I like MacOS and Linux, CPU arch, Finance Systems, Macro Econ, Energy Tech, Support Individual Liberty for every 1. Binary is for Computers, humans are nuanced.
Massachusetts, USA
Joined June 2009
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Happy Porcupine 🖥🏴☠️☢️🔌 retweeted
After experiencing 30 years of declining reimbursement from CMS, Medicare, and private insurance, I have concluded that these entities are not a sustainable model for a first-class medical system. As I see it, private pay, free market medicine is the only sustainable pathway going forward for me.
Happy Porcupine 🖥🏴☠️☢️🔌 retweeted
This is probably one of the most pernicious misconceptions in healthcare.
Sowell puts it nicely: ““Almost invariably, however, enterprises that operate without the incentive of profit have had higher costs, not lower costs.”
Of course, there are many problems with the modern insurance market, and I’d certainly like more competition and better incentives. I wish more care was delivered outside the insurance model all together (that would reduce costs the most).
But a healthcare system with no for profit insurance companies will likely cost much more.
Of course, a government run system can keep costs down with draconian price controls, which will also reduce quality and access.
If we had a strong insurance market, the plans that could provide good coverage at lower cost would get more beneficiaries than the plans that couldn’t, and be rewarded with higher profit. This is much more cost effective than a government entity haphazardly trying to ration care or control costs with other hare-brained schemes (CMMI, MIPS, BPCI, etc).
So, no, I don’t think that getting rid of insurance companies will reduce costs at all.
Happy Porcupine 🖥🏴☠️☢️🔌 retweeted
To put this in perspective in California an underage girl can get birth control, abortions, and hormone treatments without parental consent, but her brother can’t buy a protein shake.
Happy Porcupine 🖥🏴☠️☢️🔌 retweeted
Notice the difference in tone as Anthony, a seasoned (meaning middle aged) neurosurgeon makes a counterpoint to a pulmonary critical fellow.
That tonal difference is important.
Western classical liberal tradition treats a wrong argument as something to rebut with a better one. The Marxist doesn't see his opponent as mistaken but as morally defective. Disagreement is sin, not error.
Happy Porcupine 🖥🏴☠️☢️🔌 retweeted
Charlie was murdered in the middle of a debate with people who hate him while wearing a shirt that said "freedom." He died defending Chappelle's right to be offensive. And Chappelle thanks him by reveling in his death.
But as offensive as that is, none of us who knew and loved Charlie want Chappelle to suffer the same fate. We don't want Chappelle dead, and we wouldn't "feel better" if someone murdered him. That's not how we respond to speech that offends us because we're not bloodthirsty lunatics.
If you're laughing about Charlie's murder, or feeling good about Charlie's murder, you're acting within your rights. You're free to be sadistic. But that's exactly what you are. Your soul is sick. The only thing I wish for you is that you'd come to realize it — before it's too late — and beg for God's forgiveness.
Happy Porcupine 🖥🏴☠️☢️🔌 retweeted
Scott Galloway has repeatedly demonstrated that the “elite” cultural spaces he occupies are a morally bankrupt cesspool of hatred. These are the types of people that decry Trump’s “tone” and “rhetoric” then cheer for the death of their political enemies in the same breath.
I’m short, they’re progressives.
I’m told at least seven advertisers have dropped @karaswisher @profgalloway @PivotPod @ProfGMarkets On with Kara Swisher and Raging Moderates, for their incessant calls for the execution of Elon Musk — and their joking about the assassination attempt on President Trump.
I don’t believe in censorship, but advertisers need to decide if they support political violence and this kind of rhetoric
It’s extremely dangerous and disgraceful
I don’t know why a tech company would pay Scott and Karen $10m a year each to endorse violence.
Why pay for Prof G’s private jet and $4,000 hotel suites that he brags about constantly?!?
Disagree with Elon and Trump as much as you want — I certainly do — but endorsing political violence is unacceptable.
Happy Porcupine 🖥🏴☠️☢️🔌 retweeted
Hijacked American Airlines Flight 11 that my coworker Peter Hashem was a passenger on, and flew it into the North Tower of the World Trade Center, murdering him and thousands of other people.
Happy Porcupine 🖥🏴☠️☢️🔌 retweeted
Mark, you started by saying we have no idea what healthcare costs to buy or to provide in this country. None. Then your conclusion is to propose that the people who cannot see the costs should be the ones to run it.
There is a reason nobody knows what anything costs, and you listed it yourself. Medicaid, Medicare, supplemental plans, Medicare Advantage, self insured employers under a tax code that hides the premium in the paycheck. Every layer you named is a government program or a government created structure, and in every one of them the person getting the care is not the person paying for it. That is where the price went. Prices exist where buyers pay. Remove the buyer and you get exactly the fog you are describing. Universal care removes every buyer who is left.
Then look at what you are asking for. Every private contract in the industry published by federal order. Every claim in the country handed to state and federal researchers. The DOJ turned loose on the pricing structure. Bipartisan legislation to work out what care we need to provide and what it should cost. That is not a market reform. That is the state seizing the information of an entire industry so it can set the terms of trade for every doctor, hospital, and patient in the country. You call the conglomerates Too Big To Care. The entity you want running it is the only one with a monopoly on force.
And the number. The post you are replying to has CBO at $3 trillion a year in new federal spending, 21.4 percent of payroll, with the author conceding it is illustrative and not scored. You respond that nobody knows the real cost and we should find out after we commit. No investor you have ever met would fund a company on those terms, and you have never funded one that way yourself. Only government gets to spend money first and discover the price later, because only government can send the bill to people who did not agree to it.
The information asymmetry you are describing is not a reason to negotiate blind. It is a reason to stop having a single buyer negotiating at all. Put the patient back in the transaction and prices appear on their own. Cost Plus is proof that you already know this.
Mises showed a century ago that a planner without prices cannot calculate, Hayek showed why the knowledge he needs is never in one place, and Rand showed why he has no right to try. You are proposing to prove all three wrong with a commission while you admit no one has any idea how much all of it will cost. Do you think they did not know what they were talking about, or do you just not want to find out?
We have no idea what healthcare costs to buy or costs to provide in this country. None.
States cover Medicaid at some level, but not all offer the same care. Nor do they all receive federal support in the same way.
Traditional Medicare requires supplemental and drug coverage. All of which differ by plan, and are offered by mostly huge conglomerates we should break up and are Too Big To Care
Medicare Advantage is all offered by those same Too Big To Care conglomerates. Every contract with a provider differs and while those contracts have pricing that is transparent, the fees and other charges are not.
67 pct of employees that get coverage from work get it from a self insured employer. I can tell you with absolute certainty that most get it from the same conglomerates as well. As a results they have zero idea how much they are paying for medical care or medications (even with recent legislation)
Every thing that is covered and paid for in this country has an actual cost, across the direct costs and indirect costs, that is hidden by the Too Big to Care conglomerates that should be broken up.
Market Dominant hospitals and most non profit hospitals are not innocent. They play along when they have to, use their own leverage when they can. Increasing the cost of care.
And the PBMs that are owned by the conglomerates have bastardized the cost of brand and specialty drugs in a way that should be investigated by the DOJ.
Put simply , HUGE dominant distributors are forced by PBMs to pay RETAIL Price for drugs that make them unaffordable to everyone.
If we want universal care, we can say the Feds will negotiate , but the information asymmetry is so insane, they will be negotiating blind.
The first thing a bi partisan legislation should do is require that all healthcare contracts be made public with no redactions other than personal information
AND
All claims be de-identified and available exclusively to state and federal researchers to determine what care and medications COULD cost.
Then we can start to extrapolate what care we need to provide and then determine what it costs and whether it will save or cost us money.
In parallel we can determine how we will deal with the technology and processes to handle implementation of some version of universal care
Happy Porcupine 🖥🏴☠️☢️🔌 retweeted
This is from a fascinating exchange between the unnamed writer below and Mark Cuban on health care and who should pay for it.
Mark, you started by saying we have no idea what healthcare costs to buy or to provide in this country. None. Then your conclusion is to propose that the people who cannot see the costs should be the ones to run it.
There is a reason nobody knows what anything costs, and you listed it yourself. Medicaid, Medicare, supplemental plans, Medicare Advantage, self insured employers under a tax code that hides the premium in the paycheck. Every layer you named is a government program or a government created structure, and in every one of them the person getting the care is not the person paying for it. That is where the price went. Prices exist where buyers pay. Remove the buyer and you get exactly the fog you are describing. Universal care removes every buyer who is left.
Then look at what you are asking for. Every private contract in the industry published by federal order. Every claim in the country handed to state and federal researchers. The DOJ turned loose on the pricing structure. Bipartisan legislation to work out what care we need to provide and what it should cost. That is not a market reform. That is the state seizing the information of an entire industry so it can set the terms of trade for every doctor, hospital, and patient in the country. You call the conglomerates Too Big To Care. The entity you want running it is the only one with a monopoly on force.
And the number. The post you are replying to has CBO at $3 trillion a year in new federal spending, 21.4 percent of payroll, with the author conceding it is illustrative and not scored. You respond that nobody knows the real cost and we should find out after we commit. No investor you have ever met would fund a company on those terms, and you have never funded one that way yourself. Only government gets to spend money first and discover the price later, because only government can send the bill to people who did not agree to it.
The information asymmetry you are describing is not a reason to negotiate blind. It is a reason to stop having a single buyer negotiating at all. Put the patient back in the transaction and prices appear on their own. Cost Plus is proof that you already know this.
Mises showed a century ago that a planner without prices cannot calculate, Hayek showed why the knowledge he needs is never in one place, and Rand showed why he has no right to try. You are proposing to prove all three wrong with a commission while you admit no one has any idea how much all of it will cost. Do you think they did not know what they were talking about, or do you just not want to find out?
Happy Porcupine 🖥🏴☠️☢️🔌 retweeted
few understand.
so many foreign dollars put towards influencing the US to elect people that would put forward policies that disadvantage our position
the most cost-effective form of warfare
Elon is one of the few not selling out to foreign interests and is trying to save the US
Happy Porcupine 🖥🏴☠️☢️🔌 retweeted
I mean, this is basically right. The right made fun of George Floyd because they think it’s absurd to venerate a multiple-time convicted criminal, degenerate, drug addict.
The left mocks Charlie Kirk because they think it’s absurd to venerate a conservative Christian.
Rightists have trouble understanding why Charlie Kirk jokes are funny.
Maybe I can explain it in a way you can understand.
People make jokes when a situation is absurd, and more specifically, when others demand you say something untrue about a person and treat them with more respect than they deserved.
George Floyd died. You conservatives thought jokes about St Floyd were funny. In your mind, he was a criminal and a drug addict, and leftists had treated him like the Second Coming of Jesus. Or think about how you'll see a trans person playing basketball with biological women, which leftists tell you is fine and normal, and how funny it is to laugh at this.
Similarly, most Americans do not share your personal admiration for Charlie Kirk. They think he was a bigot and a conspiracy theorist. He was also not in any way a thinker or someone who contributed positively to the discourse, but a political hack who formed his opinions based on tribal considerations and owning the libs.
When Charlie Kirk died, you went around cancelling people for being insufficiently sad. Even if someone said they were sad about his death and they just thought he didn't deserve to be admired, in those cases rightists still tried to destroy people's lives. Republicans in Congress started calling for a statue of Charlie Kirk in the US Capitol, and others introduced legislation to put his face on coins.
As of April 2026, an AP article identified more than 60 Kirk-themed bills introduced across over 20 states. Among these was one in Florida that threatened to take away funding from universities if they didn't rename a road after Charlie Kirk.
Outside of your bubble in which Charlie Kirk was a great thinker and leader, this is all ridiculous.
So when people at a Chappelle show hear the name "Charlie Kirk," they're not thinking about the human being and father. They're associating the name with rightists trying to create a cult of personality, and are employing humor, which is common when people are facing a movement that is trying to tell them what to do.
Happy Porcupine 🖥🏴☠️☢️🔌 retweeted
There is a lot of back-and-forth about what jokes are and what people really mean and what they really believe in their heart of hearts, but let’s just imagine for example that everybody joking about George Floyd was totally OK with it and wants more of it to happen and everybody joking about Charlie Kirk is totally OK with it and wants more of it to happen.
Ok, fine.
In the Floyd case, what you’re saying is that it’s OK if we use harsh policing tactics on serial, lifetime criminal drug addicts, even if this sometimes results in their injury or death.
In the Kirk case, you’re saying that we should shoot political commentators in the neck when we disagree with them.
Happy Porcupine 🖥🏴☠️☢️🔌 retweeted
Economists who believe healthcare is a special commodity that can't function in a market have done real damage to the public's bank accounts.
Making sure everyone diagnosed with cancer, needing dialysis, or injured in a bad car accident gets care quickly is very different from saying the government should provide cataract surgery for everyone.
I don't want fewer people to have cataract surgery. I want more. I want a flourishing market with price signals intact, so that access widens for the people who need it.
The current system manufactures demand because "Medicare covers it." Borderline patients elect surgery. Tell a cataract surgeon that night lights bother you a bit more as you age, and you'll be scheduled: simple, easy, quick, and you'll see better. But that means the low-income patient who truly can't see has less access.
The distortions don't stop there. Why should someone making more than $500,000 a year have their cataract surgery paid for by Medicare? Do we want to guarantee universal access to surgery for mild vision changes in the wealthy? Or do we want to target people with low incomes and subsidize them directly, through a health savings account they can spend on services like cataract surgery?
Under that model, anyone who wants to spend their health dollars on mild vision loss can shop for it and get it done.
That's a far better solution. It stops throwing dollars at rich people, and it stops depending on a bureaucracy that will always be relatively incompetent at policing utilization and fraud.
US insurance companies often deny care. As a doctor and a patient, it’s frustrating.
But this idea that other countries just approve everything is a midwit take.
It’s just the government denying your care instead of an insurance company. And they often deny care that’s routine here in the US.
For example, in British Columbia, you can’t get a spinal disc replacement surgery, as case that’s routinely done in the US and has randomized trial data showing superiority over spinal fusion.
And speaking of fusion, the UK recommends against even that. Their NICE committee (which isn’t) determines what gets approved in the NHS. They state that spinal fusion offers no benefit.
Even if you agree with those two assessments, the point is that there’s still routine denial of care in socialized systems.
No healthcare system pays for everything for everybody with no utilization management.
Healthcare has unlimited demand. If someone else is paying for it, then it must be rationed.
Happy Porcupine 🖥🏴☠️☢️🔌 retweeted
As a teacher I find this maddening and exhausting. I teach high school. Do you want to know how I get boys to read?
It's a huge secret, but I'll share:
Stories like "The Sniper," lots of Roman Empire stuff with the Stoics & Julius Caesar; lots of adventure and sruvival stories ("To Build a Fire"). LOTS of sci-fi stories (Bradbury is a staple in my class) and even the occasional screenplay of a Twilight Zone episode ("Monsters are Due on Maple Street.") Poems like "If" and "The Highwayman," boys eat up that kind of doomed romance when the guy is a badass and has dueling pistols.
But ma'am, you're saying. Aren't you just reinforcing the gender binary by giving boys things they like to read?
Yes. Yes I am.
Because they're boys, not defective girls. They have to sit through some things they don't like, sure- but so do the girls.
These women just don't like boys or men. They think they are defective girls.
I teach K-6 for summer school and remediation- ON THE PLAYGROUND at FIVE YEARS OLD the boys are collecting sticks to fight dragons and the girls are climbing on the jungle gym so the boys can come rescue them from the dragons.
Nothing would reinforce the gender binary for these crazy people so fast as watching a group of about 30 kids playing. NOBODY TELLS THEM WHAT TO DO.
One of the most popular boys at summer school this year? What did he do? He gathered up like 15 sticks on the playground and he gave some to his buddies, then he gave some to the girls so they could defend their castle till the dragon was slain.
I say again, BOYS ARE NOT DEFECTIVE GIRLS. They have their own stuff going on, man. These women shouldn't be anywhere near educating children because THEY HATE 50% OF CHILDREN.
Happy Porcupine 🖥🏴☠️☢️🔌 retweeted
Then we are going to have a fundamental difference of opinion.
My source: being a high school teacher for 20 years + teaching remedial and summer reading for k-6.
I regret to inform you there is a gender binary. It is obvious by 5. Nobody has to teach this or cater to it. It simply exists and arguing with it is like arguing with gravity.
I try my dead level best every year to balance my reading list with short stories and novels boys will actually like and want to read.
Boys will read if you give them something they like. This year I designed my reading list around the trolley problem- issues of morality and ethics that have multiple modes of argumentation. No complaints so far.
The parents go- wow- how are you getting my boy to read?
Oh I don’t know: Yesterday we read a story called “The Sniper” and today we’re reading some Stoics before we dive into Julius Caesar, just the usual stuff, just lucky I guess…
Lady please.
Happy Porcupine 🖥🏴☠️☢️🔌 retweeted
Just removing primary care, labs, and imaging from insurance coverage will cut at least half of the premium cost. These are the sectors that lend themselves to "perfect competition" because of relatively low capital costs. CASH-ONLY for those items, and then insurance for the other stuff. Not hard. Of course, insurance companies will have to lay-off half of their staff. But that is a necessary correction that we have to go through in order to not be completely cannabilzed by the health-care industry. Here is an excellent chart from Dr. Ashgar.
Happy Porcupine 🖥🏴☠️☢️🔌 retweeted
I have said this before, I'll say it again: I'm self-employed. Under the ACA, my premiums went from under $800/month (family of 7) to $3300/month in 4 years. My original plan was cancelled (catastrophic care.) Yet deductible was the same. After Trump in 2016, I was able to get a catastrophic care plan again -- though $800 for family of 2. I have lots of experience and more to say about this, but ultimately, the ACA raised costs exponentially across the board and can't sustain.
The claims of the ACA were:
1. Going to save families $2,500 a year
2. Going to lower the deficit
3. You could keep your doctor
The reality is:
1. 80% of doctors are employed
2. The costs of health insurance have exploded
3. The insurance companies are seeing record profits
4. One in five in-network claims are denied
5. One in three out-of-network claims are denied
We have to borrow money to subsidize the companies that are the problem.
Americans deserve better; eliminate the ACA!
Happy Porcupine 🖥🏴☠️☢️🔌 retweeted
Affluent centrists (who thirty years ago were 70/30 moderate Republicans) are now 85/15 progressives.
This is basically akin to a midlife crisis where people way over their skis imagine themselves as protagonists when in reality something has passed them by.
After the mania finally passes, they’ll wake up frazzled, hungover, and vastly diminished.
Happy Porcupine 🖥🏴☠️☢️🔌 retweeted
Charlie Kirk got killed for having the exact same stance on trans issues as Dave Chappelle made 5 comedy specials about.
"Ever since that guy Charlie Kirk got murdered... and I shouldn't say this publicly... I feel better."
-Dave Chappelle at Madison Square Garden
And the New York City crowd laughs like a bunch of hyenas. teapawt.net/PostViralRepost/status…