s11e39: Wirecutter Reviews: The Best Person To Determine Health Insurance Coverage For Most People Is You
0.0 Context Setting
It's Friday April 22, 2022. Last night, the bluetooth cat printer I ordered arrived and I was a Good Person who waited until this morning to make sure it worked. And it works!
Listening to: Kylie Minogue's cover of Bette Davis Eyes (ha, you can't stop me)
Playing: Sackboy: A Big Adventure on PS5 (and currently on sale, apparently) with the entire family. It's so good I went and spent an ungodly amount buying two more controllers so the four of us could play couch co-op together.
Reading: Other Minds: The Octopus, the Sea, and the Deep Origins of Consciousness by Peter Godfrey-Smith and Situation Normal, by Leonard Richardson.
1.0 Some Things That Caught My Attention
Wirecutter Reviews: The Best Person To Determine Health Insurance Coverage For Most People Is You
Health insurance here in America is terrible, part ninety billion in an ongoing series, here is something that caught my attention:
We got recommended a specialist medical provider by our GP/primary care provider.
When you get a recommendation sometimes you need a referral, sometimes not, but what you normally need to do unless you're stupid rich is to find out if the provider is "in network" so you can find out how much of a loan you need to take out, or just... not get treatment.
So this type of message on new patient intake is entirely typical:
As a courtesy we will verify your mental health benefits as part of the new patient process. Remember, the best person to determine coverage is yourself as the insurance customer.
And... they're not wrong? I mean, the alternative is a health advocate or essentially an administrative bureaucracy assistant who will go and do all of that for you and believe me it is complicated. I mean, it's "is this covered by my insurance policy" and the answer, even with better data and pricing available is still "eh, who knows? Just roll the dice?" because oh wait an Arbitrary Bureaucracy Monster just attacked.
Bureaucracy is also asymmetrical warfare, by the way. Fight back with guerrilla operations against bureaucracy.
There's a joke here. The Wirecutter page for this would say things like:
Wirecutter: The Best Person To Determine Health Insurance Coverage For Most People Is Yourself As The Insurance Customer
and
Also good: Many of our contributors suggested considering not getting treatment for health conditions because of the crushing bureaucracy.
It's funny because it's true and people are dying?
Anyway, insight/where my brain goes:
Healthcare legislation / Affordable Care Act follow-up legislation should (could?) cover the practical user experience of figuring out if something is covered. There's already legislation in this are to stop surprise bills which HELLO how fucked up is that.
Here's an idea: healthcare legislation that mandates a standard API, returning a determination of insurance coverage (e.g. in/out-of-network and cost), with an SLA gurarantee of returns in less than one second (probably on the API and also rendering application end) otherwise fines.
Back it up with both automated testing against all those endpoints and also funded qual/user research testing.
(Yes, I know this is technosolutionist but it's not the bad kind because I'm doing it, okay?)
One way of looking at this is that yes, you want healthcare to be affordable in America and then you also want it to be accessible, and that there are worse-and-better ways of making sure it is accessible.
There you go. Law informing code.
Wait, hang on.
No really, code-as-law
Ed Zitron wrote in Code Is LOL about the recent trend for cryptocurrencies and DAOs to have hilariously bad loopholes that allow people to steal hilariously large amounts of mostly fake money.
The essence of this, if I may attempt to summarize Zitron's piece, is that:
Some people believe that contracts, e.g. "laws" and in companies things like "articles of association" or "shareholder rights agreements" can be expressed purely in software, automatically executed and then the results are binding
Then then believe that these agreements and contracts should be expressed in software because it's more efficient and pure and true and yadda yadda
Those people are dumb
No really, super dumb
The automatic execution and enforcement (without provision for e.g. rollback!) of such contracts assumes that the people implementing the code/law in software are capable of writing code with no bugs which is, let's say, either impossible, or extremely costly in terms of time/money/resource to actually do and verify
But you know, this whole thing is a cult
Zitron goes on to compare cryptocurrency that works in this way (with automatically executing code that manages transfer of money/value/assets without provision for rollback and so on) to asbestos which is pretty good! I am not reacting to that as the thing that caught my attention.
The thing that caught my attention is the realization that (hey, former lawyer here and someone with enough software engineering knowledge to be dangerous, which is why I don't write contracts as code!):
If the people writing code-as-law contracts were actually lawyers they'd likely have been disbarred years ago, and instantly.
I mean, imagine you're in-house counsel and supervising a bunch of contracts for your company and then they go and fuck up because there's a loophole in your contract and someone loses millions of dollars of made-up money. You'd be fired, right?
If a law firm wrote a contract for you that had such an egregious loophole when the contract was "executed" because "law is code", then you'd fire them and then sue them for malpractice or whatever and breach of duty of care to their client or I can't remember what exactly.
If you're a public company and your code-as-law-counsel did this, then your shareholders would shit a brick and sue everyone into the ground unless Space Karen comes along and memes your stonk.
But somehow this is all okay because you're not a shareholder anymore, you're a tokenholder and you don't have a shareholder rights agreement or articles of association/incorporation or member rights agreements or anything like that, you have code-as-law and oops you lost your money sorry about that, it's all play money anyway.
Code as law is dumb and is a reflection of wishful thinking that the world was ordered and predictable and not messy when guess what the reason why the world and your experience is interesting in the first place is that a) life exists, b) life literally likes to fuck around and find out, which is more or less how evolution works, c) the reason you even invest or whatever in this DAO or cryptocurrency is that humans do weird unpredictable things, d) when weird unpredictable things happen those are edge cases and you can't anticipate all of them, and e) who hurt you when you were a kid for you to need such control over everything?
Odds and ends
HUDs and GUIs is a collection of (I think?) fictional user interfaces from visual media. If you liked the book Make It So: Interaction Design Lessons from Science Fiction, then you'd probably like this too. Caught my attention because: a long long long time ago I wrote down some thoughts about what I called MovieOS, explaining why user interfaces in tv and film work and look the way they do, mainly because they need to be unambiguously intelligible in a very short amount of time to the viewer, beyond all the visual fluff stuff.
Planting Undetectable Backdoors in Machine Learning Models is a preprint of, well, a method of making other people's machine learning/AI models do what you want them to do. Caught my attention because: I stick it in my Langford Basilisk file. Cory Doctorow has a good writeup in Pluralistic.
That TV show, Old Enough, showing charming heart melting footage of preschoolers and toddlers going on solo errands is both true and unsurprisingly includes a whole bunch of preproduction + production work to ensure kids aren't put in unnecessarily unsafe situations. Caught my attention because: it's an other example of how the shape of the surface is different from the shape of the internal volume.
Some college football team (apologies if it is your college football team) is putting QR codes on the back of their players shirts for a bit which is dumb and probably will have something to do with NFTs or crypto, but on the other hand caught my attention because: listen, giving literally everything a URL/permalink isn't necessarily a bad idea, I mean it's not necessarily a bad idea that a jersey number has a canonical URL so you can see what it's done and who its wearer was over time. I mean, that'd be useful!
Responses
Reader Mark Ferlatte wrote back about Old Mode with an analogy I love: the "Oxo grips of software"
... it might be for us olds, but lots of folks would use it because it reduces strain and effort.
Which is another point in the "accessibility isn't for some people it's for every people" column, and in my "accommodations aren't accommodations" column. I'm going to go away and think more about mental accommodations for software (and therefore: business / late-stage capitalism / living in the world as we draw the jackpot) with more awareness of neurodiversity. Which brings us back right to the very top: that healthcare coverage API as an accommodation.
A brief interlude
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Okay. That's it. It's Friday. I have received pictures of GOOD DOGS and CATS and documentation of other assorted human-animal relationships and they have all been GOOD.
How have you been?
Best,
Dan