> I’m sort of dumbfounded at this level of misinterpretation.
It is difficult to get a man to understand something when his salary depends upon his not understanding it.
-- Upton Sinclair
Obviously, Paul Graham could understand, and I submit he does understand, and he doesn't even have to worry about a salary, but, like a not-quite-so-jaded version of a Koch brother or a Walton, he has a point of view to maintain and propagate.
The dictionary definition of the word empathy does not conflate it with sympathy, at all. It is simply "the action of understanding, being aware of, being sensitive to, and vicariously experiencing the feelings, thoughts, and experience of another" and has fuck all to do with whether or not you have the other's best interests at heart.
Paul Graham writes with precision, and he has written extensively and correctly about empathy. Now, does this mean that he is incapable of hoping that some of his readers conflate empathy with sympathy? Not at all. You have incorrectly made this conflation, but correctly understood that he is not describing behavior borne out of sympathy. Others may incorrectly make the same conflation and incorrectly understand that he is sympathetic.
"Like painting, most software is intended for a human audience. And so hackers, like painters, must have empathy to do really great work. You have to be able to see things from the user's point of view.
When I was a kid I was always being told to look at things from someone else's point of view. What this always meant in practice was to do what someone else wanted, instead of what I wanted. This of course gave empathy a bad name, and I made a point of not cultivating it.
Boy, was I wrong. It turns out that looking at things from other people's point of view is practically the secret of success. It doesn't necessarily mean being self-sacrificing. Far from it. Understanding how someone else sees things doesn't imply that you'll act in his interest; in some situations-- in war, for example-- you want to do exactly the opposite."
Now, if you read that carefully and don't conflate empathy with sympathy, you can understand that, for someone like Mr. Graham, empathy is orthogonal to exploitation -- it's a guide to maximum value extraction over the long term, which may or may not require exploitative techniques, depending on the circumstances.
On the other hand, more fortunes have been made by assuming that physics will catch up (closely enough, anyway) to computational needs, than by assuming that every byte and every cycle and every nanosecond matters.
In 2026 Moore's law has mostly stopped. My computer from 10 years ago still has acceptable performance today. My computer from 15 years ago would struggle a bit but still get the job done. This is nothing like the 90s where you actually could wait two years for all of that year's conceivable performance problems to be solved.
Dennard scaling has stopped (performance/clock speed increasing), Moore's law means mostly transistor count or density. The former is still going strong, the latter is slowing down.
Asymptotically, every billing system is a stock market and telecom. ;-)
My biggest career horror was realizing how much the medical informatics concepts have been structured around billing and insurance rather than scientific, biomedical requirements.
Can you make money without being highly available?
Can you be highly available without making money?
And btw I've worked in both the industries you cite. It's hard to think of telecomms having amazing uptime when you have to write a restart script for a core security daemon because the sysadmin doesn't know how.
That's like saying money is only spent on sw/hw systems which rely on ever-growing compute capacity.
Reality: embedded systems are a thing. And there's (lots of!) money in that business too. There's maaaany applications where some (fixed) amount of compute does the job, and the simplest/cheapest device that does it wins out.
I've worked in embedded, and chips, and embedded chips for most of my career.
> There's maaaany applications where some (fixed) amount of compute does the job, and the simplest/cheapest device that does it wins out.
There's usually quite a bit factored in for slop in these days, because time-to-market is a thing. There's also sometimes a cost-reduction stage (yeah, I've been involved in cost reductions where a penny a unit was awesome), but you don't bother doing the cost-reduction phase unless you have the volume to support it.
Warren Buffet famously said that "Concentration builds wealth, diversification preserves it."
In much of computing, even embedded, demos and prototypes build a product, and the right-sizing of everything to make it even more profitable happens later, if it is worth it.
I've never understood why so many self-declared programmers are so eager to brag that they can't understand a programming language which is, frankly, not really that complicated.
I don't particularly like, say, lisp, but I can in fact understand lisp programs or write them if I need to.
I admit I also don't understand the characterization of perl as a write-only language, although I can make a guess about how it's because a lot of perl programs have many embedded regular expressions, and, like many programmers, I'm not particularly thrilled by things like sigils, and I don't find the syntax particularly good.
You are right that it's not that complicated, but like any language that I'm not interested in mastering, the amount of learning that it would take to create idiomatic perl is not an investment I'm willing to make.
And, given that none of the perl scripts that I was tasked with modifying were very long, I have always treated it, rather than a write-only language, as a read-only language; when someone hands me something in perl that needs to be updated, it gets recoded in something else.
A single person, who makes $910/month before taxes, rent, transportation, clothes, and insurance, could spend a lot of time and energy on paperwork, and then net $24/month.
> A completely partisan, hate-filled/inducing rant
Those of us who live in reality might or might not find it a bit over the top, but fully understand that if a relatively accurate description of reality, hyperbolic or not, appears to induce hate, then it is, in fact, reality itself that induces the hate.
Your take on this is not at all surprising, given your risible description of the modern conservative:
After trying and failing multiple times to get any LLM to create exactly the picture that I was trying to make, I have to admit that, at one point, if one of them had succeeded, I would have felt a quantum of accomplishment.
But, since I'm not that much of a slot machine aficionado, I just completely stopped pulling the lever.
However, I can see that for the right people, this level of difficulty might encode or mimic, purposely or not, many of the features that are collectively termed "gamification."
> the only way for them grow profits is to increase cost.
And, of course, things like spurious denials drive up costs for them and for the providers. More direct costs, more costs at the provider they have to cover...
From the insurance company perspective, it's a win-win!
Anecdote is not the singular of data, but when my late wife was dying of cancer, the oncologist was attempting to follow standard care procedures. Preauthorizations were denied even after physician consultation with the insurance company.
My research showed me that the insurance companies contract with other companies (who they may or may not own) to handle the dirty work. It was only after learning the magic incantations to directly contact the "third-party" company that I was able to get traction.
"We do not believe this treatment is warranted."
"Well, her doctor believes it, so she's going to get the treatment. The only question is whether you pay now, or after I file a small claims case."
It was miraculously authorized at that point. It's the same fucking thing with car insurance. The poor people who can't fight really get screwed.
None of your links provides data on spurious denials. The third link does provide this statistic:
"Over a six-year period between 2019 and 2025, almost half of a large set of denied health insurance claims in New York state were reversed when the cases reached independent review organizations, comprised of clinicians unaffiliated with insurers"
But that doesn't get into the reasons why the claims were denied in the first place. It doesn't tell us anything about bona fide spurious denials vs. improperly filed claims (mistakes in the paperwork), clerical errors, or clients placed under investigation for claiming too early (after applying) or too often (making a lot of spurious claims), or care providers who do the same.
Insurance companies are concerned with adverse selection and moral hazard. A client who files a lot of claims shortly after getting insurance raises the suspicion that they were not honest about their health prior to applying. Similarly, a client who claims every drug a pharmacy carries raises other suspicions.
Of course, most clients aren't like that, but a not-insignificant minority are, and a small number of clients can file a very large number of claims.
> But that doesn't get into the reasons why the claims were denied in the first place.
The first link in that article does. It starts off by noting that this the third level review, so there were ample chances for the insurance company itself to fix things, and also says that "The report also showed that 47.1% of denials on the basis of medical necessity, 44% of denials based on care determined to be experimental or investigational, and 42.9% of formulary denials were overturned."
It's a pipe dream to assume that, by the time the appeals got to that point, it could be chalked up to administrative error.
> Insurance companies are concerned with adverse selection and moral hazard. A client who files a lot of claims shortly after getting insurance raises the suspicion that they were not honest about their health prior to applying. Similarly, a client who claims every drug a pharmacy carries raises other suspicions.
Yes, every Canadian gets 5 abortions a year, even the men. But seriously, the moral hazard goes the other way. It is so fucking difficult to get doctor appointments that the insurance companies should be doing everything in their power to help keep people healthy, rather than worrying about the 0.1% of the population that suffers from Munchausen syndrome.
Medical fraud is like retail stock shrinkage or fraudulent credit card charges -- no one on the customer side is aware of it, because it's handled on the other side and baked into pricing.
But there are substantial amounts of both straight fraud and too aggressively up-coding / over-billing.
The meta problem is that the because of the nature of the industry (legitimate volume dwarfs fraud), it's more financially impactful to pull levers that impact legitimate volume (read: prior auth requirements).
The anti-fraud systems are also pretty robust. As you'd imagine, insurers have been dealing with this for more than a few decades by now.
By failing to provide adequate treatment early in a disease course, further exacerbations and comorbidities can appear, and these can become their own chronic conditions requiring further ongoing treatment.
By adding tons of paperwork and time and effort. When a denial happens, often the doctor himself has to communicate with the insurance company via phone, instead of, you know, doctoring.
This often proceeds over multiple rounds. And then either the company eventually pays, or the consumer has to pay and try to get reimbursed later.
You asked this question 30 minutes after even a casual reading of my other comment, and a little thinking about it, would have fully answered it.
I would like to assume good faith, but your other comments indicate a high probability that you are an insurance company shill.
And in response to your other question about collusion, no there doesn't have to be collusion. Insurance companies putting onerous bogus requirements on providers will automatically drive up the costs.
I am deeply offended by your allegation. Not everyone who disagrees with you is a shill. I would not make the same accusations about you, nor would I act as if I can estimate the probability that you are. HN's commentary guidelines address this.
You can consider my mistake to be in conceptualizing the cost of "medical services" too narrowly, as just the medicine, and not the providers' surrounding administration. To that end I take your point. In theory, at least. Do you know how much this has? In particular, you refer to the back-and forth negotiation of claims--on what do you base this claim?
Be offended all you want. It's a free country, but, to be perfectly frank, you are still making it difficult to believe you are writing in good faith, as I will show.
> You can consider my mistake to be in conceptualizing the cost of "medical services" too narrowly, as just the medicine, and not the providers' surrounding administration.
Which is fine, except that my very first comment that you responded to explicitly explained "More direct costs, more costs at the provider they have to cover..."
So I already explained that which you said you missed, before your first comment questioning it.
> Do you know how much this has? In particular, you refer to the back-and forth negotiation of claims--on what do you base this claim?
When I wrote "You asked this question 30 minutes after even a casual reading of my other comment, and a little thinking about it, would have fully answered it." I was serious.
You still asking this question, instead of looking at that comment, indicates that at best you are completely unserious. For your edification, here is a link to that comment:
To be frank, this seems unlikely.
> I’m sort of dumbfounded at this level of misinterpretation.
It is difficult to get a man to understand something when his salary depends upon his not understanding it.
Obviously, Paul Graham could understand, and I submit he does understand, and he doesn't even have to worry about a salary, but, like a not-quite-so-jaded version of a Koch brother or a Walton, he has a point of view to maintain and propagate.reply