10 ms·

Medical staffing companies cut doctors’ pay while spending millions on ads

230 points by hhs 7y ago

deleted 7y ago
[deleted]
danans 7y ago
IMO, the most fascinating thing about this report is that it exposes a fight between two groups: 1) traditional health insurance companies 2) private equity backed provider groups, both of whom would be opposed to universal single payer healthcare as a right. It almost reads like a turf war over which industry subgroup has more right to the unusually high healthcare costs paid by Americans, driven by demand for profits from shareholders, which probably indirectly includes someone like me who has a 401k. This fight has been going on for a very long time though. One reason (among many) that large medical provider groups started forming in the US more than a decade ago was to increase their leverage against insurance companies, who they felt were undercompensating them - small medical practices have little more leverage with insurance companies than consumers on the open insurance market. At some point these larger medical groups attracted the attention of private equity investors, who themselves demand a return on investment. In the end it seems like the loser here is the healthcare consumer, who will pay the higher costs of this system, especially those without significant capital in for-profit healthcare related enterprises.
- lotsofpulp 7y ago
  Without taxpayer funded healthcare, the consumer is at a disadvantage against healthcare providers as they are completely unknowledgeable about what they are buying, and have low ability to shop around. If everyone was forced to use healthcare.gov to purchase health insurance, then we could have a viable market similar to auto or home insurance, where consumers reward the insurance companies that negotiate lower healthcare costs by signing up for their lower premiums. It is the obfuscation of costs by way of the tax advantage given to employers subsidizing healthcare that greatly reduces the insurability of the people on healthcare.gov since many healthy people are silo’d out into lower risk employer pools, and therefore reduces the amount of insurers that can exist and compete for business.
  - LanceH 7y ago
    I've said it before, but if I were allowed to make one rule in the current healthcare landscape it would be "consistent pricing". No charging different prices depending on who is paying.
    - __blockcipher__ 7y ago
      Agreed, the “charge master” system is crazy. In college I had to fight off debt collectors coming for a $3000 ER bill. $3000 to be given propofol and have my shoulder stuck back in the socket twice (they failed to restrain my arm after the first reduction, my arm flailed upon regaining consciousness and redislocated so they double charged me) I also wonder what a world where we removed almost all medical regulation would look like.we would at least get true competitive market dynamics. Why do I know exactly what I’ll pay at mcdonalds, but not what I’ll pay for a medical procesure? Instead we have just enough regulation to prevent healthy market dynamics, but not enough to have a single payer type system
      - aabeshou 7y ago
        > we have just enough regulation to prevent healthy market dynamics, but not enough to have a single payer type system this seems like a very concise summary of the problem. and insurance companies see the profits of this no-mans land
      - deleted 7y ago
        [deleted]
      - danmaz74 7y ago
        At McDonald's you pay for a completely standardized product, delivered by a non specialized workforce. Healthcare is almost the exact opposite.
        indymike 7y ago
        Interesting. McDonalds defines quality by consistency. Health care defines quality by the credentials of the providers. Maybe healthcare could learn a lot from quickserve?
- tartoran 7y ago
  How do we get rid of all this layer of inneficiency? Must be possible but nobody is talking about getting rid of this but "fixing" it. Fixing may not be possible or too expensive. As consumers we should avoid paying as few middle man as possible. Today I just found out my health insurance is,of course, going up.
  - fzeroracer 7y ago
    The only way to get around this inefficiency is in my opinion to move towards single-payer and circumvent the system entirely. Otherwise you'd have to excise all of the rent-seeking parasitical behavior in our current system which I don't think is possible. Even if you attempted to make the costs of things more transparent to consumers, there's an inherent information asymmetry between a consumer and a insurer due to the economy of scale. There's also a lot of things a consumer can't know until it's too late.
    - toomuchtodo 7y ago
      If your Congressional representative does not support Medicare For All (single payer), run against them in the next election cycle or donate & volunteer for a competitor who does. That is all that is getting in the way of policy implementation, having enough votes to pass the bill in the House and the Senate. We'll get there! I'm working on a site that will obtain attestation from Congressional reps as to their support for M4A, and for those who don't attest support, campaign funding will be funneled to competitors of said representatives who do. https://www.congress.gov/bill/116th-congress/senate-bill/1129/text https://www.congress.gov/bill/116th-congress/senate-bill/112... (S.1129 - Medicare for All Act of 2019)
      - aabeshou 7y ago
        > I'm working on a site very cool idea. I suggest posting it on /r/socialistprogrammers if you need help or if you just want to spread the word :)
        7y ago
- WalterBright 7y ago
  > driven by demand for profits from shareholders All corporations are driven by demand for profits from shareholders. If you're looking at outsized prices in the health care sector, look elsewhere for the reason. Here's a helpful article about it: https://www.theatlantic.com/magazine/archive/2009/09/how-american-health-care-killed-my-father/307617/ https://www.theatlantic.com/magazine/archive/2009/09/how-ame...
  - xnyan 7y ago
    This was the standard conservative argument for a long time: HSAs and non-comprehensive insurance. It’s just what conservatives have been saying for the last 60 years (only give benefits that have meaning to those who already have money), and not even they are trying that tactic anymore. I would be interested if any country has a system that reflects the ideas outlined by the writer, and if so what the results were. All the successful healthcare systems I am aware of our nationalize either at the hospital level, administration and financial level or some combination of the both.
    - WalterBright 7y ago
      > if any country has a system that reflects the ideas outlined by the writer The article points out that Lasik eye surgery is not covered by government programs or private insurance, and the price of it has declined dramatically over the years while the quality of it has improved.
      - danans 7y ago
        Lasik is 100% elective, and nobody needs it done immediately to save their lives or relieve their suffering. It's a cosmetic procedure - like liposuction - one that you can shop around for until you find the right provider. You can't compare it to the type of non-elective or emergency procedures performed in other areas of health care, or treatments for severe chronic conditions. You can't even compare it to routine doctors' visits which are often put off by uninsured people due to the costs, allowing minor conditions to develop into more severe (expensive) ones.
- wefarrell 7y ago
  Congress and the corrupt system of political lobbying deserve a lot of blame. Practices that are outlawed in other industries such as opaque rebates and kickbacks are explicitly allowed by law. Hell, there's even a law on the books that prevents medicare from negotiating drug prices. The bill's architect in congress went on to make $2 million a year as the head of a pharma lobbying firm.
- burnte 7y ago
  > IMO, the most fascinating thing about this report is that it exposes a fight between two groups: 1) traditional health insurance companies 2) private equity backed provider groups, both of whom would be opposed to universal single payer healthcare as a right. As someone who works in a PE backed healthcare provider, I can assure you that we are not opposed to single payer. Some are, but they're mostly in spaces that provide out-of-network coverage or other services that are still "bill what you want and argue about it later" spaces that are rapidly disappearing. OON services are increasingly difficult and are generally covered by single-case-agreements which are negotiated either before service is rendered, or at the very beginning of the treatment process. Single payer is welcomes by a wide swath of PE back healthcare because it would reduce our costs DRAMATICALLY and provide predictability that currently we do not have. It used to be there were small changes in what insurers would cover from year to year, but now the changes are potentially HUGE and we have to adjust much more quickly. We pay gobs of money to departments filled with people who have to manually verify patient benefits, validity of insurance, continually monitor the patient progress to make sure we're fulfilling the various metrics each insurer sets that varies according to the patient's plan, audit each bill to make sure everything is coded correctly to avoid a typo getting an entire claim rejected (which then we have to resubmit), then once we bill it to the insurer there's the game of nagging them to pay claims they approved weeks ago. Single payer would eliminate almost all of that. We'd know everyone was covered. We'd know what is reimbursable and not. We'd have one set of rules for all patients, one set of metrics to adhere to. One source to bill, and one source to track payments from. Literally 20% of my company's staff is just for those things. Not to mention how much time our medical staff would save by having a single set of rules to work under. PE firms are in healthcare to try to leverage economies of scale to make the money side more efficient, and thus increase margins. A stable environment is good for any business. We work hard to make things as efficient as we can, and reducing the massive overhead attached to just making money would be a great efficiency. Single payer would be great news for the industry.
  - danans 7y ago
    Well, TIL something about private equity backed healthcare providers, at least the kind you work at. FWIW everything you're saying makes sense to me personally since I used to do medical billing more than 25 years ago, and I clearly remember how disastrously complex it was for seemingly no reason. One of my first jobs was sitting in an office full of medical procedure face sheets, spending all day calling doctors offices to get billable diagnosis codes for procedures. The question I have is whether the medical provider community is ready to stand up for single payer, if only on the rationale you explained. That would go a long way toward convincing segments of the public who do won't support it on human rights grounds alone, but might support it because it makes more business sense.
erentz 7y ago
And one of those companies may now be entering bankruptcy after they were looted by Private Equity and loaded up with $7 billion of debt.[1] [1] https://www.bloomberg.com/news/articles/2020-04-20/kkr-s-envision-healthcare-said-to-consider-bankruptcy-filing https://www.bloomberg.com/news/articles/2020-04-20/kkr-s-env...
corporateslave5 7y ago
Call me crazy but doctors are over paid and given too much status in American society. Before computers you need highly intelligent doctors with the ability to hold huge amounts of medical knowledge in their heads at a minimum. Now you can google most. The value of a doctor in our society is objectively going down, the job is easier now more than ever. Not only that, the absurd rates of mal practice need to be given a critical eye. We need transparency about patient outcomes.
- jhwang5 7y ago
  Big part of the problem is the AMA which sets up all sorts of barriers to entry into the profession
- briandear 7y ago
  > Call me crazy but doctors are over paid and given too much status in American society. That's insane. You can google symptoms, but you can't google context. Doctors are paid to interpret not to regurgitate. As an example, let's talk airline pilots as an example, Air France Flight 447, the crash of an A330 over the Atlantic. The computers were giving incorrect airspeed readings because of frozen pitot tubes. The pilots, reacting based on the computers, ended up stalling the airplane. The computer gave erroneous information, the pilots (trained to fly the "Airbus way" -- i.e. the airplane knows more than you do,) reacted exactly as the computers told them to react. The "doctoring by computer" concept, while can be beneficial, can't replace the judgement of a human, just like highly automated flight decks, can't replace the skill of experienced pilots. Google also is a search engine. It only surfaces results that "rank" -- not necessarily results that are correct. And certainly not results that are necessarily correct for the specific combination of circumstances.
- tellmelies 7y ago
  By this logic all jobs are overpaid. Why should programmers command a high salary when anyone can search stackoverflow?
- lotsofpulp 7y ago
  A person capable of becoming an MD can most likely do many other things. But to be a doctor, they have to sacrifice their best years of life all the way until at least age 30, and work a minimum of 80 hours a week with sick people. And you have to move wherever you find a residency, so you don’t even get to be around or see family and friends. You’d have to dangle a pretty big carrot to get me to do that. Otherwise, change the system so that you don’t have to sacrifice the best decade of your life and more.
downerending 7y ago
I hear stories from a friend who works in a hospital (though not a doctor). One of the striking parts is that there seems to be a real reluctance to simply "just say no" to pay cuts by switching employers--certainly more so than in tech. Hate to say it, but the only signal that truly matters is leaving.
- TeMPOraL 7y ago
  Medical world is small and job-hopping is not an accepted practice - in contrast to the tech industry. Also, unlike in tech industry, some doctors are unwilling to quit in protest because this decision would quite literally harm or kill people. It's one thing to dump shoving shit for a nonsense web product at one company to shove shit for a useless product at a different company that pays better. It's another thing to transfer away from a hospital strapped for cash and personnel, knowing that this will worsen the outcomes of the patients currently under your care.
  - downerending 7y ago
    Not saying I like the situation, nor that that's how things should be. Just that without seeing a string of quits, generally organizations (private or public) won't fix their salary problems. (The one other related signal is hires, or lack thereof, but it's far weaker.) If I'm wrong about that, I'd be curious to hear the theory.
    - TeMPOraL 7y ago
      Well, I agree with you that a string of quits would be a powerful signal, perhaps powerful enough to change things. I was just trying to provide questions individual doctors face that are somewhat unique to the medical profession. I definitely do not like the current situation.
      - downerending 7y ago
        It's a bit more than academic for me personally. I'm not in that profession, but am doing a job most would say is very important from a societal perspective. I'm also paid way under market, and I'd like my employer to fix that. Realistically, though, that's not going to happen short of me quitting. I haven't so far, though I may yet. So, what's my employer to make of that? I might not be happy, but I'm still here. From a capitalist perspective, I'm being paid enough to hold me in position. So arguably my employer is getting my wage "just right", in that I'm close to not taking it, but not actually leaving. Kudos to them. This does cause a lot of secondary problems, but most of those are relatively invisible to those making these decisions. I don't have any good answers to this, but it does mean that many of the best minds of our generation end up working on elaborate advertising platforms and sometimes-dubious finance/trading applications.

230 points by hhs 7y ago

deleted 7y ago

[deleted]

IMO, the most fascinating thing about this report is that it exposes a fight between two groups: 1) traditional health insurance companies 2) private equity backed provider groups, both of whom would be opposed to universal single payer healthcare as a right. It almost reads like a turf war over which industry subgroup has more right to the unusually high healthcare costs paid by Americans, driven by demand for profits from shareholders, which probably indirectly includes someone like me who has a 401k. This fight has been going on for a very long time though. One reason (among many) that large medical provider groups started forming in the US more than a decade ago was to increase their leverage against insurance companies, who they felt were undercompensating them - small medical practices have little more leverage with insurance companies than consumers on the open insurance market. At some point these larger medical groups attracted the attention of private equity investors, who themselves demand a return on investment. In the end it seems like the loser here is the healthcare consumer, who will pay the higher costs of this system, especially those without significant capital in for-profit healthcare related enterprises.

lotsofpulp 7y ago
Without taxpayer funded healthcare, the consumer is at a disadvantage against healthcare providers as they are completely unknowledgeable about what they are buying, and have low ability to shop around. If everyone was forced to use healthcare.gov to purchase health insurance, then we could have a viable market similar to auto or home insurance, where consumers reward the insurance companies that negotiate lower healthcare costs by signing up for their lower premiums. It is the obfuscation of costs by way of the tax advantage given to employers subsidizing healthcare that greatly reduces the insurability of the people on healthcare.gov since many healthy people are silo’d out into lower risk employer pools, and therefore reduces the amount of insurers that can exist and compete for business.
- LanceH 7y ago
  I've said it before, but if I were allowed to make one rule in the current healthcare landscape it would be "consistent pricing". No charging different prices depending on who is paying.
  - __blockcipher__ 7y ago
    Agreed, the “charge master” system is crazy. In college I had to fight off debt collectors coming for a $3000 ER bill. $3000 to be given propofol and have my shoulder stuck back in the socket twice (they failed to restrain my arm after the first reduction, my arm flailed upon regaining consciousness and redislocated so they double charged me) I also wonder what a world where we removed almost all medical regulation would look like.we would at least get true competitive market dynamics. Why do I know exactly what I’ll pay at mcdonalds, but not what I’ll pay for a medical procesure? Instead we have just enough regulation to prevent healthy market dynamics, but not enough to have a single payer type system
    - aabeshou 7y ago
      > we have just enough regulation to prevent healthy market dynamics, but not enough to have a single payer type system this seems like a very concise summary of the problem. and insurance companies see the profits of this no-mans land
    - deleted 7y ago
      [deleted]
    - danmaz74 7y ago
      At McDonald's you pay for a completely standardized product, delivered by a non specialized workforce. Healthcare is almost the exact opposite.
      - indymike 7y ago
        Interesting. McDonalds defines quality by consistency. Health care defines quality by the credentials of the providers. Maybe healthcare could learn a lot from quickserve?
tartoran 7y ago
How do we get rid of all this layer of inneficiency? Must be possible but nobody is talking about getting rid of this but "fixing" it. Fixing may not be possible or too expensive. As consumers we should avoid paying as few middle man as possible. Today I just found out my health insurance is,of course, going up.
- fzeroracer 7y ago
  The only way to get around this inefficiency is in my opinion to move towards single-payer and circumvent the system entirely. Otherwise you'd have to excise all of the rent-seeking parasitical behavior in our current system which I don't think is possible. Even if you attempted to make the costs of things more transparent to consumers, there's an inherent information asymmetry between a consumer and a insurer due to the economy of scale. There's also a lot of things a consumer can't know until it's too late.
  - toomuchtodo 7y ago
    If your Congressional representative does not support Medicare For All (single payer), run against them in the next election cycle or donate & volunteer for a competitor who does. That is all that is getting in the way of policy implementation, having enough votes to pass the bill in the House and the Senate. We'll get there! I'm working on a site that will obtain attestation from Congressional reps as to their support for M4A, and for those who don't attest support, campaign funding will be funneled to competitors of said representatives who do. https://www.congress.gov/bill/116th-congress/senate-bill/1129/text https://www.congress.gov/bill/116th-congress/senate-bill/112... (S.1129 - Medicare for All Act of 2019)
    - aabeshou 7y ago
      > I'm working on a site very cool idea. I suggest posting it on /r/socialistprogrammers if you need help or if you just want to spread the word :)
      - 7y ago
WalterBright 7y ago
> driven by demand for profits from shareholders All corporations are driven by demand for profits from shareholders. If you're looking at outsized prices in the health care sector, look elsewhere for the reason. Here's a helpful article about it: https://www.theatlantic.com/magazine/archive/2009/09/how-american-health-care-killed-my-father/307617/ https://www.theatlantic.com/magazine/archive/2009/09/how-ame...
- xnyan 7y ago
  This was the standard conservative argument for a long time: HSAs and non-comprehensive insurance. It’s just what conservatives have been saying for the last 60 years (only give benefits that have meaning to those who already have money), and not even they are trying that tactic anymore. I would be interested if any country has a system that reflects the ideas outlined by the writer, and if so what the results were. All the successful healthcare systems I am aware of our nationalize either at the hospital level, administration and financial level or some combination of the both.
  - WalterBright 7y ago
    > if any country has a system that reflects the ideas outlined by the writer The article points out that Lasik eye surgery is not covered by government programs or private insurance, and the price of it has declined dramatically over the years while the quality of it has improved.
    - danans 7y ago
      Lasik is 100% elective, and nobody needs it done immediately to save their lives or relieve their suffering. It's a cosmetic procedure - like liposuction - one that you can shop around for until you find the right provider. You can't compare it to the type of non-elective or emergency procedures performed in other areas of health care, or treatments for severe chronic conditions. You can't even compare it to routine doctors' visits which are often put off by uninsured people due to the costs, allowing minor conditions to develop into more severe (expensive) ones.
wefarrell 7y ago
Congress and the corrupt system of political lobbying deserve a lot of blame. Practices that are outlawed in other industries such as opaque rebates and kickbacks are explicitly allowed by law. Hell, there's even a law on the books that prevents medicare from negotiating drug prices. The bill's architect in congress went on to make $2 million a year as the head of a pharma lobbying firm.
burnte 7y ago
> IMO, the most fascinating thing about this report is that it exposes a fight between two groups: 1) traditional health insurance companies 2) private equity backed provider groups, both of whom would be opposed to universal single payer healthcare as a right. As someone who works in a PE backed healthcare provider, I can assure you that we are not opposed to single payer. Some are, but they're mostly in spaces that provide out-of-network coverage or other services that are still "bill what you want and argue about it later" spaces that are rapidly disappearing. OON services are increasingly difficult and are generally covered by single-case-agreements which are negotiated either before service is rendered, or at the very beginning of the treatment process. Single payer is welcomes by a wide swath of PE back healthcare because it would reduce our costs DRAMATICALLY and provide predictability that currently we do not have. It used to be there were small changes in what insurers would cover from year to year, but now the changes are potentially HUGE and we have to adjust much more quickly. We pay gobs of money to departments filled with people who have to manually verify patient benefits, validity of insurance, continually monitor the patient progress to make sure we're fulfilling the various metrics each insurer sets that varies according to the patient's plan, audit each bill to make sure everything is coded correctly to avoid a typo getting an entire claim rejected (which then we have to resubmit), then once we bill it to the insurer there's the game of nagging them to pay claims they approved weeks ago. Single payer would eliminate almost all of that. We'd know everyone was covered. We'd know what is reimbursable and not. We'd have one set of rules for all patients, one set of metrics to adhere to. One source to bill, and one source to track payments from. Literally 20% of my company's staff is just for those things. Not to mention how much time our medical staff would save by having a single set of rules to work under. PE firms are in healthcare to try to leverage economies of scale to make the money side more efficient, and thus increase margins. A stable environment is good for any business. We work hard to make things as efficient as we can, and reducing the massive overhead attached to just making money would be a great efficiency. Single payer would be great news for the industry.
- danans 7y ago
  Well, TIL something about private equity backed healthcare providers, at least the kind you work at. FWIW everything you're saying makes sense to me personally since I used to do medical billing more than 25 years ago, and I clearly remember how disastrously complex it was for seemingly no reason. One of my first jobs was sitting in an office full of medical procedure face sheets, spending all day calling doctors offices to get billable diagnosis codes for procedures. The question I have is whether the medical provider community is ready to stand up for single payer, if only on the rationale you explained. That would go a long way toward convincing segments of the public who do won't support it on human rights grounds alone, but might support it because it makes more business sense.

erentz 7y ago

And one of those companies may now be entering bankruptcy after they were looted by Private Equity and loaded up with $7 billion of debt.[1] [1] https://www.bloomberg.com/news/articles/2020-04-20/kkr-s-envision-healthcare-said-to-consider-bankruptcy-filing https://www.bloomberg.com/news/articles/2020-04-20/kkr-s-env...

corporateslave5 7y ago

Call me crazy but doctors are over paid and given too much status in American society. Before computers you need highly intelligent doctors with the ability to hold huge amounts of medical knowledge in their heads at a minimum. Now you can google most. The value of a doctor in our society is objectively going down, the job is easier now more than ever. Not only that, the absurd rates of mal practice need to be given a critical eye. We need transparency about patient outcomes.

jhwang5 7y ago
Big part of the problem is the AMA which sets up all sorts of barriers to entry into the profession
briandear 7y ago
> Call me crazy but doctors are over paid and given too much status in American society. That's insane. You can google symptoms, but you can't google context. Doctors are paid to interpret not to regurgitate. As an example, let's talk airline pilots as an example, Air France Flight 447, the crash of an A330 over the Atlantic. The computers were giving incorrect airspeed readings because of frozen pitot tubes. The pilots, reacting based on the computers, ended up stalling the airplane. The computer gave erroneous information, the pilots (trained to fly the "Airbus way" -- i.e. the airplane knows more than you do,) reacted exactly as the computers told them to react. The "doctoring by computer" concept, while can be beneficial, can't replace the judgement of a human, just like highly automated flight decks, can't replace the skill of experienced pilots. Google also is a search engine. It only surfaces results that "rank" -- not necessarily results that are correct. And certainly not results that are necessarily correct for the specific combination of circumstances.
tellmelies 7y ago
By this logic all jobs are overpaid. Why should programmers command a high salary when anyone can search stackoverflow?
lotsofpulp 7y ago
A person capable of becoming an MD can most likely do many other things. But to be a doctor, they have to sacrifice their best years of life all the way until at least age 30, and work a minimum of 80 hours a week with sick people. And you have to move wherever you find a residency, so you don’t even get to be around or see family and friends. You’d have to dangle a pretty big carrot to get me to do that. Otherwise, change the system so that you don’t have to sacrifice the best decade of your life and more.

downerending 7y ago

I hear stories from a friend who works in a hospital (though not a doctor). One of the striking parts is that there seems to be a real reluctance to simply "just say no" to pay cuts by switching employers--certainly more so than in tech. Hate to say it, but the only signal that truly matters is leaving.

TeMPOraL 7y ago
Medical world is small and job-hopping is not an accepted practice - in contrast to the tech industry. Also, unlike in tech industry, some doctors are unwilling to quit in protest because this decision would quite literally harm or kill people. It's one thing to dump shoving shit for a nonsense web product at one company to shove shit for a useless product at a different company that pays better. It's another thing to transfer away from a hospital strapped for cash and personnel, knowing that this will worsen the outcomes of the patients currently under your care.
- downerending 7y ago
  Not saying I like the situation, nor that that's how things should be. Just that without seeing a string of quits, generally organizations (private or public) won't fix their salary problems. (The one other related signal is hires, or lack thereof, but it's far weaker.) If I'm wrong about that, I'd be curious to hear the theory.
  - TeMPOraL 7y ago
    Well, I agree with you that a string of quits would be a powerful signal, perhaps powerful enough to change things. I was just trying to provide questions individual doctors face that are somewhat unique to the medical profession. I definitely do not like the current situation.
    - downerending 7y ago
      It's a bit more than academic for me personally. I'm not in that profession, but am doing a job most would say is very important from a societal perspective. I'm also paid way under market, and I'd like my employer to fix that. Realistically, though, that's not going to happen short of me quitting. I haven't so far, though I may yet. So, what's my employer to make of that? I might not be happy, but I'm still here. From a capitalist perspective, I'm being paid enough to hold me in position. So arguably my employer is getting my wage "just right", in that I'm close to not taking it, but not actually leaving. Kudos to them. This does cause a lot of secondary problems, but most of those are relatively invisible to those making these decisions. I don't have any good answers to this, but it does mean that many of the best minds of our generation end up working on elaborate advertising platforms and sometimes-dubious finance/trading applications.