- Politics at work were becoming a huge problem at 37Signals
- They asked that politics be kept out of company chats, but encouraged people to be political active on non-work channels/social media/etc even during work hours
- People lost their minds at this incredibly reasonable request which then blew up on the internet
- They offered any employee 6 months severance if they weren't comfortable with the new policy. About 1/3 of the company took it.
- Rails Conf dis-invited the creator of Rails
- Obviously, this was not going to sit well as people were trying to create a very public political flex against DHH and at that point, he started getting much more vocal about the problem of politics sweeping into every aspect of life.
In the following years...
- DHH becomes very publicly outspoken against politics infecting everything
- 37 Signals publishes another successful book
- Ships much more quickly as all of the people constantly distracted by politics at work are no longer in the building
- Starts the Rails World conference to great success
- Rails Conf shuts down
- DHH ships Omarchy which is getting significant support
So the end result has been that a bunch of people tried to essentially "cancel" DHH and the result was him having virtually non-stop, resounding success while publicly speaking out against those who created the problem in the first place...because some people really do just want to build cool things regardless of your politics.
But the raw numbers like $200k for this poor gentleman’s heart attack or $500k aren’t the most alarming. It’s the Terry-Gilliam-level of absurdity of the billing process. Absolutely no one will tell you how much things are, and when you ask, they sass you that it is a ridiculous question. Even though one of my providers just recently started offering estimates, those are off by 100-200% , and completely missing for about half of what has been ordered.
We are both very strong accountants, and despite trying to do audits of these services, it’s impossible. There are 3-4 levels of referred services, bundled codes, nested codes, complication / technical / professional codes , exceptional status codes . Providers overbill, double bill. On accident and on purpose. When we call to get it corrected there is no way to make corrections.
You’ll be asked to take a diagnostic not knowing whether it will cost $10 or $15000 . Even if you try to be responsible and call the provider (who isn’t your doctor, clinic, or hospital ) – they won’t be able to tell you.
The point I’m trying to make isn’t to make you sympathetic. It’s to reinforce in all of the great technical minds here that healthcare billing is the most complicated spaghetti code cluster flock of a system that you’ve ever imagined. It’s far worse than any piece of software you’ve ever seen. And we all just accept the bills and pay them.
Supply and demand and finding a better vendor doesn’t work. There are some rare exceptions like elective MRIs – but those aren’t the norm. Nearly every service is something time sensitive or your disease will get significantly worse. Moreover, signing up a new provider has $1000+ in billing and a few hours in paperwork to make the transfer. is it worth saving $500 for one MRI when $250k worth of services are unaccountable?
The only thing I’m sure of is that there has to be tremendous amounts of incidental and deliberate corruption . Auditing a single patient’s billing is impossible – so a population’s worth is a goldmine .
America has doubled down on middlemen controlling the prices of medical care and making sure that there is no set price for anything. With the ACA effectively falling apart in the new budget, we do have a chance to move to a different reality, one where medicare prices are the set prices for everything, but that is nearly a political impossibility given the amount that these middlemen spend in keeping politicians who support that from winning primaries. Instead, we are stuck in a situation where companies get to dictate prices and access to care while we get diminishing returns in health quality and longevity.