Personal income, that which sustains someones family, is vastly different then the billions made by United off the backs of those suffering. What, are you some healthcare exec or something?
This is not the own you think it is.
This is not the own you think it is.
The person who was killed made $10M last year, while UHC provided care to 52 million patients. So, the CEO was paid approximately $0.20 per patient treated last year.
What part of all this do you believe is immoral?
It's functionally isomorphic to a black box where I make a deposit, every time it denies someone medical treatment I get back monetary reward and I can withdraw my deposit at any time. If we ask ourselves, "Should this black box exist?" I cannot reasonably expect people to say, "Yes." Yet, here we are.
I am honestly extremely baffled about what your mental model here is. When UHC doesn't deny a claim, who is paying for that treatment? You can't just look at one side of the ledger when deciding whether the system is doing good or bad! They deny some claims and they pay for others! You're leaving out the whole second half!
If the child were brought up into the sunlight out of that vile place, if it were cleaned and fed and comforted, that would be a good thing, indeed; but if it were done, in that day and hour all the prosperity and beauty and delight of Omelas would wither and be destroyed.I think that, aside from the cost, this is probably the biggest issue most people have with health insurance in the US. UHC makes a lot of money specifically in part by not covering services you need, for example by having accountants override your doctors's orders.
If it were as simple as getting the services you need in exchange for money, I don't think as many people would hate the system as much.
That's exactly how simple it is to be uninsured. The problem is the risk is not something people can absorb.
No, it isn't, which is why people want some form of insurance, whether public or private. To mitigate risk.
I was entertaining the comment about something being as "simple as getting the services you need in exchange for money". Which one certainly could do, but imposing that on everyone would also be a bad system for other reasons.
In too many instances, people pay the premiums and then do not get the benefits of the insurance.
An analogy in the travel industry might be if we had a system where at random, a double-digit percentage of air travelers were denied boarding and not refunded their money. No amount of legalese would make it acceptable, and in fact Congress regulates air travel such that practices like this hypothetical are not allowed.
Yes, people should get coverage under the terms of their agreement. I'd guess that the reason this is an issue with health coverage is because the sums involved are great, and usually the people on either side of the argument are either (1) unwilling or unable to effectively argue their case or (2) nonexperts who lack full understanding of the subject matter.
These aren't really an issue with airline tickets, not because we don't regulate insurance, but because the contract is exponentially more simple and understandable.
But I do think more should be done.
I use the colloquial "cheat" intentionally, as it is a valid descriptor.
Notably, however: most insurance delays/denials will have in common that the patient is represented by an expert (a physician) on their case, while the insurer will be represented by a person who has typically never spoken with or examined the patient and may not have ever practiced medicine. The quality of the argument and expertise of the interlocutor are red herrings.
Correct. But it doesn't matter because the contract of carriage doesn't hinge on that. There's no confusion about what a ticket actually entails. If a ticket covers "one ride at the airport, from Cleveland to Omaha", it's pretty understandable what you are getting. If health insurance was just as simple, and covered "one ride at a hospital, from sickness to health", it would be likewise as accessible. But it isn't that way (although maybe it should be a lot closer)
> Notably, however: most insurance delays/denials will have in common that the patient is represented by an expert (a physician) on their case, while the insurer will be represented by a person who has typically never spoken with or examined the patient and may not have ever practiced medicine. The quality of the argument and expertise of the interlocutor are red herrings.
I understand but that's not what I'm talking about here. I'm talking about a broader information and accessibility disparity.
Having a physician isn't any help if your insurer is deadlocking you on coverage you legally have coverage for, you need a lawyer. That's a contract law problem, not a healthcare problem.
But if you don't actually have coverage for what you need, having a physician argue that you need it, isn't going to help you. Most people buy their health insurance policy all by themselves, without any legal or medical help.
We're not in the situation we're in because anyone thought it was a good idea. We got here incrementally over ~80 years.
yes the design is a result of negotiation between countless people and groups of people, who all have varying power and responsibility and subjective consequence. yes all of these choices were made in context, but they were never the only choices that could have been made in that context.
this negotiation, and these innumerable choices, these designs have been a major if not primary concern of the past twenty years of american politics, economy, and millions of individual lives.
yes we have arrived at the implementation we see today, which seems ill-conceived, over-complicated, and pointlessly cruel. but at every moment that has passed and is passing now, different choices can be made, and a different system of different design can be implemented.
we are still in this system because there is infrastructure that prevents change to a more agreeable system. negotiation tactics may have just changed.
Technically all of the participants involved are a part of the system, yes, but my key point here is that none of them have the agency to change it.
The only people who can change it are voters and congress themselves.
Most of the participants in the system are eligible voters, so asserting that voters can change the system is very much asserting that nearly everyone in the system has agency to change it.
(The fact is “voters can change it” is optimistic, because the US is not a direct democracy and, due to gerrymandering, campaign finance, and other factors, only loosely a representative one, being functionally more of a plutocracy. The people who benefit from its inefficiencies and inequities have disproportionate power over its structure.)
For example, in Canada, the Ontario government refused to cover a cancer treatment that her doctors said could extend her life by a year or more: https://globalnews.ca/news/927721/milton-mother-devastated-a...
In the UK, two Cystic Fibrosis drugs were rejected for not being cost-effective even though they were clinically effective.
https://www.cysticfibrosis.org.uk/news/nice-rejects-orkambi
https://www.fiercepharma.com/pharma/nices-trikafta-snub-coul...
You will of course stick to your principles here? The single-payer healthcare systems in Canada and the UK are irredeemable and it's morally repugnant to look at any good they've done for anyone?
...and nothing of positive value would be lost. For a paradise predisposed on the infliction of suffering on another is ill-gotten, and taints anyone that avails themselves of it once it's true nature is known.
Our birthright is to toil to elevate one another; no more, no less. Omelas is a blight, a perversion, deserving of being scoured from the face of the Earth no matter where it pops up.
Glad to see someone else was touched by that work. Greetings fellow wanderer.
Do you honestly, after reflection, think this comment is fair?
They don’t only deny healthcare to people - if that was true no-one would pay them money because having healthcare would be no different to not having healthcare. Therefore they are not functionally isomorphic to a black box that collects money when it denies medical treatment.
If you want to make a mental model and then ask questions of the model you should have the confidence to make your model robust enough to approximate the “other side” of whatever argument exists on the topic.
Most insured individuals in America don't choose their health insurance provider, they just get it from their employer where they might have a choice of plans. The closest thing to an actual competitive insurance market we have is that provided by the ACA, and though that act did many good things the disappointment of the marketplace has been well documented.
I live in the UK where we have universal healthcare that is free at the point of need. We also have private healthcare. In most countries in Europe both private and public healthcare exist side by side. Per capita spending on healthcare (across the private and public provision) in the UK is a tiny fraction of what it is in the US and outcomes in terms of quality adjusted life years and measured in individual life expectancy and patient outcomes for given conditions were significantly better than the US last time I checked (which is admittedly a while ago).
The US healthcare system is definitely expensive and delivers a poor outcome, but you’re not convincing when you try to make a pastiche of the system that paints it as purely bad and say that health insurance simply should not exist for pure moral reasons.
As if systems always do as intended? If that were the case, my code would never have downtime!
The interactions between intent and results in any sufficiently large system is inherently complex.
If a system constantly fails to do what it was intended to do, then we should consider that what it does in reality is its true purpose. Basically this is functional structuralism.
Yes, if we could wave a wand and delete the fact that it ever happened, that would be ideal. But the problem is more difficult to solve now, because we have the problem of the health insurance system, and the problem of drastic systematic and economic change.
Perhaps we should ask borrow the "magic wand" that seems to exist for every other country. Maybe they can lend us theirs since that's apparently how realistic a system that does not bankrupt people is.
Sadly, it doesn't seem equally possible or realistic to build a system where CEO's aren't revenge murdered.
That's not to say it's impossible to do, or that we shouldn't. But, an economic, political, and social mass of this magnitude doesn't turn on a dime.
Other places had the luxury of solving the problem much earlier and on much smaller scales.
[1] In mathematics the meaning is somewhat stronger. In maths, two things are isomorphic if they cannot be distinguished in terms of structure in a particular context.
People just want to complain about not being able to afford something they want (American healthcare).
While UNH does some shameful things, even criminal things, the celebration of a public execution of a second in command guy is embarrassing for HN.
Pharmaceutical companies 20%+
Healthcare software companies (based on other software company margins). 20%+
Healthcare providers (doctor groups) Hospitals (HCA, tenet, etc) 10%+
Managed care organizations (MCOs, health insurers), retail pharmacies, and medicine distributors at the very bottom. ~2%
Legal is also up there. Those millions and tens of millions of dollar judgments don’t come from thin air.
Go ahead and get rid of MCOs, and at best you will reduce costs by 5%. Their medical loss ratios are 85% to 90%.
They are just allocating the very limited resources among more and more demand. Someone is going to have to be the bad guy unless supply of healthcare is drastically increased and tort reform happens to bring down liability costs.
Are you saying that the same populations are getting more and more sick and ill? Citation needed for that. Or are they costing more and more money? And if so, why?
Wouldn't be health insurers setting up middlemen of their own (PBS, etc.) to get around legal caps on their own profit margins, would it?
> Legal is also up there. Those millions and tens of millions of dollar judgments don’t come from thin air.
Malpractice payouts are by and large a boogey man. Texas has had them capped for years and shockingly, malpractice insurance costs are effectively identical to what they were before. As an aside, malpractice insurance in itself isn't typically as onerous as people believe it to be. What is onerous, and what that industry does differently to most other insurance segments is "tail insurance".
Tail insurance is the concept that major malpractice suits may appear well after your claims-made liability policy has ended. In most cases it's actually DOUBLE the premium you're paying for malpractice insurance, implying the insurer believes that your coverage is less than one-third of the claims they expect to pay. What -should- happen is that you carry "claims-made and prior acts" coverage. The challenge there is that in many cases your employer will cover claims-made as part of your compensation or part of their insurance, but don't elect prior acts coverage (and because of the way they do it, I suspect it's not as simple as "let me pay the difference").
But in general capping malpractice payouts has done nothing to offset malpractice coverage costs, let alone flow-through to end consumer costs.
The citation is the population pyramid flattening out and turning upside down eventually. That means more and more old (and hence sick) people, and fewer and fewer care providers (young people). Also, there are a lot more treatment option, and sick people being kept alive longer.
> Wouldn't be health insurers setting up middlemen of their own (PBS, etc.) to get around legal caps on their own profit margins, would it?
No, absent enormous fraud, all revenue and expense is reflected on a company’s 10-K. UNH/Elevance/Cigna/Humana/CVS/etc all have multiple lines of business (like most other large businesses), but the final profit margin figures are what they are including all lines of business.
Thanks for the info on tail insurance, I didn’t know that.
2. Profits to shareholders and other people contributing their time and resources are also "needed", as without profits the only incentive to provide healthcare is charity, and charity has not proven to be an effective organizing principle to allocate the time and attention of millions of individuals in a complex society.
> Everyone is going to die eventually
So why provide healthcare at all?
And health insurers don't increase shareholder returns by denying claims. Due to the minimum medical loss ratio it's rather the opposite. Most of the pressure to tighten coverage rules actually comes from large self-funded employers who use those insurers not to provide insurance but rather to administer their health plans.
https://www.cms.gov/marketplace/private-health-insurance/med...
When the decision maker is accountant, RN, or AI versus physician, I know who _shouldn't_ be deciding it.
The two experiences I've seen first hand (coincidentally both UHC):
A willingness to deny vastly improved QOL for a simple surgery unless I spend an extended amount of time to determine whether somehow, a nasal spray would straighten the cartilage of a 95% deviation to the septum.
As a paramedic, the realization that UHC routinely denied paying for HEMS (air ambulance) for serious car accident patients to trauma centers because of "lack of pre-authorization".
Insurance companies have too much power in this dynamic, and there should be limits to what they can deny once doctors deem it needed.
Now that’s definitely a lot of money, but as far as industry masterminds go it’s not indicative of being top tier at all. Second or maybe third tier really.
Is it the sort of situation where the company has 10 people all labeled “CEO” of different functions? Or was the $10M salary alone?