Everything is Shit: Tracking the Great Enshittening

[Incredulity 11541]

35 minutes ago, Chopper said:

How 'bout you go to CR where I presume you normally post? Or maybe back to your full-time job of being a youtube commenter.

Also learn how to spell gargle.

 

[JBJ 3648]

2 hours ago, 52-80 said:

that said, i have a hunch:  its a cultural decision made by the mother/family early on.  CDC reports average age of 1st birth in 1970 was ~22.  average age of 1st birth in 2000 was 25.  Today, it's closer to 30.  Less educated families also have more children than educated ones.

So it was a cultural norm that women don't go to college (only 10% had a degree) but stay home and raise babies. Today, having a kid at 25-30 means you will already have a college degree, and can enter/return the workforce with good income.  If you already have multiple children with only a high school education, the math doesnt work out to get a minimum wage job and leave the rearing to someone else.

There's a couple things wrong with this and they are common mis-beliefs.

1) Only HS dropouts have more kids.  For every other category the longer a woman stays in school, the more kids she will have.  There are probably issues with causality leading to this common misconception. 

2) Also, the age of first marriage and first child stays the same across every other education level.  Waiting to establish a career isn't really a class or education thing (although it has changed over time).

3) Low income families are more likely to be dual-income and more educated women are less likely to work.  This is a no-brainer once you think about, but we often celebrate the power couple and working mom more than the "normal" family.  Still, the reality is that couples comfortable living on one income are the ones that do it, and educated women are more likely to find partners that provide that lifestyle.

Edited February 29 by JBJ

[Bozo_Casanova 26271]

2 hours ago, Brisketexan said:

They don't do surge pricing.

They should, though.

[RDCanecutter 26246]

3 hours ago, Brisketexan said:

They don't do surge pricing.  But they do make me annoyingly carry a supply of 1 euro coins in case someone has to take a crap while out and about. 

Carry one coin, for yourself. After you let your wife and kids shit themselves, they will start carrying their own coins and your life will be better.

[Pescado_Rojo 19330]

Clear is now $189 a year, and is a worse customer experience at AUS than simple TSA pre. Yesterday there were 2 hosts at checkpoint 1, and 15-20 people in line. I just skipped it and went through the nearly empty precheck line. I don't mind paying a premium for a better experience, but Clear seems to be getting worse over time. 

[Bozo_Casanova 26271]

1 hour ago, BeardIP said:

Apparently it's not surge pricing now?

Maybe it never was? But whether you call it dynamic pricing or variable pricing or surge pricing, it is good and there should be more of it.

[Bozo_Casanova 26271]

Just now, Pescado_Rojo said:

Clear is now $189 a year, and is a worse customer experience at AUS than simple TSA pre. Yesterday there were 2 hosts at checkpoint 1, and 15-20 people in line. I just skipped it and went through the nearly empty precheck line. I don't mind paying a premium for a better experience, but Clear seems to be getting worse over time. 

I haven’t used it on my last 3 trips because the dedicated pre-lane was shorter. 
Clear+pre is no longer useful at AUS.

[Macklemore 2871]

7 minutes ago, Bozo_Casanova said:

Maybe it never was? But whether you call it dynamic pricing or variable pricing or surge pricing, it is good and there should be more of it.

Why do you hate America?

[safe sex 11676]

Is that not the market at work?

[Chopper 17150]

Amazon and health care. They purchased a company called One Medical Seniors and are expanding. Apparently they don't believe in medical obligations, just causing a slow, frustrating death to their patients. free link https://wapo.st/3wCuyRy

 

 

[RDCanecutter 26246]

Say what you will about the tenets of the French consumer, but they'd burn those Amazon-owned health centers to the ground.

[Bozo_Casanova 26271]

I’m not gonna defend Amazon, but I am a member of One Medical in Austin, both before and after acquisition and it is substantially less frustrating and has better service than every other doctors office I’ve ever dealt with in 32 years of living in this town. 
A high quality app and patient portal plus  easy to use telemedicine and 24/7 on-demand video chat vs a brain dead office staff and filling out the same forms every visit was a trade I was happy to make. 

WaPo should do a story about why most doctors can’t show up to appointments on time. 

[RDCanecutter 26246]

7 minutes ago, Bozo_Casanova said:

WaPo should do a story about why most doctors can’t show up to appointments on time. 

I always assumed it had something to do with that sick motherfucker in the next room.

[Brisketexan 104537]

15 minutes ago, Bozo_Casanova said:

I’m not gonna defend Amazon, but I am a member of One Medical in Austin, both before and after acquisition and it is substantially less frustrating and has better service than every other doctors office I’ve ever dealt with in 32 years of living in this town. 
A high quality app and patient portal plus  easy to use telemedicine and 24/7 on-demand video chat vs a brain dead office staff and filling out the same forms every visit was a trade I was happy to make. 

WaPo should do a story about why most doctors can’t show up to appointments on time. 

Look, if people would just let the faster golfer play through, this shit wouldn't happen.  Courtesy is dead, man.

[Incredulity 11541]

29 minutes ago, RDCanecutter said:

I always assumed it had something to do with that sick motherfucker in the next room.

what if I'm the only person in the waiting room, get brought to a patient room 15 min after scheduled appointment and then wait another 30 for the nurse to show up, then another 20 for the doctor?   Mindbottling.

[RDCanecutter 26246]

1 minute ago, Incredulity said:

what if I'm the only person in the waiting room, get brought to a patient room 15 min after scheduled appointment and then wait another 30 for the nurse to show up, then another 20 for the doctor?   Mindbottling.

I just checked with your nurse and doctor, and they confessed that they were in the back room watching reruns of Lassie. The good ones, not the trashy second season.

[Incredulity 11541]

4 minutes ago, RDCanecutter said:

I just checked with your nurse and doctor, and they confessed that they were in the back room watching reruns of Lassie. The good ones, not the trashy second season.

A few times over the years I have suspected everyone went home.

[RDCanecutter 26246]

4 minutes ago, Incredulity said:

A few times over the years I have suspected everyone went home.

That's when you climb up inside the drop ceiling and see who else is up there.

[Bozo_Casanova 26271]

1 hour ago, RDCanecutter said:

I always assumed it had something to do with that sick motherfucker in the next room.

It’s true! ONLY medicine and NO OTHER business contends with analogous unpredictable events throughout the day! It has NOTHING to do with deliberately oversubscribing the practice beyond what the doctors and staff can serve to drive claims and make up for what insurance is keeping for themselves.

Meanwhile Amazon, being a logistics company, models that in and delivers a consistent service level- including not oversubscribing doctors who have a full book. 

Edited February 29 by Bozo_Casanova

[52-80 19076]

5 hours ago, JBJ said:

There's a couple things wrong with this and they are common mis-beliefs.

1) Only HS dropouts have more kids.  For every other category the longer a woman stays in school, the more kids she will have.  There are probably issues with causality leading to this common misconception. 

2) Also, the age of first marriage and first child stays the same across every other education level.  Waiting to establish a career isn't really a class or education thing (although it has changed over time).

3) Low income families are more likely to be dual-income and more educated women are less likely to work.  This is a no-brainer once you think about, but we often celebrate the power couple and working mom more than the "normal" family.  Still, the reality is that couples comfortable living on one income are the ones that do it, and educated women are more likely to find partners that provide that lifestyle.

The largest distinction in fertility rate is college-educated vs non-college educated. The difference between bachelors and doctorates is small. The difference between bachelors and HS/dropout is 2x

Yes theres lots to suss out on this topic in terms of correlation v causation. 

The age of first child may be constant across education levels (i dont have the data), but is absolutely not constant across time. Question guy asked was why is it in times past, fewer mothers were working. 

Is it because the husband was already earning sufficiently? Dont think so - the *real* household disposable income was far less back then.

I’d suggest because simultaneously culture was not there and the economic opportunity was not there to entice women to work. You’re 23 years old with a toddler but no education. Are you going to finally enroll in college? 

Its the economics that draw moms to the workforce. My mother in law is an uneducated lifelong homemaker. I earn enough that my spouse could quit and take care of our kid. Would she? Hell naw she makes too much and would never want her mothers ‘QOL’.

Edited February 29 by 52-80

[52-80 19076]

6 hours ago, Bozo_Casanova said:

They do that in Europe, and they have clean public toilets all over the place. Having to pinch it back will be a thing of the past!

Yup. Having to pay for things turns out to be good.

Both the gas station bathrooms, and the public/park bathrooms, tend to be clean. 

I’ve already suggested previously…make people pay for shopping carts, too. Magically they get returned back to the corrals instead of strewn across the parking lot!

[RDCanecutter 26246]

2 minutes ago, Bozo_Casanova said:

It’s true! ONLY medicine and NO OTHER business contends with analogous unpredictable events throughout the day! It has NOTHING to do with deliberately oversubscribing the practice beyond what the doctors and staff can serve to drive claims and make up for what insurance is keeping for themselves.

Meanwhile Amazon, being a logistics company, models that in and delivers a consistent service level- including not oversubscribing doctors who have a full book. 

Have we been arguing, and I didn't know it?

If so, I have no idea why your doctor is slow. Maybe just count your blessings that your health is not overseen by a roofer, plumber, or tree removal guy, talking about over-booked.

[Bozo_Casanova 26271]

2 minutes ago, RDCanecutter said:

 

If so, I have no idea why your doctor is slow. Maybe just count your blessings that your health is not overseen by a roofer, plumber, or tree removal guy, talking about over-booked.

Maybe trusting ROFLBOX with my appendectomy wasn’t an obvious choice, but at least it doesn’t leak. 

[RDCanecutter 26246]

Just now, Bozo_Casanova said:

Maybe trusting ROFLBOX with my appendectomy wasn’t an obvious choice, but at least it doesn’t leak. 

He's a little rough with the hammer, but By Golly the hail stones bounce right off you afterwards.

[Incredulity 11541]

28 minutes ago, Bozo_Casanova said:

It has NOTHING to do with deliberately oversubscribing the practice beyond what the doctors and staff can serve

I rarely encounter a waiting room at capacity.  Nor do I walk by rooms full of patients with the doors shut.  Most often its a few people in the waiting room and mostly empty rooms.  

 

Now that said, thankfully to this point in my life I am not a heavy HC user.  So this may just be my anecdote.  But based on my visits when they give me the bullshit about first avalaible appointment is in Sept of 2025, well...

 

I can't fucking figure it out.

[Bozo_Casanova 26271]

8 minutes ago, Incredulity said:

I rarely encounter a waiting room at capacity.  Nor do I walk by rooms full of patients with the doors shut.  Most often it’s a few people in the waiting room and mostly empty rooms.  

Perchance the capacity of their physical plant is not the issue?

What you are observing are classic signs of a poorly managed business: misallocation of resources, poor customer service, fragmented delivery, opaque timetables and pricing schedules, the lot.

Edited February 29 by Bozo_Casanova

[Incredulity 11541]

1 minute ago, Bozo_Casanova said:

Perchance the capacity of their physical plant is not the issue?

I hear you.  It's just impossible for me to relate too the issue without living it.  What a waste.

[Chopper 17150]

4 hours ago, Bozo_Casanova said:

I’m not gonna defend Amazon, but I am a member of One Medical in Austin

Yeah they discuss One Medical in the link I offered.

Quote

Amazon’s health-care offerings include...One Medical, the concierge primary-care clinic with a $199 annual membership fee that appeals to young, healthy, urban patients comfortable booking appointments and talking to doctors via an app.

(and just to clarify they're trying to bring that model to cover seniors on medicare and call it One Medical for Seniors, and it's going disastrously enough for the paper that Jeff Bezos owns to write about it because the company Amazon purchased is in the DC region.)

However the question you raise makes me wonder whether you've bothered to read either of Cory Doctorow's articles about the enshittification process because it's literally about Amazon.

By the way, from the linked article..

Quote

Earlier this month, Amazon laid off hundreds of employees across Amazon Pharmacy and One Medical and announced a corporate restructuring. Current and former employees say the move reignited concerns that the e-commerce giant would start prioritizing profits over patients.

 

[Bozo_Casanova 26271]

Prioritizing profits over patients?! In America?! Just imagine! <clutches pearls>
 

Everything I’ve seen Amazon do in medicine (and I watch healthcare pretty closely) tells me they are going at the fat pools of waste and bloat and float and fragmentation that make our system the worst in the developed world for everyone but the dying (for whom we spare no expense). We don’t have a healthcare system in America, we have a billing complex that treats care like a loss leader. We spend twice as much on care as the rest of the OECD,  but not on outcomes, or because of age or lifestyle. We spend it because our system is broken and chaotic and we pay FIVE TIMES as much for administration as the G7 average.

Ive met prison doctors who left private medicine because they were tired of working for insurance companies and getting nibbled to death otherwise by third parties and systemic complexity. 

So if Amazon is pressuring the cost of delivery through overhead and leverage, I suspect better service will be the dividend, or at least it won’t get worse because we are living the worst case scenario in primary care right now.

 

[Chopper 17150]

33 minutes ago, Bozo_Casanova said:

Prioritizing profits over patients?! In America?! Just imagine! <clutches pearls>
 

Everything I’ve seen Amazon do in medicine (and I watch healthcare pretty closely) tells me they are going at the fat pools of waste and bloat and float and fragmentation that make our system the worst in the developed world for everyone but the dying (for whom we spare no expense). We don’t have a healthcare system in America, we have a billing complex that treats care like a loss leader. We spend twice as much on care as the rest of the OECD,  but not on outcomes, or because of age or lifestyle. We spend it because our system is broken and chaotic and we pay FIVE TIMES as much for administration as the G7 average.

Ive met prison doctors who left private medicine because they were tired of working for insurance companies and getting nibbled to death otherwise by third parties and systemic complexity. 

So if Amazon is pressuring the cost of delivery through overhead and leverage, I suspect better service will be the dividend, or at least it won’t get worse because we are living the worst case scenario in primary care right now.

 

Oh wow, doctors are leaving the healthcare industry because of how fucked up the system is in the US?? You don't say, captain obvious!!

While you're accurately describing some of the symptoms of our fucked up health care system your belief in amazon is amazingly Polyannish. It's easy to make cuts to health care access when you're selling some access to patients who barely need it. That's the easy part, champ. It's a little different when you target chronically ill and lower income seniors. Congrats though on having amazon's concierge care. I'm sure it'll be super amazing should you require acute care and will stay just as awesome in future years as it's been in the early going - because that's who amazon is.

 

 

[Chopper 17150]

7 hours ago, Bozo_Casanova said:

I’m not gonna defend Amazon, but I

[52-80 19076]

6 hours ago, Bozo_Casanova said:

Everything I’ve seen Amazon do in medicine (and I watch healthcare pretty closely) tells me they are going at the fat pools of waste and bloat and float and fragmentation that make our system the worst in the developed world for everyone but the dying (for whom we spare no expense). We don’t have a healthcare system in America, we have a billing complex that treats care like a loss leader. We spend twice as much on care as the rest of the OECD,  but not on outcomes, or because of age or lifestyle. We spend it because our system is broken and chaotic and we pay FIVE TIMES as much for administration as the G7 average.

 

when comparing globally on (spending/outcome) basis the outcome part gets distorted because of exogenous factors.

for example, the maternal mortality rate in the US is above EU’s level. and guess what the major contributing factor is to that….is it sepsis? bleeding? blood clots? and other medical ailments due to US health inability to deal with?

drumroll:

(WHO and CDC include all-causes of death in the methodology for their official stats)

theres other fascinating discoveries when you dive into the medical data…

anyway i agree with you on what the is the big bugbear in the US system. ive spent half my life abroad in different high-HDI countries and the access/availability and quality of care in the US is the best. the administration and billing…the worst.

long time ago i followed cigna’s guideline and used cigna in-network provider for a minor surgery to make everything easy.  i expected single-interface, single-payment to get it all done.  2 years later, out of the blue, started receiving random chunky-sized bills from various unrecognized entities. turns out, they were providers affiliated with the surgery. because i have a pulse and know how to read, i eventually got that billing mixup resolved. but for other people its probably a gigantic lingering pain the ass. 

[UpperWestside 6126]

I know a pediatrician who got completely fed up with overbooking at a hospital she worked for in New Jersey. She left and last I know she was working in a hospital in Manhattan in a newborn ward and also teaches there as well. She enjoys that more than the constantly overbooked days she had before. Still lives in Weehawken I believe and makes the commute over here.

[Bozo_Casanova 26271]

7 hours ago, Chopper said:

your belief in amazon is amazingly Polyannish.

Trust me. Nothing about my views on American healthcare or anything involving the exchange of money for goods and services is Pollyannish. 
But when it comes to primary care, Amazon can’t do worse than what we’ve got, because economies of scale work.  I’ve got no illusions about the potential downsides, they are already with us.

17 minutes ago, UpperWestside said:

I know a pediatrician who got completely fed up with overbooking at a hospital she worked for in New Jersey.

So far at One Medical everyone has seemed less stressed out, and far more patient centered. He me of the docs told me they liked it because he “just just practices medicine here.”

13 minutes ago, UpperWestside said:

She enjoys that more than the constantly overbooked days she had before. Still lives in Weehawken I believe and makes the commute over here.

Isnt that right across the Lincoln Tunnel? 

[Bozo_Casanova 26271]

2 hours ago, 52-80 said:

the access/availability and quality of care for an acutely ill or very affluent person in the largest cities in the US is the best.

FIFY

[Bozo_Casanova 26271]

7 hours ago, Chopper said:

It's a little different when you target chronically ill and lower income seniors.

Agreed and should be noted that One Medical is not the same thing as One Medical Seniors. I don’t know how well Amazon’s model will/can work with that population. That said, they are so poorly served now at the population level it’s hard to imagine that Amazon can do worse. Maybe more seniors in Florida should learn how to use an app/zoom? I mean they figured out how to use Facebook well enough to efficiently consume Russian agitprop, seems like telemedicine is the next logical step.

[52-80 19076]

5 minutes ago, Bozo_Casanova said:

FIFY

88% of full time workers in private industry have employer-provided healthcare. 

average employee-paid premium for single coverage is $150, or $600 for family. price is similar across all wage categories. 

growing up we were covered by my dads bluecross blueshield program, and thats from his extremely pedestrian blue collar job. not exactly affluent. 

[Captainant 27403]

5 minutes ago, 52-80 said:

88% of full time workers in private industry have employer-provided healthcare. 

average employee-paid premium for single coverage is $150, or $600 for family. price is similar across all wage categories. 

growing up we were covered by my dads bluecross blueshield program, and thats from his extremely pedestrian blue collar job. not exactly affluent. 

Newsflash: shit ain't like that anymore. Healthcare should not be tied to employment. 

[Pescado_Rojo 19330]

17 hours ago, Bozo_Casanova said:

I haven’t used it on my last 3 trips because the dedicated pre-lane was shorter. 
Clear+pre is no longer useful at AUS.

Same experience at BNA this morning. Clear line was substantially longer. Skipped it and went through regular pre. 

[MonkeyDoughnut 10138]

30 minutes ago, 52-80 said:

88% of full time workers in private industry have employer-provided healthcare. 

average employee-paid premium for single coverage is $150, or $600 for family. price is similar across all wage categories. 

growing up we were covered by my dads bluecross blueshield program, and thats from his extremely pedestrian blue collar job. not exactly affluent. 

Damn, sign me up for that rate. Haven't seen that family rate myself for 20 years.

[Bozo_Casanova 26271]

39 minutes ago, 52-80 said:

88% of full time workers in private industry have employer-provided healthcare. 

average employee-paid premium for single coverage is $150, or $600 for family. price is similar across all wage categories. 

And yet, their access to care varies widely by their level of affluence via their location, industry, and coverage. A 1.5X median wage small business employee who works in the trades in Seguin and pays $600/mo OOP almost certainly doesn’t have nearly the access to care or coverage as a tech worker in Austin who pays $600/mo OOP, makes 4X the median and works in tech.

Edited March 1 by Bozo_Casanova

[Guest]

37 minutes ago, Captainant said:

Newsflash: shit ain't like that anymore. Healthcare should not be tied to employment. 

Why not?  Everyone is already working, right?

and we have ACA to cover the Can'ts and won'ts.

[Guest]

8 minutes ago, Bozo_Casanova said:

And yet, their access to care varies widely by their level of affluence via their location, industry, and coverage. A 1.5X median wage small business employee who works in the trades in Seguin and pays $600/mo OOP almost certainly doesn’t have nearly the access to care or coverage as a tech worker in Austin who pays $600/mo OOP, makes 4X the median and works in tech.

Sounds like someone made different choices...

I'm probably an outlier, but medical coverage for my young family factored in significantly in my choice of employers.  I know that concept is totally fucking outrageous.

Edited March 1 by slorch

[52-80 19076]

13 minutes ago, MonkeyDoughnut said:

Damn, sign me up for that rate. Haven't seen that family rate myself for 20 years.

that was last's year govt conducted survey, sampling 13,000 establishments, sampling frame 7 million, representing 125m workers...

[Captainant 27403]

6 hours ago, slorch said:

Why not?  Everyone is already working, right?

and we have ACA to cover the Can'ts and won'ts.

Lots of employers intentionally give employees 32 hours weekly specifically so they don't qualify for benefits and are forced to the ACA marketplace - which is not a magical "fix everything and give coverage to everyone" solution as you are framing it. It's just another place to buy an insurance plan from an insurance company that exists only to stand between you and your care

Edited March 1 by Captainant

[Guest]

6 minutes ago, Captainant said:

Lots of employers intentionally give employees 32 hours weekly specifically so they don't qualify for benefits and are forced to the ACA marketplace - which is not a magical "fox everything and give coverage to everyone" solution as you are framing it. It's just another place to buy an insurance plan from an insurance company that exists only to stand between you and your care

LOLz.  I framed it?

It's reality bro.  You want equal results for everyone.  Equal misery. I disagree.

You know when the last time I averaged 32 hours of work in a week?  Seriously at age  16 or so.

 

Now let's talk "framing" of an argument and discuss what grown ass adults should be doing, or making decisions around.  You want to work part time, then that's how the comp works.

Edited March 1 by slorch

[52-80 19076]

7 minutes ago, Bozo_Casanova said:

And yet, their access to care varies widely by their level of affluence via their location, industry, and coverage. A 1.5X median wage small business employee who works in the trades in Seguin and pays $600/mo OOP almost certainly doesn’t have nearly the access to care or coverage as a tech worker in Austin who pays $600/mo OOP, makes 4X the median and works in tech.

The 50-75th wage percentile employee has total premium contribution of $1245 from employer and $640 OOP = $1885

The 90-100th wage percentile employee has total premium contribution of $1350 from employer and $600 OOP = $1950

That doesn't assure me that one party is getting the Platinum Coverage and the other a Barebones Special.  Not if they cost basically the same.  The larger employer may have leverage to get a better discount for the $, but that's something you gotta prove.

[Captainant 27403]

Just now, slorch said:

LOLz.  I framed it?

It's reality bro.  You want equal results for everyone.  Equal misery. I disagree.

I want equal access and opportunity. What people do with it is their choice. 

But once again, I must point out that you are lying and putting words in my mouth. I have never once said that. You and the rest of the businessbrainbois have repeated that to each other enough that you've conviced yourself that it's true.

You should really work on not lying and misrepresenting people as a matter of course. 

[52-80 19076]

If you wanna say that there's no John Hopkins educated Cardiac surgeon working in the city of Seguin, sure... but what is the representative medical plan and cost for the SMB employee thats inequal to the one for the Dell employees?

[UpperWestside 6126]

1 hour ago, Bozo_Casanova said:

Trust me. Nothing about my views on American healthcare or anything involving the exchange of money for goods and services is Pollyannish. 
But when it comes to primary care, Amazon can’t do worse than what we’ve got, because economies of scale work.  I’ve got no illusions about the potential downsides, they are already with us.

So far at One Medical everyone has seemed less stressed out, and far more patient centered. He me of the docs told me they liked it because he “just just practices medicine here.”

Isnt that right across the Lincoln Tunnel? 

It is. Only one stop across. She has a waterfront apartment last I remember. She grew up in Jersey from the time her parents moved the family from Nigeria to the US when she was 7. She still has one of the best stories I’ve ever heard about being an undocumented immigrant and not realizing it until she needed to apply for college.
 

Work wise she was completely stressed by her old job that she was at for several years. Loved the patients she had, but the stress of pushing people in and out so quickly wore on her a whole bunch it seemed.