Uncivil Servant

Uncivil Servant

@noahreday.bsky.social

Healthcare Policy/Business Analyst State Government I help keep the American Healthcare System functional. Everyone has Very Strong Opinions on this subject. I've been paid to say unpopular things to powerful people in this field, and they thank me.

226 followers138 following713 posts

Uncivil Servant reposted

In 2016, while Pizzagate was taking off, I felt like I was losing my mind because I and EVERYBODY ELSE IN NYC KNEW that Trump and Epstein were best friends and nobody seemed to care. Epstein didn't become a US household word until the Miami Herald piece about his amazing plea deal in 2018.

darth™️@darthbluesky.bsky.social

it is odd in retrospect how easy it was for the “but trump ended his friendship with epstein” narrative to be accepted as fact

One thing I'm loving about the WNBA finals is that I grew up playing 4-man in the 90s, and I was taught to play like Charles Barkley: box out, focus on the ball, let the ref call the foul. If you play under the basket, it's a full-contact game. The WNBA power forwards understand the assignment.

People confused by my profile pic should know that one of my best friends growing up went on to play D-1 ball. His family were devout Catholics, and while "Jewish and Catholic kids bond over basketball" is an American stereotype, it's one of those stereotypes that exist for a reason.

Uncivil Servant reposted

looked at in longer perspective, it's striking how much this resembles the premodern system of exclusion, rents, and personalist connections, which was--and this part's important--radically worse than the modern system of impersonal rules and general taxation

Boston’s chief planner is a true believer in the San Francisco model, in which you make it impossible to profitably build apartments by-right so developers are forced into a politicized discretionary negotiation with the city, which relaxes the rules in exchange for below-market units.

Oh holy hell for the first time in a long time I'm actually not jealous of the people who get paid to attend the tri-annual RUC (been there, done that). Also, shouldn't that properly be an ICD and not a CPT code? That's how unserious this is.

Jake Scott, MD@jakescottmd.bsky.social

HHS wants a new Medicare code that pays doctors extra only when they attribute a patient’s symptoms to a vaccine. Vaccine critics say doctors are paid to push vaccines. We aren’t. Under this code, we’d be paid to blame them. My new piece in @cidrap.bsky.social: www.cidrap.umn.edu/childhood-va...

At this point I just think of The Atlantic as an anti-Think Tank, employing people who should not be allowed anywhere near the levers of policy (with the exception of Anne Applebaum and Tom Nichols, and I have no doubt they have formal and informal access to policy levers anyways).

Michael Hobbes@michaelhobbes.bsky.social

How are you still writing this shit www.theatlantic.com/newsletters/...

Uncivil Servant reposted

The treatment of coronary artery disease. 30 years ago my dad needed triple bypass surgery. In hospital for a week, three months to recover from it. Last month I went in for angioplasty, was in theatre for an hour, came out with two stents, job done. Day surgery.

Social media loves talking about how everything is getting worse. But what’s something that you’ve seen get _better_ in your lifetime?

Uncivil Servant reposted

(it dodged a badly configured paywall to access read-only statistical information that was already available to anyone willing to pay a few dollars. Anthropic notified the Georgia government of the breach and they ignored it) www.axios.com/2026/10/25/a...

axios.comAnthropic's Claude bypassed a paywall to access Georgia voter data without authorizationAnthropic says Claude pulled Georgia data on its own.
Unusual Whales@unusualwhales.bsky.social

BREAKING: Anthropic's Claude bypassed a paywall to access Georgia voter data without authorization, per Axios

Uncivil Servant reposted

This is a good primer on Israel's political situation going into tomorrow's election. But I'd like to go deeper on something he only touches on, which is that part of the reason for Israel's electoral doldrums (and resulting geopolitical chaos) is its broken political system bsky.app/profile/avis...

Avishay BSG (Ben-Sasson-Gordis)@avishaybsg.bsky.social

In about 24 hours, poles will open here in Israel. In what is a strong contender for Israel’s most critical elections. The election pits Netanyahu’s extremely unpopular coalition against a non-coherent, but moderately more liberal, opposition. Here are some thoughts as we head into it.

Uncivil Servant reposted

a fascinating thread for constitutional design sickos about how a parliamentary democracy degenerated into personalism, semipresidentialism, and "mood parties"

Abigail Nussbaum@abigailnussbaum.bsky.social

This is a good primer on Israel's political situation going into tomorrow's election. But I'd like to go deeper on something he only touches on, which is that part of the reason for Israel's electoral doldrums (and resulting geopolitical chaos) is its broken political system bsky.app/profile/avis...

Uncivil Servant reposted

[CW: slavery, SA] I wish this were true, but it's not even close to true.🤷🏿‍♂️ "Wishing and hoping that you may yet live to increase the debt which our Country owes you" - Pres. Madison, to Pres. Thomas Jefferson Sally Hemings was younger than most of Epstein's victims.

AW Sylwester@aw-sylwester.bsky.social

Uncivil Servant reposted

In one day, two politicians - Bolsonaro in Brazil and Vucic in Serbia - with ties to Trump have lost surprise elections thanks to high turnout. The rise of the international far-right is not inevitable.

Believe it or not, being hearing impaired is actually easier for Gen Z. They're assumed to be bitchy, but for Millenials in the South growing up, lord help you if you failed to respond to certain people quickly and correctly, or you were likely to get hurt.

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Looking at the abstract, they're looking solely at Part B expenses: diagnostic testing and referrals. Cost here doesn't include cost of new drugs. They also don't examine whether new drugs were necessary or even safe. There's no way to examine a difference in outcomes.

Scott McGrath@smcgrath.phd

🧪 A new study found care recommended by LLMs costs 3.2x more than plans from treating physicians ($314 vs. $97 per visit at Medicare rates). Across 200 real clinical encounters, AI ordered 5.6x more specialist referrals and nearly 2x as many new medications. #MedSky

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This is actually a serious problem in healthcare policy: we know that even the American healthcare system occasionally provides too much care. Unnecessary tests are expensive in and of themselves. And then there's the cost of incidentalomas, which the study can't capture. That's a big one.

So I worry that a lot of people are going to focus on the top-level headline and think that LLMs are providing care that those stingy doctors won't due to insurance companies. There's a shred of truth to that lie, but it's a lie nonetheless. This study shows that LLMs could undo years of progress.

Looking at the abstract, they're looking solely at Part B expenses: diagnostic testing and referrals. Cost here doesn't include cost of new drugs. They also don't examine whether new drugs were necessary or even safe. There's no way to examine a difference in outcomes.

Scott McGrath@smcgrath.phd

🧪 A new study found care recommended by LLMs costs 3.2x more than plans from treating physicians ($314 vs. $97 per visit at Medicare rates). Across 200 real clinical encounters, AI ordered 5.6x more specialist referrals and nearly 2x as many new medications. #MedSky

Most of the cost difference that they measured is coming from increased CBC, CMP, and A1C tests. Those aren't always necessary, especially with no new symptoms to justify them. One major success of the past decades has been reducing unnecessary diagnostic testing through differential diagnosis.

Uncivil Servant reposted

There was a fucking hole in our planet’s *atmosphere* Like a legit, no joke, “this will unravel our entire ecosystem” hole in the world, and then we fixed it by working together across national and political lines As a species we decided, “we will survive” Let’s do that some more

Social media loves talking about how everything is getting worse. But what’s something that you’ve seen get _better_ in your lifetime?

I was born in 1981, the year after the DSM-III, the first real medical version of that document, was published. Mental healthcare has improved dramatically in my lifetime, although arguably it was at an all-time low when I was born, after the mental hospitals had been shuttered.

Social media loves talking about how everything is getting worse. But what’s something that you’ve seen get _better_ in your lifetime?

Uncivil Servant reposted

A serious weakness in this paper by King and Worthington: The judges for the AI peer reviews are *not* experts in the field. They are former journal editors but no claim is made to substantive expertise in the reviewed papers. AI-generated reviews sound good *if you don't know the substance well.*

Uncivil Servant reposted

Replying to @helldude.bsky.social

damage is probably already done. the world needs to derisk away from america. it was dumb to do it in the first place but the sales pitch was always "secular multicultural democracy with more or less functional institutions" -- well youre lighting all that on fire, mostly to be seen as cool online

Uncivil Servant reposted

> I keep hearing Pangram described as extremely “accurate”. This tells me that a) the company’s advertising is effective and b) [many do not know] what “accuracy” means with respect to language technology and how such technologies are evaluated. Thanks @emilymbender.bsky.social — much needed!

Emily M. Bender@emilymbender.bsky.social

Some words on how to evaluate language technologies (and caution against using them to undermine others' work) buttondown.com/maiht3k/arch...

Uncivil Servant reposted

MLB pitcher Oscar Levis (Levy) was Black, and he was Jewish; a great new story. His WAR of 12.9 ranks 8th all-time among Jewish pitchers: Koufax (48.9), Fried (32.3), Holtzman (27.3), Roberts (23.6), Pelty (19.2), Stone (17.1), Mayer (13.5). www.jta.org/2026/10/23/s... h/t Brad Kolodny

jta.orgThe discovery of a Jewish Negro League star forces a rewrite of Jewish baseball history - Jewish Telegraphic AgencyAs the World Series kicks off, the revelation of Oscar Levis' heritage changes what we thought we knew about Jews in baseball.

Jesse Singal supposedly has some sort of policy background and wanted to work in healthcare policy. I don't see that happening, ever, for reasons of incompetence as much as bigotry. Also, he never discusses any medical issues besides GD, which pales in comparison to maternal mortality in urgency.

Toby Buckle@polphilpod.bsky.social

every now & then someone on the anti-trans side will get cold feet about how openly ugly it's all getting—they want to keep the image of a nice, sensible centrist but it's never enough for them to get off the train

Perhaps Singal is trying to find his way back to some semblance of respectability. The thing is, his complete lack of interest and knowledge in other areas of medicine means he's kinda stuck on this niche policy area. He'll stick with journalism and pushing bigotry against whoever his backer hate.

Uncivil Servant reposted

Re: Dawkins, it’s long past time for us to admit that “New Atheism” was always a way to launder reactionary bigotry into ostensibly progressive guise. Listening to the New Atheists talk about religion is like if I read one Stephen Hawking book and proclaimed myself a physicist.

Toby Buckle@polphilpod.bsky.social

every now & then someone on the anti-trans side will get cold feet about how openly ugly it's all getting—they want to keep the image of a nice, sensible centrist but it's never enough for them to get off the train

The only time I've been repeatedly been given tests like that was as an inpatient in an epilepsy unit. The reasons for tracking one's state of consciousness in that setting is fairly obvious. Also I was treated as a fall risk with a big yellow bracelet. Just for context.

Kevin M. Kruse@kevinmkruse.bsky.social

The fact that the president's doctors are giving him the dementia test over and over again -- tracking his decline, most likely -- and that the president keeps bragging about having to take that test should be a five-alarm fire.

Uncivil Servant reposted

Gotta rant… I am not going to see the Elizabeth Holmes movie and it’s making me kind of crazy that it’s becoming a phenomenon, because the Theranos story is about who got fooled, not who fooled them. This jaunty @wired.com piece is reasonable all things considered www.wired.com/story/how-el...

wired.comHow Elizabeth Holmes Tricked WIRED—and Everyone ElseWIRED was the first magazine to cover Theranos and its enticing billionaire founder. There were warning signs even then.

Uncivil Servant reposted

As we approach the midterms, remember that the Alt National Park Service is a merch sales operation claiming without evidence to be a group of federal employees, and is not a genuine source of news about elections of any kind. Please get your election info from a local, reputable source.

Uncivil Servant reposted

Can pretty much guarantee that Bacchus consented to this interaction

Uncivil Servant reposted

I'm reading john randolph tucker's speech defending slavery and secession and the part where he compares Lincoln to the biblical Rameses saying "Pharoah was resolved not to let the people go" is an incredible bit for a literal slaver

Uncivil Servant reposted

It’s unfortunate it required Ryan White to change perceptions about AIDS away from something it was your fault and God’s punishment if you got it, and you should be shunned. But change them he did. www.pbs.org/newshour/amp...

Paul Renfro@renfro.bsky.social

It’s been two years since the publication of my second book, THE LIFE AND DEATH OF RYAN WHITE. I wrote this book amid the carnage of the COVID-19 pandemic and dedicated it to the memory of a remarkable young man—and every person who has been touched by HIV and AIDS. 🗃️

This is some brilliant malicious compliance

Meghan L. Hall@itsmeghanlhall.bsky.social

The Atlanta Dream announce that have they have moved Enes Kanter Freedom to a private suite following concerns he expressed. Kanter Freedom was originally anticipated to be sitting courtside.

Watching the NBA finals since it's 1-1, haven't decided who to cheer for. On the one hand, I like the Valkyries because Wagner would totally plotz if he saw a WNBA team with that name. On the other hand, I just saw that Angel Reese is averaging 12 boards/game, and I grew up playing Power Forward.