Medicare Advantage plans use algorithms to cut off care
statnews.com
statnews.com
Can't afford to pay? It's unfortunate, but that's your own fault.
Every time we encode and reinforce these systems through laws, market mechanisms, and now AI, we tacitly agree that people who cannot afford such things do not deserve them. If you can't afford private healthcare before the 0 cost system was implemented to decide that well... best of luck!
Sooo... Corporations are bad, but people are bad anyway so it doesn't matter? IDK. Might be a product of it's age (bitter endings were big back then, right?)
The first is a warning on populism - it falls apart quickly in the face of reality. Promising easy solutions to hard problems.
The other is the Malthusian trap (explicitly nodded to with the "Hail Malthus") line.
If there were an owner, somehow, of the air, or the air over my house, or something, then when other entities are trying to externalize their own costs (by way of dumping carbon into the air, say), then we'd be able to use vanilla tort law to recover those costs as damages.
I'm not saying we should necessarily do that - obviously there are big questions about just whose bit of water this is, and how to determine who's causing the damages. But if we could somehow answer those questions, it seems like the market could supply the answer. That, to me, suggests that moving in the opposite direction is not obviously the best answer.
Get in trouble for air pollution, convert to water pollution, the media gets upset about some chemical you release, then convert it into something no one's thought to regulate yet.
We don't have infinite time to play like this.
I can't see this at all. Can you provide any example of property rights actually being vested in air or in water?
By comparison, if we talk about pollution of the soil, we don't have very much of a problem there. I mean, it happens. Like people's oil tanks leak, but that's a big part of the reason that we no longer build houses with oil-fired heat. I knew an environmental attorney who talked about the horrors of the liability when a homeowner's oil leach into the soil. This has taught us not to do that anymore.
But precisely because no particular entity owns the atmosphere, or (in most cases) the water, there's nobody that has standing to recover those externalized costs of pollution. So we haven't gone that route, and the problem remains largely unfixed.
Water contamination lawsuits are as common as water.
Regarding air, in the town I live a cannabis product manufacturer is about to be sued by nearby property owners because their warehouse is emitting a noisome smell. I seem to recall the Siracha factory was hit with a similar lawsuit. It would not take much research to find other lawsuits that allege air contamination. I'm sure air contamination has been part of thousands and thousands of lawsuits.
Suing someone takes massive effort for uncertain results. Even if you have a slam dunk case you have to have some basic wherewithal regarding the legal system and not be afraid to show in court (say you have a minor warrant or are an undocumented migrant, or a documented migrant from a country with a history of deporting people who make probablems for big business).
It's far from ideal, and is also only possible once damage has been done.
Although I don't know what it looks like, I believe the next step has to include baking environment stewardship into the DNA of high risk companies. This might involve giving an EPA officer a board seat, requiring positive proof of emission safety and active monitoring of nearby populations rather than just waiting for the cancer patients to show up, etc.
This is an emergent property of the systems of power we allow to prevail, where sufficiently dilutive responsibility and/or authority over decisions almost always falls under our threshold to effectively regulate, and shows the power of corruptive processes.
It still boggles my mind to this day that we knew a long time ago that burning coal dumped methylmercury into our waters and is incorporated into aquatic life that we harvest for food. And yet we haplessly continue even after seafood has been so globally contaminated we went from a baseline experience our ancestors enjoyed of "eat all the seafood you care to eat in your diet", to "watch your methylmercury intake when you eat seafood". If you were able to tell your great-great-great-grandparents that we've contaminated our seafood to the point we cannot eat certain fish more than X times a year, and there is no part of the world left unaffected, they'd be horrified or think you're a fabulist.
You use companies as a vehicle, but their measurement is not "how clean is the water?", it is "how much profit?" You will need to change this, otherwise, as long it is about profit / money, you've lost that very moment, and the only way to deal with that then is via regulation.
And if it ends up being the same people who own the factories that dump carbon into the air, it seems to me that it would be much more profitable for them to arrange for a small private paradise. The air around your house, though? That's more valuable as an industrial dump, sorry. And if you don't consent, well, you are free to look for another house elsewhere, right? It's not the air owner's fault that can't afford one inside a climate controlled bubble.
For those of you who think this isn't happening with basic resources like water, let me point you to: https://en.wikipedia.org/wiki/Cochabamba_Water_War
Maybe it's ok to keep some things out of the market's reach
Makes total sense.
Everything costs something, it's just a matter of who you force that cost on to.
Traditional Medicare sucks too though.
The fix for our medical system is to bring pricing down, while incentivizing innovation and not allowing your medical system to get overwhelmed by individuals that aren't contributing any money into it. You can have an argument about how to best do that but the current government backed options aren't cutting.
So your proposal is that we let the poor die?
If we're going to play this silly game of absolutes, you're envisioning a utopia that cannot exist.
And saying it's "AI" when it's just an algorithm (or even just a checklist) is getting annoying.
I started getting annoyed when game developers called the algorithms used to control NPCs and so on "AI", when it's actually hand-made rules, finely tuned. Nowadays, if it's been anywhere near automation, then it's OK to call it "AI". A calculator could be called "AI" (if they still made them).
There are rules and then there are rules. It is the details of the particular rule that is of interest. The use of "AI" in that article seems like clickbait to me.
The article seems to suggest that predictions based on aggregate statistics are being applied to implement strict coverage approval for individuals. That seems like a complete misunderstanding of predictive value of those statistics for a particular individual. Not sure if that is gross incompetance or malfeasance. Either way, a problem.
Some well-meaning team of data scientists might have produced this model originally. But its employment in this manner cannot be assumed to be anything other than malfeasance, except in the face of significant evidence to the contrary.
I know this is the way non-technical people refer to the spooky AI action at a distance happening in social media to maximise engagement, but in my opinion it just makes everything confusing when actually trying to understand the argument.
Like what? Correctly?
A different term to use could be "machine-made decisions", which I personally think describes the issue better. Still, (and unless my understanding is mistaken) the word algorithm is technically accurate to this kind of decision-making.
The executives and shareholders who profit the most from the decisions must be the ones held responsible.
The intended audience here isn't computer scientists... it's... the public.
It's pretty obvious what they mean by "algorithms", no? I feel like this is just being "akshyually" guy
Even in the simple case, say a linear regression with all the assumptions satisfied, predictions are interpretable as means, which is to say that (and again, assumptions holding, errors are normally distributed) half of observations fall below the mean and half above it. Using the mean in a normative capacity implies that half of patients will get kicked out before they would otherwise end their treatment.
There are ways around this, like quantile regression, or using prediction intervals, but again, we don't know the specifics of the method which leaves us in the dark as to the specific way the problem manifests.
It's a perfectly sensible use of the term as is.
I would expect any insurance provider to use computer programs (i.e algorithms) to decide whether someone is eligible or not. The problem is what kind of algorithm.
...and how its outputs are interpreted. Ultimately it's less about what kind of algorithm and more about how it's used, or in this case abused.
As another user mentioned, that 16.6 days should have been the mean or mode of a posterior distribution, from which you could obtain 75% and 95% credible intervals, or at least a conditional expectation accompanied by an (estimated) sampling error and traditional 75/85/95/whatever% confidence interval.
Crossing the 17-day line could have flagged this person's case for manual review. Even if the 95% credible interval was 15-18 days, anyone who understands how statistical models work would understand that manual review is a more sensible reaction than automatic cutoff, unless you simply don't care about the 5% chance of falsely denying people health coverage.
The fact that the model is statistical is not more problematic than a chain of if/else decisions. The problem is the fact that good statistical practice was disregarded in its usage. And as others have said, there was no intention of pursing good statistical practice here, and no reason to ascribe any benefit of doubt to any decision-makers involved in deploying such a model/algorithm. It's just a fig leaf for wanting to deny people health coverage.
A set of hidden calculations that can be tweaked mainly for the benefit of the owner.
What surprises me is how long most people take to pick up on the pattern. They see person X do bad thing, shocked. Then they see same person X do a different bad thing, shocked again.
I say arrest the executives and charge them with fraud. Hopefully that will send a message.
This country is so fucked. Our plan for elder care is to literally kill them with paperwork.
The many private corporations who profit from Medicare Advantage know exactly how it works. In fact, they hired the congressmen!
The Libertarian Fallacy is a stubborn one!
Oh, your Congressman knows. It's not members of Congress they're trying to deceive with that name.
> Stop the Medicare “Advantage” Scam Before Medicare Is Dead https://news.ycombinator.com/item?id=35001728
But your dad gets vision and dental now, so that’s nice
That's the only way private health insurance can both cover (most) in a cost effective way AND be profitable for their hedge fund masters.
Basically, they cannot deny anyone insurance based on health/age.
Once a year, all insurers submit their claims data to a central pool. They will then need to pay a certain amount to the pool, or get a refund based on their claims vs the rest of their providers.
That means risk is shared between all companies, and they don't need to deny people plans like in this case on the chance they get too many "bad customers".
In the scheme of things, it's a relatively small part of the overall population, but still very important.
It's just a tool, bro. It's the people using it that are bad.
The problem is that it's almost always run by insurance companies and they're concerned about profit rather than the individual. Think of it in the same way as you would a PPP or basic HMO plan from your employer. Other than the oddities such as money to pay for over-the-counter medication (limited to $40 per quarter) there's little-to-no difference.
It's not the government limiting the care but rather the insurance companies protecting their profits. It's capitalism in action. Deal with it.
Every year I had to fill out the forms saying that I didn’t have any other insurance before they paid.
It felt like a straight up scam to get people to pay some bills that show up without realizing what was going on / receiving and returning the forms.
[0] eg one of the bullet points of widely celebrated health care reform was making it mandatory to pay the cartel!
There isn't one. I'm not saying healthcare in America is perfect or arguing that insurance companies aren't rent seeking or that this can't be changed. I'm just stating that the US is the most unhealthy country there has ever been.
More unhealthy than England during the Black Death?
Also, Mexico has already passed the US in obesity, and tons of countries have more smoking that the US.
But that rant wasn't supposed to be fact-based, was it?
In a scenario where the anti-abortion party takes control of the executive that is running Canada-style single-payer healthcare on the federal level, I could see them 1) defining abortion as "core service" rather than supplemental so that private providers can't offer it outside the system, and then 2) setting harsh term limits and other barriers like doctor approval to make it effectively banned in practice.
(Fetal personhood is another backdoor that can take this even further.)
But I do see your point that if the regressives take the presidency but not congress, then the more the government is involved in the more damage they will do. I'm not a huge fan of single payer healthcare, but I guess I accept it as a compromise as it's the only plan that's been put forth to reform the deeply corrupt healthcare system. I personally want less government involvement in individuals' lives in general (and it's necessary to include de facto corporate government in that scope as well). But I've also paused focusing on this line of argument because the regressive movement has used up so much of the air for it, in bad faith.
But really regardless, we're kind of screwed if the regressives take the executive any time before their social-media-fueled nonsense is run out of the mainstream by actual conservatives - that is people who believe in questioning change, not trying to drag us back in time 70 years to some imagined idyllic past.
State level feels much more doable. Not only that, but Canada did it that way - IIRC Saskatchewan did it first, it worked well for them, and those results entered political discourse in other provinces causing a domino effect of sorts. Then finally the feds jumped in to regulate the baseline and assist with money to help the poorer provinces keep up. But to this day, it's actually a voluntary arrangement that any province could leave at any point; it's just that even in Alberta ditching public healthcare is such a fringe extreme right position that no politician hoping to have a successful career would seriously contemplate it.
And ofc if you do it state by state, then it doesn't have to be single-payer everywhere, either. We could try that in states with a more socialized political culture, and e.g. the Swiss model in more conservative states, and maybe something like Germany's private non-profit healthcare coops elsewhere. I would probably prefer the latter for myself for the sake of decentralization.
If you're a government bureaucrat tasked with reducing healthcare expenditures, in a society that's made the determination that suicide is an acceptable medical treatment, you are incentivized to increase the practice.
I agree that Canada's pushing for classifying suicide as medical treatment is worrying. Suicide is a human right, but making it part of the medical system's all-encompassing paternalism is regressive.
In general we need less intermediation between individuals and medical care, not more. And the "insurance" cartel is one hell of an intermediary. The concept of the HMO is a complete failure, and they should be made illegal for their basic anti-competitiveness.
Better if those bonuses go into reducing deaths.
Do not do not resuscitate and forgoing treatment can make people’s lives better, reduce suffering.
They know I have their insurance… I have it so they pay… do the thing…
The only trick here is tricking yourself into thinking you've won until proven otherwise.
Our regulatory system has totally failed, which is why it is rife with these perverse incentives.
Our so-called “regulatory system” works precisely as Karl Marx expected it to 150 years ago. The so-called "perverse incentives" are fundamental characteristics of capitalism.
The delusion that haunts us originated with the idea that capitalism is not a system but a set of isolated features that we can opt into and out of as we please. Karl Marx showed us 150 years ago that capitalism is in fact a complex system with many contradictions.
And no, your so-called "free market healthcare" fantasy was not considered an option because it was in fact the problem to solve.
You haven't come out and said so, so I apologize if I'm putting words in your mouth. But it seems like you're arguing toward a position: because we can see that government control of the market has resulted in the mess that we call Medicare, we should therefore stomp out any further vestiges of the market and put the government in control of that as well. This doesn't seem like a sane position.
Of course, it's also the insurance companies who are adjudicating the claims.
https://twitter.com/generalorthomd/status/163034936649709568...
https://twitter.com/generalorthomd/status/163207481760743833...
I'm imagining a non-profit organization that solicits any denial by "insurance" companies, determines if it is based on medical reasons, determines if it is medically imprudent (including harm caused by delaying care), and files a mostly pre-prepared complaint to the appropriate medical board. Make it extremely uncomfortable to work for a death panel.
Then if the state boards start really brushing the complaints under the table to protect the death panels, turn it into a direct political issue. Right now there's too much plausible deniability to hide behind.
Besides, I look much more favorably on a startup that is automating the filing of confusing paperwork designed to prevent middle-class folks from holding on to their money, than I am insurance companies that use boiler rooms of hack doctors to deny those same folks medical care.
Perfect candidate for an insurance company; he's got no other prospects, so he'll do what he's expected to. Which is deny, deny, deny.
5 years ago a woman didn't look adequately and totaled my car. No problem with her insurance (she had a stop sign, I didn't, she was cited at the scene) until it came time to pay up--and they went silent until I contacted the insurance regulators.
Improper denials or nonpayment should carry substantial penalties.
In other news: Ford Motor Co. has filed a patent application for technology that would allow autonomous vehicles to repossess themselves if drivers miss payments.
https://thehill.com/homenews/3880884-future-fords-could-repo...
For "something" you can substitute drugs, or social media, porn, or calling others idiots on the Internet.
Wait a minute...
A model that scans for high risk patients, then passes that into another model which takes actions, which can also be fed data from the police and mass surveillance with that it can also eliminate coverage for "anti-AI" people.
All it has to do is just recognize Anti-AI behavior as a health or security risk, that's it. There was an anti-crime AI that flagged Congress members too, so its not far fetched.
Grow up. this meatgrinder didnt just condense from aether. Someone wrote this, someone can change it, and anyone in the git log can be held accountable for what they did at any time. Enough of this late-stage capitalist attempt to offshore even the very concept of accountability.
Uh, not really, no. The whole point of neural nets is they independently discover novel and unexpected ways of predicting the probable answer.
Someone chose the features, the model architecture, the training data, and SGD parameters; it might not even be a NN (and probably isn't) — it could be a traditional linear regression model, or gradient-boosted decision trees. Someone analyzed the model performance on a test set and maybe even ran simulations to see how effective the model was at learning a known functional form. Someone made reports on that performance and included estimates like "probability of falsely denying claims on average" broken down by 10-year age bracket. An intern might have helped. A team lead coordinated meetings with whatever VP was running the project and signed off on the model. Senior management budgeted months worth of person-hours on model development and integration/deployment into production systems. And the model could have been rejected or modified at any point. The model training code is probably sitting on someone's laptop right now, and absolutely can be revised at any point in time, either slightly or significantly.
This is no magic in something like this. There are no positronic brains to wonder about. It's just a fucking best-fit line, and someone had to both draw the damn line and sign off on it.
Now if you could only make an algorithm that would learn how to tune algorithms...
That exists! https://www.automl.org/
https://www.medicare.gov/sign-up-change-plans/joining-a-heal...
>Medicare Advantage Open Enrollment Period. From January 1 – March 31 each year, if you’re enrolled in a Medicare Advantage Plan, you can switch to a different Medicare Advantage Plan or switch to Original Medicare (and join a separate Medicare drug plan) once during this time. Note: You can only switch plans once during this period.
But you are only guaranteed to be able to join Medigap during your initial enrollment at 65. If you switch back from Medicare Advantage to Original Medicare you are not guaranteed to be able to get Medigap. This can leave you stuck. It will possibly vary from state to state so it pays to get up to speed with the rules in your local state.
If you're expecting to be sick in old age or if you get Medicare due to a disability that is likely to have a lot of expensive treatment or require you to see different doctors in different areas it is best (IM-somewhat-experienced-O) to take Original Medicare.
Then if you want to, oh I don't know, see a doctor so you don't go to the hospital in the first place, that's Part B, but now you're paying a premium, and also have a new deductible (thankfully only once per year for this one). Still only covers 80% of the costs, still has no out of pocket max. And all that "in network / out of network" crap you have to deal with in private insurance? Yeah that's still a thing, they just call it "participating" and "opt out" providers. Only unlike a lot of private plans where at least there's some (crappy) out of network coverage, if you see an "opt out" provider, medicare won't pay at all, no matter if you submit the claim yourself or if the service was a medicare approved service. So that's nice. Oh and if you don't sign up for part B
What's that you say? You'd like to be able to take life saving medications and prescriptions that could also keep you out of the hospital? Why that's yet ANOTHER plan (Part D) you need to sign up for, with yet another premium (medicare currently claims between $4 and $150 monthly in my state). And then like always, drugs tiers with co-pays and then the infamous "donut hole" (I worked IT for a pharmacy, the number of their patients who just... stopped being patients when they hit that donut hole every year was disturbing).
Don't worry though, Medigap is here, an insurance policy you can buy to pay for the stuff your national insurance that you're already buying doesn't pay for. For a mere $200 - >$1000 / month, some or all of those deductibles listed above can be covered.
Oh and did we mention that if you fail to sign up for part B or part D within 60 days of being eligible you might have to pay an additional penalty on your premiums for life? And as you pointed out, you might never be eligible for medigap if you don't get it the first time around. And none of that includes vision or dental coverage.
So how much does it cost to be covered by medicare? Well with all the plans and a medigap plan as well, anywhere from $200 - $2000 / person / month just in premiums. Yeah ...
FWIW I am on Medicare (due to disability) and I expletive love the experience compared to the gold plated, Silicon Valley tech company, private insurance I had before I became eligible. I've not had to think about a prior-auth or appeal in the entire time. I've had no reduction in the doctors I can see (I saw specialists across the country). And I receive about $8,000 of specialty drugs a month without any questions.
I am really naive.
But what about fraud? Well, maybe don't start a health insurance company if you can't deal with it.
Too many fraudulent/suspicious claims from a provider? Cut the provider off, not the patient.
Then don't comment. It's not complicated.
> There's lots of articles here on hacker news about how the vast majority of medical expenses come at the end of life and how we do too much to keep people alive against their wishes.
Jesus Christ.
Let me get this straight: you're saying the solution to medical expenses is "let old people die, they don't want to live anyway"?
There are certainly cases where people are kept alive beyond what's compassionate, but that's a pretty separate cultural problem from the situation at hand, which is people who need basic care and can't get it because of capitalism being involved where it shouldn't be.
The reason our society keeps lurching from unthinking outrage to unthinking outrage is that people like you who can't be arsed to read an article and respond on topic keep proposing outrageous changes to our society. If you don't like unthinking outrage, maybe be more thoughtful and stop saying outrageous things.
...which is largely irrelevant, because the state should also not be involved in the conversation about whether pursuing life-extending care is humane.
> I don't think its worth us talking any more since we don't seem to be learning from each other.
Nobody involved in internet disagreements learns from each other typically. I approach internet disagreements with the idea that non-participants reading the disagreement can learn from it. That is, outrageous viewpoints like yours should not go unchallenged because that normalizes them.
If you want to stop representing your viewpoint to readers, you're welcome to, but you can drop the smug superiority about it. If you want conversations to learn and educate, you might start by reading the articles you're responding to.
Americans already use fewer health services than most other industrialized countries, but we still spend way more than anybody else. Will using fewer health services at end of life make a serious dent in health expenditures? Maybe temporarily, but rest assured the hospitals, big pharma, insurance companies and others will raise prices until all those savings are eaten away, and more.
Make no mistake, I am totally for end of life planning, but I believe it is a completely separate question entirely.
When it came out 10 years ago, it answered questions that I'd had for the previous 15 years.
That’s quite an uncharitable take, and plainly not what they meant to express.
And critically, the person I was responding to, responded back to me, and didn't disagree with my interpretation, so...
Startup culture's brand of charitable interpretation glosses over a lot of anarcho-capitalistic sociopathy and I'm not interested in participating in that. Perhaps if you were more interested in actual charitable action such as making sure seniors' medical expenses are paid rather than charitable interpretation, this place would be a bit less toxic.
If you think my interprepation is wrong, feel free to explain, otherwise we can only conclude that it wasn't wrong, and you just don't want to have to defend your indefensible idea.
[1] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6610551/
Other interesting articles: https://www.nursing.upenn.edu/details/news.php?id=848
https://med.stanford.edu/news/all-news/2014/05/most-physicia...
But that is about what is best for the patient, not what costs less. It is is unconscionable to consider that as a systemic solution to medical costs. Profit motivated sociopaths cannot be given another excuse to deny people needed care. The profit incentives here are to literally murder people. And that can't be fixed, because keeping people alive costs money. The only solution I can see is that money is completely eliminated from the conversation.
The fact is, some people pursue life-extending treatments in cases where it is effective and does result in better outcomes. But from a cost-cutting perspective that's no different. The incentives don't change because the life-extending treatment actually works. If you let money-hungry people near this, they'll still cut the cost.
As I have said elsewhere: the decision to pursue life-extending treatment should be between the patient, their loved ones, and their doctor. Not "society" or government, as some sort of cost-cutting measure. The patient. Their loved ones. Their doctor. No one else.
Let me reiterate: end of life discussions are about patient outcomes. Not about money.
If you want to know why people don't like corporate types, this is it. If you literally can't tear yourself away from your obsession with money to have a human discussion about how to let people die with dignity, you're one of the bad guys.