The important takeaway from this is that “supplements” have 0 oversight. The CBD, probiotics, vitamin d, etc that you buy could just be capsules of vegetable oil that does nothing at all. Or they could be asbestos and cyanide for all you know (that probably would lead to an investigation though). There’s also no safety regarding packing and handling, so it might literally be a guy with unwashed hands who just picked his butt loading your gelcaps in a dirty bathroom that someone just took a massive shit in. No one checks and verifies any of this and that’s why shills and hucksters jump onto this shit, it’s a completely unregulated market where can cut corners everywhere and say whatever you want as long as you include *not intended to treat any diseases and not evaluated by the fda

A $1200 thing you buy on instagram that sends “good waves” to your brain? Supplement. The cbd you buy at the gas station? Supplement. Doterra oils? Supplement. No regulation, no oversight, just robbing people based on their desperation to fix chronic pain and mental illness

Bleed in my ass

those bass drum hertas tho

Then if you’ve met your deductible the big question is if you have a coinsurance after the deductible is met and an out of pocket maximum.

If your coinsurance is 60% or 80% or whatever, you won’t be responsible for the full bill but only that percentage of it.

If you have no coinsurance (a no charge after deductible plan) the service should be covered 100%

If you have coinsurance you should have an out of pocket max, which once hit should end the coinsurance and make services covered 100%. OOP max is typically quite a bit higher than deductible, sometimes 5-7x as much, but not always. It’s plan specific.

If your employer pays 50% that is an arrangement they have worked out and the specifics will be tied to your companies contract. This could mean they would pay 50% of any bill (unlikely as this is not a fixed cost they can plan for. Maybe if you’re like a ceo or some shit) or it could mean that up to your deductible they’ll pay 50%.

Also keep in mind even if you’re in a “covered 100%” scenario there are some instances in which you would still get billed:

Differential vs contracted rates - if the hospital charges $5000 for your procedure but your insurance only pays $4600 the hospital can sometimes bill you for the difference. This is not always the case; some contracts require the servicer (doctor) to accept the contracted rates and not charge more. Most common reason you’d get a bill in the above 100% scenarios and also the reason the math might not work out in coinsurance scenarios. Eg in the above surgery example your bill would probably be $1320. It should be 920 as that is 20% of the $4600 paid, or even $1000 as that is 20% of the 5k billed, but you pay the 920 as 20% of what your insurance paid plus the $400 difference, so $1320

Out of network providers - these can often have a separate deductible and sometimes in hospitals a provider can be out of network even though the hospital itself is in network

Non covered services - if the procedure involves a service that isn’t covered (uncommon)

Billing errors: if a bill looks wrong contest it and if your insurance isn’t reimbursing providers properly complain to them. Sometimes a medical office gets your info wrong and assumes your deductible or coinsurance is active when it shouldn’t be. Sometimes your insurance makes similar mistakes.

one of the most frustrating aspects of being a therapist in america in the past 10 years is the hand waving of the ethics involved in the financial renumeration of our relationship with those we serve

I would say a significant stressor for the overwhelming majority of the clients I have is financial woes. And because the system is backwards, those with high paying jobs well into their career tend to have the fancy PPO plans with no deductible where seeing me (or anyone) is only $10 despite the fact that they could much more easily afford a 5-10k deductible. Meanwhile the people who are making 20-50k a year on the other end of the spectrum almost always have those high deductible plans with sometimes massive deductibles and rarely have employer funded hsa.

I’m not an idiot, I run my own practice and I do the books for it. I can do the math to figure out how much take home pay someone has with those salaries. I can also conceptualize the cost of housing, food, phone, transportation, etc because I am also paying these things. So when I meet someone here and their appointments are $140 per meeting I am in a tough spot. I am asking them to take on a burden of $560 per month (assuming weekly sessions). That’s immense. And if the deductible is 5k, 7.5k, 10k, it will take ages to meet especially if they’re younger and not really making contact with many other medical providers.

I am contractually obligated to charge what your insurance pays me in these instances. If your insurance pays me $140 for the hour I have to charge you that until you hit the deductible. I could be dropped from the network if I modify this for you and get caught.

I can ask you to skip using your insurance and charge a lower out of pocket rate but this is complex. For one, many therapists can’t adjust their rate much lower. I have flexibility here because my practice is entirely telehealth so my overheads are much lower. But if you see them in an office? They are paying about 40-50% of that just in rent most places.

Additionally even with telehealth I have to be careful with adjusting rates. Insurance only pays me for specific timed and coded sessions. If you and I have a phone call for 25 minutes? Not covered. If you ask me to collaborate with your psychiatrist and I talk to them for 40 minutes? Not covered. The time I spend dealing with billing and this system, which works out to an average of 20-30 minutes per session? Not covered. So the 25% of my week doing billing shit and the overtime hours doing phone check ins, case collabs, etc. has to be covered by that.

This is why many therapists give fee schedules and charge you for all of these things. If you want paperwork from them it’s $1 a page, phone calls are $75/hr, etc. I can make it work without this because I’m not paying for office space but if I was I would need to do this to keep myself afloat.

This is also part of why many, many therapists simply don’t take insurance anymore. Just pay me the $140 directly. I can collect it via square or whatever and your billing is done. I no longer spend 5-10 hours a week on billing nonsense like fighting retracted payments, finding out why claims were denied, etc. You can submit receipts for out of network reimbursement and you deal with them.

I understand why my peers do what they do. But ethically it’s a mess. I signed up to help people and what I have become is a gigantic cash sink that puts a tremendous amount of pressure on the people I serve and is counterproductive to our work.

At the same time I deserve a fair salary for my work and this is the only way to get it. And if I protest the system by leaving it because it’s so broken then the end result is that there’s 1 less mental health provider who takes insurance. If I stop taking insurance altogether I alienate a ton of people with high need who can’t afford to pay out of pocket forever and/or don’t know how to navigate out of network reimbursement.

I cannot tell you how many times I do a screening call with someone and they say “this sounds like what I need”, they tentatively schedule, and then once I run their insurance and give them the actual numbers of what treatment will cost they simply ghost. It is a system that actively deters people from seeking assistance because it is so cost prohibitive

And the insurance lobby has its fingers so deep into the framework of america that this will simply never be fixed. It will only be changed. Look at Kamala Harris’ proposed Medicare for all: it still allows private plans. That will be a movement in the right direction because it will end the idea of someone being “uninsured”, which is great, but it will also create a two lane system in which many practitioners will do whatever they can to avoid taking basic Medicare patients in favor of the commercial plans. Commercial plans, at least in my area, simply pay more. Significantly more. Like $80/hr vs $140/hr. And in the end I will have the same problems because the unnecessarily complex private insurance system will still exist and be very powerful. I will just have one more insurer to add to the web of complexity. But no politician will ever remove the private health insurance industry. To do so would alleviate so much spending waste, so many wasted administrative dollars and man hours, but it would also result in layoffs of hundreds of thousands, if not millions, of americans whose jobs rely on processing the complex bullshit of this system

your scenario is either worded incorrectly or very atypical (which is very possible, there are a lot of different insurance plans in the us

typically high deductible plans work in a way of “meet your deductible and then we cover x% after that”

eg I am a therapist, I bill your insurance $100 for an hour session. You have a $1000 deductible with 80% coinsurance.

Our first 10 sessions will cost you $100 out of pocket, which goes to me directly. I submit billing for these sessions but get no reimbursement from the insurer because you have already paid the full amount. However, my submission of billing indicates to the insurer that you paid $100 for a medical service on whatever date for whatever diagnosis.

After the $1000 deductible is met your insurance splits the bill with you 80/20. Now you pay me $20 per meeting and when I submit the billing the insurance (hopefully) pays the other $80 to give me the $100 per meeting I am owed.

This of course assumes no other medical spending goes on for the duration, otherwise you would hit your deductible faster. If you saw me 3x and then had a surgery that cost $5,000, you’d pay $700 for the surgery to settle your deductible plus an additional $860 (20% of the remaining $4300) and then sessions would be $20 under the 20% coinsurance.

You should also have an out of pocket max, this is kind of similar to a deductible but it is different. This is a tally of your total spending and once you hit it your coinsurance usually drops and you pay nothing.

Also important point is that deductibles reset every plan year. This should have been made abundantly clear to you but I still encounter many who do not know this

Additionally your insurance may have certain services covered that don’t cost you anything or where the deductible doesn’t apply (eg you’d only pay 20% even if it’s the first appointment of the year). Typically this is preventative care, things like physicals and vaccinations

That is the most typical. But like I said it there are many plans and variations. It’s possible you have a plan that prior to meeting the deductible you pay 50% of billing and then have a 0% coinsurance. This would be really great insurance.

It’s also possible that you have a benefits package from your employer that is basically paying 50% of your deductible in a roundabout way. this is far more commonly done by the employer funding an hsa/fsa account which would be a payment card that you use on medical spending and not the insurer. However, I have encountered plans where the hsa and insurance were rolled together and joint companies, where the hsa would pay all or part of billing prior to deductible on the patients behalf

Using the same examples above you’d pay me $50 until you met your deductible, then nothing once the deductible is met. If you had a $1000 deductible, saw me twice, then had the 5k surgery you’d pay me $100 and $900 for the surgery. If you have one of the situations where the employer is covering 50% of the deductible it would be the same but the surgery would be $400 because ultimately you’re only paying $500 of the $1000 deductible and your employer is covering the other half. This is not a situation I’ve ever encountered

Another important point is that deductible status is dependent on your providers doing timely billing and your insurance processing said billing in a timely manner as well. This does not always happen. As a result you may meet your deductible but my billing verification shows that is not the case. The examples I used above were clean and easy but it’s never that simple. Most people have a deductible around $2500 (and many 2-4x this) and see several different healthcare services.

I submit my billing at the end of each day but some places are sloppy and will take weeks to submit. This can lead to situations where you are charged money because I was under the impression you had a deductible but you should not have been. Eventually the insurer will pay me once things sort out. If I am good at record keeping (I am great at it for this reason) I will catch the double payment and send you a refund. This is why it is important for you to keep track of deductibles and medical spending. Not all offices are managed well. I’ve personally had money stolen from me (because this is literally fraud, to not refund the double payment) and I don’t believe it was ever intentional, just offices with shitty management. Let your providers know if you’ve met your deductible. I will always hold off on charging you if you tell me this, submit billing, and see what the insurance reimburses. If they reimburse me in full then you were right. If they don’t I send you a bill and if that is incorrect you need to call your insurance to complain

You should be able to track deductible and out of pocket spending on your insurances consumer portal (eg go to Aetna.com or whatever and click “for subscribers” and make an account, if you haven’t already). This should also give you an explanation of plan details.

Most importantly you should be able to call the office of the place (or billing dept if it’s a larger health network) doing the procedure to have their office manager check what you will be expected to pay for the procedure both at time of service and expected cost total. This takes only a minute but be forewarned it is essentially an estimate and not a guarantee. Billing can change last minute depending on how the procedure goes (eg added complexity allowing them to add another cpt code for something)

There’s a lot more to it than this unfortunately. Some plans have tiered deductibles, sometimes a staff member in a hospital isn’t personally enrolled and then are considered “out of network”, which is a whole other thing, sometimes you are still responsible for a certain services that the provider requires but the insurance refuses to pay. That last point especially: every time you establish with a medical office or get a procedure you sign something that says you are financially responsible for services not covered by insurance (I guarantee this, every time). So if you get bloodwork with like 30 tests and 2 aren’t covered even if you’ve met your out of pocket max and have the best insurance in the world you’re getting a bill (and potentially a hefty one, some blood tests are extremely expensive)

Sorry this is very long and complex but that is kind of how insurance is? To boil it down to a “eli5” 2-3 sentence explanation would either require your specific plan information in much more detail or to overgeneralize and potentially mislead you.

Also nontraditional warfare that has technically been seen but not really (at least in an officially acknowledged way, maybe something like stuxnet?) like offensive cyber warfare. If things truly came to trading blows russia does have very talented cyber espionage folks and the us has shown many times that it has pretty shocking vulnerabilities on many critical points of cyber infrastructure. these probably haven’t been attacked because it would be a literal act of war to go after the power grid, weapons systems, water delivery systems, etc but if the gloves come off then you better believe these systems start getting attacked by state sponsored actors who will never come anywhere near american land

Put a rubber band between screwdriver and screw, otherwise the other things already stated like CA glue, filing a flathead groove, or drilling the cap off

in the future use the appropriate sized driver and retire drivers when they become stripped

they’re almost all owned by the same parent network (iheartmedia, which was clearchannel) so it’s stupid easy to coordinate

They retired, though

Watch it happen and complain after the fact based on historical precedent. Perhaps they will later appeal to the judicial system that will not care because trump spent his term fairly efficiently jamming it full of shit. Then instead of escalating the issue they will just let it go, because “decorum”

but my (not really my) conspiracy theory for this is the opposite of open source: when someone is good at cracking games companies like denuvo track them down and offer them jobs to harden their product and take another cracker out of the scene. like I bet denuvo is just filled with nerds that spent their teenage years in sketchy irc rooms with handles like -DooMSlAyEr- and used to actually be members of razor1911 before they realized they could get game companies to pay them 200k a year

She is kind of a shithead tbf and fwiw it’s more like she’s the only person who is willing to do it. granted cracking denuvo is something that is extremely difficult and only a small subset of people can do but it’s not like she’s literally the only person on the planet who can. There was that guy who would just release the yearly update of football manager, for one.

It’s far more likely the people who have that skill set just don’t really want to bother with cracking videogames and the potential legal issues that come with distributing them online.

Technically this is necessarily true, for any licensed psychiatrist or psychologist in the USA at least practicing under the scope of the APA ethical framework

The interesting piece is why

In 1964 when Barry Goldwater was running for president a piece was run on him that polled a number of psychiatrists regarding whether he was fit to be president. He was compared to dictators by many of the respondents and described with very unflattering language. He successfully sued the magazine that ran the article, Fact, for the modern equivalent of about $630,000.

In response the APA created the guideline (section 7) which states the need to contribute to improvement of community and betterment of public health. Specifically section 7.3 considers commentary on public figures:

On occasion psychiatrists are asked for an opinion about an individual who is in the light of public attention or who has disclosed information about himself/herself through public media. In such circumstances, a psychiatrist may share with the public his or her expertise about psychiatric issues in general. However, it is unethical for a psychiatrist to offer a professional opinion unless he or she has conducted an examination and has been granted proper authorization for such a statement.

Thus, commentary by psychologists and psychiatrists on political candidates and such is generally not okay. Debate on this specific issue was widely renewed over the past 8 years, for obvious reasons

The interesting part is the debate is changed, quite a bit, in the modern era. In goldwaters day there was a more valid argument that his public persona and personal self were very distinct. But now you have trump, who lived on twitter for years and shit out every thought he had relatively unfiltered. Is that the same? Not at all, but at the same time from a clinical perspective it’s still a public persona trump puts forward and not necessarily indicative of who the man actually is

but the other side of the debate is the freedom of speech issue. this becomes interesting in the trump era because new issues become relevant. In the goldwater era the issues were primarily about if the guy was a fucking monster, basically. But now we also have concerns about cognitive capacity. Barry goldwater was 55 when he that article came out. Trump is 78. There are cognitive decline issues that can be observed from video that while not definitive are at least huge red flags for further screening and warning that this man shouldn’t be put in charge of the United States for the next four fucking years as he continues to decline, because unfortunately age and time do not reverse.

Essentially one can argue it is my opinion that trump is a sociopathic narcissist, for example, because I have not met him and cannot actually say for certain that these views are truly his or if this is just pomp that he is using to curry political favor. As such I should not use my licensure and standing to harm his because I cannot be sure that it’s not just an act. But on the other hand I can be pretty sure that I am seeing an increase in repetition in phrases, decreased vocabulary, flight of ideas, tangential speech, and most worrying is a few instances of word salad. I cannot publicly comment on this, ethically.

Biden had similar issues to be fair but he stepped down, thankfully. Biden is also harder to evaluate because he had a known history of speech issues.

The Goldwater rule is not inherently bad though. It’s actually a good rule. It’s a good reminder that we don’t know the person behind the tv. But on the other hand one could argue evaluating the presented persona is still somewhat valid. If John q president comes in to run in 2028 and puts forth a persona of being a total jackass Warhawk narcissist but it turns out they’re a total soft hearted lovable guy in their personal life, does that matter if they run shit like a total jackass Warhawk narcissist? Does it even stop being true if they actually act that way? Etc.

I don’t know specifically for that state but in many states legal and medicinal weed has been overtaken by a few companies that are quickly buying each other up and rapidly expanding into other states as quickly as they can. in true American fashion the minute weed is legalized nationally we will essentially have the groundwork laid for giant weed conglomerates, the weed equivalent of walmart. keeping prices as high as possible, lowering product quality, and making the experience worse overall. I wouldn’t be surprised if they either were ready to expand into your state directly or had subsidiaries that would, probably lobbied hard to do so long before the law passed

when I was on the west coast a while back legal weed was cheap as fuck and great. dispensaries were all over and randomly named. I’m sure there was intense rivalries and people pushing to consolidate but you could get stuff dirt cheap that was great. nothing like what I’m seeing here on the east coast with companies like curaleaf, truelieve, etc that charge $40-60 for a gram for shit that’s just okay. I quit smoking a few years ago though, maybe it’s better now, but I doubt it

Other replies have given you good advice to use as a jumping off point but assuming you are taking data you find very meaningful (pictures and videos) and putting it on hardware you own there are two concepts you should familiarize yourself with asap before going too deep into purchasing stuff and building/installing

RAID: provides redundancy for when a drive inevitably fails. Will require multiple drives to create an array (the amount of drives depends on what kind of raid) but this helps you avoid downtime. Drives will fail, it happens.

Backup: provides resiliency for when your raid array entirely fails so your data isn’t completely destroyed. As you learn about and experiment with raid you may be lulled into a false sense of security, especially the first time you resliver a drive into the array. It’s honestly a bit like magic, you pull the dead/dying drive out and pop in a fresh drive, test it to make sure it’s good to go (not essential but good practice), and then after awhile it’s rebuilt from parity and your data is back. But this process is stressful on the drives and after years of running a home server I’ve finally had an occasion where reslivering caused an additional drive to fail.

Additionally all of the above is pointless in a disaster situation. If there’s some kind of extreme hardware failure that zaps all your drives at once, your house floods/burns down/etc, raid won’t help you obviously at all.

This is where backup gets annoying. If you have 4tb of data it’s pretty inexpensive to create a local backup, a 4-8tb external hard drive (or even larger) can be purchased or made for a couple hundred bucks. Sometimes you can get a refurb 18tb drive under $200 and slap it in a cheap external enclosure.

But offsite for that amount of data is costly and pulls you back into the amazon/google/apple/etc ecosystem, which if you’re anything like me you’re trying to get away from. Another option besides an external drive is a bluray burner and discs. They’re relatively cheap now. I have a different off site backup solution now that I was able to purchase property but the bluray thing was what I did prior to buying land. The downside is that backups were done at longer fixed intervals so there was a risk of losing ~3 months of data. I would burn them and then take them offsite, to a trusted location that I visited fairly regularly.

I wouldn’t say it’s common, that’s misleading. some people do it, probably, but I’ve lived in PA for 2 decades and have never met anyone who has claimed to do so nor have I seen any actual statistics on the matter

Civil matter, not criminal

Cloudflare has absolutely told websites to fuck off because they don’t like their content. They haven’t done it a ton of times but they absolutely have. No one cares because the sites they’ve done it to are toxic cesspool shitholes that, to be fair, the world is probably better off without. But each time it showed that cloudflare can simply wield its power if it feels like it.

If your site becomes controversial in the future and is protected/hosted by cloudflare don’t be surprised if they suddenly send a letter saying “fuck off”. They’ve become arbiters of internet censorship and we have accepted it because the daily stormer and kiwi farms and 8chan are bad.

The ridiculous part is all of those sites are still accessible; daily stormer and kiwi farms both still accessible from clearnet (iirc 8chan is tor only) so cloudflare dropping wasn’t even all that effective. Well funded hate speech found a way. But for the next ones that don’t have major alt right cash behind them to fund cloudflare alternatives they’ll just simply disappear. And then we will have the internet where corporations like cloudflare, who should absolutely be content agnostic, decide what we can and cannot see. You may think it’s fine right now because they’re doing it against websites that are admittedly gross and terrible, but what happens when they overstep and the line blurs?

They should act like a proper tier 1 provider: find evidence of crossing a legal threshold, get a court order, and terminate service if something that bad has occurred. Anything less and they suck it up and honor the contract they signed. They haven’t, so fuck cloudflare. The internet is an amazing place but it’s also a disgusting abhorrent cesspool. Don’t get involved in hosting it if you can’t deal with that.

Flac 44.1 16bit level 3. Host with something that meets your needs. I have my files in jellyfin and navidrome and can then access the library remotely either through jellyfin web client, navidrome web client, substreamer, Finamp, kodi, etc. but this way if another amazing format comes up down the line I will always have my library in a good state to transcode from. Tag and sort everything with beets.io (or musicbrainz picard is great, I just like that beets is cli). This results in a library I can access on my phone, laptop, tv, carplay, etc

Technically you could go for 24bit but imo the extra file size isn’t justified. though one could make that argument for flac vs 320cbr mp3, transcoding 320 mp3 is more likely to create artifacts, thus the reason for keeping around flac

Alac may be easier for you if you use mac

This is probably related to the neural systems for olfactory fatigue, eg why you stop noticing certain smells that are constantly present like your own body odor and the smell of your home/room

There’s a very good Wikipedia article that explains it much better than I can. But taste and smell are closely linked and the sensory systems become fatigued from overindulgence somewhat quickly. Conjecture but the massive amount of flavoring and sweetener in modern beverages is probably a factor in hastening this process