I don't think this is the future or anyone is boxed in.
Trump & Co are by no measure the sharpest tools in the shed. In Trumps own words they have been up against some really inept people, who have all lost credibility.
Therefore the counter-reaction, which is building, will come, and it won't look like what Trump & Co are used to dealing with in the past. I think that's what interesting about where the story goes next. Whose is going to lead? What are they going to stand for? How are they going to organize? Its an opportunity for the best in America to shine.
Its the environment that compounds the complexity. Go down the list of Largest companies by revenue in the US and 8 in top 20 are related to "health" - are they running hospitals? are they pharma companies? No.
They run pharmacy benefits management, health insurance and drug distribution.
The estimate is 4-5 Trillion flows throw these firms. Which is larger than the GDP of India. So this gigantic structure has emerged that doesn't really make too much profit btw (very similar to Amazon Platform Economics) but is layer upon layer upon layer of cash flow passing through middlemen.
Drastic change requires new ideas about what do we do about all these middlemen who shape the environment on top of which everything exists.
Alas, independent middle layers have long been the US solution to avoiding monopolies. This is the whole reason car manufacturers can't sell directly to consumers, and micro breweries can't sell to consumers except for on-site purchases. Breweries in particular have to sell to distributors, who sell to stores.
Banning the middle layers here (absent other changes) just means that the companies that replace their spots in the top 20 will be vertically integrated conglomerates that manufacturer, distribute, prescribe and provide insurance (i.e. payment plans) for pharmaceutical drugs.
> Banning the middle layers here (absent other changes) just means that the companies that replace their spots in the top 20 will be vertically integrated conglomerates that manufacturer, distribute, prescribe and provide insurance (i.e. payment plans) for pharmaceutical drugs.
Except these companies are already vertically integrated, to a large degree. All the biggest insurers have their own in-house PBMs.
Revenue is an incomplete signal of the complexity and waste. It’s just a signal of the money flowing through. A “single payer” system would probably also show a huge revenue number even if the profit was <=0. There’s just a lot of money and a lot of people who are patients.
I don’t disagree that the system requires change and is extremely complex, however.
The real problem is that it’s nearly impossible to “scale” healthcare and keep it personalized, and people want personalized healthcare - because that’s shown to be more effective healthcare. Doctors can only see a limited number of patients a day, and they need to be paid some compensation commensurate with their skills and efforts. That alone makes it hard for everyone “healthy” to see a doctor often enough and for long enough to get deeply personal care. Most people realistically can pay out of pocket for preventative care. $100-200/yr for an American isn’t crazy. Even most drugs are super affordable out of pocket if the profit margins are kept low (which is started to be available, bits at a time).
The real complexity, of course, is the long-tail where a few people get cancer and car accidents and other serious conditions which swamp the costs of everything else.
I don't think $100-200 per year for preventative care is enough. I reckon $1000-$10,000 per year, depending on age, is more accurate. You should spend at least $500 per year on nutritional supplements like Vitamin D. Switzerland has a better medical system that's cheaper than our system, but it's still expensive.
Indeed, it may be the case that the middlemen aren't individually all that profitable, but if the money passes through several stages and each one skims off a few percent, you end up with the present situation where health care costs twice as much as it does in any civilized country.
Its like expecting farm animals to keep track of how the farm works, as the farm gets more and more sophisticated in animal domestication and exploitation. The individual action argument was weak 10 years ago and its worthless today.
The is a Systemic problem. Doesn't matter what the individuals do.
The trouble is people thinking it can be fixed with the system. I've been to a few dictatorships, none of them had the slightest clue what I was doing because the government was too poor and distracted with stuff like militias at their door to take much interest in what I was doing.
Safety comes from dysfunctional governance. Surveillance is a property of functional governance. Embrace disfunction.
Plenty of ineffective dictatorships will happily line you up against the wall with bogus surveillance. And shitty surveillance states will happily fake surveillance or data to look more effective.
The danger with these types of
State organs is they are constantly trying to justify their existence and cover up their mistakes, and if you can be thrown in the gears, some places are happy to do that.
>Plenty of ineffective dictatorships will happily line you up against the wall with bogus surveillance. And shitty surveillance states will happily fake surveillance or data to look more effective.
Sure, but that's the exception. Governments have a pyramid of needs too. Governments don't throw a bunch of resources on things with poor returns, like shooting people who haven't done much wrong, when there's easier fruit to pick. Sure, you can go full jackboot on specific issues here and there but that's not sustainable on a "will I retire in peace of will I hang from the overpass" timeline. And even if you're the dictator's henchman and want to go down some rabbit hole of killing people you don't like the the fact that the dictator may have you shot for waste or as a sacrifice when that provokes unrest or dissatisfaction among the people generally keeps the government in line. And the government really doesn't want to be killing people because it needs people to do things and pay taxes.
Look at all the historically violent dictatorships that lasted a long time and for many leaders. They all provide for their people generally. They might not be competitive absolutely but they keep things generally moving in a positive direction decade over decade and keep the country doing at least as well as its peers. The ones that don't tend to fall apart after a couple bad leaders.
I really shouldn't need to be explaining this. This is how every European monarchy worked just with god and birthright as justification instead of backroom dealing and politics and false elections.
Im sure when I fought for the YPG Assad might have liked that, unfortunately all the bogus surveillance in the world is no use when your army cannot enforce their borders or sovereignty. In any case I saw guys with AKs posting to Facebook, no bogus stuff needed, they were already publicly providing all the evidence needed for the death penalty without any worry of being prosecuted.
I don’t think we’re disagreeing. My point is that while those folks shooting AKs in the air are doing their thing, some other random putz that never did anything like that is probably getting nailed to the wall by the same system.
And unlike an effective/accurate surveillance system, you can’t be safe by just not being the AK weilding guys. In fact, sometimes you’re safer because you’re more dangerous, and they’d rather find someone easier to pick on.
Third world places aren’t what they are because of a lack of rules or systems (usually), but rather because the rules and systems aren’t fit for purpose and produce the wrong outcomes.
Ah yes absolutely. Under no system is anyone safe if they're unable to bear arms to protect themselves/family, they will be systematically vulnerable or vulnerable to the next bandit. This just becomes more visible under disfunction.
Its the McDonaldization problem[1] that sociologists used to talk about when McDonalds was conquering the world.
And then they stopped talking about it, cause no one has come up with a model that not just survives side by side, but replaces the McDonalds model.
Everyone just ends up copying that model, cause it did produce results no one had seen before. Laws and regulations evolve to help that model out. Investing more and more in that model becomes automatic.
Restaurant count kept multiplying, franchises were willing to spend more and more on the best real estate with highest foot traffic UPFRONT. Costs of running things kept falling, thanks to all these accumulating network effect/economies of scale. Price stays low. All fantastic right? To the point people started asking why can't the McDonalds model feed the world? And naturally anyone who was very happy with their profits and fries would start assuming it could.
Only once you start digging into that question, do you start seeing how their success at optimizing for a few specific variables really well, comes at the cost of all the other things they don't optimize for. Their success is not possible without rising external costs.
As a reaction there are nows lots of restaurants that survive with alternative models that optimize for other things. But no one has taken down the McDonalds model yet.
He has to announce some bullshit every day to Capture Attention or someone else is going to get the Attention. And that puts pressure on him to keep announcing things, more than anything else.
Given how the Attention Economy works Content keeps exploding, but eyeballs and time to consume it all don't grow at the same rate, so post frequency and absurdity of the posts shall grow with time. Keep count.
Also, new bullshit today prevents people from thinking too deeply about yesterday’s bullshit. If Trumpers thought too long about yesterday’s report on those 150 year olds getting SS, they might realize all the holes in it, so distract. We are truly in an idiocracy.
Product is usually a risky cash sink if your experience is services. You haven't mentioned how big your business is, but if its small split the costs of the experiment with larger firms. Pitch your plan to them. If you can raise 3-6 months of funding for a team then go for it.
Not really. See what Claude Shannon has to say about channel capacity of what your brain can digest if Grok finds 8 million things that are happening currently that might be interesting to you.
You can also thank the arrival of social media for amplifying delusions - "You think I am wrong or stupid?? Then how did I get so many Likes/Views/Followers"
With that population scale delusion amp working 24x7, we get the most over ambitious attention craving people rising up the food chain faster than they usually could. But speed is useless in ecosystem evolution. Anything moving faster than the rest of the system will run into issues faster too.
Lina Khan types need solid support and fire power to make a dent.