Long wall of text incoming, but please read if you want to know why drug pricing works like it does:
It’s because of the way insurance works in the US. Insurance companies have formularies, which are essentially menus of what products they cover. They also will label certain medications as “preferred” and actively steer consumers to them. Pharma companies fight to get preferred coverage from insurers.
Because of this, pharmaceutical companies go through complex negotiations with insurance companies. In theory, this is to get pharma companies to compete on price and offer discounts (called “rebates”). An industry of middlemen called pharmacy benefit managers (PBMs) has arisen who negotiate with pharma companies on behalf of the insurers and create the formularies. The problem is, these guys take a percentage cut of the discount they secure for the insurers. This creates a perverse incentive to give preferred status to more expensive drugs. Take this hypothetical example of two competing drugs:
- Drug A costs $150, but gets negotiated down to $100
- Drug B costs $200, but gets negotiated down to $100
- The PBM gets a fee of 10% of the secured discount, meaning they make twice as much for creating a formulary with B rather than A
To no one’s surprise, drug B gets given preferred status over A.
Pharma companies figured this out a long time ago, and began to jack up their prices each year, only to immediately negotiate them back down to where they were previously, in the form of rebates, because this increased the likelihood of getting out ahead on the formulary by the PBM. The best example of this might be insulin, which has skyrocketed in list price, but profit for the insulin companies has actually remained much more stable. This is because each year the sticker price is raised, and then immediately slashed in the “negotiations” with the insurers.
After a while, the pure sticker shock began causing a lot of justified outrage among patients and the public. Pharma companies saw they were taking the blame for skyrocketing prices even though at the end of the day they were negotiating these prices down and weren’t actually making that money due to rebates. So they began to offer alternatives for customers not on insurance, in the form of “coupons”, “savings cards”, etc. These often get you prices close to what the actual cost of the medicine is before the “jack up the price then rebate it down” dog and pony show. But insurers/PBMs reacted poorly to these, and began punishing pharma companies through the formularies. This is why these have become shadowy “backdoor” programs.
It’s also important to note that the PBM’s aren’t even independent middlemen. 80% of the PBM industry is dominated by 3 companies, all of whom are owned by insurers: Express Scripts (Cigna), CVS Caremark (CVS/Aetna), and OptumRx (UnitedHealthcare)
So why even go through all this?
- Pharma companies don’t really have a choice, they have to to get on the formulary
- PBMs make their money entirely through this scheme
- Costs for insurers aren’t ultimately changing much from year to year. However, higher sticker prices means the public is ever more dependent on insurance for medical bills. It also provide justification for increasing premiums more than their costs might otherwise. And pharma ultimately takes the brunt of the blame.
Lastly, if you are wondering why this doesn’t exist in other countries, it’s an unsurprising reason: government subsidized health insurance. Unlike insurers and PBMs, there are no perverse incentives or profit motive, so cheaper prices are an actual benefit. Medicare/medicaid doesn’t have to go through these shenanigans, but they aren’t available widely in the US. You don’t even need healthcare for all. You just need a public healthcare option for everyone. That introduces an actor whose motives actually align with consumers, invalidates this entire charade, and forces insurers and PBMs to actually compete on merit and price.
TLDR: The lack of public healthcare options in the US has created an insurance cartel that has both consumers and pharmaceutical companies by the balls.
Imagine we want to know the ratio of men to women in a particular population. We could count all men and women one by one, but it would take too long, so instead we take a random sample and count the men and women in the sample, and from that we infer the quantity that we want to know. This is statistical inference.
In Bayesian inference, the population ratio is seen as a quantity that can take different values each with a associated probability (i.e. a random variable), and the result of Bayesian inference is an estimate of the probability distribution of the population parameter, in this case the population ratio. Now, in reality the population ratio is a concrete number, say 9-to-10, meaning that there are 9 men for every 10 women in the population. But Bayesians don't care. They'll tell you that the population ratio is a random variable which can take many values, and that the probability that it is equal to 9-to-10 is whatever number between 0 and 100%.
This is nonsense because the population ratio is NOT a random variable. People don't come in and out of existence randomly, right? In a way, they're saying there are infinitely many possible universes, each with a different population ratio, and then they come up with an estimate of the probability that the universe in which the ratio is 9-to-10 has whatever probability of occurring. This is absolutely BIZARRE. (I hope you agree). And it's wrong because it's impossible to know how likely one universe is compared to all other possible universes, since we live in our universe and this is all we can hope to observe.
So? It would apply to sex chromosomes and only sex chromosomes, which is just one observed sex characteristic.
We are talking about sexual dimorphism and secondary sex characteristics.
Humans were understood to be sexually dimorphic before we discovered sex chromosomes in 1905, and we usually label our babies with a biological sex without the aid of consumer genetic testing.
I don’t believe it is an enterprise feature. I did some testing on Bifrost just last month on a free open source instance and was able to set up virtual keys.
The exact opposite is true. Virtually everyone’s intuition is aligned with the Bayesian model. That intuition has to be hammered out of people in their stats classes because for decades frequentist approaches were computationally more feasible, even if they don’t align with how most humans interpret probability.
That's a fair challenge. My operational perspective is heavily anchored by the systems we run. From an engineering leadership standpoint, our entire observability stack-SLAs, p99 latencies, error budgets-is fundamentally frequentist. The cognitive shift I'm highlighting isn't purely mathematical; it's getting an on-call engineer to reason in distributions of confidence rather than binary threshold alerts. When a distributed system is degrading, the 'hammered-in' frequentist threshold is often the fastest path to mitigation.
I live in an area that has been declared among the safest in America. Two months ago a 17 year old girl from our city disappeared. Turns out she had been being groomed for a year over Discord and in Roblox by a 39 year old the next state over. He eventually convinced her to let him pick her up, after which he filmed himself having sex with her, killed her, and then dismembered her body. He apparently was grooming other underaged girls in a similar way as well.
The digital age presents with it novel forms of danger for children, and for adults for that matter, and there is absolutely no way to effectively address these risks without some amount of reduction in privacy. And before someone inevitably says “where were the parents?” and wash their hands of the situation, a healthy society should care for and protect all children, especially those whose parents do not.
It’s one thing to hold the opinion “I am willing to sacrifice some number of lives, in order to preserve privacy”. That is an honest and potentially justifiable opinion someone may hold. But declaring the situation to simply be a facade to harvest people’s data seems to me like a reflexive response to avoid uncomfortable truths regarding the situation.
If the government knew every single user on the internet's name, address, phone number and what they had for breakfast, it would not stop monsters like this, or even slow them down.
> But declaring the situation to simply be a facade to harvest people’s data seems to me like a reflexive response to avoid uncomfortable truths regarding the situation.
Well, your example wouldn't be solved by age verification in any way. They could still legally access Roblox or a discord private chat (or even another private chat method) after this law.
So the example show how it is about irrational fear and not protection in any way.
And this is an tragic edge case, if you want to take this kind of edge case in consideration, you also have to take in consideration what the age verification would imply as tragic edge case.
I'm here wondering why it would make a difference whether the girl is under 18 or not. You could argue that the criminal has to cover up his crime by getting rid of the evidence (murder) because the girl wasn't 18 yet and therefore it makes sense to stop under 18 year old girls from using the platform because they are living evidence, but it actually sounds more like a problem caused by the law itself.
After all, dating apps are an even more extreme version of this. If you're attractive enough, you get to have many one night stands and many murder opportunities.
Okay but going off the details you provided this would've also happened if she were 18+? If not via Discord or Roblox, they'd find some other avenue to groom people, lure them in and kill them. 16 might not be an adult, but at least where I come from it's not exactly a child either.
There's always a chance of horrible shit happening, but we shouldn't put every single person under a microscope to ensure the one in a million doesn't occur.
There will always be weird tail risks. The law should only get involved where there are widespread systemic problems.
People are occasionally hospitalized due to self, family, or friends handling food improperly. That doesn't warrant a legal intervention whereas dining establishments do.
> before someone inevitably says “where were the parents?” and wash their hands of the situation
Nope, that's exactly what I say. The law cannot reasonably replace responsible parenting if society is to remain a pleasant place to live.
Many of us are pretty damn okay at beating back the flame and controlling the flow of the worst of things away from homes, but nobody is perfect.
We don't expect every family and parent in these areas to have fire fighting skills, self evacuation is recommended.
Parents every where now find themselves surrounded by the delibrately laid gasoline of addictive social media and grooming risks et al. and it's infeasible to expect every parent be skilled in defensive cyber secuirty.
It's reasonable to expect communities to want simple barriers and means of protection, the existance of reasonable control and throttling options for parents.
I agree with that however I'm puzzled by your comment because in the context that you're responding to I don't think I said anything that would imply otherwise. Being particularly skilled in "defensive cyber security" isn't a requirement to avoid grooming of your child in the general case - some combination of communication, supervision, and filtering is.
> It's reasonable to expect communities to want simple barriers and means of protection, the existance of reasonable control and throttling options for parents.
I agree 100%! However ID verification is not a reasonable (or even particularly effective) solution to that. I apologize if I've misconstrued your intended meaning but given the broader context that's what it seems like you're implying.
Realistically there's no way to prevent grooming other than keeping tabs on your child. The least labor intensive (but also most intrusive) way to do that is probably whitelist parental controls and watching for unauthorized devices. It is not even remotely realistic to expect a communication platform to detect that a child is speaking with an adult they don't know (as opposed to one they do) and also that it isn't a benign interaction (such as a gaming group or etc) and then somehow act on that information (how?) without manufacturing an absurd dystopia in the process.
When it comes to filtering I think it would be reasonable to impose a standard self categorization protocol on all website operators. That would make non-whitelist filtering much more reliable (a boon to parents, educators, and employers) without negatively impacting privacy or personal freedoms.
* there are very few urban population clump on the planet that don't face the threat of child grooming and exploitation, both before and after the digital device explosion.
* that threat vector significantly increased and morphed with the spread of personal digital devices for children; the threat comes no longer from potentially any personal with contact in real life, it has now expanded to include potentially the entire digital world and now can be automated via groomGPT
* A simple "where were the parents" response on a per parent basis is unfair in the sense that spotting grooming in a digital device world is a difficult challenge .. even a simple constrained playground with stock babytalk language construction can be socially backdoored (See: "I want to stick my long-necked Giraffe up your fluffy white bunny" )
* Concerned parents will look for solutions, communities, at local, state, and federal levels should devote resources to providing solutions in informed contexts and graduated levels.
* Unaware parents will exist, and will likely dominate the demographics, or not?
* Is the correct _default_ social policy here (answer varies by country and culture) to shield the less cyber aware from the worst of the worst with filters ... that the better informed can bypass or deselect?
I guess where we diverge on PoV is where the perimeter of swiss cheese protection should extend to.
Still none of that necessitates the type of mandatory partial-ID verification being pushed by these laws.
Roblox can straightforwardly require ID verification on their own, of both the parent responsible for the account, as well as the children directly (request documentation from their school, birth certificate, etc. Yes, high touch to verify these documents. But we're talking protecting children here, right?)
If anything this type of legislation is about absolving them of the responsibility of doing so!. Imagine a company making their offering "for adults only", with de facto kid usage as parents relent and just let their kid use an older age on the computer.
I'm sure the same government that held the Epstein class responsible will get right on to making sure his proteges are brought to justice, we just need to give up more freedoms first.
You are not making a good faith argument when you refute this person by saying this “doesn’t fit your narrative” two comments removed from you telling another person that you have no interest in their statistics because of how you feel.
Idk, I’m in the minority here it seems, but Claude Code has been working pretty well for me. Honestly, it puts out code that is at least as solid as a lot of my coworkers, and in many cases it’s better.
Poor in the US and around the world often don’t have access to the healthcare they need. If you get cancer, are you turning down chemotherapy so you don’t seem soft? Are you turning down your next raise because some teacher somewhere is getting underpaid?
If you want substantive rebuttals you should make a substantive argument first.
It’s the exact opposite, managers are employed to make employees job easier. Employees get the jobs done, managers are there to coordinate that work, remove blockers, and enable workers.
The relationship is reciprocal. I lay the tracks so my supervisees can do their job (and, indeed, have a job to do!). They help me produce far more work for clients than I ever could myself.
It’s because of the way insurance works in the US. Insurance companies have formularies, which are essentially menus of what products they cover. They also will label certain medications as “preferred” and actively steer consumers to them. Pharma companies fight to get preferred coverage from insurers.
Because of this, pharmaceutical companies go through complex negotiations with insurance companies. In theory, this is to get pharma companies to compete on price and offer discounts (called “rebates”). An industry of middlemen called pharmacy benefit managers (PBMs) has arisen who negotiate with pharma companies on behalf of the insurers and create the formularies. The problem is, these guys take a percentage cut of the discount they secure for the insurers. This creates a perverse incentive to give preferred status to more expensive drugs. Take this hypothetical example of two competing drugs:
- Drug A costs $150, but gets negotiated down to $100 - Drug B costs $200, but gets negotiated down to $100 - The PBM gets a fee of 10% of the secured discount, meaning they make twice as much for creating a formulary with B rather than A
To no one’s surprise, drug B gets given preferred status over A.
Pharma companies figured this out a long time ago, and began to jack up their prices each year, only to immediately negotiate them back down to where they were previously, in the form of rebates, because this increased the likelihood of getting out ahead on the formulary by the PBM. The best example of this might be insulin, which has skyrocketed in list price, but profit for the insulin companies has actually remained much more stable. This is because each year the sticker price is raised, and then immediately slashed in the “negotiations” with the insurers.
After a while, the pure sticker shock began causing a lot of justified outrage among patients and the public. Pharma companies saw they were taking the blame for skyrocketing prices even though at the end of the day they were negotiating these prices down and weren’t actually making that money due to rebates. So they began to offer alternatives for customers not on insurance, in the form of “coupons”, “savings cards”, etc. These often get you prices close to what the actual cost of the medicine is before the “jack up the price then rebate it down” dog and pony show. But insurers/PBMs reacted poorly to these, and began punishing pharma companies through the formularies. This is why these have become shadowy “backdoor” programs.
It’s also important to note that the PBM’s aren’t even independent middlemen. 80% of the PBM industry is dominated by 3 companies, all of whom are owned by insurers: Express Scripts (Cigna), CVS Caremark (CVS/Aetna), and OptumRx (UnitedHealthcare)
So why even go through all this?
- Pharma companies don’t really have a choice, they have to to get on the formulary
- PBMs make their money entirely through this scheme
- Costs for insurers aren’t ultimately changing much from year to year. However, higher sticker prices means the public is ever more dependent on insurance for medical bills. It also provide justification for increasing premiums more than their costs might otherwise. And pharma ultimately takes the brunt of the blame.
Lastly, if you are wondering why this doesn’t exist in other countries, it’s an unsurprising reason: government subsidized health insurance. Unlike insurers and PBMs, there are no perverse incentives or profit motive, so cheaper prices are an actual benefit. Medicare/medicaid doesn’t have to go through these shenanigans, but they aren’t available widely in the US. You don’t even need healthcare for all. You just need a public healthcare option for everyone. That introduces an actor whose motives actually align with consumers, invalidates this entire charade, and forces insurers and PBMs to actually compete on merit and price.
TLDR: The lack of public healthcare options in the US has created an insurance cartel that has both consumers and pharmaceutical companies by the balls.
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