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Yeah, chain restaurants have dominated most of the market everywhere out through and including the exurbs.

But if you go to somewhere deeply rural you can still find cheap crappy diner food.


Some of the random non-chain diners in the middle of some forested area are super nice and somehow not expensive, like the kind you stop at on the way to a ski trip. I'd think they'd be pricey cause of tourism or difficulty getting supplies.

Since the late 90s, the US has been continually moving the opposite way of what you are suggesting. You are hearing about it because people have been demanding changes to the way it used to be.

There's going to be a day when we look back at $200/mo price tags and say "wow that was cheap".

The breakeven at this price is 6 minutes of productivity per work day for an engineer making $200k.


Okay, but then by that logic a person making only $20k would break even at about an hour.

Are you suggesting that someone making $20k should be spending $200/mo on Claude?


I'm talking about the cost of labor.

If you pay someone $20,000 for labor, and they save 65 minutes worth of labor per day using a $200/mo Claude subscription, you are better off buying the Claude subscription.


Everyone is arguing why I'm wrong or that I should have presented more data.

You've got the real insight with this claim.

This is the way the world is moving. Open source isn't even going where the ball is being tossed. There is no leadership here.

You're spot on.

If the cost to deliver a unit of business automation is:

    A. $1M with human labor

    B. $700k human labor + open source models

    C. $500k human labor + $10,000 in claude code max (duration of project)

    D. $250k with humans + $200k claude code "mythos ultra"
The one that will get picked is option "D".

Your poor college students and hobbyists will be on option "B". But this won't be as productive as evidenced by the human labor input costs.

Option "C" will begin to disappear as models/compute get more expensive and capable.

Option "A" will be nonviable. Humans just won't be able to keep up.

Open source strictly depends on models decreasing their capability gap. But I'm not seeing it.

Targeting home hardware is the biggest smell. It's showing that this is non-serious, hobby tinkery and has no real role in business.

For open source to work and not to turn into a toy, the models need to target data center deployment.


You are assuming (imagining) a cost relationship which doesn't exist and when researched was the opposite of what you claim.

Yeah, I don't wanna shit on open source, there will certainly be uses for all different kinds of models.

The real money in this market, though, is going to be made in the C suite, and they don't really care about the model. They don't care if it's open source, closed source, or what it is. They don't want to buy a model. They're interested in buying a solution to their problems. They're not going to be afraid of a software price tag -- any number they spend on labor is far more.

Labor is something like 50%+ of the Fortune 500's operating expenses -- capturing any chunk of this is a ridiculous sum of money.


Errors can be a significant problem in manual charting as well.

I know a medical professional who does a similar evaluation process to what is outlined in your second link to human written charts. They then use that feedback to guide the department on how to improve their charting.

So, don't presume that those error rates cited in those studies should be compared to a baseline rate of zero. If you review human-written charts, you will often also not have an error rate of zero.


Has anyone considered simply asking the patient to sign off on these things as well? I realize many wouldn't but at least some would.

In the US, HIPAA gives patients a right to access and have corrections added to their medical record.

But in my conversations with a person I know who does this work -- I don't think that the typical problems with patient charts are anything that would be remotely noticeable to a patient -- they're often deficiencies of a technical and/or clinical significance.


It is standard practice to ask patients whether or not they want the scribe used, and in many cases required by law.

For now. It always begins as voluntary. But then doctors will start to treat people who opt out the way TSA treats me when I opt out: a hostile adversary.

I already get glares and sighs when I dare to actually read every word of a multipage form I am expected to sign without reading. Was told once I would lose my appointment if I took longer than a few minutes to read more than 10 pages because I could not be checked in until I signed. Other patients are waiting, your exercise of your human rights is inefficient.

Then soon I'll have to pay a higher copay to opt out. Then I won't be able to opt out at all.

All in the name of optimizing patient NPS scores and patient throughput.


I've never had this problem. IME every doctors office recommends showing up 15-20 minutes early to a new-patient appointment for the explicit reason of filling out paperwork.

Right, doctors and CIOs get to use AI transcripts but you, a lowly patient, will write your name, address, and insurance policy number fifteen times with an exhausted Bic pen.

>For now. It always begins as voluntary. But then doctors will start to treat people who opt out the way TSA treats me when I opt out: a hostile adversary.

You sure this is a privacy issue?


> Was told once I would lose my appointment if I took longer than a few minutes to read more than 10 pages.

I'd be finding a new doctor at that point. Ridiculous. I love it how doctors can be 30 minutes late for their appointments because they're running late and all their appointment delays are cascading, but if the patient reads a document for 5 minutes, they're the problem!


There is no legal requirement to inform patients about the use of scribes, human or AI. If a telehealth session is recorded many states are two party and require telling the patient, but AI scribes are treated the same way other electronic tools are are are covered by your general informed consent policy. We inform patients in writing, their providers make the patient aware, and they are given the opportunity to opt out of the use. No recordings are kept, the session goes directly to transcription, that transcript is deleted after the note is saved.

I'm referring to recording laws, as you allude to.

There might be some real concern about the cognitive and patient-interaction impacts of speech recognition being used... but on the other hand, it's more likely that details are missed when information is captured manually.

And the privacy/informed consent concerns here are silly, they apply to any of your charted data... and if you're going to any office that doesn't use the latest technology, your patient information is probably being sent between offices over fax anyway.


The mouse in the photo was made somewhere between 1987-1993. I have computers older than that which work just fine.

Same, but I didn't spend a lot of time putting my grubby hands on those computers.

No, they are loosely regulated.

It's a little bit disingenuous to call intentional wont-fix features "vulnerabilities".

That's a double edged sword. Investors demand a return regardless of what IP law is. They'll invest in the companies that find some way to protect their investment -- NDAs, stronger technical protections, services-models, etc.

Maybe it's time the economy shifts from having to prioritize the investors for everything

You don't have to prioritize them. You can choose to encourage the rich to hoard their money elsewhere. But there are consequences to every policy decision.

The rich don't have money, they have assets, and those assets can't go anywhere. It doesn't matter if the rich buy or sell a farm in Canada, the farm is still in Canada.

> The rich don't have money, they have assets

Yeah, we're talking about the same thing.... the word for a rich person who exchanges their cash for non-cash assets is "investor"


> It doesn't matter if the rich buy or sell a farm in Canada, the farm is still in Canada.

Have we learned nothing from what happened to the US's industrial economy.

If you turn the farm into an obviously poor investment it'll go tits up because neither wall street nor main street is dumb enough to invest money into a losing proposition.


We got rich by not prioritizing the needs of investors in the first place. Maybe we need to start prioritizing the needs of the larger society again.

You certainly don't need economic investment to become "rich" in culture, enlightenment, or humanity, for sure. And there is value to that.

However, financiers played an indisputable role in the current state of economic wealth in today's world.


Indisputable role in economic precarity, more commonly known as wage slavery.

Economic uncertainty is negatively correlated with market capitalization per capita.

Slavery is positively correlated with market capitalization per capita.

It is not.

It is.

Good talk.


You're factually wrong. Graph any Global Slavery Index against market capitalization per capita -- you get a negative correlation.

You are factually wrong.

'Global slavery index' is not a credible source, even according to Wikipedia.

I'm sorry I spent 2 minutes of my life looking it up - I should've known better.

This conversation is over. I can't trust you to not throw random crap a google search produces that supports your fantasy that I then have to spend brain cells to debunk.


Then pick a different one. Which measure did you use to come to your conclusion?

I suspect you didn't use one at all, because I am not aware of any measure of "slavery" that correlates positively with any measure of investment activity.

Labor practices and protections are much better in countries with high economic investment.


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