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Why doesn't the US study how other countries achieve affordable health care?

Note: The title of the question has changed from “Why doesn’t the US have affordable health care like other countries?” My answer is for that original question - not the current version.For some, with little real experience of other countries’ healthcare systems, it is due to a few simple factor (“greed”, “no single payor”, “expensive drugs”…). However, those are symptoms and signs, not causes, in my humble opinion (after direct experience of UK, Canadian, Argentine, French, Swiss, Mexican and Singapore systems). Each country worked out what was best for it but guided by an underlying solidarity philosophy; some have single payor (national HMO’s, like the UK), some have multiple payors (national PPO’s) and other have mixed systems (France and Mexico among others) where the two models co-exist.I. Socio-political factorsLack of solidarity. Some Americans do not feel that they should take responsibility for the wellbeing of other citizens. Despite what Hollywood portrays, the USA still includes large segments of population who don’t empathize with all citizens.Covert Racism. Blacks and poor immigrant groups disproportionately benefit from social welfare programs and many voters resent that. No politician or even private citizen on record would admit to this motivation as it is politically incorrect. It’s usually described as “sponging off hard working Americans who pay taxes”.Extreme Mercantilist Vision.Some view healthcare as an expense that is best managed in a free market.Medical education is not subsidized as in other developed countries where healthcare is seen as an investment by the State and a right by their citizens (like education, court system, roads, water supply, waste management, transport, electricity, military…). So, unless they are rich or have scholarships, American MD’s often end up with some $500k in student debt if they attend a private university ($20–60k per year’s tuition, plus living expenses) and so are very motivated to seek high remuneration, i.e. do not become Generalists but more highly-paid SpecialistsThe lack of coordinating Generalists leads to highly inefficient use of medical resources except for well-run HMO’s (provider plans that use a gatekeeper Generalist who are in extremely short supply in many areas)A judicial system based on adversarial parties with punitive malpractice awards, encouraging:“defensive” hyper-specialization with circumscribed liability“defensive” overuse of diagnostic testsvery costly malpractice insurance (hundreds of thousands of dollars for some neurosurgeons)US doctors’ average remuneration is at least two-to-five times that in other developed countries.II. Vested Interest - ObstructionismHealthcare provider lobby.Consolidation of healthcare provider groups. MDs cannot survive alone so they become employees or join groups that can share the administrative burden of office staff to deal with hundreds of pre-authorization and payor processes.Each US State has a Medical Board that guarantees a closed medical employment market, requiring State Licensure as a means to hinder the free flow of MD labor across State lines in many cases.Despite the resource of thousands of MD immigrants, the accreditation process takes at least 3–5 years for foreign medical graduates, with an obligation to compete for hospital training (“residency”) spots. For all but young doctors, it is an obstacle that is difficult to overcome and they end up in other professions. It is tantamount to protectionism in the medical profession from foreign labor.Medical industry lobby. Drug and device manufacturers lobby to prevent national-scale price negotiation as it has to with Medicare, the Federal health insurance program for the elderly. The actual cost of drugs and equipment is kept secret by the insurers and suppliers; this opacity of pricing prevents free market dynamics in both those industries.Health Insurance lobby.Deliberately obscures pricing and quality data from the marketplaceDeliberately encourages fragmentation of the insurance offering into individual States; an insurer can “pull out” of a given State if it is not profitable enough, while continuing to exploit other States’ markets. A more equitable regulation would be to require an insurer to cover all parts of a State without exception, not being able to “cherry pick” subscribers.III. Structurally Distorted MarketLack of the basic requirements of a free market including price information, product description/definition, open competition. The market has been partitioned between Providers, Payors and Patients. Providers are healthcare professionals (individuals but mostly groups), Payors are insurance companies and Patients are consumers.Extreme opacity in Pricing. Neither Providers nor Patients have free access to the core cost of healthcare products or services! (i.e. The doctor can’t tell you what it costs for any procedure, and the Patient cannot find out beforehand what a complex procedure would cost!)Extreme variability in Pricing. Pricing is decoupled from actual cost and highly variable not only by location but by patient category (uninsured, specific negotiated rate with insurer, procedure coding used…) In general, the “list price” is discounted by as much as 40–90% depending upon annually negotiated rates between insurer and provider organization.Extremely onerous administrative costs due to Extreme Multiplicity of Policies / Unstreamlined Payor & Claims Management. Due to lack of harmonized claims and payment processing, providers have enormous administrative staff to deal with the hundreds of insurance policies, each of which has its own “process”. You usually deal with 3 non-medical staff, 1 auxiliary medical staff for 1 MD consultation.Fragmented, relatively unfettered insurance offering - There is no single, national healthcare marketplace in the private sector. Each State is a separate insurance market, so consumers do not face a competitive continental-sized marketplace but much smaller, fragmented markets dominated by fewer players. This inherent inefficiency leads leads to higher costs as insurers are allowed to only address the most lucrative markets (i.e. UnitedHealthcare withdrew from the Florida PACA Healthcare Marketplace but maintained its private and company insurance policies in that State; it also withdrew from specific geographic markets within the State beforehand.

How do I get job at Google or Microsoft? Right now I'm doing my BTech in CS from VIT. Can you guide me on how to get a job, in regards to CGPA , projects or interviews? What should I study, and where should I study?

I have worked in Google for 4 years and here is my interview on how I got there:Anna, why do you think you were selected among other candidates?Google is a company that looks at how daring people are, how easily they merge into new environments, how well they know a product/their potential role and overall, how Googley they are (I will elaborate on this term later). I want to believe that I met those criteria, because my background is more versatile than even I realized when I applied to Google. I am going to tell you my story with the hope to inspire you rather than simply tell you what I have achieved. I want to show you that you can do it too.I was born during the time of the Soviet Union in Uzbekistan’s Kyzylkum Desert, and I have a very ordinary family. I did not graduate school with excellent grades, but I studied quite well – although some teachers hardly believed in my potential:My math teacher called me “Dried Apricot,” referring to my dry brain and being unable to process obvious math logic. My classroom teacher believed I was only good enough for a technical school and said I shouldn’t even dream about University. They would be very surprised I have a Job with Google (Anna smiles).University timeWhen the time came to enroll at a university, I failed my entrance exams. However, instead of lowering my ambitions, the following year I decided to apply to the best university in the country – The University of World Economy and Diplomacy. I have to admit though, my mum’s motivational trick helped a lot: she threatened that she would get me a job as a babysitter in a kindergarten class if I didn’t enter any university. Plus, I would have to cook for her everyday. And guess what? I did enter that University! No one could believe it, not even me.Was I the best student at the University? No, I wasn’t. But unlike other students who went home after their studies, I headed to my internships (don’t remember who gave me such a good tip, but it was very valuable). I did a one year internship at United Nations Development Program and a four month internship with the International Red Cross. This experience sat beautifully on my CV.Masters Degree in Poland at Lancaster University ProgramDuring my last year at University, I intensively applied for scholarships to study abroad, and I got one. It covered my MA in Politics & Society tuition in Poland and my living costs, $3000 for 1 year. That was like a fairytale for me. If I didn’t get the scholarship, my mum (a single parent) would never have been able to afford to pay for my studies. Thus, I travelled to Poland to study at Lancaster University and entered its program in Polish Academy of Sciences.In the beginning, I really struggled. Even though I studied at the best university in Uzbekistan, the level of instruction was still quite low. Imagine, I didn’t even know what plagiarism was. When I came to Poland, I did a copy-paste job for my first paper, and I failed miserably with a D-. It was a shock to me, but I was a fighter. Spending day and night in the library, I finally got my first C+, then my first B and ultimately began earning As. My philosophy professor used to say, “I don’t know if your papers are brilliant or if they’re complete bullshit.” I didn’t know either (smiles).I graduated with merit, earning my MA and feeling very proud. In the process, I gained so much valuable knowledge in structural analysis, research and academic writing. It helped me greatly on my professional journey.Recommended to read: 3 Valuable Lessons I have learnt working in GoogleMasters Degree in ItalyOne master’s degree was not enough for me. I got another scholarship to study Cooperation and Development in Italy. This was a more practical course rather than theoretical, and it allowed me to experience the practical side of International Organisations. What was great about this University is that it offered paid internships at interesting organisations. When searching for a University for yourself, take this important factor into consideration. It will serve you well later on.InternshipsAs I have mentioned, the MA program in Italy offered a paid internship somewhere in a developing country. I chose Ethiopia, because they had a project on Capacity Building that was of great interest to me. For 3 months, I performed research on Human Capital in Northern Ethiopia, living in quite harsh conditions.This internship helped me apply my theoretical knowledge to the practical world. Even so, the experience was tough: my dwelling was a mud and straw house, the toilet was just a hole outside the dwelling and the food was very poor in diversity. Forget about chocolate, the most sophisticated treat was sugar cane! Most disturbing, rats were frequent visitors in the house. Nevertheless, I still enjoyed the experience very much, and I learnt, learnt, learnt!Work experienceAfter three months in Ethiopia, the organisation I worked for, Cooperazione Internazionale, offered me a six month contract South of Ethiopia, in Negelle. I accepted. My task was to research the sustainability of local farms. The central question was: why were some farms sustainable and others were not. It was an amazing experience. I saw how foreign aid negatively effects local communities, how much money is wasted, how unsustainable foreign aid is, etc. This experience changed my attitude towards charity and everything that comes with it. Ultimately, I decided that I didn’t want to work in this sector because it contradicts my values.After that, I have found myself in Ireland, and I decided to try the commercial sector. It was 2008, a year of crisis. During the whole year, I managed to only get a two month contract at the International Organisation for Migration where I did research on Georgian and Moldovan communities in Ireland.Accenture/MicrosoftI continued my search. After multiple applications, I finally managed to get job at Accenture. I was doing customer service outsourcing for Microsoft packaged goods. Salary was low and treatment wasn’t particularly good: there was a lot of manipulation and bullying. My self-esteem crashed through the floor, but I was fighting. In one year I was offered a promotion, but my rebellious spirit didn’t allow me to stay there anymore. I left.Recommended to read: How not to give up your dreamsServiceSource and finally GOOGLEMy next employer was another American company that renewed IT licences for the largest IT companies in the world. I enjoyed working there and earned a good salary, but after a year I felt that I can’t renew licenses all my life. I was not learning anymore, and so I started searching for new opportunities. Browsing through vacancies I noticed a position for a Russian speaker at Google. My heart started beating. Why not, I decided. Instead of applying directly, I decided to get some more information from someone who worked at Google. That was a good decision. Always try to get information from insiders before applying anywhere.I have found a person who worked at Google, and he gave me valuable advise: Google looks at four main values while selecting people: Leadership, Analytical skills, Googliness and Professional Knowledge. I made sure I had good examples from my experience for all of these areas, nailed my CV to perfection and threw myself into the storm of interviews.In case you don’t know, Googlers get bonuses for the people they refer. They are, therefore, interested in you being successful and can give you useful insights and guidance.How did you prepare for an interview?As I mentioned, I contacted a person at Google, got general guidance and then compiled all possible questions in concerned categories. After that, I categorised the questions and composed the best answers, writing all of them by hand.I also collected all the information about the position I was applying for and studied Adwords products, market trends and different solutions for different businesses in the context of Adwords.Then I practiced, literally. I sat down at a desk, took a proper posture and talked through all my answers.How many interviews did you have?I had 7 interviews in total: three over-the-phone and four on-site.The first phone interview was mainly about my CV and my experience. Be prepared to discuss every point you have on your CV, even your hobbies (some people…Read further at HOW I GOT A JOB IN GOOGLE - Lifehacks for your smart livingJoin Anna’s social pages:Success.Studio | Facebook - the place to learn and share online business building best practicesIQloris | Facebook - here you can see Anna’s articles from her blog Lifehacks for your smart living

How can the traditional angel network or angel group model be improved?

For helpful context, I've done all of the above, as well as founded one of the largest networks in the country (New York Angels) and founded Gust (company), the platform that is used by angel networks to manage all facets of their operations around investment review, collaboration and funding. See my bio for additional details.The bottom line on angel networks is pretty much what Winston Churchill said about democracy: "It's the worst form of government there is...except for all the others."Angel networks (that's typically the European term; in North America they're generally known as 'angel groups', with the term 'networks' reserved for the few organizations that bring together several separate groups or chapters, such as Golden Seeds and Tech Coast Angels) play a surprisingly significant role in the early stage financing ecosystem. They help bring new investors into the market, they provide a generally open framework for funding submissions that don't rely on the 'who you know', they aggregate capital to help organize investment rounds that would not be done by later stage investors, they often provide amazing mentorship to young companies, and much more. During the past 12 months, angel groups have funded well over 1,000 startup companies, which is more than all professional VC funds have together. At the same time, however, they have earned a partially-deserved reputation for being process-bound, time-wasting, nit-picking and occasionally unprofessional. Both descriptions are accurate.The problem lies in the inherent contradictions and realities surrounding the whole concept of angel groups:Unlike venture capitalists, angels are not full-time, compensated, 'professional' investorsUnlike venture capitalists, angels invest out of their own, small-ish, pockets, instead of out of funds containing hundreds of millions of dollars of other people's moneyUnlike venture capitalists who make lots of investments, individual angels may make only one or two small minority investments a yearUnlike small, structured, cohesive, venture capital partnerships with a specific investment focus, angel groups consist of 25–250 independent, Type-A, former entrepreneurs with widely varying levels of experience, interest and skills, and widely varying investment theses.If an angel group is actively led by an investor member, the fact that he/she is an accredited investor with other interests means that there's no one to do the day-to-day work; but if it is led by a 'professional manager', that person is not an actual investor and can neither commit to an investment, nor control the members to whom he/she reports.If the manager is not particularly good, then the group will be ineffective at best, and dissolve at worst; but if the manager is great, he or she will eventually face the overwhelming incentive to leave the group, become a professional VC and raise a real venture fund.As a result, angel groups and networks are unnatural life forms that are inherently unsustainable.The traditional process of coming to a decision within the construct of an angel group is exactly that: a group process. And the larger the group, the more process is required. The Catch 22, however, is that the more process, the longer it takes, and the more of a pain in the neck it is to get through.All of the leading angel groups are, I can assure you, well aware of this, and all of them spend significant amounts of time trying to improve their processes. There is an annual Summit organized by the Angel Capital Association, and an annual Leaders Conference for angel group leaders at which these issues are discussed exhaustively, best practices are shared, common documents are drafted, and joint activities are undertaken.But since this question is asking about potential improvements to the process, the best I can offer is a pretty shameless plug for Gust (company). What started eight years ago as an application platform for angel groups under the name of Angelsoft, is now a very significant force helping to unite and streamline the entire global angel group/angel network 'industry', such as it is.Gust has been adopted as a standard by over 800 of these groups and networks, by more than 15 of their national federations, and by their parent NGO, the World Business Angels Association. That means whether a company is applying for funding in Manhattan or Morocco, Manitoba or Mumbai, it will be using the same platform. And whether the entrepreneur and the potential investors speak English, French, Spanish, Portuguese, Russian or Chinese, the process will be similar.As a result, we are slowly but surely helping to codify, structure and implement best practices; streamline the process from initial pitch through to investment closing and beyond; and bring increasing transparency and professionalism to what has been likened to 'herding kittens'. By creating a single, free Gust profile, a startup can easily apply to virtually any angel group in the world, most business plan competitions, many venture capital funds, and even scholarship programs such as recent ones for the DEMO launch conference and the Astia women entrepreneurs program.Here's what Basil Peters, the highly respected author of Early Exits, has to say about the Gust platform:But at the end of the day, there is no question that the angel group process is still an inefficient and painful one, that everyone is convinced can be improved. And there is no question that we are working intensively to do so. Beginning in 2013 we will be introducing some significant enhancements to Gust that we have been working on with many of the country's most active groups. My guess is that those structural and workflow changes will have a demonstrable impact on the efficiency of angel groups and networks.I also believe that the advent of JOBS Act crowdfunding in 2013 will significantly raise the overall profile of early stage investing, bringing a large number of new investors into the process. This, in turn, will help bring the power of scale to the industry, and result in solutions such as Gust being developed and enhanced in order to support early stage investments at scale.May it only be so!

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