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The entire system is an ineffective accountability sink that is highly vulnerable to vertical mergers that capture incredible amounts of money from our society while providing empirically subpar results — results on a dimension that matter quite a lot to people (the health and wellbeing of their loved ones)
Go do some Googling on the antitrust suits against the different combinations of UnitedHealthcare, Optum, and OptumRx.
Doctors (the AMA) killed the public option because it would save money by lowering their salaries. American healthcare is expensive because of providers.
(Another example is that we banned opening new hospitals unless nearby competing hospitals approve of it. This is called "certificate of need".)
https://en.wikipedia.org/wiki/Partnership_for_America%27s_He...
There are significant generational issues, too. For example, older doctors who owned highly profitable private practices took a very different position from younger doctors who are employees of huge companies, and the pharmaceutical lobby wasn’t opposed to the ACA as long as it didn’t involve cutting their profit margin to what Medicare or the VA pay.
At least blame the right people.
Also FWIW every doctor I know supports universal healthcare, granted most of them are under the age of 40 but you're foolish if you all doctors believe the same thing.
I see you didn't look up the relationship between UnitedHealthcare (the single largest insurer in the country) and Optum (the single largest healthcare provider in the country), did you?
Hint: They're both owned by UnitedHealth Group.
I of course have a nice tech employer plan, but they won't do early refills on medication which means I have to pay cash (well, GoodRX) for that anytime I travel for more than a week. Not a life changing expense but an annoying one. (Maybe my fault for choosing the HSA/HDHP plan?)
Also, I was talking about hospitals and don't believe Optum controls those. Here the plan that runs everything including hospitals would be Kaiser, and as far as I know people are happier with them, but I haven't tried it. Haven't tried ACA marketplace plans either.
Optum doesn't own hospitals specifically because they have strategically chosen to own almost every other type of clinic, including wiping out thousands of independent practices and small groups in just about every medical specialty (including primary care) that you can name.
Kaiser is an example of a much-less-bad version of this same pattern (called a pay-vider). They're non-profit so they don't have nearly the same incentive to leverage one side of their business to benefit the other.
Seriously: go do some research on how UnitedHealthcare, Optum, and OptumRx all coordinate to wipe out competition in local clinics and pharmacies.
> They're non-profit so they don't have nearly the same incentive to leverage one side of their business to benefit the other.
Most US hospitals are nonprofits, but that doesn't make them behave better. You can still earn and pay out a lot of revenue as a nonprofit.
Here's a quick primer: You're a doctor in Podunk, Pennsylvania. UnitedHealthcare is the largest insurer in your region, like it is in most regions. Optum wants to move into your town. UnitedHealthcare will cut your reimbursement rates by 70%, requiring you to see far more patients per day, cut your staff, downgrade your equipment, and generally run a shittier business. Once you're finally on the edge of burnout and fully strangled, Optum will come in with a buyout offer. After the buyout (or after you go bankrupt and they just replace you), suddenly UnitedHealthcare is able to restore rates mostly to where they were previously.
Ta-da!
Note if you take the buyout and then regret it and want to break free: too bad. This deal came with an extremely rigid non-compete clause that they will absolutely actually enforce. FTC tried to get rid of these, in large part for this specific use case, but thankfully the American people (read: megacorps) have the GOP looking out for them so that was struck down.
What exactly does marginal doctor supply fix in this particular scenario? Pretty much nothing. All of them have to accept insurance and the vast majority of their potential customers are insured by the same very few insurers.
Re non-profits: I didn't say it "makes them behave better." I said it subjects them to different incentives. Don't strawman. Kaiser in particular is an exceptionally strong organization in pretty much every way except its financial performance. If you think being non-profit isn't a factor, you're just playing dumb.
Non-profit doesn’t mean what it seems to imply.
Why are you still shifting blame from the politicians who created this system? They didn’t have to listen to the healthcare industry. They are accountable to the public. They got voted into office and they put this system in place. Of course the healthcare CEOs are going to argue in their own interest - but they don’t call the shots here! The politicians do.
The health insurance industry is a modern example of the banality of evil, and there is enough blame to go around.
Night janitor? Probably not enough nexus to be blamed. The Tech Lead on the “Deny Healthcare for Corporate Profits” initiative? Probably as culpable as the CEO.
Satirical example: "Okay, so maybe we knowingly sold guns and mustard-gas to the Elbonian death-squads which they used to kill millions during the genocide, but it's not our fault they were the highest bidder. You can't blame us for a perfectly moral transaction because all parties made a voluntary agreement to exchange goods. In fact, it's people like you who are the real evil ones here, trying to infringe on my right to do whatever I want with my property!"
And "politicians" didn't create that mess either, corrupt politicians who acted on behalf of their donors, rather on behalf of the people they represent, did that. It's not mainly politicians profiting off this after all, some of them kinda just read from the teleprompter. Does that make them blameless? Of course not. Every single person in the chain, be it a chain of command or incentives, is responsible for not refusing to participate.
well that shows why you're not aligned with those out there who are frustrated with Healthcare. We weaken universal healthcare almost the moment the administration shifts. It may as well be unilateral.
/s
#FORCED_CEO_LABOR_HAS_DIRE_CONSEQUENCES
To argue in good faith, I have to assume that you believe what you've written. How should one interpret it? Be explicit.
If I were the face of a company using junk AI and other obstruction methods to achieve industry leading denial rates to potentially life saving healthcare, all to build up my company's coffers, I would feel pretty unsurprised.
Maybe he was surprised though. In a possibly apocryphal story, Alfred Nobel was so shocked on reading the way he was described in his (mistaken) obituary that he felt compelled to turn around his legacy.
That's a tremendously generous way of saying, "Many of their customers are dead because the company opted for profit over treatment".
This seems at odds with the numbers I have seen shared here. If not, what do you think would happen if UHC lost money by paying out every claim that they previously denied? Is there an alternative to charging everyone much higher premiums?
Are you saying a government-run insurance company could be run more efficiently, and collect the same amount in premiums yet somehow pay out more in claims?
Do you think it is moral for UHC to deny _any_ claims because they are for treatments which are not medically necessary, or too expensive given the potential benefits? Should UHC pay $1M of policyholders premiums for a risky liver transplant for a chronic alcoholic who is still drinking?
If you accept it is moral for UHC to deny some claims, how do you know that UHC's policies around denying claims (which led to their 6% profit margin) are actually wrong? Because you read some articles with anecdotes about people's bad experience with them?
Beyond that, I have no desire to engage in this conversation with someone who, very clearly, cannot discuss things in good faith right now.
Articales show they had lots of unhappy customers.... Also when employes get income of several million a year seems excessive. The CEOS income was around $50,000 a business DAY , probably more that lots people earn in a year. Its reported these customers died/ went bankrupt as a result of insurance company refusals . ( Ive always thought needs to be much stronger government laws around documentation so people aware of what is covered and what is not, could have reduced the number of unhappy customers )
Do you think those patients would have been better off with that $0.20 still in their pocket, and a less qualified CEO running the company?
Yes, if that means that $0.20 went towards patient care.
The money is better spent caring for patients than compensating one man.
Something along the lines of how technology dehumanizes and displaces us.
That person could then move to a shack in Montana and start mailing bombs to the engineers and tech workers.
Time to reflect how your work is affecting the world, folks. But even if you take action and quit now it's likely they'll find other guns to hire. If you want to make a difference you have to do a lot more than that.
As Joseph Weizenbaum said, that's like saying there are a lot of rapes every day, so it's fine to rape.
Let those other "guns" who get hired (tempted) try and fail to make peace with what they do. If you take their place before they can, you're them, look no further.
We are ALL complicit in the systems behind all this when we are the ones building and maintaining them.
Myself included.
The first step to ethical responsibility is honestly acknowledging what I've been taught to do and have done without unlearning those things. Second step is to consent to unlearning that and learning a different way that addresses all the issues. Third step is actually doing the unlearning/learning.
And even if a major tech CEOs like Zuckerberg or Bezos got shot, while there would be plenty people joking about that, too, it wouldn't be anywhere remotely like this, I'm 100% sure of it. There's something about denying care for profit to people screaming in agony that pushes a whole other set of buttons.
And if you're not doing that, then your point doesn't seem to make sense in the context of the thread.
Trying to highlight different perspectives people can have, and to challenge readers to reflect on the use of violence.
Pick any arbitrary group of people, and you can find another group that thinks they are destroying the world.
https://en.wikipedia.org/wiki/Ted_Kaczynski
All that being said, obviously there's no doubt that the healthcare system is pretty messed up.
Many of those jobs even include rich CEOs of billion dollar insurance companies in industries that manage to actually fulfill a (comparatively) reasonable amount of customer claims.
Yes. Happens all the time.
AND ... you seem to be implying that all companies are [ethically, morally, practically] the same.
Without taking a position on the shooting, I will tell you this: all companies are not the same. And this particular company seems to be one of the worst, and that too in an arena that directly impacts people's literal lives.
The issue I see with all this is the anger isn't because this CEO denied claims that should have been accepted (that would be reasonable anger), it's that they denied claims at all. How do people expect insurance to work? An insurance company that never denies claims doesn't stay in business.
(And obviously, yes, I think the US healthcare system is lousy. But in the system you have now, you have insurance companies, and they need to operate in the real world.)
That'll be the people (UNOS) managing the transplant list, which is sorted already sorted by severity and chance of surviving the procedure.
https://www.cnn.com/2018/05/13/health/liver-transplant-mom-e...
> More than 100 doctors at three of the nation’s top medical centers have weighed in on her case, which is complex and exceedingly rare. Their conclusion: The only way to save Erika’s life is to give her a new liver.
> After weeks of evaluation at the Cleveland Clinic in December and January, Erika finally got her big break.
> On February 2, doctors there approved putting her on the wait list for a liver transplant.
> But Erika hit an immediate wall. Her insurer, UnitedHealthcare, denied coverage for the transplant, saying it would not be a “promising treatment.” She appealed and was rejected again.
1. It's explicitly stated, including by the doctor involved, that this is a "groundbreaking" (read: experimental) procedure, having been performed exactly twice in the US this century.
2. The doctor even says "he can somewhat understand the insurance company’s initial reluctance at coverage".
3. The insurance company denied it because "unproven health services is not a covered benefit" - this is expected, the insurance company can't just take a single doctor's word that "it'll totally work, I'm super good at this surgery".
4. The insurance company ended up approving her claim.
And then, from a different article - https://www.kgw.com/article/news/health/portland-mom-who-sur...
5. UNOS actually downgraded her score on their list (highlighting that, unfortunately, this was not a 'promising treatment').
6. She died during the liver transplant operation.
> Erika had waited more than a year for a liver due to insurance issues.
Yes, if you delay long enough, chances of survival go way down.
(There’s a reason “delay” was one of the three words on the bullet casings, I suspect.)
She was delayed by "insurance issues" by at most 3 months.
She waited more than a year for a liver because she wasn't a good candidate for a liver transplant.
https://www.cnn.com/2018/05/13/health/liver-transplant-mom-e... has a nice illustrative example of how silly the system UnitedHealthcare and others set up can get.
https://www.nytimes.com/2024/12/05/nyregion/delay-deny-defen...
> Earlier this year, a Senate committee investigated Medicare Advantage plans denying nursing care to patients who were recovering from falls and strokes. It concluded that three major companies — UnitedHealthcare, Humana and CVS, which owns Aetna — were intentionally denying claims for this expensive care to increase profits. UnitedHealthcare, the report noted, denied requests for such nursing stays three times more often than it did for other services. (Humana had an even higher figure, denying at a rate 16 times higher.)
https://www.propublica.org/article/unitedhealth-healthcare-i...
> As United reviewed McNaughton’s treatment, he and his family were often in the dark about what was happening or their rights. Meanwhile, United employees misrepresented critical findings and ignored warnings from doctors about the risks of altering McNaughton’s drug plan.
> At one point, court records show, United inaccurately reported to Penn State and the family that McNaughton’s doctor had agreed to lower the doses of his medication. Another time, a doctor paid by United concluded that denying payments for McNaughton’s treatment could put his health at risk, but the company buried his report and did not consider its findings. The insurer did, however, consider a report submitted by a company doctor who rubber-stamped the recommendation of a United nurse to reject paying for the treatment.
They can, in fact, have their billions of profits while not putting their customers in the grave. It's just slightly less profit than they currently get.
Squeezing the blood from the stone here is entirely a choice.
That shows the gross margin of insurance companies (based on premiums vs paid claims). Note that it's negative in some states, and also that's gross margin - so all the insurance companies' costs need to be paid out of that.
They are not making as much profit as you think they are.
How much do you think they should be entitled to make?
If the answer is zero, why would anyone invest in a company that can’t make money?
If the answer is that healthcare should be run by the government, why are you blaming the CEO instead of politicians?
Who has a greater moral accountability to the public - politicians or corporate CEOs?
The correct answer is “both, they are willing accomplices”.
When the options are deny healthcare to someone that has paid you for healthcare and give them the healthcare, it's not morally grey.
Wanting to not be dead or miserable in exchange for a company fulfilling their obligations and maybe having billions in profit instead of billions in profit +1 is far from 'unreasonable'.
This CEO was not some faceless cog with no agency. He was someone with real power and control that willingly made decisions that actively severely and often fatally harmed his customers.
So I do feel morally in the clear to cheer over the death of someone whose bonus hinged on him increasing the suffering and reducing the life span of completely random, innocent people, that, as a group, only had in common „not being rich“.
UHC deliberately denied coverage to millions of people, at least hundreds of whom died as a result. Right now experts are saying that 7 out of 10 juries wouldn't vote to convict Luigi, and based on conversations I've had with people across the political spectrum I'd say the only jury that would convict Luigi is one made up entirely of healthcare executives.
I'm just surprised that this didn't happen sooner.
> The company dismissed about one in every three claims in 2023 — the most of any major insurer. That’s twice the industry average of 16 percent, according to data from ValuePenguin, a consumer research site owned by LendingTree that specializes in insurance. The group’s analysis is based on in-network claims data from the Centers for Medicare & Medicaid Services.
https://www.welcometohellworld.com/this-is-the-most-ghoulish...
The article is biased, as you should also be in the face of evil, but you can follow the links through and eventually get to the materials as presented in court if you're motivated.
This is hideous.
Are cancer patients not miserable? Do oncologists work for free or for minimum wage?
They profit off of providing treatment to human misery. A health insurance company profits off denying treatment. It's not that difficult to understand. But given that every reply from you in this thread has been pathetic and embarrassing defences of healthcare companies and CEOs it's clear you are not operating in good faith.
Is minimizing healthcare spending unethical?
You’ve never been an oncology patient apparently. They don’t see it as ‘profit’ at all, they are trying to save lives.
>If your reaction is “Oh, but I’m not the CEO!” you’re deluding yourself (at best).
I don't have much of an IRL online presence, so it'd be a helluva a lot harder to plan a retaliation against me than a public figure.
But yes, I live in downtown L.A. It would not be hard at all for me to piss the wrong person off, or simply be in the wrong place at the wrong time.
Yeah nothing I worked for bankrupted people because they used an out of network surgeon though.
Me refusing to accept a return on some golf shoes without a receipt is not morally equivalent.
I feel safe in that regard.