bigchewy

if you read it 4x and don't see his point, consider reading it another 4 times. you seem to be advocating that certain employees, "bottom of the food chain" in your parlance, aren't culpable for their actions whereas the parent was saying everyone is culpable for their actions

huh?

The stories I've heard from CPAs and other friends is that it it's amazing for small companies < ~$300K annual revenue and then falls apart pretty quickly once you need to do something other than just basic reconciliation and pay taxes

I don't think you understand the definition of the words that you are saying. Consider looking up the definition of e.g. fraud

Ummm unless lawyers somehow have evolved different brains than the rest of us, they, too, prefer to make more money vs less. So if they are billing hourly, then yes they all do want to spend more time. Now, they might fight against that urge (E.g. believing that spending less time on Client A will improve their reputation and lead to more clients) but your statement is naive re how incentives work

> I have a blocker for all news sites so i can't access them without going through like 20 steps.

Then consider no longer commenting on news related articles, sources etc that you don't know anything about. Wild speculation isn't helpful.

what you are saying is that you don't know any hikers that care significantly about weight.

I can also state that the majority of people I know care so much about weight that they would never carry mountain house type food around.

If we both extend our friends to the general public, we have a clash. Or, maybe, there are different types of people in the world, some of whom think that Soylent is a great alternative for many of the situations they find themselves in.

bold statement. I'm assuming you mean the potential env. damage, correct? Have you done a thorough analysis on, say, Blue Apron's impact on the environment? for example, do people who use Blue Apron decrease usage of their car to go to restaurants? I'm not convinced it's as black and white as you imply it is

you were the recipient of people that were terrible and/or just new at active listening. If it's done right, you just feel like you are enjoying the conversation. no different than writing code, playing the piano etc. related, some people are just genuinely interested in other people; that's also not noticeable.

thanks for reminding us - I just put in my card on a repeated monthly donation. Easier to keep giving if set on auto-pay vs forgetting

look at the government plans - police, fire, teachers etc.

you must not have gone to b-school, nor know many graduates. The one thing that b school doesn't do is teach people operations. Many professors consider operations easy / tactical / something vs strategy. I actually think b school would be much better off if it did concentrate on teaching students how to properly operate.

and, btw, as a person who has spent 10 years analyzing the healthcare industry, we need more "medical factory" thinking not less.

any time a problem of this magnitude hasn't been solved AND you think the answer is 'blindingly obvious', consider that you don't fully grok the problem. I've been in healthcare analytics for 10+ years and it's incredibly difficult to measure outcomes. Take your example of 3 year outcomes, are you saying that the entire reason why someone is alive is because of the hospital they went to 3 years ago? There are so many confounding variables that even trying to measure outcomes 90 days out is difficult.

On top of that, the other commenter mentioned the unintended consequences of simplistic measurements like the one you describe. Look at measuring patient satisfaction - 'what could possibly be wrong with measuring patient satisfaction', people say! hold docs/hospitals/etc. accountable. but when you look at the data, patient satisfaction scores are weakly correlated with evidence based care and healthy outcomes but it is strongly correlated with things like how much time the patient sat in the waiting room or if the doctor prescribed them a medication.

perhaps not insightful to you, someone with knowledge of the area. but how about others? how about me? where should I gain my insights into all of the various industries that I don't have direct knowledge of today?

please stop forcing your views of how this site should work on everyone else. this site doesn't exist solely for you and your views. Others, perhaps, have alternative views

well, sorry to say this but healthcare operates in a way that puts individuals at risk for the benefit of moving medicine forward. For example, surgeons tend to be at at their prime in their early to mid 40s. Getting operated on by a typical 35 year old is flat out dangerous, statistically speaking, but we allow it because to get better, people have to practice their craft.

we started a practice ~1 month ago that a friend taught us. we now ask 3 questions of each other 1) How were you brave today? 2) How were you kind today? 3) How did you fail today? I've found it amazing how much conversation and learning it provokes.

gini coefficient is probably pretty close to what you are looking for. it shows the delate in inqequality between high and low earners in [country/region]. haven't looked at that stuff for a while but, traditionally, much of S America had high gini coefficents

the challenge is that ~40% of healthcare spend is even plausibly directed by the patient. the majority is not elective, a result of an acute situation, etc. The concept of free market, unfortunately, doesn't work. It's easy to confuse this because most people on HN are (relatively) healthy. 15% of the population consumes 80% of total healthcare spend. These are the ones that we need to solve for

Sources: lots of research I could link to but don't have handy and, with great dismay/frustration, I've spent a decade analyzing the root causes of US healthcare spend.

>The problem with the "can't negotiate" argument is that insurers have every incentive to negotiate on behalf of the patients they cover. And they have scale—United Healthcare covers more lives than the NHS.

No, they don't. With ACA, insurance companies must spend 85% of their revenue on medical. This means that their profit margin is effectively capped and the only way for the industry to increase profits is to increase the amount they pay out to providers, pharma, etc. so, no, the insurance company does not have every incentive to negotiate. In fact, sadly, most of the time it's the opposite.

There's a great book catering to people just like who you described (me included) - "If you're so smart, why aren't you happy?" I'm part way through it and it's been helpful.

https://www.amazon.com/Youre-Smart-Why-Arent-Happy/dp/B01DYF...

Essentially no researcher has found that your anecdotal belief matches the data they analyze. Why do you think all of the studies that indicate diminishing returns of income on happiness are wrong?

What do you think happens to the person who receives a single lab result, out of many, indicating that they have cancer? Human nature is to focus on the negative. To assume that humans can, by looking at a multitude of data points, ignore the small # of false positives is to misunderstand the evolution of human emotion.

https://www.psychologytoday.com/articles/200306/our-brains-n... talks about why we are evolutionarily programmed to latch on to the negative aspects of our life

For those who haven't had a chance to read about the negative impact of testing, check out Atul Gawande's Overkill - http://www.newyorker.com/magazine/2015/05/11/overkill-atul-g...

It explains why one of the most dangerous things for a healthy person to do is get tested. I've been in healthcare analytics for almost a decade now and see the same thing in the population data.

Theranos and other pro-testers are usually well intentioned but fundamentally misguided and haven't looked at population wide data sets, which tell a different story.

what do you say to the 73% whose lives got negatively impacted? Prostate screening is a great example. Elevated PSAs are indicative of cancer, which people want to get rid of. So they have a procedure done, which often leaves them incontinent. But the reality is that, the majority of the time, prostate cancer remains effectively dormant. The end result is a lot of old men who would have been healthy but are now walking around in diapers because they got a test.

Given the overall sales numbers and your survey of 0 out of 75, I think your opinions may be shining through despite your efforts to contain them. My equally anecodatal evidence is the opposite - Probably a dozen of my friends have purchased Echos in the last couple of months and almost all rave about it

in the early 2000s I was a young guy and board observer on a .com that was growing extremely rapidly and had a 9 day complete outage.

The venture funds, including the one I was part of, came in screaming, "who's getting fired for this", to which the CEO responded: "are you kidding me? We just spent $1.5M educating this team and you want me to hand them over to our competition?"

Every investor and other board member got real quiet, realizing how correct the CEO was. Good CEOS recognize that mistakes happen. The best make sure they retain the people that have learned through those mistakes.

I largely agree. We got one in October and use it every day. The sonos devices now gather dust.

Now we have expanded to 8-10 more use cases largely due to the integration with IFTTTHE.

e.g. It took 5 minutes to set up my niece's echo in Boston to automatically trigger a remote treat dispenser I built in SF and return a video to her phone. It was cool enough to impress an 13 year old girl, which is a high bar

if you like this area, I highly recommend reading Adam Tooze's The Wages of Destruction - The Making and Breaking of the Nazi Economy. It takes an economics lens on Nazi Germany both pre and during the war. A lot of the book centers on Speer and other 2nd/3rd tier people in the Nazi regime.

great ideas. thanks