They already doing that with AI, rejecting claims at higher numbers than before .
Privatized insurance will always find a way to pay out less if they could get away with it . It is just nature of having the trifecta of profit motive , socialized risk and light regulation .
If you think that insurance companies have "light regulation", I shudder to think of what "heavy regulation" would look like. (Source: I'm the CTO at an insurance company.)
Light did not mean to imply quantity of paperwork you have to do, rather are you allowed to do the things you want to do as a company.
More compliance or reporting requirements usually tend to favor the larger existing players who can afford to do it and that is also used to make the life difficult and reject more claims for the end user.
It is kind of thing that keeps you and me busy, major investors don't care about it all, the cost of the compliance or the lack is not more than a rounding number in the balance, the fines or penalties are puny and laughable.
The enormous profits year on year for decades now, the amount of consolidation allowed in the industry show that the industry is able to do mostly what they want pretty much, that is what I meant by light regulation.
I'm not sure we're looking at the same industry. Overall, insurance company profit margins are in the single digits, usually low single digits - and in many segments, they're frequently not profitable at all. To take one example, 2024 was the first profitable year for homeowners insurance companies since 2019, and even then, the segment's entire profit margin was 0.3% (not 3% - 0.3%).
So it's weird to see folks on a tech site talking about how enormous all the profits are in health insurance, and citations with numbers would be helpful to the discussion.
I worked in insurance-related tech for some time, and the providers (hospitals, large physician groups) and employers who actually pay for insurance have signficant market power in most regions, limiting what insurers can charge.
I agree, and I can see where it comes from (at least at the state level).
The cycle is: bad trend happens that has deep root causes (let's say PE buying rural hospitals because of reduced Medicaid/Medicare reimbursements); legislators (rightfully) say "this shouldn't happen", but don't have the ability to address the deep root causes so they simply regulate healthcare M&As – now you have a bandaid on a problem that's going to pop up elsewhere.
I mean even in the simple stuff like denying payment for healthcare that should have been covered. CMS will come by and out a handful of cases, out of millions, every few years.
So obviously the company that prioritizes accuracy of coverage decisions by spending money on extra labor to audit itself is wasting money. Which means insureds have to waste more time getting the payment for healthcare they need.
I should have been clearer - profit maximization above all else as long it is mostly legal. Neither profit or profit maximization at all cost is nature of everything .
There are many other entity types from unions[1], cooperatives , public sector companies , quasi government entities, PBC, non profits that all offer insurance and can occasionally do it well.
We even have some in the US and don’t think it is communism even - like the FDIC or things like social security/ unemployment insurance.
At some level government and taxation itself is nothing but insurance ? We agree to paying taxes to mitigate against variety of risks including foreign invasion or smaller things like getting robbed on the street.
[1] Historically worker collectives or unions self-organized to socialize the risks of both major work ending injuries or death.
Ancient to modern armies operate on because of this insurance the two ingredients that made them not mercenaries - a form of long term insurance benefit (education, pension, land etc) or family members in the event of death and sovereign immunity for their actions.
That would be illegal though, the goal is do this legally after all.
We also have to remember all claims aren't equal. i.e. some claims end up being way costlier than others. You can achieve similar % margin outcomes by putting a ton of friction like, preconditions, multiple appeals processes and prior authorization for prior authorization, reviews by administrative doctors who have no expertise in the field being reviewed don't have to disclose their identity and so and on.
While U.S. system is most extreme or evolved, it is not unique, it is what you get when you end up privatize insurance any country with private insurance has some lighter version of this and is on the same journey .
Not that public health system or insurance a la NHS in UK or like Germany work, they are underfunded, mismanaged with long times in months to see a specialist and so on.
We have to choose our poison - unless you are rich of course, then the U.S. system is by far the best, people travel to the U.S. to get the kind of care that is not possible anywhere else.
> While U.S. system is most extreme or evolved, it is not unique, it is what you get when you end up privatize insurance any country with private insurance has some lighter version of this and is on the same journey .
I disagree with the statement that healthcare insurance is predominantly privatized in the US: Medicare and Medicaid, at least in 2023, outspent private plans for healthcare spending by about ~10% [1]; this is before accounting for government subsidies for private plans. And boy, does America have a very unique relationship with these programs.
My take away is that as public health costs are overtaking private insurance and at the same time doing a better job controlling costs per enrollee, it makes more and more sense just to have the government insure everyone.
I can't see what argument the private insurers have in their favor.
It is more nuanced, for example Medicare Advantage(Part C) is paid by Medicare money but it is profitable private operators who provide the plans and service it a fast growing part of Medicare .
John Oliver had an excellent segment coincidentally yesterday on this topic.
While the government pays for it, it is not managed or run by them so how to classify the program as public or private ?
This is a great application of this quote. Insurance providers have 0 incentive to make their AI "good" at processing claims, in fact it's easy to see how "bad" AI can lead to a justification to deny more claims.
The question is how you define good. They surely want the Ai to be good in the sense that it rejects all claims that they think can get away with rejecting. But it should not reject those where rejection likely results in litigation and losing and having to pay damages.
By 2015 they were trying to hide how much of the group growth and profits were largely contributed by just AWS , i.e. they were hiding the e-commerce margins .
Without AWS and subscriptions, Amazon is quite an unprofitable company.
Both overall growth and margin driven by AWS(and prime) while E-commerce revenue remains outsized because they count GMV as revenue which is iffy even when they own the merchandise, but being largely a marketplace these days GMV is very misleading metric.
It would be like Stripe decided to count their revenue as $1.4T the amount they processed this year as revenue rather than $10-20B they actually got after paying the banks, merchants , VISA etc . This 20B is not profit either just the pie from which salaries cloud costs etc have to be paid to get to actual profit.
Correct. It wasn’t a secret that AWS was profitable. Revealing those numbers put a lot more pressure on Amazon to get other business lines in better shape financially. Something Amazon was keen to avoid for as long as it could.
I code as a founder/CTO on weekends, I don't expect weekend work done by anyone else and most people rarely check in if ever on weekends.
The job profile of founder-CTO has not a lot of overlap with that of an individual contributor to be leading by example, the overlap is quite narrow even for senior engineering leadership.
Until recently[3] leaders with prior coding skills were always discouraged from code contributions and focus on management exclusively, for all the reasons some of them you describe.
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I usually say that I am a part-time coder, not a professional one, and caution not to look at what I do as a benchmark or signal.
Vast majority of the code I write are DevEx or QoL for internal teams[4], or refactor tech debt that no one has time to deal with. Even mid-stage startups may not be large enough to invest in dedicated teams for this type of work.
Occasionally I have written such integrations like OP[1]. It is typically a PoC for a demo, never a production one to actual customers. It would be unfair (and failure prone) to expect anyone else to start supporting a production integration without the full tooling or documentation.
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I agree it is a fine-line and you can err on the wrong side of it. It is easy and tempting to start focusing on production code and lose focus of the core job, but so many decisions as a founder are like that. I am hardly the best or optimal founder-CTO. However the value of being close to the metal is important and worth some risk in early to mid stage startups.
Perhaps there is also value in a CTO who understands what individual contributors are doing and is able to be more realistic about outcomes instead of being purely few layers above and not clued in.
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[1] Not skipping legal that seems ridiculous, even if I wanted to, I can't imagine any partner would agree to it.
[3] Now I do encourage to try the new tools, it is not they contribute to production or be an IC, it is to get a sense of what is possible and what is not today. A lot of pipe-dreams are being sold in the industry, without hands on experience using the new tools ( which are rapidly evolving) managers can tend to overestimate or misunderstand what is doable.
[4]This is the core of the CTO job, writing code is rarely the bottleneck for productivity that was true even before generative coding tools, it is everything around that which creates friction. If you can reduce it, even writing some code to do so, it shouldn't be a problem or a flag.
If you want to work on the weekend - and occasionally I find myself doing so as a staff level IC consultant who does need to spend an inordinate amount of time mentoring, project management, suppprting sales, interviewing candidates, babysitting clients, etc… - don’t send messages on Slack or email outside of business hours. I schedule messages to go out Monday morning and I never mention I worked on the weekend.
I don’t want to set the expectation that people should work outside of business hours or that I’m willing to.
Charging devs a percentage App Store sales is very different from shoplifting and equating the two is extremely misleading.
Devs voluntarily choose to publish apps on the App Store and doing so gets them both another discovery channel and a low-friction sales channel. Stores being robbed by shoplifters don't voluntarily enter that arrangement and they get no benefit from it.
Look I'm not going to say the analogy is perfect. No analogy ever is.
But at a fundamental level, they are breaking the law to extract money from people. You may not call that stealing, but imho it's not a huge stretch of reality.
There is no choice involved. You either pay Apple the required blood sacrifice or you lose access to more than half of all possible customers for your business.
This is like saying that every American can choose to trash their car and take public transit. It sounds like a choice, but the real world has consequences and in fact most Americans do not have the ability to eschew private transport. That is just simply not how the world works.
Whatever they did could be quite legal in those other geographies. What you are saying is like say a country in middle east prosecuting you for smoking weed or drinking alcohol somewhere else when you visit.
Laws apply to jurisdictions, there are no universal laws which are legally binding.
Even if it is illegal, it is for them to collect their own fines for that crime .
It is not just about the having a good voice, whilst that is important, you also need voice acting skills to show in the voice, as in a good voice actor would change their accent, tone, language, style for every character and seed it with emotion and so forth. A lot of thought (and skill) goes into it[1]
Stephen Fry is good for audio books because he is a talented voice actor amongst his many other skills. Attenborough is a treasure and known for his audio work, but he is not a voice actor - or at least doesn't do that kind of work which requires lot more range rather than one specific one we all recognize. I wouldn't like his voice style to narrate a fiction book for me.
A planned production with editing and nuanced prompting even with just AI voice actors will still vastly better for immersion than just an app doing it real time.
Domesticated mammalian[1] pet which share 80+% of our DNA and bred and naturally self-selected over few ten thousand generations for their obedience and take fair amount of training from birth is not the same as anything else on earth let alone from another planet.
[1] Domesticating of non mammalian animals is already quite hard with limited true successes, some birds probably come the closest.
Not if you want to build something production ready. Even a simple thing like say static IP ingress for the Lambda is very complicated. The only AWS way you can do this is by using Global Accelerator -> Application Load Balancer -> VPC Endpoint -> API Gateway -> Lambda !!.
There are so many limits for everything that is very hard to run production workloads without painful time wasted in re-architecture around them and the support teams are close to useless to raise any limits.
Just in the last few months, I have hit limits on CloudFormation stack size, ALB rules, API gateway custom domains, Parameter Store size limits and on and on.
That is not even touching on the laughably basic tooling both SAM and CDK provides for local development if you want to work with Lambda.
Sure Firecracker is great, and the cold starts are not bad, and there isn't anybody even close on the cloud. Azure functions is unspeakably horrible, Cloud Run is just meh. Most Open Source stacks are either super complex like knative or just quite hard to get the same cold start performance.
We are stuck with AWS Lambda with nothing better yes, but oh so many times I have come close to just giving up and migrate to knative despite the complexity and performance hit.
>Not if you want to build something production ready.
>>Gives a specific edge case about static IPs and doing a serverless API backed by lambda.
The most naive solution you'd do on any non-cloud vendor, just have a proxy with a static ip that then routes traffic whereever it needed to go, would also work on AWS.
So if you think AWS's solution sucks why not just go with that? What you described doesn't even sound complicated when you think of the networking magic behind the scenes that will take place if you ever do scale to 1 million tps.
Don’t know what you think should mean but for me that means
1. Declarative IaaC in either in CF/terraform
2. Fully Automated discovery which can achieve RTO/RPO objectives
3. Be able to Blue/Green and % or other rollouts
Sure I can write ansible scripts, have custom EC2 images run HA proxy and multiple nginx load balancers in HA as you suggest, or host all that to EKS or a dozen other “easier” solutions
At the point why bother with Lambda ? What is the point of being cloud native and serverless if you have to literally put few VMs/pod in front and handle all traffic ? Might as well host the app runtime too .
> doesn’t even sound complicated .
Because you need a full time resource who is AWS architect and keeps up with release notes and documentation or training and constantly works to scale your application - because every single component has a dozen quotas /limits and you will hit them - it is complicated.
If you spend few million a year on AWS then spending 300k on an engineer to do just do AWS is perhaps feasible .
If you spend few hundred thousands on AWS as part of mix of workloads it is not easy or simple.
The engineering of AWS impressive as it maybe has nothing to the products being offered . There is a reason why Pulumi, SST or AWS SAM itself exist .
Sadly SAM is so limited I had to rewrite everything to CDK in couple of months . CDK is better but I am finding that I have to monkey patching limits on CDK with the SDK code now, while possible , the SDK code will not generate Cloudformation templates .
> Don’t know what you think should mean but for me that means
I think your inexperience is showing, if that's what you try to mean by "production-ready". You're making a storm in a teacup over features that you automatically onboard if you go through an intro tutorial, and "production-ready" typically means way more than a basic run-of-the-mill CICD pipeline.
As most of the times, the most vocal online criticism comes from those who have the least knowledge and experience over the topic they are railing against, and their complains mainly boil down to criticising their own inexperience and ignorance. There is plenty of things to criticize AWS for, such as cost and vendor lock-in, but being unable and unwilling to learn how to use basic services is not it.
Try telling that to customers who can only do outbound API calls to whitelisted IP addresses
When you are working with enterprise customers or integration partners it doesn’t even have to be regulated sectors like finance or healthcare, these are basic asks you cannot get away from .
people want to be able to know whitelist your egress and ingress IPs or pin certificates. It is not up to me to say on efficacy of these rules .
I don’t make the rules of the infosec world , I just follow them.
This architecture[1] requires the setup of 2 NAT gateways (one in each AZ), a routing table, an Internet Gateway, 2 Elastic IP and also the VPC. Since as before we cannot use Function URLs for Lambda we will still need the API Gateway to make HTTP calls.
The only parts we are swapping out `GA -> ALB -> VPC` for `IG -> Router -> NAT -> VPC`.
Is it any simpler ? Doesn't seem like it is to me.
Going the NAT route means, you also need to have intermediate networking skills to handle a routing table (albeit a simple one), half the developers of today never used IP tables is or what chaining rules is.
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I am surprised at the amount of pushback on a simple point which should be painfully obvious.
AWS (Azure/GCP are no different) has become overly complex with no first class support for higher order abstractions and framework efforts like SAM or even CDK seem to getting not much love at all in last 4-5 years.
Just because they offer and sell all these components to be independently, doesn't mean they should not invest and provide higher order abstractions for people with neither bandwidth or the luxury to be a full time "Cloud Architect".
There is a reason why today Vercel, Render or Railway others are popular despite mostly sitting on top of AWS.
On Vercel the same feature would be[1] quite simple. They use the exact solution you suggest on top of AWS NAT gateway, but the difference I don't have to know or manage it, is the large professional engineering team with networking experience at Vercel.
There is no reason AWS could not have built Vercel like features on top of their offerings or do so now.
At some point small to midsize developers will avoid direct AWS by either choosing to setup Hetzner/OVH bare machines or with bit more budget colo with Oxide[3] or more likely just stick to Vercel and Railway kind of platforms.
I don't know how that will impact AWS, we will all still use them, however a ton of small customers paying close to rack rate is definitely much much higher margin than what Vercel is paying AWS for the same workload is going to be.
Mistakes are human yes we all do make them all time.
However when representing an reputable organization, people are expected to be cautious or otherwise required to have their comments reviewed and most organizations would enforce this to protect their brand or reputation.
As Carl Sagan said it best, extraordinary claims require extraordinary evidence. This was a pretty extraordinary claim and multiple senior staff at the org endorsed the comment without even a cursory check first. I would think serious observers are more concerned by the process and controls in OpenAI or lack thereof here, rather than a specific single mistake.
Like them or hate them, OpenAI is the leader in the industry, and everyone lookup up to them and their employees in a public forum for credible information so will hold them to higher standard than a lesser known lab.
The burden of checking for quality comes with having a reputable brand . The burden is being monetized / compensated with the valuation or size of fund raise a org is able to command.
The parent poster is talking about the Younghusband expedition into Tibet of 1903[1], I don't think it is the boxer rebellion in which British Indian troops had no direct involvement(AFAIK) and also those events happened before 1901 establishment of the Nobel Prize, which is the time period OP cites as the starting time range.
To see the Tibetan military expedition as an invasion of China, means to accept the Qing dynasty and its successor states (ROC,PRC)claim of sovereignty and not suzerainty over Tibet. A claim at the time which was not recognized by other countries specifically Russia, Britain and also Tibet.
The refusal of Tibetan government to accept terms of treaties they were not party to directly (i.e. the ones Qing China signed) was the official reason stated for the invasion by the British.
Either way it is a deeply contentious topic never legally settled in the 1907 agreement and had implications both to that era and modern geopolitics. No one then or now is purely looking at merits of the arguments.
The points will end up into esoteric discussion on whether is kowtowing and kneeling are the same thing, or is acknowledging supremacy is same as sovereignty, or the differences between vassal state or autonomous region or protectorate or suzerain.
Also the views of the countries/entities (or their successors) have also changed including the Tibetan government-in-exile in the last 120 years.
My knowledge of history is at best a passing student at high school level, this kind of discussion requires deep understanding of relationship of states, and of Chinese culture and language during Qing dynasty i.e. professional expertise which I certainly don't have.
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[1] My initial read was they meant either Arunachal Pradesh( South Tibet to the Chinese), Aksai Chin or the MacMohan line etc, but they clarified it wasn't the case.
The Boxer Protocol wasn't signed until September 01901 and involved permanently establishing a dozen foreign military bases inside China, so didn't, from my point of view, end the invasion. But it's true that the actual fighting was almost completely the previous year.
India has similar number of laureates and nowhere had the similar kind of social upheaval or authoritarian regime like China or the soviet union had.
I think it is bit more nuanced than just Mao, pre 1935 you could do ground breaking research in almost any field with limited to no funding at all. Since the war you need increasingly large amount of budgets which western universities with full government support enjoy, ans it was not possible to compete for India or China or even the Soviet Union to keep up.
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The cultural changes you allude to, certainly were a medium term negative factor, but the pre 1950 setup were hardly sustainable or efficient. In pre Mao China or similarly British India (or even till recently) it was not a meritocracy there was a privileged elite who had all the opportunity and few shined if they were also talented.
Today China is one of the most meritocratic economies after all - despite all the authoritarian flaws, we are only seeing positive growth in foundational scientific research and rapidly in contrast with the rising anti-science sentiment we are seeing in so many parts of the western and western influenced world.
The socio-cultural reset was important and necessary for both China and India to progress, the methods of the Mao era are questionable both for their cruelty and also for how efficient and effective they were it was just bad all around however the need of the reset came from a valid place I think.
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There is whole dimension of bias which does disadvantage particularly Chinese research output today. Don't get me wrong I am not saying there is conscious bias against Chinese researchers. The bias is because despite the esteem the Nobel prize is not a global one.
The committee sit in Scandinavian countries closely working with Norway government. The members are predominately affiliated to western universities and fluent in English or other European languages and read Nature / Science type of western journals.
This always put Soviet researches before and now Chinese and Indian(to a lesser degree) at a disadvantage compared to their western peers.
The committee are not equipped to judge the research output of the whole world, till recently this was not a problem, because western research post WW-II was the majority of the world output, but that is increasingly not true and in a multi-polar world.
> the methods of the Mao era are questionable both for their cruelty and also for how efficient and effective they were
Also for killing tens of millions of people, which not only is murder of each person but also those millions of people - and then their families - never benefit.
Absolutely, I am in no way saying Mao era methods were justified, warranted or even effective.
They were misguided, ineffective, and directly or indirectly killed people in the millions.
I am just pointing out that, the atrocities of the era doesn't justify seeing pre 1960s or pre1950s years of China with rose tinted glasses as a better era, it wasn't unless you were in the elite.
It would be no different than seeing the 1970s or any earlier generation in U.S. history as a better era. Only a very small in-group perhaps had it good. Everyone else be it black, women, indigenous, various immigrants, religious, neuro or sexually diverse have only seen net improvements in last 300 years.
They were awful and achieved almost nothing but ruin, so by definition they were unnecessary.
But are you saying reform and change were unnecessary? The people of China were suffering immensely; the country had been in a state of domestic violent conflict, on and off, since before 1911 (as of 1949). The Communist Party became more corrupt.
Mao's policies and politics made all that much worse, but that doesn't mean nothing needed to be done.
China was already developing economically and technologically -- especially in coastal areas and in Manchuria (there was a large migration of Chinese to the area after it came under Japanese control).
That development would have continued.
I understand the anger and the desperation that made the Communist takeover possible but doing nothing at all and keeping all the elites in charge (instead of replacing them with new ones) would have been better.
> China was already developing economically and technologically
That's an odd version of history. China just went through WWII, including the awful Japanese invasion, which interrupted a massive civil war that restarted afterward, and which followed decades without a real national government.
> there was a large migration of Chinese to the area after it came under Japanese control
Japanese control didn't work out well for Chinese people, to say the least.
> keeping all the elites in charge
The elites had led China to disaster for a century, 'the century of humiliation' it's called (though blaming outside forces, which do deserve some blame).
> replacing them with new ones
Here we agree.
> would have been better
Certainly there is no source that can more than guess at that.
The better option would have been true democratic reform. It has worked superbly well in parts of China - Taiwan and Hong Kong. It was starting to work in 1989, and leaning in that direction before Xi.
Another point about Soviet scientists: it was very often a career-ending move to accept a Nobel prize unless you were a truly untouchable cult of personality and/or direct friend of those in power. See Andrey Sakharov, who first invented the soviet hydrogen bomb and later dedicated himself to non-proliferation which earned him a Nobel Peace prize. He was however barred from traveling to Oslo to accept in 1975, having already been blacklisted from classified work since 1968.
I wonder to what extent that lead to the curbing of consideration of those behind the iron curtain.
Peace prizes are different from science prizes. The Soviet Union had no problems with its scientists getting science prizes. It did sometimes had problems with letting them leave the country to actually receive them, of course.
While your disambiguation is valid, they very much wanted to minimize the potential fallout from individuals staying in, say, a Norwegian hotel and sampling the local culture only to return and speak fondly of said trip "beyond the curtain". Usually this was outweighed by the national prestige (and subsequent propaganda opportunity) from having a Soviet Nobel recepient but the KGB had an extremely heavy hand in deciding who got to go, regardless of scientific breakthrough.
Privatized insurance will always find a way to pay out less if they could get away with it . It is just nature of having the trifecta of profit motive , socialized risk and light regulation .
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