What about quality of care tradeoffs? In Canada, for example, you are forced to use the government system, and if it doesn't deem you important enough, there is no private option.
Interesting. In every European country I know of, the private option is still available. Just vastly cheaper and more beneficial due to having to compete with a public option which covers basic necessities, surgery etc.
Yes, this is what I find a little odd about the US proposals. I've lived in UK and Spain and in both they have great free public healthcare for everyone, and if you (or your employer) want to layer private insurance on top you can. Wouldn't that be a much more appealing proposal to Americans?
Perhaps, but given the current shortage of healthcare providers we would probably see many doctors drop out of the public healthcare system and only accept private insurance or cash payments.
Is this quality improvements including or ignoring the 30-ish percent rejection rate of the most popular healthcare system, including such gems as insulin and pre-authorizations refusing surgery for necrotic tissue when “maybe they could PT it, have you tried?”
PT? Luxury! My daughter had PT referred by her pediatrician, then the insurance didn't pay all of it and when I asked the insurance company for the EOBs they said they were not allowed to give them to me because it would violate my daughter's privacy.
Our insurance paid for the bill from my wife's surgeon but spent 8 months refusing to pay for literally anything else, including the anesthesia. They said it was "medically unnecessary".
There are private options for lots of things in Canada, depending on the province.
Without data on what proportion of people are denied and what the consequences are, this isn’t a good faith argument.
On the flip side, cases that would get care in Canada are denied in the USA by private insurance. Private options are far outside the means of most people.
This is frequently true in the USA as well. My provider's dermatology department is pretty backed up and couldn't make me an appointment for an excision until November. Fortunately it's not urgent.
Agreed, it was 2-3 months wait to get to see an ENT for me last year. My daughter's regular eye check identified a problem and it's 3 months to get her into an eye specialist to review it.
Somewhat related: a couple years ago my spouse had cancer, and the doctor could do surgery either 5 days after our insurance was changing companies, or 2 months after that, those were the next two openings. The insurance said that if we proceeded with the surgery, without the new insurance company giving us approval, but they couldn't start approving it until the insurance started, and the pre-approval from the other company didn't give us anything. We finally decided to go ahead with it and take on the risk of ~$70K if it was denied. Which we decided to do rather than my spouse spending a few months worrying. Turned out that was a really good call, because when they did the surgery it turned out that instead of the expected slow growth, it was actually growing extremely fast. That was probably the difference between it being fatal and it being treatable.
ZocDoc isn't reflective of availability as a whole. It has a lot of depth in certain areas, like dentistry, dermatology, and primary care, and less in other specialties. Many of the providers are not physicians, they're NPs and PAs. Perfectly qualified for certain kinds of issues but not others.
ZocDoc is also, obviously, working only with the providers who are willing to pay for new patients, such as newer practices trying to build a patient base. An established practice that is booked out for the next two months obviously isn't going to use such a service.
Finally, you're not considering insurance and continuity of care.
So yeah, in an urban area, you can probably find someone to see you sooner than later if they're in network or you can afford to pay, and you're okay with seeing someone you might never see again or with whom there might not be continuity of care.
Are all of those specialists "in-network"? Have you tried contacting them to see if they truly have availability? It's common for providers (or the insurance carrier), at least in my area, to claim they take new patients when in fact they do not.
(For those not in the know, out of network means costs to the patient are much higher).
I agree with the main point. The thing is, in the US, wait times are a function of how much you're willing to spend. You can always pay for priority. But most people won't pay more, and the reality is that most healthcare systems have far less provider supply than demand, particularly in dense urban areas where most people live.
> If you need to see a specialist, you regularly have to wait months, assuming you can even get a referral in the first place.
Two months can be a luxury. With my insurance in the US, it usually takes longer for me to see an in-network specialist. For my kid, it has often taken over 6 months.
Of course, none of these were urgent, so it was fine. If it really was urgent as deemed by a medical professional, I likely could get a quicker appointment.
But my friend, who has even worse insurance, developed a condition and was having trouble getting a diagnosis. He got referred to neurology, and none of the in-network specialists had an appointment for over 2 months. His condition made it hard to sleep every night (averaging about an hour of sleep a night). Due to the lack of sleep, he couldn't function at work. Took a leave of absence, got a plane ticket to go to a relative's country, got to see a neurologist the next day, got treatment that day and had his first good night of sleep in a long time.
Lost his job because of it, though. Unsure what his medical insurance situation is while living on welfare...
That's not at all unusual in the US. My dad saw a neurologist for chronic severe headaches. It was very common for us to go to an appointment, have the doctor request a follow up appointment in 3 months, then be told during checkout that the earliest available time was in 5-6 months.
Hah, even with "platinum" healthcare in the US, urology referral, 4 months. "You should start PT immediately" after a car accident, "we can see you in 5 months".
"Oh, your septum is deviated ~90% on the right. Surgery? No, first you need to go on these nasal sprays for a few months so we can decide they didn't reshape the cartilage in your nose before your insurance will decide whether they want to "allow"[1] surgery."
[1] Insurers will always say, and have won in court, saying "We don't allow or deny anyone any care they need. We are just saying we won't pay for it."
Yeah, I think we have a lack in our area. Years ago when I had a kidney stone, the L3 Trauma Center hospital a few minutes from me had to load me up on dilaudid and ship me from their ER across town via ambulance.
The US is not much different.
We don't have a wealth of specialists available to see people right away.
I've flat out been rejected from a specialist because they had no availability at all.
I actually tried again and got to be seen, but an appointment is months out, always.
I don't know about Canada, but here in Spain you have both. You have public health guaranteed, but many people also have different levels of private coverages, usually to get quicker appointments.
As I understand Medicaid, it would just be open Medicaid for 100% of the US population regardless of the income, remove Medicare (they are now under Medicaid), leave the private sector as it is. Do you think Medicaid is too slow, too low quality, too terrible in general? Pay for private insurance, but you can still go to Medicare if needed.
I'm in Canada. The only time I ever needed a doctor in my life it was denied. I ended up having an issue that took ~5 years to resolve, which could have been prevented easily by any competent doctor in a 30 minute session.
I'm originally from Mexico. With what I have paid in tax here over the years I can afford to set up and operate my own small hospital over there, with new equipment, this is not an exaggeration.
"Free" healthcare, as with many other free things, turns out to be the most expensive kind of healthcare. Anyone who thinks otherwise doesn't really know what they're talking about or they're just stupid.
What could work, imo, and since we're all giving opinions here, is private healthcare with a ceiling on profits. Let players take 2x-5x, but not 50x which is what they do now, bring and enforce usury laws into healthcare.
Does American private insurance pay for everything? And if you say "but they can pay out of pocket", well Canadians can come to America and pay out of pocket too.
For a lot of people it very much doesn’t. And the cost is very prohibitive for people getting any care at all when insurance doesn’t cover it, so they end up not getting necessary care and then ending up on disability for life.
A healthy population *makes money for taxes and buying things*, too.
First off, all Canadian provinces are different. Here in Quebec, there is a absolutely a private option. Not everyone likes that it exists, but most people seem to like having that option.
Canadians live better for longer on average (for cheaper healthcare overall). Any other metric is just a misguided attempt to justify the US status quo, which has nothing going for it unless you're rich.
The differences in life expectancy are due entirely attributable to vehicular accidents, homicide, and life style factors. It has nothing to do with medical care.
My dad, in the US on Medicare (one of the government funded systems), was denied a test. Because we have the option and had the money, he went and got the test himself on his own dime. That kicked off a series of events that led to a quadruple bypass, avoided an impending heart attack, and likely added many years to his life and his ability to remain and functioning member of society.
While I love the idea of never having to think about health care costs for a variety of reasons, I do like that some services are available to anyone with a wallet and not locked behind government controlled gates.
What about them? The Canadian healthcare system has better outcomes than the American healthcare system in several areas. Most simply, Canadians live longer.
I'm 29 and when I was a kid, getting a family doctor used to be an easy task and if you needed to see your doctor you could get in that day. Now all the doctors are so overworked, they're fleeing to America where they can get paid a reasonable wage for a reasonable amount of work. If you can even get a family doctor, if you want to book an appointment, they'll ask you which day you'd like 4 months from now.
My mom's been dealing with an issue with her lungs for the better part of the past year, and trying to get help through any of the intended methods just gets her put on a 2 year wait list. At this point her plan is to pay tens of thousands of dollars out of pocket to see a specialist in America.
The current generation of elderly Canadians now having lived a long life spent most of that life in an entirely different Canada. My generation is going to die on a waitlist.
Life expectancy is a function of demographics, which averages ignore.
Income is also an assertion not supported by data. For simple procedures such as a knee or hip replacement, many people earning under $80K CAD opt for US treatment.
Likely because Canada has extremely bad waitlists which are continuing to deteriorate. That coupled with a lack of specialist medical options and lesser quality.
In Canada, a woman with breast cancer could be waiting 2 months to even start treatment. In the US, you'll be starting next week.
It's just because America is big and has a lot of hospitals and has changed dramatically many times over the past 100 years.
There's lots of places in America with spare hospital capacity. In those places, locals still cannot get affordable treatment, because our health insurance system is bad.
Meanwhile, plenty of places in the US have the absurdity of our broken healthcare system, and get to wait 4 months to see a doctor after having a stroke, like my mother had.
Or like my ex, who had to wait TWO YEARS for an MRI and neurology appointment, and that took so long that by the time her appointment was coming up, her situation had changed and needed other investigation and that appointment was not really a good fit anymore.
The situation is so mediocre in most of the US, that you have to travel hundreds of miles to see specialists anyway.
Nearly every single person in Maine who needs to see a specialist is waiting months. If you are in northern maine, you will have to wait months and travel to southern maine, or wait a year for a traveling specialist who has to fit a hundred patients into a timetable meant for 20. If you need to see a special specialist, you will be triaged on the same list as the entirety of New England for the one doctor in Boston who can actually do anything for that condition.
The same guild system that keeps US doctor compensation high is also keeping supply low! Someone is going to be waiting to see a doctor! If they weren't, US doctors wouldn't be paid as much!
I also feared this, until I read that some US citizens avoid going to the doctor until it is unbearable. Take this examples: here in Spain you go to the doctor because you think that mole is slightly bigger than past year. They point you to the dermatologist in january 2027, a terrible 6 months waiting. In the US a lot of people thinks "hey, doesn't look that bad, and it could cost me $5,000". Five years pass, and now the mole is five times bigger, it bleeds and... well, it is a full blown melanoma: you get to the dermatologist 1 day after consultation, yet is too late.
In New Zealand we have private insurance and universal health care. Insurance kind of fills the gaps and usually has faster turn around time, like 1-day vs 1-month for an MRI.
But like insulin is free for everyone, so nobody is going broke while dying here rationing it.
This is what is never mentioned. Quality of care, access to cutting edge treatments, timely access to care are never discussed when moving to universal healthcare. There are examples of private and public systems out there, which would be a much better model.
My understanding is that a clinic or hospital can’t legally charge you for a procedure that’s universally available through the provincial healthcare system.
So you’re free to pay for anything else if you want.
This is just a version of individualism vs the state. Much of western society has become increasingly confused about what violence is acceptable, let alone who should be allowed to commit violence, or have a monopoly on violence.
If we can't agree on that baseline, then its quite obvious that we'll continue to have an escalation in the types of violence that we've seen in the past few years, against the political and corporate classes in the US, with very little end in sight.
Part of the point about violence is it has little to do with societal agreement, to start with. It's what happens when that agreement breaks down. And in the end, it can change the agreement.
That seems to me like a somewhat odd way to put it. From where I stand, the large majority of objection to "state monopoly on violence" comes from those who otherwise express a strongly collectivist worldview.
Brussels appears to be extremely tone deaf to the basic needs of ordinary people, and taking further steps in a direction to centralize power is just going to push more people to the far right.
For example, the fact that right-wing governments in central and eastern Europe are protecting their borders, represents a very popular perspective, apparently shared by very few in the EU governing body.
Consolidating power at a moment when many EU policies are clearly unpopular seems like it will have unintended consequences.
It is really make or break for the EU "regime".
This is because the EU never had a clear goal and so the project cannot be finished if it was to survive.
First it was about harmonizing law and standards, then the Euro and stabilizing and rebuilding the eastern Europe. All those things were good ideas and great successes, but now what?
This is why they really wanted to absorb Turkey 20 years ago, and now Ukraine, Brussels needs a new project so it can justify it's existence and expansion.
So it becomes a devouring mother who keep their 40 years old kids at home and try to find new one to adopt.
The EU is also unfortunately a very pre-Internet and pre-globalization project.
Just put yourself in the shoes of the previous generations who had to imagine a system to have Germany, Portugal and Greece adopt standards to be able to work efficiently together? This is a very hard problem in 1970 or 1980.
Today if Greta from Hamburg want to get in business with Portugal she search on Google, send an email, go on a Zoom meeting with real time translation and can pay with a stablecoin. If she need to figure out some laws in Portugal she can ask ChatGPT. This was science fiction 50 years ago.
That is not even necessary, she can go on aliexpress and do business in China instantly. China is not part of the EU but it seems we are very interconnected and do a lot of business with China anyway. And your shipment from China is protected by the Seventh fleet, not the EU.
Protecting the borders or raising an army? those are not things a bureaucracy know how to do or can do... it was not designed for this.
So yes the EU is trying to find a new frontiers: physical, ideological or digital. This is why in recent year it has been a lot about regulating the Internet, social media, porn, crypto, chat, AI, etc. But regulating a technology when the cat is already out of the bag is really hard so they will have to get China level authoritarian to show some results.
I've been building something similar (GPU-native OS research project) and wanted to share a mental model shift that unlocked things for me.
The question "why run CPU code on GPU when GPU cores are slower?" assumes you're running ONE program. But GPUs execute in SIMD wavefronts of 32 threads - and here's the trick: each of those 32 lanes can run a DIFFERENT process. Same instruction, different data. Calculator on lane 0, text editor on lane 1, file indexer on lane 2. No divergence, legal SIMD, full utilization.
Suddenly you're not running "slow CPU code on GPU" - you're running 32 independent programs in parallel on hardware designed for exactly this pattern.
The win isn't throughput for compute-heavy code. It's eliminating CPU roundtrips for interactive stuff. Every kernel launch, every synchronization, every "GPU done, back to CPU, dispatch next thing" adds latency. A persistent kernel that polls for input, updates state, and renders - all without returning to CPU - changes the responsiveness equation entirely.
A few things to try at home if you're curious:
1. Write a Metal/CUDA kernel with while(true) and an atomic shutdown flag. See how long it runs.
(Spoiler: indefinitely, if you do it right)
2. Put 32 different "process states" in a buffer and have each SIMD lane execute instructions for its
own process. Watch all 32 make progress simultaneously.
3. Measure the latency from "input event" to "pixel on screen" with CPU orchestration vs GPU polling an input queue directly. The difference surprised me.
The persistent kernel thing has a nasty gotcha though - ALL 32 threads must participate in the while loop. If you do if (tid != 0) return; then while(true), it'll work for a few million iterations then hard-lock. Ask me how I know.
If you're running vastly different processes in different ALU lanes, the single master "program" that comprises them all is effectively an interpreter. And then it's hard to have the exact same control flow lead to vastly different effects in different processes, especially once you account for branches. This works well for inference batches since those are essentially about straight-line processing, but not much else.
It'll go much faster if you give each process a warp instead of a thread. That means each process has its own IP and set of vector registers, and when your editor takes a different branch to your browser, no cost.
Seattle is the type of economy that is heavily threatened by AI. Desk jobs that Claude basically already knows how to do, and just needs to be integrated into the existing systems to have impact.
Most people in Seattle "tech" are middle management with no discernible skills other than organizational deckchair arrangement. It is a place to optimize for work-life balance, and not take risk - this is why the region, despite its technology density, has such a disproportionately small startup scene.
AI IS a huge threat to a place like this and I am not optimistic about the ability for people to adapt.
China has 900M people making less than $400/month, and 600M people making less than $100/month. relative GDP is a joke, go to China to see what most of them are eating (hint: it's unsafe food filled with chemicals, or its mostly carbs) and where these people are living (hint: it's shoddy constructed condos or run down farm houses)
Not sure why you have something against the flyover states. I'm sure there's more shoddily constructed condos in Florida/California/New York per capita than there is in the Midwest. Same goes for cheap high calorie food.
Of course, the same can probably be said about the large population centers in China too. More people concentrated in one area tends to mean more poverty in that area and all the things that come with it.
The parallel is that there are rich and poor? It is unscrupulous to argue in imprecise, binary terms while ignoring the difference in scale. People in flyover states are not making only $400/mo or even occupying that same societal equivalent of China in America.
I'm always unbelievably pissed off when I reserve a premium tier of car at SFO for a business trip, and Hertz tries to stick me with a Tesla, as if it is a premium car (horrible interior build quality), and with the assumption I have time to install apps and figure out how to use car charging infrastructure.
The Tesla is not the kind of car I'd like to just jump into for a two day trip, but the neither the car charger or key card entry requires an app, or is particularly weird. You touch the key card to the door column to open or lock, and you plug the charger in.
But the interior build and the touchpad interface mean it'll never be a top choice. It's just awful.
Maybe I want the novelty of trying out an electric car on a business trip. But far more likely I just want a bog ordinary car that I can drive from point A to point B.
My theory is it will work itself out in time. Once let’s say a quarter or maybe half the population is driving EVs, they’re not specialty vehicles anymore. There will be plenty of people willing to accept them so if you run into someone who absolutely doesn’t want one you’ll probably be able to compensate just fine. It will cease to be a specialty car.
It will be a little more like manual versus automatic used to be. Anyone can drive an automatic, but some people can only drive an automatic.
But if you don’t give EVs to people charged and there aren’t enough chargers around then even people who would otherwise take them (owners + the curious) will avoid them.
Sure. At some point EVs become something that someone renting a car would be expected to know how to deal with. Of course, that could take a while though. And it may be unevenly distributed. The uptake of automatics has been much slower outside of the US and, within the US, I've actually had a service associate need to have a tech drive out my car because they couldn't drive a stick.
Conversely, I get frustrated when I ask for a long range electric car and they either only have ICE cars or they have, like, a Bolt (an EV that I love, but long range it is not).
At the same price point Teslas have a very spartan and cheap feeling interiors compared to almost any European manufacturer.
Sitting on a Mercedes CLA is much more comfortable than any Tesla around US$ 45k. It becomes even more disparaging when you go higher on price, a Tesla Model S at US$ 73k interior looks dreadful compared to any Volvo/Audi/Mercedes/BMW at the same price.
It's not even a nice looking minimalism, it's just spartan and cheap looking/feeling.
Base/rental trim -A and -B Benz interiors are terrible (in the US). Hard seats, plastic everywhere, shit tier center LCDs; list goes on. Civics are better.
I agree that the Model S interior falls short of most cars in its price range, though.
I'm comparing from living in Europe, have no idea how these cars are in the USA.
I ride in Teslas cabs quite often here in Stockholm and they are comfortable but not at all what I'd expect from a high-end interior, the Mercedes, Lexus, Volvo, and similar cabs here look much better inside than any of the Teslas I got so far (Model S/Model Y).
The A and B trims in the US are the lowest tiers that Mercedes-Benz offers and are spartan, but tacky.
Tesla’s high-end cars don’t have high-end cabins; we agree there.
In the recent past, a Model S with FSD was $143k for the Plaid trim. This was comparable in price to a Benz S550 or a BMW 750i, both of which have incredible, incredible interiors. Super plush, real leather seats; rare wood grain everywhere; customization to no end; coffin-quiet cabins; plush air suspension; etc.
That’s before taking the dealer experience into account. I don’t have experience with Benz dealers, but my understanding of them is that they are actually worth spending time in, and they take care of you when things go wrong (loaners of equivalent trim or just below; great coffee; clean centers; etc.)
Meanwhile, both Teslas offer cabins that I’d say are beneath what you’d get from a maxed-out Honda Accord. I have two Model 3s (old and new designs) and have rented the S a few times now, and I love Teslas, for what that’s worth.
Mobile service kicks ass, but if you need to bring the thing in for service, you’re probably looking at Uber credits. Shameful for the price.
Technology was the only thing the Tesla had the upper hand in.
The funny thing is. China can talk about removing the U.S. dollar and trade when Yen. But they need a stable currency to convert between and so conversion is still done with the U.S. dollar. The U.S. dollar won’t be removed from trade in our life time.
China doesn’t let the RMB float freely, so trade still happens in dollars. Also, the American government buys a lot of treasuries, so it’s easy to save a few billion quickly when you need to, which isn’t really supported by any other currency…saving money by lending it to the USG conversely prevents it from re-entering your own economy and stoking inflation (China isn’t the only country to use the USA like that, Japan buys more treasuries than China usually).
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