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I’m gonna punt on the question of where the line is for hostile actions and use some past legal justification of “I know it when I see it” and I see it clearly here.

The second part is the more interesting question to me:

Appropriate reactions would seem to include:

  - finding a new doctor/practice/provider. Super hard in practice as they seem to be geographical monopolies a la the cable networks
  - providing appropriately hostile feedback to your current doctors — but this is likely only to garner empathy as the docs have little say over this
  - stop using smartphones and claim hardship — not sure how this would pan out. Probably not well?
  - channeling Luigi and murdering the people responsible for our ongoing dystopia

Seriously what other options are there? You can either complain to the ether and it goes nowhere. Or you can take up violence and it still likely goes nowhere and you fuck up your life.

This is why so many people are content to let the world burn. It ain’t for us anymore anyway.



> stop using smartphones and claim hardship — not sure how this would pan out.

This is basically what I do now. When someone tells me to install their app or give them my cell phone number I tell them that I don't have a cell phone. Sometimes I do it while holding a cell phone in my hand.

I've told employers that if they make using an app a requirement they'll need to buy me a cell phone.

If people really push on why I won't use an app I'll tell them all about how my buying a phone doesn't make me the owner of one since multiple people at multiple companies have privileged access to the device I paid for far beyond my own level of access which enables them to access/add/remove/modify files and settings at any time and for any reason without my permission or even without making me aware that they've done it. Why would I use a system controlled by an unknown number of others who are only interested in enriching themselves to keep highly personal information like my medical history or banking information? Cell phones are inherently insecure and adversarial devices designed to collect and leak our private information while stealing our attention.


This is all downstream of consolidation of ownership in private equity of clinics, community health centers, emergency rooms, veterinarians offices, end-of-life care facilities, etc.

This is what happens when you let the bean counters and MBAs a quarter turn around the world with no on-the-ground experience or institutional knowledge make decisions from their spreadsheets to "optimize out inefficiencies".

Let's call it what it is: strip mining.


> downstream of consolidation of ownership

No, if anything, people buying and running multiple offices are exactly in the business of optimizing the last few percentage points of efficiency and that include amortizing better software across all these offices to make them run with fewer humans in the loop. Causing more people to talk to more humans is NOT what they do.

The issue is lack of care, incompetence, stupidity - exactly the things that will get you fired from these operations. Eventually.

The problem is "eventually". Unfortunately it will take too long for that to happen, compared to the rest of our lives.


You have forgotten sabotage or whistle blowing. If i would work for such a crappy manager, i would let upper management know.

Feeling helpless is the moment you loose.


Is stupidity instead of hardship a legally valid claim? Are cognitively disabled people, unable to operate a smartphone, a protected class?


wcag has provisions regarding cognitive issues, I have been thinking about writing an article arguing that dark patterns being liable under accessibility laws - but have not really shopped it around.

Of course one thing is nobody wants to sue someone because they don't understand something, because they think it means arguing they are stupid.


If anyone needs a test case, I consider myself a reasonably intelligent human who is absolutely too stupid to use modern technology and would be glad to proclaim that to a court. (executive function, working memory issues. latency is a killer for me.)


On a similar note, I think the inability to pause all animations on a website seems like a kind of WCAG violation as well.


They are protected if we collectively-enough (laws, or culture, religion, ethics, or...?) agree to provide equitable access to people with disabilities. Human rights are made up (the local deer that spent the night in the woods near where I spend the night have no rights, they just exist in a mix of cooperation, reciprocity, and some competition. Actually, I don't know if they afford each other rights in the way we do that. Likewise, I don't know if deer focus on "productivity" as much as so many of us do...), and for good reasons (?). I wonder if rights were codified back when we were far less numerous and living so much closer to the land, amidst so much more abundant life.


If the entire world requires smartphones to take part and you are unable to use a smartphone you deserve some protection, yes.

If you see other options I’d be happy to hear them?


My question is can I sue based on that?


If you’re a protected class I would assume yes. IANAL this is not legal advice and this is not a real situation anyway


That's my question, am I a protected class for not being able to operate a smartphone? I think many of a typical doctor's constituency fall into that category.


No. You're not.

Blind people are. At least, insofar as we still have the ADA.

One thing these companies are doing is charging blind people extra. Phrase it that way and you can maybe move some policy levers.


I don’t think “person who is unable to operate a cellphone” is a protected class. There might be some overlap between those people and people in other protected classes. But it is hard to say just based on a hypothetical, right?


> a typical doctor's constituency fall into that category.

My 95 year-old mother can't use apps on her iphone because she can't figure out the navigation and various modes. Because of this her phone usage is limited to answering incoming calls, making calls to the six icons we've preset on her home screen, receiving texts and replying to the last text she received (because it's still on the screen). Anything else is iffy. And she's not cognitively impaired. She's actually quite sharp for her age and lives on her own within an assisted care community.


- Call the office and ask them to read the message that they couldn't be bothered to put in regular email.

- Switch to paper mail notices

(Here, health insurance "improving" their web site - again - to a useless two-factor auth that loops indefinitely.)


VOTE MOTHERFUCKER

Local government politics work. State politics even kinda work.

The fact that murder is on your list but not voting is mind boggling.


Where can I vote for "Medical establishments should have an accessible-friendly browser-accessible no-javascript webpage for all functionality"?

I see the "democrat" and "republic" checkboxes, but I don't see the magical third "Good apps, and also health insurance companies have to cover medical claims without questioning whether my doctor is competent, denying each claim once, and requiring 3 months of arguing on a phone"

I've been voting, and as far as I can tell every option I have ever been able to vote for has been fully in support of crappy apps and crappy healthcare.


>Where can I vote for "Medical establishments should have an accessible-friendly browser-accessible no-javascript webpage for all functionality"?

Get off your ass and start a ballot measure. If you want to literally vote for a direct regulation that’s the way to do it.

Alternatively, start talking to state legislators and get them to support a bill doing it.


Democrat is the only sane choice if you want a functioning government. Republicans have departed reality.


There are no sane choices. We're only stuck with republicans now because democrats were happy to maintain a status quo that was keeping them rich but wasn't addressing the needs of the people. The dems might throw us a bone now and then, but they weren't willing to make the kind of meaningful changes that might threaten their power or the interests of the corporations and industries bribing them. Now we're left with folks who just want to pillage everything they can and burn the rest to the ground.


> The fact that murder is on your list but not voting is mind boggling.

for hundreds of years our government and the corporations who bribe them have worked to limit the influence of the average person on the laws and regulations that we live under. After seeing our broken two party system, the gerrymandering and voter suppression, the open bribery, the lack of integrity or accountability, the inability/unwillingness of congress to do their job, and the growing list of laws and policies most Americans support and problems we want solutions for that get ignored time and time again while laws are being passed to appease corporations and industries, I really don't blame people for thinking that their ballot box is not the solution to their problems.

When people feel they don't have a way within the system to get the things they need they'll look for ways to get them outside of the system. Our government used at least put in the effort to give the appearance that working within the system could be successful, but these days they barely bother to do that.

Personally I still like to hold onto hope that voting can make a difference, especially at the local level, but it's a hard sell these days and getting harder all the time.


You’re talking about national elections. California has demonstrated time and time again that it’s able to regulate businesses and impose environmental regulations beyond the federal government


> The fact that murder is on your list but not voting is mind boggling.

It's not. Unlike voting, it has a nonzero chance of improving the app situation.

In this situation, instead of anything on the list above, I recommend going to press/Twitter and stressing the angle that this bullshit actually ruins people's lives permanently (or kills them prematurely).


I vote. I am 50. I have voted in every election I was able to. In my life my preferred candidate has won exactly twice: Obama’s second term and Biden’s first. This includes local, state elections, and national.

To quote George Carlin: “If voting mattered, they wouldn’t let us do it”.

Trump lost in 2024 but took the win because his cronies disqualified enough voters in enough states to win.

So, please, spare me. We’re up to violence already. You’re just well behind the times unfortunately.


Don’t mean to be antagonistic here, but do you have a source for the claim that trump took the win?

Would be really curious to see how this could be proven or at the very least convincingly induced.


Go look for how many ballots were disqualified in the swing states?


I googled around, but I couldn't find an authoritative source showing either the numbers disqualified, the reasons, and that those ballots were majority not-trump ballots.

Can you provide a source for that data for a specific swing state of your choice?


“My preferred candidate only one twice” is the hallmark of a “only the federal govt elections matter” midwit. The federal government is the least effective way to lead on regulatory change. California has demonstrated leadership this way repeatedly.

>So, please, spare me. We’re up to violence already. You’re just well behind the times unfortunately.

There have been nut-jobs saying this and inflicting violence since the beginning of the country. Then there are people who actually affect change. Pick a side.


Contra Carlin, if voting didn’t matter they wouldn’t be putting so much effort into making it harder.


Your argument is, violence is an option, because your preferred candidates don't win as much as you like?

I would see a point in saying voting is pointless, because no matter who you vote for, all end up on the payroll of the people doing enshitification. But not because your side always loose. Because this then won't likely change when you turn to violence - your side will be still the smaller one and we tried the whole voting thing, to not have all arguments solved with bloodshed.


Ok, maybe something less desperate than voting but appropriate in this case: create a competitor to disrupt the suckers? Maybe using the same API?


The users of the sub-par app are captive, the hospital or insurance company is mandating it, and neither the doctor nor patients are free to choose a competing app.

If you create a technically better app for the users, people still won't be able to use it unless you also are chosen by those higher up, and since there's likely already a strong existing relationship between the executives at the existing company and at the medical compan(ies), that means creating a competitor also will require building a lot of social capital with the decision makers, taking them to dinner and on golf trips, and so on.

It will take years of your life, millions of dollars (since a 1-man company will never be seen as legitimate enough to provide a medical app, you'll need a large company with many employees), and the chance of success is minimal.

I don't see how this is an "appropriate" response to a bad app.


I was just thinking of a better front end for the same API that trifticon mentionned. Still a lot of work of course, but may not require as many approvals.

I wish we lived in a world where all these APIs were open, regulated, and everybody could compete on the implementation on both sides... One day, if capitalism survive technofeudalism...


Even avoiding the problems with getting a foothold into this space any start up that tried to do the right thing would get bought up by someone else and enshitified until it was just as bad if not worse. There's more money to be made by screwing over the public than by not screwing them and our entire system is centered around making the most money at any cost and placing money over every other concern.




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