Usually there's one or two job responsibilities among many, that you can do, but not the way everyone else does them. The ADA requires employers to make reasonable accommodations, and some employers don't want to.

So less, the job requires you to stand all day, and more, once a week or so they ask you make a binder of materials, and the hole puncher they want you to use dislocates your hands (true story). Or, it's a desk job, but you can't get from your desk to the bathroom in your wheelchair unless they widen the aisles between desks (hypothetical).

Very large employers don't have a group rate. The insurance company administers the plan on behalf of the company according to pre-agreed rules, then the company covers all costs according to the employee health situation.

Read your policy!

I believe existing laws carve out exceptions for medical fitness for certain positions for this very reason. If I may, stepping back for a second: the reason privacy laws exist, is to protect people from bad behavior from employers, health insurance, etc.

If we circumvent those privacy laws, through user licenses, or new technology - we are removing the protections of normal citizens. Therefore, the bad behavior which we already decided as a society to ban can now be perpetrated again, with perhaps a fresh new word for it to dodge said old laws.

If I understand your comment, you are essentially wondering why those old laws existed in the first place. I would suggest racism or other systemic issues, and differences in insurance premiums, are more than enough to justify the existence of privacy laws. Take a normal office job as an example over a manual labor intensive job. No reason at all that health conditions should impact that. The idea of not being hired because I have a young child, or a health condition, that would raise the group rate from the insurer passing the cost to my employer (which would be in their best interest to do) is a terrible thought. And it happened before, and we banned that practice (or did our best to do so).

All this to say, I believe HIPAA helps people, and if ChatGPT is being used to partially or fully facilitate medical decision making, they should be bound under strict laws preventing the release of that data regardless of their existing user agreements.

> And if it's insurance, there's a group rate.

Insurers derive rates for each employer from each employer's costs where laws allow this. And many employers self fund medical insurance.

It doesn't though. As an aside, I have been using a competitor to chatgpt health (nori) for a while now, and I have been getting an extreme amount of targeted ads about HRV and other metrics that the app consumes. I have been collecting health metrics through wearables for years, so there has been no change in my own search patterns or beliefs about my health. I just thought ai + health data was cool.

Do you have any proof they don't? Do you have any proof the "AI System" that they use to filter out candidates doesn't "accidentally" access data ? Are you willing to bet that Google, OpenAI, Anthropic, Meta, won't sell access to that information?

Also, in some cases: they absolutely do. Try to get hired in Palantir and see how much they know about your browsing history. Anything related to national security or requiring clearances has you investigated.

Probably not directly, that would be too vulnerable. But they could hire a background check company, that could pay a data aggregator to check if you searched for some forbidden words, and then feed the results into a threat model...

No they do not.

Anyone who has worked in hiring for any big company knows how much goes into ensuring hiring processes don't accidentally touch anything that could be construed as illegal discrimination. Employees are trained, policies and procedures are documented, and anyone who even accidentally says or does anything that comes too close to possibly running afoul of hiring laws will find themselves involved with HR.

The idea that these same companies also have a group of people buying private search information or ChatGPT conversations for individual applicants from somewhere (which nobody can link to) and then secretly making hiring decisions based on what they find is silly.

The arguments come with the usual array of conspiracy theory defenses, like the "How can you prove it's not happening" or the claims that it's well documented that it's happening but nobody can link to that documentation.

I'm kind of amazed that so many people in this comment section believe their Google searches and ChatGPT conversations are being sold and used.

Under this conspiracy theory they'd have to be available for sale somewhere, right? Yet no journalist has ever picked up the story? Nobody has ever come out and whistleblown that their company was buying Google searches and denying applicants for searching for naughty words?

Not yet. But Google itself would ask you for your resume if you happened to search for a lot of things related to programming.

Health is imaginary, life is imaginary, this is all imaginary. There’s no point in drawing an arbitrary line in the sand for what our purpose is or lecturing us on what we should be focusing on.

We have seen, again and again, business encroach on our quality of life and it does warrant skepticism and alertness about their motivations.

In some respects, the ideal world is one in which everyone’s premiums are tied to a free and easy Apple Watch-like device that silently tracks exercise, blood sugar at a frequency that can tell when you ate a big dessert, air quality (and the presence of smoke or pollution), blood alcohol content, whether you are in speeding cars, whether you are participating in dangerous sports, etc. Such a system would directly confront individuals with the cost of their behaviors in an economic way, probably leading many or even most people to improve their habits in the aggregate.

But such a system comes at other costs that most people intuitively feel infringes on core values they have.

Edit to add: this system would actually have some great advantages over an “existing conditions” tax in that now you pay low rates until you have diabetes, all during the time you are leading the unhealthy lifestyle. But once you have it you are not rewarded for starting to exercise and eat healthy and get it under control. In the hypothetical scenario above, you’d be punished economically during the period you were building bad habits and you would be able to restore sane costs after course correction

It also fails to take into account the fact that eating clean and exercising daily doesn't eliminate your risk of getting cancer at age 40 or having your car's brakes fail randomly.

Is the obvious retort to this:

I don't think we should play arbiter for who has and hasn't lived a healthy enough life to still believe they should get healthcare?

The entire purpose of health insurance is spreading risk across a wide and diverse risk pool.

> why should I also be subsidizing Billy "video-games-are-my-exercise" fatass's chronic health conditions?"

Nobody is asking you to: enrolling in insurance is a choice in the USA.

Also, replace "chronic health conditions" with "unavoidable inherited genetic risk factors". We don't want Billy to be screwed for life just because he was born to a suboptimal combination of parents.

> "If I focused on my health, ate clean and exercised daily, why should I also be subsidizing Billy "video-games-are-my-exercise" fatass's chronic health conditions?"

Then why are you not asking your insurer why they cover a lot less preventative health or other options. For example, Kaiser flat out refuses to prescribe GLP-1s for weight loss, others insurers are the same with gym subsidies or not covering nutritionists.

But they'll happily pay for your gastric bypass.

There are plenty of health insurers that are not publicly traded, and in fact are non profit, and yet they have the same premiums as the publicly traded ones. See Kaiser, Providence, Cambia, Regence, and the dozens of other BCBS affiliated plans.

If your claims were true, then the publicly traded businesses would have no customers.

> Insurance premiums have only gone up as far as I can remember, though there's a ton of variables at play here.

An interesting thing about rising health costs is that it has happened at roughly similar rates in most first world countries for the last 50+ years.

For example in 1990 the UK, FR, and US were paying 2.0, 2.2, and 2.6 times their 1980 costs per capita. By 2000 that was 4.1, 4.1, and 4.2. By 2018 (the last year I had data for when I calculated this a few years ago) it was 10.6, 7.5, and 10.2.

Here's the 2000 to 2018 increase for those and some others: DE, FR, CA, IT, JP, UK, US were 2.1, 1.8, 2.0, 1.7, 2.6, 2.6, 2.3.

When politicians in the US talk about rising health care costs they usually put the blame on recent policies from opposing politicians. That so many first world countries with so many different health care systems all have seen similar increases for the last 50+ years suggests that it is due to something they all have in common and that government policy doesn't affect it much.

The individual mandate part of the ACA was the part designed to reduce premiums. You need healthy participants in any health insurance scheme to subsidize unhealthy people.

That was eliminated by a Republican bill, the Tax Cuts and Jobs Act of 2017.

In 2010, it was already known the proportion of old to young was increasing, and the proportion of doctors was decreasing.

Prices were always going to increase.

Aetna has their own scumminess. Want the convenience of 90 day refills? Have to use their mail order service. They'll refuse to authorize >30 day supplies of medication through any other pharmacy.

> The insurance business in general is very competitive and not very profitable...

Knowing several Americans, and how much they pay for health insurance (and are still required to pay for some things "out of pocket"), this is incredible to me. And that's before you even get to the process of making a claim.

Such a broken system.

The ACA doesn't prevent some magical fairy-dust AI from pricing premiums, though, which is currently all the rage amongst insurers. (Not because AI will be accurate or anything, but because it offers a completely opaque pricing process.)

I was criticizing the rhetoric, not the sentiment. I’m skeptical of an argument when it flies too close to what I associate with irrationality and pseudoscience, especially considering what’s happened in medicine over the past 5 years.

The “myth [of] perfect attention and treatment” is an easy strawman for grifters and conmen to take advantage of: see RFK Jr.

How do you measure productivity? Profit per employee has never been higher, probably, as PE and other rent-seeking leeches (residency caps) have wrapped their fingers around the throat of the industry.

Positive outcomes per patient is probably also higher, due to research and technology advances. So many lives saved that would have been written off just a decade or two ago (e.g. spina bifida).

But I agree with you that there’s a hypothetical universe where seeking healthcare as an American doesn’t suck, I just don’t know if “productive” is the right word to describe it.

Agreed, I described it elsewhere in this thread as K-shaped outcomes.

> They are held less accountable compared to other professions.

I have no idea what other professions you’re talking about. Doctors are the only professionals where it’s common for multi million dollar judgements to be awarded against individuals. In may cases, judgements larger than their malpractice insurance limits.

Take a doctor working alone overnight in the ER. They are responsible for every single thing that happens. One of the 4 NPs that they are supposed to have time to supervise while they are stuck sedating a kid for ortho to work on makes a mistake—the doctor is the one that’s getting sued. A nurse misinterprets an order and gives too much of something, doctor is getting sued. Doesn’t matter if it’s their fault or not. Literally ever single one of the dozens of patients that comes in with a runny nose or a tummy ache, or a headache is their responsibility and could cost them their house. And there are far too many patients for them to actually supervise fully. They have to trust and delegate, but in practice they are still 100% on the hook for mistakes. For accepting this responsibility they might get $10 per NP patient that they supervise.

Healthcare professionals also occasionally face criminal prosecution for mistakes at a level that wouldn’t even be me a career in other professions.

> Lawsuits against medical professionals are difficult in many cases impossible for the average person to win

Malpractice attorneys operate on contingency, so they’re more accessible to the average person than most kinds of attorneys. It’s one of the many reasons healthcare is so expensive in the US.

It’s harder for a doctor to get fired for saying showing up late to work than it is for a cook at McDonald’s I guess, but compared to other professionals? I’ve seen software engineers regularly skip through companies leaving disasters in their wake for their entire careers. MBAs regularly destroy companies, lawyers and finance bros get away with murder, and police officers literally get away with murder.

The only profession that faces anywhere near the accountability that doctors do that I can think of might be civil engineers.

They do. To the point where I'm getting absolutely furious at work at the number of times shit's gotten fucked up and when I ask about how it went wrong the response starts with "ChatGPT said"

Do you double check every fact or are you relying on yourself being an expert on the topics you ask an llm? If you are an expert on a topic you probably aren't asking ab llm anyhow.

It reminds me of someone who reads a newspaper article about a topic they know and say its most incorrect but then reading the rest of the paper and accepting those articles as fact.

I have them make up stuff constantly for smaller rust libraries that are newish or dont get a lot of use.

"Often" is relative but they do give false information. Perhaps of greater concern is their confirmation bias.

That being said, I do agree with your general point. These tools are useful for exploring topics and answers, we just need to stay realistic about the current accuracy and bias (eager to agree).

I just asked chatGPT.

"do llms give wrong information often?"

"Yes. Large language models produce incorrect information at a non-trivial rate, and the rate is highly task-dependent."

But wait, it could be lying and they actually don't give false information often! But if that were the case, it would then verify they give false information at a non trivial rate because I don't ask it that much stuff.