Disco Elysium has been out for several years now and nothing else like it has yet been released. So I wouldn't say it's revived anything, just that it's proved that it's still possible to do something amazing in the genre.
I like to say Disco Elysium is one of my top five books I've ever read.
> It is probably reasonable to believe the mRNA vaccines were not improving mortality rates of other diseases,
By now, this is not a reasonable belief. We know that COVID can cause cardiovascular damage, kidney injury, diabetes, neurological problems, and systemic inflammation, all of which increase mortality risk from other causes. It only makes sense that preventing or reducing the severity of COVID infection prevents those downstream complications and reduces all-cause mortality.
mRNA can't cause wolbachia. Wolbachia is a bacterium that actually lives inside cells and gets transmitted through eggs to offspring. it's a persistent organism that reproduces. There's not a way for mRNA to grow bacteria.
mRNA is just a molecule that breaks down, and the mRNA in these vaccines is extremely fragile and temporary. Once injected it enters whatever cells are nearby (muscle cells)and ribosomes read it to produce the inert spike protein. The mRNA itself is gone within hours. Your cells have enzymes specifically designed to break down RNA because cells naturally produce and dispose of mRNA constantly as part of normal function.
The mRNA in vaccines never enters the cell nucleus where DNA is stored, so it can't integrate into your genome or affect reproductive cells in that way. And it doesn't replicate itself either.
And millions of babies have been born to vaccinated parents by now. If the effects you are talking about were even possible they would definitely have shown up by now.
I’m not suggesting comirnanty is wolbachia. If there is reproductive harm, or reproductive harm passed on to children, then we will not know for a long time.
I believe that you’re well read on the CDC’s messaging on this topic. I’d like to bring to your attention that glyphosate was scientifically shown to pose no harm, but that key paper was retracted 25 years later. Pfizer is making over $10B/yr on comirnanty and at one point it was over $50B. Would you lie for that kind of money? Could you imagine someone who would?
Yes, but imagine how much money hospitals can make if they can convince idiots to skip affordable preventable medicine and instead pay tens of thousands for hospital stays.
Hospitals were paid much more for the Covid patients that died than those who lived. There’s some very strong circumstantial evidence about this driving treatment protocols.
I too despise the existence of a profit motive in public health, the sane (not perfect) alternative is to nationalize medicine, not to ban it because the profit motive makes it suspect.
I'd like to bring to your attention that many people on the internet have made claims which were later retracted, thus your comment is unreliable.
Amazing, every single dollar goes to care! Not a single dollar to overhead! Where are these insurance companies' profit margins coming from? How do they even pay their executives' salaries? Boy have I been mistaken about how inefficient the American system is
> How do they even pay their executives' salaries?
I suspect less goes to executives than you think. Most of it is going to pay employees in the insurance industry.
The irony is that they are being paid to say "no." Perhaps if they instead went to work as service providers, we could get more services for what we spend.
I'm loathe to agree here, but you are highlighting a point that people miss about other OECD countries. Many very expensive treatments available in the US are covered by insurance (to a point) but are simply unavailable in the UK, Japan, or France. In the US a tremendous amount of money is spent to extend lives by a few scant months at a very low quality of life.
End of life is the biggest problem with over use but it's not limited to that. In the US literally everyone who shows up at the emergency room talking about chest pain gets an expensive ct scan even if theres effectively no chance of it catching anything. Procedures that have been shown in studies to not work are still prescribed, because why not/lobbying groups of the doctors that perform them whine loudly enough. At no point is anyone in the system trying to save money, so costs just grow and grow and grow.
I think about the fact that everyone in the hospital gets a private room a lot. Having a private room does not increase health outcomes at all, but it costs an absolute ton of money. It does increase satisfaction so it should be available, but hospital users should be able to choose shared rooms and get a portion of the savings they create but this just isnt possible in the US because of the incentives we've created.
> I suspect less goes to executives than you think.
How can it be less than nothing? The graph is literally showing that all the entities that are not care facilities operate without any costs and without any profits. Apparently both CEO’s and workers at these organizations are volunteers.
Healthcare executive pay is pretty darn high, more money than any family needs to live comfortably.
Keep in mind this is just for Blue Shield California. There are executives of other health insurance systems in other states and regions who are making similar compensation.
However, I'll go ahead and say right now that I support the idea of these executives being paid these salaries, but on one condition: that we first achieve the goal of 100% of Americans having affordable access to healthcare. Once that goal is achieved, then we can start paying executives big bonuses and incentives. Deal? (Yeah, right...)
Below is a summary of the compensation paid in 2024 to Blue Shield of California’s President and Chief Executive Officer (CEO), Chief Financial Officer (CFO), and top three highest paid executives (other than the CEO and CFO) who were employed by Blue Shield of California at year-end.
Epic Systems is a private company, so there's no executive pay information, but the founder Judy Falkner's estimated net worth is $7.8 billion. Perhaps Epic could reduce the price of its very expensive software for providers to help ease healthcare costs and maybe Judy could give up some of those billions and not notice any difference in her quality of life?
BCBS CA revenue is approximately $25B. The total of above is $25.6M. That's 0.1%.
You may view those salaries as appropriate for leading companies of this size or immoral and outrageous. But either way executive comp is not the big problem with US healthcare costs.
$14,570 per person is our healthcare cost per capita.
For one thing, cutting out even that tiny 0.1%, that's a savings of $15 a year if I wasn't paying my insurance company's CEO. I would absolutely love to keep that $15. The idea that more than one dollar every single month from every single person is going to the CEOs of all our healthcare services is actually INSANE when you think about it.
That really means that out of my $14,570 yearly healthcare cost I could be paying something like $5/month just on executive salary. Who knows, maybe it's even more!
This is, again, insane. Why do Cleveland Clinic executives need to be paid $30 million/year?
This isn't administrative cost, like all the hard-working people who do the clerical work that keeps these systems operating. This is just the salaries of an extremely small group of people, less than 10 people per company.
All of these entities are allowed to make excess profit and/or have loose definitions of non-profit status, and pay CEOs dozens to hundreds of times the salary of their lowest paid employees. There isn't really a limit to the amount they can compensate top executives.
And? Do they do 30x more work than other companies C-suite? Do they have multiple PhDs or some impossible to find skill that makes them better than other people doing the same job? If such small fractions of money are so inconsequential, why are they nickel and diming all their customers and the healthcare system?
It isn't even a secret that these positions are largely based on networking and inter-company politics, not their skills or productivity or often even any real merit. Maybe a couple bucks isn't much to you, but it is to other people. And we haven't even gotten into all the non-cash extras that are often a huge bonus on top of their actual salary. How many more doctors is 25 million dollars could that be providing? How many lives saved?
This isn’t gossip, it’s publicly disclosed information.
Their salaries don’t scale because they’re grossly overpaid. The fact that ~10 people in an organization get paid enough to be a separate line item in a company of 6,500 employees is insane.
The executive compensation at Blue Shield of California could employ approximately 300 nurses.
> This isn’t gossip, it’s publicly disclosed information.
The gossip part isn't the facts of the matter, it's the deciding how much a business should pay its executives.
Their salaries don't scale because there's only one of each of them. It's nothing to do with them being overpaid. Overpaid isn't an objective word. It's just gossipy nonsense.
> The executive compensation at Blue Shield of California could employ approximately 300 nurses.
I think this summary is reductive, because it ignores the surprisingly dense layers of middle management in hospitals and clinics that are paid more than the medical professionals (and even that ignores external middle managers like PBMs etc).
Blue Shield of California has 4.5 million plan members, so all of these executive salaries combined add up to 49 cents per member per month. It's not a significant factor in premium costs.
I think that's highly significant. Keep in mind that that's only one provider in the system. You've also got to pay the executive salaries of your hospital system, your pharmacy chain, your drug company, medical equipment company, etc.
If we figure that every company involved in your $15k/year healthcare cost is paying 0.1-0.5% of their revenue to executive compensation (Cleveland Clinic as a random example pays 0.4% of revenue to the executives, $30 million) then we are talking about a small streaming video subscription worth of cost just which is allocated not on paying a productive group of administrators to keep the lights on, but instead paying excess incentives to an extremely small group of people.
In reality, if CEO compensation was capped to something reasonable like $500,000/year or 10x the pay of the lowest paid employee, there would still be CEOs and the quality of CEOs would not decline because it would still be the highest paid job on the market. Everyone involved in our economy would be just that much richer if the wealth wasn't getting unnecessarily concentrated.
$500,000 is a lot of money, I don't want to minimize that, but it would not be the highest paid job on the market. There's a number of roles in medicine, law, finance, and nowadays software that pay more for fewer managerial duties. There really isn't much room to argue for cutting executive pay without arguing that it's unimportant to get the best people in executive roles.
And that's an argument you can certainly have, but it seems strange to make it a precondition to fixing the healthcare system, when cutting executive pay would resolve only a small fraction of the problem.
And all of those things listed requires far more skill set/experience or education to achieve. You would be hard pressed to identify c-suite skills of any established corporation that can't be found in abundance among lower employees if anybody bothered to look instead of doing the 95% networking and politics games that most c-suite are chosen from.
It would be the highest paid job on the market if the law limited executive pay.
Maybe this idea is sacrilege to the hyper-capitalist brain but it is entirely reasonable to limit personal salary and assets because income inequality has known and proven negative impacts on society.
No one person should make a salary greater than ~$1 million/year nor should they be able to control more than ~$100 million in assets. Prove me wrong on that concept. What possible reason could an individual have to require such excessive wealth?
As far as your second paragraph, your argument is that we can’t fix one piece of a multi-faceted problem without fixing the other pieces, which is logically weak. Paying executives less would make non-zero progress toward cost reduction.
Sweet. Let's charge 49 cents per million dollars of unrealized capital gains per month, it's not significant and less of a burden than 49 cents per month for healthcare.
I don't understand what connection you're trying to draw here. Why would we set the rate for a new tax based on the per-subscriber compensation of Blue Shield California's executives?
While you’re right on paper, the incentive plan (the PDF I linked further up) discloses that the a good chunk of executive compensation is based on performance metrics that would essentially mimic stock incentives for any other company.
50% of the executive incentive is based on membership targets and operating income.
Blue shield discloses that their CEO pay is about 70x their median employee. This is less than the for-profit organizations’ 250x ratio but that only serves to distort the spectrum of ethics.
We can call these organizations non-profits all day long because they fit our secular corporate law definitions but I’m not sure how a company that pays an employee enough money to own multiple homes with a Ferrari parked at each one would be considered non-profit in the eyes of God. [1]
[1] Not claiming the dude exists but you get the point I am making here.
That's pretty pathetic pay when we have run of the mill employees(ie non-founders) like Sundar and Satya becoming billionaires from their pay packages.
> Where are these insurance companies' profit margins coming from?
Vertical integration.
UnitedHealthcare's (Larger insurance company in the US) profits are effectively limited by the Medical Loss Ratio rules from the Affordable Care Act.
But they are owned by UnitedHealth Group, which also owns OptumHealth (the largest network of physicians in the US), OptumRx (pharmacies), and OptumInsight (technology consulting, which goes into the COGS for UnitedHealthcare). This is where they make their profits.
UHG controls which physicians + pharmacies are in their network and what their negotiated rates for many services are (the exception being medicare + medicaid).
> Amazing, every single dollar goes to care! Not a single dollar to overhead! Where are these insurance companies' profit margins coming from?
they kinda have it on chart but without overhead numbers: insurance collects 1T of payments, than for business segments, they pay around 60% of that as medical expenses, and for individual plans it is more like 40% of medical expenses, meaning for individual plans insurance corps have 60% profit margin.
> More than half of excess U.S. health spending was associated with factors likely reflected in higher prices, including more spending on: administrative costs of insurance (~15% of the excess), administrative costs borne by providers (~15%), prescription drugs (~10%), wages for physicians (~10%) and registered nurses (~5%), and medical machinery and equipment (less than 5%). Reductions in administrative burdens and drug costs could substantially reduce the difference between U.S. and peer nation health spending.
Spam can be filtered effectively client-side with a good spam filter. This has worked well for me for decades without the need for any server-side spam filtering.
You mean like LLM filters? Right now it's all reputation based on IP and domain with a whole ecosystem of anti-spam companies like Spamhaus, SenderScore, ProofPoint, etc.
Using NLP / LLM spam filtering would presumably be either inaccurate or expensive or both. Someone would have to pay for it.
Bayesian filters are basically just a cheaper / worse version of what an LLM filter would do. Very easy to beat. Especially if the spammer is using an LLM to write a semi-unique email for each recipient.
What I'm trying to tell you is hat this has de facto worked for me during the past 20+ years. I get ca. 100 spam mails a day and they all get neatly sorted in the spam folder. There is no server-side filtering at all, my email provider allows users to switch that off entirely (and better should because it's very faulty).
As I've said, I'm not interested in theoretical arguments. All of my domains wildcard forward to the same email address, too. Filtering client-side has never been a problem.
That's pretty interesting if true. It must be because you're the only one still doing it. Using techniques just for your idiosyncratic inbox doesn't make sense to a spammer. But if every inbox was only doing this, then your experience would be much different. Nothing but unstoppable spam. Exposure = money. Why would they not spam you? They don't like money?
Knuth once said there’s two kinds of programming languages in the world: Languages everyone complains about, and languages nobody uses. I feel like there’s some corollary here…
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