The Hospital Business – A Consumer’s Perspective

Emergency room visits are an incredibly inelastic good, where elasticity is the degree to which the desire for something changes as its price rises. It has an elasticity of -0.04, where an elasticity of 0 means that the demand does not change with an increase in price and an elasticity of -0.04 means that demand decreases by about .04 units per one unit of price increase. Let’s say that a hospital suddenly doubles all of its emergency room bills to keep from closing. The price increased by 100%, but the demand only decreased by 4%, so they just made a lot more money. Hospitals in the United States are either private businesses, or they are non-profits which operate like private businesses. Either way, their goal is to make money, and money is revenue minus cost.

Recently the government required hospitals to publish their chargemasters, which are fake wildly inflated prices that are used as a starting point for price negotiations. In my local hospital’s chargemaster, I saw a price per Wellbutrin tablet that is just under the standard price per Wellbutrin tablet, but multiplied by 100. There are over 33,000 line items in that chargemaster (not including over 10,000 CPT codes and many HCPCS codes which are not listed), and nobody has time to negotiate over every single line item, so my guess is that with the chargemaster, my hospital takes the unit cost, multiplies it by 100, throw that x100 price at the health insurance companies as a “high ball” number, and then the health insurance companies throw back a “low ball” multiplier (maybe times two), and then they go back and forth until they agree to a multiplier that is somewhere in between the high multiplier and the low multiplier (maybe times 5). This all happens behind closed doors of course, but my guess is that they have some sort of “cost multiplier” and rather than arguing over each item, they basically argue over the multiplier (like I will pay 5-10% of your charge master prices). Bigger health insurance companies have more bargaining power than small ones, so they can negotiate smaller “multipliers”. In practice the prices on my local hospital’s end aren’t fixed – they can increase the price for a given CPT code in their computer, run it, and I believe it will go through on the health insurance company’s end as long as it’s within a range. Anyway, the multiplier is necessary to make sure that they make enough profit to keep the place open, and it all has to happen behind closed doors so they they can profit off of the fact that people don’t know how much they’re being ripped off. Keeping the discounts secret also stops smaller buyers of healthcare (like smaller health insurance companies and people without insurance) from asking hospitals to match the rates that they charge bigger buyers of healthcare (like larger health insurance companies and Medicare). Medicare is an outlier because Medicare forces hospitals to take their patients at a financial loss, resulting in hospitals increasing their rates on non-Medicare patients to compensate for that loss.

Every business in the healthcare industry rips off the end consumer because the end consumer is the one with the least bargaining power. What, are you going to bargain during a heart attack? Of course not – you aren’t going to do any bargaining in advance – you have no leverage. The only bargaining that you can do is after the fact, and that’s only because hospitals lose a lot of money handing bills over to debt collectors and dealing with things like the administrative overhead of long term low interest loans and taking people who don’t pay their medical bills to court, so you the consumer are able to bargain because you have these prospective monetary losses as your leverage. Most consumers don’t of course, and they don’t get to negotiate prices in advance, so as the party with no information, no leverage, and little bargaining power, they get the worst deal financially.

Simply put, the hospital prices don’t mean anything, other than maybe some sort of individual cost unit estimate multiplied by some sort of secret multiplicative factor. Frankly, I don’t believe that they should even be allowed to do this – I believe that they should be allowed to set a multiplicative factor that is high enough for them to remain open with maybe a little profit and that the rate for each item multiplied by this multiplicative factor should be the price. Not a negotiable rate or a price for a particular health insurance plan, but the price from which no negotiations may be made. For example, let’s say that the price per Wellbutrin tablet is $1 and the hospital’s price multiplier is times five. When the patient gets the bill, it will say “1 Wellbutrin tablet – $1*5 = $5”. If they have an unmet deductible greater than $5, then all of that $5 will go towards their deductible. Great, now the price for that tablet is $5, so the hospital gets $4 toward overhead expenses. If the hospital is in financial straights and needs to stay open, they can raise the multiplier. If they intentionally charge more money for things without changing the multiplier so that they can collect more money to go towards their overhead, that should be illegal, and if they add on unnecessary things to raise the bill, that’s a felony. Everyone gets to know the per unit price and everyone gets to know the current multiplier. All health insurance companies are forced to take every hospital at their rate – no negotiations. The purpose of insurance is to insure, not to wheel and deal. The doctors must be able to look up all the rates and multipliers just like everybody else because when they know the cost, they tend to leave out extra unnecessary costs like unnecessary tests. No switch to “value-based care” or “bundling” needs to happen if the doctors know how much money they’re charging their patients and take measures to avoid incurring unnecessary charges.

Of course, hospitals are money oriented businesses that seek to maximize revenue and minimize cost, so it is absolutely not in their interest to do this. Instead, they wheel and deal with everyone and in every way that they can in order to maximize their revenue minus their cost. This results in MASSIVE administrative burdens which alone make up 25% of the cost. In theory that burden could be mostly removed via automation if things were simple and unencumbered, and doctor’s pay could be cut by almost 50% before it would be in doctor’s financial interest to move to say Canada for financial reasons. That being said, as private businesses, there are all sorts of shady things that hospitals could do to manipulate costs and prices to bring in more revenue. They could come up with some horse shit which obfuscates prices even further (ex. “bundling”). They could leave out or add line items or codes. They could manipulate prices – the health insurance companies won’t stop them as long as they don’t do something big and obvious – little mistakes pass right through. Consumers don’t catch these things – most medical bills contain some sort of error and consumers don’t understand their bill because obtaining understanding requires looking up and asking people about each item, which involves a lot of time, effort, and frustration.

And what about the third parties like third party radiology and anesthesiology? Frankly I don’t even understand how they work – their pricing calculations are complicated and it’s harder for me to get prices out of them than it is to get prices out of my hospital and my health insurance company – in fact it’s impossible. What if they and the hospital that they work with start rejecting health insurance plans, “narrowing” coverage so that they are more likely to be billed out of network? Holy fuck. The prices for services like radiology and anesthesiology should be subject to the same price transparency requirements as hospitals, including making them reveal all their codes (CPT, HCPCS) and work units, the price per code/unit, and the math used to calculate their bills. If there’s a multiplier on them (let’s say the anesthesiologist bills $100 and that fee goes on to the end consumer as $120), then all that information should be public as well. Holy hell this is all very complicated and messy. The system is deeply fucked, but I believe that the more transparent and the less complicated the system, the better.

As for profits, here’s what I think. A hospital should be thankful to be open, and a doctor/surgeon should like what they do even if their salary isn’t a ridiculously high $471,100 (which is the median salary of a heart surgeon). If you only became a doctor for the money, you should never have pursued that vocation in the first place.

Why I Really Want To Help The Homeless

Because giving to them makes me feel happy and I feel bad for them. That’s it. When a homeless person asks me to take them out to a restaurant, saying “no” makes me feel sad and saying “yes” makes me feel happy. Also, I like homeless people. I like strangers in general but most strangers don’t want to chat for long. Homeless people are totally down to tell me the whole story about their descent into alcoholism. I like homeless people and I feel bad for them and that’s why I want to help the homeless.

Do I want to eliminate all homelessness? Not necessarily. Maybe someone likes the freedom. I wouldn’t want to get in the way of that. The majority don’t like it, though, and at the very least I want them to be healthy, happy, and comfortable. If they’re going to sleep outside or in a park I want them to have good camping gear so they don’t freeze or get soaked. I want them to have a doctor so that they don’t die prematurely. And I don’t want them to get harassed by police. I think there should be a right to sleep on the sidewalk because I don’t think people should be put in jail or targeted just because alcoholism or mental illness landed them into an unfortunate spot.

– John

The Case For Abortion

I will start by saying that souls aren’t real and that a person isn’t really alive unless it has a functioning brain. Without a functioning brain, a person’s body is just an inanimate object. When abortions happen, they happen well before a fetus or embryo has a functioning brain that is capable of thinking or feeling. There is some debate about when pain can be felt, but that number is somewhere in the 18 – 28 week range. “Only 1.3% of abortions occur after 21 weeks of pregnancy in the US.

Basically, abortions happen when the fetus or embryo isn’t actually a person in the sense of a mentally thinking feeling person. The people who do have abortions tend to be single poor women who aren’t ready or willing to be parents, and I don’t think those people should have kids. Their children will be fatherless and disadvantaged and ultimately they will contribute to the cycle of poverty. Black women and women on Medicaid tend to be much more likely to get abortions and if they don’t, they will pass on the poverty to the next generation. I don’t know about you, but I don’t believe that people deserve to be born into poverty. Money might not buy happiness past a point, but researchers found “$105,000 to be the ideal income for life satisfaction in Northern America. Earnings past that point tended to coincide with a lower levels of happiness and well-being, researchers found.” Extreme poverty leads to less life happiness and I don’t believe that people deserve to be born into extreme poverty with only a single mother if they can avoid it.

I Am A Loser by John Reed

I am 25, unemployed, single, and I live at home with my parents. I am a loser. Now, I could justify being a loser by saying it’s because I have a mental health problem and if I didn’t have it I would be “normal” and probably employed, but that’s besides the point. In the US, the political right talks about hard work and lifting yourself up by the bootstrap and the left talks about equality. To be honest – I don’t work that hard and to be honest – I am a straight, White, cis-sex male with upper middle class parents who are willing to support me. About a billion people on Earth don’t even have access to electricity. I don’t have it that bad. I am not super disadvantaged, so I can’t say it’s because I come from a disadvantaged background. I am just a loser.

There are countless other losers out there, and nobody hears their stories. White men who have nothing to cry about. They can’t cry about racism or sexism. They are maybe unmotivated and/or they have a mental health problem. They aren’t justified. Right now, I am one of these people.

If I could wave a magic wand and have anything I could ever want, I would have a beautiful wife, a home in an urban area, two beautiful kids, and a stable job that I love. Instead I can’t hold a job, I struggle mentally, and I can’t get sex or a relationship regardless of how much effort I put in. I am one of the left behind people. Left behind by the left and the right.

But I don’t have it that bad. On the streets there are other people with mental problems who are homeless. There are people with real problems. Then there’s me. I can’t do much right now other than wait for a job interview (trust me – I applied to almost everything), so I might as well be happy.

What is the point of life?

I hit rock bottom when I was involuntarily detained into a mental institution. I wanted nothing more than to be free. I was so unhappy when I was trapped. I naturally gravitated towards happiness from there.

If you listen to an evolutionary biologist like professor Robert Sapolsky, he says something along the lines of that the purpose of life is to pass on genes. Some animals form colonies and packs based on kinship because of shared genes (“I would lay down my life for two brothers or eight cousins” is a quote referring to the shared genes and kinship based on genes from kin selection). Now, let’s take a moment to assume that the purpose of an individual’s life is to pass on their genes.

You run into a big honking problem when you run into gay people. What is the purpose of a gay man’s life if he can’t or won’t pass on genes? In this simplistic view of the world, the purpose of a person is to get married and have kids. What if they don’t want to? Would they be going against their purpose?

I would argue that you shouldn’t look at people or yourself this way. It leads to all sorts of dark paths, like the notion that gay people have no purpose and that certain genes can be removed from the human population. I would argue that a better way is to say that the purpose of life is human happiness. You would be treating people as people if you believed that the purpose of life is human happiness. Like the kind of happiness that a prisoner experiences from freedom. That’s why prison is a punishment – nobody wants it and in a perfect world nobody would be no prison.

People naturally gravitate towards this higher form of happiness. People do it through self-actualization and being and perfecting themselves. The deprivation of it to a sufficient extent can make a person suicidal.

Oh my God I just realized I don’t give a fuck about other people. That is why I am single – who wants to be with a totally selfish person?

YouTube video:

“Fixing Incarceration” by John Reed

The problem with incarceration is that it leads people into repeated incarceration rather than preparing them for the outside world. Rather than online job training, the incarcerated have long stretches of no employment, a black mark on their applications, and no skills training. As an example, imagine a computer programmer who goes to jail.

Computer programmers need constant skills training, and the way they get that skills training is through self education. They learn on the job, online, and by doing say programming projects. A computer programmer in jail gets none of those things. They are essentially left to rot, and when they get out their odds of landing a job are much lower than before they went in. Basically, prison prepares people for more prison. That’s the problem with incarceration.

My Atheist God

For all practical purposes, I am an atheist, but my atheism is still sort of like a faith in and of itself. For all the religious people out there, I would like to introduce you to my Atheist God.

As a person, I have a lot of love, but it is internal rather than external. I feel it in my chest, and I love myself immensely (although I used to fucking hate myself). I am very much drawn to things that I love, and very opposed to the opposite. This is what pushes me towards certain things, this feeling that I have about things. I see indulging in things which are more like “impulses” or “pleasures” as sins (see related: So things like cigarettes, gambling, fucking (not like people who you are actually attracted to, but like the impulsive kind), gorging on candies, etc. Like to me eating junk food when there is a healthier optional available is bad or sinful, and good is achieved through discipline (like self discipline) and love (like self love). To me sinful acts are like engaging in pleasure without purpose – hedonism. I believe that hedonism is bad. It looks superficially appealing or “glam”, but it is bad and I do not love it. I actually hate it. It is a waste of time and counterproductive to the purpose of life, or at least of your life. My current theory of moralist is loosely based on Kant’s second formula of the Categorical Imperative, which states “Always treat others as ends and not means”.

Going back to the subject of sin or hedonism, some people kind of get drawn to it when they have nothing more important to pursue in life. For example, when I was younger I disliked my life and wanted to kill a lot of time and became engrossed in a video game addiction. It is meaningless. Writing a piece of software for someone at least has meaning, but video games are just sort of a waste of life. In a similar way, building a business has meaning for some people, but gambling is a waste of life. I personally am more into technology than money, but it’s the same idea. It’s people throwing their life away to sin or hedonism in order to fill a lacking.

As an atheist person, I see the world differently than theist people do. Everything I do is a conscious decision on my part. If I don’t make any conscious decisions, I will basically just lie there and do nothing. Or maybe my legs will get kind of restless lying there, so then I will move them to ease the restlessness in my legs, but that’s still a conscious decision coming from me. My God (which is generally non-existent from my perspective) makes absolutely zero decisions for me. I make the decisions, and my God is just kind of inside me, or maybe she just kind of floats there and does nothing. Whether my sense of God is inside me, just over my shoulder, or floating (invisible) like 20 feet above the ground, she does nothing. She just kind of is. I am her. We are one. I feel love in my chest, and that’s my God. I think God is love, but my God doesn’t do anything, and she usually isn’t on the outside.

I guess one reason for my atheism is that regardless of whether my God is inside me, over my shoulder, or above me, my God is for all practical purposes impotent. I am the one who does everything. She doesn’t do anything.

Yesterday on an airplane I listened to a religious women sitting next to me talk. The subject that we were talking about was abortion and the concept of “pro life”. I mentioned that women have periods all the time and that sperm meets egg forming a fertilized cell that can and often does just get menstruated right out. “We know that about half of fertilized eggs never stick around. They just pass out of the woman’s body” (see: If God put a soul in a cell when sperm fertilizes egg, then my (hypothetical) decision to have unprotected sex with a women during or just before her period would be murder because I would be creating a soul that is then extinguished through menstruation. She (the conservative woman) replied that that doesn’t count because that’s not intentional where as abortion is intentional. My response, which I didn’t say out loud, is to me everything is intentional. God doesn’t do shit. On rare occasions I will think that something is a strange coincidence and maybe that coincidence was an act of God, but then I realize that it was just a coincidence.

Going back to the topic of abortion, if the unborn baby is at eight and a half months old it’s a fucking baby – do a cesarean section for Christ’s sake. This situation was avoidable. A good medical doctor should know this stuff and be able to figure out what the right course of action is, and everyone should have access to a good medical doctor. Medical doctors shouldn’t do medicine for the money. Saving and fixing human people isn’t supposed to be a for profit thing. There shouldn’t be people who “slip through the cracks” or “can’t get care” in the medical system because the existing US medical system is this bloated, disorganized, decentralized, beauraucratic piece of shit that was formed by compromising with stupid, greedy, and even heartless people who frankly should have been told to go fuck themselves. The CEO, shareholders, and board of directors of [BLAH] healthcare company already have a shit ton of money. They don’t need any more money, so they can go fuck themselves. The same is true for the people who collect undergraduate student tuition (50 grand a year? Seriously? What a waste of fucking cash – I went to state school and made good money – private university is a bad investment for the vast majority of people). The cost of undergraduate universities in the US is crazy high, and the big loans that people get don’t exactly force them to pick the lowest price, causing people to pay for bloated “premium” education with lots of “fluff“. Both the hospitals and the universities are bloated fluff services with poor competition and excessive adverting (which looks kind of like catchy sin to me). The medical sector and the higher education sector could use some control from a higher hand. The higher hand of top-down executive control!

Anyway, going back to the story, I was saying that to me everything that I do is intentional (and not an act of God, although to be honest I sort of have this “Messiah Complex” thing where I think that I am like a little God or that God is inside me or something like that, but at the very least I don’t believe that what I do is the result of action taken by an EXTERNAL god who is not me, if that makes any sense). This includes bad things that I do or that I could do (but in general I don’t actually want to do these sorts of things). For example, if I pick up a baseball bat and hit a person on the head with it like Babe Ruth hitting a home run ball, that is intentional. I just (in the hypothetical) made the decision to kill a person with a baseball bat and then did it. That wasn’t the decision of the Devil. That was a decision that I made. If there is a Devil, my Devil, then my Devil doesn’t actually do anything. I mean yeah I get a feeling inside that killing a person by hitting them on the head with a baseball bat is bad, but that feeling is from inside the same way that my feeling of Love is from inside. My “God” or my “Devil” is inside and they don’t actually do anything – I do everything. I exert “top-down executive control” over myself – I am like my own internal God and Devil. Maybe because they are inside, I don’t see any God or Devil or anything on the outside. The closest I get is maybe an invisible feeling or something from over my shoulder or maybe a little above me, but I think that originates from inside my head. In addition, my thinking is basically that even if they (Love/God or Hate/Devil) aren’t there (which they usually are not from my perspective), it generally doesn’t make a difference because they (God/Devil) do nothing (and to me aren’t even real). I’m the one who is doing stuff, not God or the Devil. The hand of God or the Devil or whatever doesn’t move me. I move my hand, not God, and they are just there, as feelings or something from inside me.

I basically don’t have a God or a Devil or whatever (at least not from my perspective) because they are just me. I am like the God or Devil or whatever.

In addition, I think the height of my ego has something to do with my sense of worship (or perhaps has some connection with my “Messiah Complex”, which I do believe that I have, like in this Twitter thread). Pete Buttigieg said that the decision for him to be gay (a same-sex attracted male) was made “way above my pay grade ☝️”. He was referring to his God, which is way above him. My God isn’t way above me. I’m a little like Donald Trump in that I have this big tall ego, so my God isn’t that far above me. Maybe I can get up to the height of my (imaginary) God with a ladder. Maybe if I am feeling grandiose, my God or Jesus or whatever and I are at about the same height. I think that Jesus was just a flesh and blood human who I could have just made eye contact and said “hi” to if we were both living in Galilee around the year 20 AD. We wouldn’t be talking in English, but still. I don’t think of Jesus as this magic man (see: ). Maybe other people thought that, but I think if video cameras existed at that time and the whole thing was on video tape, I don’t think it actually would have looked that way on video tape.

Was Jesus super incredibly influential? Yeah, but so was Adolf Hitler, and he wasn’t magic. Maybe some people thought he was (he thought was the Messiah or something, and the name he gave to himself, “der Führer”, meaning “the Leader” sort of connotes this greatness which other people bought into), but that’s not actually magic like Harry Potter kind of magic. That is more like emotional influential force. Every time a politician (or preacher) gets up on stage and gives a speech, they are sort of exerting emotional influential force. Some speakers exert more emotional influential force than others, but it’s still coming from a flesh and blood human person. Donald Trump may have given off the impression of being this super great thing that is 20 feet tall, but he’s actually this 243 pound man in his 70’s who is six feet three inches tall. If you were sitting next to him, you could poke him with your finger. Some people are more or less emotionally influential that other people, but they are all still flesh and blood people, and that includes Jesus (when he was alive, at least).

On the subject of very emotionally influential people, I think it is really important to use emotional influence for good rather than evil. Some people are really dumb and uninformed, and they will believe shit with no proof just because some emotionally influential person said it or preached it. Looking at Adolf Hitler’s quotes, I think he was aware of this:

People will believe things that politicians and preachers say even if there is no evidence, and based on Adolf Hitler’s quotes, I think he knew that he was lying. A person who fact checks everything to make sure it is true wouldn’t say “Make the lie big, make it simple, keep saying it, and eventually they will believe it.”

Hitler favored science over religion, but his science wasn’t actually based on true facts. Like look at these “Nazi Scientists”:

Measuring skulls (circumference of the skull, etc) is bullshit science. Like it’s one thing if a scientist gathers objective information, puts that information together, and then comes up with some conclusion that is derived from that factually correct objective information, but this is more like smart people intentionally seeking out information that props up something that they already believe which isn’t actually true. It’s bad science.

I can relate to Adolf Hitler a little bit, what with the ego, science, atheism, intelligence, and even an un-attraction away from or a response to physical cash money (*ugh*) [I dislike money – I would rather live in a tent than a gold mansion], but this is just wrong. I mean maybe if he had good mental health and positive, healthy relationships with his parents (there is something kind of Freudian about one’s God) he wouldn’t have lead the German people to commit mass murder. Also, there were bad economic times and a stupid post WWI policy that produced a massive economic problem that contributed to the rise of anger or hate (sort of like the Great Recession did while Obama was President), but after the WWI economic problem Hitler definitely contributed to the whole genocide thing.

Anyway, changing the subject a little bit, I think Bernie Sanders has emotional influence when he speaks, and he influences his followers, but he comes up with stupid shit like changing the federal minimum wage from $7.25 to $15.00. You can’t just change the wage from $7.25 to $15.00. That’s not how it works. You consult with economists who set up a plan to gradually increase it over a period of several years to a mathematically calculated inflation adjusted number, which by the way isn’t as high as $15.00. I think Bernie just picked a number that sounded good and said it over and over again. He’s got leadership skills, and I believe his intentions are good, but I honestly don’t think he’s that smart. My preference for him is based on the assumption that he will have someone smarter and more practical (like Elizabeth Warren) behind him, keeping him from doing something stupid.

What was I talking about again? Oh, yeah, I’m not religious. Also, vote for Bernie Sanders and Elizabeth Warren.

  • John

Blog post from Twitter thread:

Continuation blog post:

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Balancing Government (Socialism) With Corporations (Capitalism)

A corporation’s profits should be tied to the benefit it provides to people (i.e. beneficial and desirable products or services). If a business’s profits are tied to harm, inefficiency, waste, and damage, it should be penalized, reduced, or regulated accordingly. Pollution (including greenhouse gases), usurious and entrapping loans, for profit prisons, for profit healthcare, for profit war industry, and for profit harmful substances like cigarettes and harmful drugs should be regulated or reduced because their money making is tied to harm.

Does this mean that we should get rid of capitalism? Absolutely not. But a capitalists’s stock prices should be tied to the benefit that they provide to the public. If their stock prices are tied to doing bad things or harming people, then they will be incentivized to do bad things and harm people. Cigarette companies make more money and see their stock prices go up when they get more people hooked on cigarettes. For profit prisons get more money the more people go to prison. War companies don’t want peace because that would cut their flow of money. Someone making money off a high interest rate loan has a financial incentive for the borrower to remain indebted. Healthcare companies see more money the more people need expensive surgeries. It is not in a their interest to end disease and suffering in the population as a whole because then they wouldn’t make a cut off all the surgeries and treatments that people need.

There should be an alignment of interests between the companies and the people. When companies that do not benefit the people lobby Washington to bend the rules in their favor at the expense of what is best for the people, these companies do not deserve to profit. They should see their stock prices go down, not up. The healthcare industry is an industry where I have seen this conflict of interest. One big centralized electronic health system built by tech companies would be faster and more efficient than a bunch of spread out systems built by hospitals and health insurance companies, but people who make money off the healthcare system do not want one centralized system with transparent prices because to lose money (and some jobs, but we can help cushion that).

There must be a balance between government and private sector, and if elected, I will do my best to uphold and maintain that balance for the benefit of all. When government is too big and inefficient, I will try to cut government. When corporations are bad or inefficient, I will try to cut, reduce, or regulate them. I will balance capitalism with socialism using my best judgement and as appropriate for the benefit of all.

Thread: .

#Corporate #Capitalism #Government #Socialism #Industry #Regulation #Regulate #Corporation #Economy #USA #World #People #Humans

Why I Will Use The Woman’s Restroom

Short Answer:

Gay men use the same bathroom as other gay men and lesbian women use the same bathroom as other lesbian women, and they fucking get over “same sex attraction” because they’re socially competent adults in a developed society.

Long Answer:

I write this piece from the comfort of a toilet seat, in my single person bathroom, in my single person apartment. I remember when I was in middle school we had gym class and the boys all had to change in the men’s locker room. It was an uncomfortable feeling, to come into a circle around a wooden bench with a bunch of guys and change into and out of gym clothes. There was like this wooden bench that guys put their clothes on while changing, and behind them there were green gym lockers. I went to a single person’s stall in the locker room and changed there instead, or at least I did the first several times. I remember telling a classmate of mine in the men’s locker room “I wish I were normal”. He replied something to the effect of “nobody is normal” or “what is normal?”. I couldn’t answer that question, but after puberty (and after a run-in with symptoms of bipolar disorder), I didn’t think I was normal. I did think this other guy was normal, though. He seemed content and reasonably confident in himself, with no apparent psychological or psychiatric problems, and he later dated a very normal seeming girl who also seemed reasonably content and confident in herself. Both of them were a little quirky, but they seemed very normal, more normal than I ever was. In addition to being mentally sane, they were also apparently much more emotionally straight that me.

As a young male person, I hated women (and also myself). I wanted to lose my male virginity, and women did not want me to fuck them. I made a list of desirable characteristics in a woman, and at the top of that list was “short stature”. I didn’t understand that there was a connection between relationships and sex at this time in my life (or for many years after puberty, honestly), but I did understand that I wanted to put dick in girls, and they didn’t want me putting dick in them, and this was a problem because if I couldn’t put my dick in girls I couldn’t lose my male virginity. Yes, this is basically how my male brain worked as a teenager. Some women even seemed to like or love me, but I didn’t really understand that until over a decade later. Like this one girl named “Cathy” got me this Teddy Bear for Valentine’s Day in 8th grade, went to my birthday (which was at a beach where I basically stared at her boobs), and later at the end of 11th grade (I think it was 11th) she wrote this in my yearbook. We were friends and I think she liked me or loved me (at least at one point – we had lunch alone behind the school together a few times, and to me that was like middle school dating). I liked her too, like as a friend who I could eat lunch with in 8th grade. She later ended up dating my older male friend, which I didn’t like. Me personally, the thing I remember most strongly about her is how tingly my hands felt on top of her bra (don’t ask how they got there – she took my math book and I kind of tried to wrestle it from her) when I was in 8th grade and we were having lunch alone together behind the school. The feeling, it was like lightning that shot up through my body starting from my hands, then up my arms, and to my head, and my bipolar made it stronger. I felt kind of embarrassed feeling sexually turned on around her (it was instant), and when I was in middle school I took active measures to conceal erections. I felt really embarrassed, and I acted awkwardly. I remember hiding this erection and saying to her that I had to go look at an encyclopedia or something. Man teenage years suck.

Cathy had this annoying high pitched laugh, a friendly voice (she liked me), and she constantly asked me to shave, just like my mother did (I don’t think either of them realized how much I hated that), because apparently they both find a clean shaven look to be more sexually attractive than facial hair. Oh boy. Hey – I also find pretty boys to be more attractive! I kind of had this pretty male friend (no sexual attraction, although to be honest his face sort of resembles that of my current girlfriend – they both have hot eyes). He did ballet and later wrote poetry [click “The Work” at this link to see his poetry]. He was adorable, and he had this blond anime boy hair that sort of moved back and forth when he shook his head, and he liked this song. Oh Stefan. He’s adorable, and I talked to him a lot and he listened and occasionally made wry comments, and the two of us were inseparable when we were together. He was on the way to a friend’s house when we bumped into each other near some trimmed hedges. He had a volleyball, so we played 1-on-1 volleyball over the shrubbery, and later I would literally show up at his house at like 7AM on a Saturday, and he would open the door in his pajamas with this funny look on his face and be like “Do you have any idea how early it is? *Hrmph*“. We were friends, and I loved him. One time we were talking about girls and I said I didn’t like girls, and he retorted that this implies that I was gay, and I said that I wasn’t gay. Later on he or his father said that he thought that homosexuality was a choice, but for me fucking guys was physically not something that my body could do, so to me it wasn’t a choice (although I later did question whether or not I was straight). His future girlfriend didn’t look like someone who I would want to fuck, so I guess I can see how he might be a little gay in a way, although I think he really loved her. This was many years later. Anyway…

Going back to the story, Stefan moved overseas because his parents had issues with taxes, and I was absolutely destroyed, and when I was 13 I kind of threw myself at Cathy to fill the deep emptiness that I felt after Stefan was gone. I was unhappy about the end of my friendship with him for years afterwards. We mentioned something about doing long distance over Skype, but it never worked out (although we did one Skype call), and that made me very sad for a long time. I didn’t really have closure. It took what felt like an eternity for me to find that kind of a relationship again. After a long time he found me on Facebook and added me as a friend (I wonder if he was ever attracted to me in some way), and one time my parents went over to Europe and we played soccer together, but it just wasn’t the same. I kind of went from this happy kid to this miserable narcissist after I went through puberty, and my heart was closed off, and it just wasn’t the same. I just wanted to fuck chicks to fill my sadness whole. *Wha ha ha ha*. Years later, I sort of randomly messaged him “I love you” on Facebook messenger, and he was sort of like “OK”. If he told me he wanted to have sex with me, I probably would have had about the same reaction 🙂.

Anyway, back then I changed from this kid who was always smiling to this mentally fucked up person. I became embarrassingly and uncomfortably hyper-sexual (and the mental problems probably contributed). I fantasized about Cathy when I masturbated, which is generally not something that I do with people who I am actually in a real romantic relationship with. Like I don’t fantasize sexual scenarios involving my girlfriend or the person who I was in a relationship with before her, or the person before that, or Stefan (*eww*, lol ❤️). Generally if I fantasize sexual scenarios about someone, I’m not actually into them in real life (regardless of what thoughts pass through my head at 11PM the next day). Why would I fantasize sexual scenarios about someone if could have real sex with them in real life? I think some sexual fantasies are just a result of sexual repression – like things that you want to do but don’t. The point is that I never loved Cathy. Anyway…

I didn’t really have any psychological connection between romantic love for a person and sex with women (attachment, sure, but not love), and I didn’t really connect relationships with sex until later in life. Like I just thought someone else turned you on and you turned them on and then you two fucked (sort of like a male and a female animal that are alone together). I didn’t really have a relationship with a woman that wasn’t sex based until after I graduated from the University of Florida. I mean I had a female friend who I had sex with and became attached to, but it was a bad relationship (although she instigated almost all of the sex) and she had to bully me or trick me to get me to have sex with her. Like I didn’t have the kind of relationship where it gradually progressed from hanging out to kissing to more than kissing until after I received my bachelor’s degree from the University of Florida (at age 22). I mean at an LGBTQ+ nightclub (which had drag queens and a “men get in free” night back then) at the University of Michigan, a femme looking lesbian who I was sort of dancing face to face with grabbed me by the neck once and started tongue fucking my mouth, and that felt hot, but that never became a relationship. I’m not sure why she did it, but she kind of noticed my eyes, was drunk (and probably turned on), and later used the term “animalistic urge” to describe the feeling that she acted on when she sort of grabbed me and started making out with me. I got her number, but when we were texting, she texted that the making out didn’t feel hot to her like it did to me and also she was in a relationship with this older, butch looking lesbian who was in another city at the time (I didn’t know about this until after). I liked her as a friend and she was very hot.

Anyway, I don’t think it occurred to me that there was a connection between sex and relationships because I never really connected sex with love (assume that healthy attachment and love are not the same thing). Like in my late teens I had a guy friend who I loved (different guy friend, also attractive) and I had “girl friends” who I wanted to have sex with, but I didn’t really come to the conclusion until later that I was supposed to have both of those things (like the romantic attraction to the person and the sexual attraction) both in one person until later. Like some people (who are kind of like me) sort of have someone of the opposite sex who they’re attached to and have sex with and they have someone of the same sex who they would go on long walks on the beach with, but those were two separate people. You don’t marry two people and get sex from one person and love from another person. You marry one person and get both love and sex from the same person (hopefully). I mean some people don’t feel sexual attraction and they have sex a little differently, but there is still some sort of coupling that holds you two together, where your needs are met, and you are secure (hopefully, although you should be secure before you find this other person).

Anyway, the point is I love men (I admit it!) and that I’m emotionally gay but heterosexual. Like I’m gay when it comes to the person, not the body. I hope that makes sense. I think my girlfriend is also like that, because if she wasn’t like that I don’t think we would have the gender balance that we do and I don’t think she would be into me the way she is. Like she likes Chuck Norris and she talks kind of like Chuck Norris (from “Walker, Texas Ranger”), but despite her masculine characteristics I still want to fuck her (love + sexual attraction is the best). I’m sexually attracted to the opposite sex, but it’s a neck-down thing. Don’t Google this if you don’t want to see anything explicit, but look at the lady from “BehindTheMaskk” and you’ll kind of get what I mean by “it’s a neck-down thing”. I’m not gay or straight. Technically, I am a homoromantic heterosexual (Google “romantic orientation” if you don’t know what “homoromantic” means). There’s a gender balance.

Anyway, I’m kind of like a girl a little bit. Like I often feel like I want to be in “women’s” places, like for example at the University of Michigan there was a feminism club where girls (young women) met every week to sit in a circle on couches and talk about stuff from women’s studies and feminism. Or like I would do hot yoga, aerial silks, that kind of stuff. I like this and occasionally I’ll sing along. There is this sort of love for femininity that some gay men (including some masculine looking gay men and also me) have. That being said, I sometimes felt pressured to be more of a man. Like with my female friend who bullied me in to sex (in a bad relationship), I would sit down to pee and she would ask me why I didn’t pee standing up. Apparently she wanted me to pee standing up. I sometimes get a sexual feeling when I see guys peeing standing up from behind, and I guess she was looking for something like that from me *eww – I am not into her – get away from me*. Like when I look at James Deen at that link in the previous sentence, I can kind of feel this sexual feeling in my junk, but I don’t have any desire to like touch myself or anything the way some girls do when they look at something online that gives them that sexual feeling (I am guessing that this is the same feeling that some femme straight women feel when they watch lesbian porn, which according to PornHub is a popular form of porn for straight women). From my perspective as a guy, straight girls are gay (I mean just look at how they look up Kim Kardashian on PornHub), but that’s just how it looks from my perspective, with my definition of the word “gay”. The way I define “gay”, straight women are gay. I don’t look at naked dudes the way straight girls look at Kim Kardashian on PornHub. I’m a top, not a bottom, and I’m not physically sexually attracted to males. No “same sex attraction” as Dr. Michael Brown calls it, but I honestly think that femme straight girls do have some of that “same sex physical attraction”, which is why they come off as gay to me.

Anyway, getting back to the point, I pee standing up because it’s faster, but in general I like to pee sitting down. Heck, sometimes I even do my eyes to make them look attractive, although I very rarely wear eye makeup (except for this YouTube video). I’m messy and not super self aware, and I rarely put in the effort or care to make myself look good unless I am making a YouTube video or maybe going on a date or something like that. My girlfriend offered me liquid eyeliner before though, a gesture which I appreciated. On the exterior I am very male (for example I want arm muscles), and I am apparently masculine on the outside, but on the interior I’m kind of the opposite. Also, when I look at the men’s and women’s bathrooms, I kind of have a tendency to go towards the women’s bathroom and I have to kind of catch myself and steer myself into the men’s bathroom, and also I like gender neutral bathrooms. On multiple occasions I accidentally walked into a women’s restrooms and then rushed out, although to be honest nowadays a lot of them look almost the same except for the urinal in the men’s room.

Also, it is really awkward when me and another guy pee side by side. Like occasionally there is no divider between the urinals and I kind of sort of notice or want to look at the other guy’s dick. I’m not gay, but there is something sexual about dicks. Don’t tell anyone this, but I secretly own a dildo. Okay, it’s not that secret. Anyway, if there is no divider, I would rather just use a stall. Basically, I’m like a woman or a “male lesbian”, and I would like “to achieve the complete dismantling of all gender based institutions“, as I Tweeted, because sexism, homophobia, sexual repression, etc. are bad for people and I don’t think that restricting people socially or keeping them from being themselves helps. Just look at what happened to the gay Catholic priests:

But yeah, I believe that these sorts of things mess people up in the head. I know these sorts of things affected me in the past.

I am a liberal, god damn it, and I will pee in a girl’s bathroom.

See Twitter thread:

The Problem of Poor Tech Leadership at Bank of America

At Bank of America, I ran into the worst codebase that I had ever seen. It was written in the Scala programming language, and I love Scala, but this codebase was like a wooden ship that had gone without maintenance for so long that the wood was rotting and it had taken up water. Morgan Stanley also ran into issues with its Scala codebase, but this was worse. Java and Scala are two different programming languages and the way you run a Scala project is different than the way you run a Java project. Java is backwards compatible and Scala is not because Java is fully matured and Scala is not. I believe this delay in maturity was a deliberate design decision made by the creator and head of the Scala programming language, Martin Odersky, because without backwards compatibility, it is possible to retroactively fix flaws in the programming language. That being said, without backwards compatibility, and with a totally different programming paradigm, a certain additional degree of care must be taken (including additional maintenance), and the people who handed me this Scala codebase DID NOT take this additional degree of care and DID NOT do any maintenance. Imagine a president who ran up their country’s debt up to the absolute max before handing it over to a new president from another political party. Or imagine that you bought a used car that was on the verge of breaking down. There was a lot of technical debt to be paid back and a lot of maintenance and updating that needed to be done. The old ship (codebase) must be repaired before it can set sail again (i.e. before new features can be added), and this codebase was in a complete, utter state of disrepair. It also had many security holes, which to me went part and parcel with how flawed and shitty it was from a software perspective.

Looking at the logs, people who originally built this codebase no longer worked at Bank of America. I looked one person up on LinkedIn and he apparently left to work at Facebook. The last code change in the build was over three years ago. Apparently this codebase had been built sloppily and neglected for years before being handed off to unsuspecting me (plus some other people), and I couldn’t even contact the people who wrote the code that I was working on because they either did not work here anymore or they were in India. Basically, they left a complete and utter dysfunctional mess, and now it was my job to continue where they left off. Oh boy.

The codebase was the worst thing that I had ever seen. None of the tests ran and passed. The build was completely messed up. Everything was deprecated and needed to be replaced. This codebase was like a car where the engine, headlights, oil, carburetor, and every major component was broken and needed to be fixed before the thing could make forward progress again. The fact that they left the keys in the ignition (a massive security hole) was the least of my problems – if they knew exactly what they were doing the security hole wouldn’t have even been there, but they winged it – poorly. I wing things, but I first do my research, plan it out, and execute it meticulously, but these people were sloppy and didn’t do their reading. My main concern at the time was that the codebase was so bad that it was virtually impossible to make changes or updates to this codebase without redoing almost the whole thing. The codebase was built on top of an HTTP library that was deprecated (Spray), and they were supposed to have switched to a different one (Akka HTTP) years ago, but apparently these people did not get the memo. The memo was posted on the Spray website for years, like so:

If you look at the website, it is clear that you were supposed to migrate from Spray to Akka HTTP, but they didn’t migrate. The people who created Spray tweeted and posted in multiple places that all the users should migrate, but the people at Bank of America apparently didn’t get the memo. The Bank of America firewall blocked all the social media websites, so one possible explanation is that the people who created Spray were posting and posting, but nobody at Bank of America got the memo. This codebase was built on top of rotting, deprecated shit, the people who built it were no longer available, and now it belongs to me. Oh boy. On top of that, the bank employees who used this codebase had no idea that it was supposed to have regular maintenance and updates. The people before me didn’t really know what they were doing and they just left the thing, and now I am supposed to add new features to it. This never goes well.

One difference between Java and Scala is that because Java is almost totally matured, it doesn’t change as quickly, so things don’t get old or deprecated as fast. It doesn’t change or move as quickly, so it doesn’t need as much updates and maintenance. Bank of America has these ancient codebases written in very old versions of Java, plus they had mainframes that were running code written in COBOL. They were very behind the curve technologically, and this particular project was constructed by a startup like organization that was acquired by or inside of the Bank. The startup type people apparently picked the most experimental, bleeding edge, pre-release technology and then abandoned it and then the bank people took it over. The only problem was that the startup people were good enough to be hired by a company like Facebook, and the bank people were in India and I could barely understand their English. This codebase was in such bad shape that it crashed constantly, ran terribly slowly, and was impossible to work with. The people who worked on it (including the guy who left to work at Facebook) didn’t know what they were doing (perhaps because there is a learning curve, the functional programming language Scala is not meant to be coded in like C++ or Java, and also because the documentation was blocked), and it was the worst software system that I had ever seen. At least at Amazon someone code reviews your code before you push changes, so if one person disappears you can always talk to the person who did the review, but here there was zero review. The bank just kind of paid money for a thing and the people who were in charge of this thing didn’t what they were doing. For the tech people it was like “the wild west”, and for the bankers, it was constant frustration because the software kept breaking and crashing, and it took FOREVER for them to see new software features.

A while back my mom told me a story about a guy who was assigned a software system to work on. This software system was like a trading program that had previously been built by one guy. The trading program made a lot of money for the bank, but then the guy suddenly quit. They needed to make changes to this trading program, so they grabbed this other guy and told him to continue where the previous guy left off (this isn’t exactly what happened, but you get the idea). I could imagine sitting down at this other guy’s trading program and feeling like it was written in Chinese and also busted in 50 different places. No, it wasn’t literally written in Chinese, but it was unintelligible. There was no code review, no oversight, and no responsibility. The previous person just abandoned the thing. Now you have to either learn Chinese and fix all the things that are broken or start over and create a new trading program that trades just as well as the old one. Normally you would do the former, but in Scala there is no backwards compatibility, so you can’t just abandon it for years, especially if the stuff that it was built on is already rotten and deprecated. The whole thing needed to be migrated to a new system and redone, and apparently the only person at Bank of America who had any idea how to do this was me. I was now leading the charge (without issuing a single verbal order), and people almost twice my age were coming to me.

Scala is a bigger, harder programming language than Java. If you’re not a great programmer, you could write Apache Spark (data processing script type) jobs because you don’t actually have to fully know the Scala programming language to do that, but you’re going to run into problems if you try to do a big, complicated backend system with no guard rails. These people who came before me tried to do something big and complicated, and they wrecked the thing and left it in god awful shape before abandoning it. The setup instructions hadn’t been updated in like four years and I basically wrote entirely new setup instructions and provided them to everyone, bought everyone technical books, and planned out a migration path. At Bank of America, there were people of all skill levels from people who had no idea what they were doing up to me (and some people who I think were pretty close to me but didn’t work as passionately), and these people were spread all over, from New York City to India. They totally screwed the whole thing up. Heck, in order to talk to another person who was working on the same code as I was, I had to wake up early in the morning and get on Skype because I was in the US and they were in India. Apparently Bank of America never heard that coworkers are supposed to be in the same time zone.

Ideally, you have someone running the show who is really smart, thoughtful, can lead without having to yell orders, and who knows what they are doing (i.e. the technical lead or software architect). Bank of America didn’t have someone like that, at least not on the codebase that I was working on, so I kind of filled in for the absence of that person. Before I worked at Amazon Web Services, and everyone was good or better and they were all in the same building. Here there were people ranging from “I have no clue what I am doing” to “I have this super detailed plan to fix everything, but I don’t have approval because the person who is supposed to give me approval doesn’t actually understand the problem”. You can guess which one I was.

In software engineering, this state of being stuck in a problem is called “The Tar Pit”, a term taken from the book “The Mythical Man-Month“. This group of programmers was in “The Tar Pit” because there was nobody in charge who knew what they were doing and the thing was in a total state of utter disrepair. There was nobody with prior knowledge and experience to enforce structure and order. Nobody read the manual, and because of the firewall, the website with the manual on it was blocked anyway, so I had to use my phone to read it at work. I used my phone, but apparently the people before me did not. They just winged it, and they did it terribly. I took control of this situation, and then my recruiting company, TekSystems, kind of mysteriously fired or transferred me from Bank of America, and then the Russia Investigation happened, and I got thrown into some stuff. From there my life became crazy.