Washington and California are already signatories. Naturally, it's the red states that are dragging their heels, as they feel like they have the most to lose.
If Texas manages to finally flip during this presidential election, though, I'd say all bets are off and the NPVIC might finally become law of the land.
I don't think it is meaningful if Texas flips, only if it becomes a swing state. If Trump looses Texas he will already have lost the election a long time ago so it doesn't really matter.
Note that some states with almost similar number of electoral votes are going in the other direction. Florida is becoming more safe red all the time, and PA is a swing state and might become safe red at some point.
That's what it flipping would mean. TX was purple. Then it became red. Its demographic trends[0] show it coming into play again.
The good news is that under a national popular vote, a Republican could probably survive a narrow popular vote loss in Texas or Florida and still win the presidency, because every GOP vote in those states would still count toward a national popular vote majority.
Swing state and flipping is (or can be thought of as) different things. The democrats can possibly win Texas this year, and Beto was fairly close. But if Biden wins Texas the election is already long over, he will have won more than 270 delegates for sure. If you look at the snake chart here: https://projects.fivethirtyeight.com/2020-election-forecast/ you can see Texas if 6/7 states away from being the swing state for this election. Currently if Texas goes democratic there is realistically no path for republicans to win a presidential election.
To say it a different way, at some point if the democrats gets popular enough they win every state. That doesn't mean that every state is a swing state, just that people are fed up with that party.
Long term the demographics are not looking good for Texas GOP, based on current voting trends. Most likely the party will adept and come up with new policies to attract different voters. Or you know suppress the vote and rig the elections.
It’s great video and it seems a fair and honest explanation of the electoral college. I completely disagree with the idea of a national popular vote subverting the interests of an electorate. Just as the video explained the concept of US government is republican, representative, and based upon compromise opposed to purely popularity which is a democracy. The fear is that a collective mob will dictate priorities to a disenfranchised minority without a balanced recourse, which sounds like something close to separate yet equal.
“Collective mob”, aka the majority of the population? Remember the government was setup as a republic to ensure a minority of the population, landowning white males, retained power regardless of demographics. By-and-large people of color, the poor, and women were not allowed to vote.
That isn't historically accurate. The constitution intentionally imposed representational government to ensure dual-federalism as a necessary means to supersede the prior government, Articles of Confederation.
> I completely disagree with the idea of a national popular vote subverting the interests of an electorate.
Citation needed. The electoral college does not represent the interests of the electorate more than a popular vote does.
We don't go ask, say, Catholics which presidential candidate they prefer, and then award the winner the entire Catholic vote (including those who have been disenfranchised from voting, or who didn't vote). Yet we do that with states.
As a case in point look at the state of Washington. Two counties comprise all aspects of the state's politics, due to their population size and density relative to the rest of the state, often in stark contrast to the rest of the state. The majority of the states residents are thus represented, but the majority of districts and communities comprising that state are not.
I don't care about the feelings of districts. Districts don't have feelings, or wants or interests. I care about people. People have feelings, wants, and interests.
A district, like a religious orientation, is not a hive mind, where a minority of people who vote for the most popular candidate should be able to co-opt the voting power of the rest.
Under a popular vote, counties besides King and Snohomish would have representation, instead of being ammunition used by those two.
> I don't care about the feelings of districts. Districts don't have feelings, or wants or interests.
I disagree. A rural agricultural community has very real security and economic concerns very different from a high density urban community. Those feelings are very real. Under a purely popular vote those concerns are instantly and conveniently discarded. That concern is the principle benefit of representational government and that concern is essential.
I think one of the comments in here mentions that Japan only accepts PET plastic which apparently doesn't have these issues. Regardless the main issue is that the US is not strict about how we label things or regulate things related to recycling. There is only a small subset of plastics that are recyclable.
As the other poster mentioned, med schools aren't actually the barrier to increasing the physician workforce. In order to be a practicing physician you need to go through residency training. However the number of residency spots has stayed fixed for the last 3 decades and is controlled by government funding.
If you want more doctors, lobby your government to increase residency training funding.
The number of residencies is set by a board which the AMA controls a majority of the seats on. They blame the lack of Medicare funding for additional residency spots, but that is such a preposterous excuse. American medicine is one of the most lucrative industries in the world, and American doctors some of the highest paid people in the world. They don't need the public to subsidize their training.
The AMA is a guild and the doctor shortage is their fault.
Yes. One time I was (politely) arguing this with a MD acquaintance and I let him convince me it was an unfortunate, unintentional outcome rather than a successful hustle.
A few weeks later I read an article about a new cuneiform tablet that had just been translated. The oldest translated writing in the world, at the time. Evidently the brick-making guild hadn't been training enough young apprentices and the price of construction was becoming excessive. They wanted the king to step in. It was the same trick! This was literally the oldest trick in all of recorded history!
I am still somewhat adjacent to the biomedical scene and I've heard that the AMA has reversed course recently -- but I don't know the degree to which the new words correspond to actual actions. In any case, the sentiment is correct: if they don't become part of the solution, they will be seen as part of the problem when the eye of Sauron turns in their direction, and the terms imposed on them will be much worse than the terms that could otherwise have been arranged.
I’m less optimistic. It’s just too easy for the AMA to say “hey we are saving lives and we need to make sure we have the best of the best!”. I think a parallel system needs to happen which won’t be controlled by AMA. It will happen eventually but it will probably take a long time.
I think it's happening right now. There's a reason CVS and Walgreens are both trying to position themselves less as drugstores and more as walk-in clinics.
There's a huge opportunity in the market for providing low cost care that has fewer regulations and restrictions.
Honestly, I don't know if it will work or not, but I think it's interesting they're trying to take advantage of the (frankly ridiculous) medical situation in the US right now.
Or to lower the requirements. Doctors with no experience but a medical school are still much better than no doctors. I don't need a doctor with a fancy license, I need a doctor who has a scientifically adequate (and up-to-date) idea of how does a human body work and what has a good chance to be a reasonable way to cure my sickness.
I agree with this comment. US medicine has setup a long and tortuous road, which might result in extremely well qualified people (or might not), but other developed countries seem to do just fine without the hazing ritual the US required doctors to go through.
Why would you ever choose to be a doctor over an employee at a FAANG? It would be worse for your mental and physical health, and now the pay isn’t even much higher for doctors.
I would guess the average pay is not higher at all. Even if you don't account for opportunity cost and the time value of money, I think it may be that top tech cos pay better for someone with similar levels of experience. Certainly I don't think many of my doctor friends my age are making as much as I do, and I was also earning for almost a decade before most of them were able to become attending physicians. And many of them went into family practice or other solidly middle class specialties, which certainly pay a good deal less. This is not even accounting for the fact I work like 36h a week with zero on call time (at least on the current project), and few doctors can swing that.
I left FANG for medicine. I think this is not a good argument for 2 main reasons.
1) People tend to compare FANG to family medicine. It wouldn't be more apt to compare the average tech worker making 100-200k to family medicine, or compare to some of the more competitive specialties.
2) Salaries are underestimated by many people. The best source is the MGMA is is often used to negotiate salaries by the hiring side. Unfortunately the data is expensive to access so few have it - there's an older screenshot someone took [1]. Further, these are biased lower since academic medicine and part time researchers tend to make less. You can also tailor you're career with more flexibility. Want to make $1M? Go for it. Want to work 2 weeks a year and still bring in 2-300k? Go for it.
Now if you want to live in NY or SF tech will pay more as medicine pays more as you get more rural.
I think the last 40 years were golden years for doctors in the US. They made great money, but now the jig is up and there are 2 options for the next generation:
1) if US goes with taxpayer funded healthcare, expect pay to go down similar to other developed countries with taxpayer funded healthcare. Because there will be no negotiating power.
2) with the ACA framework, it’s a race for insurers, hospitals, and physicians groups to get as big as they can do they can gain as much negotiating power as they can. I can see it with all the M&A in the hospital and provider space, and the rule of thumb is “the closer you are to the money, the more you make”. In this case, insurers will hold the money, so it will be at their mercy that they approve or deny payments for certain procedures.
The American people themselves don’t have enough money to continue paying for this gravy train, and the government was picking up the slack, but I think that’s going to be over soon.
The CVS/Aetna vertical integration model is interesting too, as they are talking about adding doctors to their stores to make it a one stop shop. Insurance, provider, medicine all in one, similar to Kaiser.
And then there’s doctor groups who are able to pump out more work from one doctor by using physician assistances and nurse practitioners to actually see patients “supervised” by one doctor, but the doctor never actually sees the patient.
Pay may go down a bit. I don't have a source off hand but a huge portion of medical expense are due to administrator bloat, doc pay is much smaller. Ideally the regulations and billing gets simpler cutting that bloat. Regardless many docs advocate for better healthcare despite lower pay. I don't have data to say most, but my experience has been that in a conservative part of the US.
The NP/PA practice is also a growing concern amongst doctors. Those groups are advocating for independent practice despite reduced training.
I'll admit, I'm a fairly stereotypical introvert tech guy and tend to judge people more than I should. Talking to patients has a way of shifting your views. I used (and I suppose still do a bit) to judge alcoholics, drug users, and other preventable conditions. But you realize how they really are a result of social or medical circumstance and I think for that reason many doctors are willing to sacrifice some pay. Hell I went into medicine for the security and money (mostly, plus more academic stimulation than software), as taboo as that is, and I'd be ok with it.
That said I think specialty medicine pay is fairly safe. Fact is supply is limited, right thing or not.
I doubt there are many doctors that bring in 200-300k in two weeks a year of work. :) And are these numbers net of expenses or gross? E.g. is it net of malpractice insurance costs?
But yes it appears the median doctor gets paid somewhat more than I thought. Although only a few of the surgical specialties outstrip my personal compensation, I would guess I'm a good deal above the median for software engineers and the median engineer is probably only in the same neighborhood as the median doctor, not above.
It was always on the radar for me so I just worked for a few years and applied.
I do know people who were engineers for a decade plus, and they had to do a year of coursework (special medicine program) before applying to med school.
If it's something you personally are interested in, happy to talk more.
Yeah, I'm interested in chatting with you on this because I'm curious about the process. I looked in your profile but couldn't find an email. Would you mind sending me a message at renewiltord@protonmail.com
Depends on the specialty, I would think. Pediatricians, general practice, etc. can probably have lower standards than other specialties since they are where people typically enter the medical system for treatment. If they haven't seen a malady before, they refer the patient.
However, for cardiologists, anesthesiologists, neurosurgeons, etc. you probably want a higher education standard.
I think what'll happen eventually is that the doctor situation will be sidestepped and the role doing stuff like looking at patients coming in to check on a generic cough or headache will go to physician assistants and nurse practitioners. To some extent I'm already seeing it happen.
They're already kind of doing that with Nurse Practitioners. I used to have asthma, and for years I always saw a doctor. Towards the end, I rarely saw a doctor but saw a nurse practitioner instead. I strongly doubt the difference in pay was reflected in my bill.
The way Medicare funds residencies is also odd. What they do is add a pay bump to all reimbursement for a teaching hospital.
For example, for an appendectomy, a non-teaching hospital might be reimbursed $4,500. If you’re a teaching hospital you get an extra 1.3% (too lazy to look up exact number, but it’s quite small), so $4,559. And that’s for every procedure at the hospital, whether the resident was involved or not.
Seems like a more direct, “here is $80,000 for each residency spot” would make things a bit more transparent?
Such a requirement doesn't exist. 77% of residency slots are funded by the federal government. But there are slots that aren't funded by the federal government. And this makes sense because residents make residency programs money.
I'm sheltering in place and in the past 3 hours, I've coded in like 3 areas of my house. I also need to move when my partner is working and is on a call.
Not having a dedicated work area like a home office or just a desk and office chair in a corner of the living room (this is my solution) sounds like a nightmare to me.
Having a single spot to work at, never to change location, posture, or surrounding sight sounds like a nightmare to me.
I have two sofas, a small desk and a bigger one in two different rooms, a balcony, a table in the kitchen and one in the garden. I frequently switch and move between all of those, which helps me a lot in getting out of coding slumps and refocus. I was so happy to give up my static one desk multimonitor setup at the office for a nimble 13" laptop work from home situation.
I used to think the way you do as recently as just a few years ago. I couldn't imagine not being able to pick up and move to a cafe or co-working space. I was working a lot of hours and working from home when I probably shouldn't have.
What I've found is that since having a desktop and a dedicated desk and office in my house, when I leave the room I don't bring work with me. I also don't have push notifications enabled on my phone, including email. When I go out, I enjoy other things and then when I come back to my desk, I am much more focused and ready to concentrate on work.
Yep, different people have different subjective preferences about working situations, who woulda thunk it? I am interested to hear peoples perspectives though.
I have a desktop PC at home in a home office. My wife is right near me.
I think this is probably a problem because I also play games on it so the room sends very mixed messages to my brain.
I help with a small business so have to use my PC for that. With my day job I have a laptop provided and do move around the house to get a mental disconnect and help me focus on some tasks. The problem is it's not a great device for stuff like in-depth research, I really want a big screen for that, so usually have to use the PC and get distracted.
I have one of those. I've been remote for a couple years so none of this is new to me.
I just unplugged my laptop from my standing desk and went to lay down for my postprandial chill session. I'm going to get some work done as soon as I'm done faffing about on HN (whomst among us...) and then I'll probably plug back in again.
It's just easier to do it this way rather than synchronize state between a desktop and laptop. One less thing to own, also.
It's interesting because you know we are weeding out talent that comes from low socio economic backgrounds and who need cash flow to support their families. At end of the day, we shouldn't be weeding out our doctors to only be folks who don't need to support their families for the next 10 years.
There is a limit put in place on supply (seats at medical schools) already. Weeding out is part of that system already. The question is should cost be part of that.. we decided somewhat yes which is fair if you decide to limit supply in the first place.
To limit supply is mostly to control price, like how OPEC controls oil. Current doctors have a vested interest in remaining a scarce commodity and lobby accordingly on the boards it matters.
The actual limit is residency slots. Every year there are many students who graduate from medical school but are unable to practice medicine because they can't get matched to a residency program.
Yep, that's the true barrier to entry. The main issue is there is that Congress has capped the Medicare funded residency roles to the same number since 1997 (Balanced Budget Act of 1997). In that time period, the US population has grown 21%.
Can you explain your logical reasoning for why you believe most folks with medical school debt come from well off middle class families?
I'm confused because need based financial aid for medical schools is still mostly loans. My partner who comes from a relatively poor family (they used to be on welfare) had most of their need based financial aid in the form of loans. Out of her residency class the highest % of folks taking out loans were from low to middle income families not well off families. So I'm curious where you got that stat from?
Anecdotally, I know some people who did not come from well off families who got need-based financial aid that covered the entirety of their medical school tuition. There was still some loans for living expenses but that’s about it.
To give an example, they prioritize audio over anything else. Which makes sense because if you can't understand what the person is saying, you can't have a meeting. So they automatically downgrade or upgrade your video to try to keep latency decent on audio. Meet just has a manual setting where you can up or downgrade video or audio.
For the most part my understanding is that zoom is better at quality because it does not use webrtc - but hangout meet does. This means webrtc needs a lot of the fixing, which is hard because it's a standard.
zoom sends proprietary stuff over web sockets instead. Which is also why they prefer you use their fat clients with native decoding
There are some CSAs that target south bay that might work for you. These support farms and you get a strong assurance that you will have food every week.
We also have enough rice and beans in our house that we can probably go for about a month without groceries. Make sure you have rice and beans.
The China case is no where close to applicable to the US. They specifically locked residents into their houses so they couldn't leave and locked down all transport in and out of the province. We are doing nothing of the sort, which means our spread will be much different.
