Haha, your reply beat out mine by only a minute.

This does not agree with what the Social Security Administration has published:

Q20: Are Social Security numbers reused after a person dies?

A: No. We do not reassign a Social Security number (SSN) after the number holder’s death. Even though we have issued over 453 million SSNs so far, and we assign about 5 and one-half million new numbers a year, the current numbering system will provide us with enough new numbers for several generations into the future with no changes in the numbering system.

For the historical questions, I don’t really have answers, especially where it involves departures from the Western world. I did, however, briefly touch up on Islamic banking, which I’ve always found intriguing as the Islamic faith does not permit charging interest on loans, viewing it as usurious. I’m informed that Christianity also had a similar prohibition on usury, but apparently it fell due to the need to fund the constant wars in Europe.

I’m not really seeing the difference in feudalism except a members only kind of participation with a crony pool of inbreds, not all that different than the billionaires of today.

I think the important distinction insofar as stock markets is that the crony pool of inbreds have access, but so too does the commoner. Well, the middle-class commoner usually. And we’ve seen David-vs-Goliath cases where the commoners put up a decent fight against the inbreds’ institutions; the whole GameStonk fiasco comes to mind. An equivalent economic upset would have been wholly impossible at any point during any feudal period in history.

What are the idealist or futurist potential alternatives between the present and a future where wealth is no longer the primary means of complex social hierarchical display? My premise is that basing hierarchical display on the fundamental means of human survival is barbaric primitivism.

From conversations I’ve had previously, possible answers to that question are presented in the works of Paul Cockshott, author of Towards A New Socialism. I’ve not read it, but friends in Marxist-Leninist parties have mentioned it. The Wikipedia page, however, notes that it’s an economics book, which could be fairly technical and difficult to read. Sort of like how Das Kapital is more-or-less a textbook, in contrast with how Wage Labour And Capital was meant for mass consumption.

Wealth extraction neglects the responsibility of the environment and long term planning.

True. The cost to the environment is not “internalized”, to use the technical term. Hence, it doesn’t need to be paid for, and is thus “free real estate”. Solutions to internalize environmental harm include carbon taxes or cap-and-trade. But the latter is a lukewarm carbon tax because it only looks at the end-result emissions, rather than taxing at the oil well, so to speak.

I’m curious how humanity evolves in a distant post scarcity future but without becoming authoritarian or utopian/dystopian

Might I recommend The Three-Body Problem and the trilogy overall by Liu Cixin? This phenomenal hard scifi work describes a space-based future where the human species faces a common, external threat. After all, much of today’s progress was yesterday’s scifi. So why not look to scifi to see what tomorrow’s solutions might be. It’s no worse than my crystal ball, which is foggy and in need of repair.

If you’re in the USA, I cannot understate how useful it may be to refer to the US Bureau of Labor Statistics’s (BLS) Occupational Outlook Handbook (OOH), a resource which I believe has no direct comparison:

How can I learn about an occupation that is of interest to me?

The Occupational Outlook Handbook (OOH) provides information on what workers do; the work environment; education, training, and other qualifications; pay; the job outlook; information on state and area data; similar occupations; and sources of additional information for more than 300 occupational profiles covering about 4 out of 5 jobs in the economy.

I’ll take a shot from the hip at this question, but note that I won’t add my customary citations or links.

The stock market is the paragon of property and trusts, contracts, corporations and law, and the capitalist socio-economic system. The very existence of the stock market implies a society that has some or most of these concepts.

For example, for shares to be traded, there generally must exist ownership rights upon the shares, distinct from the ownership rights that the company has of its own property. Or if not outright ownership of a share, then the benefit that a share provides (eg dividends). It also implies a legal system that will enforce these rights and the obligations of the company to its shareholders.

For a tradable company to exist, it must be organized/chartered as an entity distinct from any single person. This is different than the feudal days, when ventures would be undertaken “in right of the King” or some member of the nobility. It has to be this way, or else the King/Duke/Count/whatever could stiff the shareholders by just taking all the earnings. The company still needs to be created by legal means, either an Act of Parliament/Congress, by letter patent from the Monarch, or the modern administrative method of applying to the state Secretary of State (USA) or Companies House (UK) as examples.

Even the structure of a for-profit tradeable company – when to a state-owned enterprise, a non-profit, a co-op, an NGO or QUANGO – is a representation of the values inherent to capitalism. A company is obliged to use the shareholders’ funds – which is held by the company but is owed to the shareholders – to extract the greatest return. But this can come in many forms.

Short-term value from buying investments and quickly flipping them (eg corporate home buyers) is different than rent-seeking (eg corporate landlords) and is still different than long-term investments that actively work to build up the value (eg startup incubators, private wealth funds, Islamic banking, transit-owned adjacent property). If a for-profit company doesn’t have a plan to extract a return… they’re in hot water with the shareholders, with penalties like personal liability for malfeasance.

Another way of looking at the stock market is that if you have all the underlying components but don’t yet have a stock market, it would soon appear naturally. That is to say, if the public stock markets were banned overnight, shares would still trade but just under the table and without regulation. But if any critical part underpinning the markets stopped existing, then the market itself would collapse.

History shows numerous examples where breakdowns of the legal system resulted in market mayhem, or when corporate property is expropriated for the Monarch’s wars or personal use, or when funds invested into or paid out of companies is hampered by terrible monetary inflation.

As for what the stock market does, its greatest purpose is to organize investments into ventures. Historically, ventures were things like building a ship to sail to the New World and steal obtain goods to sell at home. Merchant ships were and are still very expensive, so few singular persons could afford it. And even if the could, the failure of the venture could be catastrophic for that person’s finances. Better to spread the risk and the reward amongst lots of people.

What was once the sole domain of the landed gentry and nobility, slowly opened to the nouveau riche during the Industrial Revolution(s), then in turn to everyday people… for better or worse. It’s now almost trivial to buy a share in any particular listed company, but just opening the stock market to everyone would have been chaotic at best. I think it’s NYSE that still has on-floor traders/brokers, but imagine if all shares in that market had to be traded in a single room. It’s already quite lively, now add all the online trades from middle class Americans on payday. It would be impossible.

Likewise, a pure capitalist stock market would permit awful things like bribing journalists to write fake stories to crash a stock, then buy it for cheap. Or pump and dump scams. And would have no “circuit breakers” that halt during so-called flash crashes.

I’m reminded of a scene from the ITV show Agatha Christie’s Poirot in the episode “Appointment With Death”, where a wealthy woman is not only murdered but her business empire collapses because the markets panicked and sold up. The relevant implications here is that despite her company not having changed its financial picture, it got cut up for scrap and thus lost most of its value, rendering the business worthless in the end.

Suffice it to say, the stock market is a lot of things. But I view it as a natural result of certain other prerequisites, meaning we can’t really get rid of it, so instead it should be appropriately regulated.

I think you’re spot on, since using a random power/torque/rpm calculator online, an 85 Nm mid-drive motor rotating at a reasonable crank cadence of 80 RPM yields a power output of 710 W. That’s just shy of the max power regulation in the USA for ebikes, at 750 W. And motors can definitely go faster than 80 RPM.

Mid-drive motors could probably be built with even more torque, but because electric motors maintain near-constant torque through most of their RPM range, the motor controller would have to perform more current limiting at the higher RPMs to stay under the legal power limits. So there’s less benefit, unless someone really badly wants more low-RPM torque.

At that point, though, other parts of the bicycle drivetrain might start disintegrating under such forces.

From an urban planning perspective, there are some caveats to your points:

A new downtown would make a subway very easy and cheap to build, you could cut and cover instead of tunnelling

Cut-and-cover will make shallow underground tunnels cheaper to construct in almost all cases irrespective of building in an old city center or as part of building a new city center from scratch. In fact, older pre-WW2 cities are almost ideal for cut-and-cover because the tunnels can follow the street grid, yielding a tunnel which will be near to already-built destinations, while minimizing costly curves.

Probably the worst scenario for cut-and-cover is when the surface street has unnecessary curves and detours (eg American suburban arterials). So either the tunnel follows the curve and becomes weirdly farther from major destinations, or it’s built in segments using cut-and-cover where possible and digging for the rest.

Cheeeaaap land for huge offices, roads, and even houses

At least in America, where agricultural land at the edges of metropolitan areas is still cheap, the last 70 years do not suggest huge roads, huge offices, and huge house lead to a utopia. Instead, we just get car-dependency and sprawl, as well as dead shopping malls. The benefits of this accrued to the prior generations, who wheeled-and-dealed in speculative suburban house flipping, and saddled cities with sprawling infrastructure that the existing tax base cannot afford.

Green field is just so cheap.

It is, until it isn’t. Greenfield development “would be short term appealing but still expensive when it comes to building everything”. It’s a rare case in America where post-WW2 greenfield housing or commercial developments pay sufficient tax to maintain the municipal services those developments require.

You may want to include a photo of the piece, ideally many photos from various angles.

But to be frank, unless you find someone within a max 1 hour’s travel distance, it’s not likely someone will be found who is also willing to take on this project. Wood furniture is, for all its pros and cons, heavy.

A few months ago, my library gained a copy of Cybersecurity For Small Networks by Seth Enoka, published by No Starch Press in 2022. So I figured I’d have a look and see if it it included modern best-practices for networks.

It was alright, in that it’s a decent how-to guide for a novice to set up sensible, minimum network fortifications. But it only includes an overview of how those fortifications work, without going into the additional depth needed to fine-tune or optimize them for specific environments. So if the reader has zero experience with network security, it’s a worthwhile read. But if you’ve already been operating a network with defenses for a while, there’s not much to gain from this particular text.

Also, the author suggests that IPv6 should be disabled, which is a terrible idea. Modern best-practice is not to pretend IPv6 doesn’t exist, but to assure that firewalls and other defenses are configured to handle this traffic. There’s a vast difference between “administratively reject IPv6 traffic in/out of the WAN” and “disable IPv6 on all devices and pray no one ever connects an IPv6-enabled device”.

You might have a look at other books available from No Starch Press, though.

I lost it when coming across this commit: https://github.com/WinampDesktop/winamp/commit/67c68e6dc24f36b266427034d016fb86ef4d486c

This is a good question and I don’t really know how this device would affect drafting and related manoeuvres. But if I had to guess, drafting behind a lead cyclist should still be beneficial, but the “zones” where it works might change.

So for example, the optimal distance lee-ward of a lead cyclist might become shorter or longer. Longer could mean more space to vie for that position directly behind the lead. But shorter might mean it’s impossible to draft without crashing into the lead.

Side-to-side drafting distances might also be affected, like how birds travel in a vee-shape. Maybe the vee would become wider? That might not be beneficial, though, if it’s so wide that it’s impossible to stay on the racecourse.

TL;DR: I have no idea, and aerodynamics are hard. That’s why I’m intrigued by the field.

My understanding is that it has to do with form drag – aka pressure drag – which results in vortices forming in the “separation region” directly behind an airfoil. Or in this case, a rider. Essentially, the swirling of air behind the rider is turbulent – which is why a hoodie might flop all over the place – and that causes energy to be lost.

This video on Nebula (and YT as well) describes pressure drag at about the 02m30s mark for a sphere. But this graphic from Skybrary also shows the problem:

By providing a smooth surface for air to “cling” to, where it would otherwise form vortices in the separation region, should reduce form drag, although it will cause additional induced drag (aka friction with the new surface). But induced drag scales with speed and at cycling speeds, that’s less a problem than it would be at airplane speeds.

A related drag-reducing device has been used for semi-truck trailers, and those have really been proven to reduce fuel consumption. Although the Wikipedia article does not describe in detail the aerodynamic principles at play.

The thing to keep in mind is that there exist things which have “circumstantial value”, meaning that the usefulness of something depends on the beholder’s circumstances at some point in time. Such an object can actually have multiple valuations, as compared to goods (which have a single, calculable market value) or sentimental objects (“priceless” to their owner).

To use an easy example, consider a sportsball ticket. Presenting it at the ballfield is redeemable for a seat to watch the game at the time and place written on the ticket. And it can be transferred – despite Ticketmaster’s best efforts – so someone else could enjoy the same. But if the ticket is unused and the game is over, then the ticket is now worthless. Or if the ticket holder doesn’t enjoy watching sportsball, their valuation of the ticket is near nil.

So to start, the coupon book is arguable “worth” $30, $0, or somewhere in between. Not everyone will use every coupon in the book. But if using just one coupon will result in a savings of at least $1, then perhaps the holder would see net-value from that deal.

That said, I’m of the opinion that if a donation directly results in me receiving something in return… that’s not a donation. It’s a sale or transaction dressed in the clothes of charity. Plus, KFC sends coupons in the mail for free anyway.

Notwithstanding the possible typo in the title, I think the question is why USA employers would prefer to offer a pension over a 401k, or vice-versa.

For reference, a pension is also known as a defined benefit plan, since an individual has paid into the plan for the minimum amount will be entitled to some known amount of benefit, usually in the form of a fixed stipend for the remainder of their life, and sometimes also health insurance coverage. USA’s Social Security system is also sometimes called the public pension, because it does in-fact pay a stipend in old age and requires a certain amount of payments into the fund during one’s working years.

Whereas a 401k is uncreatively named after the tax code section which authorized its existence, initially being a deferred compensation mechanism – aka a way to spread one’s income over more time, to reduce the personal taxes owed in a given year – and then grew into the tax-advantaged defined contribution plan that it is today. That is, it is a vessel for saving money, encouraged by tax advantages and by employer contributions, if any.

The superficial view is that 401k plans overtook pensions because companies wouldn’t have to contribute much (or anything at all), shifting retirement costs entirely onto workers. But this is ahistorical since initial 401k plans offered extremely generous employer contribution rates, some approaching 15% matching. Of course, the reasoning then was that the tax savings for the company would exceed that, and so it was a way to increase compensation for top talent. In the 80s and 90# was when the 401k was only just taking hold as a fringe benefit, so you had to have a fairly cushy job to have access to a 401k plan.

Another popular viewpoint is that workers prefer 401k plans because it’s more easily inspectable than a massive pension fund, and history has shown how pension funds can be mismanaged into non-existent. This is somewhat true, if US States’ teacher pension funds are any indication, although Ontario Teacher’s Pension Plan would be the counterpoint. Also, the 401k plan participants at Enron would have something to complain about, as most of the workers funds were invested in the company itself, delivering a double whammy: no job, and no retirement fund.

It is my opinion that the explosion of 401k plans and participants in such plans – to the point that some US states are enacting automatic 401k plans for workers whose employers don’t offer one – is due to 1) momentum, since more and more employers keep offering them, 2) but more importantly, because brokers and exchanges love managing them.

This is the crux: only employers can legally operate a 401k plan for their employees to participate in. But unless the employer is already a stock trading platform, they are usually ill-equiped to set up an integrated platform that allows workers to choose from a menu of investments which meet the guidelines from the US DOL, plus all other manner of regulatory requirements. Instead, even the largest employers will partner with a financial services company who has expertise on offering a 401k plan, such as Vanguard, Fidelity, Merrill Edge.

Naturally, they’ll take a cut on every trade or somehow get compensated, but because of the volume of 401k investments – most people auto-invest every paycheck – even small percentages add up quickly. And so, just like the explosion of retail investment where ordinary people could try their hand at day-trading, it’s no surprise that brokerages would want to extend their hand to the high volume business of operating 401k plans.

Whereas, how would they make money off a pension fund? Pension funds are multi-billion dollar funds, so they can afford their own brokers to directly buy a whole company in one-shot, with no repeat business.

Although copyright and patents (and trademarks) are lumped together as “intellectual property”, there’s almost nothing which is broadly applicable to them all, and they might as well be considered separately. The only things I can think of – and I’m not a lawyer if any kind – are that: 1) IP protection is mentioned broadly in the US Constitution, and 2) they all behave as property, in that they can be traded/reassigned. That’s it.

With that out of the way, it’s important to keep in mind that patent rights are probably the strongest in the family of IP, since there’s no equivalent “fair use” (US) or “fair dealing” (UK) allowance that copyright has. A patent is almost like owning an idea, whereas copyright is akin to owning a certain rendition plus a derivative right.

Disney has leaned on copyright to carve for themselves an exclusive market of Disney characters, while also occasionally renewing their older characters (aka derivatives), so that’s why they lobby for longer copyright terms.

Whereas there isn’t really a singular behemoth company whose bread-and-butter business is to churn out patents. Inventing stuff is hard, and so the lack of such a major player means a lack of lobbying to extend patent terms.

To be clear, there are companies who rely almost entirely on patent law for their existence, just like Disney relies on copyright law. But type foundries (companies that make fonts) are just plainly different than Disney. Typefaces (aka fonts) as a design can be granted patents, and then the font files can be granted copyright. But this is a special case, I think.

The point is: no one’s really clamoring for longer parents, and most people would regard a longer term on “ideas” to be very problematic. Esp if it meant pharmaceutical companies could engage in even more price-gouging, for example.

To be clear, the legs would support the topper when it’s positioned over the tub, and also support the topper when it’s beside the tub? If that’s the case, do the legs really need to fold away? Would fixed legs be acceptable? Or is there a requirement that the legs be foldable to provide clearance over the edge of the tub?

If you hold a patent, then you have an exclusive right to that invention for a fixed period, which would be 20 years from the filing date in the USA. That would mean Ford could not claim the same or a derivative invention, at least not for the parts which overlap with your patent. So yes, you could sit on your patent and do nothing until it expires, with some caveats.

But as a practical matter, the necessary background research, the application itself, and the defense of a patent just to sit on it would be very expensive, with no apparent revenue stream to pay for it. I haven’t looked up what sort of patent Ford obtained (or maybe they’ve merely started the application) but patents are very long and technical, requiring whole teams of lawyers to draft properly.

For their patent to be valid, they must not overlap with an existing claim, as well as being novel and non-obvious, among other requirements. They would only file a patent to: 1) protect themselves from competition in future, 2) expect that this patent can be monetized by directly implementing it, or licensing it out to others, or becoming a patent troll and extracting nuisance-value settlements, or 3) because they’re already so deep in the Intellectual Property land-grab that they must continue to participate by obtaining outlandish patents. The latter is a form of “publish or perish” and allows them to appear like they’re on the cutting edge of innovation.

A patent can become invalidated if it is not sufficiently defended. This means that if no one even attempts to infringe, then your patent would be fine. But if someone does, then you must file suit or negotiate a license with them, or else they can challenge the validity of your patent. If they win, you’ll lose your exclusive rights and they can implement the invention after-all. This is not cheap.

I’ll address your question in two parts: 1) is it redundant to store both the IP subnet and its subnet mask, and 2) why doesn’t the router store only the bits necessary to make the routing decision.

Prior to the introduction of CIDR – which came with the “slash” notation, like /8 for the 10.0.0.0 RFC1918 private IPv4 subnet range – subnets would genuinely be any bit arrangement imaginable. The most sensible would be to have contiguous MSBit-justified subnet masks, such as 255.0.0.0. But the standard did not preclude using something unconventional like 255.0.0.1.

For those confused what a 255.0.0.1 subnet mask would do – and to be clear, a lot of software might prove unable to handle this – this is describing a subnet with 2^23 addresses, where the LSBit must match the IP subnet. So if your IP subnet was 10.0.0.0, then only even numbered addresses are part of that subnet. And if the IP subnet is 10.0.0.1, then that only covers odd numbered addresses.

Yes, that means two machines with addresses 10.69.3.3 and 10.69.3.4 aren’t on the same subnet. This would not be allowed when using CIDR, as contiguous set bits are required with CIDR.

So in answer to the first question, CIDR imposed a stricter (and sensible) limit on valid IP subnet/mask combinations, so if CIDR cannot be assumed, then it would be required to store both of the IP subnet and the subnet mask, since mask bits might not be contiguous.

For all modern hardware in the last 15-20 years, CIDR subnets are basically assumed. So this is really a non-issue.

For the second question, the router does in-fact store only the necessary bits to match the routing table entry, at least for hardware appliances. Routers use what’s known as a TCAM memory for routing tables, where the bitwise AND operation can be performed, but with a twist.

Suppose we’re storing a route for 10.0.42.0/24. The subnet size indicates that the first 24 bits must match a prospective destination IP address. And the remaining 8 bits don’t matter. TCAMs can store 1’s and 0’s, but also X’s (aka “don’t cares”) which means those bits don’t have to match. So in this case, the TCAM entry will mirror the route’s first 24 bits, then populate the rest with X’s. And this will precisely match the intended route.

As a practical matter then, the TCAM must still be as wide as the longest possible route, which is 32 bits for IPv4 and 128 bits for IPv6. Yes, I suppose some savings could be made if a CIDR-only TCAM could conserve the X bits, but this makes little difference in practice and it’s generally easier to design the TCAM for max width anyway, even though non-CIDR isn’t supported on most routing hardware anymore.

To start off, I’m sorry to hear that you’re not receiving the healthcare you need. I recognize that these words on a screen aren’t going to solve any concrete problems, but in the interest of a fuller comprehension of the USA healthcare system, I will try to offer an answer/opinion to your question that goes into further depth than simply “capitalism” or “money and profit” or “greed”.

What are my qualifications? Absolutely none, whatsoever. Although I did previously write a well-received answer in this community about the USA health insurance system, which may provide some background for what follows.

In short, the USA healthcare system is a hodge-podge of disparate insurers and government entities (collectively “payers”), and doctors, hospitals, clinics, ambulances, and more government entities (collectively “providers”), overseen by separate authorities in each of the 50 US States, territories, tribes, and certain federal departments (collectively “regulators”). There is virtually no national-scale vertical integration in any sense, meaning that no single or large entity has the viewpoint necessary to thoroughly review the systemic issues in this “system”, nor is there the visionary leadership from within the system to even begin addressing its problems.

It is my opinion that by bolting-on short-term solutions without a solid long-term basis, the nation was slowly led to the present dysfunction, akin to boiling a frog. And this need not be through malice or incompetence, since it can be shown that even the most well-intentioned entities in this sordid and intricate pantomime cannot overcome the pressures which this system creates. Even when there are apparent winners like filthy-rich plastic surgeons or research hospitals brimming with talented expert doctors of their specialty, know that the toll they paid was heavy and worse than it had to be.

That’s not to say you should have pity on all such players in this machine. Rather, I wish to point to what I’ll call “procedural ossification”, as my field of computer science has a term known as “protocol ossification” that originally borrowed the term from orthopedia, or the study of bone deformities. How very fitting for this discussion.

I define procedural ossification as the loss of flexibility in some existing process, such that rather than performing the process in pursuit of a larger goal, the process itself becomes the goal, a mindless, rote machine where the crank is turned and the results come out, even though this wasn’t what was idealized. To some, this will harken to bureaucracy in government, where pushing papers and forms may seem more important that actually solving real, pressing issues.

I posit to you that the USA healthcare system suffers from procedural ossification, as many/most of the players have no choice but to participate as cogs in the machine, and that we’ve now entirely missed the intended goal of providing for the health of people. To be an altruistic player is to be penalized by the crushing weight of practicalities.

What do I base this on? If we look at a simple doctor’s office, maybe somewhere in middle America, we might find the staff composed of a lead doctor – it’s her private practice, after all – some Registered Nurses, administrative staff, a technician, and an office manager. Each of these people have particular tasks to make just this single doctor’s office work. Whether it’s supervising the medical operations (the doctor) or operating/maintaining the X-ray machine (technician) or cutting the checks to pay the building rent (office manager), you do need all these roles to make a functioning, small doctor’s office.

How is this organization funded? In my prior comment about USA health insurance, there was a slide which showed the convoluted money flows from payers to providers, which I’ve included below. What’s missing from this picture is how even with huge injections of money, bad process will lead to bad outcomes.

Source

In an ideal doctor’s office, every patient that walks in would be treated so that their health issues are managed properly, whether that’s fully curing the condition or controlling it to not get any worse. Payment would be conditioned upon the treatment being successful and within standard variances for the cost of such treatment, such as covering all tests to rule out contributing factors, repeat visits to reassess the patient’s condition, and outside collaboration with other doctors to devise a thorough plan.

That’s the ideal, and what we have in the USA is an ossified version of that, horribly contorted and in need of help. Everything done in a doctor’s office is tracked with a “CPT/HCPCS code”, which identifies the type of service rendered. That, in and of itself, could be compatible with the ideal doctor’s office, but the reality is that the codes control payment as hard rules, not considering “reasonable variances” that may have arisen. When you have whole professions dedicated to properly “coding” procedures so an insurer or Medicare will pay reimbursement, that’s when we’ve entirely lost the point and grossly departed from the ideal. The payment tail wags the doctor dog.

To be clear, the coding system is well intentioned. It’s just that its use has been institutionalized into only ever paying out if and only if a specific service was rendered, with zero consideration for whether this actually advanced the patient’s treatment. The coding system provides a wealth of directly-comparable statistical data, if we wanted to use that data to help reform the system. But that hasn’t substantially happened, and when you have fee-for-service (FFS) as the base assumption, of course patient care drops down the priority list. Truly, the acronym is very fitting.

Even if the lead doctor at this hypothetical office wanted to place patient health at the absolute forefront of her practice, she will be without the necessary tools to properly diagnose and treat the patient, if she cannot immediately or later obtain reimbursement for the necessary services rendered. She and her practice would have to absorb costs that a “conforming” doctor’s office would have, and that puts her at a further disadvantage. She may even run out of money and have to close.

The only major profession that I’m immediately aware of which undertakes unknown costs with regularity, in the hopes of a later full-and-worthwhile reimbursement, is the legal profession. There, it is the norm for personal injury lawyers to take cases on contingency, meaning that the lawyer will eat all the costs if the lawsuit does not ultimately prevail. But if the lawyer succeeds, then they earn a fixed percentage of the settlement or court judgement, typically 15-22%, to compensate for the risk of taking the case on contingency.

What’s particularly notable is that lawyers must have a good eye to only accept cases they can reasonably win, and to decline cases which are marginal or unlikely to cover costs. This heuristic takes time to hone, but a lawyer could start by being conservative with cases accepted. The reason I mention this is because a doctor-patient relationship is not at all as transactional as a lawyer-client relationship. A doctor should not drop a patient because their health issues won’t allow the doctor to recoup costs.

The notion that an altruistic doctor’s office can exist sustainably under the FFS model would require said doctor to discard the final shred of decency that we still have in this dysfunctional system. This is wrong in a laissez-faire viewpoint, is wrong in a moral viewpoint, and is wrong in a healthcare viewpoint. Everything about this is wrong.

But the most insidious problems are those that perpetuate themselves. And because of all those aforementioned payers, providers, and regulators are merely existing and cannot themselves take the initiative to unwind this mess, it’s going to take more than a nudge from outside to make actual changes.

As I concluded my prior answer on USA health insurance, I noted that Congressional or state-level legislation would be necessary to deal with spiraling costs for healthcare. I believe the same would be required to refocus the nation’s healthcare procedures to put patient care back as the primary objective. This could come in the form of a single-payer model. Or by eschewing insurance pools outright by extending a government obligation to the health of the citizenry, commonly in the form of a universal healthcare system. Costs of the system would become a budgetary line-item so that the health department can focus its energy on care.

To be clear, the costs still have to be borne, but rather than fighting for reimbursement, it could be made into a form of mandatory spending, meaning that they are already authorized to be paid from the Treasury on an ongoing basis. For reference, the federal Medicare health insurance system (for people over 65) is already a mandatory spending obligation. So upgrading Medicare to universal old-people healthcare is not that far of a stretch,

Good luck with your endeavors! Always keep in mind that when debugging a complex problem, try isolating individual components and testing them individually. This can be as easy as swapping a web application with the Python SimpleHTTPServer to validate firewall and reverse proxy configuration.