Torrent of Hate for Health Insurance Industry Follows CEO's Killing
nytimes.com
nytimes.com
this is amazing thing to me as European living in the United States, people want Gov to spend money for education or healthcare or ... COMMUNISM!! but corporate subsidies and 984 trillion dollars to the department of offense - oh RIGHT ON - let me get another gig job to pay more to that :)
Everyone will require healthcare at some point, and at the points where you need the most you can't go do some window shopping and price comparison. Why make it more difficult, cumbersome, expensive, and bureaucratic? Ideologues can be rather illogical.
Less sick people is better in general for a society, not only socially but also economically speaking, do you agree with this statement?
I agree with the statement as you present it, all other things being equal.
And they still get nothing done when it comes to entrenched interests. Let's not glorify the average voter either.
... But you still have group A (patients) paying group B (doctors) with group C's (taxpayers', or currently insurers'/policyholders') money.
What point are you making here?
Otherwise, I agree with you.
You’re even replying this to a comment that literally contains “I agree with you”.
It’s like stepping between your friends complaining about jet lag to talk about how your corner bodega raised the price of bubble gum.
If you just want to talk about providers then write a screed on it. People will comment their opinions on the subject you want to discuss.
Then share an opinion on that.
> in the hopes of getting a maybe 5% savings break on their health insurance costs?
You were so close.
All you had to do was condescendingly presuppose a motive, and fabricate a statistic to make it about your desired topic again.
Regarding providers overcharging, the following article by Atul Gawande (from 15 years ago!) had a big impact on me -- it agrees with you:
https://www.newyorker.com/magazine/2009/06/01/the-cost-conun... / https://archive.ph/g8zXl
But you don't expect someone dying from losing health care to shut up until they come up with rational cost management system? The point isn't that the average person needs to how to portion blame but that the health care system needs to stop treating people in the fashion it does.
- the company pays out-of-pocket for all employee health expenses
- they don't want to directly deal with bills from doctors and hospitals, so they contract that out to a third-party administrator (TPA), which purely handles paperwork and has no financial role at all
but this doesn't remove the tension between the employer wanting to pay less, and the patient wanting more to be paid for
(and for single-payer systems, you still have the tension between taxpayers wanting to pay less and patients wanting more care, although those groups at least overlap a lot more)
Americans React to UnitedHealthcare CEO's Murder: 'My Empathy Is Out of Network' (141 points, 12 hours ago, 329 comments) https://news.ycombinator.com/item?id=42327272
Moderators Delete Reddit Thread as Doctors Torch Dead UnitedHealthcare CEO (45 points, 3 hours ago, 22 comments) https://news.ycombinator.com/item?id=42332347
This won't win me any points in this particular forum, where this opinion (that I strongly hold) is unpopular, but I'm reminded of what someone else said about Net Neutrality: it's a bunch of people suiting up and taking sides on behalf of one group of giant corporations against another group of giant corporations. That's the "health care debate" in the US, where medical staff are paid 2-3x more than they are in other countries, and expensive procedures are prescribed and delivered at drastically higher rates. It's my problem with "Medicare For All", which more or less absolves providers from their role in choking people out with health care costs, despite the leading role they have in this situation.
At any rate: there's no serious theory of change that begins with murdering health care industry people.
I dunno. This is the most publicly-united I’ve seen people against the industry maybe ever. Usually they’re separately-angry at the industry in their partisan silos (everyone hates it, more or less—hence the amazingly consistent and widespread reaction) but this has been the closest thing to a bipartisan healing moment since, like, the week after 9/11. Not particularly close to that, sure, but I can’t think of anything closer.
If this were part of a theory of change, it strikes me as no less serious than any other I’ve seen. At least.
This is top of my list for conversation topics to steer things toward when I’m around Republican relatives, so we’ll have something we can agree on.
Law-abiding doesn’t mean much when you can kill lots of people for money and remain within the bounds of the law. Killing one such person is definitely far less bad than killing a bunch of people arbitrarily. Yet only one of these cases is illegal, and it’s the better of the two.
Similar reaction for the other examples. I’m baffled that they look similar to anybody at all.
[edit] hold on, ok, another angle that may clear up why I’m confused: if my health insurer denies my legit claim, should I be more, less, or equally angry with the leadership of that company, or with every single person in the country who fails to donate to my resulting gofundme? I’m immediately inclined to wish horrible things on one of these groups, and to find the idea of wishing horrible things on the other confusing and repulsive.
Health insurance has a fixed profit margin on claims paid. Denying claims costs them money. Pay 10 billion in claims and they make 2 billion. Deny half the claims and they make half as much.
look up that ACA 85/15 law
Because there is a clear legal understanding of how much profit is acceptable.
Ahhh. I guess you're not aware of stuff like this?
https://www.newsweek.com/hospitals-are-reporting-more-insura...
https://www.theregister.com/2023/11/15/unitedhealthcare_ai_m...
One of the primary jobs of insurance companies is to vet claims. If we didnt want that, you could just make a shared bank account and let doctors and hospitals bill anything they want to it. You might save 10% on overhead, but it would collapse instantly.
If that were true then United Healthcare wouldn't have rolled out an automated system that (reportedly) denies ~90% of people regardless of their actual need.
The CEO getting shot seems to indicate it's probably more true than less true.
The ACA’s loss ratio rules don’t apply to self-funded plans (many large employers use these) even if they’re administered (and possibly re-insured) by a health insurance company, which is usually the case. Just doesn’t apply at all.
Certain plans also allow much lower loss ratios, like 60/40 for expat plans.
A provider that manages to have a lot of new plans in a given state in a given year is immune from loss ratios rules in that state, for that year. I don’t know how gameable this is but my WAG would be it’s only state insurance commissions preventing this from being the case in every state, every year, for every provider, and keeping it to only some states in some years for some providers (I bet the biggies manage to rotate their state[s] and have at least one most years)
So a company the only business of which is health insurance can easily spend far less than 80 or 85% of income on payouts, and only need maintain that ratio on some subset—possibly small—of the premiums it’s collecting.
I don’t know how the game of this affects decisions for insurers that also own providers, but I bet there’s something beneficial there and that’s why they’ve been snapping up provider offices for the last several years.
At the end of the day, my experience is that my UHC healthcare is about 10% more than healthcare from non-profit Kaiser, and Kaiser is far more stingy with services.
I think there is a hell of a lot wrong with healthcare in the US, but I don't think that constitutes murder just because the stakes are life an death.
Ethics depend not just on the outcome, but the processes that leads to that outcome.
The incentives in healthcare are terrible, but it is the government which has structured the system and those incentives.
The majority of people in this particular industry have nothing to do with actually providing health care, just as the majority of employees at a major university have never stood in front of a blackboard.
So, yeah, you'll have to do a little better than that.
You usually come up with better arguments than this. We all have off days, I guess.
https://web.archive.org/web/20210421025041/http://theinciden...
(Shrug) I'm OK with the notion that doctors contribute somewhere between 4 and 7 times more value than your average schlub driving a bus, and I'm OK with paying them accordingly.
Now, how much do the administrators, insurance-company execs, and other noncontributors make?
> pushing back on anesthesiology pay on the East Coast.
Not even close. BCBS was just pushing extra charges onto patients.
> insurers working to make surgeries cost less
This is laughably ill-informed, I don't know where to begin. The only thing insurers are doing is increasing the gap between what they collect and what they have to pay out. They do this by denying claims. Making the service cheaper has nothing to do with it.
> where medical staff are paid 2-3x more than they are in other countries
Because medical school is so expensive. Also, doctors spend 3-8 years working for minimum wage (ie medical residency) and the cost of billing and administration is enormous. One study showed a primary care doctor spent $99,000 a year on billing and roughly 25% of ER income spent on the same [1].
The US spends the most per capita on healthcare than any other OECD country, by about 50% (Switzerland is #2) [2] for less coverage, worse outcomes and lower life expectancy.
Medicare spends almost all (~98.5%) of its funds on patient care and ~1.5% on admin, compared to 15-25% on admin for private insurers (including Medicare Advantage).
It amazes me how concifently wrong and ignorant about a subject can be while having such strong opinions.
[1]: https://www.fiercehealthcare.com/finance/study-billing-for-m...
[2]: https://www.oecd-ilibrary.org/sites/7a7afb35-en/1/3/7/2/inde...
You cannot reasonably support Medicare and claim that Anthem was doing something unconscionable, because Anthem was adopting Medicare's own policies.
Medicare's admin cost ratio is a function of who it covers. Somewhere in the comment history on HN, there's a short writeup I did of how the math works out if you extend Medicare to the whole population; the admin overhead, for obvious reasons, shoots up --- people pay the same amount of money but require far fewer services, reversing the "advantage" Medicare has in the metric currently.
The Medicare schedule is generally low because of the negotiating power of the Federal government so when Anthem (or whoever) says something like "we'll pay Medicare rates" or "we'll pay 120% of the Medicare rate" they're really just cutting payments and increasing patient costs. Nothing more.
In the recent BCBS case, all they were doing was saying "it may take 8 hours for the surgery but we're only going to pay you for 3". They haven't made the surgery cheaper to provide. They just wanted to pay out less.
Also, if we're going to simply do everything based on Medicare, why exactly do we even need private insurers? Just expand Medicare to everyone if the schedules are good, right?
You are exactly right that Anthem is demanding providers charge less for surgeries, not for surgeries to take less time. Providing "less anesthesia" is not a thing. This is entirely about preventing health providers from charging more money to Anthem and, in turn, their customers. That's why Medicare does the same thing.
This is about the trade association for anesthesiologists deputizing angry people on Twitter to go to bat for them overcharging for their services.
we like to think we are just da best at everything
after all, I sometimes read about people coming to the US for care so it must be better?
Solutions? I'm worried that there aren't solutions. There are only bandaids.
I thought the American Medical Association were the ones who artificially constrain the supply of physicians. Is that not true, or is the AMA constraint transitively related to the Medicare caps in some manner?
It is just one aspect of how incredibly constrained the supply of healthcare is in the US. Medications that are over the counter in many countries requires someone with 12 years of training.
Residents provide healthcare to patients with real value. This healthcare either gets attributed to the attending physician or goes unbilled. The market value of care provided exceeds what it actually costs to employ and train a resident.
You sure about that? Show me one theory of change where the oppressed somehow rise above without violence? Even the groundwork for Ghandi's peaceful protest were laid by a strong anti-colonial military force that led assassinations of British military officers. You think Britain left because Ghandi said some profound things and changed their minds? The official position was that continued occupation of India would be met by violent resistance and they retreated.
There have been many many examples throughout history of oppressed people rising up with violence against their oppressors. The majority of the substantial changes in culture happen this way - things reach a boiling point and it spills out on the streets.
I'm not saying mob justice is an ethical or principled way to instill change. But historically it has been extremely successful.
There is one group, the insurance companies, which have unequivocally stated that they will physically harm other people if it yields marginally higher profits. That's not up for debate, that's the stated business model. It is extra-judicial killing for profit, backed by the state. And when the state abuses their monopoly on power, history shows that people will claw it back as violently as they feel necessary.
To be fair, we’ve never tried it.
European countries solutions range from free to government subsidised (for those who can't afford it). The free ones vary in quality, but systems where you pay unless you can't work pretty well, and the quality is very high.
Why is this such an issue in the USA? Is it purely a "powerful people with vested interests" thing?
The journalists' tone and choice of words here, which I've italicized, isn't helping the overall feeling many Americans have of "the people running the show have active and unceasing contempt for us", which of course is what's driving the "torrent of hate for health insurance industry" that this article sets out to document.
I'm sorry, but where do these writers get off wagging their fingers and tut-tutting people who'd prefer not to spend their neurons on sympathy for someone at the helm of an inhuman system? The point's already been made, but plenty of monsters are husbands and fathers.
What I do find disappointing is the lack of concern over people being gunned down in the street, and the not so subtle glee some people are expressing.
Murder should not be normalized or endorsed. It isn't healthy for a society and doesn't lead to progress.
This is (was) the CEO of the largest health insurer in the country which has shown a lack of concern for paying out insurance or securing data both private and medical. Their data leak this year is second only to National Public Data's leak (also this year) of practically every single SSN on the planet and arguably worse because their leak also contains medical data.
Murder is never okay, but this guy is also about the most unsympathizable man in the country.
There's no way that is true. It's only remotely possibly true if you're only talking about people who at least nominally obey the rules and laws of society. You don't actually think that he was worse than a murderer, or a rapist, or a child abuser, of which we have many, many thousands in this country.
The difference in opinion might be many people considering the guy himself to be a murderer, and not just of one or two people?
Even if you’re a few levels removed from the deaths you’ve caused, you still have blood on your hands imo.
I'd rather have the Sackler family show up for a dinner than the Manson family, but if we're being honest, the former is responsible for several orders of magnitude more deaths than the latter.
An ounce of prevention is worth a pound of cure.
I think there is not much point in defining a single metric of "worse" because that is confusing. A rapist is worse if they are following your spouse. This guy is worse if he is about to make a decision that will prevent your loved one from getting medical treatment at the exact time that they need it.
The acts of Murders, rapist, and child abusers are far more heinous than health insurance CEOs. However, I would argue the magnitude of damage is larger from the decisions of health care CEOs.
Sure. That includes the US health care system too.
The company that person was the key decision maker for has apparently been murdering people for years legally.
So, karma?
People should not kill law abiding citizens they disagree with because everyone has a different opinion.
Good when it works, but what happens when it fails?
Maybe I'm sensitive because I have been reading about the french revolution, and how mob rule lead to mass murder which left everyone worse off.
From your point of view was the "everyone left worse off" a short term thing, or did it eventually come good for most, or something else?
How far along the path do you reckon the US is to the same kind of thing?
I don't think any of the revolutionary elements can get enough support for governmental change, and the majority wold rather give up their freedoms than give in to terrorists.
Get a grip. For all we know the shooter was pissed b/c his girlfriend was banging the health insurance executive while babysitting for him!
[I would loooove for HN to have optionally-visible meta-threads, so onlookers like me could sit in the gallery, drink a beer, joke and remark about what is posted w/o affecting the stream of thought. Now back to y'all...]
We do, but unfortunately it heavily favors the party with the most money. If you want to take a health insurance company to court it's gonna cost you a lot of money in lawyer fees and you'll face a phalanx of corporate lawyers who have a lot of experience in crushing cases brought by their customers. That's not to say that people should go out and take matters into their own hands, but there is a lot of pent-up frustration out there and we really need to start addressing some of these issues before more of this happens.
Someone has turned to vigilante justice here not because they believe that the courts are useless, but because they believe that this is such an extreme case that courts would not have worked in this case.
What I believe people fear is not the rise of anarchy due to one killing, but a fundamental shift in attitudes of the ordinary people in response to the unreasonable rise of the power structure. This threatens not order but the very power structure itself, which implies that a lot of people who benefit from injustice will suddenly be at risk of losing those benefits (money).
also people should most definitely NOT kill law abiding citizens! we do have laws for that
These are the laws that your fellow citizens have chosen and established.
killing CEOs is not the kind of violence any reasonable human being can condone, but people tragically affected by someone’s actions may not be all that reasonable
By abandoning democratic law, you also abandon 3rd party discretion and control over which injustices are legitimate.
jokes aside, I am not saying this tragedy was justified in any way but we are not talking here about “opinions” and “religion” for sure
At what point is defending their murdering of people an acceptable approach? :)
Not at all. The US "health care" system has the extremely bad reputation it has for a reason.
This guy seems to (for all we know) have only killed a single person (so far).
The person he shot has likely killed far more. I'm not sure why you're ok with that, or am I misunderstanding?
https://www.theregister.com/2023/11/15/unitedhealthcare_ai_m...
>At what point is defending their murdering of people an acceptable approach? :)
We have laws that define where your responsibility starts and ends. For a random citizen, you have 0 obligation to help someone pay their healthcare bills.
For a health insurance company, they have a legal obligation to spend 85% of revenue on member healthcare, with all expenses and profit coming from the remaining 15%. This is codified by the ACA 85/15% law passed under Obama. United meets this obligation.
That's not what happened.
Brian Thompson isn't a "law abiding citizen I disagree with" he's a law abiding citizen who killed people. If you or your loved one died because of his actions, would you "have a disagreement with him"? Is that what you'd call that?
How many millions of people did he save?
Tell that to the people whose family members died due to his actions.
I'm not arguing this with you again for you to ignore what I say again.
> If you attribute the deaths from healthcare denials to him, did he also save every life that wasnt denied?
> How many millions of people did he save?
None that wouldn't have been saved by anyone doing his job. Literally, it was just his job, and he was close to as bad at is as he could get away with. All the evidence I've seen is that this guy was an obstacle to saving lives at every opportunity he got.
Even if we somehow pretend he made any effort to saving lives, how many lives do you have to save to get a free pass for a murder in your mind? Is that how you think this works?
Honestly, I think there's something wrong with your conscience. Grow some compassion for other humans.
If this were you or I it would be a segment on the 6 o'clock news and a cold case
That the murderer, who killed someone in literal broad daylight on the sidewalk of one of the biggest cities in the world, is still on the loose speaks volumes to me about all sorts of things.
I guess the American revolution didn't lead to progress then. Or any of the other revolutions, many of which had assassinations. And murder is not being endorsed. Putting an end to it is.
What’s this norm you mention?
What norm?
You might have beef (or whatever you call it these days) with his job and industry but in the end a man was murdered. You may not like and "hate" seems appropriate to describe how you feel about a legitimate industry in the USA. Your issue is with a deeply embedded part of the US experience - health insurance, and not with this man.
Please attack the industry that you hate and not the individual ... who was murdered. That is what the journos are doing.
Depending on the shooters motivation, I think they're of the opinion that the time for dialogue has passed.
Given your spelling of dialogue, I think it's unlikely we'll ever really understand the shooter's motivation.
And what exactly is your solution?
Healthcare should be a charity from the rich?
It should be nationalized, and somehow magically all the problems go away?
I’d maybe vote against state level single payer, let alone taking over healthcare entirely, because I think it’d be a ton less efficient than doing it at the federal level—enormous amounts of money already go to various federal healthcare programs and it’d be better to pool that, and also lack of state level control over their markets is likely to cause problems. I dunno, it might depend on the law, but my gut reaction is a “no” vote on that, too.
Anyway, as for the other question, I believe that the rise of the postwar think-tank industry (a mash up of k-street and Madison Avenue, but for white papers, as it quickly became) and deliberate party and industry efforts to shift public sentiment in pro-market directions, tied up with lots of government spending on anti-Soviet messaging (were they bad? Oh, yeah. Were all the things the government tried to lump in with them and decry as un-American bad? Ehhhh… I mean atheism is among those, see the change to the pledge and to our money at the time, among other things, and I think atheism’s fine) is probably why healthcare can be this incredibly messed-up and nationalization remains not just not-popular-enough-to-pass, but entirely outside the Overton window, yes.
M4A is nationalized health insurance if not quite nationalized healthcare, but the point remains that the only reason we don’t have major steps in this direction is because of people in power who will not let it happen.
For example, the ones establishing and profiting from so-called "social media" at the expense of organisations that employ journalists.
Advertisers choose between supporting organizations that employ journalists versus supporting ones that do not, the ones profiting instead from the "torrent of hate". NYT has plenty of paying subscribers; it is not 100% dependant on ads, unlike "social media", generally.
Indeed "the people running social media have active and unceasing contempt for us". They prefer computers over people. Surveillance over sympathy.
1) any reform has to get past the Senate, and the Senate gives a lot of extra weight to states with conservative electorates. In 2009, this meant the pivotal Senators were right-wing Blue Dogs, an independent (Lieberman), and a former Republican (Specter). In 2024, this means the pivotal Senator will be a conservative Republican, since Dems run fewer Blue Dogs, and liberals can't win states like North Dakota and Louisiana.
2) people don't only vote on healthcare; Democrats also support much less popular stances on other issues, especially immigration.
Lobbying etc. matters some, but is much less important than those two big ones.
https://www.the-independent.com/news/world/americas/us-polit...
I think the reform that would be acceptable to the median voter is a public option for Obamacare. Just let people select Medicare as an option instead of one of the private companies (and even better, let companies provide it as an option for their employees as well).
If set up this way, I dont see why anyone would reject it. At worst, it would be another option amongst many.
The poison pill would be if opt-in medicare was funded from taxes on the general public who were paying concurrently for their private insurance. Medicaid funding would continue to support the poor.
However, this would only be a start. The real problem with US healthcare is a lack of spending controls. European socialized healthcare refuses to purchase treatment if the cost/Quality of life improvement is too low.
* The resulting customer shifts will result in private insurance becoming more expensive or, worse, exiting some markets, which violates the requirement people have that, in the worst case, their current insurance remain accessible to them.
* The resulting customer shifts will drastically increase the cost of Medicare, threatening the existing program with benefit cuts.
Regarding the first, I dont think that this is a forgone conclusion, at least immediately, but admit I haven't thought through how the transition would work. With any public option gaining members, there are bound to be insures that lose them.
The current Democratic Party is essentially "Republican Lite", Republican with a happy face on it. Democrats as a whole are more interested in defeating progressives and leftists than they are in defeating Republicans.
[1]: https://news.gallup.com/poll/468401/majority-say-gov-ensure-...
[2]: https://thehill.com/policy/healthcare/351928-poll-majority-s...
Approval is high for "Something Else" but low for the alternatives.
Back in the days, mainstream media had enough control over the narrative to water down the "manifesto" part and avoid copycats. This time, "rogue" social medias are much more prevalent, so there's not much of a barrier to prevent the perpetrator from becoming a hero. We can think that copycats will emerge.
I guess that billionaires around the world are dusting off their "apocalypse bunker" protocol...
...when it is simply a consequence of America's system and the solution (public health insurance) is implemented in every other places.
Have we all got drunk on libertarianism until we would rather see CEOs murdered on the street than admitting maybe, sometimes, government managing its own citizens' welfare is an acceptable solution?