care. Or where they cannot afford their blood pressure or cholesterol medicine, and instead of our society helping provide these very affordable interventions, we pass the buck. So when those individuals inevitably have a heart attack, we then pay many times more for care that they may not have needed had they simply gotten good preventative care.

    I will happily stand up and bash the current US healthcare system. I despise its insistence that human lives and suffering are secondary to wealth-extraction. But as much as I hate it I can’t change it, and while I will advocate for policy to change things, for now all I can do is continue to provide care to the patients presenting as a symptom of an ill society.

    I hope others can see that these patients presenting to the ER are simply doing the best they can to take care of themselves and their families, and that the real blame and consternation should be placed on the government, hospital, insurance, and pharmaceutical officials and lobbyists who continue to exploit their illness for profits.


  • Let’s see if I can add something to this conversation. I’m a fourth year medical student in the United States, who in a few short months will hopefully begin training to be an emergency medicine physician. You are absolutely correct, that the government subsidizes health insurance, and that in a decent number of cases, individuals without insurance or the means to pay for healthcare are eligible for Medicaid. You are also correct that the ideal use of the emergency room is to evaluate for medical emergencies, I say this as someone soon to be an emergency room doctor. Lastly, there are certainly physician groups which are capable of providing cash pay based care.

    However, the process to apply for Medicaid can be quite complicated, particularly amongst those with low medical or even just general literacy levels. This disproportionately impacts individuals for whom English is a second language. As I said above, in a perfect world, the emergency department is only for true medical emergencies. However, patients as a whole are notoriously bad at knowing if their symptoms are from an actual emergency or not. Secondarily, in many communities, the emergency department is the only reliable access some individuals have to the health system due to difficult difficulties with transportation and scheduling. With regards to your last point, while there are certainly clinics that can provide cash based care, the majority of individuals who cannot afford insurance are also likely the patient who cannot afford a cash pay clinic.

    The fact is also that a large number of uninsured patients will simply have their ER bills written off by the hospital, and/or social workers within the ED will help sign the patients up for Medicaid if they qualify so they become insured can then have the visit billed for, as opposed to the individuals giving fake names.

    Unfortunately, the current state of the US Healthcare system is that for many disadvantaged populations, the ER is their primary care physician. This is not ideal, but I will not admonish my patients for doing what they can to seek care in a system that otherwise leaves them abandoned and uncared for



  • Except these physicians are often completing something called a “peer-to-peer” on behalf of the insurance companies, not just making broad treatment decisions. This is a process by which an ordering physician is required to call a physician employed by the insurance company to justify a testing or treatment course to their “peer”. Unfortunately these “peers” are often composed of physicians who did not complete residency and/or who do not currently practice, let alone in the specialty of the physician who is required to call for the peer-to-peer.

    This leads to rather absurd results in which a board certified, practicing sub specialist (cardiologist, neurosurgeon, oncologist, etc) with 5+ years of specialized training after medical school has to convince a physician who may never have even practiced that they know what they’re doing. I personally think if you’re not a neurosurgeon, neuroradiologist, or neurologist then you aren’t really qualified to cancel a neurosurgeons MRI, but hey, I don’t get a bonus for denying claims.

    • A Fourth Year Medical Student and Pharmacist