MurphyA/hacker-news huggingface dataset:
Ask HN: Almost a thousand dollars for a 20 minute new patient visit?
by throwaway052501 | 2025-05-23 22:17:54+00:00
I live in the Bay Area and have a high-deductible health plan. Recently, my primary care doctor left UCSF to become a concierge physician — tired of the bureaucracy and low pay despite managing thousands of patients annually.

I booked a new-patient visit with a UCSF physician. The appointment lasted about 20 minutes. A few weeks later, I got the bill: $867. I assumed it was a mistake, but after calling, I learned this was the correct charge for CPT code 99204 (new patient visit, 45–59 minutes). Insurance won’t cover it due to my deductible.

This feels absurd. I get that healthcare is broken, especially in tech-heavy cities like SF, but $867 for a routine visit is hard to justify.

Is anyone working on viable alternatives? Concierge models? Subscription care? Could this be a startup opportunity or is regulation the only fix? Curious how others are navigating this and whether there's a scalable path forward.
by lucataco | 2025-05-23 22:18:51+00:00
Ever wanted a custom AI image generator but don’t have a supercomputer or ML team? Fast Flux Trainer (on Replicate) lets you train a bespoke image model in minutes by just uploading a few pictures and a keyword. It uses a clever approach with beefy GPUs behind the scenes to turn 20+ minutes of training into ~2 minutes

The result: you get your own tailored model (e.g. a specific art style, or a product/object concept) for about the price of a coffee, with almost zero setup. This is huge for indie devs and startup founders – it cuts the complexity of fine-tuning advanced models down to a simple web form

In short, Fast Flux Trainer makes “AI fine-tuning” as easy as using an API, so more people can experiment and build cool things with custom AI without being ML experts
by fullStackOasis | 2025-05-23 22:20:07+00:00
> hope you don't need to see a doctor for anything serious, or go to a dentist for that mater.

That's the first thing I thought about.

His budget of $432/mo doesn't include health insurance. But $5K/y probably gets him Medicaid eligibility. Let's assume he's on Medicaid, then. In NY state, that covers quite a lot of dental care, if you believe this: https://www.health.ny.gov/health_care/medicaid/program/denta... Not saying it's a good option, but it's there.

> Taking the bus that goes 3 times a day is one thing, needing to move stuff is another thing.

What kind of things do you think he might be moving? He probably has just about no possessions with that budget (and a 600 sq ft house). In a pinch, perhaps he can rent a truck from Home Depot. Apparently, there is a Home Depot in Massena, NY, so maybe it's not quite so far out in the boonies as it seems.

Personally, I wouldn't do it - the lack of choice would get very unpleasant very fast. But it could work for some.
by dzaima | 2025-05-23 22:20:48+00:00
rr does support multithreaded and multi-process applications, via, like Undo[1], allowing only a single thread to run at a time. (edit note - that's only about multithreading; Undo might have parallel multi-process recording)

[1]: https://undo.io/resources/undo-performance-benchmarks/ - "Undo serializes their execution"
by victorNicollet | 2025-05-23 22:22:35+00:00
The atmosphere is estimated to have ~830PgC worth of CO₂, and plants are estimated to photosynthesize ~120PgC worth of CO₂ every year, so a given molecule would have 14% chance to be broken down in a year. The probability to survive for 2000 years would be around 1e-60.

Of course, CO₂ contents of the atmosphere have varied over the last 2000 years, and not all CO₂ is produced into or consumed from the atmosphere (it can be dissolved in surface water, etc).

EDIT: since there's much more O₂ than CO₂ in the atmosphere, a given O₂ molecule has a 8% chance to not be broken down by respiration over 2000 years.
by godelski | 2025-05-23 22:22:40+00:00
(Karpathy's might be more a call back to Halevy, Norvig, and Pereira's "The Unreasonable Effectiveness of Data"[0].)

But I think is a good example that fits the OP's critique (I don't think the critique fits to the arXiv paper. Even though I expected the main results, see my main comment).

The "unreasonableness" in Karpathy's post[1] is using sequencing to process non-sequential data. But the reason this isn't unreasonable is that we explicitly expect non-sequential processes to be able to be reformulated as sequential ones.

The SVHN (hose numbers) he shows is actually a great example of this. We humans don't process that all at once. Our eyes similarly dart around, even if very fast. Or we might think about how to draw a picture. We don't do everything at once, but we work in sections, building up, and have layers that end up being ordered even though this technically isn't a requirement. I'm actually struggling to think of things that cannot be broken down into sequences. He says as much here

| an important point to realize is that even if your inputs/outputs are fixed vectors, it is still possible to use this powerful formalism to process them in a sequential manner.

So really the question is: what part of this was unreasonable? Or what part was unexpected? Honestly, we should be expecting this as the nature of neural nets is itself sequential, data being processed layer by layer. Hell, every computer program has a trace, which is sequential. I can give tons of examples. So it is quite reasonable that sequential processing should work.

[0] https://static.googleusercontent.com/media/research.google.c...

[1] https://karpathy.github.io/2015/05/21/rnn-effectiveness/
by btilly | 2025-05-23 22:22:56+00:00
I found https://x.com/gm8xx8/status/1925768687618773079 to be a little more understandable summary of what was actually shown.

Any Diophantine equation can be reduced to one of at most 11 variables and degree at most around 10^63. No algorithm can decide solvability in rational numbers for this class of Diophantine equations.
by turtleyacht | 2025-05-23 22:23:15+00:00
Filtering AI crawlers at HTTP feels like high-level firewalls, a lot of redoing of the network stack.

Remember when Flash enabled interactive websites? You walk forward with W and peruse the headlines. Press E to grab the newspaper. Piece the tattered pages together. Seven coins for your proof of work.

Those coins are redeemable across certain other sites in a webring?

Although, sounds like a lot of work for a single visit, or onerous for repeat ones.
by Scramblejams | 2025-05-23 22:23:44+00:00
Such a fun topic. And then there are some things tunnels can't do, or can only do in the most limited form, like analyse post-stall behavior. You can't very well have your model tumbling free in your flow, it might crash and make a mess. (Well, there have been attempts, some of them successful, but also quite limited in their parameters.)

So you have to resort to a free flight model, scaled down to simulate the parameters required. There's a (fascinating, for those so inclined) treatise on it here[0].

[0] https://ntrs.nasa.gov/api/citations/20110012492/downloads/20...
by mimischi | 2025-05-23 22:24:12+00:00
Just that it’s all done from the comfort of the editor one knows and loves, with the same key binding and semantics that at there, whether you edit files in fired, write code, a commit message or an email.

Not to get too deep into this, but there’s this warm fuzzy feeling of not having to use /yet another different app/ that’s ever so slightly different to the optimal workflow you have otherwise
by tim333 | 2025-05-23 22:26:24+00:00
>It's also worth pointing out that Winger's (position) paper[0] is really about something that would sound silly today. He's arguing that we should use math to drive physics.

I think you misinterpret what it's about. He's pointing out how remarkable it is that the universe obeys laws like E=MC^2 exactly as far as we can tell which is not something you would probably expect just from looking at the world. The pre scientific understanding of the world was it was driven my gods and spirits. The mathematical laws were only discovered by scientific investigation.

Or as he puts it:

>The miracle of the appropriateness of the language of mathematics for the formulation of the laws of physics is a wonderful gift which we neither understand nor deserve.

If he was just saying use maths it would be boring and not a famous paper 65 years on.
by klabb3 | 2025-05-23 22:27:11+00:00
> "Data for me but not for thee"

Exactly. Consumer tech has been locking down APIs and actively working against interop since the advertising business model became dominant. Web 2.0 is the most obvious example, but there are plenty more.

Look, you don’t even own your own contacts on social media sites. If you access Google from an atypical browser you will get fingerprinted, captchad and rejected. Anti-scraping, anti fraud, paywalls, even lawsuits because you’re using ”our” APIs (see oracle).

It’s not the tech, it’s the business model. It’s adversarial, it’s a Mexican standoff. Doesn’t matter how good the MCP spec is, it’s not gonna go anywhere with consumer apps. As long as the economy is based on ads, your B2C company needs a sidebar to show ads (or in rare cases, subscriptions). You’re not gonna make money from providing a free API.
by II2II | 2025-05-23 22:29:01+00:00
Granted, this was 20 years ago, but I remember taking the Greyhound and people were getting on or off the bus in the middle of nowhere. By nowhere, I mean the nowhere in the literal sense: at the intersection of two highways in the northern Ontario with no other development in sight. Of course, they also serviced the other types of nowhere: the lone gas station or the tiny village.

The author is being somewhat misleading in the sense that this is not the type of bus service that one would use for your weekly commute to that 10 hour shift at the gas station, never mind the three or four times per week that you would need to cover the bills. It may be fine doing errands in town, where the arrival time and departure time don't much matter. It may also be fine for spending a day or two in the city, assuming you have the budget to stay over night.

I'm not saying that the type of lifestyle alluded to is impossible, but it is not going to be the type of lifestyle accessible to young people. Then there is the question about whether they are equipped to live that type of lifestyle.
by lwansbrough | 2025-05-23 22:29:49+00:00
In the 4th paragraph the author suggests that the economic backbone of the country - young people - simply desert economic centres of growth and prosperity and to instead assume a life of poverty in a rural teardown. A life substantially worse than their parents live, simply because their parents don’t want more homes near their own home.

I didn’t bother to check if the article gets any more serious from there.
by thomastjeffery | 2025-05-23 22:30:25+00:00
That sounds to me more like evidence that an LLM is never reasoning at all, even when it looks like it is.

The mock conversation that is written between think tags is not a conversation. It's the collection of tokens that are most likely to be written after a prompt to a model that was trained on example conversations.

Why is that different? In a real conversation, participants use logic to choose what is worth saying next. The next statement is already determined in the speaker's mind to be logically sound. In a mock conversation (the LLM's CoT), there is no logic. The next statement is only determined to be statistically familiar, then written immediately.

The end result of a desirable CoT interaction is text that would have been written by a thoughtful/logical conversationalist. Whether or not the mock conversation itself is logically consistent with the mock conclusion is irrelevant, because the LLM is only concerned with how familiar that mock conclusion is to the prompt, its mock conversation, and its training.

The overall vibe of how something is written behaves as a replacement for actual logic. Logical deduction is replaced with measures of confidence, conversations turns, etc. in writing style. It all works out in the end, because we are so consistent with the style in which we write real logical deductions, we have ended up providing an invisible semantics for the LLM to follow.

There is something meaningful that we are entirely blind to. Unfortunately, it doesn't follow rules the way logic does, so it's not a trustworthy replacement. Fortunately, it's useful for more general exploration.
by godelski | 2025-05-23 22:31:13+00:00
It's not "unreasonable" if you weren't anthropomorphizing COT, equating it to thinking or "internal dialogue." The results aren't surprising to people in this camp, but I also wouldn't say that makes the work less impactful.

But it would also be more unreasonable to dismiss the fact that a significant portion of the research community (and even greater portion of the public) was operating under these beliefs: that COT was akin to thinking (it's literally there in the name...). It is possible to disagree with something but also not believe someone is being unreasonable by coming to different conclusions.
by timewizard | 2025-05-23 22:31:52+00:00
The tables should be better ordered. "speakers" is obviously the primary table here and should be top left. The "session_speakers" should be between it and the table it maps "sessions." Then "reviews" and "events" on the bottom. There's an obvious "top end" and "bottom end" of this structure that this graph completely gets wrong.

You could argue that "events" are primary in which case just switch the order of that and "speakers."

I'd color the table headers differently and different from each other and have the arrows leaving that box match the color of the box it's leaving. Also drop "public:". It's expected and default so it does not need to be displayed here.

Drop the key icon and just make the key fields in bold or with a different style.

Don't make me hunt around to match information and don't be afraid to use differential styling.
by canadiantim | 2025-05-23 22:32:04+00:00
Actually Trump wanting to absorb Canada puts Alberta in a great position.

Canadians like to argue that no province can secede from Canada because it would be illegal but the reality is that if a referendum showed 50%+ of people in Alberta supported independence then the US would support Alberta and that’s the only thing that matters. A lot of Canadian press is wilfully ignorant of that fact.
by GuB-42 | 2025-05-23 22:32:16+00:00
Another "fun fact" somewhat more relevant to the article is the gradient (aka. grad, or gon), it is a unit of angle equal to 1/400 of a turn, slightly smaller than a degree.

It goes well with the metre because 1 km is 1/100 grad of latitude on earth. It mirrors the nautical mile in that 1 nautical mile is 1/60 degree (1 arcminute) of latitude on earth.

The grad is almost never used on a day to day basis, even in France. It is still used in specialized fields, like surveying.
by OutOfHere | 2025-05-23 22:33:30+00:00
The way they usually get a job is by first getting higher education in the US, so lying on the resume of any experience abroad doesn't really factor in. The job is mainly on the basis of the domestic education, not the foreign experience. Foreign work experience alone doesn't carry much if any weight for getting employment in the US.

The US is supposed to be a free country without any protected class either way. In the same way that I wouldn't support a protected class for descendants of slavery, I wouldn't for any settlers either.

The hardship faced by immigrants now have to do with with the stability of their visa, which is something that settlers never had to put up with. It is not a joke to be chronically stressed by whether one is at risk of losing one's legal status, also waiting for years for their paperwork to process. These are stresses that people like you and I never experienced first-hand.

I believe in merit-based employment and in training of citizens, without favoritism of any kind. As for work visas, I have already noted that they should be limited to those with a PhD (except for farm labor), and this will eliminate much of job-related concerns that people like you and I might have. Taking extremist ring-wing positions is not only unnecessary, but it opens the door down the road to someone eventually classifying you as not being sufficiently righteous.

Note also that one benefit that citizens already have over visa workers is that citizens have more possibilities for entrepreneurial activities without being encumbered by work restrictions.
by spookie | 2025-05-23 22:33:46+00:00
Well, with packages you want various filtering steps to happen before they make it into users' systems. Or layers of security that make it harder for a system to be compromised.

Let's take a look at the xz incident, then at how fast rolling release distros get their packages in. That's part of the equation. Bottom line is: you're the first line of defense against potential malicious supply chain attacks. This is why Fedora is Red Hat's testing distro, why Debian has an unstable branch or why openSUSE Tumbleweed exists. Now, Arch isn't just a "testing distro", but it is, by design, more susceptible to these attacks. Thinking bleeding edge is more secure is a fallacy. It is but a consequence of assuming the source maintainers are on your side, which is usually the case, but not always. Or, assuming software is properly tested for bugs every release. If you are still doubting this, look at npm.

Furthermore, have you ever asked why you need to constantly update package signing keys? There is no central build server for Arch. Maintainers are building packages in whatever machine they are on, signing with whatever keys they have there and uploading the binary blobs. This isn't trustworthy. There is now a clean chroot process and all, but still, maintainers are still able to build the packages in their machine and upload it.

The other problem is not having any mandatory access control security policy by default (SELinux, AppArmor, etc...). You can, of course, install your own and go through the trouble of actually creating the security profiles yourself for the various packages on the system. This is in stark contrast with other distros, where not only they provide a security policy by default but their packages also ship with security profiles when needed to make sure it actually works (Fedora and openSUSE come to mind).

Finally, the AUR is cool and all, but my god are you at the mercy of whatever is put on there. Sure the PKGBUILD is super legible, but are you really checking where things are being pulled from? There is a layer of filtering being taken away here, you are the one doing your due diligence.

Now I'm sure different people have different takes on this, some might say that security policies are dumb and useless, others might prefer to be in the bleeding edge assuming the latest and greatest is safer. But take all the layers I have mentioned here, and how their non-existence on Arch could affect security. I hope to have drawn a clearer picture.

(Edit: I must say, I like Arch, I've used it a lot and when in a pinch is my go to. But I've come to appreciate how other distros approach security, and how they layer the process so they have more time to assess vulnerabilities. It is a balancing game, and I hope Arch improves on their processes, I really do.)
by tomcar288 | 2025-05-23 22:34:53+00:00
you could get a wood burning stove heater. as long as you have enough trees to be sustainable, burning firewood is a great way to go. and with the clean burning filters they have now a days, you'll much much better off than from the days when they used to burn fires inside a house with no container/stove/filters or even a chiminey at all! (just a hole in the roof if you were lucky.)
by fullStackOasis | 2025-05-23 22:34:58+00:00
I think most of your points are fair ones. I also feel that it's rather cynical to drop out of the "rat race" by relying on the participation of lots of other people to pay for your Medicaid expense and so on. However, on average, there are just so few people doing this type of thing that I don't think we have to worry about free riders damaging the system. Most people who complain about the rat race aren't willing to take the extreme steps that this guy is suggesting in order to get out of it.

> The budget didn't include mortgage/housing cost

True, but I don't think you can get a mortgage for a $29K house. I'm guessing the guy is saving up for his house by sticking in the rat race until he's got his $29K saved up (presumably made easier with his wife?). Then, he shops around for a house on a bus route. I suspect it is possible, especially in a state like NY.

> if the author of this article gets cancer I bet they'll want to visit a hospital where doctors are working 12 hour shifts grinding out the era of "overabundance."

This is one point where I disagree. I'd really rather that doctors were working shorter hours. I don't want someone taking care of me if they're at the end of a 12 hour shift. Forget about the fact that it's so bad for her, it's also bad for me and the level of care that I get.

> Water is $0? Even well water requires some level of upkeep

Oh yeah, we just paid $800 to replace our pressure tank. His roof will need to be replaced one day, the gutters will leak, etc.

I actually think I detect a bit of tongue-in-cheek in the article. I think this guy will do this for a while, enjoy his adventure, and then go do something else.
by schoen | 2025-05-23 22:36:07+00:00
Yes, we actually considered the "have the protocol transmit all of the required math values in a decent form and get an x.509 cert back" version, but some people who were interested in using Let's Encrypt were apparently very keen on being able to use an existing external CSR. So that became mandatory in order not to have two totally separate code paths for X.509-based requests and non-X.509-based requests.

An argument for this is that it makes it theoretically possible for devices that have no knowledge of anything about PKI since the year 2000, and/or no additional programmability, to use Let's Encrypt certs (obtained on their behalf by an external client application). I have, in fact, subsequently gotten something like that to work as a consultant.
by teleforce | 2025-05-23 22:36:13+00:00
Thanks for the info although I was around during the released of µTorrent and one of its early users, I didn't know Ludvig Strigeus was instrumental in the Spotify early days.

Apparently he also the original author of OpenTDD and ScummVM, and it seems that he's the legit Carmack 2.0 [1].

[1] Ludvig Strigeus:

https://en.wikipedia.org/wiki/Ludvig_Strigeus
by throw0101b | 2025-05-23 22:36:22+00:00
> Some people don't want to be forced to run a bunch of stuff they don't understand on the server, and I agree with them.

There are a number of shell-based ACME clients whose prerequisites are: OpenSSL and cURL. You're probably already relying on OpenSSL and cURL for a bunch of things already.

If you can read shell code you can step through the logic and understand what they're doing. Some of them (e.g., acme.sh) often run as a service user (e.g., default install from FreeBSD ports) so the code runs unprivileged: just add a sudo (or doas) config to allow it to restart Apache/nginx.