I have a nearly total opposite take. I can't tell you how many times I've read a book, a paper or something else and been confused by some ambiguity in the author's prose. Being able to drop the paper (or even the book!) into an LLM to dig into the precise meaning has been an unbelievable boost for me.
Now I can actually get beyond conceptual misunderstanding or even ignorance and get to practice, which is how skills actually develop, in a much more streamlined way.
The key is to use the tool with discipline, by going into it with a few inviolable rules. I have a couple in my list, now: embrace Popperian falsifiability; embrace Bertrand Russell's statement: “Everything is vague to a degree you do not realize till you have tried to make it precise.”
LLMs have become excellent teachers for me as a result.
By asking it to cite its sources. Whenever I use AI, I have it pull direct quotes from the text to justify its interpretation. Sometimes it's spot on, sometimes it's wrong. But skimming a paper to fact-check a few specific quotes is still vastly faster than reading a dense paper completely blind.
Right question to ask, however, good readers/professionals do have some sense for this and ability to dig further as needed. On the other hand, books and articles are often over-detailed, with the key stuff buried in the lede or even remaining tacit.
For me, LLMs have often pointed me to answers or given food for thought that even subject matter experts could not. I do not take those answers at face value, but the net result is still better than the search remaining open-ended.
Well how do you know anything in that case? You could be dreaming right now sound asleep, or you could be locked inside a mental institution but living in a complete delusion. You might have been in a coma for the past 7 years and AI was just something you dreamed up.
We actually don't disagree at all—you are perfectly illustrating my point.
Applying strict epistemic discipline (Popper, Russell) to resolve ambiguity and accelerate actual practice is the very definition of deep work. You aren't using AI as a shortcut to skip thinking; you're using it as a Socratic sparring partner to deepen it. This is exactly the paradigm shift I'm advocating for.
I’m strongly reminded of early google every time I use AI for research. I used to be able to know little about a topic, try to search on it and get shit results. But, google would give me pages of results. So I could skim a lot and eventually on page 10, I stumble across some term of art, and that term would greatly improve my search. Rinse and repeat, and I’d have a good sense about the topic I was interested in.
You can’t really do that with google anymore, and I can’t remember the last time I bothered to actually learn something that wasn’t trivial from google. ChatGPT, however, has been a game changer. I can ask a really dumb question and get some basic info about the thing I’m asking about, and while it’s often not quite what I’m looking for, it gives me clues to follow, and I can quickly zero in on what I’m looking for, often in new contexts.
As an autodidact who’s main motivation to go to college was to get access to the stacks and direct internet access, I can’t even begin to tell you how game changing LLMs seem to be for learning.
To your point though, my concern is we don’t know how to teach how to learn, and LLMs will likely seduce many into bad behavior and poor research hygiene. I treat my research the same way I attack the stacks, but take someone who’s never been to a research library and ask them to create a report on some topic, and just why? That is the basic resistance, why?, why do what an LLM is almost literally built to do. Yet that is also highly related to individual learning, to take a bunch of disperate sources and synthesize output related to the input.
I suspect we’ll learn how to use LLMs in the same way we learned how to use calculators. But I have no doubt that on average (or maybe median or mode?) calculators have made us less capable to do basic arithmetic, and I suspect LLMs will also cause a great percentage of the population to be worse at sythesizing information. I’d hope that it’s only the same people who would have otherwise only gotten their information from TV, but I do have a slight fear it will creep past that subsection of the population.
An LLM can't invent meaning in a text where there is none. It's equivalent to CSI's classic "zoom, enhance" on resolution limited photographs. You need to consider you're learning a load of rubbish from LLMs.
You know where LLMs boost me the most? When I need to integrate a bunch of systems together, each with their own sets of documentation. Instead of spending hours getting two or three systems to integrate with mine with the proper OAuth scopes or SAML and so on, an LLM can get me working integrations in a short time. None of that is ever going to be innovative; it's purely an exercise in perseverance as an engineer to read through the docs and make guesses about the missing gaps. LLMs are just better at that.
I spend the other time talking through my thoughts with AI, kind of like the proverbial rubber duck used for debugging, but it tends to give pretty thoughtful responses. In those cases, I'm writing less code but wanting to capture the invariants, expected failure modes and find leaky abstractions before they happen. Then I can write code or give it good instructions about what I want to see, and it makes it happen.
I'm honestly not sure how a non-practitioner could have these kinds of conversations beyond a certain level of complexity.
Every time I request the wrong OAuth scope that doesn't have the authorization to do what I need, then make a failing request, I hear Jim Gaffigan affecting a funny authoritative voice saying, "No." I can't be the only one who defensively requests too much authority beyond what I need with extra OAuth scopes, hoping one of them will give me the correct access. I've had much better luck with LLMs telling me exactly which scopes to select.
And the libraries provided by the various OAuth vendors are only adding fuel to the fire.
A while ago I spent some time debugging a superfluous redirect and the reason was that the library would always kick off with a "not authenticated" when it didn't find stored tokens, even if it was redirecting back after successful log in (as the tokens weren't stored yet).
oauth is the one area where I genuinely trust the LLM more than myself. not because it gets it right but because at least it reads all the docs instead of rage-quitting after the third wrong scope
Maybe you are already an expert in those so its fine. But for anybody else, using llms extensively would mean becoming way less proficient in those topics. Skip building some deeper senior knowledge and have a rather shallow knowledge. Anytime I grokked anything deeper like encryption, these saml/jwt auths, complex algorithms was only and unavoidably due to having to go deep with them.
Good for the company, not so much for the given engineer. But I get the motivation, we all are naturally lazy and normally avoid doing stuff if we can. Its just that there are also downsides, and they are for us, engineers.
The worst integration problems tend to be conceptual mismatches between the systems, where--even with the same names--they have different definitions and ideas of how things work.
That's a category of problem I wouldn't expect a text-based system to detect very well.. Though it might disguise the problem with a solution that seems to work until it blows up one day or people discover a lot of hard-to-fix data.
Well that's another use I have for LLMs: asking questions about these informational or architectural impedance mismatches. LLMs get it wrong sometimes, but with proper guidance (channel your inner Karl Popper), they can be quite helpful. But this doesn't really speed me up that much, though it makes me more confident that my deliverable is correct.
This is fundamental. Well, not really - a strategy SV tried to use is absolute market dominance to the point where you have to integrate with them. But in spaces where true interoperability is required, it's just philosophically hard. People don't mean the same thing.
Couldn’t agree more and especially when some docs are incorrect and AI is able to guesstimate the correction based on other implementations or parallel docs that it’s found. Goes from “Let me spend a few days scouring the internet and our internal repo to see if I can maybe find a workaround” to “This can definitely get done”.
Itops related work in general is so suitable for ai agents. Configuring clusters of barebone servers. I normaly spend days on configuring things like nfs, sysctls, firewalls, upgrades, disks, crons, monitoring etc. now it's hours max. I can literally ask it to ssh into 50 vps machines and perform all tasks I tell him to do.
MCP connects the LLM to the APIs, which can be consulted with "tool calls." I'm talking about integrating the software I produce (with LLM assistance) to APIs. Traditionally, this is a nightmare given poor documentation. LLMs have helped me cut through the noise.
I built an MCP server to speak WHOIS/RDAP so I could have Claude give me better domain name suggestions that weren't already taken. It can also be used in LLM-enabled applications (provided that the model is "tool calling" and that there's an orchestrator).
In principle, MCP servers can be created for just about any OAuth-protected API. However, you still need to create the server, and this is where the usage I'm talking about shines: when working on the MCP server, an LLM can be quite helpful in getting the right APIs integrated.
The same goes for other development that doesn't need an LLM context built-in. If I wanted to sync two calendars, for instance, I wouldn't build an MCP that speaks CalDav and Exchange and then let it loose (though this so-called agentic workflow is becoming more popular); I'd want to build software with an LLM's help that can speak both protocols by having it generate code to handle whatever OAuth tokens and scopes are necessary and then help me deploy the thing.
I see a lot of the comments operating from an empirical framing. This is valid analysis and is good; we should want to understand the waste in the system as it stands.
However, that isn't enough. US healthcare is wildly inefficient because the paying customer is different than the serves customer. This has been known for sixty years, since Arrow published his paper (he identified four reasons, three of which are not exclusive to healthcare and seem to be mitigated well in other industries). I'm surprised people posting can't quite see this: when you go to the doctor, would you call the experience efficient? You check in, then wait, then are called back, tell the nurse or PA why you're there, wait, see the provider who asks you again why you're there, has a short exam, wait, finally get all the paperwork and sign out.
If you have labs or tests, you then wait again. And of course if you need a specialist, you wait again, sometimes for months. If you need any sort of "specialty" medication or equipment, then you REALLY wait, as specialty pharmacies, DMEs and the like jump in.
The whole system is woefully inefficient, and overhead is only a part of the explanation. No one knows what anything costs, and the people who pay (insurance providers, the largest of which is the US Government) want to believe they're not getting scammed - they still are, but at an acceptable level.
The question we ought to ask is how we can buy better health outcomes for people. And I think part of the answer is that in most cases, individuals and families themselves must allocate resources they control to make this happen.
I worked in healthcare start-ups for many years and the main problem is mis-aligned incentives.
The #1 thing we need to do is make it illegal for your healthcare to be tied to your employment. We can still have your employer provide a X% or $Y to an HSA account that the employee can buy health coverage wherever they like. (I'm not optimistic that this will ever happen politically)
The issue today is that NOT healing you makes everyone more money, like a LOT more. There is no incentive for anyone to help people get healthy just to have a different insurance company benefit from the decreased claims.
This is also the only way forward to value based care (for primary) where doctors (providers et al) can take on the risk/reward. They get some amount (say $1K ??) per year and they keep it and submit no claims. However, if there costs go above, they eat it loss. Now the doctor and the insurance company (payer) are all incentivized to get and keep people healthy.
The #1 thing we need to do is make it illegal for your healthcare to be tied to your employment
Yes. Or at the very least, stop making it mandatory. Health insurance should work like literally everything else: your employer pays you money, and you use that money to buy it.
> Health insurance should work like literally everything else
Eh, everything else varies significantly by company. Tradesmen have to buy their own tools. FANG provides free lunches.
I've yet to see an argument for why a singular person is going to be able to do a better job making healthcare more efficient than a company that shells out millions of dollars for that line item. Like why doesn't HR drop the health insurer that just keeps lock-step increasing prices? And why doesn't that reason apply to an individual?
> We can still have your employer provide a X% or $Y to an HSA account that the employee can buy health coverage wherever they like. (I'm not optimistic that this will ever happen politically)
Doesn't this already partly exist? My (US) employer offers an HDHP (high-deductible health plan) that comes with an HSA.
(It's not quite what you described, because you have to use the insurer that the company picked. I think you're describing something more like the Singaporean system with Medisave.)
The main difference there is that with an HDHP your employer is still the one choosing the insurance provider, and the insurance provider views your employer as the customer. There's no risk that you as an individual will switch to another provider as long as the employer remains with this one.
Removing that layer of indirection would make it your own choice to pick a provider, and the provider is then incentivized, at least a little bit, to provide you with a good outcome or else you may freely switch to another provider.
There's also the component that, right now, you lose the discounted group rate insurance premium as soon as you lose or leave a particular job. Putting the purchasing power with the end consumer means that you can keep your provider at the same premiums even if you switch jobs. All that might change is your employer contribution.
I think the mechanic they're trying to speak to is that due to insurance being tied to employer, no insurance plan (besides Medicare/Medicaid) is truly motivated to ensure good health outcomes beyond a ~4 year horizon. You'll switch jobs and get a different plan.
FEHB plans would also have this incentive. I think at least historically Federal employees didn't switch employers as much (though job-hopping between agencies happens), but more importantly if you retire from the Federal government you keep your health insurance.
Yeah, what I'm suggesting is that your premiums are funded through your HSA, not just your deductible and medicines. Obviously, the max HSA funding amounts would have to change.
Why make this so complicated when we can just have medicare for all? You're right that healthcare shouldn't be tied to your employment, but what you're proposing is something that only the rich + affluent can achieve independently.
All you're doing is playing musical chairs with different capitalists, just stop playing the game. A large part of the electorate wants to stop playing the game.
You need to do some actual canvassing and get out of your SV bubble, M4A polls at a consistent 60% support where both independents and democrats are at nearly 80% support.
What you're advocating is more corporate welfare that I don't see happening but it's the only playbook those with money seem to advocate for.
The reason you tell several different people why you are there is because that is important. if a system doesn't they need to start!
people often remember things when asked latter. this gives more opportunity to ask about everything you care about even if you forget the first time.
people sonetimes grab the wrong chart. This helps ensure that they check for things that matter to you and not someone else - your history is on the chart if they are watching you for something weird in you history this is important.
Or the patient makes the mistake. I've seen it happen:
My wife has a foreign name--an English speaker coming at it cold is going to butcher it. Someone gets it right--either they've been told or they speak some Chinese. (It's not hard to say, but you have to know the Chinese Pinyin rules to get it right.) Over the decades we have grown used to responding to anything in the ballpark and then sitting back down if someone else responds. Oops--L shaped waiting room, we didn't see the somebody else. She ended up in back, the check caught it there.
Or look at my own name. That's the male spelling--but most people don't realize there is a male spelling. It's caused confusion over the years.
I mean isn't that why they ask for name and DoB each time? I get that they want to ensure they're working with the correct patient. I just don't love trying to recall on command the litany of symptoms I've experienced and remedies I've tried before seeing a physician.
I am less interested in the quantitative analysis, but the qualitative analysis. Why, culturally, has the US shot itself in the foot in this way?
> And I think part of the answer is that in most cases, individuals and families themselves must allocate resources they control to make this happen.
Assuming uniquely American selfishness got us in this mess, I don't buy that rugged individualism is the route out. You'll just get that classic pattern of those with enough resources to manage criticizing the resource management of those with too few resources to learn to manage. That just further corrodes solidarity.
> Assuming uniquely American selfishness got us in this mess, I don't buy that rugged individualism is the route out. You'll just get that classic pattern of those with enough resources to manage criticizing the resource management of those with too few resources to learn to manage. That just further corrodes solidarity.
I chose my words carefully so as not to imply "rugged individualism" was the solution. I mean I even explicitly invoked "families" as an institution greater than the individual. And I used the word "control" rather than "earned" or something.
Weirdly, "rugged individualism" is kind of why American healthcare is so bad: we tie it to employment for those under age 65. Before the ACA, this was simply because healthcare is exempt from income tax; with the ACA, it's literally mandated. In order to get health insurance, you need to pull yourself up by the bootstraps and get a job OR pull yourself up by the bootstraps and pay extremely high premiums.
Disentangling healthcare from employment and allowing for other institutions like churches or schools to play a part in helping fund it would do a lot. And for the truly catastrophic conditions like cancer, we should just have a universal policy that kicks in.
The unfortunate answer is that the US seems to be very bad at fighting regulatory corruption which allows small parts of the market to buy laws which give them a moat. Rinse and repeat over the last half century and you get to the situation we're in.
One key problem appears as misaligned ("perverse") incentives. But it has to be that because its essentially impossible for an average person to purchase health care in the moderately informed and choice-filled fashion that I can purchase a vacuum cleaner.
Of course, another key problem is trying to divide distinct parts of health care into distinct costs. Everyone benefits from having a good quality hospital in their area and so assigning a health care provider's cost to just a given patient and then trying to reduce the patient's cost is quite irrational.
Essentially, you have a public good that the state and private interests are trying to make into a public good. A lot of profit comes from this but little good for the patients.
We already have mandated covering the things where spending now saves more down the road. And the medical community has standards of proper care. If there was a way to reduce costs by improving patient health it would already have been done!
Think we haven't learned a fair bit about our own health issues? If there was some magic answer a lot of people would have found it.
And yet it is still vastly more inaccessible and inefficient than other countries where the same holds. There is a lot that could be learned from other countries. So it's good to see that this repo does so.
I notice the repo has no data on supply of doctors per person in different countries. It's well known that the US residency system with its limited slots constrains the supply of doctors who can practice in the US.
There exist similar systems in pretty much any other western nation. The problem is that teaching doctors is expensive and isn't something you can ramp up quickly because you need other doctors to teach the new doctors. The supply of doctors is a problem that is universal to essentially all western nations especially if you move away from metropolitan areas. It's largely due to aging populations and failure to increase spending on medical education over decades. I think the US is actually better off than many other countries, because they pay disproportionately high salaries so get more immigrants.
That said I don't think there's evidence that lack of doctors is what is driving up cost in the US. Just an example, growth in hospital administrators has significantly outpaced medical staff over the last decades, which will directly increase cost.
> Because it makes pretty much no economic sense for anyone else to do it
I think other funding models simply haven't been explored. I'll pull one out of my ass. The hospital does it themselves. In exchange the doctor works at the hospital for the next N years, or pays a contract break penalty. The hospital can pay the doctor somewhat less than market rate and doesn't have to deal with staff turnover.
It should be obvious that other funding models will be invented if government funding goes away. Because the alternative is no new doctors and people start dying without treatment.
Residency training costs like $750,000 to $1.5MM per physician
Primary care doctors would have to work 12-15 years while giving up 25% of their gross salary just to pay for the residency program. They'd also have to pay x% of their salary to pay for their debt from med school training before the residency.
People just wouldn't go into the field, which is already happening even in a world where the residency is funded. The economics of being a doctor are simply not that great anymore, especially relative to other things you could do.
> It should be obvious that other funding models will be invented if government funding goes away. Because the alternative is no new doctors and people start dying without treatment.
There is an infinite number of jobs that would be great to have but we can't reasonably fund and so don't exist.
We currently live in a timeline where there are no new personal one-to-one tutors for middle schoolers and therefore every single middle schooler in the country receives subpar education, causing vast amounts of economics losses as compared to if they could be trained more thoroughly.
I find it completely unbelievable that residencies are not a profit center for most teaching hospitals. The residents do almost all the day to day work with a half dozen of them reporting to a single attending physician.
It’s not like you get a discount if you’re seen by a resident vs attending either. Sure the first year or maybe two a resident needs a lot of close supervision, but not nearly as much as people think happens.
I would bet dollars to donuts that the vast majority of patients seen by a resident have no clue. They simply call them doctor.
My bet is it’s all accounting tricks. You’d be utterly incompetent not to somehow make a profit on 60-80hrs/week of basically free doctor labor even if those are junior doctors. They generate massive amounts of billable services. Plus they are basically guaranteed to work for you for 4+ years, aside from the few that wash out.
> The question we ought to ask is how we can buy better health outcomes for people
spend more money. you DO live in the greatest country on the planet, surely if an american citizen cannot raise the funds for healthcare, in what country can you expect to?
Montana is both cold and sparely populated, so I figure data centers would be good there. Also, I figure Zefram Cochrane could use all that compute for his warp theories in a few decades.
I expect that access to inexpensive energy is more important than the population density, typical ambient or "favorable" state laws (this law doesn't seem to really do all that much).
Like the region I live in is cold and has lots of water, but we import energy, might as well build closer to the regional mega cities (where it is still relatively cold, with relatively abundant water). There is some kerfuffle going on in the county here about preventing data centers, and I can't imagine there is even anyone interested in building one.
I used to read it daily. Even continued for a few years after the acquisition. But at this point, I haven't looked at it in years. Even tend to skip the articles that make it to the first page of HN. Of course, most of the original writers I still follow on social media, and some have started their own Substack publications.
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I feel like this is already addressed in the "Aha! But you see..." section. There is nothing that one can't poke holes in, but if the holes are not big enough, the proposal is still sound.
It's interesting and you should keep iterating. My critiques: it requires a scroll container with sufficient margin to move the top and bottom elements (or I guess left and right) past center; the "place" button is quite unintuitive and should be placed nearer to the pick-n-place container, or even on the selected element itself; and the position of the selected element isn't quite right, though this seems more like a bug.
Keep iterating! Drag-n-drop is good on desktop, but I disprefer it for mobile.
Now I can actually get beyond conceptual misunderstanding or even ignorance and get to practice, which is how skills actually develop, in a much more streamlined way.
The key is to use the tool with discipline, by going into it with a few inviolable rules. I have a couple in my list, now: embrace Popperian falsifiability; embrace Bertrand Russell's statement: “Everything is vague to a degree you do not realize till you have tried to make it precise.”
LLMs have become excellent teachers for me as a result.