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Single Payer Healthcare

People who answer “single payer healthcare” every time a problem with the U.S. healthcare system is brought up are part of the problem.  

Mashing the SPH button every time the grownups are talking simplifies the conversation about US healthcare to a useless degree.  SPH is the goal, but just injecting those three magic words into every conversation does nothing to address the complexity and nuance, and only allows the person saying it to feel good.  Most of them are just as uneducated as people who want it to remain a for-profit system.  

If you are in favor of SHP, as every sane person should be, then you need to get your hands dirty and educate yourself on some things.  Here, I’ll start you off: 

1. Torte reform.  Want to curb over testing and over prescribing? Torte reform.  Doctors need to be able to not worry about being sued because they missed your zebra or something unrelated to what you saw them for, and they need to feel comfortable saying, “No, Barbara, you can’t have a zpak for your virus”. TORTE.  REFORM.  

2. The cost of med school.  As it stands, most students leave med school with 300-400k in debt.  As single payer statistically speaking involves a drop in pay, this becomes untenable.  They should not be paying a mortgage when they get out of school.  

3. Residencies are underfunded.  Doctors can sometimes come out of school, with the debt mentioned above, and not be able to match into a residency and finish their training.  

4. Doctor shortage.  2 & 3 would help address this, but if we want to switch to SPH we need more doctors to handle the load, otherwise you’ll be waiting weeks to see one.  Plenty of smart, potentially qualified people go to a different field because they don’t want to take on the crushing debt.  

5. Preventative care.  The whole conversation around this needs to change, to emphasize it over emergency care.  Treating stage 1 cancer is cheaper than treating stage 4.  2, 3, and 4 are related to this.  A heavier primary care load means we need more primary care doctors.  

6. Transparency of pricing.  Everyone involved in the process, especially doctors, need to know what things cost.  This also goes towards over testing (Noticing a pattern? It’s all connected.).  Right now that’s not the case, and to avoid being sued, expensive tests are probably being ordered in excess of what is necessary if there’s an efficient cheap one.  

7. Profit limits.  Now, I tend to lean more capitalist than most of Tumblr does, so I don’t have a problem with some profit being made.  BUT.  There needs to be a limit to how much drug companies, hospitals, and insurance companies can over charge.  That could be a flat %, I don’t know.  But it would definitely help limit the expenses and how much is paid in general (which makes it easier to switch to SPH.).  Drug companies especially.  

8. Doctors need to be educated about how the admin side works (thanks @md-admissions for that one.) so they can be better prescribers and be more aware of what it’s like on the other side of the fence.  Here’s the quick and dirty: Dr. dxs and codes for that.  –> treatments are added in the form of HCPCs –> After the appt, stay, etc. is over the billers charge the insurance company, after going through a whole host of corrections.  Mostly because of the next step, and because you can only use certain ICD codes with certain HCPC codes –> bill goes to a clearinghouse, whose only purpose is to check it for errors.  It’s an automated system that will reject for completely minor things.  Bill is either accepted and sent to the payer, or rejected and sent back to the provider for corrections –> Biller performs corrections and resubmits.  This part can literally go on for months, but it’s eventually sent to the payer, or the exasperated provider gives up –> once at the payer (insurance demon I mean company), they look it and either pay it or reject it.  Often they refuse to give you more reason for the rejection than an arcane code.  If it’s medicare you may or may not get a human-readable report.  It’s a crapshoot if you get a 277 or 999, as far as I can tell.  If the payer rejects it sometimes they won’t even discuss it with the provider, and insist you use the clearing house as a go-between.  They look for any reason to reject and providers lose *millions* to this BS. –> After all of this, the balance is either written off or forwarded on to the pt.  

9. Eliminate clearing houses and insurance companies.  This would happen as a by-product of switching to single payer, but none-the-less, it still addresses the problem of administrative waste that would still need to be watched out for under a SPH system.  Clearinghouses are useless.  People who do the job of checking the coding and whatnot tho (coding is important and necessary, because it allows for tracking of illness for stat reasons but also because that’s how they know what to pay.) could be transitioned to the same job in a SPH system.  

Ok this isn’t exhaustive, but I think it’s a good start.  

So please, SHP people, before you go beating that drum make sure you’re ready to address the complex mess that is American healthcare because I’m tired of listening to your smug assertion of “single payer would fix this” and I agree with you.  It’s lazy and uninformed.  

Araxxor Information

Here is a list of all of the information that I found out about Araxxor (as well as some small tips and ideas I had for the fight) for all of you who missed out on the livestream. It will be released at 1-2 PM BST. Hope this helps!

Pre-fight Information:

  • Araxxor is in Morytania, right under Port Phasmatys.
  • There is an Agility shortcut (level 92 Agility required) in Port Phasmatys. Run south and a little bit east to get to the cave.
  • There are no requirements to kill Araxxor. You must be able to access Morytania (Which means that you must have slain the Ghoul or completed the Priest in Peril quest).
  • The Ghost Ahoy quest is recommended for access to the Port Phasmatys bank and an Ectophial will help you get there.
  • Araxxor is a solo boss, meaning you fight him by yourself. If you choose to duo the boss, it will be in a harder difficulty where everything is increased by double.
  • 90 stats and 90 weapons are recommended. The benefit of a duo would be that a higher level players with better equipment can carry you through the fight if you don’t have the best equipment. It is possible to do it with Armadyl and Chaotic weaponry as done by Mod Ramen.
  • It may be possible to complete in Legacy but it will be very difficult.
  • There will only be a Completionist cape requirement on release (this will probably be the Music tracks). There are no Trimmed Completionist Cape requirements on release.
  • At least a 10 minute fight.
  • There are 4 phases during the Araxxor fight. After each phase Araxxor will heal to full, however the more that you lower Araxxor’s health before leading him down a path, the easier the minions will be on you at the end.
  • Araxxor starts each phase with 100k health.
  • There is no escape mechanic to exit the Araxxor lair (like Rise of the Six).
  • Familiars can be hurt and killed by Araxxor and it most likely is not possible to defeat Araxxor without a Beast of Burden.
  • An instanced fight costs 200k.
  • The graveyard is similar to Vorago.
  • Araxxor’s fight runs on a rotation. Every four days it changes. The first four days (release date) will include Path 1 and Path 2 available. Path 3 will be blocked off. Four days later, Path 2 will be blocked off and Path 1 and Path 3 will be available.

Phase 1:

  • Throughout the fight you’ll want to use Deflect or Protect prayers instead of Soul Split.
  • When Araxxor spawns it randomly picks an attack style. It is still possible to kill Araxxor with weapons of the opposite combat triangle. *Using Void might be worth it for tri-bridding purposes (less switches).
  • If it spawns with Red Legs he’s in his Melee form, Blue Legs means that he’s in his Mage form and Green Legs means that he’s in his Ranged form.
  • There are three special attacks in Phase 1. The Cocoon, the Web Shield and the Cleave.
  • If you don’t attack him when his Web Shield is active he heals 1000 health every tick. If you attack him with his Web Shield active he reflects damage back to you. Dismember and Slaughter are recommended to use during the Web Shield special attack because he’ll reflects light damage back to you and it will stop him from healing completely.
  • Araxxor will never do the same special attack in a row. If he does the Cocoon special attack, the next special attack will either be Web Shield or Cleave.
  • Anticipation and Freedom will aid you with escaping out of the Cocoon special attack. If you are stuck in the Cocoon, spam click on an area to escape from it. If you use Anticipation you will be able to spam click less to escape it.
  • If Araxxor pulls you in, use Surge or Escape to get away.
  • When Araxxor uses the Cleave special attack, run. The Cleave radius is large so Surge or Escape might be helpful. Cleave will hit your familiars and it can deal 3-4k damage.
  • Araxxor’s basic attacks have passive side effects. The melee passive will give you a bleed that does rapid damage which is cumulative (Use freedom to stop the bleed, I’d suggest using freedom at one of it’s higher points). The ranged passive will poison you (Use an anti-poison potion to stop it). The magic passive will have a stat drain mechanic (Stay overloaded and have a super restore potion ready).
  • To move onto Phase 2, you have to burn down the web for the path that you want to take Araxxor down. It takes 1 minute for the web to burn down so burn down the web at the start of the kill.

Phase 2 (Tunnel 1):

You can skip this phase but if you do, it will cause more spider minions to spawn later within the fight.

  • Incinerating Eggs. If you don’t burn the eggs, they’ll hatch and you’ll fight more spider minions.
  • Kill baby spiders (some are simple, some have effects).
  • As you kill the minions, Araxxor gets mad (rage) which will result in him dealing more damage to you (see below).
  • Araxxor is easier to kill if you don’t blow up the eggs however you’ll have to fight the spider minions later on.
  • The buff icon at the top means that spiders are still spawning and the mechanic is going on. When it disappears that means you have finished the mechanic and spider minions will no longer spawn.
  • The other buff icon next to the mechanic timer is the rage tracker. If you hover over the rage tracker, you will see how enraged Araxxor is from you incinerating the eggs.
  • Move on to Phase 3.
  • You can go back to the start of the fight (beginning room) but the path you didn’t choose is blocked off. You will still be hurt by going back since the fight is still going on.

Additional information on Phase 2 (Tunnel 1), special thanks to Kakamile (via Reddit) on figuring this out:

  • Minions spawn - spiders spawn with three different colors (which seem to identify their attack style); red/black, blue/green and green/blue. The spiders can take damage while dropping down.

  • Egg drop - Within Tunnel 1 eggs drop from the ceiling. The eggs can be incinerated. For those who are duoing, you must be on the same square when the eggs burn for typeless damage, however incinerating the eggs will also hurt the minions. It is recommend that players lure them to either prevent spawns or drain its mechanic.

  • Pulsing Spider - The spider with the red back spawns and spits a slow green beam at you (with an aid icon), if he tags Araxxor he will heal him for 5k health.

  • Rage - The more eggs that you break, the more Araxxor becomes enraged. You can either rush through the phase which will result in more spider minions later or complete the mechanic for fewer spawns in the later phases. There is a buff showing you how many more spider minions must be killed.

Other Phases - special thanks to Kakamile (via Reddit) again for figuring this out:

  • Acid attacks - Your characters body is covered in acid. The effects are unclear, but it was shown often in the BTS. You can see both acid venting and acid bubbles in the pit.

  • Surge - Araxxor will charge towards you. Dodges that were shown include both sliding under and climbing on top of Araxxor. This could possibly be similar to the Rise of the Six mechanic when you’re trying to escape where you have to dodge collapsing environment or you’ll get hurt.

  • Smoke/gas - Red smoke will spew out and sink into the ground. There is no known mechanic as there is no damage  shown but smoke appears between players and Araxxor continuously.

Map Events - special thanks to Kakamile (via Reddit) yet again for figuring this out:

  • Acid pit - You might have to drag Araxxor through this pit or fight him within it. This is shown in the BTS.

  • Collapsing floor - This is also shown in the BTS (when Araxxor stomps the floor). This could either be a visual effect or an actual fight mechanic.

  • Draining acid - Required phase activity. This seems more as a Duo mechanic rather than a solo.

The Weapons:

  • “Noxious” weaponry consists of all two-handed tier 90 weapons. They are the Noxious Scythe, Noxious Bow and Noxious Staff.
  • The weapons are degradable but you can repair them just like all of the other tier 90 weapons.
  • These weapons all have a special attack but the special attack is the same for each of them. The special attack is called “Mirrorback”.
  • The weapons stats are 1147 damage and 2458 accuracy with an “Average” speed type. The Noxious Scythe has 2011 damage and is classified as “Slashing”.
  • Full stick, tradable, final weapon tradable - pieces are not tradable (stick parts and head part)
  • The weapons cannot be disassembled.
  • There are three pieces to the “stick” (similar to the Godsword blade and the three Godsword shards). The full stick will be tradable. The final weapon will be tradable but the pieces (The melee, ranged and magic head attachments as well as the three individual stick pieces) are not tradable.
  • The pieces of the weapon (stick) are dropped randomly from Araxxor. You don’t get the stick pieces from the final loot.
  • Getting each piece of the stick depends on what path you take.
  • You have a greater chance at receiving a melee head piece from the melee version of Araxxor, a better chance at the ranged head piece from the ranged version of Araxxor and a better chance at the mage head piece from the magic version of Araxxor. Which depends on how you build your boss.
  • The weapon will not be able to be made on the first day due to Path 3 being blocked off (which is required for the third stick piece).

The drops (besides the Noxious weaponry):

  • The 100% drops at Araxxor are the new arrows for the Noxious bow as well as charms. It will mainly drop blue charms and will give you anywhere between 10 to 15 per kill.
  • Each loot is 300-400k on average.
  • Onyx bolts are a confirmed drop.
  • There will be a spider pet drop (less rare than Vitalis from Vorago). Once you receive the spider pet you can unlock additional achievements by killing Araxxor to re-skin your spider. These achievements can be found out at the cocooned figure outside of the Araxxor cave once you have the pet.

Duo/Hard Mode Information:

  • If someone dies during a duo, it’s possible to complete on your own but you have to get lucky. The cocoon special attack within a duo requires two people to break free and if Araxxor uses this special, you can not complete it on your own.
  • Drop chances are not increased within a duo. There are more chances to get something since there are 2 of you but you will both receive different loot at the end.
  • Everything is doubled (damage, minions, attacks, bleeds, etc).

Extra Information:

  • The XP rewarded after the kill is 19k.
  • There is no “instakill” mechanic but you have to build up Araxxor (how you build him up is how hard he gets). You can make him really hard early on and easier at the end or vice versa. If he uses certain mechanics early on, you might have an easier back half of the fight. There are different ways to tackle the boss.
  • There will be an Anti-farming mechanic that will make it harder to kill Araxxor the longer you’re there. (Not as farmable as the Queen Black Dragon).
  • The lunar spell “Spiritualise Food” can heal your familiar but that would require you to be on Lunar magic, not allowing you to use Mage to kill Araxxor. Might be helpful to use.
  • Araxxor won’t count for spider slayer tasks (might be changed in the future).
  • The Ectophial will be kept on death (Ninja team fix).
  • There will be no Morytania tasks alongside the Araxxor release.
  • Play with dynamic lighting on for a better looking boss fight.
  • Shields will be helpful.
  • Dreadnips work on Araxxor.
  • Cannons are not allowed in the boss fight.
  • There might be a new spectator camera as well as a spectator mode at Araxxor for people to go in and watch as others try to fight him.
  • Deathtouched Darts would only work for one phase.
  • The first Araxxor kill will be tracked and it might be broadcasted to the World.
  • Weapon pieces will be broadcasted in-game.