Obviously the insurance company actually dictates your healthcare and the prescriptions you receive, not your doctor. If you have great insurance, more physicians and treatments will be covered. Under insured is just having insurance that doesn’t cover your treatment.

Anytime a drug comes to market, manufacturers need to make sure drugs are covered by insurers. So, pharma companies go out to the “payers” (it’s what’s we call them at work) and vie to get a good position on the payer’s “formulary” (the list of drugs covered by insurance).

In this negotiation, you have things like “prior authorization” where the prescriber needs to make a case to the insurance company before a drug can be prescribed. There’s also different tiers for a class of drugs. This means the payers allow certain drugs to be covered only after a patient steps through other (cheaper) treatments. If it’s not covered, you can pay out of pocket but none of this shit is priced for an individual.

There’s a cold calculus on both sides where the pharma company has sunk $300 million to $5 billion dollars to bring a drug to market that can sometimes take a decade to go through clinical trials and receive FDA approval — they need to charge a lot to recoup their investment and hopefully become profitable. Meanwhile, insurers have a population they need to cover and a set pool of money and they don’t need a new $50,000 therapy when there’s a generic that will treat 80% of patients. The other 20% can jump through the hoops or get stuffed…

PSA from someone who works in the industry. Drug manufacturers offer “patient assistance programs” where people who are under insured or uninsured can receive treatments at a discount or sometimes free. They are not broadly advertised and I had no idea they existed until I started working in the space. Just search the drug + patient assistance or financial assistance.

Also to state the obvious… The US healthcare system is fucked — mostly insurance companies but also pharmaceutical companies and hospital systems in the US are all doing everything they can to increase their profits at your expense.

1. Hospitals and pharma set high menu prices in order to negotiate with insurance companies. 2) Insurance companies make money by NOT paying. So you’re fucked unless you’re fortunate to have a cushy white collar job with good benefits. The people that get fucked the most are the ones that can’t afford the premiums

Yep, I spent a month refactoring a few thousand lines of code using GPT4 and I felt like I was working with the best senior developer with infinite patience and availability.

I could vaguely describe what I was after and it would identify the established programming patterns and provide examples based on all the code snippets I fed it. It was amazing and a little terrifying what an LLM is capable of. It didn’t write the code for me but it increased my productivity 2 fold… I’m a developer now a getting rusty being 5 years into management rather than delivering functional code, so just having that copilot was invaluable.

Then one day it just stopped. It lost all context for my project. I asked what it thought what we were working on and it replied with something to do with TCP relays instead of my little Lua pet project dealing with music sequencing and MIDI processing… not even close to the fucking ballpark’s overflow lot.

It’s like my trusty senior developer got smashed in the head with a brick. And as described, would just give me nonsense hand wavy answers.

I’ve definitely seen GPT-4 become faster and the output has been sanitized a bit. I still find it incredibly effective in helping with code reviews where GPT-3 was never helpful in producing useable code snippets. At some point it stopped trying to write large swaths of code and started being a little more prescriptive and you still need to actually implement snippets it provides. But as a tool, it’s still fantastic. It’s like a sage senior developer you can rubber duck anytime you want.

I probably fall in the minority of people who thinks releasing a castrated version of GPT is the ethical approach. People outside the technology bubble don’t have a comprehension of how these models work and the capacity for harm. Disinformation, fake news and engagement algorithms are already social ills that manipulate us emotionally and most people are too technologically illiterate to see how pervasive these problems are already.