My blood pressure rises everytime i use Enterprise Copilot at work. It seems they truncate message history heavily (to save input token costs?) and Copilot forgets the last thing you told it in the chat. It is like a real-life version of Momento (https://www.imdb.com/title/tt0209144/) mixed with Waiting for Gadot (https://en.wikipedia.org/wiki/Waiting_for_Godot), pretending to be in league with Anthropic.
Fair point, that happens when i'm trying to be on MS Teams for a conf call, while watching my claude code terminal and then browsing HN on another monitor :-/
Doing research work with it that outputs any kind of artifact is.. really painful. It constantly crashes, has to regenerate.. and then the output is often very difficult to carry to other Microsoft products, like Sharepoint. I end up creating PDFs that I import.
I'll go ahead and burn working hours on it because I'm getting paid, and people like the things I create.. but it's a very crippled and painful version of what you get with the frontier products and most OSS options.
It boggles my mind that Microsoft can fail to deliver even bare minimum working software so consistently, with all the engineering talent they house. What are the product teams doing?
I feel it is even worse than bare minimum -- it is so bad it infuriates the user. It is hard to get away from that reaction when one uses better alternatives in their personal life.
You're right using Microsoft products is like mixing Momento with Waiting for Gadot :)
I recently switched to New Outlook and it's full of weird subtle bugs. It takes them years to fix things and make them barely useable. Given their track record I'm not optimistic for Copilot given both the vision and the execution are questionable at best.
It's such a broken POS. Code snippets, especially for html, frequently don't render, or if they do, they render as rendered html which will frequently be an empty box, and you have to manually (for each snippet box) switch to show code mode.
I can tolerate Teams being a bit mid because the core functionality nearly always works. I can tolerate Outlook being meh because it's doing a lot (nothing I, a lowly IC really need though I can imagine the top hatted boss who does) and I think it does okay with the scope it's tackling.
But the M365 copilot app is inexcusable for being as core to Microslop's strategy.
Huh... not my experience with the "premium" license. The interface isn't as nice and definitely less powerful than something like codex/claude code/whatever, but I don't seem to have any issues with truncation or things like that. I'm usually using 5.6 thinking (not clear which 5.6 model exactly) when I'm using copilot at work. It seems... fine? I always see people here always complaining that it's nerfed, truncates things, etc etc. The only difference I see is that interface isn't as nice nor as powerful, but I don't notice the answers being noticeably worse or anything like that. Occasionally it messes up code block formatting, but that's the only thing I can think of that annoys me.
Now, the "copilots" integrated in certain Microsoft products can be really horrible. I assume those are some sort of custom models that are not very capable, most of them I consider effectively worthless. But the web chat interface where I can pick chatGPT 5.6 seems fine...
Given you're comparing to codex/claude code you probably arent talking about MS Copilot (e.g. the thing inside MS Teams but also available standalone as MS Copilot 365). Try it out and be convinced :-)
I totally dont by the "no medicare funds for training". A doctor will see you for 10min (perhaps another 10min prep) and bill $1000. If you doubt this, just check your EOB statements from the insurance company or check your deductible history.
The entire salary for the resident can be earned back in 3-4 days. You still have 360 days left to pay back admin overhead, facility overhead, supplies, etc. That is earned back in the next several weeks. After that, the next ~300 days of the year are profit.
In states with balance billing, the doctor can set any price and bill you for the remaining figure with a balance bill. In NY and NJ these can be thousands or tens of thousands. If you dont pay, it goes to collection and the provider still gets 10 to 15 cents on the dollar. So no...the $75k annual salary of a resident is not a barrier to training more doctors according to any math i'm seeing. What am I missing?
What seems more likely is that supply is artificially constrained to increase scarcity and prices.
First, private practice docs see patients with very good employer provided insurance, but residents are largely seeing patients that private practices wont see - patients who are far too medically complex to fit into a 10 minute slot and who also have particularly stingy insurance.
So as opposed to a private practice doc who is seeing 30 patients per day and billing an a average of $250 to $300 per patient (certainly not $1000 - that is unrealistic in my experience), a resident is seeing more like 10 to 15 patients per day (30 minute slots) and billing less than $100 per patient.
Second, residents have to be supervised. You have not included the salary of the physicians supervising them in your calculation.
Third, and I have mentioned this many times before on HN, training is limited by chiefly by the number of training sites that can offer quality training. For example, most hospitals will not see a single case of Guillan-Barre in a single year. Would you want to be treated by a nuerologist who trained at such a hospital? This is why neurology training is generally limited to places with a high volume of neurologic cases that would be considered rare at the average hospital, and these hospitals can only accommodate so many residents. Even for general medicine, you probably do not want to be treated by a doctor who trained at a hospital where any case that passed a certain complexity was transferred out to a bigger center.
You're on a board full of technologists. Many are in SF or Seattle or NYC. A 10minute commute means you live in a 5-20 Million dollar home in SF. Not sure how realistic that is.
I work in NYC. The salary doesnt support having a home in the city. Yes, it can support a 1br apt, perhaps a 2br with roommates. Definitely not accomodations for a family.
i think there is a big diff between 10-30min and 45min
your 45min assessment is probably right for early career. once you have a family, it gets much harder and less common
Whether your company is WFH or RTO is a decision, but please dont try to do a hybrid -- where some employees on the same team are remote while others are in office. You end up with team members going to the office, and just staying on a zoom the entire day without actual interaction. Worst of all worlds.
>> Medicare pays 50% less than private insurance. So doing this would require either layoffs, cutting salaries for doctors/nurses/etc, or both. This may well be the right decision for society as a whole--that's a big part of the debate here--but there's no free lunch.
You arent considering
1. Hospitals eating the cost of the uninsured, which this would solve
2. Hospital spending tons on administrative duties fighting with insurers on coverage, which this would reduce
> Hospital spending tons on administrative duties fighting with insurers on coverage, which this would reduce
Would this go away, though? Instead of fighting with insurers they would be fighting with the government insurer?
I am very pro universal healthcare, I just don’t want to pretend there aren’t still going to be fights over what should be paid for.
No matter what, there are going to be disagreements on what medical procedures should be paid for and who needs them, as well as how much they should be billed for.
The way a lot of other countries deal with this is that the government calculates out a benefit vs cost assessment for every new treatment and only covers ones that come out ahead. But, that ends up with things like new targeted chemotherapies being unavailable for years after their initial release, vs in the US where they are available to much of the population once the right prior auth is filed. There is also more top down management of costs, such as long term life support for people in vegetative states.
All of this was branded as "death boards" in the American healthcare debate.
People hate it when faceless bureaucrats decide that some health care expense is too expensive for the large faceless bureaucracy to cover, when they have a medical issue that they would like the large faceless bureaucracy to spend money on. Perhaps in that world, some insane guy with a back injury who's unhappy about the quality of his care assassinates the Secretary of Health and Human Services, rather than the CEO of a medical insurance corporation (and hey, a lot of people hate RFK Jr. anyway, so maybe that assassin still becomes a folk hero for doing it).
This is already how Medicare works and it covers 70 million Americans. I’m not aware of any of these hypothetical violent outcomes being a huge problem for the program.
> Instead of fighting with insurers they would be fighting with the government insurer?
1. I'd rather fight the non profit-motivated entity
2. We can probably compare to VA and Medicare and even other countries to see what the fight will be like. I'm willing to bet it will be a big improvement.
> No matter what, there are going to be disagreements on what medical procedures should be paid for and who needs them, as well as how much they should be billed for.
Government insurance has a service motive. Private insurance has a profit motive.
What hospitals makes has nothing to do with physician pay - those are separate categories. Hospitals aren’t going to magically start giving some of their profit to doctors to help cover their lower fees.
OP makes a good point. The studies assumes two diametrically opposed things will happen - doctors will take a 50% pay cut but access to primary care physicians will increase.
Why would we solve the primary care physician shortage by cutting their pay?
Those are two real effects, but together they wouldn't compensate for the rate cuts.
About 8% of the population is uninsured. The uninsured population skews younger, with less healthcare utilization (Medicare already covers everyone 65 and older).
Another comment in this thread estimated billing overhead at 8.5%. Medicare for All would eliminate some, but not all of this, since Medicare is still a claims-based system. You would remove a lot of overhead around prior auths, which I agree is a good thing, but could be achieved with more focused legislation.
> .. 8% of the population is uninsured. ..
this is Bogus, one of the first argument hospitals make for inflated pricing is that they have to cover the cost of uninsured. if the uninsured doesnt exist then the whole line of BS argument falls.
> 2. Hospital spending tons on administrative duties fighting with insurers on coverage, which this would reduce
This layer won't go without a fight. Maybe it _is_ the layer we're fighting against. The owners will still make profit, the providers still have jobs.. but the middle layers are useless bloat. They don't have skills to provide care, they don't operate at the capitalist layer. They are useless today, and even more useless tomorrow.
And that is likely useless layer is millions? of jobs.
How would this change solve: "Hospitals eating the cost of the uninsured..."?
Wouldn't it just transfer the cost from the hospitals to the universal coverage agency? This would make the financial picture even worse for the proposed system.
>>> Hospitals have an operating margin of 2-5%. Medicare pays 50% less than private insurance.
The hospital can be paid less without reducing their margin if they can remove a cost from their balance sheet. It does not make the system cheaper overall, but it means the hospital does not have to bear those costs directly. They may not have to bear them at all, because hospitals are not the only things in the system.
>> Putting 2 servings of ice cream in a thick plastic jar was always a dumb gimmick.
One gimmick I quite detest is the use of highly concave bottoms some companies use, so as to reduce the volume of actual product. Similar to deep indentations orange juice bottles use as a "handle" but which actually exists to reduce the volume of juice.
> And you must ask yourself, is the ability to sell your company to another company a benefit or should there be considerably stronger hurdles for this kind of thing?
Distribution is a huge problem for small companies. So you almost have to sell to a bigger firm to get beyond a certain size.
or partner with someone who can do distribution? I don't see why that necessitates selling the company. It's like saying the story in my game sucked so I sold it to Disney.
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