My spouse is a physician, and "patient messages" (aka "non-face-to-face" encounters) usually aren't reimbursed by insurance. Having a friendly online conversation with a patient doesn't generate the "RVUs" they need (contractually!), so time spent messaging is time taken out of their personal day on top of their regular workload.
Responding to messages can also just be very difficult and time consuming. Maybe you ask concise, clear, pertinent messages to your doctor (or think you do!), but most do not. It's similar to problems HN readers might be more familiar with: user-created support tickets, and comment moderation. Medical office staff help with this triage and moderation, but it has become a big problem to manage with how easy it now is for bored/sick/scared patients to send messages.
I agree that charging a fee can be fine. For me it's often a win-win. I spend less time having to go there, and the doctor can spend less time than an in-person visit and even do it on some down-time. But it's still a service, so paying about same as a regular doctor visit (about ~$20 or so here in Norway) is fine.
My biggest gripe here is that if the doctor answers me outside office hours, an additional "emergency / inconvenience fee" is added. Like, I can't control when you answer, and I didn't choose it. If I send in something during daytime and you didn't get to it, answer me the next day, then. Or make it a choice that I want a prioritized answer so at least I decide. It's just bonkers.
I recently was informed that the question to my doctor over messaging qualifies as “e-visit” and was giving 3 different CPT codes(differing by time physician would spend answering it)
The CPT is how services are identified for medical billing and I called my hospitals financial assistance line to find the contractual “allowed amount” they would charge my insurance(and therefore me since I did not hit my deductible)
The cost for this e-visit message would range from $65 if it took less than 10 minutes to $438 if it took more than 25 minutes.
With absolute zero accountability on how this time was spent.
Lawyers are way more transparent than medical billers
If my actual doctor responded to my messages within some SLA (2 days?) then I'm more than happy to pay much more.
Now a days what happens is I send a message with photos or many details, and some poor nurse who is assigned message triage is going through many and responds with generic pointless text for my issue.
My wife works at an academic hospital and bills for messages sent through the portal. If it hasn't arrived yet, it will. Patient care specialists (nurses, physicians, etc.) are spending a ton of time everyday responding to patient "text" messages.
A friend is a vet and frequently rolls their eyes when I mention that I'm going into a doctor's office to review lab results. But in that meatspace discussion, we talked about dietary changes, upcoming medications and potential interactions, how my primary should get some records from another doctor, and I was able to ask about if an elective medical procedure was advisable, given my medical history. It was easily 20 minutes of relaxed discussion about an actual medical plan.
If it was three minutes of "these are your lab results; you should/shouldn't come in for a follow-up," I'd agree that it should be a phone call that's covered under the cost of the original appointment. But given that vet friend is constantly pressed for time and doesn't get to bill separately for those callbacks, I can't imagine why my primary doctor would want to do the same.
I don't want medical professionals responsible for my care to squeeze things in when they have time. Insurance is likely to be even more of a pain in the ass, and cramming in tasks because they're unpaid means lower quality of care.
Glad to see this mentioned (twice even!). Ambrosia Software! This was the first game I was really exposed to "mods" and user created content with, too. Takes me back!
My neighbor breathlessly informed me a couple months ago that I should be worried about my EVs burning down our house. She seemed a little surprised when I mentioned that my Ford (not an EV) is actually the bigger risk for spontaneously burning down my house.
When discussing fire risk, I remind people that ICE cars have "combustion" in the name for a reason - its propulsion literally comes from controlled explosions using flammable liquids.
If your gasoline is exploding in the cylinders instead of combusting, you should use higher octane or adjust your engine. When gasoline explodes in an internal combustion engine, it’s called “detonation” and if it persists, it can increase the number of parts in your car rather suddenly.
It always disappointed me that humans haven't really managed to make the rotating detonation engine work. Its theoretical efficiency and power density is really high.
Now I'm imagining something like a fidget spinner combined with a Nuclear Pulse Engine[1] and it's awesome because I'm imagining that it can provide both propulsion and rotation...but I bet we need some great advances in material science before anything like it could exist.
A Wankel was what I thought of first, since it's the closest we've come to a rotational explosion engine, but I'm a space nerd so the combination of rotation and propulsion could make for some interesting applications related to space travel.
Technically a deflagration is also an explosion, it's just subsonic, whereas detonation is supersonic. Plenty of explosives don't detonate: they're called "low explosives" and gunpowder is an example, as well as normal petrol-air mixtures.
Unless you have a weirdly fire prone Ford, I think this is another example of people often really confusing the fire stats for ICE vs EV.
Yes, mile for mile gas cars catch fire more often.
The problem is, gas cars catch fire usually when they are older and neglected. Oil leaks and fuel leaks being 95% of the culprits. And when they do catch fire, they do so while on, not in your garage. And if they DO catch fire in your garage, they do it within minutes of you returning home... When you're still awake and alert.
Compare that to EVs, that catch fire a little less often... Except they do so when almost NEW with zero visible faults that you could catch (like an oil leak onto your exhaust). This is way more problematic.
I'm not talking about ongoing statistics about fires in older cars, or singling out gasoline as the problem. Just look at recalls in the last few years alone for spontaneous fires in unattended vehicles. The 12V battery and associated electronics are more than capable of starting a fire, and once a car gets going, they all burn really hot and fast whether fueled by electrons or gasoline.
Do we have good numbers on EV fires now? Aside from what, 19 fires due to the faulty LG batteries in the Bolt, I don't hear a lot about spontaneous combustion being a thing. It's really hard to get anything like current numbers, but from the few places I've looked which try to collect such data, it seems that nearly all fires are secondary to impact damage.
I've had multiple different vehicles have recalls for fire situations with them without the requirement of them being recently driven. One vehicle even had multiple recalls for fires like this.
That's great. I'm talking about vehicles that catch fire not recalls for possibilities. Beyond that, the only way a vehicle that hasn't been on to catch fire is from a really faulty 12v system. EVs have those too.
It's related to Ohm's law, but if you have a specific load you need to power (say 8 watts) a 12 volt system can run that using 0.6 amps (at 18 Ohm) while a 48 volt system can run that same 8 watt load at 0.16 amps (at 288 Ohm).
Another way to look at it is a little easier with something like a 24 volt PoE injector vs a 48 volt PoE injector. The 24 volt supplies the needed energy at 1 amp, but the 48 volt supplies the same energy at 0.5 amps. Both work out to 24 watts (volts*amps=watts) but a wire carrying 48 volts doesn't generate as much resistance, which would be lost as heat into the wire carrying the load. If it loses too much heat because the resistance is too high, well, that's how you make a heating element -- cram amperage into a wire until the resistance makes it hot.
For example a 960 watt fan - fairly typical of the cabin air fan, at 12 volts would need 80 amps, whereas at 48 volts would need only 20 amps. (Power in watts = Current in Amps * Voltage)
If you have a bad connection in that cable of 0.01 ohms, then that bad connection would generate 64 watts of heat on the 12v/80a system (enough to melt the plastic on the cable and start a fire), whereas on the 48v/20a system it would only make 4 watts of heat (probably safe). (Power in Watts = Current in Amps Squared * Resistance in Ohms).
I had a recall on my Ford Van. The hydraulically actuated brake switch used by the cruise control could crack and leak brake fluid into the electrical contacts. That would then start an electrical fire. That could happen when it was parked. The notice from Ford said not to park it in a garage until the issue was fixed.
You are correct. Brake fluid gets water and other stuff in it over time. That makes it conductive. The problem was the hot side of the switch was always live because it uses the same 12V source as the brake light switch. Which has to work when the car is off.
Ah yes - it dissolves paint and many plastics, so I could imagine some insulation was dissolved away... Although the most common wire insulations, PVC or XLPE, aren't impacted by it.
All cars, regardless of fuel, are extremely flammable. Once they get going they burn quick & hot. The fire department usually doesn't spend much time trying to put out a car fire inside a garage, they knock it down enough to throw a chain on it and drag it out onto the driveway.
> the insurers don't, care about the car catching fire
Of course they do. You think an insurance company would cover a vehicle using an open flame for power at the same rate and an ICE? And how often do charges actually catch fire where it’s not a total loss? For the insurance companies, the result is the same - a replacement.
I can tell you that insurance companies charge more (though low double digits on the year) when your house is heated with e.g. a pellet stove vs a typical oil furnace.
IMO it's notable that since then literally millions of ICE cars from companies like Ford and Hyundai have also had "keep outside" warnings due to recalls. For some reason that doesn't seem to discourage buyers.
Yes, but maybe a company or organization is, in fact, looking at political climate change solutions, but needs tech hires for their operations, etc.
As the target audience for a job board like this, the question I am starting with isn't "how can tech solve climate change?", it's "how can I apply my tech skills to a problem like climate change?".
In Utah, my understanding is that the primary purpose of state owned lands is to generate revenue for the state. Utah uses them to make money, not to protect them. This includes mineral leasing for oil, gas, coal, etc, and grazing, but in some cases, like the "SITLA" School Trust lands, the state will literally auction off land into private hands. This is ostensibly to raise money for public schools. I strongly support public education, but this way of removing beautiful tracts of Utah desert from the public is very final. You can hike around an oil well, and eventually sort of clean them up, but outright selling off limited resources like lands is frustrating. Compared to normal revenue sources, like taxes, these land auctions raise such a small amount for money for the school system it's even more tragic.
The outdoor recreation industry in Utah is growing rapidly, largely part due to the National Parks, Monuments, and other amazing public lands we have to recreate on. Our 5 national parks (Arches, Canyonlands, Zion, Bryce and Capitol Reef) are some of the most visited in the country. This isn't hunting recreation, like the Field & Stream article is about. Most of this is mountain biking, climbing, hiking, rafting, etc. (Think family vacations and young web developers in Vanagons, not gun toting hunters in big trucks.) On top of the burgeoning hospitality industry supporting this tourism, outdoor companies like Backcountry.com, Petzl, Goal Zero, Black Diamond, Altra, Kuhl, Scott, etc have large presences in Utah now. By some counts, outdoor recreation is one of the largest economic drivers in Utah. And between the aspirational outdoor photos people in the city like on Instagram and generally affordable travel, this visitation trend will only continue upward.
In response to Utah's politicians passing resolutions and endlessly promoting "taking back" Federal land into State hands, the outdoor industry that relies on public land access has started to fight back. To make a stand against these anti-federal politics Patagonia, Black Diamond and some other large retailers threatened to boycott the "Outdoor Retailer" trade show, held in Utah. In response, there was a call with the Governor and he basically gave the outdoor industry the finger. They are moving the trade show to another state now - more symbolic than actually hurtful to Utah's economy, but an interesting development nonetheless. After the ceaseless "jobs" and "pro-business" rhetoric from red states like Utah this antagonism towards one of it's largest and fastest growing industries is frustrating and puzzling. I can't tell if my politicians really see using public lands for finite oil and gas extraction as a better plan than protecting them for generations of future vacationers - or if they just get better campaign contributions from those extraction industries. Either way, as someone who likes mountain biking and who has high hopes for solar energy and electric cars, there is nothing positive to me about these state attempts to control my Federal lands. (I do vote, but I will probably not be able to affect Utah's red state politics for a long time.)
Fascinating. If not a hoax - perhaps an early example of schizophrenia? A rare case where an educated schizophrenic had access to bound calf skin, creating a book with their own invented language and theories?
"Yoshi brings the gas station to your gift recipient, refueling their car regularly wherever it's parked. Any commuters on your list will thank you for removing the hassle of the gas station from their lives forever."
I get it, filling up your car is a chore, if your time is super valuable... whatever. It's hard to fill the YC portfolio every year with only companies working on "big problems", I'm sure. But it really does feel like "Valley bullshit". I hope it was pitched as "disrupting the archaic gasoline distribution system - we're going to do to fossil fuels what Amazon did for books & movies".
(I will have a good laugh if this dismissive comment is pulled up years from now as an example of "another negative Hacker News post about a now-hugely successful company")
That was actually one of the few services which looked interesting to me. $20 to save at least 40 minutes a month and they also regularly check your tires. Has anyone here used it?
Ironically the most obvious pivot for the company is anti-EV range anxiety-as-a-service where they'll do something like triple A specifically for EVs by rolling up in a truck with a 500 HP giant diesel generator and fast charge your EV anywhere in a service area, eliminating range anxiety.
Honestly you could probably run something like that without any capital expense at all by just collecting monthly premiums and advertising "$1000 if we can't charge your EV in an hour" and then never paying out due to fine print or paying out $1000 in service gift certificates. If you sell enough plans then you could consider maybe building the truck for real.
I wonder what a 500 HP generator at full battery charging blast sounds like in a residential neighborhood at 2am. Probably similar to a freight train. That alone might be entertaining.
> Honestly you could probably run something like that without any capital expense at all by just collecting monthly premiums and advertising "$1000 if we can't charge your EV in an hour" and then never paying out due to fine print or paying out $1000 in service gift certificates.
That's one of the most succinct examples of a certain patently unethical SV style way of thinking about business I've ever seen. Perhaps Parker Conrad's got the bandwidth to be a cofounder.
I mean, I know it was posted tongue in cheek, but taking money from people and then leaving them stranded is, you know, wrong.
Well, that's exactly what I thought when I read about that service. Since I drive a Leaf, a gas fill-up would be useless to me.
Many EV owners would object to having their car being charged by a dirty diesel generator. Plus, if we are hauling a giant generator, what about a giant battery pack? Someone will have to do the math on that.
As well as a "rescue" vehicle, it could be very useful as a temporary "mobile quick charger" when traveling to underserved spots (say, you want to cross Nevada on EV). Schedule a time and place, meet your "tanker", refuel and keep going.
> I wonder what a 500 HP generator at full battery charging blast sounds like in a residential neighborhood at 2am.
I think you had a good idea with the on-demand EV charging, but I would imagine they'd have a truck with a high-capacity battery (like Tesla's Powerwall) which could be charged via solar panels.
Billings is actually one of the more diverse towns in Montana (which isn't saying much) due to how close the Crow and Northern Cheyenne Indian Reservations are. 4.4% Native American according to Wikipedia. But I guess that's not part of the image this marketing team wanted to project...
After living in Montana for almost 10 years, this video is kind of funny. It's like an ad for all of the things that _other_ Montana towns like Bozeman and Missoula are famous for!
Granted Billings is obviously changing (for better or worse), but it's known for it's industrial plants, not it's bike trails. I will say the "rimrock" above town is lovely and unique (and it's home to one of the most challenging disc golf courses in the country!) but in terms of trails and other recreational development Bozeman and Missoula are years ahead in development.
Billings actually does have some diversity due to it's close proximity to the Crow Reservation (4.4% Native American), but that fact is just as absent as the 3 oil refineries in this cheery white-washing promo video.
As a side note: it's incredible how many breweries and distilleries are springing up across the country - even in Billings! I love beer, but it's kind of overwhelming.
Responding to messages can also just be very difficult and time consuming. Maybe you ask concise, clear, pertinent messages to your doctor (or think you do!), but most do not. It's similar to problems HN readers might be more familiar with: user-created support tickets, and comment moderation. Medical office staff help with this triage and moderation, but it has become a big problem to manage with how easy it now is for bored/sick/scared patients to send messages.