- Banksy, AdBusters interview backintheday
The issue is not that these choices are available, the issue is that these choices crowd out the sensible ones. There's a lot of fallacious product design in toothbrushes. At the same time, it makes sense to apply what we know about dental hygiene to what we know about human habit to what we know about materials science to what we know about merchandising because even an expensive toothbrush is what? $4? $5? That's before you get into the land of Sonicare and its ilk and there are justifications to that, too. I have a $140 toothbrush. It was recommended to me by my dentist over my $100 toothbrush because apparently I was brushing hard enough to require some repair at the gumline to the tune of $900 billed to my insurance. The difference? The new one tweedles at me when I brush too hard. First world problems? You betcha. Asymptotic improvement? Mos def. BUT it is innovation in pursuit of improvement.
Dollar shave club, on the other hand, doesn't help you shave better. What it does is provide you access to bottom-of-the-barrel no-name Chinese blades at substantial markup to you. Yeah - a bag of Bic safety razors is like $3 for 24 or whatever so obviously you don't have to purchase that, either, but Unilever spent a billion dollars buying Dollar Shave Club instead of, I dunno, making better razors.
Lather, rinse, repeat. You rightly state that you are not directly impacted by any of these deeply silly Silicon Valley choices but you are indirectly affected. As you state, you're a fan of Blue Apron - what if Silicon Valley spent $120m on improving the efficiency of produce delivery to wherever you are instead of $120m on ways to sell chopped fruits and vegetables for $10/lb?
Henry Petroski has argued many times that necessity isn't the mother of invention, luxury is - we do not invent a fork because we cannot eat without one, we invent a fork because it's easier to eat with one. The inventor/manufacturer profits off of the increase of ease he provides us, and we pay him gladly. The argument put forth in the article (not as clearly as it could be, no doubt) is that the Silicon Valley business cycle is not focused on efficiency, it's focused on inefficiency and predation. And while this is not universally true, the argument for "disruption" is not "make the world a better place" it's "break laws and make money until they legislate you out of existence."
I have thousands of hours of music on hard drives. I used to have hundreds of CDs. My access to music went up an order of magnitude with the advent of Napster... but I can't really say that MP3s improved the state of music. It used to be that technological innovation was largely in pursuit of quality-of-life improvement and that argument could easily be made about Napster et.al. However, the inefficiencies of the music market also provided a living for most of the people involved in its generation.
And that's another issue - companies like RentBerry and Fiverr are, at base, eliminating inefficiencies. However, in a marketplace that's even a little unfair or uncompetitive, "inefficiencies" are often the profit of the disadvantaged. On a perfectly level playing field, assembly line workers in Detroit should have no problems competing with assembly line workers in Guadalajara.
Hi. Freelancer. Years of experience. Union member, skilled laborer. And where I work, the middle has dropped out. I'm one of the youngest people in my industry that I know of and my 20-year reunion was a while ago. See, used to be you started out as a gopher PA and then you became a set PA and then you picked up a skill and then you started making a little money and your network grew and you started making more money and eventually you had a wife and two kids and a house in the Valley. But now there's a sea of film school grads who can work for free because mommy and daddy understand that you have to do that for a while in order to get experience so they'll pay Janie's $1900/mo rent for a studio in Panorama City while she struggles for free until eventually it becomes clear that as soon as she starts to ask for money there's ten more Janies eager to take her place so eventually she's going to go back to live with her parents in Dayton and take orders at Applebee's while meanwhile, the guys that are actually hiring new kids who don't know what they're doing are generally doing it with their parents' money, too, and they're going to fail out within however long it takes for their folx to get sick of paying for their hobbies and in the meantime, we're all getting older and we're all hanging on to the gigs we have and the kids? The kids are not coming up because the opportunities that are available to them are a mirage.
Make no mistake. I'm the other side of that divide. Comfortably. But the gig economy, in my industry at least, is a fucking meat grinder for those without protections. Multiply times everything.
I've taken to referring to my time in Los Angeles for work as the time when I'm within the event horizon for the black hole. Communication in or out is tricky and time stretches to the point where your frame of reference is no longer valid.
This time last week I was in Los Angeles which appears to have boosted the Schwartzchild Radius.
My daughter is in an immunotherapy study. It's going to take years but there is a high likelihood that she'll be less allergic to peanuts on the other side. I phrased it to her as "how would you like to help other kids be less allergic to peanuts?" and she went all in, despite the fact that they had to make her back itch and draw her blood. Then her bloodwork came back with low immune response levels (probably because she had the sniffles) so she had to go in again. She likes the "magic cream that makes her arm tingle" but still, she's four and has had her blood drawn twice in two weeks with no complaints. The administrator told us that they really hope they can get her in because while they can't tell me her peanut IGGs, her regular IGGs are the highest in the entire study. Go kid. Glad you're more allergic than anyone else they've ever seen. not.
Had lunch with my buddy. Told him I'd done reasonably well in cryptocurrency, told him that if I couldn't use it for shit like chemotherapy copays what the fuck can I use it for, told him that the point you stop being able to be proud and refuse charity is well before the point where your relatives put out a GoFundMe for you and cut him a check for a thousand dollars. He cried and said it was really valuable to him to have long-term friends around (we've known each other since we were 4) so I punched him in the face and told him to stop being such a pussy. We now have a regular lunch date for as long as I'm in town.
Saw Front 242 and Severed Heads in Los Angeles. mk did not because he is lame. We got wasted - 60ccs of bone marrow aspiration be damned, I drank like four doubles of well bourbon and blasted my fucking mind out with EBM. The last time I saw Front 242 I ran lights for them and everyone was 20 years younger. The local alt-rag made fun of Front 242 back then for being totally into their music and dancing around like "a bunch of boojie boys" well past their primes because alt-rags are always bullshit. And here it is 20 years later and there's Jean-luc DeMeyer, 60 fuckin' years old, black leather jacket, sunglasses at night, rockin' it like it was '85. And the audience was not nearly as gothy as it would have been in Seattle - i mean, there was a guy in a hawaiian shirt and a fanny pack. And fuckin'A I was wearing goddamn cargo shorts so who the fuck am I to say anything.
one of my buddies is insecure. I told him to be more like Jean-Luc De Meyer - rock the sunglasses at night. That mutherfucker has known exactly who he is for 40 flippin' years and nobody remembers that bullshit alt-rag review but me while he's still sitting there headlining sold-out houses ten thousand miles from home. And then I got home and dropped my kid off at school wearing fuckin' house slippers and the same goddamn cargo shorts and realized that everyone else was all dressed for work'n'shit and I realized I have no fucks to give.
A friend turned me onto a Boeing gig doing tedious webcast shit. Sure, why not. So you talk to the recruiter. She wants a "resume." Oh, right. Out here in the world they still care about that shit. Fine, here's a thing I did in Pages like three years ago which I refuse to install on my computer to fix the address and email so here's a PDF with some wrong info because I can't be sussed. Then they want an "interview." Oh, right. Out here in the world they still care about that shit. Fine, okay, I'll pick up the phone, yeah, your rate is half what I make but so long as you give me enough work to not fuck up my unemployment checks until I get to my real job I'll take your money. What's that? You want me to fill out a profile on your website so that other recruiters can reach me? I mean, Okay...
At some point in the not-too-distant past I gave OftenBen a ration of shit about millennials because everybody harshes on the next crew but Millennials are the first posse that thinks it's okay to show up to an interview in flip-flops or some shit. It's a trope that's been in Forbes, Huffington Post, Time, whatever. Ben, I owe you and the rest of your generation an apology. Flip flops are what you wear to interviews you don't give a fuck about. The fact that you don't give a fuck about the interview doesn't say anything about you, it says a lot about the job being interviewed for. It says a lot about your regard for the culture that wants you to jump for their bullshit hoops.
I'm about to be 43 fuckin' years old and I have successfully opted out of that culture. My contempt is cushioned by disinterest and success; I can easily see it coming from a position of despair and resignation. Hipsters? Hipsters are the kids that aren't putting up with your bullshit and still feel kind of okay about themselves. A fully enlightened millennial generation will be a sea of vinyl-listening, avocado-toast-eating, flip-flop-wearing hipsters.
I've been to four watch-making classes. I'm learning not a lot and having the time of my goddamned life. The watchmaker at Vacheron Constantin recommended a book that is hard to find and very expensive. Turns out one of the instructors at the class scanned that fucker to PDF but never read it. It's DOPE. Did you know that there are really only five gears in a watch necessary to tell time? Did you know they're really fuckin' fun to take apart? Did you know that ten years building scale models, 20 years working with surface-mount electronics and 30 years tuning carburetors and otherwise performing fine work on motor vehicles gives you orders of magnitude more manual dexterity and fine motorwork than your peers? I didn't. I do now. I'm fuckin' good at this shit.
That's a pallet fork. It's about 4mm wide. Turns out that 10x macro lens that clips onto your phone that you got in your stocking can be really goddamn useful. So yeah. Took apart a pocketwatch and got it back together again in the amount of time it took everyone else to take it apart. LOVING IT. With a semi-decent CNC machine I could build these things from scratch all goddamn day long and be a pig in shit. I would be utterly and completely divorced from this bullshit "show the recruiter where on your resume the bad career touched you" society and walk around in my goddamn cargo shorts and house slippers all day because I don't have a boss to care.
Finally, my car is dying. It needed $1500 worth of work six months ago and still does. Then I gave a buddy a thousand dollars so he wouldn't fucking die and figured maybe, as a 43-year-old man, I deserve to drive something that doesn't smoke when it warms up and doesn't have gorilla tape keeping the headliner out of my hair.
So I'm negotiating on a Porsche 911 carrera cabriolet because my inner douchebag clearly wants out. Even better, it's the shitty 996 water-cooled one that Porsche nerds love to hate because apparently every time you turn the key Ferry Porsche spins in his grave because it's water-cooled and made with Boxster parts and has headlights like fried eggs and and and. Here's what I know - if I can get a car? That sold for $80k? With 21k miles on it, new tires and $15k worth of service just done on it for less than the price of a Prius C? I'ma do it.
State farm wants $7 less per month to insure an '02 Carrera than they do to insure a '95 Dodge. Put that in your pipe and smoke it.
mk, thenewgreen, I might be rippin' through San Fran at some point soon because taking a ragtop Porsche up the PCH in fall sounds like a pretty nice birthday present to myself.
What you're explaining loud and clear is that you feel the people responsible for the truth on the ground are not giving it the proper consideration. When I called you out for arguing (as a grad student) that you knew better than the law, you doubled down:
I took one (1) acoustics class. It was taught by the two acoustics Ph.Ds at UW. And we started the class with one of the profs explaining the measurement rig he had pointed out the window: see, the buses outside were loud, but it was spring and soon the trees would be covered in leaves and it would be much quieter. et voila. Acoustics.
We believed him - I mean, I was 22 and the actual math of the attenuation of a shit-ton of leaves is intensive. Nonetheless we never did end up comparing beginning and end. Once I started working in the field I relayed this story to my boss and she laughed uproariously and showed me the B&K chart listing attenuation on the x and "meters of forest in hundreds" on the y.
These are acoustical professors with Ph. Ds prestigious enough in their department to fund a boat that flips on its tail for sonar studies. And we learned all sorts of great stuff about nodal analysis, resonance, deep channels and the like which provided a fundamental basis for the practical knowledge that I then picked up in the field. Because "practical knowledge" wasn't their thing - they were busy rewriting the theory. And for environmental acoustics, the theory was laid out by a dude a hundred years dead.
We'll disregard my profs' erroneous assumptions about the way environmental acoustics work. We'll even disregard the fact that when they were busted, they shined it on as if it never happened. We'll focus instead on their attempts to broaden the body of knowledge that we all benefit from and thank them for it. We'll even spot them the assumption that if my boss were to walk into that room and give them a lesson on the acoustical isolation of leaves, they'd listen interestedly, ask intelligent questions and have a rigorous debate about the mathematics at play.
Because nobody comes out ahead when we assume everyone else is a fucking idiot.
FIIC. Field Impact Isolation Class. A two-digit number that takes two trained professionals two days and ten thousand dollars worth of equipment to arrive at. Lucrative, no? I mean, we couldn't roll one for less than $3k. Which means we didn't get to roll them nearly often enough. And we spent a day burning through the math in custom bullshit Excel spreadsheets that sucked and that wasn't any fun either. So when we were presented with an opportunity to test some composite floors so we could build up some better mass law models, my boss paid me to schlep concrete and sand up to the 4th floor of a condo for six weeks so we could do our own testing. Contribute our own models. Put in our own research.
I billed out at $150 an hour, dude, and she sank 240 hours into it.
So I'm glad you're "all worked up." You should be. You "want the underlying assumptions, biases and structural issues unearthed and discussed" which can only mean you think they aren't. You "want to know in which context they work and in which context they don't" as if you think people don't fight over this shit every goddamn day. And I've been trying to say this a dozen different ways and you aren't hearing it, probably because it's offensive, and because it assails your worldview:
The experts in the field know more than the people they measure.
That's it. That's my beef. That's my fundamental observation, that in any esoteric body of knowledge, the practitioners of that knowledge know more about that knowledge than the people who encounter that knowledge glancingly. No matter how broad your evaluation of mapping and GIS, it will never be as focused as the mid-level bureaucrat in some forgotten town who has jurisdiction over where roads go in his township.
The argument put forth in your essay is that the experts are fucking idiots. When I tried to find something about objective vs. relational you came back with "no, it's that the experts are fucking idiots." When I came back with "you know, the experts I've worked with seem to know their shit" you came back with "they don't know it nearly enough because research." So yeah. I'm fucking offended. Your argument hinges on the idea that the practitioners of a science are incurious about the theory of the science, which is the argument people always make, so often that you actually whipped out
The "arrogant" engineers are the ones that know they know more than you and are sick of having to explain it. They're the ones whose knowledge is called into question because somebody just did a study somewhere. They're the ones being forced to (temporarily) rewrite their entire code of behavior because some expert somewhere in another unrelated field has better PR.
These are Assistive Listening Devices. They cost about $300 each, plus about $1000 for the transmitter. And thanks to the Americans with Disabilities Act, if you have an auditorium that holds more than a hundred people you have to have enough of them for five percent of the audience. That means if you have a school somewhere with a gym that seats 300 people, $5500 is going to be spent on shitty FM radios that nobody ever listens to... rather than band instruments, rather than gym equipment, rather than art supplies.
This happened because a well-meaning audiologist argued back in the mid-80s that deaf people were being left out of public events because they couldn't hear, and a lot of them couldn't afford hearing aids, so clearly any public building should be forced to pay to bring them in so that they would be "handicapped-accessible." And none of them ever get used - you wanna stick someone else's grody earthing in your ear? - but they're mandated by law and building inspectors across the US have to count the fuckers every time there's a permit issue. Millions of these things, mouldering away in closets.
Repeat for in-class reinforcement, smartboards, etc. What usually happens next is some journalist gets a bug up their ass to investigate waste and comes after whatever the it-thing is and administrators are pilloried for wasting money on that thing that only has one study to back it but ALS has hung on for three decades because the ADA was written by the Pope, effectively, so here we are. But fundamentally? People who don't know telling people who do know bones it for everybody.
My argument, simply put, is it's dangerous and offensive to assume that the people doing the majority of the work are in the knowledge minority. And the fundamental argument put forth by this argument - and by you - is that if we have a number, and everybody agrees on it, it reflects calcified thinking and oppression of the populace.
The only way you could want this is if you hold deeply the idea that "people" aren't already doing it.
And fuck right off with that shit.
There's a great Frontline that answers all your questions. Unfortunately it hasn't been digitized.
The problem with trading up the chain, simply put, is that law enforcement only knows what criminals tell them. They are not constructing parallel cases. They're not making the roads safer, they're filling their quota of speeding tickets.
Torture doesn't work for the same reason - if you tell me you'll stop pulling my toenails off if I tell you who gave me the IED, I'll stick with the pliers so long as my source scares me more than you. Which means all I need to do is give up someone who scares me less than you do - and there's no downside to iteratively throwing names out there.
Let's say I've got four buddies - Alex, Bob, Chuck, Dave and Elvis. You've got my phone and you know that I call all of them. You're going to throw me down the forever hole unless I give up my dealer, and you suspect it's Alex, Bob, Chuck, Dave or Elvis. I play cards with Alex. Bob occasionally buys weed from me. Chuck's a single dad who hits me up for money. Dave gets me work sometimes as a bricklayer and also loves to share his collection of child porn. Elvis works for the Zetas cartel.
I'm going to give them up in the following order:
1) Chuck because he's a drag on my bottom line
2) Alex because I lose money when I play him, even if it's usually fun
3) Bob, because I'll miss that income
4) Dave, because I'll really mis that income
Never) Elvis, because I don't want my entire family to end up beheaded on the side of the road outside Amarillo
Presume, for the sake of kindness, that the DEA can rule out Chuck and Alex immediately. They are obviously, visibly harmless. Bob? The DEA is going to squeeze Bob, who will give up his own list that also doesn't include Elvis. Each one of the people on his list will be squeezed until eventually someone is stupid enough to flip a supplier. That supplier is then going to play the exact same fucking game. Elvis is doing just fine, the DEA is chasing their tails, and low-level addicts are suddenly drug kingpins because they're all narcing on each other.
Let's add some financial incentive to the pot, shall we? Every single person who gets implicated is also subject to DEA seizure. That means they get to take anything that touches drugs. Did you drive a car with drugs in it? it belongs to the DEA. Did you ride in a friend's car with drugs in it? It belongs to the DEA. Store drugs in your house? It belongs to the DEA. Store drugs in your landlord's house? It belongs to the DEA.
Along with everything in it.
Let's take my buddy Dante. He was addicted to Meth. He got clean for the sake of his life, and for the sake of his son. And then his buddy, who helped him get clean, told him that he needed 2 kilos of coke to make it across town by 5 or the Zetas would kill him. So my buddy Dante got the keys out of a mailbox, got in the car and started it up.
The car? The DEA's. The drugs? The DEA's. Dante's buddy? Trading up the chain, giving up Dante rather than the guys the DEA wanted because Dante couldn't make him show up headless on the side of a freeway outside Amarillo. Dante, of course, had no one to give up so he was charged with trafficking and faced a ten year bid for a first offense. Lost his truck, lost all his musical equipment, is a felon forever.
Well yeah. Shouldn't have gotten in the car. No shit. But if you think policing, public order, the war on drugs or any civil good has been advanced by this travesty of criminal justice you're not only high, you're evil.
And that's what's wrong with it. Dante is real. The seizures are real. The dead on the side of the road outside of Amarillo is my sister's ex-boyfriend. And here's the DEA, getting low-level smurfs to snitch on each other for fun and profit while the Coast Guard siezes 225 tons of coke.
That's a buddy of mine, couple weeks ago. I've known him since I was three. He's center left. I'm center right. This was my seventh birthday.
He was my main rival through elementary school; the other smart kid. We were the twin towers of nerd-dom. Only he got distracted by other stuff and basically flaked out on school; I think he literally got perfect SAT scores but his academics blew. He now thinks it was the paint chips he ate as a baby because apparently he's got other hallmarks of lead exposure. Me? I started hanging out with the overpass kids and noped the fuck out of academics pretty hard so by the time anyone gave a fuck about achievement we were both too cynical to care.
We have lunch when I can find time; it's always striking to me because I show up wearing WTFever and he shows up in coveralls with his name on them. perfect SAT score. My life was no bed of roses but fuckin'A.
He's gonna die.
He's three months to the day younger than I am and he's gonna die. He's got two kids; one just graduated high school, I think, and the other is three or four years out. His wife got him all the way through recovery and then decided that she didn't want to be anyone's wife anymore. And his commute is miserable and he's gotta deal with shit like dialysis AGAIN.
I've done well in Ethereum. It's play money, too. And my instinct is to frickin' pay off his gofundme. I mean, there's a girl on the roster there a thousand miles away whose existence I'd forgotten until yesterday and she put $250 towards this guy she prolly hasn't seen in more than 20 years. I've had lunch with him like twice this year and I haven't been here for half of it. Maybe that'll buy him another couple years. But then I put my name on it and it hangs over both of us. Maybe I don't put my name on it and then it hangs over me. I don't know.
His parents are government employees with rippin' pensions but he doesn't talk to them anymore of course and besides, he's a grown-ass man. A grown-ass man whose sister is begging on the Internet to pay his medical expenses because we live in the most advanced Western democracy in the world with the best healthcare in the world and the best doctors in the world and we're crowdfunding someone's renal failure.
I make reality television for a living and my daughter's inhaler costs me $5. Her epipen costs me $5. Her ER visits? A whopping $70 ZOMG. I get hot towels when I fly and he finishes out the day with Gojo and growing up, his was the house the nicest one I'd been in and his mom was on the city council and their cars were always new and I hunted mice so I could sleep and here we are and I don't understand how we've created a society where a million little choices by a million little kids lead us to this place where I keep my bike tools in a Harry Winston bag and he's begging the Internet for another couple years on this earth, please.
So I'm home, and I slept in my own bed, and I started a class in taking apart watches and I've got a feature and a short to mix and what really fucks me up - and has been fucking me up - is my buddy.
I sent him a text saying we were setting up a standing lunch date, my treat, he picks the day of the week and the place. I haven't heard back.
I firmly believe that "single payer" would get a lot more support if people stopped talking about it in grandiose themes and noble vignettes and started talking about it in real terms. All the liberals I know are in heavy favor of "single payer" without any of them knowing what the fuck it is.
HERE'S WHAT THE FUCK IT IS.
I've got a medical facility - Al's Medicine. Al's subcontracts to Betty the Biller and Cindy the Client Specialist. I operate in a state where my medical facility is covered by Medicaid. We also take private (employer-provided) insurance, which is underwritten by the following insurance firms: Q, R, S, T, U, V, W, X, Y and Z.
Al's must sign individual contracts with Q, R, S, T, U, V and W. These contracts are "take it or leave it" binding: they say that for ICD code 1, Q will pay Al's $7.50 but for ICD code 1.000000001, Q will pay Al's $0.00 because fuck you, Al's. Note that Q might pay Joe's $6.50 or $9.50 or pi.ie^2 for ICD code 1. Q is entirely within its rights to do so. Al and Joe, on the other hand, are contractually forbidden from discussing their rates for ICD Code 1. If Q gets wind that Al and Joe know what the other are getting, they can drop both because fuck you, Al and Joe. Also know that Joe might not get anything for ICD Code 1 because Q has decided that all of Q's contracted healthcare clients can drive 75 miles to Al's for those services because fuck you, Joe. Also know that Q can tell Al's they'll pay $7.50 for "services" verbally and in writing, but when the actual contract comes through the actual number listed is $2.25 because fuck you, Al's. Also know that they won't tell you what ICD codes they'll pay for, they'll just say "services" and let you resubmit your bills over and over and over again until you find the ICD code that pays out the most because fuck you. Also know that the ICD code they choose to pay for can and will also change because fuck you.
A few other notes: Al's might have to provide, for example, rhogam shots to prevent babies from dying from blood type incompatibiliy. These rhogam shots might cost Al's $28 but Q is going to pay $7 because fuck you, Al's. If you ever wondered why hospitals charge you $40 to hold your baby it's because they're trying to claw back the $21 the insurance company isn't paying for medicine they're required by law to administer (for example). Also note that your involvement, gentle consumer, starts when you get an "explanation of benefits" from the insurance company listing all the outrageous charges the doctor hit you with. It will provide no explanation. It will show how generous they were in all their disbursements and then show you that your doctor's office is going to bill you STILL MORE MONEY because they're such bloodsuckers.
This is where Betty Biller and Cindy Client Specialist come in. Betty makes 10% by pickaxing all the money she can get out of Q. Betty's whole job is knowing what Q pays out on. Betty knows which ICD codes Q pays out what on, and can turn your "normal child checkup" into 42 different codes that pay the maximum rate Q has contracted to pay. She is literally a medical billing bounty hunter. Betty is the back office side while Cindy talks to you, the client - here's what's coming, here's what it means, here's how to get your insurance to pay for this ahead of time, here's how to get preapproval for that.
For those keeping track at home, billing specialists outnumber doctors 2:1 in this scenario.
Multiply times insurance companies R, S, T, U, V and W, who all have their own rates, all have their own codes, all have their own geographic exclusion areas, and probably have seven or eight sub-plans so that it's not actually "V" it's V.a, V.b, V.c, V.d, V.e, V.f and so on. Suddenly, Betty and Cindy look positively useful and you will pay them gladly because the act of billing for care takes three to four times as many man-hours as actually providing that care. Betty and Cindy make good livings and their existence is entirely parasitic on the insurance companie's deliberately opaque, byzantine and antagonistic reimbursement practices.
Not Y and Z, though. Y and Z contract through Medicaid. Medicaid has no patience for that bullshit. They will pay the following amounts on the following ICD codes. Anybody who contracts through Medicaid bills those codes and gets that money. It is known. Y knows, Z knows, Al knows, Joe knows, and all of Al and Joe's clients can fuckin' look it up. And when Medicaid's reimbursements lag behind the real world, it gets turned into a bill that goes to the legislature that raises the rates for everyone.
Al's, in fact, might get better reimbursements out of Y and Z (because of medicaid) than they get out of Q, R S, T, U or V.
Unfortunately you as a patient don't get your insurance through Y and Z because you make more than the poverty level for your county. You get whatever insurance your job provides, which might be V.c, might be Q, might be nothing because you drive for Uber and fuck you.
As a provider, we get to choose who we contract with. We do not get to choose what those providers pay us. And if 50% of your clients work for Microsoft, you bloody well better be able to take V.c, despite the fact that they reimburse at exactly half what Medicaid reimburses at (which is funny, because all your Microsoft mommies make six figures). R, on the other hand, may decide that they'll never cover you because they have enough of your specialty in network, never mind that the nearest provider is a ferry ride away (because this way they don't have to pay for those services).
As an insurer, you get to decide who you contract with. You can pick the providers that are the stupidest, that will accept the lowest rates, that have the lowest conflict rate of you arguing over charges. And you get to discuss this with the HR reps of companies large and small, none of which have any background in medicine, medical billing, accounting or statistics. To no one's surprise, they choose on price.
But the poor people? They pay what the state says they pay, the insurance companies collect what the state says they collect, and they contract with the providers the state says they contract with.
THEY STILL MAKE MONEY.
They're still private insurance companies, privately managing your health care, privately paying out private doctors. It is not "socialized medicine." It is not "universal healthcare." It is not the National Health Service. The healthcare industry is something like a tenth of the US economy; you're never getting that. But you go single payer and all of a sudden things go from back-room knife fights between Q, R, Betty and Cindy to state-mandated pricing and state-mandated coverage.
My future is tied to health care. I've got more in a medical practice than you have in your house.
And I'm a big booster of single payer.
And so's Aetna, who in this example is R.