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Comment: Re:Backfire (Score 2) 105

by shilly (#47382863) Attached to: London Regulator Says Uber Is Operating Legally

On the other hand, cabbies are known to sometimes be complete and utter shits, and there's virtually no comeback.

Failing to stop for fares is a common one.
Spouting off vile opinions.
Driving like a twat.
Driving people the long way round to make extra cash
etc

Uber doesn't eliminate all this, but it certainly does make it much more difficult for a driver to take the piss, given that the journey details are recorded, including passenger and driver details.

Cabbies are their own worst enemy, I'm afraid.

Comment: Re:Can an "atheist company" refuse too? (Score 1) 1314

by shilly (#47382343) Attached to: U.S. Supreme Court Upholds Religious Objections To Contraception

Now you're sounding like an ideologue, in that you prefer to stick to your convictions despite the clear evidence about what constitutes good value care.

There is excellent and comprehensive evidence that routine and chronic care reduces overall costs by cutting the frequency of acute exacerbations. That is why having good primary care has been a cornerstone of good health practice around the world. There are companies whose business model is predicated on the active management of patients with chronic conditions to keep them well and out of hospital - like ChenMed. Easy access to strong primary care has been the saving grace of several national health systems. Honestly, you are dead flat 100% wrong to assert the contrary on this.

Simple maths explains why this is the way it is: a typical visit to a PCP might cost about $100; a diabetic foot amputation costs maybe $40k. So even a weekly PCP visit is worthwhile if it avoids the costs of an amputation. If consumers had to pay 100% out-of-pocket for routine care, there would be a material decrease in the numbers receiving routine care from a PCP for their diabetes, which would lead to an upsurge in more acute exacerbations, which would cost more money as well as causing a lot more harm.

Comment: Re:Can an "atheist company" refuse too? (Score 1) 1314

by shilly (#47377325) Attached to: U.S. Supreme Court Upholds Religious Objections To Contraception

If you make routine and chronic care FFS, then you discourage uptake of preventive treatments and cause more expense further down the line. You also widen health inequalities, as rich folks can afford the co-pay but poor folks struggle and put it off and thus suffer worse health later on. Plus, you stifle innovation by paying for specific activities, which may otherwise have fallen away as new more efficient or effective activities are invented. That's why the UK introduced capitated payments for primary care a couple of decades ago.

Best solutions are probably the kind of episode-bundling and population health payments that Arkansas is experimenting with. They're not perfect, but they introduce value as a concept and align incentives more effectively than many current systems.
See this for more: http://www.mckinsey.com/insigh...

Comment: Re:Let them drink! (Score 1) 532

by shilly (#47359271) Attached to: NYC Loses Appeal To Ban Large Sugary Drinks

Agreed. But it doesn't seem to contradict what I'm saying, it simply suggests some rules about implementation:
- regulating tends to be more effective and less harmful than outright banning
- bans tend to be more effective when aimed at providers rather than consumers
- legislation needs to fit broadly with the trends of the times. If you push too hard against the current, you create terrible problems.

My objection was to the blanket statement. I wasn't claiming a blanket statement in the other direction, nor suggesting it was easy to get things right.

Comment: Re:Companies don't pay for healthcare, workers do (Score 1) 1314

by shilly (#47359211) Attached to: U.S. Supreme Court Upholds Religious Objections To Contraception

But you seemed to be arguing with several of your questions that the employer should have some say in what the insurance covers because they've gone to some time and trouble to set it up. And my counterpoint was, maybe they should have some say, but (1) they shouldn't have unlimited say and (2) it doesn't seem to me that they should get the say because they write the checks, and that the time and effort it takes them is not a sufficient reason. Then the questions become, what is the distinction between "some say" and "unlimited say", and "on which side of the line would these contraceptives fall?"

I agree with you that "no say" is an untenable argument. I also agree with those who say "all this demonstrates that employers ought to be incentivised to move away from offering this benefit".

Comment: Re:Gee Catholic judges (Score 1) 1314

by shilly (#47359155) Attached to: U.S. Supreme Court Upholds Religious Objections To Contraception

You don't have control over the absurdity of the entire debate, but you do have control over the absurdity of your contributions. I think the debate at hand ought not to be about "should governments override religious beliefs to deliver contraception" but instead "what obligations should an employer be required to assume by virtue of being an employer, and how does this balance against their rights?"

 

Comment: Re:Let them drink! (Score 1) 532

by shilly (#47358865) Attached to: NYC Loses Appeal To Ban Large Sugary Drinks

By partisan, I mean arguing in favour of a cause.

"Using laws to change social norms is stupid, because it doesn't work without having serious negative consequences which outweigh any possible good results."

The cause you are arguing for here is some version of libertarianism. You are saying that government ought not to legislate to change social norms. You advance an argument that to do so is ineffective in all circumstances. Because you do not allow for any circumstances in which such legislation could work, your statement can reasonably be characterised as partisan and non-pragmatic. You can choose to take issue with some of that if you wish, but it does seem like a perfectly reasonable interpretation of what you wrote, even if it goes against the way you like to think of yourself, as some uber-rational and even-handed individual.

Your response to my mentioning DUIs shows that *you* have missed the point. At the time DUI laws were introduced, there was a social norm that said "it's perfectly fine to drive home after having had a beer or two". Such attitudes still exist in some places, such as parts of the British countryside. The laws were introduced to shift social attitudes. The reason legislators wanted those attitudes to shift was, as you say, because drinking causes a clear and present danger. But to be blind to the fact that the laws were introduced in the teeth of opposition claiming this was Nanny Statism and saying that attempts to shift social norms should be resisted is, well, silly. (On clear and present danger, smoking laws are contested precisely because this isn't the case, but they remain attempts to legislate to change social norms" and they have been pretty successful and the benefits in my view clearly outweigh the harms.)

I say again: it is perfectly reasonable for a government to introduce a law to shift a social norm, and it is possible to do so in a way that results in more benefit than harm. There are many examples of where this has happened.

Comment: Re:Companies don't pay for healthcare, workers do (Score 1) 1314

by shilly (#47358709) Attached to: U.S. Supreme Court Upholds Religious Objections To Contraception

I'm not sure why any of your questions really matter. Employers provide buildings in which their employees work, as well. The fact that they provide those buildings, sign leases, negotiate rentals, install aircon, and undertake a huge range of other tasks, some quite onerous, in order to provide the workplace does not give them a free pass over all aspects of those buildings. Instead, the government requires the buildings to be safe and healthy workplace environments and has laws in place to make that happen.

"A mind is a terrible thing to have leaking out your ears." -- The League of Sadistic Telepaths

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