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Comment by munksbeer | Hacker News Reader

Usually I don't tend to get caught up in stories like this. But one thing has me completely fascinated, is how far off the deep end the internet went over the last few days. A murderer became a cult hero online. I saw many posts even suggesting "the snitch" should be hunted down and get what's coming to him/her.

I try not to overreact to stuff online, but this took me a bit by surprise. Things really feel like a melting pot at the moment, with so much pent up anger amongst people who actually lead pretty decent lives.

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> who actually lead pretty decent lives.

It's because the whole image is fake. In theory everything is fine but you know there is something very bad about the healthcare system, and the power of an institution to decide about someone else's life or death is just one aspect of it; prices inflated beyond imagination is another one (these two are related). So we pretend to live normal lives but in the back of our head we pray we don't ever need to become a victim of this system. But on the outside yes, it looks like everything is fine and we have decent lives.

I can explain my perspective which echos kinda what you say.

I am in my 40s, I make pretty good money. My life is good.

My mom died last year. The medical system and her medicare "advantage" plan killed her. She had a stroke. However, within a day, she was up and walking around with assistance.

However, the hospital was understaffed so two things happened. She fell going to the bathroom AND after that happened, they did not get her moving enough and she got a huge bed sore.

The huge bed sore would not have happened if her medicare advantage plan hadn't denied denied denied having her moved to get physical, occupation, and speech theray. If she had just good ole medicare, they would have approved it the day of request (it was requested the day after the stroke, I was warned that her plan was going to deny because they always do where medicare always approves). Instead, she rotted in an understaffed wing of the hospital for a week while I fought to get shit approved.

After getting approval to be moved, she was making slow slow progress due to the bed sore. It is hard when your body needs to recover and you have a huge wound on your back.

Once again her medicare "advantage" plan denied giving her more time in therapy. Guess what? Medicare would have just approved. Her advantage plan said the "community" could care for her and she could just get better over time. Do you know what that means? They wanted me to quit working and care for my mom 24/7. That is what they meant by community care. I am an only child with no other family except my wife and kids.

The hospital social worker was great and refused to discharge my mom because she knew I couldn't physically move my mom around or give her the care she required. That started a month battle where her insurance was refusing to pay anymore hospital bills, refused to get her more therapy, and essentially killed my mom. If the social worker had allowed my mom to be discharged, I would have been fucked.

She slowly got worse and died. The american medical system with its private "advantage" plans took what would have been a recoverable bad health incident and allowed it to kill my mom for greed.

BTW, after a month of fighting, emails to the insurance board of directors and CEO, I got more therapy approved for my mom but it was too late by then. She died a few days later.

You can probably guess how I feel about the CEO's murder........

that sounds like a true nightmare. i'm sorry that happened.

Yep, and it is preventable. The one thing I can say is NEVER let your parents sign up for a "medicare" advantage plan. There is no advantage. The company my mom was with is one of the largest and profited something like 18 BILLION off medicare last year. How do you think that is possible? Because they overcharge medicare and deny coverage.

Source? UNH’s entire net income in 2023 was $22.3B, and their market cap is more than 5x the next biggest managed care organization (MCO).

The other MCOs all had net income less than $8B (CVS/Elevance/Cigna/Humana/etc).

There is no way a business earned a profit of $18B just from Medicare and it not being visible on their net income figures.

That is not to say Medicare Advantage is good for most customers (the common advice is to stay away from it), but fantastical numbers don’t help arguments.

Profit is not income. That $18B could be spend on salaries, bonuses, company assests, etc, and I'm not an accountant but if it's getting spent on the business it doesn't have to be included in their income reports.

Profit without a qualifier is assumed to mean net income, which is all revenue minus all expenses.

But even supposing that the business earns $18B from Medicare Advantage after all is said and done, it doesn’t pass the smell test because at that level of profit, these businesses should shut everything else down and just do Medicare Advantage.

Wish I could upvote this more. Switched mine to BCBS PPO with medigap supplemental plan for their Medicare provider. They got to go to the best cancer hospital and specialists you can just call up the office and schedule. It costs like $900 a month though and they pay 20% with 80% plan coverage up to catastrophic out of pocket limit. PPO if you want to give your loved ones a fighting chance.

People sign up for (or are tempted to sign up for) Medicare C because traditional Medicare is too complex and bafflingly bad. Traditional Medicare requires paying for your Part B premium, a separate Part D plan and premium (from the private insurance companies), likely a third “Medigap” plan and premium (also from the private insurance companies IIRC) and then separate private vision and dental coverages.

And for all of that, you’re stuck paying at least 20% of everything, on top of separate deductibles for each part and no out of pocket caps at all (meaning Medicare isn’t even an ACA compliant health care plan). Part C simplifies this for so many people by rolling all of Part B, Part D and usually vision and dental into a single premium and puts out of pocket caps on the amount of money you might need to shell out. Is it any wonder people keep choosing Part C even if it means their providers have to fight the insurance more?

It makes me want to commit a murder just reading this.

this right here. all the people in this thread acting like "everything is fine" and things aren't so bad for most people...i sincerely hope they get the reality check they deserve but not like this. to see a loved one - who did nothing wrong other than existing - to be murdered by the system? i've witnessed this first hand and to say one's blood boils is understatement of the century. all preventable but when profits are always always always always the most important thing...you're nothing but a cost; an expense to others' egregious profit motives. and as such....expendable.

I will freely admit, I didn't know shit about medicare advantage plans prior to this shit show happening. Most people don't have a clue. But if you talk to a social worker at a hospital, they see it every single day. They are beat down trying to fight for their patients while watching them get fucked by insurance.

Never go HMO, PPO is worth the extra $ when you want to choose hospitals and specialists.

How's that work? My employer doesn't offer health insurance, just reimbursement and every plan on the marketplace is an HMO.

What state are you in? You should be able to get PPO plans in the healthcare marketplace. Expect to pay considerably more a month of it isn’t subsidized

I'm not sure all of this is profit seeking caused given their small margins. It feels like it could be a down stream effect of business sustainability and competition. The bag is necessarily covered by those who have less long running health complications, and so you need to provide a competitive price to them so they pay in with you. The price offered when you don't need care becomes lower than the amount needed to cover everyone when you do. Which would incentive denials out of necessity as well.

It's bureaucratic violence. Slow. With maximum kafkaesque torture to draw it out.

How many people die for greed? Is that not violence?

"The noble person that goes to work and pray like they s'posed to? Slaughter people too, your murder's just a bit slower."

- Kendrick Lamar

I wonder if there is a niche to ameliorate this sort of thing by offering payday loans on insurance payouts.

The incentives are pro-social: insurance companies have an incentive to delay payouts, because their profits come from interest (they pay out more money than they take in) so the longer they can hold onto money the better. But that's reversed for this hypothetical loan issuer - they want to make the payout as fast as possible in order to earn as much interest as possible as quickly as possible.

And if there's a systematic tendency for medicaid advantage plans to deny claims that eventually get approved, and if you could predict which ones will get approved 'just' by really understanding what medicaid would approve, then this might be self-sustaining or even profitable?

The solution is disallow private insurance being the middle man between medicare and the patient.

What possible benefit to the patient is having a whole bureaucracy sit between the gov't insurance and the person in need of medical care? It only exists to make money off the backs of the people they are harming.

Now, if you don't know why people sign up for them, you don't understand what they are doing. My mom, like many others, was on a fixed income. If you sign up for a medicare advantage plan, they will do things like give you an extra $100 a month to you directly. Why would insurance be willing to PAY you? Because they make all their money billing medicare and denying you coverage.

18 billion in profits last year running a middle man between patients and medicare

> Why would insurance be willing to PAY you?

Why would the government introduce an intermediary in the first place?

I haven't researched how all these came to exist but I assume it is the typical conservative talking point about the free market being more efficient so why wouldn't we want this. It will save us all money. And no, I don't believe any of that BS.

Network effects. They outsource all the medical billing and management to the big insurance racket companies. Protip: go with a PPO Medicare plan and medigap supplemental plan if you want your loved ones to see any specialists and go to any hospital. I switched mine off the HMO advantage plans to BCBS PPO cause HMO Medicare advantage plans deny everything by default fighting tooth and nail.

Wikipedia says the government introduced intermediaries to cut costs (i.e. create a scapegoat people can blame for denying claims or reducing payments to providers and not have the finger point at the government).

https://en.wikipedia.org/wiki/Balanced_Budget_Act_of_1997

> The act had a five-year savings goal and a ten-year savings goal following its enactment in 1997. The five-year savings goal was $116.4 billion which would be achieved by limiting growth rates in payments to hospitals and physicians under fee-for-service arrangements.[7]

>This plan also involved the change of the methods of payment made to rehabilitation hospitals, home health agencies, skilled nursing facilities, and outpatient service agencies as well as the reduction of payments to Medicare managed care plans and the slowing of growth rates of these same care plans.[7]

>The ten-year savings goal was $393.8 billion using the same savings methods as the five-year goal to achieve the savings in 2007.[7]

Is it just me or does this sound like a terrible bill? I've gone through the page and it just sounds like it was trying to save money by making healthcare beneficiaries worse off.

Or, I don’t know, maybe we do what every other Western nation has done and just present a public option for healthcare coverage to the average person?

Nah, better to have millionaires lying to the sick and dying about the company not having the money to pay for the coverage that the sick person paid a hefty monthly premium to provide.

There is no niche, that makes a fundamentally inefficient system, more efficient.

If any such niche existed, for any system, then this niche would be the system.

Nice, a hyper capitalistic solution to a problem which only exists because of a hyper capitalistic system. Why not add another middleman with a financial incentive to a system overburdened by middlemen with financial incentives?

The solution would be to remove useless leeches providing no value or benefit to anyone other than shareholders, not add more of them.

And what do you know, most of the rest of the developed world has managed to do that. And even the parts that have private healthcare have managed to put strict rules controlling it, and costs and outcomes are much better.

I'm so sorry about what happened to your mom. I'd be furious, too. It sounds like you did everything you possibly could and really fought for her.

It really makes me sad, but thank you for sharing your story.

This is my story, just replacing "mom" with "dad". Thanks for telling it and sorry for your loss.

Medicare Advantage is HMO right? I just switch my folks to BCBS PPO with Medicare and a “medigap” supplemental plan to cover things that Medicare won’t. My head is still spinning up to my neck in paperwork for the cancer and hemorrhagic stroke bills from out of network physician groups billing, truly 24/7 job. Sorry for your loss. You did a lot to help I can tell after going through this myself. Be kind to yourself. They denied my mom’s chemo drugs it’s absurd. She paid into the system for decades without incident.

I'm genuinely amazed by the distribution of opinions in this thread.

If y'all feel that way, why don't you vote for a "socialist" healthcare system like we have over here in communist Europe?

I mean, I'm over here in Germany and I'm not going to claim the system is that great, but it's really not half bad either, and it does seem to prevent the most extreme tragedies.

Vote where? Do you see that on the ballot?

It's on the ballot a lot; Obama wanted, but was ultimately unable to, implement a broad individual mandate within the ACA; Bernie Sanders and Elizabeth Warren supported medicare for all.

A number of states have implemented individual mandates; including Massachusetts under Mitt Romney.

It seems quite clear that you'd get it if you (collectively) voted that way, or not for candidates who very actively oppose it.

Your description reminds me of the opening scene of Blue Velvet.

Its because the generally applicable standard way globally to know if things are bad for someone, doesn't work in US. Most people have homes, there is a car standing outside, they have clothes to wear, people are generally private (due to high focus on individualism) and unless you try, you can't really overhear your neighbour - so these issues hide behind closed doors.

The problem is I don't see any "easy" solution to this issue, simply because there will always be an institution in place to decide about someone else's life our death.

Be it a privately run for profit insurance system that runs on perverse incentives, or a government agency that runs on power and influence and corruption.

The “easy” solution is to try and remove profit as much as possible from the equation. Pretty much every other high GDP country in the world has single payer healthcare.

Guess how many people get told their anaesthesia won’t be covered for their full surgery. That shouldn’t even be a question, and yet the US system makes it one.

Two people I know who moved to the US from countries with single payer healthcare said that in their previous countries they would have to wait a long time for certain operations, but in the US can get them almost immediately.

From what I understand, wait time can certainly be an issue with single payer healthcare. However, there's people in the US who have effectively infinite wait time because they can't afford treatment at all.

I have an excellent insurance plan and ready access to a large US hospital system. The wait to see a dermatologist as a new patient is ~6 months. Definitely not unique to single-payer systems.

Also, this wait times in many part of the US are in line with the single payer countries. The quality of care in the US is heavily dependent on location.

Depends on criticality. Yes, the US beats Canada for example on wait time in a lot of cases, however, as a Canadian I can walk into a ER and not have a co-pay.

I had my appendix out a few years ago, I walked into the ER at 2PM, had the surgery done by midnight, and was able to be discharged by 9AM the next day. The only cost was my parking, because I drove myself over. Meanwhile, I've also had friends in the US who were clearly quite ill, and made the conscious decision to not go to the ER because it would have cost them hundreds of dollars.

It's all a balance, but I'm happier with my single pay system, because for the most part, health decisions aren't at the whim of my bank balance being too low. I personally wouldn't be as disappointed in the US system, if the reason someone can get a surgery immediately didn't balance out with something like UnitedHealthcare's 32% rejection rate, because someone wanted a $10MM / yr salary or a $40MM yacht.

The US has a law that 80% or 85% of premiums needs to go to healthcare. So if an insurance company is already up against the limit, increasing the rejection rate will actually decrease salaries and yachts (because less money will be spent on healthcare, thus premiums need to be reduced, and the 20% available for employee salary becomes smaller).

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

Although, if increasing the rejection rate allows the insurance company to decrease individual premiums, which causes a lot more people to sign up for coverage due to low cost, that could increase total premium income, total spent on healthcare, and salaries.

Some problems in those countries are also caused by for profit healthcare existing in America. The shortage of doctors in Canada is not helped by the appeal of making much more money down south.

Not to mention Canadian expats are generally the ones who would be able to afford the American healthcare costs.

Also sounds like Canada isn't paying their doctors enough, which isn't to say America's healthcare is better, but it is something to take into account.

Canadian doctors are extremely well paid by Canadian and international standards, just not by the standards of American doctors (who have to repay massive medical debt). Increasing their wages is not really feasible, outside of a few underpaid specialties.

Waiting time increases with accessibility and aging population. Most developed countries with universal healthcare amd the hospitals are full with elderly. The developing countries are often much better due to younger population. Places like Turkey are incredibly accessible and cheap compared to the develped countries.

Dutch and Swiss healthcare systems are entirely private (more so than in the US since there are no Medicare or Medicaid equivalents) yet they are highly regulated and profits are limited.

Why can’t the US just copy paste them? It’s not like single payer is the only option..

US health insurance is profit limited too:

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

> Dutch and Swiss healthcare systems are entirely private (more so than in the US since there are no Medicare or Medicaid equivalents)

and Swiss doctors are paid very well compared to let say German ones. There is long waiting list of German doctors that would like to practice in Switzerland.

> Pretty much every other high GDP country in the world has single payer healthcare.

This is just completely not true. Take France and Germany for example.

> Guess how many people get told their anaesthesia won’t be covered for their full surgery. That shouldn’t even be a question, and yet the US system makes it one.

So anesthesiologists should be able to ask for any amount their heart desires and the insurance is the bad guy if they don’t want to pay it? Anesthesiologists have a profit motive too, you know.

> All French citizens are required to have health insurance, and there are three main health insurance funds. The funds are non-profit and negotiate with the state on healthcare funding.

> Does Germany have free public healthcare? Yes, all Germans and legal residents of Germany are entitled to free “medically necessary” public healthcare, which is funded by social security contributions. However, citizens must still have either state or private health insurance, covering at least hospital and outpatient medical treatment and pregnancy.

Neither of those are single-payer systems, which you can see by the fact that both of your quotations involve multiple payers. Google "does france have single payer healthcare" or "does germany have single payer healthcare" for more info

> So anesthesiologists should be able to ask for any amount their heart desires and the insurance is the bad guy if they don’t want to pay it?

Obviously not; if they're billing 72 hours a day, that's fraud.

If my procedure goes long because of a complication, I'd still prefer they not wake me up mid-procedure for a credit card and signature.

Naturally they would not wake you up mid-procedure for payment, nor ask you for payment later. What anthem wanted to do was put a cap on the number of billable hours per procedure, and have anesthesiologists accept payment based on that cap as "payment in full", meaning they would not expect additional payment for the extra time they spent after a procedure went long, either from the patient or the insurerer. This would have resulted in anesthesiologists making less money (as well as having less opportunity for fraud), which is why they didn't like it.

But it was presented in popular media as if the insurance company was trying to shift the cost of overlong procedures onto the patient, rather than onto the anesthesiologists. Thankfully there was a public outcry and the anesthesiologists won, well-deservedly so considering they must be barely scraping by on a median income of $470,000/year.

> What anthem wanted to do was put a cap on the number of billable hours per procedure, and have anesthesiologists accept payment based on that cap as "payment in full", meaning they would not expect additional payment for the extra time they spent after a procedure went long, either from the patient or the insurerer.

The policy even had a path for the anesthesiologist to justify the overrun so that portion could be covered too. No doubt Anthem would scrutinize the justification closely and reject cases where they detect abuse, and the incentives are for Anthem to be too strict, but there was nothing wrong with the policy on its face. These sorts of things are absolutely necessary in order to drive healthcare costs, which are absolutely obscene, down.

When you remove profit from the equation, you also remove the incentive to increase supply. That's fundamentally what profit is: a reward for fulfilling the needs of consumers. If you can fulfill those needs better or more efficiently or at a larger scale than your competitors, you get more profit.

    When you remove profit from the equation, you also remove the incentive to increase supply.

Uhhh, what? What kind of wongo bongo thinking is this?

What other incentive is there? There might be some willing to go deep into debt in medical school so they can work for free out of the goodness of their hearts, but that's a vanishingly small number of people.

And yet apparently countries all over the world have to artificially raise the bar for med school because so many people want to be doctors for incentives aside from just the money.

What are you talking about? Almost every country has a doctor shortage and Doctors are still well paid professionals there.

People don't go bankrupt at anywhere near the rate Americans do for medical reasons. People don't constantly bring up dealing with insurance as the #1 burden during medical procedures.

sure, but that has nothing to do with your last statement, which was nonsense.

That's like saying 2+2=5, then when someone points it out, saying the sky is blue.

Would you go to work without being paid? I wouldn't.

The same is true for those working in healthcare.

United healthcare wouldn't even exist if there was a ton of people who wanted to found, fund, and work at nonprofit health insurance companies.

>>Would you go to work without being paid? I wouldn't.

Do you think doctors and nurses work for free in countries with socialized healthcare?

They do get paid. A lot if you're a specialist too - it's a very lucrative field to be in. Admittedly, not for everyone - nurses and junior doctors usually don't get paid very well, but it's my understanding that in US it's not like these professions make bank either.

>>if there was a ton of people who wanted to found, fund, and work at nonprofit health insurance companies.

That's the whole point that Americans are missing - you don't need the insurance companies in the first place, if the entire system is owned by the public. You go to a hospital, you get an operation done and that's it, at no point is there anyone sitting there are processing your "claim" - if the operation is one allowed by the system(and it almost certainly is) then it's just done and the system pays for it from general taxation budget. No one negotiates rates with the hospital, argues about your excess or premiums or in or out of network coverage. Health insurance is something you get for travelling abroad, like if you have an accident while skiing and need a helicopter to get you out, not for visiting a doctor or a hospital.

It’s still an insurance system though, whether it’s publicly owned or privately. There are still bureaucrats who decide what is covered and what is not, and they make that decision for the entire population. Things like cutting edge cancer treatments (often developed in the US) are many years late arriving to public healthcare systems. And many expensive treatments are simply not covered, or covered as second or third line (eg. immune therapy), when patients in the US with appropriately good insurance receive them as first line with far better outcomes.

> No one negotiates rates with the hospital

No one negotiates period. Coverage decisions are made unilaterally by government officials, and services that those officials deem too expensive are simply not offered. The same issue exists with medical equipment. The wait time for an MRI is absurd in eg. Canada because government only funded so many machines. In the states there are simply more machines, because supply was more elastic, and more freely able to meet demand.

Sure. Don't get me wrong, I'm sure American healthcare system can be amazing in certain cases, and like you said, in specific instances the "market demand" is able to solve issues that socialized systems struggle with. But the same is true in the opposite direction - plenty of stories of people being denied lifesaving care because insurance companies decide it's not worth it. People who have their cancer treatment stopped because their employer changed the insurer and the new insurer has to do a full re-evaluation before they approve the treatment to continue, so in the meantime you get no cancer drugs for months while they do their process. And so on and so on. We could both do this I'm sure.

>>when patients in the US with appropriately good insurance receive them as first line with far better outcomes.

The problem I have with that is basically you're saying the quality of the treatment depends on what insurance you have. In socialized healthcare everyone gets the same treatment.

And in fact this is reflected in the average quality of care received on average, with outcomes in US being much worse than elsewhere. US has mortality from "preventable causes" twice as bad as Australia, Japan or France(paragraph 5). So in US few people get amazing care better than anywhere else. And most people get worse care than anywhere else.

https://www.kingsfund.org.uk/insight-and-analysis/blogs/comp...

>>Things like cutting edge cancer treatments (often developed in the US) are many years late arriving to public healthcare systems.

Obviously it's hard to make a general statement on this because every country has varied policies around this. But to share an anecdote - my own dad was enrolled into an experimental programme at a leading oncology hospital in Poland because he had a very rare and ultra aggressive cancer which had no known treatment other than a brand new(then) Glivec, which wasn't even approved for that cancer yet, but he had the whole course of his treatment fully funded under our socialized healthcare. In those very very rare cases where regular treatment is not available there are avenues to explore experimental treatments, and they then serve to direct general treatment plans for the rest of the population. Again, this is a specific example from one country.

You would concede that, as a consequence of imposing involuntary obligations on their citizens, socialized systems are less free? And you would also concede that reasonable people can disagree about the priorities of their values, and that valuing personal autonomy over collective well-being is a reasonable position?

> people being denied lifesaving care because insurance companies decide it's not worth it

You get what you sign up for. Like in any business transaction, doing your due diligence and understanding the details of both parties obligation is table stakes. We also have courts precisely for cases when such disputes become intractable.

> so in the meantime you get no cancer drugs for months while they do their process.

No one is stopping you from paying for the drugs yourself. Insurance will reimburse you once they validate your claim. Bureaucracy takes time.

> the average quality of care received on average

And the quality of care on the upper end is markedly worse in many ways. Wealthy people from all over the world travel to the US for their medical procedures for a reason. You're effectively arguing that net-contributors to society (people who pay a lot of taxes) should accept an increase in their tax burden for the privilege of a degradation in their personal access to and quality of care, in order to bring up the average. I hope you appreciate just how directly this opposes the interests of this class.

> From each according to his ability, to each according to his needs

You can't have a system like this in a free country. I want the freedom to associate (in an insurance pool) alongside other people with a similar risk profile to myself (eg. no drinking/drugs/smoking, daily exercise, good sleep, healthy body composition) to the exclusion of others. I want my insurance company to carefully scrutinize its applicants and claimants, on my behalf, to ensure that my interests are being well-represented. Insurance does not mean absolution from personal responsibility.

Well, needless to say, I disagree with every single sentence of your post. I don't think there's a reason to continue - we'll just not agree here.

The government still negotiates. Refusing to buy a product/service at X rate is a negotiation, and there is a back and forth with providers/manufacturers.

Same for state employed healthcare professionals, which have salary set by the state.

Im responding to a comment that thinks the following is crazy and wrong.

>When you remove profit from the equation, you also remove the incentive to increase supply.

Yes, socialized system countries have doctors because they pay doctors, ensuring supply. This proves the point above.

If you pay people to do something, you get more of it.

Health insurance companies dont provide healthcare. They dont stich you up or manufacture pills. They are in the business of vetting and denying claims to ration healthcare provided by others.

>No one negotiates rates with the hospital, argues about your excess or premiums or in or out of network coverage. Health insurance is something you get for travelling abroad, like if you have an accident while skiing and need a helicopter to get you out, not for visiting a doctor or a hospital.

It works different in various socialized systems, but there is always someone negotiating with the hospital, the workers, and the manufacturers. Sometimes this is the government, sometimes it is private insurance.

I dont know which country you are talking about, but almost every country has some sort of Health Insurance. What differs is the level of involvement by the citizens in selecting it.

A classic example would be Germany, which is a multiple payer system with both government and private insurance. 85% percent of people have the government health insurance, which is paid by employers and employees and mandatory. the government manages and negotiates rates for this plan. You can opt out and get private insurance instead, and those insurers have sperate negotiations and offer different services. There is also supplemental insurance, also private, also negotiated separate.

From my understanding Germany is an outlier among countries with socialized healthcare because their system is either straight up reliant on insurance or is modelled after insurance-like systems. My experience is based on Poland and UK. And sure in the UK you pay for "national insurance" which partially funds the NHS, but the point is that it's almost irrelevant to your coverage - as long as you live in the UK legally you are entitled to treatment, whether you pay NI or not. Again, the difference(imho) is that if you go to a hospital and a doctor there decides you need an operation done, it only goes through a cursory check to make sure the operation is covered and then it's carried out. It doesn't go to some central office where someone checks if you as a person X are entitled to have this done or not, it's not a "claim" like a one you would make with an actual insurance company.

And yes, of course you can supplement that with private insurance if you wish, but vast majority of people don't.

And yes, of course the government negotiates with providers - but when you get treated that's not something that affects you. You don't get a bill that says "your treatment was £10k, but the goverment will only pay £5k, cough up the rest". In fact no one(patients) gets any bills ever.

I'm pretty sure that UK is the outlier, where healthcare providers are state employees. Wikipedia says the NHS is the largest employer in Europe with 1.4 million employees.

I think the vast majority of countries have some sort of a situation with the government as at least one of the payers, and Private health care providers.

I completely agree that the US is an outlier in how involved the patient is in the payment of their healthcare, and the fact that they can be left with the bill instead of the provider if the insurance is denied.

On a psychological level, I think people are more frustrated by being offered care that they can't afford and dealing with uncertain coverage then not being offered the care at all.

I'm a huge proponent of healthcare reform in the US. That's sad, I think one of the biggest problems with getting it past is unreal expectations. Americans have a caricature of European healthcare in their mind that is totally inaccurate.

And pretty much every one of those countries also has widely used private insurance because the public one most definitely has price caps, longer waits, and lesser service.

No system could afford to spend unlimited amounts for anyone wanting it. You get triaged since resources are not infinite.

Pick your favorite system, say the UK, and google UK healthcare rationing to find state policy on what limits people face.

Any medical system inevitably has limits of what they can spend per patient. Do you prefer the limit to be set and enforced by the government that is amenable to political process, or anonymous profit-seeking insurance company board members, like in the sibling comment case https://news.ycombinator.com/item?id=42375998 ?

That comment was about a person on Medicare Advantage, which is extremely heavily regulated by Medicare, the epitome a of govt medically regulated cost per procedure system.

Here is the govt Medicare page about Medicare Advantage Plans, with references to all the pages of legislation and Medicare rules such plans must comply with.

https://www.medicare.gov/health-drug-plans/health-plans/your...

For example, select “What should I know about Medicare Advantage Plans?”

It states, among other things, “ Medicare Advantage Plans provide all of your Part A (Hospital Insurance) and Part B (Medical Insurance) benefits (also called “Original Medicare”), including new benefits that come from laws or Medicare policy decisions”.

Op claims Medicare “always” provides PT, which is not true. Here’s some rules about it: https://www.healthline.com/health/medicare/does-medicare-cov...

Note in particular Medicare advantage will provide any PT where Medicare would.

If you look at peer reviewed research, MA outperforms M in outcomes and satisfaction by a slight amount.

These are reasons why forming or reinforcing beliefs on anecdotes and not understanding the truth is a bad way to make claims.

So now that you see this outcome was medical care “set and enforced by the government” and not the outcome from “anonymous profit-seeking insurance company board members,” will you redirect your outrage?

Was it a governmental agency or a private entity that denied coverage in their case?

A first step could be to look at health care outcomes across the globe and see if the ones at the top have anything in common: https://en.wikipedia.org/wiki/List_of_countries_by_quality_o...

There is a huge difference between US and pretty much the rest of the world. The most corrupt healthcare system is US, hands down.

You just described one of quite a few reasons (higher education falls into same category, overall security could be mentioned in such topic too) that I consider some parts of western Europe a better place to live and raise kids than anything US can provide. Despite having much lower numbers on paychecks alone.

I get that system needs to push folks into working hard and motivate exceptional efforts (and luck), but sometimes this goes into properly bad directions where few gain and majority loses. In any functional society, all this is never isolated and it has ripple effects.

>In theory everything is fine but you know there is something very bad about the healthcare system,

No merely healthcare, but employment, housing etc. It's easy to single out healthcare for obvious reasons.

You can leave! Nothing is stopping you from staying in the US. Particularly if you're on this website, you probably have talents other countries would like to acquire. The fact that you haven't says you don't believe what you say.

The "America, love it or leave it" tactic? It's intellectually dishonest and shortcuts any kind of debate or thoughtful discussion. Or is this more of the "you haven't left your wife beating husband so you must like it" tactic? That's also philosophically bereft and avoids anything substantive.

Suffice it to say, constructive criticism is vital for democratic improvement.

If your belief is the United States is so bad that it justifies murder, you should leave. If you're more reasonable, I would not recommend leaving.

My belief is that there are people who get what they deserve. The CEO was one of them.

> If your belief is the United States is so bad that it justifies murder, you should leave.

That's a weird conclusion. For me, it's rather "The USA has its flaws (for me - healthcare and higher education financing above all) so we as a society should focus on fixing these problems". Killing people or leaving the country are not solutions, they are are an equivalent of short Twitter replies on a nuanced subject.

I agree! I'm only suggesting leaving if you think murder is justified.

Why should anyone care what you do or do not recommend?

Isn’t this how it is supposed to work in America? People own guns to fight tyranny. The gunman carried out his own judgment, but that’s the whole point. And there is reasonable belief that the CEO is responsible for a lot of suffering and expected life lost.

So, everyone who ever joined the police? That is certainly a new take.

> Don't like it? GTFO out loser! Uproot your family, move away from everything you know, all your friends, and go take a chance in a completely different country. Just change everything about your life and stop trying to make anything ever better. Otherwise STFU about it!

- You

It’s funny how we treat these things. Kill a bunch of people by putting lead in their drinking water and it’s a shrug. Occasionally you might lose your job over it. In extremely rare and egregious cases you might end up with a minor criminal conviction.

Kill one person by putting lead in their heart at high speed and now it’s a serious crime. If the victim is Important then you get a massive manhunt and national news coverage.

>Kill one person by putting lead in their heart at high speed and now it’s a serious crime.

I wish this was an attempt at a joke.

Me too. I’m describing it flippantly for effect, but I’m deadly serious. There are ways to kill people that get the attention of law enforcement, and ways to kill people that are de facto (and often de jure) legal. And wouldn’t you know, the latter category tends to include the methods used by the rich and powerful.

>I’m deadly serious

I figured that. It feels a little like the country is going crazy.

How could we not, when the rich and powerful kill with impunity?

Or coming to temporary clarity? Things like the “culture wars” are distractions pushed by the elites to keep the lower classes fighting amongst themselves and not their true enemy. But extractive robber barons are the real problem behind everyone’s life getting worse all the time, and for a brief moment everyone has seen that and been in alignment.

If we have a functioning democracy, you know, where we vote for what we want, how do we end up with the healthcare situation in this country? (For god's sake I'm NOT inviting a right-vs-left debate here!) Nobody wants this, and yet we haven't solved it by any legislative actions. That tells you clearly there is an invisible 4th arm of government (not "shadow government", corporate government) going on here that we are just beginning to shed light on.

It’s not even subtle. The deciding vote which kept Obamacare from having a public option was Joe Lieberman, commonly referred to as “the Senator from Aetna.”

The country has been going crazy yelling about trans people and gay people and black people and Irish people and "Ingins" for hundreds of years. Suddenly we stop worrying about 7 trans athletes and pay actual attention to what's actually going on and you say we're going crazy? I say we, just for a few days, collectively woke from a delusional nightmare to see the world as it really is.

Don't worry. We're already drifting back to sleep.

There's a barely-known Italian song from 2006 by Italian rapper Caparezza that deals with this exact theme. It's about a guy trying to "legally" kill his wife.

https://www.youtube.com/watch?v=bxhmOfk-L5Q

Lyrics here https://www.angolotesti.it/C/testi_canzoni_caparezza_1135/te...

That's not funny; that's just not how things actually work.

It’s not?

Air pollution alone kills tens of thousands of Americans a year. More die from air pollution than die from what’s legally defined as murder, by a substantial margin. How many people are in prison for it? Most of that pollution it outright legal. The illegal parts are rarely punished and never on the level meted out to “murderers.” And that’s just one example.

It’s totally legal to deliberately kill innocent people, as long as you do it in certain ways.

You're using the word "deliberately" wrong when talking about things like air pollution. Pointing a gun and shooting at someone is quiet a different thing than is causing air pollution.

Are people who smoked next to other people deliberately killing them? After all, second hand smoke was quite dangerous.

Please explain the difference, in terms of how it should affect my opinion of the person who carries out the act. Pretend, for the sake of argument (and because it’s true) that I don’t see it.

A factory boss decides to release some toxic pollutant. They know that it will result in some number of deaths over the next years. They choose to go through with it anyway, because they make more profit than if they disposed of the stuff properly, and that money matters more to them than the lives they’re ending.

What’s the difference between that and some petty criminal shooting someone in the street so they can take the victim’s wallet?

And yeah, smoking counts too, why not? The saving grace there is that the harm from an individual smoker isn’t very large. Even over a period of years, someone who habitually smokes near people who don’t consent to it only takes a tiny fraction of a life. That’s why I think smoking bans should be enforced with reasonable fines rather than life in prison.

> Please explain the difference, in terms of how it should affect my opinion of the person who carries out the act.

Sure.

> A factory boss decides to release some toxic pollutant. They know that it will result in some number of deaths over the next years. They choose to go through with it anyway, because they make more profit than if they disposed of the stuff properly, and that money matters more to them than the lives they’re ending.

This depends a lot on context you haven't provided. Most importantly - is this legal?

If releasing this toxic pollutant is illegal, then they should be prosecuted to the fullest extent of the law. For good reason, that is usually not a death sentence. But if you have an issue with how harsh or not the sentence is, that's a question to take up with the legal system, not with the individual.

Either way, vigilante justice is not needed.

If releasing this pollutant is legal, the question is different. Firstly, why is it legal? If it shouldn't be, then again - this is something to take up with the justice system. Sometimes it's legal for good reasons - it's not clear yet that it is truly toxic. That should definitely inform how we treat someone - releasing something that might be a pollutant is definitely different.

There's just a lot of nuance to this question, it's not an easy soundbite, because the real world is complicated.

> What’s the difference between that and some petty criminal shooting someone in the street so they can take the victim’s wallet?

Let me make a very important point here.

The legality of an action matters a lot more for society than the morality of an action. That's kind of the whole reason we have a legal system, and for good reason! And a pretty fundamental principle of the legal system is that intent matters a whole lot.

Here's some of the differences of the two cases:

- With a criminal shooting someone in the street to take their wallet, I am very scared that he will continue doing this - he will likely shoot more people to get their wallets, because he ignores the laws and morality.

As opposed to the factory boss, who (assuming this is legal), would presumably not do something if it were illegal. So I don't have to worry about his actions - he's not likely to "kill" anyone else if it's against the law.

- A criminal shooting someone is almost certainly trying to kill or at least harm them. The action is very direct. This matters a bunch, because we can be pretty certain of their intent, and therefore how they will act in the future.

As opposed to a factory boss - where the indirectness of the action is far more ambiguous. Did he really know that this would cause deaths? Are there mitigating circumstances (like him being pretty sure it's far enough that it won't cause deaths because it's small amounts, or far from populations)?

---

The biggest problem with your examples is that there are really two options here. You either agree with the legal system - in which case, there's a perfect remedy for actions like releasing toxic chemicals, which is using the legal system to prosecute such people.

Or you don't agree with the legal system - you think some things should be illegal, but they aren't.

And this is what is secretly (or not so secretly) motivating most of the pro-vigilante comments. They think that what they consider to be moral is good enough to use to enact justice - they don't need to actually convince their fellow citizens, or convince their lawmakers, to enact their ideas into law. It's enough for them to fervently be sure they are right - that's supposedly a good enough reason to inflict their morality on other people using violence.

And that is a disgusting, anti-democratic worldview, that would leave society in tatters.

Society can't function if everyone can just decide that their morality is the ultimate justice. We have to come together as a society and agree on rules. Because as everyone understands - 99% of people do something that someone else considers wrong.

If our society functioned via "well I'm sure I'm right about what is moral, so I can execute people based on my morality", then pretty soon we'd have total anarchy.

Do you think abortion is murder? Go ahead and kill some doctors. Do you think creating weapons should be illegal? Go ahead and kill the CEO of a weapons manufacturer. Do you think protesting war is terrible because it puts "our soldiers" in danger? Go and shoot up people leading protests. Perhaps you think that climate change will kill us and anyone who works in the car industry is therefore tainted? Go and blow up some car factory workers.

I agree with some of the position above, disagree with some others, as I'm sure most people do. And that's fine! But decent people understand that disagreeing about things, even things that directly pertain to life and death - is not a good enough reason to start killing each other over. We all have to live together, so we all have to work together to agree on what is right or wrong, and to appoint people to collectively enact the will of society - not just have individual citizens run off and do what they want based on their ideas.

> This depends a lot on context you haven't provided. Most importantly - is this legal?

Whether it is legal or not is irrelevant. You are entering into a conversation about morality. The law does not dictate morality, as much as it can morality dictates the law. The entire point of the person you are replying to is that acts with moral equivalence are treated differently by the law because of the social and economic status of those likely to commit those acts.

A very real example of this from American history is that crack cocaine and powder cocaine had different mandatory minimum sentencing guidelines for charges of simple possession as well as charges of possession with intent to distribute. Both are effectively the same drug, but one version of this drug is more commonly use by poor and non-white people, and the other version used by rich white people, and so we ended up with a gross disparity in the law over exactly morally equivalent acts.

You are not actually engaging with the argument that the person you are replying to is making. Nobody gives a shit what the law says, they care about what is right and what is wrong. Then we mold the law to match.

> Whether it is legal or not is irrelevant. You are entering into a conversation about morality. The law does not dictate morality, as much as it can morality dictates the law.

There are various ideas about morality. But I think even in the most common-sense interpretation of morality, most people agree that there are things that are legal, but immoral, things that are perfectly moral but illegal, and that respecting the law is a meta-rule that is important regardless of morality.

Simple example: Most people agree that cheating on a spouse is wrong and immoral. Not illegal though. Do you think it makes any sense to suggest that the only options are either we change the law to make adultery criminal, or we take vigilante justice on adulterers? Or is it just possible that some things might be immoral (to some people) but should be legal?

> A very real example of this from American history is that crack cocaine and powder cocaine had different mandatory minimum sentencing guidelines [...]

Yes, and I think the law was wrong in this case, like it's been wrong many times in history (slavery was once legal too). The correct thing to do was to try and change it, which is what eventually happened.

An incorrect option would've been to jailbreak prisoners because you disagree with the law, despite lots of people being imprisoned for longer than they should've been.

> You are not actually engaging with the argument that the person you are replying to is making. Nobody gives a shit what the law says, they care about what is right and what is wrong. Then we mold the law to match.

I am engaging, because I disagree with this idea. The law and morality are connected, but distinct things, as I've shown above. We have to have legal systems in place to make broad decisions - we can't go based off of people's personal moral ideas. Explain to me how you would like things to work and still be compatible with that idea, given the above examples I've given.

And I think the idea that "nobody gives a shit what the law says" is a statement that is... very, very incorrect.

The biggest question here is: what is the purpose of the law?

The standard answers are things like, the law exists to protect people, or enforce broadly agreed conduct, or to deter or punish criminals.

Those answers are all wrong. The purpose of the law is this: to convince people not to take matters into their own hands.

Civilization depends on people mostly not taking violent revenge when wronged. The law exists to replace revenge with “justice” in the minds of the aggrieved. Everything else is window dressing.

If this starts to break down then the law is failing. The fix isn’t to convince people that following the law is inportant, the fix is to show people that the law offers a viable notion of justice, whatever that might entail.

> If this starts to break down then the law is failing. The fix isn’t to convince people that following the law is inportant, the fix is to show people that the law offers a viable notion of justice, whatever that might entail.

I agree. I just don't think the system is as broken as you seem to think it is. Compared to almost any other place and time, the system is the best.

> Those answers are all wrong. The purpose of the law is this: to convince people not to take matters into their own hands.

Btw, while I do agree with this in a democracy, note that many, many people throughout history (and today!) live and have lived in places where some people really are above the law. That doesn't seem to preclude society functioning.

If the system is the best then it should work. If it worked then there wouldn’t be a bunch of people cheering on a cold-blooded murder.

Have you lost a loved one because health insurance refused or delayed payment for treatment? I can't take you seriously when you say the system isn't that broken when I see people sharing their experiences of how people died and suffered unnecessarily because some health insurance company fought them on it. How is that not insanely broken?

Here in Germany, I've never had to worry about whether my healthcare would pay my treatment when I've had to go to the hospital and had to be operated on. The idea that this is possible in other countries is unfathomable to me. I didn't choose to have whatever illness I might have. My doctor decided the best way to treat my illness. Why does some third party get to decide "but nah bro, it can't be that bad, let's just wait and see how the patient does in a week or two". Why can they override what a doctor thinks is best?

And why are there people like you who thinks "it's not that bad/broken".

Let me clarify. First, I'm not from the US. I completely agree with you that their healthcare system seems incredibly broken.

That, however, is not what I was referring to - I was talking about the system of laws, of democracy, etc. That was what the discussion was about - whether it's "ok" to kill someone in a vigilante way, and whether the legal system or general system of Western countries works well in terms of aligning the law to what people think it should be.

> And I think the idea that "nobody gives a shit what the law says" is a statement that is... very, very incorrect.

I would say almost the entire body of social science and moral philosophy (setting aside the replication crisis for the moment) more or less proves the correctness of saying "nobody gives a shit what the law says". Society is bound by social mores, not by laws, laws are intended to encode social mores and give a vehicle to systematically enforce those mores without relying on vigilantes. Without the law, we'd have more direct culture clashes around topics like immigration, because people try to bring their cultural values and social mores with them, the law encodes and enforces whatever social mores exist, as much as the people of a society can control its laws.

It's not the law people care about, it's the social mores. And the social mores extend from the collective consensus of morality. People don't generally kill other people, not because it's illegal, but because it's wrong. But sometimes, killing other people isn't wrong, such in the case of self-defense or protecting your family. Sometimes the law even convicts and punishes people for committing crimes, because the law has a narrower interpretation at the margins than wider social mores. This is exactly what you're observing here. There is a moral equivalence between murdering thousands of people via a bureaucratic decision and pulling the trigger on the gun, but the law treats them differently, society does not. /This/ is why so many people condone the shooter's actions.

You aren't getting it. The law does not matter. The law is a reflection of society, society is not a reflection of the law. The law is a tool of language to try to explain, communicate, and enforce something that exists outside of it, but the thing which gives law power is the thing which exists outside of it. Morals are way more important than laws.

For all situations that actually matter, nobody gives a shit what the law says, and they never will. They only care about what other people will think of them, what they will think of themselves, and how their moral compass and social mores guide their decision-making process. This is exactly why we generally think of people who murder as being sociopaths, lacking a moral compass, because it's the moral compass and not the law that prevents most people from being murderers.

You think I'm being flip, I'm actually making an incredibly cogent point that you continue to miss, just as you missed the point of the person you replied to originally.

> You think I'm being flip, I'm actually making an incredibly cogent point that you continue to miss, just as you missed the point of the person you replied to originally.

I think it's a bad approach to assume that you're making incredible points and I'm just not getting it, rather than assuming we're just disagreeing and that, potentially, you are wrong.

> Society is bound by social mores, not by laws, laws are intended to encode social mores and give a vehicle to systematically enforce those mores without relying on vigilantes.

Maybe we're talking past one another by talking about whether the law "matters" or not.

Social mores are against adultery. Many people do in fact commit adultery, and continue to have totally fine lives, despite this.

On the other hand, lots of people hate taxes. Try not paying your taxes, and you'll end up in jail.

I don't think the law is a reflection of social mores - almost everyone agrees that the law, while obviously based on many in society, shouldn't encompass all social mores, and has to include things that are not, prima facie, moral. You shouldn't, in general, put someone in jail for being too poor to afford food, and stealing some food. Very few people agree that that's moral in a specific instance. But if you don't jail people for stealing, very soon society breaks down.

I'm not sure which of the above, if any, you disagree with. Maybe none of it - in which case maybe we just agree with each other and are using different language to explain ourselves. If you disagree with something in specific, maybe we should drill down on that.

> On the other hand, lots of people hate taxes. Try not paying your taxes, and you'll end up in jail.

You seem to be making the argument that the law has a life of its own, which isn't entirely untrue, but case in point: While most people don't enjoy paying taxes, they do so because they understand it's necessary to have a functioning society they want to be part of. There are many legal ways to get around paying most or all of your taxes, but they're generally so costly to setup that they're only available to the very rich and to corporations, and most people morally judge this as a negative thing even though it's legal, they don't generally morally judge paying their taxes as a negative thing, but the avoidance as negative.

We do disagree, and it's not a question of semantics, it's a question of causality. You are essentially saying that the law and social mores have no causality relationship, I am saying the law comes from social mores, and the law does not influence them. The law is /subordinate/, which is why nobody really cares about it. Obviously "nobody" is intentionally overbroad, policy-makers, lawyers, and judges care quite a lot about the law, but the vast majority of the population (99%+) does not, they do however care very very deeply about social mores and cultural norms.

My entire point here is that there are some kinds of unjust killings which are legal, and that the disparity is heavily skewed such that the kinds that tend to be done by rich and powerful people are the kinds that are legal.

There are a few related but different questions for a given sort of killing: is it legal? Is it just? If the first two answers are different, what should be done about it?

For the first two questions, the answers for regular lead poisoning are yes and no respectively, and for high-speed lead poisoning it’s no and no. I think this disparity is a serious problem.

Why do you think there is a disparity? Is it purely the product of democracy and the will of the people? If so, it seems like a hell of a coincidence that the legal killings are mostly the ones that rich and powerful people do.

I agree that it’s bad to take it into your own hands and kill people you think the law has failed to cover.

But it’s going to happen sometimes. In a healthy society it’s going to be universally condemned. This one wasn’t. What does it mean and what should we do about it?

Some segment of commenters seems to think that it means people are sick and should be shamed into condemning this killing like they’re supposed to.

I think that’s stupid. People are how they are. It’s more interesting and useful to look at why this particular killing gets so much support.

The failing in our society isn’t that too many people cheer on this killing. That’s a symptom. The problem is a system which treats people’s lives cheaply, which allows some people to kill in the name of profit, and not only fails to condemn them, but rewards them handsomely.

If you want people to work within the system, they need to believe that it’s worth doing. They mostly do, but cracks are showing. It would be wise to fix the problem before those cracks produce a total failure.

> My entire point here is that there are some kinds of unjust killings which are legal, and that the disparity is heavily skewed such that the kinds that tend to be done by rich and powerful people are the kinds that are legal.

I think you're flipping the causality. It's not like society looked at all ways of killing people, said "well these ones are done by poor people and these by rich, let's decide what to do about things based on that". It's that rich people in general got that way by working within the system, doing legal things, etc. (Usually, but not always, with a lot of starting privilege that made it easier for them, or course.)

> Why do you think there is a disparity? Is it purely the product of democracy and the will of the people?

Mostly. I think the disparity is because shooting someone is a lot less ambiguous than doing things like using pollutants. I think you're refusing to acknowledge the nuance here.

But just to be clear - you think poisoning someone with lead is legal? Or releasing lead into places that would affect people is legal? Cause I'm pretty sure you're wrong on both counts. Lead is heavily regulated, and I'm fairly certain clear-cut cases of "I released a paint with lead in it" would be illegal.

> I agree that it’s bad to take it into your own hands and kill people you think the law has failed to cover.

> But it’s going to happen sometimes. In a healthy society it’s going to be universally condemned. This one wasn’t. What does it mean and what should we do about it?

Well I think you answered your own question - it shows that our society is unhealthy. That's why I'm spending my time arguing on an internet forum on why I think we should all condemn this kind of thing - I'm fighting for the ideals of a healthy society!

> Some segment of commenters seems to think that it means people are sick and should be shamed into condemning this killing like they’re supposed to.

> I think that’s stupid. People are how they are. It’s more interesting and useful to look at why this particular killing gets so much support.

Not at all stupid (I say, as someone doing this). I don't agree with this "people are people" idea. I believe in ideas, in debate, in persuasion. I believe we as a society are pretty lost if we can't come around such basic ideas as "murder is wrong and we should all condemn murderers".

And btw, I think despite the huge amount of noise we're all seeing about this, in absolute terms I think 95% people the population is firmly on the side of "murder is wrong", with a very large online contingent of people making it appear that there is some groundswell otherwise. I'm also trying to fight this perceived groundswell, if only by showing that the other side exists.

> The failing in our society isn’t that too many people cheer on this killing. That’s a symptom. The problem is a system which treats people’s lives cheaply, which allows some people to kill in the name of profit, and not only fails to condemn them, but rewards them handsomely.

I think this is just an utterly wrong view of society. We live in a golden age compared to any other society that has ever existed. People generally live longer, healthier lives by almost any actual statistic that measures such things. We have access to a vast wealth of almost anything we want, from experiences, to material goods, to entertainment - things that would've looked like miracles to a person at almost any other time in history.

And I think this idea that the system treats people's lives cheaply is absurd, frankly. There are specific problems, the system isn't perfect - but you can't objectively look at current (Western) society and not see that it's the pinnacle of human achievement - so far - by almost any objective measure.

That this translates into a populace that is somehow very upset with some vague "the system" is a problem, but I think you're misdiagnosing it as something actually being wrong with "the system", as opposed to being wrong with people's perceptions.

(Of course a lot of this hinges on what you mean by "the system" here - certainly every country has lots of specific problems that you could point out and I'd agree with. But I usually hear these complaints phrased very abstractly, without any concrete understanding of what specifically is wrong or what better "system" you are imagining. If you want to tell me what your answer is to either of these questions - I'd be very interested in hearing!)

> I believe in ideas, in debate, in persuasion

do you? Are you open to be convinced of the opposite of your view on this issue?

> I think despite the huge amount of noise we're all seeing about this, in absolute terms I think 95% people the population is firmly on the side of "murder is wrong"

I think you are wrong. Society very often sides with the side that is perceived as the threatened person acting in self-defense even when they use violence.

Also we cannot rule out racism. If the killer wasn't white (then fit for the role of hero in the US), it would be all different.

> do you? Are you open to be convinced of the opposite of your view on this issue?

Yes, always.

But I think it's a pretty high burden of proof to convince me that murder is OK, or that it should be celebrated.

> I think you are wrong. Society very often sides with the side that is perceived as the threatened person acting in self-defense even when they use violence.

I think very few people would consider killing someone in cold blood an actual act of self defense.

I could be wrong of course. Hard to tell how people genuinely feel without some kind of real survey.

> Also we cannot rule out racism. If the killer wasn't white (then fit for the role of hero in the US), it would be all different.

I'm not sure what you mean here, could you explain?

Society did precisely what you say it didn’t do. As polluting industries arose, society decided what to do about it. For a long time it was nothing. Then some restrictions, generally increasing over time. The fact that restrictions were enacted and changed means there was a deliberate choice here. We looked at industrialists profiting from mass poisoning, and our response was, could you tone it down a bit? And not, killing innocent people for money is wrong, so you’re going to prison.

There are plenty of circumstance where it’s legal to release lead into places where it would affect people. Sometimes outright not forbidden, and sometimes technically illegal but barely enforced. Examples of the former include leaded gasoline (still legal for some application) and coal power plants (they exhaust all sorts of nasty stuff, including lead). For the latter, consider Flint Michigan, or you can find random cases such as Smith Foundry where they exceeded limits for years and consequences were light.

I recognize that it’s a lot easier to draw a causal line for a gun than for pollution. I don’t think it should matter aside from the increased difficulty of proving guilt. I recognize that it does influence perceptions, but I don’t think it should.

Interesting thing about living longer, healthier lives than ever before. In the US, that leveled off about 15 years ago. Lately it has started getting worse. Health care costs continued to rise steadily. Insurance bureaucracy gets ever more onerous. And the wealthiest people in society continue to get vastly more wealthy.

You could say that people are still a lot better off than they were 50 years ago or whatever. And you’d be correct. But people really don’t like it when things get worse. They especially don’t like it when the pain isn’t shared by the upper crust.

Would you rather have a health care plan that provides quick, easy access to leeches, or a plan with a million forms, an annoying call tree, and opaque decision making, which gives you proper medicine 90% of the time and leeches 10% of the time? The second one is the objectively better option. But the people who offer that plan will probably be lynched. You can acknowledge that and work with it, or you can insist on treating people as rational and get absolutely nowhere.

“Murder is wrong” is a tautology. “Murder” means a killing that is wrong. (Either morally or legally depending on context.) The question isn’t whether murder is wrong. Everyone agrees on that. The question is which killings morally count as murder and which don’t. And don’t say “they all count!” Almost nobody actually believes that and you probably don’t either. People draw the line in different places but you can almost always find some circumstance where they’d say, yeah, that killing was acceptable. It’s a little surprising that a bunch of people think killing an insurance CEO is on the other side of the line, but it shouldn’t be surprising that there is a line.

Society is unhealthy. We agree on that. Why do you think it’s so? Is it just something that happens randomly, or is there an underlying reason?

> Society did precisely what you say it didn’t do. As polluting industries arose, society decided what to do about it. For a long time it was nothing. Then some restrictions, generally increasing over time. The fact that restrictions were enacted and changed means there was a deliberate choice here. We looked at industrialists profiting from mass poisoning, and our response was, could you tone it down a bit? And not, killing innocent people for money is wrong, so you’re going to prison.

So maybe society got it wrong. Maybe you're getting it wrong. Maybe they didn't fully understand things back then, maybe you don't fully understand the actual options society faced.

I'm not arguing that society always gets things right. I'm arguing that single-handedly deciding it got things right and therefore doing whatever you think is best is something society can't condone.

The greatest thing humanity understood over the last 500 years, however imperfectly, is the idea of being able to live side by side and not kill each other, even when you strongly disagree about things. Before that people were killing each other over differences in religious interpretations, differences in ideas, etc. People always disagree about things - but we learned to live together, and in democracies, learned how to work together to steer society to (hopefully) better places. You really want to unwind that?

This isn't hypothetical. I'm asking a direct question - what would you do with a father who, say, kills a doctor who performed an abortion on his daughter? From the father's point of view and ethics, the doctor literally murdered is grandchild. Do you cheer him on? Excuse him? I'm genuinely curious how you answer.

> Society is unhealthy. We agree on that. Why do you think it’s so? Is it just something that happens randomly, or is there an underlying reason?

I think the underlying reason is what I said about - that people are forgetting the fundamental idea of being a unified society, living together and even loving each other, without necessarily agreeing on everything. Even when the disagreements are profound, hurtful and run very deep. I think Western society has misplaced its sense of purpose and sense of being virtuous - so of course it's easy to slide into "well everything sucks, of course we should just ignore the law and do whatever we want".

> I'm not arguing that society always gets things right. I'm arguing that single-handedly deciding it got things right and therefore doing whatever you think is best is something society can't condone.

I keep agreeing with that and you keep arguing it so this all seems like a complete waste of time.

Maybe. What do you think we disagree about? Open to hearing your POV.

I think widespread approval for cold-blooded murder indicates a fundamental problem with the system that needs to be fixed. You think it indicates a problem with the populace that needs to be fixed.

Ok yes. I agree with your summary of our positions.

(Except that I think it's not really "widespread approval", it's just a very vocal bubble that gets amplified online.)

> Most importantly - is this legal?

If legality is determined based on what's beneficial to the rich and powerful, then this is equivalent to saying "most importantly, does it benefit the rich and powerful?" which is, of course, the point of the person you're arguing with. So this is not the gotcha you think it is.

> vigilante justice is not needed.

This does not feel like a good faith argument. This is the exact same "but do they really need to protest about it?" argument made by everyone who wants to see the status quo preserved. You're saying that the status quo is intrinsically good and everything must be done within the legal system as it's set up. That gives no redress to the people for whom the legal system has been specifically designed to fuck over. Your argument completely falls apart if the legal system is not 100% foolproof, and I simply don't believe anyone could argue in good faith that it is foolproof.

I do not want to see vigilante justice. But I also recognize that if the legal system is not producing justice, people will find ways to bring about their own version of justice. This is a predictable consequence of a system that has been specifically designed to never hold anyone in power accountable for anything. The way to stop vigilante justice is to improve the legal system so that people do not feel that it is necessary.

> If legality is determined based on what's beneficial to the rich and powerful, then this is equivalent to saying "most importantly, does it benefit the rich and powerful?" which is, of course, the point of the person you're arguing with. So this is not the gotcha you think it is.

I don't think it's true that legality is determined based only on what's beneficial to the rich and powerful.

In any case, if you think asking if something is legal before deciding whether it's ok to do it is some kind of gotcha, then you're throwing out the whole concept of law and order - of society. I'm not sure where you go from there.

> This does not feel like a good faith argument. [...] You're saying that the status quo is intrinsically good and everything must be done within the legal system as it's set up. That gives no redress to the people for whom the legal system has been specifically designed to fuck over. Your argument completely falls apart if the legal system is not 100% foolproof, and I simply don't believe anyone could argue in good faith that it is foolproof.

Wow, you're making a lot of assumptions there. I don't think the legal system is 100% foolproof, not at all, nor do I think it's intrinsically good. No sane person would argue that.

But there are a lot of ways to deal with that fact, a whole spectrum ranging from "doing nothing" through "trying to change the legal system" through to "just agree to ignore the legal system". You're arguing that if the system isn't perfect, we should skip right to ignoring it.

I'm arguing that we improve the system. Keep working on it, keep arguing and persuading and sometimes getting our way and sometimes not.

When did we get so jaded and decide things can't improve? Western civilization has gotten vastly better for most people, things that are considered moral absolutes today were not even considered in polite company less than 50 years ago (not to mention some things less than ten).

> But I also recognize that if the legal system is not producing justice, people will find ways to bring about their own version of justice. This is a predictable consequence of a system that has been specifically designed to never hold anyone in power accountable for anything. The way to stop vigilante justice is to improve the legal system so that people do not feel that it is necessary.

I strongly disagree with the idea that the legal system never holds anyone in power accountable, there are myriad counterexamples to that. And not as many actual examples of "the system" letting people be unaccountable.

And there's a gigantic difference between understanding that sometimes people want vigilante justice, and excusing it or cheering it on. Of course it's understandable. There are even more clear cases - family members of murder victims would totally understandably want to kill the people who murdered their loved ones. I would very much empathize if someone were to do that; I'd still condemn it as wrong. Wouldn't you?

> I don't think it's true that legality is determined based only on what's beneficial to the rich and powerful ... I don't think the legal system is 100% foolproof

Nor do I, but it sounds like I (and likely some of the others responding to you) think it leans a lot further in that direction than you do. That's a worthwhile discussion, but my point was that "the most important question is whether it's legal or not" feels out of place -- almost bad faith -- in a discussion about whether the legal system is working or not.

> When did we get so jaded and decide things can't improve?

When we saw the United States backslide into 1960s-era Jim Crow discourse, and even 1930s-era Totalitarianism discourse, that we thought we were over and done with.

> Western civilization has gotten vastly better for most people

Over what timeframe? "Western civilization" has gotten worse for almost everyone since the 1980s by many measures. We're drowning in multiple forms of debt. Wages have stagnated. Expected lifespan has plateaued or even declined. Racism and sexism seem to be on the rise. Medical issues can bankrupt even privileged rich kids. More people are in prison or homeless than the 1980s. The rich have much more societal power over the poor than they have since the gilded age. How far back do you expect us to go to maintain this positive outlook? Telling us it was much worse 90 years ago feels hollow when it was better 10 years ago, better than that 20 years ago, even better 30 years ago, and better still 40 years ago. The only thing that's significantly better is technology and science, especially medicine -- but most of us aren't really reaping the benefits of those improvements in medicine for risk of going bankrupt.

> I strongly disagree with the idea that the legal system never holds anyone in power accountable, there are myriad counterexamples to that

Are there myriad counterexamples? There are some salient ones like Elizabeth Holmes, SBF, and Bernie Madoff -- who all fucked over other rich people in addition to the poor. But there are many more counter-counterexamples: our incoming president was convicted of 34 felonies with no consequence and has openly stated he's going to pardon all his buddies for any level of corruption they might be guilty of. The Panama Papers, the Epstein files -- people aren't seeing anyone held accountable for these things. Meanwhile compare the response of the NYPD to the CEO's murder versus the murder of a black teenager in a poor neighborhood. What's the difference, really? Both are a private citizen being murdered. Why the different response? What's really different about those two people?

> law and order - of society ... If our society functioned via "well I'm sure I'm right about what is moral, so I can execute people based on my morality", then pretty soon we'd have total anarchy

A lot of your arguments have this feeling of "maintaining order in society is more important than individual justice or morality". That's a rather authoritative/totalitarian stance, which I don't say just to dismiss it -- it's a valid political viewpoint, and there arguably can be "good" kinds of totalitarianism. I think there are hypothetical societies where I would agree with you, and societies where I would strongly disagree. In the United States in 2024, I medium-disagree. "Maintaining order" usually just means "maintaining the status quo", so you have to actually look at the status quo. The status quo is that people are getting charged $291 for a 10-minute virtual followup consultation, $6000 for an ambulance ride, going bankrupt if they need major surgery, and sometimes just dying without treatment if they need major intervention but get denied by their health insurance. The status quo is that the rich can legally murder others stochastically if it increases their profits, and can even commit actual felonies without very much risk of consequence. The status quo is that few of our representatives are willing to challenge these systems, and those that do get ostracized, and even then their efforts are struck down by an openly corrupt supreme court. The status quo is that overwhelming waves of disinformation and rage-bait have made it impossible to "out-vote the ignorant" to enact any meaningful change in the system. The status quo is absolutely fucked for the vast majority of people. So no, in the United States in 2024, I don't think "maintaining order" -- preserving the current winners and losers in society -- is more important than individual justice and morality.

People, culture, values, morals and ethics predate law. The code of Hammurabi reflects those aspects of ancient Babylon.

Law must reflect to some degree and scope, the morals of its culture or people. If this does not happen for enough time and affects enough people, then you see a regression to tribal or vigilante justice.

Law is a form of centrally managed punishments that strongly influence individuals to behave according to the local population's values, morals and ethics.

What if a small class of people with enough resources, wit and motivation can hack this system to their favor? How will the rest of the population react when they realize this had been going on for years? Will they be able to "patch the bug" in the code of law and stop the exploiters?

What happened with the CEO of a system that is antithetical to American values, culture and morals, is an individual workaround to a long running lethal bug ignored by the maintainers of the code of law. This was ignored because the maintainers are a cog in the machine of that small class.

I agree with law and democracy, but we may no longer have that since the bigger population has no agency to shape laws. We may just have some other unnamed system that on the surface looks like law and democracy, but under the hood seems to be an oligarchy.

I agree with most of what you wrote as hypotheticals, I just disagree it describes things as they are.

I don't know why you are so eager to think people don't have agency or can't influence society. So many things change all the time. Just one example - twenty years ago most gay people lived in secret, because being out was a huge problem for society; the idea of gay marriage was ridiculously distant. Today, in most places, it's seen as a non-issue.

That didn't happen by chance. It happened because of the hard dedicated work of a lot of people, who convinced society to see things differently, and won.

While I feel similarly to you I would argue that society have two well working indicators of disconnect between enacted laws and average morals/perception of reality: - violence - sentiment towards violence justification

And if anything this murder shows the extent of issue of the disconnect above.

>putting lead in their drinking water

Flint, Michigan

Yep. Guess how many people went to prison for that one.

Accidentally kill someone with your car because you're distracted, no problem. But if you're drunk? Crime.

Good example, distracted driving that ends in death should be treated much more harshly than it is.

I'm not sure people are actually leading pretty decent lives. The people I know are working stressful dead end jobs and living with roommates in order to barely make ends meet. They don't have much prospect of improving their lot because doing so requires capital that they don't have (e.g. to start a business or go to college). Even though they have health insurance, they avoid going to the doctor unless absolutely necessary because they can't afford the co-pay. In some cases the states that they live in actively seek to discriminate against them.

The people I know are pretty much exactly the opposite of you so I think it comes down to age/experience, location, and other factors.

Yeah, you're quite literally in a bubble.

It seems that people are increasingly convinced that “in this country it is necessary, now and then, to put one health insurance exec to death in order to inspire the others to pay”.

That is a sign that people believe they can't obtain redress through widely available legal means.

What you are looking at is the people checking the power of the institutions they tasked with providing legal recourse who have mostly been sitting on their hands and/or serving parties other than the people.

If the state, courts and other systems don't get people justice or something you can squint at and call justice when they are wronged some fraction of those wronged will go outside the systems and seek to get even instead.

Public sympathy for the (rare, perhaps crazy) people who shoot CEOs or armor bulldozers are what gives the parts of the institutions that want to do what the people want the political capital to something other than the status quo.

Everyone is walking a tightrope.

I, and probably a lot of people reading this on HN, are outwardly very comfortable.

I have cash/assets that would be life changing for most people (especially when I read comments on reddit where people say that $10k would be life changing for them) - and a "good" white-collar job.

I'm also lucky enough to be old enough to have not been 100% screwed like our even younger generation has (I only got 90% screwed).

I've been very lucky in life, but when I see the level of wealth inequality and how corporations have completely captured our government, and our two-tiered justice system, it makes me feel sick and angry.

I still feel like I'm being held hostage by the 0.1%, under pressure to keep working to line other's pockets for much longer than I would otherwise have to, and like the whole thing could all come crashing down in a week's time given some improbable but far-from-impossible set of circumstances.

I also don't feel like I would be supported by my government, corporations, or society in general if those circumstances actually occurred.

So I definitely sympathize with the frustration of people who feel unsupported by society and unrepresented by government - especially those who happened to be unluckier in life than I.

And with the current state of affairs, there must be a LOT of them around.

I sympathize with that frustration a hell of a lot more than I sympathize for a dead CEO who made a career out of systematically denying treatment to people who paid him for coverage.

In fact, I'm happy he died as a reminder that nobody is untouchable, no matter how much lobbying your corporation has done to make social murder legal, and no matter how much you've tried to isolate yourself from the consequences of your terrible actions.

I read a reddit comment about the alleged shooter's arrest before:

"murder is such a strong word, can't we just call it removing a cancer?"

> how far off the deep end the internet went over the last few days.

Side note - the "internet" is very likely a mix of bots and real humans nowadays. What might seem initially like a real person saying "hunt the snitch down" could very likely be a bot that is meant to sow and influence discord. That bot's followers could very likely be real people who then say "ya i agree with this account! get your pitchfork!"

This is generally true but I've never seen clear evidence of bot activity on HN – have you? I think it's very likely that those reactions on Twitter are 50/50 bot, but I've seen HN people posting their own version of "wow, what a guy" in ways that were convincingly human and very surprising.

Huge disagree - there's no convincingly human anymore for internet text, especially for short internet text. Since the coming of LLMs, when I read HN, Reddit or even blog posts, I always keep it in the back of my mind that whatever I'm reading can very well be written by a bot. Fine-tune/prompt an LLM the right way and you'll get content indistinguishable from human text even for highly specific niche topics/contexts.

This is a random reply to a different comment Aerbil313 made for their benefit as their email in hackernews seems expired.

----

I have a family member suffering from multiple exposures to fluoroquinolone (FQ) antibiotics. While the research doesn't understand the root-cause reason for how FQs cause trouble, my journey with dealing with my personal family-history of diabetes and my family's chronic illness has gotten me to go down a road of understanding how to solve some issues.

From what I understand, mitochondrial dysfunction appears to be at the core of many issues like I said. However, to expand on what I've found useful in my n=1-2 experiments, juxtaposed against much of the Phd/MD health podcast sphere information, most interventions like exercise and nutrition fundamentally are there to improve metabolic health. Many markers like VO2 Max or A1c are integral that gives a snapshot of one aspect of one's metabolic health.

In my family's and my specific journey, I've put together a variety of molecules/supplements we've found useful in their journey and framed it in such a way as to be actionable, but also presentable enough to the public.

https://docs.google.com/spreadsheets/d/1Fo2F851i0OE4tIQb0hQ7...

It's a lot of information, but hopefully it would be useful for you and others. Feel free to ask any questions on my rationale, thinking, or reasoning behind why certain things are useful, and how I came to certain conclusions.

I read your comment history and I’m 99.9% sure you’re a human.

For what it’s worth, I am also human. Hi.

> convincingly human

We are long past that being a means of distinguishing a bot for anything other than obvious crypto scams. I have no doubt at all that a substantial number of HN posts, especially on divisive topics such as this one, are made by foreign agents. HN is an ideal means of targeting the types of people driving Western economies, and so I am certain that it is one of the top targets for such operations.

Bots don't independently invent opinions separate from the people running them. Not even with LLMs. "Bots" are just sock puppets - people creating multiple identities for themselves so they can ballot-stuff the Court of Public Opinion.

So it's not so much that there are no real people who want to hunt down the snitch, but that there's a very loud minority of performative extremists with an army of sock puppet accounts who want to hunt down the snitch.

> there's a very loud minority of performative extremists with an army of sock puppet accounts who want to hunt down the snitch

The people running the bot armies for foreign influence operations probably do not care about hunting down the snitch, they are simply following orders to spread that message.

Unfortunately, sometimes the law allows for the legal murder of people by pen. More people are killed by keyboards and pens, and I don't mean like John Wick, than are killed by guns because we have "for-profit healthcare". That means that the motive of the company is not determined by whether their decisions will kill people by the policies they create, but whether the decisions they make will be profitable. As long as those decisions don't run afoul of the law, they can kill at will. If that sounds fucked up, it is because it is fucked up.

Back in the 19th century a lot of Russian Revolutionaries came from families of well being, or are even aristocrats.

> so much pent up anger

And one reason it's pent-up, as opposed to released, is due to corporations taking over our society and ruining human lives. All within the confines of the law and democracy. That's what this is about. There is no recourse or effective vehicle to be heard.

> ...so much pent up anger amongst people who actually lead pretty decent lives.

This is the part of the story that must be discussed more, lest there will be more killings like this one.

Yeah was wild to see that.

I take it as a reaction to the wider public feeling that the US medical system is broken and the appropriate channel to fix it (voting & politics) being broken too thanks to lobbying.

Under circumstances like this people’s perception shifts to a more relativistic perspective. A bit like perception of a rioter throwing a stone at riot police depends on whether the viewer agrees with the movements goals even if in isolation they wouldn’t normally approve of throwing rocks at people faces.

I imagine that's what the start of the French revolution felt like too - one day you could walk down the streets of Paris as a noble minding your own business, the next day you had your head chopped off because people got fed up. Not saying that this is what's happening in the US right now, but I imagine the societal feelings of anger against "the elite" are similar.

Americans burned down a police station over George Floyd, stormed the capitol, and there were two assassination attempts on Trump last year.

Basically, we’ve begun normalizing events that fit a timeline of domestic turmoil.

I thought it was a joke when I saw the posts on the Reddit homepage celebrating the murder and even the murderer. Partly because I thought Redditors were above that type of thing, but also because I thought it was against their TOS.

It's a real reminder of how little sympathy people can have about people who they consider the enemy or the "other". I'm almost certain nearly all of the people celebrating the murder believe that they're good people and believe in justice too. Humans are so flawed. And I'm not suggesting for a moment I'm above it. I've often noticed how I don't care as much as I should when someone I dislike is harmed or suffers injustice.

I was even more surprised by the response on Bluesky because I naively expected it to be 'better' than that. But I saw vitriol and hatred directed at people for daring to suggest that other, unrelated CEOs shouldn't be shot. It was like a reflection of the worst elements of X, even though these people claim to be the 'good' side.

A lot of people feel that he as the CEO of the health insurance with the highest rate of denied claims is indirectly responsible for the death of a large number of people. Thus killing him is justified as vigilante justice. And vigilante justice is frequently seen in a positive light when the justice system is unable or unwilling to act.

These CEOs have found a way to game the system, but the system presupposes mutual respect. If one side reneges on this contract and says that technically they're following the rules, well, the other side will just disregard the rules. It's like the kid at the playground who won't play fair but insists that technically they follow the rules, ignoring completely the outcome -- kids just don't want to play with them anymore, and will probably be mean to the `cheater'.

That may feel acceptable, but I hope those people remember it when someone controversial they admire meets a similar fate, greeted by applause from the other side.

Once we start tacitly approving of extrajudicial killings, it doesn’t stop with just those you dislike or even just the outspoken figures. Consider how many completely innocent civilians died during the Troubles or the French Revolution, or how easy it would’ve been for someone completely innocent to get harmed here.

It’s easy to approve of this in a vacuum, it’s just a path full of extreme cognitive dissonance.

One of the many purposes of the justice system is to serve "justice" so people don't feel the need to take it in their own hands. The fact that so many people feel this murder is justified shows a clear breakdown of the justice system. Which should give everyone pause because that path does lead to the terrors you describe.

But the path to solving that has to involve adjustments to the system that address this mismatch, not just condemning the act or creating some huge diversion in the hope people will forget about it.

I would say that this is not only one of its proposes, but by far the most important. The system primarily prevents violence by convincing people they don’t need to commit violence to achieve justice.

If that starts to break down, people in power need to wake up and fix it. The system does not, cannot, protect them from the masses entirely by force. I fear that they have forgotten.

I’m not disagreeing.

I don’t think we should rejoice that justice has failed so miserably that people are applauding extrajudicial killings.

It’s a really, really, really bad thing.

It is absolutely not the duty of citizens to bend to an unjust system, but rather that of the justice system to reflect the ethics of its citizenry. Clearly there is a severe disconnect and "civil society" reached a breaking point around this issue.

I mean, we’re already there. There wasn’t a shared reality in the past few years, and now we even have the generative tools to ensure there is even less shared reality.

Don’t be too glad to celebrate it, is my point.

What do you mean, “once we start”? It has always been. The only really unusual thing about this instance is that the target was not the sort of person who’s traditionally been seen as deserving it.

Things have notably gotten worse over the last decade or so, if that hasn’t been made abundantly clear.

Perhaps, but on a longer time horizon none of this is new.

On a longer time horizon the norm is brutal warfare that leaves many innocent people dead.

I don’t think we should be so keen to embrace that.

Even in times of peace, Americans love our righteous killings and murderous folk heroes.

I’m not keen to embrace it. But I think the finger-wagging is idiotic. Chastising people will accomplish nothing except for making them think you’re out of touch.

Folks disturbed by this outpouring of support for this murder should instead be asking why people feel that way. Maybe it’s because of a system that treats their lives as an expense to be minimized and gives them no recourse. If wide support for Luigi Mangione worries you, maybe look at fixing that.

Seems like you’re awfully annoyed by this conversation so I’ll let it go, but I hope you remember this convo the next time this happens to someone.

Right now, Daniel Penny is being celebrated by half the country for killing Neely, and the other half wishes something like this would happen to him.

I keep getting this response and I do not understand it. Why would I change my opinion just because other people might disagree?

It’s especially bizarre here because I haven’t even expressed an opinion about the killing. All I said is that love of killers is nothing new, and if you want it to stop then you need to change the circumstances that make people like killing, rather than just telling them that they’re bad.

There is a belief that Daniel Penny acted in the direct defense of those in the area. That is quite different than killing a CEO who is probably going to be replaced by the same type of person.

That's already happening. Just yesterday someone got acquitted of murdering a homeless person in NYC. The only thing that's different here is that it was a CEO who got killed instead of one of the peasants.

Yes, near 50% of the country is cheering that he was acquitted and someone was killed. The other 50% would be glad if he faced extrajudicial punishment.

Not a good state to be in.

Murder wasn't even one of the charges, so even if he had been found guilty on all counts it still wouldn't justify you calling him a murderer

I don't think that the law necessarily defines whether or not someone is a murderer.

Stated another way, the law's job is to act in accordance with right and wrong, not to define it.

> greeted by applause from the other side.

Considering the other side is a minority of top-level executives and media outlets, I wouldn't bank much on that.

People are going to celebrate killers regardless, as they always have, when the perpetrator shares the viewpoint of the majority. It happened with Jesus and Barabbas, it happened with Cromwell and Charles I, it happened with Louis XVI and the French revolutionaries.

In fact, I'm not surprised that Luigi has a bigger fanbase than the Trump shooter. The majority then were in awe of Trump, if not openly cheering him. Here, they're cheering Luigi, with some even insinuating that it was his plan to get caught (something which might as well be true).

> Considering the other side is a minority of top-level executives and media outlets, I wouldn't bank much on that.

The other side is often 50% of the country. Whatever controversial figures you like, near 50% of the country would gladly applause or at least quote Clarence Darrow if they were brutally murdered.

Something to keep in mind.

Trump just got elected and is appointing a cabinet of billionaires.

It should be noted that the context with Jesus and Barabbas is probably the failed Jewish revolt against Rome that led to the destruction of the temple in 70CE, with the gospel accounts looking to separate the emerging gentile Christian movement from the Jewish rebels.

Thankfully don’t admire anyone that kills people to boost profits

You might! You’d be surprised how many people have ties to the “defense” industry.

It's similar to war heroes. Yes, Abraham Lincoln killed people. Yes, we could avoid glamorizing him and empathize with the poor southerners. But generally, war heroes are idolized. This guy is like a war hero who killed someone on the other side.

A CEO like this is an employee. He didn’t invent private insurance. He doesn’t get the 50 billion a year. He is a symbolic scapegoat.

Every person with a 401k probably owns UHC somewhere, and they expect it to increase every year. He is merely part of the system to help make that happen.

Try going into work tomorrow and saying “boss I think our VP’s initiatives are wrong and I’m going to take us in a different direction”.

There are good reasons to oppose his murder, but they are not found within him.

I don’t have to defend anyone against murder, it’s illegal and wrong.

Usually illegal, not always wrong.

I would prefer to see a distasteful person sent to retire to rural North Dakota, rather than murdered, but maybe I’m a little soft.

Just a cog, is your defense of him.

Do you think UHC is bad because the CEO happens to be a uniquely evil person and if it was someone with a good heart it would be good?

What kind of alternate reality would that be? The people heading these companies are good at rationalizing why they are not evil. Don't play their game.

The interesting question to me is where murder is justified in your ethics. You came in with absolutes, after defending him.

> He is merely part of the system to help make that happen.

Yeah, we saw that defense at Nuremberg. Didn't work.

https://en.wikipedia.org/wiki/Superior_orders

I’m sure you never do anything because it’s enforced by the systems you are a part of. Always an independent thinker, looking out for your personal integrity.

You’re also comparing an insurance CEO to nazi organizers. Reality check.

The serious point is that blaming individual moral character is not going to fix healthcare. We need systemic change.

> I’m sure you never do anything because it’s enforced by the systems you are a part of.

I mean, I can quite confidently state I've not received tens of millions of dollars for my role in denying medical care to millions of people.

> You’re also comparing an insurance CEO to nazi organizers. Reality check.

I'm saying "I'm just a little peon in the system!" isn't a good defense. Doubly so for C-suite level folks. This wasn't some call center drone following a script.

> The serious point is that blaming individual moral character is not going to fix healthcare. We need systemic change.

Systemic change often requires individual people to be ashamed of the current setup.

Ok just to be clear: Your position is that UHC is bad because of the exceptionally poor morality of the CEO? And that if we name, shame, and threaten we will hopefully get a moral one who will turn it around?

> I'm just a little peon in the system!" isn't a good defense.

I agree. It’s not a good way to morally justify to yourself why you killed someone.

My position is that a CEO of a large publicly traded company doesn’t get to shimmy out of responsibility by going “woe is me, it’s the system’s fault!”

I think if the system keeps refusing to change something breaks. We just saw that in Syria. I think people are unsympathetic in this case because health insurers have already broken the social compact they’re supposed to operate within.

> woe is me

Who is saying that? I’m advocating for the change that will fix the system. Not the one that gives warm fuzzy feelings from righteous bloodlust.

But nothing is keeping you from working for that change, certainly not the fact that so many people want it so badly that they even cheer over the murder of a healthcare CEO. It's not a dichotomy; you can do either of these things, both, or none.

This idea of there being a "game" that just magically is, while players that cannot be blamed for playing, nonsense. We need to change the system people with low individual character created for their own benefits, yes. But that's still why we have those systems in the first place, that wasn't an accident or oversight or lack of an effort of common people to try and make the world better. They fight and struggle every day, against the efforts of people the likes of which Brian Thompson played willing executive for.

> You’re also comparing an insurance CEO to nazi organizers. Reality check.

They're comparing an excuse. It would be the same correct comparison if it was about someone parking illegally. And accepting and enabling suffering and death of people for profit rather than out of fear of being shot isn't exactly better.

There are two separate ideas here:

1. Wanting to determine blame, and assign good and bad morality labels.

2. wanting to make healthcare better.

1. is merely psychosocial. It’s ultimately to make you feel better by constructing a revenge justification narrative.

Murdering administrators does nothing to fix 2. They will just replace him with the next guy in line.

No matter how you construe it, he didn’t make healthcare bad and he is not empowered to fix it.

This just occurred to me though. Is UHC going to have a hard time finding a CEO that continues this practice? Have they actually been given any reason to change? Any reason to believe they won't just double down?

If this murder doesn't change anything, was it justified? I just don't know.

Ironically, the net result may be an increase in CEO compensation.

some people believe the CEO's death is justice. engels called what insurance companies do "social murder" where these institutions and the state commits violence against individuals or kills them through policy or profit motives. and it's perfectly legal. it's only when an individual uses self defense against this social violence that it is considered wrong.

Honest question, do you think there is a point where someone has earned death? For example, was the mission to kill Bin Laden wrong? Was the mission to kill the Iranian General in Iraq wrong? Is it wrong to kill someone via the death penalty for the rape and murder of a child? Many people fundamentally believe those things are good examples of killing other humans. And realistically, those people are responsible for less harm and suffering , not to mention deaths, that CEOs of healthcare providers being investigated by the DoJ.

It’s not that there. Is a lack of sympathy, it’s overwhelmed by the feeling of justice. And not the injustice you think occurred.

Only about a quarter of the world's countries have the death penalty so even if "many people believe that's a good example of killing other humans", most do not. While I abhor the nature of privatised healthcare in the US, I think judging—and, certainly, killing—people based on potential indirect harm they've caused is a very slippery slope.

I don’t know of a single country without a military nor a country that doesn’t allow law enforcement to use lethal force. So your statement that most people don’t think they are valid examples of a good killing of someone is disingenuous.

I was specifically referring to the death penalty.

But my point was about justice and if we think there is a point someone deserves to die. If we say there is, which I think it’s clear, there is. The whole question about people being happy is about them being happy that they‘re seeing justice. But you tried to side step that.

Also, on the death penalty, I don’t think it’s ever gone to a vote where the people decided. So saying most people are againist the death penalty sounds hollow.

There's martial law and there is civil law. Martial law applies to enemies and in wartime. In this case, killing enemies like Bin Laden is acceptable.

However, in civil law, for the state to kill someone it has to be done through the courts. There is evidence given on each side. Killing someone without this is not justice.

People talk as if it is so obvious UHC CEO was responsible for the deaths of many people but he never got to make his case. That's not justice at all.

I‘m talking about justice and what is legal and what is just are two different things.

Is it just a child rapist, who there is video evidence commuting the crime, gets to walk free because they can’t find the victim to testify in court? And yes, that is the law in some countries. The uk had to wait for someone to come back to the uk because they could convict without the victims but the country he committed the crime couldn’t.

And it’s only not obvious that he‘s responsible for a lot of pain and suffering when you ignore the facts. The accused doesn’t need to give their side of the story for people to know what happened.

> The accused doesn’t need to give their side of the story for people to know what happened.

There is always a defense in court. This is not necessarily the defendant explicitly testifying. That's what I meant by the defendant making their case.

Justice can fail in the courts, I agree. But you can't have justice without (a) an authority with the power to judge, usually the state, and (b) a court proceeding where evidence is weighed.

If you say the UHC CEO killing was justice, then you must, to be consistent, allow for other such killings. Should all healthcare CEOs now be knocked off?

There is a difference between “earning a death” as some sort of justice, and killing being justified to prevent further harm. The death penalty is more of an example of earning death, as it is a punishment more than it is to prevent the person doing harm. Whereas a police shooting is a “justified” killing to prevent harm to others. In the former the goal is killing, in the latter the goal is to stop a threat and the outcome is killing.

The killing of Bin Laden and Soleimani were justified, in my opinion, as declared enemy combatants and leaders of hostile State and non-State military forces. They didn’t “deserve” to die for justice. They were taken off the battlefield. Whether I agree with that decision or not, I understand the justification.

Killing a rapist and murderer via the death penalty is wrong, in my opinion. It is killing in cold blood as a punishment, not to protect others or prevent harm. I do not think government should engage in retributive killing. But that is just me.

As for the United CEO, I don’t think he deserved to die or earned a death. I do think that a compelling argument can be made that government institutions have failed to act to protect human life at the hands of the American healthcare system, and that an individual could see his killing as a justified means to force change and protect American lives. It is the eternal question of when is someone a terrorist and when are they a freedom fighter?

Bin Laden should have been arrested and processed by a court. Killing the Iranian General was wrong. (this is a place for covert action, perhaps)

Same with everyone else the US has killed by drone.

Sentenced by a court to die, given the rule of law, is OK.

(note my personal belief is that the death penalty is wrong. today, it is legal).

The actions of his company —which he led and dictated policy for— can be considered evil by a reasonably dispassionate measure - they deliberately caused undue suffering or shortened the life of countless thousands of vulnerable people.

I (obviously) don’t support vigilante justice, and felt somewhat sad when Hussein and Gadaffi were hanged/lynched because despite their evil, I’d rather we don’t treat human beings like that.

But I don’t think it’s hyperbole to consider the actions of this CEO and his company in the same breath as such evil tyrants; and as such, I can understand why many might be happy about what took place, especially if they had personal animus with the company.

> But I don’t think it’s hyperbole to consider the actions of this CEO and his company in the same breath as such evil tyrants

But it is. Tyrants round up women and children and execute them. Healthcare is more complicated because you have multiple causes at play: the health conditions of patients, the hospitals and what they bill, and the insurance companies.

Money is a big factor here. People talk as if insurance companies should spend unlimited resources on every person. I understand the resentment over wealth inequality, but someone recently calculated that the top 4 billionaires could only support healthcare for everyone for 3 months. Money is not an infinite resource. Rationing is unavoidable.

But I get that there is a problem. Automatic denials and denials over treatments that have clear and significant benefits are a problem, absolutely. And the system could run more efficiently. But we also can't avoid death due to old age or sickness. Nor painless death.

But we can avoid murdering people in the streets in cold blood.

When people are tired of a system and the powers that be, they take action into their own hands. I'd rather a few dead CEO's and a renewed zeal among the populace to address these issues, then roll over like a dog.

What about deploying an AI that automatically denies 90% of appeals incorrectly? Is that Tyrannical or is that "complicated"?

https://www.medicaleconomics.com/view/unitedhealthcare-used-...

There is no reason why you need middlemen between the people and healthcare, beyond enriching the rent-seeking middlemen.

> But it is. Tyrants round up women and children and execute them.

That's just a difference in methods.

> People talk as if insurance companies should spend unlimited resources on every person.

You're right that US healthcare is a total mess (that's a much bigger area for discussion) but that doesn't mean that it's therefore okay for insurance companies to deliberately trade people for profits. That's literally what they do. Seriously, they could choose to make less profit, or pay lower salaries, and treat patients proportionally better. (And of course, as we all know from the reporting in the past week, UnitedHealth is the worst of all in the US for treatment denials.)

> But we can avoid murdering people in the streets in cold blood.

I totally agree; but that wasn't the argument I was making.

This overall dynamic has become very concerning to me- people have sorted themselves into echo chambers online that dehumanize anyone not in their group- to the point of justifying murder for just for not being in their specific group. This has happened universally across the political and ideological spectrum. Parts of Reddit for example has a seething hatred for anyone elderly “boomers” and/or well off “billionaires and landlords” with lots of extreme essays on why people in these groups should be systematically harmed or even executed becoming well liked. Anyone adding nuance to the discussion is attacked- empathy and nuance are labeled as themselves evil. Everything is based on a cartoonishly oversimplified model of the world with pure good and evil actors- not understanding that unfair outcomes are most often simply the banal result of bad planning and locked in structures that appear organically and can persist even when everyone involved wants them to change but can’t coordinate well. This dynamic is repeated everywhere and not unique to just the right or left. Nothing good will come off this.

This is a spot-on description. The locked-in banality seems to be the source of fuel for many issues people are taking offense with. Housing cost too much? Oh well. Food costs too much? Oh well. Medical costs too much? Oh well, etc. etc.

There doesn't seem to be many release valves other than "accept your fate" especially when you have seemingly little control over your own fate.

When you have a complex locked in problem that most people genuinely already want to solve, it can be solved with good leadership- someone needs to have a clear and workable vision and get all of the players organized to collectively act at the same time.

One doesn't need to be a politician to do this, but just as an example Obama was able to do this to make some improvements to the US healthcare situation.

Unfortunately, the people most affected by these problems are probably not in a position to acquire the knowledge and skills to lead the entire field to a better solution like this.

> I'm almost certain nearly all of the people celebrating the murder believe that they're good people and believe in justice too.

It's because they believe in justice that they are celebrating the murder.

For some definition of justice. Maybe not the same definition the rest of us are using, though.

A kind of justice that hasn't ben particularly just in the past, which is why vigilante justice isn't legal. The point is to not have citizens deciding to carry out their own idea of justice. That's for the state, which in a democratic society, we vote on, they pass laws which judges interpret and so on.

Because we can't trust everyone to deal out their own idea of justice without it turning into endless blood feuds and partisan killings. Not to mention all the lynchings and witch hunts. This doesn't even bring up the fact that most individuals don't have the resources or motivation to carry out a proper independent investigation. So then the wrong person gets hung by an angry mob, or beat to death by a family member of the victim.

Kill one man, and you are a murderer. Kill millions of men, and you are a successful healthcare insurance CEO.

Brian Thompson was CEO for all of 3 and a half years. He was also only about 50 years old, I don't think he's quite the bond villain you want him to be.

I don't follow your reasoning, 3 years is a significant time. Are you saying that you need to be above 70 to become a "bond villain", haven't seen that movie.

But in any case he was working for United since 2004, according to Wikipedia.

On the one side you have a mass murderer that’s part of the politically untouchable class, and on the other, one of his permanently injured victims managed to survive and deal out frontier-style justice.

It makes for a good story. We’ve all seen that movie 100 times.

I wonder if the shooter will survive long enough to make it to jury trial. That’s when the real circus will begin.

(All I know about this story is that United Health has one of the highest incorrect claim rejection rates in the industry. I know nothing about the CEO, but we’re way past 140 characters at this point, so these things don’t matter to social media.)

> melting pot

Did you mean tipping point?

Yes, probably. But I don't think we're at an actual tipping point. I don't think we're about to see a breakdown or anything like that, soon, but we're certainly heading in that general direction.

What is the euphemism I'm actually looking for? Knife edge? No.

Powder keg?

Yup, that's it, thank you.

I assumed it was "boiling point".

This makes the most sense, since it explains how we got the pot involved.

Maybe powder keg

It's not surprising. Most people don't comment. The tiny minority that comment likely have extreme views. Sorting algorithms that drive engagement makes this worse.

https://old.reddit.com/r/slatestarcodex/comments/9rvroo/most...

So everybody online can be dismissed, except the people posting online that everyone who posts something online can be dismissed? How does that work?

https://news.ycombinator.com/item?id=42371412

It's everywhere. You're simply wrong. Sort by date, sort by score, look on any broader news story and check out the comments. They're not "extreme", either. Even if their content was, which it isn't, it still wouldn't be extreme by definition at this point.

The point isn't to dismiss everything outright, it's simply cautioning that online commenters are a tiny minority of the overall population, and if you see a surprising opinion showing up in the top comments, you shouldn't extrapolate that everyone holds those views.

This only holds for opinions. If someone posts a link to a survey that says out of a representative sample of Americans, 70% of them support abortion or whatever, you should believe that (assuming there are no issues with the organization conducting the survey). Same with other forms of argumentation. You shouldn't distrust the top answer on stackoverflow just because it's from 1% of the population, although you probably not think the average person is some sort of expert on every programming question either.

Sort by date, no difference. And FWIW so far I only heard the idea that this CEO deserves empathy online

It's kind of sad. But I think that most people are fundamentally good -- they're just reactive and understand our broken healthcare system so little that they actually consider the victim to have actually earned a death sentence. When really, he was still a cog in the machine, not much closer to harming people than a software developer whose code ends up being used in military drones.

The problems with US healthcare boil down to there being more demand for healthcare than supply, and a fat bureaucracy sprouting up to partition that limited healthcare, often screwing over people who need exceptionally special care or who can't afford insurance in the first place. Who is to blame? You could reasonably apply some blame to the shortage of doctors created by the AMA, the FDA's guidance and the sugar industry's lobbying resulting in people being less healthy, lack of consumer protection laws around opaque medical pricing/gouging, and private insurance.

Would changing any one of these alone fix healthcare in the US? Maybe the first 2, if given a long time to materialize. But do any of these people deserve to die? It says a lot about you if you automatically dehumanize these people and say yes.

> Things really feel like a melting pot at the moment, with so much pent up anger amongst people who actually lead pretty decent lives.

One of the reasons that many people voted for Trump, is nihilism. The real belief that Trump is the one most likely to burn the ‘system’ to the ground. That is the brightest hope some voters have.

Please put more effort into understanding people's issues with the system as it stands today.

And please understand that virtually no one wants to leave a burned-out wreckage on a desolate hellscape. Everyone fancies themselves Shiva, or a phoenix, or whatever cultural imagery makes sense to you.

I know this is a sensitive topic. I am sorry it bothers you.

The sadder truth is, that I say what I say - AFTER having already applied your advice. I have spoken to strangers, reached out to see what they think. I spend the time to understand the many subcultures people are not parts of.

Go look at what is showing up in streamer feeds.

Talk to people, and when a 20 year old tells you “yeah bitcoin is great, because I have no hopes. So even if it goes to the shitter, how much worse can I be.”, you will see that people are truly happy to see things go to hell.

I do wish I had seen other things and had different interactions. But there is a substantial level of nihilism.

If you wish not to believe me - we’re in a thread where an insurance CEO was assassinated and the perpetrator is being hailed as a hero.

This conversation won't last much longer unless you actually listen.

People are hailing the shooter because of the resulting society they want to grow out of this, not because of some shallow death-drive diagnosis by an aspiring armchair psychologist.

I mean this genuinely. I believe you are being earnest.

Why do you have a strangle hold on meaning, and not what people themselves are saying ?

You seem to be rejecting observed reality, while accusing me of not listening.

Perhaps your objection isn’t clear?

I don't think anything is unclear. You assert that people only want destruction and that they disregard what comes after. I disagree, your opinion is disrespectful to the human spirit and indeed implies you see people as subhuman, acting purely on a musky animal instinct with no regard for the future. I am saying that the vast majority of those expressing glee in the shooter's actions aren't stupid, they know what they want to grow out of the ashes.

What "observed reality" are you even referring to? In the end all we're doing is speculative mass-psychoanalysis. Something tells me you don't quite know what you're even saying...

i think its because the accused dude is just as online as the average social media user who has latched on to this.

Given the number of people who think that Oswald did not shoot three people, that James Earl Ray did not shoot anyone, that Mumia Abu-Jamal did not shoot anyone, the mental gymnastics are not surprising. It's always been like this; the internet just allows us to know about it in real time. There are still people to this day who will tell you that the Yippies really DID levitate the Pentagon.

Imagine modern Russia. You can't have much of an opinion on pressing subjects of today unless that opinion is sanctioned by Russia's authorities - otherwise you're dead, or incarcerated or at best left the country. The propaganda machine is working 24/7. Now, Russia is a young country - counting from the last big turmoil in 1991, it's only 30+ years old - but some of the people there lived through USSR times. And some 100- years ago USSR was going through grim times itself, with millions suffering in purges, and even more millions and tens of millions learning to conform. And, as some prized artists and writers said there, the country killed a lot of progressive and inspired and very many of who're left are those who did purges, participated in them or from their families. So now the Russia's population - many involuntarily - support the war which was started for, frankly, really wrong reasons. And the future the Russia is perhaps looking towards is grim, hard and thankless no matter how things will progress. Can you imagine the scale of the task of getting back from the proverbial pit towards what we'd see as a more normal way of a country, what's going on in the heads of those people trying to live a normal life there?

Now, you might be surprised but America also has problems under the surface. America likes to project the good impression, but certain problems exist, aren't addressed enough for some time, got accumulated and it's harder to gloss them over. And since those problems are decades old, you have some parts of generations quite familiar with them. And we have Trump - first winning in 2016 and then even more triumphantly winning in 2024 - and those "normal", "good" sort of decidedly lost this November to those who's combined message might well be "things aren't well". Maybe we need to look at what's normal, as in if we have that state? Should we consider normal something only 40% think? 50%? 70%? That is, if 30% have long running reasons to think things aren't normal - is it enough for you to pause?

To the melting pot. What would you think if, looking into the pot, at the extreme you'd see the whole pot is full of that pent up anger, and nothing - or almost nothing - of what's "normal" here? Do numbers matter here? And, if they are suddenly too large, what you're going to do with lots and lots of those who'd think, figuratively, that lynching is still a good idea? Or in other somewhat known words, what would you do the good from, if the only thing you can do that is from evil?

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