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It was 1T post merger with xAI being 250B of it, SpaceX being 750B

I'm pretty sure this is the school that was on the corner of a military base, and the school building hit was previously part of the military base.

That's a non excuse.

I live near a military base, and there is a daycare, school, rec center, pub, ice rink, church, and grocery store, open to the public, and not managed by the military. All of it is on land owned by the military, but outside the wire.

The fact that these facilities exist on military land near a base (which a hostile government would surely argue IS the base) does not mean that the people in those buildings have it coming.


Technically the statutes of Rome forbid using human shields.

A nation state bombing US mainland bases sounds rather implausible, although I certainly would prefer that civilian infrastructure to have a minimum distance to military targets, even in the US, even if only to set the right example to the rest of the world.

I do believe there would be value in modernizing the statutes of Rome regarding human shields, which would force nation states to compile machine readable lists of school locations, so that non-existent reported childrens schools and secret childrens schools would be automatically screened.

Keeping the school secret, or reporting a school location too close to a military base would then activate the right of the international community to attack that nation, in order to prevent nation states from using elementary schools etc. as human shields.

IRGC wants nuclear ICBM's. Iran invests heavily in STEM education and physics. The whole population is aware of such goals, the whole population is aware of the adversarial relationship with the Western hemisphere. Imagine your child being allocated the school that was bombed in Iran, but before it was bombed: wouldn't you protest and ask for your child to be allocated to a different school? They risk being the first casualties when the inevitable escalation to war occurs. Clearly in this fun society of Iran, those parents didn't get a choice, and could only pray their kids get through elementary before such a foreign attack occurs.

IMHO, the most damning aspect is that proper, modernized international law clarifying the permitted action-reaction patterns around human shields could have prevented these deaths, by disincentivizing such nations from using kids as human shields.


I don’t live in the US.

No one is using human shields. There are just non viable targets next to viable ones. Blowing up a school intentionally because you have bad intel or incompetent staff is tan unmitigated fuckup and war crime. We also don’t give two shits about “Roman statutes”. There is no moral obligation to attack a country that has schools near military facilities based on a dead empire from a couple millennia ago.

On closer reading, this is an insane take on a bunch of levels. Your username being a well known nazi isn’t a mistake is it?


Who is "we" in:

> We also don’t give two shits about “Roman statutes”.

?

It doesn't improve credibility if you openly express disdain for that section of international law that describes human shields as war crimes, which defines the concept of human shields, and then proceed to dictate that nobody uses human shields. Are you claiming this section of law is superfluous because it never happens?

BTW, my user name refers to a well known frozen pizza brand.


The well known food brand was run by a card carrying wafen-SS member name Oetker who used his influence with the party to get sweetheart deals to supply the Wehrmacht. It’s an odd choice.

I’m not expressing disdain for the part of international law that bans human shields. I’m saying that civilian infrastructure near military infrastructure is not that. The “Rome Statute” - the accepted name for the law you are calling the Roman Statutes - does not have anything in it about it being fair game to massacre civilians. The disgusting argument that these girls had it coming since they were being g used as human shields is bunk since they were specifically targeted by precision munitions intended only for the civilian target. The entire tragedy could have been avoided with the same military outcome by just not bombing the school.

I’m not going to get into the weeds on semantic details with someone who coincidentally uses a nazi username and claims a moral imperative to bomb countries for placing a school within an arbitrary radius of a defense facility.

Your takes are wholesale indefensible, regardless of any quibbles about details.

There is never a justification for intentionally bombing a grade school. Period.


> There is never a justification for intentionally bombing a grade school. Period.

let me focus on this word "intentionally", intent.

When I take the ladder I hid somewhere else under the bridge, and climb in my secret homeless bum nest, I am taking that ladder with intent. So I know intent exists. When I intend thin gs I do them intentionally, and sometimes I don't intend things like accidentally knocking over someone else's glass of drink, then I know I didn't do it intentionally.

Whenever theres a conflict before the courts, and whenever the relevant laws refer to presence or absence of intent, there will be an interest for both the plaintiff and the defendant to make claims on intent: the plaintiff might claim the defendant did such and such with intent, while the defendant has an incentive to claim such and such happened without intent. People take risks, plaintiff took risks, defendant took risks. Often both are co-responsible for a sequence of events, the law (at least on paper) is not monocausal. It is important to be able to attribute faults with causal links to damages, but an even more important role of law is to align incentives such that all parties avoid ending up in these situations. The law serves more than remediation, it serves a prevention role!

I believe it is important to prevent tragic events like girls schools being bombed.

I simply believe it is more effective to prevent harm by focusing on provable facts at hand.

How can a judge verify if something happens with or without intent?

Suppose your loved one was on the Iran Air flight that was downed, do you really care if it was with or without intent? Your loved one is now gone. Wouldn't it be wiser to leave the world in a better place, and have intent-oriented language eliminated so that the international community can promise to act strongly and swiftly when a nation state violates certain intent-agnostic conditions. Keep the (war) crime criteria objective without reference to intent, and don't do reckless stuff which can result in downing civilian air craft (whether its Iran Air or the Dutch plane above Ukraine).

Don't do reckless stuff like have a military complex, then change one of the buildings into civilian use and not marking this change on places like OpenStreetMap.

At the very least a global international list of all childrens schools, universities, etc. And unconditional permission for the international community to use ground penetrating radar, acousting sounding etc to investigate claims of colocated military compounds. International community coffers that can only be used to investigate claimed colocations (human shields). A disincentivation mechanism to prevent malicious parties constantly calling wolf to drain this coffer to prevent investigation of themselves.

Why do people believe that we somehow already have the optimum of all possible laws? Do you sincerely believe no better system of laws can be designed that prevents most of these tragedies?

To be precise:

1. I used to work in a car factory

2. Somehow a conversation with colleagues turned to my diet

3. I told them I like to eat frozen pizza

4. They started calling me Doctor Oetker half the time, and "StreetFighter" the other half of the time.

5. Thats how I got a nickname.

Whats your story, apart from shooting down ideas on how to restore objectivity in international law, because any subjectivity will result in entities believing they can get away by playing the infinite "was too! was not! was too! was not!"-game on the topic of intent...

EDIT: also I just looked up more about the history of Dr. Oetker; and you seem to conflate a couple of things

you state:

> The well known food brand was run by a card carrying wafen-SS member name Oetker who used his influence with the party to get sweetheart deals to supply the Wehrmacht. It’s an odd choice.

But Oetker didn't run this company during the war, his stepfather did. On wikipedia I read he was an SS party member though, and organized support groups for SS members and other Nazi apologetism, which is disgusting indeed...


That’s a lot of words trying to reason around destroying several hundred families by liquifying their children due to negligent intel.

Here’s how we handle this: fuck semantics. If your missile is targeted at and destroys a school, you should be held responsible. In fact, you can remove the school from the equation. If you aim a weapon at something, and fire the weapon, you are responsible for the outcome. If the outcome is a destroyed military base, congrats, you get credit for that. If the outcome is children being returned to their parents in closed caskets, you better believe you get the blame for that. Bad targeting data is the responsibility of those doing the targeting, not the people being targeted.

We already have laws around all this. The school bombing was unequivocally a war crime.

I’m not going to hear any more stupid ideas about how we can change laws to shift the responsibility for not getting obliterated by a missile onto civilians.


Does that make it not a school, somehow? Or are we cool with killing kids just because their parents might be in the military? I'm not clear what the excuse being made actually is.

It's definitely not cool to have a school adjacent to a military base. Not saying this specific attack was justified, but whoever allowed this, let alone if it was done intentionally as a strategy, also has blood on their hands.

Where do you think the children of our armed forces go to school? There are hundreds of schools on or adjacent to military installations in the US. The only people with blood on their hands for bombing a school are the people who bombed the school. It’s really not more complicated than that.

> It's definitely not cool to have a school adjacent to a military base. Not saying this specific attack was justified

I mean, you kind of are saying it was justified, given the entirety of your focus is on justifying it. The blood is solely on the hands of the useless, dumbshit military that couldn't identify a school and avoid bombing it. And that's the charitable interpretation of their actions.


Bro, American bases have schools all over them, houses with families, etc.

“I’m going to either steal your work in a way you don’t consent to, or not consume it” isn’t really great. The alternative is paywalls


Steal? Their server gave me some HTML and it’s up to my user agent to present it however I want.


Anything that kills adtech faster is a good thing at this point.


Much of their work consists of poorly sourced articles, sensationalism, disinformation, and bias to sway the audience.


Then the correct stance is to not visit those sites.


The steelman is that this issue is politically loaded, and there is not yet proven public evidence for the most explosive version of the claim. That makes it an easy target for partisan amplification, especially because it maps perfectly onto an existing fear people were already primed for. It is emotionally potent by design.


> there is not yet proven public evidence for the most explosive version of the claim.

Again, there doesn't need to be evidence. The point is that a claim like this is clearly plausible and worth investigating because of political decisions this administration made. They took a non-political issue (access to social security data) and explicitly made it political. You don't get to later use those same politics as a protective shield for criticism.

> it maps perfectly onto an existing fear people were already primed for.

People were primed because of the repeated warning that experts were giving about the security of this data and carelessness in allowing access. You are helping to prove my point that the administration encouraged this by their own actions.


Anyone whose looking at this administration as anything but corrupt thieves that need to be immediately jailed is a patsy, a fool, or a thief themselves.


To clarify, "steelman" is just another term for making up a fictional scenario that doesn't bore out in reality, like "strawman"?


I'll treat this as a genuine question. No, to "steelman" is to engage with the strongest possible version of your interlocuter'so argument, rather than the weakest. An especially effective steelman case will (genuinely!) strengthen or clarify the opposite point of view before laying out the case against it. It's a way of granting respect to those with whom you disagree, and (I find) a discipline that helps me avoid empty rhetoric.

But, yeah: if you find that the steelman version of the opposing argument won't be borne out in reality that's a promising line of attack. You'll argument will be more likely to be effective, however, than if you attack the strongest rather than the weakest ("strawman") version of the case.


I don't understand, declaring on your own terms what you think the argument actually is isn't respectful, it's deeply disrespectful. Take the claim at face value, details can and will be clarified through conversation.


> declaring on your own terms what you think the argument actually is isn't respectful

Which is usually a strawman tactic, and I agree both disrespectful and useless.

But... We will always respond to our own understanding of someone else's argument! That's inevitable, short of mind-reading. A habit of steel-manning the opposite case is a useful discipline for demonstrating respect - and, ideally, minimizing the necessity for clarification.

In practice, this means to make (to the best of your ability and understanding) an honest and accurate restatement of their case, and (if you see an opportunity - you won't always) a genuine suggestion that it would be stronger if it considered [x, y, z], before you attempt to refute it. You may not get it quite right, but you will have given your interlocuter a straightforward opportunity (as you say, conversationally) to clarify.

I think this is, given as I say that we're not able to inhabit anyone else's mind directly, the closest that we can rhetorically come to taking another's claim "at face value".


The opposite of this has been my experience.

HN comments bias far more negative towards technology, tech companies, and current politics than the people I know in real life. People who mostly don’t work as professional software engineers, at least not anymore. And the (employed) engineers I know are all having a lot of fun too.


We usually just call this collective extraction “taxes”


A tax takes a percentage of value that someone else created. A royalty collects payment for access to something you already own. When Alaska collects from oil companies, it's not taxing their profits. It's charging them for extracting a resource that belongs to the people of Alaska. The oil was never theirs.

It being a royalty and not a tax is the reason Alaska's dividend is politically untouchable while tax-funded programs get gutted every budget cycle. Ownership is a fundamentally stronger claim than redistribution.


“While the pouches are considered a tobacco product, they don’t contain any tobacco, and are instead made from the plant fiber cellulose”

It’s just Zyn, which doesn’t seem that dramatically different than coffee. But maybe that’s because I don’t drink coffee or use nicotine


Nicotine is addictive, much more so than coffee


It is really not so clear at all this is the case for pure nicotine products. See https://gwern.net/nicotine#habit-formation, and https://gwern.net/nicotine#dependence for a starter / some brief counter-evidence.


Anecdotally, I found I developed a dependence on nicotine pouches very quickly. It was also very easy to exceed the nicotine equivalent of a pack of cigarettes daily without even noticing.

But it was also easy to quit by substituting nicotine-free pouches, and withdrawal symptoms only lasted like 3 days.


Nicotine is depending on how you measure the 3rd or 4th most addictive substance on the planet. It's up there with Heroine, Fentanyl, Cocaine, and Meth.

If you consider heroine a "not even once" type of drug then nicotine should give you pause.


What dimension of “addictive” are you anchoring on? Capture rate? Withdrawal severity? Reinforcement strength? Relapse rate after quitting? Nicotine dominates on some of those and not others.


Pretty clear from the responses to OP that most people are quite unaware there is almost two decades of decent research on pure nicotine now, and that, outside of vaping (where hard evidence is mostly lacking, due to the novelty), the purer stuff probably really isn't all that addictive, in the grand scheme of things. In many cases it is hard to even say it is much different than caffeine.


It's a reasonable mistake, I'd say. We spent those decades conflating "nicotine" with "smoking" and, through herculean efforts, managed to get the smoking rate down to 12-14% (in Germany it's still 22.7%!). Now, tobacco companies have come through with genuinely less harmful, genuinely less addictive products, but because of their previous wild duplicity, nobody really "believes" it. They think that nicotine must cause cancer. "Fool me once," for sure.


Whether nicotine is addictive is a completely different question than whether it causes cancer


Can you point to said research because everything I can find from any kind of authoritative source is that form doesn't matter and nicotine is strongly addictive in all of them.

There is like zero messaging out there from anything resembling a health organization that says, "nicotine in purer forms is okay actually." It's an extraordinary claim that nicotine is super addictive only when mixed with other stuff and if you get the pure concentrated drug that actually lessens its pharmacological effects.


https://www.psychologytoday.com/us/blog/addiction-outlook/20...

The delivery system modulates speed and magnitude of the hit, which affects how rapidly and how strongly dependence forms, but every form produces dependence with sustained use.

There isn’t anyone who is going to say “nicotine in purer forms is okay actually” because there isn’t anyone who is tasked with answering such a broad question.

Also, be careful not to shift the frame. Spivak ranked nicotine with other drugs. You changed the framing to “all are highly addictive.” These are different assertions, and both can be true at the same time. That’s why it’s more important and more interesting to discuss it in terms of addiction subtypes


Plenty of the sources I linked at https://gwern.net/nicotine are scientific and high-quality, that is not just some lazy list or junk compilation.

Nothing wrong with still being cautious about pure nicotine products though, and I definitely would be cautious about vaping.


it's like 25x more addicting than coffee, not sure how OP misses that


Probably not the case for some modern pure nicotine products (gum, patches). Vaping is harder to say due to lack of data and clear cases of addiction in young people, but pure nicotine is definitely a different animal than the classical delivery forms. See my response to GP.


I wonder if the issue with vapes isn't the sweeteners they put in them. I sometimes vape a specific liquid, which has never given me any cravings. I'll just stop after my bottle is done for multiple months until I remember to buy some more. I never carry my vape with me when I leave home (not to the office, not for multi-week holidays, nothing). It's not difficult to go without, I don't even think about it when I don't have it.

But the other day I ended up vaping some melon-flavored liquid. When it was empty, I was going crazy for a few hours, I absolutely had to have more. And it didn't even have more nicotine than what I usually vape. It was just the sweet taste that had me wanting more, exactly like back in my college days when I was eating Snickers bars like no tomorrow. Now that was a habit that was tough to break. And most people I see vaping out in the street seem to be vaping those ultra-sweet smelling liquids.


> which has never given me any cravings

I've seen multiple friends that could give up an addiction: until after a while and then they couldn't.

For many people, addictions are not that addictive until they are.

Be careful generalizing from your own experiences. Try and learn from the mistakes your (often older) peers have been taught the hardest way.

I've seen it with drinking, vaping, smoking, meth, bad partner, gambling; my friends that weren't hooked, could take it or leave it, and then one day they find they are hooked.

Take care.


An interesting thought, I myself have met at least a couple people that tried to break an addiction by switching to vape products that were essentially just flavour (no nicotine, no THC; THC vapes are common and legal in Canada) and somehow stayed just as addicted to the flavour / oral stimulation. So that sounds at least plausible to me.


they miss it because they're an industry plant, mate.

bots are very active on HN and are very effective


bullshit. i've been smoking cigars for 5 years now. sometimes 2 or 3 a day and have zero issues stopping or going without a smoke for months. i was surprised as i was never smoker, but it is what it is. nicotine addiction is not nicotine addiction but cigarette addiction. cigars are pure tobacco. nothing else. cigarettes have over thousand ingredients in them. cigars also have higher nicotine dose than cigarettes and as i have said, zero issues.

know thy enemy.


It is bullshit. Stopping nicotine is like 2 days of mild discomfort. Stopping caffeine is absolute hell.


as i said, nictoine is a non-factor. as for caffeine, i quit multiple times. once the headaches are gone, which takes a week or two, followed by another week, or few, of feeling lethargic, it is back to normal(ie. give it a month altogether). so it's not too bad. it might be also easier to wean off slowly by decreasing caffeine consumption over longer period than quitting cold turkey to avoid the negative effects altogether.


Utter nonsense. I have replaced my ADHD prescription with nicotine patches, and in my experience I have had worse withdrawals, and greater desire to consume caffeine than either dermal nicotine or dexamfetamine. And I’m only a cup a day kinda guy, and I used to be a heavy smoker for years, so I know how dangerous the stuff can be.

If we’re talking about smoking or vaping, or nicotine pouches, sure, but mode of administration and how quickly it peaks in your bloodstream cannot be hand-waved away like that.


> mode of administration and how quickly it peaks in your bloodstream cannot be hand-waved away like that.

Then surely you have some evidence, especially that caffeine is more addictive, rather than "hand-waving it away" via personal anecdote?


Utter nonsense

Got something other than anecdata? Because a web search returns a list of contrary sources as long as my arm.

But, hell, if we are trading stories, I dipped snuff for 30 years and I’ve consumed coffee since middle school. I can go days without coffee, even if I might not be happy about it. Quitting tobacco, OTOH, that was tough, with multiple starts and stops until success.


Tobacco is not pure nicotine. If you can’t even get your basics straight, I’m not sure on what level we can even have a discussion about it.

Here’s from someone that knows what they’re talking about: https://gwern.net/nicotine


Coffee doesn’t give you mouth cancer


Does nicotine?


Cancer no, but nicotine is implicated in heart disease and other cardiovascular issues.


Is that because it's a stimulant, or is there some other known mechanism? It seems like most (maybe all) stimulants I've read about are correlated with cardiovascular issues.


I think one theory is that nicotine is a vasoconstrictor. Though whether, in its pure form, it is a particularly significant one, i.e. any worse than caffeine, is really not so clear.


No, //cancer stems from the carcinogens in the burning / heating of tobacco//. Nicotine is not cancerous in itself any more than caffeine.

I'm not a doctor though so while I might sound sure it's based on what I've read on the topic over the many years.

Edit : rightly corrected its not just heating and burning, its tobacco and others in general. But nicotine itself is not cancerous.


Cancer also stems from non-heated tobacco because the plant itself contains carcinogens that are pressed into the skin in the mouth for example, often including lesions and such


Chewing tobacco causes cancer


But not because of the nicotine.


These kind of synthetic nicotine products aren't carcinogenic. They were originally developed as a safer replacement for the traditional Swedish practice of stuffing a bag of tobacco in your mouth, although after acquisition by Phillip Morris they've become common among people who never used tobacco in the first place. (As the article gestures towards, they are "tobacco products" under US law because of their nicotine content, even though they contain no tobacco leaf.)


they are horrendously addicting though which is the huge difference between nicotine and caffeine. Even though I love caffeine I can go days without it no problem (besides being slightly more tired). Habitual nicotine users tend to need to re-up every hour or so


I quit zyns a year ago and still crave them daily. Sooooo good and addictive and they don’t have that “it’s killing you” imperative to quit like cigarettes do


I'm not sure it is actually all that clear that pure nicotine products really are so addictive as people believe. E.g. most studies claiming such addictiveness may simply be because those that get addicted to patches / gum were already addicted to cigarettes (or other classic tobacco product) prior. See e.g. Gwern's notes on the topic.

https://gwern.net/nicotine#habit-formation

https://gwern.net/nicotine#dependence


Both of these links go to self-reported data about how addicted people feel themselves to be, which I don't think is credible at all. It's very common for addicts to falsely believe that they're not addicted and could quit whenever they want.


> Both of these links go to self-reported data about how addicted people feel themselves to be

This is an incredible and outright lie.

Actually try reading the page I linked, there are plenty of links to scientific studies, scientific reviews, and high-quality resources, as well as lots of careful notes about serious confounds in the usual studies. This includes in exactly the sections I linked.

By all means still be cautious and not careless about using the stuff, that is a perfectly sane position. But I think it is very clear that e.g. patches and gum are highly unlikely to have anything even approaching the risk profile of classic tobacco products.


Do nicotine pouches give you mouth cancer?


I don't think zyn has been studied enough to be conclusive, but it does have some negative effects similar to dip I suppose? Dip on the other hand is described as using something like 'fiberglass' that cuts your mouth so your gums can absorb the nicotine quicker, of course the tobacco industry denies this. I've only tried dip once, and it was like a kick to the face. I'll stick to casual cigar smoking (its been 4 years though!).


According to several reputable sources (cancer societies around the world), it isn't known if this is a risk yet. What are you being this on?

I'm not encouraging anyone to use these things, but we should only make claims that are based on evidence.


Given the long-term, widespread usage of coffee, is there something specific they're waiting on? Or is that an "absence of evidence is not evidence of absence" thing?

Your final statement doesn't really add value without knowing that, unless you agree that we shouldn't assume other people are actually people, and not lizards in people suits until they prove, definitively, otherwise.


My mistake. I interpreted their comment to be implying that nicotine pouches do. I'm not referring to evidence for the safety of coffee, but of nicotine pouches.


As you know, this is a subjective take. (I enjoy my experience there more now, for example, with less social politics in my feed.)

And their head of product claimed that X only has around 30 FT employees apparently working on it, so it's much more than 80% since then.

https://www.ndtv.com/feature/x-head-of-product-claims-compan...


Just because you agree with the social politics the algorithm is throwing out now vs. before doesn't mean it's not political


Experience is usually a subjective thing. But it seems pretty clear to me. I’m was huge advocate of free speech and a political moderate but X made me question my priors on content moderation. There was genuinely heinous shit on my feed and i had no good way to filter it.


There was? It's full of nazi shit now? What was it before?


I used was because I no longer have an account


I don't use that site much nowadays, but every time I do, I am shocked at just how many fucking bugs there are. This idea that they laid off whatever percentage of their workforce with no impact to the quality of the software is not based in reality whatsoever.

And don't get me started on the UX. Fucking dumpster fire of an experience. But network effects gonna network effect.


It has 30 FT people working on the core product. That isn't counting infra/ai/ads/legal/ etc.


I logged into xitter recently after a long time, and my feed was cluttered with anti immigrant scare stories, western values under threat etc. that I got really scared thinking what the future holds if people are getting brain washed to this extent. It was things I never followed anywhere, so Elon is literally stuffing this crap down everyone's throat. Vibes of invention of radio and television powering the Holocaust.


Would nuclear energy research be a good analogy then? Seems like a path we should have kept running down, but stopped bc of the weapons. So we got the weapons but not the humanity saving parts (infinite clean energy)


Nuclear advancements slowed down due to PR problems from clear and sometimes catastrophic failure of commercial power plants (Three Mile Island, Chernobyl, Fukushima) and the vastly higher costs associated with building safer plants.

If anything the weapons kept the industry trucking on - if you want to develop and maintain a nuclear weapons arsenal then a commercial nuclear power industry is very helpful.


Nuclear energy hasn't been slowed down much, let alone stopped. China has been building new reactors every year for more than a decade and there are >30 ones under construction.

The same will go with AI, btw. Westerners' pearl clenching about AI guardrails won't stop China from doing anything.


They copied LLMs from the west. the more the west does the more they have.


> Seems like a path we should have kept running down, but stopped bc of the weapons.

you mean like the tens of billions poured into fusion research?


It's a path we should have never started going down.


I’m married to a Brit and she is constantly in awe of how much better our healthcare is here in the US. And she paid for private insurance there too.

Quality of facilities, low wait times, quality of staff interactions, organization, etc.

She even freaks out about how we have free parking at our doctors and hospitals here!

We’re on corporate insurance.


So why are so many of your citizens without even basic affordable healthcare?


Define "so many". Most people have health insurance through their job, which translates to them having basic affordable healthcare. Not everyone has this, so I'm not saying it's perfect, but it's not some abysmal state of affairs where most of the country is suffering.


They aren't. Anyone can go to the ER, and if you're poor it'll be billed through Medicaid. When I was young and poor, I had a multi-day hospital stay and multiple surgeries that totaled to $3.50 out of pocket. Urgent cares are everywhere and affordable.


I had a cholecystectomy a few years ago and had a complication that caused a gallstone to get lodged in my common bile duct after removal. Three days after surgery I was in the ER, I let them know I was in debilitating pain and that I just had surgery. They made me sit in the waiting room for 8 hours and only took me back when a doctor walked passed and noticed I was jaundiced. After his shift ended, the nurse who was watching me overnight while I waited to have an emergency surgery (because the surgeon had already gone home for the day by the time I got triaged) was told to keep an eye on me and do blood draws hourly. I didn't get seen once and by morning my liver enzymes were so high they were off the testing scale.

Sure you can go to the ER. The level of treatment you get heavily depends on luck


That's a ER triage complaint, not a financing complaint.


ER isn't the only part of healthcare that matters. Most things can be prevented with easy access to GP level care.

ER is for accidents and when health problems get out of hand. If you end up at ER with a preventable problem the system has already failed you.

Only having free access to ER doesn't constitute healthcare.


> Anyone can go to the ER

They'll treat you if you have a heart attack and make it in alive. They won't put you on blood thinners or statins 10 years before that to keep you out of the ER in the first place.

I don't think ERs do chemotherapy either.


Yup, ERs are not a replacement for actual medical care.

Their only goal/duty is to stabilize you during an acute medical emergency so you don't immediately die.


>> so many of your citizens without even basic affordable healthcare

> They aren't. Anyone can go to the ER, and if you're poor it'll be billed through Medicaid.

You guys are both wrong, and arguing with broad brushes about something that's complicated and subtle.

Health insurance is available to everyone in the country, but it's expensive and extremely complicated (among other things: you don't "bill through" Medicaid and lots of folks who qualify aren't on it because they can't figure it out).

It's true that the pre-ACA world where getting sick without employer-provided insurance means dying poor is gone. Almost everyone who needs serious care in the US gets it in some form, but lots of care is delayed because people aren't covered, as getting covered is "affordable" but extremely expensive (unsubsidized family plans run $20k/year and up!). It's much better than it used to be but not a great system.

The flip side is that it's also true that the large-payer corporate insurance system provides "better" care in the sense of access and outcomes[1] than the state-run systems in Europe. It's extremely rare in the US to hear the "on a waiting list" stories about elective care that you hear especially in regard to the NHS.

It's complicated, basically, and not well-suited to yelling on the internet.

[1] Obviously the system pays for this with much (and I mean much) higher service rates than the rest of the world extracts for the same care. US doctors and health systems do very well.


What do you do to address health concerns before they become ER-level?


Medicaid or ACA subsidized insurance


It’s good if you’re rich I assume


Not "rich", but "employed by a major corporation". Large-payer private insurance in the US is fine and produces outcomes at or above the level you see in the rest of the industrialized world. All the yelling is about ACA plans and subsidy programs.


Healthcare trilemma


US healthcare is excellent – if you can afford it.


Yeah that's the crux isn't it? Either you provide healthcare for everyone and thus have to ration it or you make it unavailable for the poors.


What is the 'INSERTNAME' law that explains how all conversations on HN, which is ostensibly focused on tech, devolve (evolve) into the realm of the humanities?


Seems like a corollary of Godwin’s Law.


UK isn't EU, especially when it comes to health system. I lived in the US for quite some time (from Fr), the healthcare is great... if you can afford an expensive health insurance AND pay some extra money when required. The avg US people can not pay and when you can not pay the experience is just far worth than terrible.


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