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Comment by VyseofArcadia | Hacker News Reader

I think it's important to recognize that a lot of Americans (most? nearly all?) simply don't have a choice in health insurance. If you are on United, it's probably because that's what your employer has offered as a benefit. I don't remember how much choice I had when I purchased my own health insurance through the ACA, but that was also almost a decade ago and the market has likely changed. In light of that, I think this

> They go to sleep at night knowing the populace hates them. And yet there's a complete inability to look inward.

is because they go to sleep thinking, "what are our customers going to do about it? They're a captive audience. We only have to treat them as well as we are legally obligated to." And they are wholly unprepared for how many Americans are currently thinking, "hmm, I suppose murder is something we could do about it."

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> I think it's important to recognize that a lot of Americans (most? nearly all?) simply don't have a choice in health insurance. If you are on United, it's probably because that's what your employer has offered as a benefit.

As a non-American, this was indeed a big surprise when someone here recently replied to me to make that exact point.

All the disadvantages of a monopoly, none of the advantages of a free market.

Kinda like the UK rail network and water systems, neither of which the British hold in high regard.

>> All the disadvantages of a monopoly, none of the advantages of a free market.

Yes. One thing I hate is the coupling of insurance and employment in the U.S. These things don't belong together. Most employers offer different "plans" but all through the same insurance company. A good question to ask in an interview is "who is your insurance provider?" Some really are better or worse. But again, it's wrong that this can even be a consideration in finding work.

Keep in mind that many/most medium size and larger companies will self insure and pay for administration of the plans.

I suppose the management contract probably won't really include terms about how aggressive the manager should be in rejecting terms (so you get what you get).

> All the disadvantages of a monopoly, none of the advantages of a free market.

Just wait until someone tells you about Comcast.

Comcast executives would be in real danger if their customers got working internet.

>is because they go to sleep thinking, "what are our customers going to do about it? They're a captive audience. We only have to treat them as well as we are legally obligated to." And they are wholly unprepared for how many Americans are currently thinking, "hmm, I suppose murder is something we could do about it."

This is obviously incorrect. Simply being hated has never been cause for finding fault with oneself . Most people think they are misunderstood. Half of America hates the other half, and vice versa.

>> They go to sleep at night knowing the populace hates them. And yet there's a complete inability to look inward.

> is because they go to sleep thinking, "what are our customers going to do about it? They're a captive audience.

I doubt they go even that far. Most nights, if not all, they probably don't even think about whatever harm they're doing. People have massive capabilities for self-justification, cherry-picking, and avoiding uncomfortable thoughts. Their whole ego is working full-time to make themselves the good-guy hero of their story.

I was surprised yesterday to discover that this awful "United Healthcare" company which everyone apparently loves to hate was in fact my own health-insurance provider for the last year. I had not noticed, because my employer routinely switches insurance plans, for reasons which presumably make sense somewhere far above my pay grade. (They switched us all to Regence last week. Is that bad? Is that good? I have no idea, and it doesn't matter, because there's nothing I can do about it anyway.)

Your assumption is wrong. The Affordable Care Act (Obamacare) imposed a minimum medical loss ratio on health plans. If they pay out less than that on claims then the excess is refunded to customers.

https://www.cms.gov/marketplace/private-health-insurance/med...

Most large employers now have self-funded health plans where they bear most of the financial risk and indirectly pay most of your claims. Thus HR departments have a major incentive to switch carriers to lower costs. Regence probably negotiated lower rates with their network providers.

But if you really think it's a scam then you're free to opt out of coverage during open enrollment.

I do think that any sufficiently consumer-hostile system becomes morally indistinguishable from a deliberate scam, but that part of my comment was a distraction and I deleted it. Sorry to have left you replying to a ghost.

> We only have to treat them as well as we are legally obligated to

They don't even do that. They only treat you as well as your state's AG is inclined to be interested in your situation.

The important point is that the patients are almost always not the customers.

Health insurance in the US is like a twisted version of the stilted app that corporate IT forces on employees, only different in that if it breaks it could kill or maim you or one of your loved ones.

The patients are the fuel that drive revenue

I had a lesson in this 25 years ago. I think it was National Semiconductor. They had an early website that was engineering focused and really good for the time. You could do parametric search, compare products, ask questions of their sales engineers, ask for samples. Download datasheets.

One day it was completely replaced by a site extolling the virtues of National Semiconductor stock and the CEO, CFO, and the board. With smiling head shorts and bio's of each. WTF? A few months later the old site reappeared as a link down in the lower right corner.

The lesson. I thought of National Semiconductor as a company that designed and sold mixed signal semiconductors. And the CEO and Board thought of National Semiconductor as a company that sold stock. And they didn't care at all about the people buying semiconductors, they cared about their real customers.

I think that's what happens when you hire from outside the company and the people brought in have no relationship with the people that buy the products.

I think it's really worse than that. I'm always surprised how much psychological buy in you can get out of people with the right social incentives. It seems difficult for people surrounded by people with cultural attitudes and way of thinking to not slowly become corrupted by it.

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