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[personal profile] siderea
Canonical link: https://siderea.dreamwidth.org/1891517.html


This is part of Understanding Health Insurance





The Three-Stage Model



When you have health insurance, you have a contract (health plan) with the insurance company that says that for the duration (the plan year) of the contract, you will pay them the agreed upon monthly fee every month (the premium), in exchange for them paying for your health care... some.

How much is "some"? Well, that depends.

To understand what it depends on, you have to understand the three-stage model that health plans are organized around.

This three-stage model is never described as such. It is implicit in the standard terms (jargon) of the health insurance industry, and it is never made explicit. There is no industry term (jargon) for the model itself. There are no terms (jargon) for the three stages. But health insurance becomes vastly easier to understand if you think about it in terms of the three-stage model that is hiding in just about every health plan's terms (agreements).

Read more: 12,170 (sic!) riveting words about health insurance in the US] )

This post brought to you by the 221 readers who funded my writing it – thank you all so much! You can see who they are at my Patreon page. If you're not one of them, and would be willing to chip in so I can write more things like this, please do so there.

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tcpip: (Default)
[personal profile] tcpip
Kate R and I have boarded the big silver bird to travel to South America and Antarctica, the first stop being Santiago de Chile. The flight was twelve hours, and due to the peculiarities of time zones, we arrived two hours before we left. Our stay was in the CBD, NH Collection Plaza, quite upmarket with nice features and next to the World Trade Centre. The afternoon arrival provided the opportunity for a walk through the local "Parque de las Esculturas", then a hike up the famous Cerro San Cristóbal parkland to catch the sunset and return - a round trip of about five hours. It was sufficiently impressive that we returned the following day and took the ascent via teleferico (with the oversized statue of Mary that looks over the city) and descended by funicular to viist the nearby "Casa Museo La Chascona", home of the Nobel Prize winning poet, politician, and diplomat, Pablo Neruda, a person who was certainly not without significant flaws as well as greateness.

This would be the start of en epic walking trip through Santiago that would be measured at 45km for the day (yes really), which would include a visit to the beautiful Museo Nacional de Bellas Artes, the Catedral Metropolitana with it's overwhelming baroque features, past the ridiculous over-sized flag at the Palacio de La Moneda, then to the Museo de la Solidaridad Salvador Allende and, on return, to the remarkable collection in the El Museo Chileno de Arte Precolombino and the "Horizonte Antártico" exhibit at La Biblioteca del Congreso Nacional. El Museo de la Memoria y los Derechos Humanos, which was high on the agenda, was unfortunately closed for renovations.

Whilst far from the most visually spectacular part of the trip, the Salvador Allende museum was definitely the most emotionally significant location for me. The Allende events were utterly critical in the formation of my own political opinions when I became aware of them in my early teens. Helped by the film, "Missing", I became a voracious reader of the history. For those who don't know, the summary is that a socialist president was elected supported by a left-wing alliance and implemented a programme of nationalisation of resource industries, land redistribution, significant health and education welfare improvements, and the remarkable economic and logistics computer system, Project Cybersyn. Allende was dedicated to the idea that socialism could be achieved through parliamentary democracy; but ultimately the military disagreed (unsurprisingly supported by the United States) disagreed. A coup and the installation of the Pinochet regime resulted in years of torture and deaths of thousands of democratic activists. The Allende events is tragic and utopian, providing insights on the nature of the capitalist State, and has a lasting impact on history.
tetsab: An @ sign in a box (@)
[personal profile] tetsab
When I picture the rhythm of the year I tend to picture Not Bloody Much in the cold months and a fair bit more for the rest. This is because I hate the cold and am generally inclined to hibernate. Once again, the value of doing these lists is that I can actually scroll through them and see that, really, this is just a picture in my head and not actually reality, but, in 2024... the picture actually was the reality. )
andrewducker: (Teddy of Borg)
[personal profile] andrewducker
About a month ago Gideon watched a bunch of videos about Minecraft, asked if he could play it on her tablet, got a few pointers from me to get him going and then dove in and started building stuff. At an impressive rate considering that he can't read any word more than 4 letters long.

Yesterday I mentioned Minecraft to Sophia, and she showed interest, so I set her up on my desktop and she got stuck in. She's asked for more help than Gideon has, but has been happily building herself an underground house. And just now I wanderd into my office to see her on the desktop and Gideon sitting on the floor with his tablet, with the two of them intermittently showing each other cool things that they'd found.

So tonight, after they're asleep, I'm going to set them both up for online play, and rent a realm*, so that they can be in the same world with each other.



*I am totally willing to pay £3.99 per month to not have to maintain my own server.
liam_on_linux: (Default)
[personal profile] liam_on_linux

I think there are many.

Some examples:

* The fastest code is the code you don't run.

Smaller = faster, and we all want faster. Moore's law is over, Dennard scaling isn't affordable any more, smaller feature sizes are getting absurdly difficult and therefore expensive to fab. So if we want our computers to keep getting faster as we've got used to over the last 40-50 years then the only way to keep delivering that will be to start ruthlessly optimising, shrinking, finding more efficient ways to implement what we've got used to.

Smaller systems are better for performance.

* The smaller the code, the less there is to go wrong.

Smaller doesn't just mean faster, it should mean simpler and cleaner too. Less to go wrong. Easier to debug. Wrappers and VMs and bytecodes and runtimes are bad: they make life easier but they are less efficient and make issues harder to troubleshoot. Part of the Unix philosophy is to embed the KISS principle.

So that's performance and troubleshooting. We aren't done.

* The less you run, the smaller the attack surface.

Smaller code and less code means fewer APIs, fewer interfaces, less points of failure. Look at djb's decades-long policy of offering rewards to people who find holes in qmail or djbdns. Look at OpenBSD. We all need better more secure code. Smaller simpler systems built from fewer layers means more security, less attack surface, less to audit.

Higher performance, and easier troubleshooting, and better security. There's 3 reasons.

Practical examples...

The Atom editor spawned an entire class of app: Electron apps, Javascript on Node, bundled with Chromium. Slack, Discord, VSCode: there are multiple apps used by tens to hundreds of millions of people now. Look at how vast they are. Balena Etcher is a, what, nearly 100 MB download to write an image to USB? Native apps like Rufus do it in a few megabytes. Smaller ones like USBimager do it in hundreds of kilobytes. A dd command in under 100 bytes.

Now some of the people behind Atom wrote Zed.

It's 10% of the size and 10x the speed, in part because it's a native Rust app.

The COSMIC desktop looks like GNOME, works like GNOME Shell, but it's smaller and faster and more customisable because it's native Rust code.

GNOME Shell is Javascript running on an embedded copy of Mozilla's Javascript runtime.

Just like dotcoms wanted to dis-intermediate business, remove middlemen and distributors for faster sales, we could use disintermediation in our software. Fewer runtimes, better smarter compiled languages so we can trap more errors and have faster and safer compiled native code.

Smaller, simpler, cleaner, fewer layers, less abstractions: these are all goods things which are desirable.

Dennis Ritchie and Ken Thompson knew this. That's why Research Unix evolved into Plan 9, which puts way more stuff through the filesystem to remove whole types of API. Everything's in a container all the time, the filesystem abstracts the network and the GUI and more. Under 10% of the syscalls of Linux, the kernel is 5MB of source, and yet it has much of Kubernetes in there.

Then they went further, replaced C too, made a simpler safer language, embedded its runtime right into the kernel, and made binaries CPU-independent, and turned the entire network-aware OS into a runtime to compete with the JVM, so it could run as a browser plugin as well as a bare-metal OS. Now we have ubiquitous virtualisation so lean into it: separate domains. If your user-facing OS only runs in a VM then it doesn't need a filesystem or hardware drivers, because it won't see hardware, only virtualised facilities, so rip all that stuff out. Your container host doesn't need to have a console or manage disks.

This is what we should be doing. This is what we need to do. Hack away at the code complexity. Don't add functionality, remove it. Simplify it. Enforce standards by putting them in the kernel and removing dozens of overlapping implementations. Make codebases that are smaller and readable by humans.

Leave the vast bloated stuff to commercial companies and proprietary software where nobody gets to read it except LLM bots anyway.

 

[Adapted from an HN comment.)
 
 

podcast friday

Dec. 12th, 2025 07:03 am
sabotabby: (doom doom doom)
[personal profile] sabotabby
 Here's a series from a week or two ago that you really should check out: It Could Happen Here's "Darién Gap: One Year Later." It's four parts and I recommend listening to the whole thing, as it's some truly brilliant reporting, but if you are like me, the one that will stand out the most is the second episode, "To Be Called By No Name." It begins with a song written in 1948, Woody Guthrie's "Deportees (Plane Crash At Los Gatos)" that has horrifying resonance now, nearly 80 years later. From that jumping off point, James discusses the media coverage of the manufactured migrant crisis.

The four part series focuses on two migrants in particular, Primrose and her daughter Kim, from Zimbabwe. Primrose's family opposed the regime there and her father was disappeared; she and her daughter fled a deadly situation to try to claim refugee status in the US. The plight of migrants from African countries is even less discussed than those from Latin America or the Middle East; in detailing Primrose's story, James makes her visible, a heroic protagonist facing impossible odds, someone who lodges in your heart and stays there. It's great storytelling as well as great journalism. He refuses the objectivity of the mainstream reporters, who just don't bother to talk to migrants, let alone give voice to their names and stories.

Even posting about this tears me up. I know a lot of you reading this are doing your best to fight ICE but I want to beat every one of those bastards to death with my bare hands and by the end of this series, you will too.

Update [me, health, Patreon]

Dec. 12th, 2025 06:49 am
siderea: (Default)
[personal profile] siderea
So, I, uh, got my RSI/ergonomics debugged!* I then promptly lost two days to bad sleep due to another new mechanical failure of the balky meat mecha and also a medical appointment in re two previous malfunctions. But I seem back in business now. The new keyboard is great.

Patrons, I've got three Siderea Posts out so far this month and it's only the 12th. I have two more Posts I am hoping to get out in the next three days. Also about health insurance. We'll see if it actually happens, but it's not impossible. I have written a lot of words. (I really like my new keyboard.)

Anyways, if you weren't planning on sponsoring five posts (or – who knows? – even more) this month, adjust your pledge limits accordingly.

* It was my bra strap. It was doing something funky to how my shoulder blade moved or something. It is both surprising to me that so little pressure made so much ergonomic difference, and not surprising because previously an even lighter pressure on my kneecap from wearing long underwear made my knee malfunction spectacularly. Apparently this is how my body mechanics just are.
siderea: (Default)
[personal profile] siderea
Canonical link: https://siderea.dreamwidth.org/1890494.html


0.

Hey Americans (and other people stuck in the American healthcare system)! Shopping for a health plan on your state marketplace? Boy, do I have some information for you that you should have and probably don't. There's been an important legal change affecting your choices that has gotten almost no press.

Effective with plan year 2026 all bronze level and catastrophic plans are statutorily now HDHPs and thus HSA compatible. You may get and self-fund an HSA if you have any bronze or catastrophic plan, as well as any plan of any level designated a HDHP.

2025 Dec 9: IRS.gov: "Treasury, IRS provide guidance on new tax benefits for health savings account participants under the One, Big, Beautiful Bill"
Bronze and Catastrophic Plans Treated as HDHPs: As of Jan. 1, 2026, bronze and catastrophic plans available through an Exchange are considered HSA-compatible, regardless of whether the plans satisfy the general definition of an HDHP. This expands the ability of people enrolled in these plans to contribute to HSAs, which they generally have not been able to do in the past. Notice 2026-05 clarifies that bronze and catastrophic plans do not have to be purchased through an Exchange to qualify for the new relief.

If you are shopping plans right now (or thought you were done), you should probably be aware of this. Especially if you are planning on getting a bronze plan, a catastrophic plan, or any plan with the acronym "HSA" in the name or otherwise designated "HSA compatible".

The Trump administration doing this is tacit admission that all bronze plans have become such bad deals that they're the economic equivalent of what used to be considered a HDHP back when that concept was invented, and so should come with legal permission to protect yourself from them with an HSA.

Effective immediately, you should consider a bronze plan half an insurance plan.

Read more [3,340 words] )

This post brought to you by the 221 readers who funded my writing it – thank you all so much! You can see who they are at my Patreon page. If you're not one of them, and would be willing to chip in so I can write more things like this, please do so there.

Please leave comments on the Comment Catcher comment, instead of the main body of the post – unless you are commenting to get a copy of the post sent to you in email through the notification system, then go ahead and comment on it directly. Thanks!
tamaranth: me, in the sun (Default)
[personal profile] tamaranth
2025/196: The Naughty List Manager — Remy Fable
"...Go see what this young man is really like. Then come back and tell me if he truly deserves coal in his stocking."
It was absolutely against protocol. It was wildly inefficient. It was a complete deviation from two centuries of procedure.
"I could leave tomorrow," Noel heard himself say.[loc. 61]

Short sweet Christmas m/m romance novella: Noel Frost, an elf, has been managing the Naughty List Department for over two hundred years. For the last decade, he's pulled the file of Ezra Vince, street artist and befriender of stray cats, who's been on the Naughty List for the last ten years. Noel is something of a stickler for the rules, but Mrs Claus sends him to investigate whether Ezra is actually Naughty or ... the other thing.

I was suffering from a surfeit of pre-Christmas crowds and hecticity: this was the perfect antidote. Nicely written, sweet, humorous and fun. There are more in the 'Claus Encounters' series...

It finally happened

Dec. 11th, 2025 08:24 pm
sweh: (Cybook)
[personal profile] sweh
When I retired in May 2024 one of the things I was hoping would happen is that I would start reading more books. When I was a kid I could easily get through 4 books a week (4 books was the most the local library would lend at a time).

As I became an adult I had less time to read. Getting up at 6:30am to catch a train to go to London to work, then drinking with co-workers and getting home gone midnight... yeah, not much reading time there!

And, of course, books got larger. A 1960s Asimov story.. oh, let's say "The End Of Eternity" (a book I loved as a kid) was 72,000 words long. A modern SciFi book starts at 100,000 words and can easily be 120,000 or more. Peter Hamilton books, maybe 170,000 words :-)

And, bluntly, stories became more sluggish. You can sprint through an Asimov story because they're pretty shallow; they have one point of view, they have a singular story vector... it's easy to read. I would get a Discworld book for Christmas and consume it in 3 hours. Something to do after Christmas dinner when people would fall asleep in front of James Bond :-)

Compare that to, say, Alastair Reynolds; we have multiple points of view, the story might be sluggish by design, to emphasize the struggle of the viewpoint character; the world might be dirty and slimey and it doesn't really encourage you to be there. Is it a more textured story? Definitely! Is it something I can read as quickly; no. Is it something I might reread? Possibly not.

Since 2008 I've been tracking the number of books I've read each year. I kinda tried to normalize the numbers ("2 Peter Hamilton Books is the same as 3 Charlie Stross books" just based on word count). Yeah, it's not a real number. But a good estimate.

And this year, I finally broke my record in that time period. I'm at 56 books and climbing. Now part of that might be because I'm re-reading the Simon R Green books (Nightside and Secret Histories). Green's writing is "quick and easy" to read.

But part of it is because I've stretched out on my sofa, put on some background music (maybe Tubular Bells, maybe Jean-Michel Jarre) and then just read for a few hours. And then gone to bed and read some more.

I think I'm getting the hang of this "retirement" lark!

Timeline of a new phase in my life.

Dec. 11th, 2025 07:12 pm
andrewducker: (Unless I'm wrong)
[personal profile] andrewducker
About two months ago, I had a nasty respiratory infection. And while I was lying awake one night, I could hear my heart beating quite loudly.

Having had multiple friends go to the doctor to check on something and then have the doctor tell them that they urgently needed medication before their high blood pressure did them serious damage/killed them, I thought I should pop in to the doctor for a chat.

They checked me on the spot, said my blood pressure was a little high, but nothing terrible, and told me to join the queue to borrow a blood pressure device. [personal profile] danieldwilliam gave me his old one, and I spent a couple of weeks taking results. Which mostly showed that my pressure is fine in the morning, but that after I've spent 90 minutes shouting at Gideon to stop bloody well mucking about and go to sleep, it's a fair chunk higher than it should be. They also sent me for an ECG (which showed I have Right Bundle Branch Block, a harmless and untreatable condition that affects 15% of the population), an eye test (which found nothing), and a fasting blood test (which showed I'm still not diabetic, even though I can't have sugar in my diet even slightly any more).

They then had a phone call with me to chat it through, said that I'm a little high (on average), and a little young for it to be a major worry, but if I was up for it they could put me on some pills for hypertension.. I agreed that it sounded sensible, and the doctor sounded positively relieved that she hadn't had to bully me into it.

The weird feeling is that this is the first time I've been put on to a medicine that I will have to take for the rest of my life. There is now "The time I didn't have to take medicine every day" and "The time where I had to take medicine every day". Which definitely feels like an inflection point in my life. (Endless sympathy, of course, for people I know who have to take much worse things than a tiny tasteless pill with very few side-effects.)

So all-in-all, nothing major. Just the next step. I'm just very glad for the existence of modern medicine.
wildeabandon: picture of me (Default)
[personal profile] wildeabandon
...but I have (sort of) a plan this time. I've put a weekly reminder in my diary to post, which I hope will help, and I'm going to create a sort of vague template of 'things to update about' which I can follow if I'm feeling uninspired, but not restrain myself to if there's something in particular that takes my fancy.

I had a resolution this semester that I was going to study less and socialise more, which is perhaps not an entirely typical student resolution, but felt like it would be appropriate for me. I largely failed. This is partly because there were a number of occasions where I made a plan to go to an event, and then when the time came around I was faced with a choice of going outside and travelling to somewhere with lots of background noise where I would have to interact with unfamiliar humans, or staying in the quiet warm library with my books and my translation (or other work), and somehow the latter was always much more appealing.

So on the one hand, it doesn't actually feel particularly unhealthy that I'm studying instead of socialising because that's what I want to do rather than because I feel it's what I should do, but on the other hand, if I want to reach the stage where I have a francophone circle of not-unfamiliar people to spend time with here, I'm going to have to go through the 'socialising with unfamiliar people' bit first.

On a related note, I am feeling a bit frustrated with my (lack of) language acquisition here. Before I moved out lots of people suggested that being here and using French on a daily basis would lead to a big improvement, but it doesn't seem to have happened. Partly that's probably because I'm /not/ really using French on a day to day basis. I mean, I use it in the shops and to read the news and listen to announcements on the railways, but my actual day to day work is in English, and although I can read fairly fluently, follow to audiobooks and some podcasts, and have an interesting conversation 1-1 with plenty of context cues, no background noise and an interlocutor who is speaking clearly, I still struggle in fairly basic situations without those accommodations. And crucially, I don't think I've improved significantly since moving here, so I need to do something more active to improve, so I've found a "table de langues" to try next Wednesday evening, and if I just don't go to the library after my final lecture that day, it should be easier to escape it's gravity.
tamaranth: me, in the sun (Default)
[personal profile] tamaranth
2025/195: Voyage of the Damned — Frances White
She’s cutting off the weak to save the strong. No, not even that. Cutting off the poor to save the rich. [loc. 6441]

There has been peace in Concordia for a thousand years: the twelve provinces are united against the threat of invasion, and each province has an heir who's been granted a magical gift, a Blessing, by the Goddess Herself. Voyage of the Damned begins just as Ganymedes ('Dee'), the representative of Fish province, is desperately trying to avoid embarking on the eponymous voyage -- to a sacred mountain, on the Emperor's own ship -- with the other eleven Blesseds.Read more... )

tetsab: Screenshot of a brickbreaker game where the bricks spell out 'Meh' (MehBounce)
[personal profile] tetsab
So the thing I really noticed about doing the 2022 is that I'm not so sure how much of all of what was there was truly nice. There were a couple of months that hardly seemed to have anything 'nice' at all and somehow I started drifting these from 'nice life-y' to just 'things I do outside of work'. I'm going to keep that pattern up for the for the next 3 of these (i.e. until I'm actually caught up) for ease of comparison and then re-evaluate what I want to actually capture )
Alright, that was absolutely Not As Bad as 2022 -- much better balance of the 'remote' not-work-work and actual Nice Things To Do.