Abhi Muthiyan

CTO
Former CTO @patagoniahealth, Base healthcare

[Cursor @cursor_ai]

We had a team of agents rebuild SQLite from its 835-page manual.

It created a replica in Rust which passed 100% of a held-out test suite.

Interestingly, cost varied 15x depending on which model mix we used.

[Mark Cuban @mcuban]

Then I asked for a simplified version of the above :

Here it is in plain English. Denver hired UnitedHealthcare to run its employee health plan. Denver pays the actual medical and drug bills itself — United just processes them. That’s what “self-funded” means. The problem is that Denver can’t see what it’s actually paying for drugs.

1. United buys the drug for one price and charges Denver a different price. It keeps the difference. Say the pharmacy gets paid $40 for a prescription. United bills Denver $100. United keeps $60. Denver never sees the $40. The contract says this out loud in three different places — it’s not hidden, it’s just written in language nobody reads. There’s no cap on how big that gap can be.

2. Drug companies pay rebates. United keeps all of them and hands Denver a flat number instead. United collects rebate checks from drug manufacturers. Instead of passing those through, it promises Denver a fixed amount per brand prescription (about $740 in 2023). If the actual rebate was $1,500, United keeps the extra $760. The contract literally says any rebates above the fixed amount belong to United. Denver has no right to know what the real number was.

3. United decides which drugs are “specialty” — and specialty drugs are where the money is. The contract defines a specialty drug as, essentially, “whatever United’s own specialty pharmacy sells.” United also reserves the right to reclassify drugs whenever it wants. Once a drug is labeled specialty and filled at United’s own pharmacy, it drops out of the normal price guarantees entirely. So the most expensive drugs are the least protected.

4. The most expensive drugs of all — the ones given in a doctor’s office or infusion center — have no price guarantee at all. The contract flatly excludes them. Cancer drugs, infusions, injections administered by a provider. Zero pricing protection.

5. Denver can’t shop around, and it can’t leave without a penalty. Denver isn’t allowed to negotiate directly with any drug manufacturer. It must use United’s mail-order pharmacy exclusively. And if Denver hires an outside vendor that steers employees to cheaper drugs or cheaper pharmacies, United can cancel all the pricing guarantees. If Denver ends the drug program early, United keeps every rebate it owes.

6. Denver can’t audit its way out of this. Denver is allowed one audit a year, capped at 300 prescriptions, using a random sample United has to approve. No auditors paid on commission. No computer-based searches for errors. You cannot find a pricing problem across hundreds of thousands of claims by randomly checking 300 of them. The audit rules exist to make sure nothing gets found.

Is any of it illegal? Almost none of it. It’s a legal contract that Denver signed. The one thing that might cross a line: federal law since 2021 bans “gag clauses” — contract terms that stop an employer from seeing its own cost and claims data. This contract says United may let Denver see its pricing information, at United’s discretion. Federal regulators have said that “only if the vendor allows it” language is exactly what the gag-clause ban prohibits. And Denver has to certify to the government every year that it has no gag clauses in its contracts.

The one thing Denver could actually do about it: Colorado banned this drug markup practice, effective January 2025, and self-funded employers like Denver can opt in. It’s an election, not a lawsuit. Somebody should check whether Denver ever filed it.

The bottom line for an HR person: the drug program looks free. There’s no fee for it anywhere in the contract. That’s the tell. United isn’t working for free — it’s getting paid out of the drug prices, and the contract is built so Denver can’t measure how much.

[Krish Ashok @krishashok]

A meandering thread about one of life’s most enigmatic and joyful foods: ice cream. A minor pet peeve of mine is that when ice cream is served in big events in India (at weddings or aboard Vande Bharat/Shatabdi), Nassim Taleb’s “Minority Rule” applies, and we end up getting eggless ice cream

[Abhi Muthiyan @abhivm]

@jeresig Thank you John! Started using jQuery in 2009. Still the best library experience out there!

[Abhi Muthiyan @abhivm]

Fantastic details with clear explanation about icon design flaws in Apple's Tahoe. Masterclass in icon design and layouts!

[Jason Fried @jasonfried]

Exceptionally good article on UI design, using Tahoe's regressions as examples of what not to do. Lots of side-by-side examples making the abstract obvious.

https://t.co/SQYsBiT40W

Via @daringfireball.

[Abhi Muthiyan @abhivm]

@mhp_guy https://t.co/gBFTMx2Y1S does this from North Carolina. With FL and TX locations. Online booking.

2 guys running the business. Talked to them earlier this year. Fast growing. Capital intensive to build the storage racks. revenue sharing with parks.

[Abhi Muthiyan @abhivm]

@mhp_guy Great analysis of door to door sales. Always wondered why so many pest companies show up in spring and summer.
What other services are sold similarly?
What about HOAs who want stop these sales?

[Abhi Muthiyan @abhivm]

That was close! Fun final to watch. Fantastic bowling under pressure by Indians 💯

[BCCI Women @BCCIWomen]

𝐂.𝐇.𝐀.𝐌.𝐏.𝐈.𝐎.𝐍.𝐒 🏆

Congratulations to #TeamIndia on winning their maiden ICC Women's Cricket World Cup 🇮🇳

Take. A. Bow 🙌

#WomenInBlue | #CWC25 | #Final | #INDvSA

[Balaji @balajis]

DECOUPLING FROM DOLLARS
The US sends India billions in printed dollars for valuable goods. This is actually the US government ripping off India, like it does Vietnam, and everyone else, including its own citizens...not vice versa.

To be precise: last year India exported $87B of valuable goods to the US for $42B of goods plus $45B worth of increasingly worthless dollars:

That difference of $45B was, effectively, made up by money printing, which the Fed does at will:

The current administration incorrectly thinks this is a bad deal for America, because they haven’t fully thought through the fact that the US can print dollars. India was giving America something that's always valuable (namely goods) for something that America can just print out of thin air (namely US dollars):

So...who was really ripping off whom?

As mentioned, this is the same trade America had with Vietnam. Vietnam worked hard to send America shoes, while America sent Vietnam printed dollars. And it’s the same trade America had with many countries, before the trade war. The world sends the US valuable goods, and gets mere Federal Reserve database entries in return:

The only reason the US had the right to do that — to run the financial database of the world, to print trillions for itself, and to freeze and seize the funds of billions — is because it set up what we call the rules-based order, what is in reality the American Empire. And of course it profited from that empire tremendously, but so did most of the empire's participants.

But now MAGA is dismantling that empire. It’s cutting off trade, talent, and even tourism. It’s abandoning its military commitments and telling allies to fend for themselves. It’s cutting off foreign aid and domestic universities. It is, in short, becoming a country not an empire.

The reason is because MAGA is fundamentally confused. It romanticizes 1945 America (the manufacturing country) without fully admitting that 2025 America makes its money in a completely different way, by managing the hub of a global financial empire.

Because the US is in denial about what it is — a money printer, not a manufacturer — it's currently on track to lose both the money-printing and the manufacturing. For example, the tariffs target the entire world (thereby reducing demand for the dollar in global trade) while also cutting off machine tools and raw materials from US entrepreneurs (thereby inhibiting the buildout of domestic manufacturing).

Anyway, I won't linger on the outlook for the US. It's made its decision and will live with it. Perhaps it will indeed be a Golden Age of Reindustrialization. And perhaps the transition to a "republic, not an empire" will go much better than the similar imperial climbdown of the UK or the USSR.

What should countries like India and Vietnam do?

They should turn a necessity into a virtue. The trade war has provided a powerful Schelling Point for the entire world to simultaneously stop using the dollar at the same time. This is also what America says it wants, for foreigners to stop "exploiting" it by accepting its printed dollars for hard goods.

So: abide by America's wishes and stop trading goods with America for dollars. Instead, trade goods with each other for local currencies (rather than USDs) and use gold for storing value (rather than USTs). Because there is no global reserve currency issued by a single country, trade remains roughly balanced over time.

Singapore's former PM calls this "world minus one." It's the continuation of global capitalism, just without America, who has voluntarily taken itself out of the game. Yes, there's a short-term adaptation cost, but the quicker that a country can decouple from the dollar the better.

Start saving in hard money instead.

[Abhi Muthiyan @abhivm]

@Dial8_ai Running this now with Cursor. Like the history feature, gives me clipboard history! very cool

[Abhi Muthiyan @abhivm]

Droid Run is awesome! It can automate complex tasks like navigating apps and interacting with UI elements, and even generate creative content! It created this tweet 💯🔥 @droid_run

[Abhi Muthiyan @abhivm]

Must have when visiting any government office in India. 😂 Which one will they want?
One more passport photo
one without glasses
with white background?
Black and white only
😜

[Massimo @Rainmaker1973]

Xiaomi Mi portable photo printer
https://t.co/msNCRFrZFM

[Abhi Muthiyan @abhivm]

@ChrisJBakke That is my start up. One platform to manage your startup launch to angel investing. AI powered. automatically tracks journey, meeting minutes and legal battles. creates podcast material.
Vodka brand in basic version
Premium version creates SPAC.
Raising at $30M pre.

[Abhi Muthiyan @abhivm]

Let's go king kohli! 💯

[India_AllSports @India_AllSports]

BREAKING: RCB WIN their maiden IPL TROPHY after beating Punjab Kings by 6 runs in the Final! 🔥🔥🔥

18-year wait finally ends. 🙌

#IPLFinal

[Abhi Muthiyan @abhivm]

Looking forward to presenting the session "The Future of Public Space Management: AI and Machine Learning in Landscape Architecture" with Shweta Nanekar and Alex Godette at the NC ASLA 2025 conference. https://t.co/Zb2JGNzG0g

[Abhi Muthiyan @abhivm]

@bobbyfijan HOA rules are bad and anti freedom until a neighbor does something that you don't like.
Or when a neighbor continues the bad behavior after you point it out to them.

[Abhi Muthiyan @abhivm]

Agreed. The knowledge part - Gen Z and later are not reading as many books. They are collecting knowledge efficiently from the sources you mentioned.

[KP Reddy @reddy_kp]

The Future is GenZ

I post a lot about AI and robotics, however it doesn’t mean that I don’t understand that humans are the biggest part of the AEC industry.

Yesterday, I was in a roundtable talking about the construction workforce of the future. The few millennials in the room sighed with relief that the discussion moved to how challenging the Gen Z are and not on them. I guess they are out of the cross hairs now from us GenX and those Boomers.

I happen to be the dad of 2 GenZ and through our emerging innovation leader program, I meet many more. As a rule, every generation thinks the next generation is lazy and terrible. That’s consistent. However, I think good and bad is not the right rubric, every generation is just different than the last. Each generation has a mixed bag of levels of work ethic, etc. IE .. every generation has the same percent of lazy no-good doers as the last.

What makes a generation different, their life experiences that shaped them.

Here are a few observations.

1. “They don’t want to pay their dues”. Why is this important? Is it because you are trying to connect with GenZ through a shared experience or do you believe that it’s important that they learn the basics in an experiential manner? If it’s the former, take that GenZ to play Top Golf and stop pushing them to follow your path. If it’s the latter, the learning process has changed and is accelerated. What may have taken your generation 5 years to learn through experience, can be learned in a year through videos, e-books at 1.5X etc. The opportunities for getting content optimized for the way an individual learns is tremendous for the GenZ.

2. “They don’t understand relationships “ why? Because they aren’t great at in-person interaction and want to engage via text and messaging? Your definition of relationship building may just be different. Once again, GenZ moves fast. You can learn a lot very quickly and get to know someone very quickly via text. They are very good at filtering the BS factor with people. That seems like a very important skill in business.

3. “They aren’t ambitious “ This is not true. They don’t believe that their employer is the platform for ambition. They saw their parents get screwed over, laid off and otherwise have a realistic view that your employer is not family. They pay you to work and if they don’t want to anymore they ask you to leave. They don’t believe your song and dance about the culture of your firm. Show me, don’t tell me.

4. “Meritocracy” This generation has been built on gamification. Things like 360 reviews etc and being assessed by people makes no sense. Tell me the metrics and math for me to progress in my career. Attending your dumb offsite shouldn’t be part of my performance evaluation. Give me a scoreboard, share it transparently and let me know if I’m winning. If I’m not winning, I will switch it up and go play a different game somewhere else. If I can find cheat codes to win. That’s not your business.

[Abhi Muthiyan @abhivm]

Ah! Things you could get away with on the airport in the good old days! 😂

[Seinfeldism @Seinfeldism1]

Where's George? / S04E12 The Airport https://t.co/wGzcdfbpv9 #Seinfeld #Seinfeldism

[Abhi Muthiyan @abhivm]

@AskPerplexity What significant carve outs are included in the liberation day tariffs?

[Abhi Muthiyan @abhivm]

@kmr_dilip Agreed. whatsapp may be 4th trusted source 😊