The article does not provide any data/link to the alleged destruction of environment.
Chicken is a lot like fracking - it probably has some external cost - but its a lot better than beef,tuna . . or any other meat out there - in terms of environmental sustainability.
Its also possible to recycle almost all parts of a chicken.
For example people in europe,america like what is know as the "white meat" ( not sure if its a co-incident ) - breast,thigh - and people in asia like "brown meat" - which includes leg,wings.
So what the global food producers do is recycle and even out the demand which is one of the reason why white mean has became so much cheaper in europe.
I remember reading this really wonderful article on the levenshtein distance on HN 2-3 months ago.
basically I have difficulty understanding why the Wagner-Fisher's algorithm works - the intuition behind it - I remember it was dynamic programming but I really want to read that article again.
The format was similar to medium with wonderful diagrams :( I tried searching for it on HN but searching on HN is really difficult and it was my own fault for not saving it on Pocket.
I would really appreciate the help since it was one of those "better explained" gems.
oh wow ! didnt know there was a handy search engine for HN.
basically it explained 1-dimentional Levenshtein distance first.
That blew my mind since its much easier to think about the 1d case and then apply it for a 2d matrix.
but i remember reading only half-way through the article before had to do something else :( sorry - but I really want to read it again since it will really help me out at my work !
I hope it's the hardware side of the company waking up that the software and "solutions" side of the company is a gangrenous fifth limb.
Things like trying to start an app store when they didn't have content (e.g. Steam) or a platform (Google, Apple, Microsoft), trying to pivot that abomination into a media store after Netflix already won and the studios are all trying to start their own, trying for way too long to deliver solutions of putting parts in verticals (e.g. tablets, micros) where they are at best only competitive on one of price, power, or performance and immediately face-planting, but limping along seemingly oblivious to why any of these projects fail.
The mention of IoT though makes me think this isn't the case. Definitely part of the brain-dead trendy "solutions" thinking. I don't think you're going to compete with commodity cheap micros with the best IP or the best process size... price is king.
There are too many layers at Intel, and that leaves too many of those layers too well insulated, able to believe it was the brand that won them their markets (not the economics: Wintel monopoly in personal computing history, having the best server and laptop parts currently), and that despite the economics of new products and "solutions", the brand will somehow convince people to buy in.
Like, why do I ever see you on Television, Intel? Who is the audience for these ads, potential investors? Shouldn't they rather see higher dividends? People don't go to the mall and buy Intel chips, they go buy Macbooks and they use Instagram. Facebook and Apple buy your chips at a scale where it's all ROI, and you deliver that, so what are the ads for?
This shit is why I left, and why always did the quicksale on the stock purchase plan.
Intel needs to just keep making the best parts and leave it to the market to conjure up asinine things to do with them. Kill all the product lines where there's no road to being #1 ROI within 10 years, keep those in the lab.
I'd still like to know whose idea it was to try and compete in the Internet of Things market by pitting a buggy warmed-over 486 (the Quark) against ARM's best, most modern chip designs. Sure, Intel got a bunch of headlines in the tech press about their new IoT solution, but the technical details just didn't add up. The performance and power figures were dire, it couldn't run existing x86 code, it looked like a bear to integrate into anything, it just made no sense.
Intel's latest Quark has gotten to 1.5ua sleep current with sram retention. That's not the best ,but that's good enough for many applications. And it's using 22nm so it may be the cost leader, by far. And that's mostly what counts in embedded.
Thanks for sharing and providing that wonderful insight !
I agree with all your points - the last time I though about Intel as a brand was in 2002 while wanting to build my own PC ( a very small market of geeks at that )
What particular thing would you say that makes it difficult for them to built good software as compared to amazon ? Intel seems to have a bottomless pit when it comes to money.
>There are too many layers at Intel, and that leaves too many of those layers too well insulated, able to believe it was the brand that won them their markets (not the economics: Wintel monopoly in personal computing history, having the best server and laptop parts currently), and that despite the economics of new products and "solutions", the brand will somehow convince people to buy in.
Well, as a gamer, intel (and nvidia) are just the best.
I had AMD Athlon and it was an amazing processor. The modern ones just do not compare to Intel ones.
AMD also pulled riddiculous shit when they stopped releasing drivers for linux on 2 or 3 years old GPU's - therefore they can go fuck themselves.
Ive got 4790K and it is just great, runs cool (just a decent upsized aftermarket radiator for ~30$ - no water!), doesn't abuse my fans, will probably last me 5 or 6 years performance wise
For a bulk buyer of crappy throwaway corporate laptops, the AMD might have some appeal...
Exactly, even if gamers were a big market, they follow the ROI too. Intel can't try to be a brand the way Nike is or the way LV is, they sell technical things to technical people but mostly to industry.
You'd be surprised -- they already are. Their original "Intel Inside" campaign was groundbreaking and helped them immensely in reaching domination in the PC space. A lot of barely-technical consumers will not have heard of AMD or other minor competitors, but they will recognize Intel and buy accordingly. Techies don't care too much about brands, but non-techies do.
Part of the problem they have today is precisely that their brand is basically worthless in the only growing segment (mobile); they must find and occupy all other niches just to stay alive, and marketing is part of that.
Sure, they spend on marketing, they're visible to the public, and their products are popular, those don't mean they have a brand -- a wide and loyal base of customers asking for their products by name for subjective reasons.
The chips sell because they're the best. If people really wanted "Intel" (and knew what they were even buying there) and not just the cheapest / fastest / longest lasting device regardless of how or why it has those properties, Intel's attempts to push into mobile despite failing to hit the required price/performance/power points might have worked like management always pretended it was going to.
They have a very polished image and spend plenty to get broad awareness. Plenty of visibility across all segments, it's not that they failed to capture mobile end-customer's eyeballs, it's that they failed to deliver a mobile chip with an ROI to mobile OEMs.
The most fervent Intel fanboy can't buy your Meego/Moblin/Whatever(Maybe people will forget it failed if we rename it every year)-powered Intel-chip phone if it never hits the market because it fails to have a day's battery life and the OS is basically vaporware (we can't ship updates for existing systems, we're too busy with politics, switching UI toolkits and starting over).
Intel pays to try to build a brand and labors under the assumption that means it has one (for instance, wanting to build their own Platform [SOC+OS+App store] thinking the brand will pull it to market despite reality, instead of just accepting Android from the beginning) but it simply doesn't. All the marketing money looks to be just a bonfire.
Back when AMD got a foothold and was able to be competitive on price, people bought them, I don't remember seeing any AMD commercials.
If people only love you in the categories where you're objectively the best, maybe it's not because you have the cool circuit pattern branding, threw all those parties and bought those super bowl spots.
No matter how much they spend and pretend to be a consumer brand, it just doesn't matter one bit outside the ROI for OEMs and ISVs, since those are Intel's customers, they are only ones making buying decisions of any consequence, and they're never going to buy a part that's detrimental to their own bottom line. Intel Inside partnership was in my opinion about OEMs fleecing the marketing spend for a reduced bill of materials. The sticker meant nothing, no consumers really cared. Enthusiasts only cared when Intel meant it was a better chip, only a minority of that enthusiast minority would prefer a weaker Intel chip over an alternative.
If I were to call my grandmother (70s), mother (50s) and niece (20s) and ask them if they'd prefer a computer with an Intel chip in it, I suppose they'd say yes (and as much as my ego might want that to be because I worked there, it's most probably the ads). However I happen to know that two of the three of the CPUs in question are AMD. Why? I don't know, but the relatives all buy cheap HP or Dell Windows machines (choosing those OEM brands despite better options, real brand effect) on a whim (a.k.a when the last computer's OS installation became unbearable) from the nearest Best Buy (picking that retail brand despite better options, a brand effect) and the OEM chose an AMD part (probably for margin reasons, creating lines of products for undiscriminating consumers) and these relatives didn't notice or didn't care (no brand effect). I wonder if I asked them if their computer had an Intel CPU, if they might even think that they do. I'll try that next time I see them.
No matter how hard Intel pretends they're like organizations with similar marketing spend, they simply don't have a brand like those do: there's no verticals and no consumers aside from self-built-PC enthusiasts, and for consumers the latter are quite a touch more objective than those in fashion or apparel.
I disagree. With all their failures in mobile, you mention it yourself: consumers do know the brand. One of the reasons Intel keeps dominating the PC space is that even at its peak, AMD simply could not get get past the assumption that "chips must be from Intel" in many quarters, be them OEM or consumers. That's real brand power. In fact, their complete dominance is what undermines their own branding: people now assume what they buy will be Intel and don't even check. I bet the Best Buy sales guys studiously avoid mentioning AMD, because it would kill the sale. That's real brand power. Obviously it's not easy, being a component supplier rather than a direct b2c vendor, but I think that Intel punches well above its weight in brand power. It might not be as big as Apple or Nike yet, but it's definitely in another league from competitors.
> The sticker meant nothing
I absolutely disagree. It did mean something, when it was the only sticker. There is a reason stickers became popular right after that.
> Intel can't try to be a brand the way Nike is or the way LV is
They have a surprising amount of advertising at gaming events which seemingly tries to do exactly that. Even though they are more-or-less the only option. (although AMD was (maybe still is? I'm not following that to closely) better at integrated graphics solutions which were interesting for low-end gaming, most gaming profit is probably near the high-end)
Maybe to promote PC gaming in general, over other activities and specifically consoles?
I asked a friend who worked at Intel and he said part of it has to do with the company's hiring and organizational structure. The basic gist is that people are brought onto teams that only exist long enough to fulfill their initial objective. While some teams are dedicated to long-lived consumer product lines, others might focus on R&D or custom B2B orders. Once a team has fulfilled its responsibilities within the larger company, it is likely to be dissolved and there's no guarantee for room in other teams for the leftover employees.
That's how I understood it, at least. If anyone more familiar with Intel's inner-workings thinks I'm off-base, please feel free to correct me.
I'm not aware of what you're referring to. The most recent series of layoffs at Amazon was due to poor sales of the Fire Phone [1][2]. Most companies in Amazon's position would have done the same thing.
I don't believe that's a thing that happens at Amazon. I've worked here nearly 4 years, across several product launches (hardware and software) and only known of one person being let go, and that was for entirely unrelated reasons (politics and such).
Just a guess, but tech companies are occasionally release % of their workers to clean its workforce, boost productivity and make space for new, young and experienced engineers.
Stagnation and idea depletion is dangerous for tech companies, fresh employees bring fresh ideas and boost competitiveness between workers.
Perhaps some people believe that is what happens. But if I were a talented employee, I'd see an 11% staff reduction as a sign to stop ignoring those recruiter emails.
We had layoffs/firings here and that is what happened for a lot of people. There is no point in sticking around when the same moronic manager is kept around while talented, productive people are forced out. Many of us are only here until our shares vest. Our stock price has taken a huge hit as result.
Which means the best employees are the ones most likely to leave. The ones who weren't fired, but who can't easily get another gig are what you are left with. It's a tough cycle to beat.
I don't think levemi is saying anything about morals -- rather, that results will be better if employees are cooperating with one another rather than playing zero-sum games in the hope of missing the next round of layoffs.
But it could just as easily be argued that a highly political environment which necessitates such behaviors leads to poor morale, quality employees leaving etc. etc. which couldn't be good for the company long term...
I don't know about other people, but my next Intel CPU will have AVX-512, which Skylake doesn't have. I'm expecting AVX-512 to (up to) double integer/FPU vector computation capacity.
I also want to see some proof future Intel processors (especially 10nm and smaller) have not lost durability due to electromigration [1] (or some other durability issues small feature size can cause). There's already some indication this might be happening on current Skylake CPUs.
Of course not all workloads will get faster, but it could help with things like parsing (XML, json, etc.), games, media processing, compression, physics simulation, etc. -- or really anything vectorizable that needs to run on CPU for reason or another.
You might be surprised to learn that AVX-512 is not available in Skylake - it will only be in the Xeon line. It also won't give you anywhere near double performance, since a lot of AVX2 code is memory bandwidth bound anyway (which is probably one of the reasons it's not in the desktop chips.) I would've bought a Skylake so that I can test code on an AV-512 machine. Now I'll keep my money and wait and see.
I know about bandwidth issues, but you can also use big vector sizes to mitigate, more opportunities for simple schemes for realtime (de)compression of data. (Usually called packing/unpacking).
But where you can work around bandwidth issues, you can get up to twice as much work done.
Intel finally realized that ARM is dominating growing sectors (mobile and embedded[1]), while they're dominating the shrinking ones (desktop and server).
Treating callbacks as monads is literally the definition of promises. If that code does the same thing it did in 2011 when I last looked at livescript, that's not treating callbacks as monads, thats just borrowing a syntax that Haskell uses for monads and using it for callbacks.
Imagine we go to space and get access to infinite energy and infinite natural resources.
Does it solve world hunger ? Don't we already have more than enough food ?
Does it solve cancer ? ..
Does it solve the economical crisis we are in ? Its mostly due to lack of political organization and lack of education.
I think the argument that Neil Degrasse Tyson makes - about inspiring the young - it can be done by trying to solve world hunger, cancer, etc. We do not need to burn more fossil fuels to try to figure out how to mine the moon.
The biggest argument would be that we already have infinite resources here on earth. Space mining doesn't make much sense when you can much more cheaply extract resources from earth.
I think the biggest issues in society is education and healthcare. And the free market seems to direct us towards that anyway.
Healthy and educated people are inspiring - space mining seems to be trying to solve the wrong problem for the right reasons.
> The biggest argument would be that we already have infinite resources here on earth.
Earth's resources are very much finite and that's a fact. It's only a matter of a couple of decades before fossil fuels become extinct, our oceans are dying due to overfishing and pollution, rainforests are cut to make room for more agricultural land, existing agricultural land is acidified due to overuse of chemical fertilizers and pesticides, potable water sources are vanishing, those solar panels that people keep talking about and the iPhone in your pocket need rare metals to be mined, etc, etc.
Also have you seen how open pit mining looks like, have you seen what it leaves behind? Earth mining is cheap only because the costs are subsidized by the environment. But of course, our children will pay the real bills.
> our oceans are dying due to overfishing and pollution, rainforests are cut to make room for more agricultural land, existing agricultural land is acidified due to overuse of chemical fertilizers and pesticides, potable water sources are vanishing
So you think rain-forests and clean water exists on space ??
We can solve those problems withing sending more rockets to space - which ends up burning more fossil fuel. Remember, every day that you are alive ( assuming you are living a developed country ) you are emitting huge amount of carbon.
Just keeping you alive is making the earth more inhospitable - dont talk about sending rockets to space ( with other people's money ) as a method to combat climate change and solving the resource constraint on planet earth.
I can't parse this opinion. You're disagreeing, but I don't understand how. You also went on a tangent, avoiding my main point.
Are you aware that advancements made for space exploration have helped the medical field? Things like NASA's digital image processing of the moon helping with MRIs and CAT scans. Or LVAD leading to artificial heart pumps. NASA is basically able to claim at least partial credit for things like ear thermometers, automatic insulin pumps, implantable heart defibrillators, improvements in digital mammography technology, programmable pacemakers, LEDs, etc.
The discussion is about mining and I see no reason for why space mining colonies couldn't be self-sustainable. If they cannot be, then space mining isn't feasible or too costly. And if they are self sustainable, then the fossil fuel mined and burned on earth would be worth it. If this was meant for me to feel shame of being alive and consuming carbon, take note that this is reductionist thinking, the same reason for why we find ourselves in the current predicament. Carbon emissions are only important as long as we have an impending global warming phenomenon potentially pushing us over a dangerous threshold. And while that's certainly a potential catastrophe, it's reductionist thinking in the sense that carbon emission isn't the real problem, just a reaction in a long chain of reactions and focusing just on carbon emissions will spell our doom.
But going back to your first question, we'd have plenty of water if we wouldn't pollute it, I don't see the need for mining decreasing, quite the contrary, so instead of dynamiting mountains and filling the area with cyanide for extracting gold or whatever, I'd rather have all of this happen in space, instead of our backyard. Mining on earth is only cheap because the costs are subsidized, being implicit in the damage to the environment, a cost that we'll pay sooner or later. If we'd factor in the real cost, if space mining is possible, I don't think it will look that expensive.
We can find lots of resources and turn them into useful energy and things.
But that only exacerbates the pollution issue, regardless of where we obtain the resources. Especially noxious is the non biodegradable pollution and the millions of years worth of carbon released from the ground.
> But that only exacerbates the pollution issue, regardless of where we obtain the resources.
Factually untrue!
Obtaining resources on Earth generates pollution that stays on Earth. If we move mining off-world, the byproducts of mining don't go into streams, soil, etc.
Furthermore, generating energy in space and beaming it down to the planet means not having to burn coal, reducing the risk of nuclear accidents, and eliminating the need for dams that disrupt ecological systems.
Yes, we'll need to burn more fuel to get there, but that's the nature of progress. The other alternative is to fall back to a pre-industrial lifestyle limited to only those parts of the globe where the temperature is mild year-round - unless you want to keep burning wood for heat in the winter.
I am proposing we slowly phase out mass producing products out of NON BIODEGRADABLE materials yes.
As for the Carbon - it doesnt matter how slowly we do it, we will still remove it all from the ground. It is a non renewable resource. Look at what we've done to slowly renewable resources like species - how many have gone extinct in the last 100 years? So yeah I think with carbon it's a foregone conclusion that we will floodthe atmosphere with it. But non biodegradable plastics etc. at least we can phase out.
I understand, but I disagree, because you can have carbon emissions, or you can have carbon emissions along with whole areas left uninhabitable due to mining and the need for mining resources will still be there, whether we want it or not. I stand by my opinion. I'd rather have mining happen in space.
And I understand the concern, but if reducing CO2 emissions is the goal, the first targets should be the production of electricity, heat, transport and agriculture. Food gets transported nowadays by airplane and maybe we shouldn't shut down nuclear power plants to replace them with coal plants. Plenty of low hanging fruits if you ask me.
for first time, I see some one that think like me about nuclear plants. Nuclear should be only closed to be replaced by modermand and more secure nuclear, or by solar/wind/sea powered centrals.
> So you think rain-forests and clean water exists on space ??
The point was that they (in the "all around us" / Earth sense) do not, so it is therefore more difficult to pollute them via space industry.
There's something to be said for an environment where you can run an unshielded nuclear reactor without causing any particular damage around your craft...
> We can solve those problems withing sending more rockets to space - which ends up burning more fossil fuel. Remember, every day that you are alive ( assuming you are living a developed country ) you are emitting huge amount of carbon.
Even if you launched 10 rockets a day, it's a tiny percentage of combustion compared to hundreds of millions of cars, trucks, buses, planes, coal and oil and gas boilers, etc.
I don't understand your second point.
But regarding "clean water on[sic] space", there are in fact ice comets containing tons of water that could be harvested by a future space colony. It makes sense that we'd want to exploit that source rather than try to move H2O into orbit from the Earth's surface. The Jupiter moon Europa is thought to possibly have a vast water ocean beneath its icy shell. The Moon may also harbor vast amounts of water locked in minerals or in subsurface ice.
With water, we can have colonies. Colonies can grow trees, entire forests in fact. The sky's the limit, so to speak. Really, there's a lot of exciting possibilities for spreading civilization into orbit and onto other planets and moons.
The spin-offs and economic expansion that space colonization will undoubtedly bring more than justify the costs of exploration. A few space colonies and mining operations will solve poverty on Earth. It's worth it.
There's a wide variety of ways that easy access to space could help the ecology. Battery technology at the moment needs a lot of rare earths, which could be obtained in space. Mining activities in space are mining activities not occuring on Earth's surface. Solar power may be augmentable using space technologies. Any high-pollution industry that can be moved to space is either polluting something already clinically sterile (remember pollution is not "intrinsically bad", that's a cognitive shortcut that works on a planet with life in every cubic centimeter, pollution is bad because of what it does to life; really, if there's no "life", there's no "pollution"), or "polluting" into something that will just be blown away on the solar wind, which makes it irrelevant. Easy access to space also enables some ways of controlling climate change; I've always preferred the space mirror approach to manipulating the climate because it's so fantastically controllable, unlike almost all other proposals to try to fix it here on Earth. (If you get it wrong, you can stop.)
Also, before you trot out the tired old "oh, we never thought we'd finish polluting the ocean"... first, run the math, it's very different, and second, the universe is already terminally polluted, in the sense that nothing much can live there until we go out and clean some space out. There's no life out there, not within anywhere we can get in your lifetime. It can't get any more uninhabitable than it already is.
Something that gnaws at the back of my mind is that the survival of our species is contingent on absolutely nothing catastrophic happening to the single planet we inhabit. All of our eggs are in one basket, so to speak.
Until we have a viable network of colonies offworld, we will continue to have this problem.
Absolutely. Ultimately we must leave this place. Not now—and certainly not in the near future—but eventually "we" (or whatever we become) will have to leave this place in order to ensure the survival of our descendants.
Think about the explosion in scientific understanding, world commerce and enlightenment values that came with the expansion of the British empire. Then think about the explosion of world commerce and related technological advances that came from colonising North America. We're still feeling those benefits wash over us as a species. Then think about what happens when we reach a tipping point where exploiting and colonising near Earth space becomes commercially viable. Like war, rapid expansion into virgin territories can be at once chaotic, uncontrollable and radically socially, technologically and economically invigorating.
The problem is even if we discover and obtain 100x more resources, that wouldn't solve the pollution problem. Life continues forward but creates entropy around it. Non biodegradable byproducts and all that carbon being released from the ground are the greatest threat to life on Earth!
If we get access to infinite energy and resources, then the answer to all your questions is YES.
But space.time is not infinite, far from it. We can easily imagine, eg. computational problems (ie. computer programs that can easily be written) that would require more memory than the number of particule in the universe would allow, or more time than the life expectancy of the universe would allow. So unless we are able within this space.time left to invent a way to create new universe or survive a big crunch/big bang event, or a cold death, no, there's no infinite energy and no infinite resources to be taped, and therefore:
- world hunger is not a problem of resources, but a political problem. The question is whether we're ready to gather in a concentration camp the psychopaths of the world, and exterminate them once for all.
- yes, we have already more than enough food.
- all hints are that cancer is a man-made illness. Once you've removed the psychopaths who build poluting processes to earn more $money or more power, we should revert to a more natural and canceless world.
- nope. It is not an economical crisis, it is an economical system set up by those psychopaths to keep accumulating money and power. They already own 99% of the money and of the power, but they still need to acrrue it at a significant percentage each year.
I should also mention, that assuming a population growth such as we double the population every 20 years, going to space would not solve any "overpopulation" problem if it was any more real than human-made climate change, since that would just mean that you would have to colonize new planets every 20 years. Very soon, the whole galaxy would be "overpopulated", and then soon enough the whole universe.
So going to space, offers no solution to "we".
However, having a space ship, and being able to leave this planet of psychopaths, crazy people, and savages, would solve "MY" problem! I would at least escape from this asylum-prison!
And there's hope the galaxy is big enough that if you escape, the US government and the banksters won't be able to catch you up to make you pay taxes and interests on the debt.
Healthy and educated people are looking for a way out, space mining serves only to build bigger, faster and better space ships to go farther, until we can get out of the reach of the psychopaths. And THIS would be the BEST solution, if you don't like the concentration camp/final solution.
While we in the tech community may find it morbidly entertaining to watch Theranos burn to the ground. Someone out there needs to attack healthcare. The not dying motivation is fairly important.
All the attacking that needs to be done is political/social, not technical. Want to attack healthcare? Strip middlemen out so that the money flows to providers and researchers (Single payer + pouring additional money into the NIH/NSF, with the results being public domain).
All of these YC startups I see "hacking" healthcare (Dr Chrono, HealthSherpa, etc) are just bandaids on a patient bleeding out from the jugular.
EDIT: Before you chime in to state that single payer can't be done, 58 countries [1] enable it just fine. Governments can be even more accountable than the current breed of private health insurance providers (I cannot replace the board at my insurance carrier, nor can I FOIA them).
If you want to "hack" healthcare and fix the problem, get involved in government and get single payer done.
My post never said it would be cheap. It would ensure 1) everyone was covered and 2) less funds were skimmed out by health insurance companies, leaving more funding to be used for health providers.
It would also help if a republican Congress didn't require Medicare to _not_ negotiate on drug pricing with for-profit drug companies. Way to leach off the public teat "small government party".
I prefer to make the distinction between Corporatism vs. Capitalism in these type of discussions. Corparatism, the big companies and governments as a symbiotic unit, not Capitalism is the problem. I have lived in Montreal with its public health care system for a year, and I now live in a rice farming village in East Java, Indonesia with their public healthcare system, and I grew up in Brooklyn, NY, so I speak from my experience and what knowledge I have acquired. Sure, you can go to the doctors here in East Java, and pay $1 to $2, and walk away with 3 or 4 prescriptions, but I am not sure that is good for several reasons. People go without even a thought to thinking about their ailment or complaint. The doctor doesn't do more than listen, and possibly listen with a stethiscope, and then prescribe generic medications to treat the oral complaint. I have seen my father-in-law come back with 7 medications due to high blood pressure. I checked it with my portable monitor, and he does have high blood pressure. They prescribed a blood thinner, an antacid, and bunch of other meds you would see as possible prescriptions. My twelve year old niece had a blood test at school, and her cholesterol was a bit high. Result: 3 prescriptions, and not a lot about diet change or exercise. Lines are longer the closer to the city you get. Here people are there with sore elbows, headaches, etc... These are people who shake off a lot of hard daily work and bruises. They go at a whim when they are not working, and bored, and the simplest of ailments are perceived. I am anxious about the amount of prescriptions handed out, and the quality.
In Montreal, in Spring or in stretches of good weather, there would be lines outside the emergency room. I went and inquired if it was for flu shots, or some other special day since they had setup folding tables and chairs to handle the patient load. The jaded healthcare worker explained this was typical, and made some comment about if somebody sneezes, is bored on unemployment, they head to the emergency room.
My daughter needed surgery back in NJ, USA, while I was in SE Asia, and I thought it was going to cost me $16k to $20K, since my coverage had just expired. I asked how much to pay up front in cash to make sure she could get the surgery, and it turned out that if I paid the hospital, the anaesthesiologist and the surgeron each separately the cost would be and was $5k. I asked why, and I was told by all 3 offices, that this was their real price, and that when it goes through the insurance companies they spend up to a year or more trying to collect, and at a 40% rate or less. The gratitude of me pre-paying in cash, was shocking. They never have that, and it makes for less work for them. They were so thrilled. The hospitals and doctors charge a lot more to make sure they cover the administrative costs of tracking and chasing payments, and to cover the costs of the procedures themselves. I guess that's what you get when you let big companies and government intervention do their thing.
I am sad at this Theranos thing. I do not know about the truth; I guess we shall soon know. I see the idea of disrupting the labs and innovation as a good thing. So I hope guilty completely, partially or not, it has at least challenged the status quo. I know their are smaller quantities of blood testing kits available, not as small as Theranos, but I sure never heard of them before this fiasco. The benefit of reading HN! The conspiracy side of me, urges me to look at big Lab and Pharma as not wanting this to happen, or at least outside of their walls. They will make a slightly more volume blood test work, and now reap the publicity and sell it to the public and government. My Uncle Victor, who upon seeing my drawing of a car running on water buy using a solar cell to perform electolysis on water and exhaust of water back in 1974 (I had just built a solar oven and purchased a small solar cell, too small) spurned the idea, said to me: The big oil companies, or (pardon the racist, parochial remark here relayed) the 'arabs will come after you'. We used to call him Archie Bunker from All in the Family. A very funny show that would cause many to protest if it were on the TV nowadays.
Sweden is always held up as a model of public healthcare, but we forget their financial crisis in the 1990s that started with slow growth once the US ended the gold standard in August 1971. They didn't get out of the 1990s crisis until they started embracing more capitalistic practices, so their healthcare system should not be used as an argument for it to be applied in the US. Not to mention, costs of covering 9.5 million people in a smaller geography, vs. 310 million people in a much larger geography. It is not simply a scaling problem or application.
@pinaceae I accidentally upvoted you looking for 'reply' button. I admit I wrote this with little sleep after a game jam, and it is lengthy, and not my best writing, but I was responding to the healthcare aspect of @toomuchtodo's thread. Was your remark intended to be snide? I find it offensive in any case that you would compare what I have written to a murderer. I guess with all of your karma here on HN, you find it easy to hide behind your keyboard without much consequence. I am always eager to hear opposing view points, not for argument's sake, but to learn. Hopefully this can turn into a less ad hominem discussion, and we can both walk away a bit better off for it.
[EDIT] - moved reply to @pinaceae, and deleted from under my comment.
One, the private costs are off the chart with regard to our peers, but the government spending is just "more than average". but more than average is presented as being just as bad as the outlier we are in the first case.
Two, medicare is responsible for the most expensive health years of a person's life. The time when our bodies just start to fall apart and require a lot of specialized care. Medicare's cost controls seem really good when their youngest clients are 65. Comparing their costs to a private company, who insures working adults, seems like a shallow analysis.
I think the argument is that US government financed health care that only pays for maybe half the population is already more expensive then paying for 100% of the population in other countries.
So it's a stretch to imagine that having the US government take on many more patients would lower costs.
The problem with the U.S system is everyone has their hand out for money. In America, Money is considered the universal yardstick for success and universally effective solution to all problems. The health care industry grew 20% last year? Fantastic!
It's a perfect example of the civilizational collapse process that Joseph Tainter, a professor of archeology, wrote about in his book "Collapse of Complex Societies"[1]. A society will get some sort of civilizational process that works to create wealth in their society. The civilization will continue to increase complexity to exploit this process and when the process starts returning negative marginal returns the collapse process begins because the whole civilization can't switch into reverse. This happened to the Romans with their conquer and receive tribute process for example. It eventually started yielding negative returns and they couldn't reverse course. The inertia was just too great.
Well, its politically impossible now, but people opposed to it are dying every day.
Same sex marriage, marijuana decriminalization/legalization, etc all took time. This'll take time as well. I just wish people didn't have to suffer and die because of their fellow citizens' shortsightedness.
You need a politically strong somewhat lefty government to ram it through against the vested interests who are rich from the present system. Single payer was opposed similarly in the UK but we had a landslide left wing government after WW2 who got it done. A shift in the US towards say Sanders could do it but it doesn't look like that's happening this time around.
There's hundreds of factors affecting the efficiency of a singe payer system in the US compared to other countries, including population size, illegal immigration, crime rates, etc.
Solutions for one country may not work for another
While converting from our current patchwork system of government healthcare (a system that's been fragmented in large part due to insurance industry lobbying) will have a high initial cost, it will ultimately be more efficient. As it stands, the insurance companies add enormous overhead (office buildings, sales, advertising, etc), without actually providing any care.
In the US, I think the current grass roots movement towards Direct Primary Care plus catastrophic coverage or a health savings account is more politically and logistically viable.
Single Payer would be great if you can trust the uh, payer. But our government is delightfully corrupt, so I'm sure a lot of people with more rare medical conditions would end up with worse treatment than they can get now.
In my country, we have a single payer - the NHS - and we also have private insurance which people can buy, or more commonly be given as a perk by their company, on top of that.
Result? Everyone gets generally great healthcare, nobody has to worry about bills if they get in an accident or fall seriously ill, and people who fetishize "great customer service" (mostly shorter wait times for certain things, though they don't have facilities to handle nearly as much as the NHS does) can get what they want too.
Is it actually corrupt? I hear a lot of hot air about the USG being corrupt, but I almost never hear about quid pro quo scandals... just politicians asking for money because their constituents demand expensive campaigns. We don't like what the government does sometimes, e.g. NSA etc, but I think we have an honest disagreement with them on the best way to protect the country (though they use shady tactics to get their way).
Essentially, it looks to me like government is incentivized to do their job, and most of the problems are due to the way people vote (though gerrymandering and voter disenfranchisement schemes like voter ID are a big problem). The soon as voters change their tune, politicians flip on a dime. I've seen it time and again.
So that said, I'm tired of this corruption meme. Can we talk about implementing good systems instead of assuming other people are out to get us?
Single payer manages to function in plenty of countries with worse corruption than the US. The US is one of, if not the only rich country without a universal healthcare system.
Is it better that the majority who have common ailment get easy and very cheap treatment, at the cost of having a more expensive treatment for rare ailments?
Maybe we should outsource much of our government operations to people from western Europe. I propose a new law that only people from Iceland are allowed to run for Congress!
> If you want to "hack" healthcare and fix the problem, get involved in government and get single payer done.
So we can turn what health technology gets developed into even more of a political game? Building a board of government insiders as opposed to scientists and clinical experts is exactly the kind of move that would work especially well in a single payer system. You want to know what healthcare would look like when governments were the only payors worldwide? Look at defense contracting. Or aerospace. He who had the best lobbyist would win.
If I could change one thing about the commenting on the state of our health care system it would be to require everyone who says "oh we just need single payer" to spend a year working for an insurer, a hospital, and a health technology manufacturer. Then come tell me that changing who pays will fix all problems. Here is a following not-comprehensive list of things that would not be fixed just be going to single payer:
- the US subsidizing all health tech (drug/device) development
- fee-for-service payment structure leading to perverse incentives
- malpractice fears leading to risk-averse, defensive medicine
- poor reimbursement rates yielding waiting lists to be seen by a doctor
- bureaucrats in CMS (the payors) exerting influence on the FDA to not approve new technology because they feel it is too similar to existing technology
- regulators creating vague rules that get applied differently from case to case, making them impossible to plan for
I could go on. I do agree with you that a lot of startups in the space are putting a bandaid on a bleeding jugular. But saying "let's get government more involved" neglects the fact that we're in this problem in part because government is very involved and has been since WWII.
There are three ways you can make healthcare better and cheaper for everyone:
- Make health technology cheaper
- Change the way health care is paid for (I credit Oscar for trying to make it in this space but for various reasons think they're unlikely to succeed)
- Change the way that health care is delivered
There are a number of startups tackling the latter (telemedicine, doctors on demand, drugs delivered to you, etc). Unfortunately the Affordable Care Act has many provisions that make it difficult to innovate in this space, because of the view that it's much easier to control costs when the point-of-care is controlled by a few big hospital systems.
I run a startup that's trying to tackle my first solution: making health tech cheaper by making it easier for startups to get their products through regulators and disrupt incumbents.
But even if we're wildly successful and can start lowering health tech costs across the board, the problem won't be fixed until we fix the payment structure, which will require innovation in payment models, not a one-size-fits-all government plan.
...to spend a year working for an insurer, a hospital, and a health technology manufacturer
Living decades in a "single payer" country gives you another outlook: that's a solved problem. You're just doing it wrong. Everybody that has seen it working knows it's wrong and will shrug off whatever ellaborate argumentation you choose.
fee-for-service payment structure leading to perverse incentives
Wouldn't a single payer system make this easier to change? I guess there is a high chance that a single payer law might codify the payment structure and do it in a bad way, but at least then there is a clear path to improving the structure. Legislation modifying the single payer system to work better would probably be less controversial than legislation modifying our current system.
I'd like to see the tax advantages around employer health benefits disappear so that people have to take a nice clear look at just how much they are spending on health care, rather than just handing money to providers.
I'd also like to see providers that benefit from regulation be required to provide up front information about the prices of low risk services.
The attacking part is great. It's the "fail fast" part that they messed up on. If the machines worked, would we be having this conversation about a company accused of lying to regulators and defrauding investors?
Maybe it's a problem of Theranos setting investor expectations poorly, maybe the regulators are looking to make an example of someone for playing fast and loose in the traditionally tightly regulated healthcare industry, maybe both. Hopefully it's growing pains for a burgeoning biotech market and not actually fraud from the top.
Medical care and health care aren't actually the same thing. And the problem is that actually improving health for humans tends to be relatively cheap and culturally based. It is pretty much not a big money space. It involves things like inventing soap and getting people to wash their hands. And this is a thing most people do not want to hear.
Better drugs and better surgeries are all ooh, shiny! but they really are not optimal. The optimal approach is boring and hard to even see. People who fail to get sick are incredibly hard to measure. Heroic interventions after the fact are far easier to measure and make for more interesting press. They also can be charged big bucks.
Good summary. Especially the healthy people being hard to measure. Never heard anyone put it that way before. Now that I think of it, it's usually easier to tie data points to specific illnesses than to a lack of them. I have a feeling I'll be wondering about this in the future.
Quick guess is that healthy relies on emergent behavior of locally interacting cells. Lots and lots and lots of complex behavior with few observable inputs and outputs into the body. The inputs might not have a direct correlation to healthiness. We'd have to have a model of all those processes before we'd see evidence of healthiness in the data points.
Healthcare like almost every major enterprise vertical is a wicked problem[1] and these problems are pretty much rife with far more than just technical problems. Most of the VC founded ventures are honestly quite terrible at attacking the Fortune 100 that dominates these verticals including reasons like collusion as well as regulatory capture. A $10M+ series A seems like big money to a lot of the people in tech, in the enterprise space of the Fortune 100, that's a rounding error resolved by just firing one or two middle managers. I can hardly afford good sales guys covering all the regions for long enough of a sales cycle that I could confidently ever make a single deal on that alone - the enterprise approach to relationship-focused sales and procurement cycles forces the necessity of well-networked, very expensive sales people, unfortunately. That's the kind of slow-moving, massive capital flows that are at play, and there won't be any company that can attack that problem head on because it's not a technical problem whatsoever. Even worse, because these industries are capitalized heavily as public companies, their board of directors appoint super risk averse leaders culturally and will not move forward without finding a business model that will not cannibalize existing sales. Even still, if such a technology and business model existed, it is simply very, very easy to torpedo these efforts politically within these companies because these companies are already so profitable (think Hollywood-style accounting for a second, not tech company or even i-bank style simplistic accounting) they'd rather get rid of emerging competitors than to actually innovate. After all, in the health insurance space, as long as people (and, more importantly, companies) are paying premiums and subsidizing a sufficient number of costly patients that need care, there's little reason to really try to innovate in terms of technology there. That becomes something up to healthcare providers to try to work at, but they're typically courted by a very, very well capitalized and networked cartel of healthcare companies typically founded by doctors first, not technology people. Doctors may be smart oftentimes, but they're just not technology people fundamentally after decades of practicing medicine.
I agree that the problem must be attacked, but I have my doubts that it would come from a VC funded company in the same vein as most SV companies that have done so well. And as Theranos shows, I have my doubts that the highly kleptocratic cronyism driven private government contracting space will do it either. It may very well require a completely new model that incorporates the best ideas of both funding vehicles to avoid the common pitfalls of enterprise b2b companies.
<sarcasm You are violating the fundamental commandment of tech optimism: throw enough money and naive young nerds at it, you can solve ANY problem. Google is even trying to defeat mortality. /sarcasm>
It's better to make photo-sharing apps and sell iphones. While healthcare is very hard, also needs alot of money. My idea would be: create photo-sharing app/telegram/iphones etc to make alot of cash and THEN try real-science-shit (like Elon Musk / ~Paypal Mafia).
Chicken is a lot like fracking - it probably has some external cost - but its a lot better than beef,tuna . . or any other meat out there - in terms of environmental sustainability.
Its also possible to recycle almost all parts of a chicken.
For example people in europe,america like what is know as the "white meat" ( not sure if its a co-incident ) - breast,thigh - and people in asia like "brown meat" - which includes leg,wings.
So what the global food producers do is recycle and even out the demand which is one of the reason why white mean has became so much cheaper in europe.