'United Healthcare' using DMCA against Luigi Mangione images | Hacker News Reader

'United Healthcare' using DMCA against Luigi Mangione images

abovethelaw.com

385 pointshaunter240 comments

It's also quite possible that someone falsely claiming to be UHC is doing this. This is a major loophole with the DMCA, there's very little vetting of takedown notices.

If you misrepresent that you are authorized by the company making the takedown request, that's literally the only thing that the DMCA considers to be perjury.

So weirdly enough:

* Not owning the copyrighted work and claiming you own it = Okay

* The work you're taking down not even being the claimed copyrighted work = Okay

* Saying you're authorized by the company to file the notice, and you're not = PERJURY

It’s not that crazy when you consider that someone might be wrong about whether their work is even copyrightable, but they can’t realistically be mistaken about whether they are acting as someone’s authorized agent. That’s the kind of relationship that lawyers know very well how to make explicit.

But they should also have foreseen the routes for abuse. That's also their job.

The DMCA is a disaster.

They did foresee the routes for abuse and set up a formal counterclaim process. Neither the source article nor the original reporting really explain why the targets of these takedown orders didn't want to file a counterclaim - in some cases there can be privacy concerns, but the T-shirt artist at least has already publicly identified herself.

The process is extremely assymmetric, the counterclaim process has much higher requirements than a takedown notice. Like having to actually provide evidence you aren't infringing, provide your real identity, and often convince an AI that your content shouldn't be taken down or least get it seen by a real person. And if you succeed, you just get your content back up. No compensation for any damage caused by your content being down for a while.

Maybe you’re describing YouTube’s DMCA process? The actual law doesn’t specify any of that [1]:

> If the user believes that the material was removed as a result of mistake or misidentification of the material, the user may submit a counter-notice requesting the reinstatement of the material. To be effective, a counter-notice must contain substantially the following information:

> (i) a physical or electronic signature of the user;

> (ii) identification of the material that has been removed or to which access has been disabled and the location at which the material appeared before it was removed or access to it was disabled;

> (iii) a statement under penalty of perjury that the user has a good faith belief that the material was removed or disabled as a result of mistake or misidentification of the material to be removed or disabled;

> (iv) the user’s name, address, and telephone number, and a statement that the subscriber consents to the jurisdiction of Federal District Court for the judicial district in which the address is located, or if the subscriber’s address is outside of the United States, for any judicial district in which the service provider may be found, and that the subscriber will accept service of process from the person who provided notification under subsection (c)(1)(C) or an agent of such person.

1: https://www.copyright.gov/512/

(iv) sure sounds like giving them your true identity to me.

You have to give them information to sue you (or do other nefarious things), but they don't have to provide you with information that say, you could use to sue them for perjury or try to recover damages from the time it was taken down.

Again, you seem to be conflating YouTube’s DMCA process (which is designed to optimize the experience for YouTube, not to maximize the rights of YouTubers) with what the law actually specifies. The filer must provide contact information (paragraph iv), which can be used to serve process.

> (i) the signature of the copyright owner or an authorized agent;

> (ii) identification of the copyrighted work claimed to have been infringed, or, if multiple works are on a single site, a representative list of such works;

> (iii) identification of the infringing material or activity (or the reference or link to such material) and information reasonably sufficient to permit the OSP to locate the material (or the reference or link);

> (iv) contact information for the copyright owner or authorized agent;

> (v) a statement that the person sending the notice has a good faith belief that use of the material in the manner complained of is not authorized by the copyright owner, its agent, or the law; and

> (vi) a statement that the information in the notice is accurate, and under penalty of perjury, that the person sending the notice is authorized to act on behalf of the copyright owner .

I agree the system is intentionally asymmetric, because it was built by people who understand how quickly material proliferates once it’s been posted to the Internet. That makes it abusable to chill speech, as in this case. But the law was also written with an expectation that anonymity does not guarantee full participation in civil society.

"contact information" is not the same as "user’s name, address, and telephone number".

"Contact information" could just be an email address, or even a social media handle.

These laws are bought and paid for by corporations of the trillion dollar copyright industry. They hire expensive lobbyists to get these laws passed. It's no surprise that the laws only foresee the abuse that could hurt their bottom lines.

The better question is: why have the people's representatives failed to protect their interests? Why didn't they foresee the abuses that hurt us all?

> why have the people's representatives failed to protect their interests?

Nobody cares about copyright.

There is a vocal minority of us who do. But we're only slightly more useful on it than the privacy advocates, both sharing a good chunk of people who are lazy or nihlistic about the political process to the point of being politically irrelevant. As a result, a representative who brings up copyright reform gets like one call in support and zero net new votes. Meanwhile, they get powerful and patient adversaries from the Big Tech to the record companies and their billionaire artists.

It really depends on how you phrase it. If you talk about copyright in the abstract, then yes, few people will care. But ask them how they feel about stuff like this specifically, and it'll be rather different.

The Senate is quite deliberately there to protect the interests of the wealthy and powerful.

It's unfortunate that the UnitedHealth Group death has fanned the flames of this hatred of corporations.

Artificial Intelligence is going to change how we work. Many top software engineers on Hacker News may be ok for a while. Although everyone could use help.

But already many artists and junior engineers feel pressure. Lack of copyright protection can make that even worse for many. These are allies and people who we mentor.

Just brainstorming, Social Purpose Corporations could provide innovative co-op opportunities for artists and engineers. That's just one example.

I don't see the management class failing to forsee the financial reality in the global workplace. But I do worry about dependents facing division and hate. Bully that, right?

I can't fucking forsee every possibility, traps and all, though. Maybe not social purpose corporations but just hyper-incubators that enable a million small indy corps. Man, I'm imagining Jar Jar binks manning the hyperspace lychgates across from the content generators.

Sorry, stupid digression. I'm sorry for wasting cycles on that.

Corporations have earned all the hate they get, UHC even more so.

Whether AI decimates the likelihoods of everyone is only more likely with unchecked corpo power in control of everything.

"AI" is like anything else. Big capital will weaponize it to further entrench themselves and further disadvantage smaller businesses and individuals, in the pursuit of increasing profits and growth.

I hate copyright and would rather see it abolished.

AI is just the latest iteration of endless corporate abuses. They think copyright exists to keep the likes of us in line while they get to do whatever they want. If we infringe copyright, they compare us to raping and pillaging high seas pirates but then they turn around and say it's OK to infringe copyright on a massive scale so long as they launder it via AI first.

I want intellectual property gone so that we can do the same. I want them to be forced to open their weights too.

> The better question is: why have the people's representatives failed to protect their interests

Because there are no "people's representatives" after the voting is done. They just go with the biggest bidder. That's why companies are spending bilions on lobbying.

As someone receiving a notice you have no idea if it's legitimate or from a AOL account someone made 15 minutes ago, the threat of it being perjury doesn't work when there's no authentication whatsoever of who sent it. Unless the DMCA is signed by Zaphod Beeblebrox the receiver has no choice but to assume it's legitimate.

What happens if you ignore it?

You lose safe harbor protections, which means if the notice was legitimate, you could be on the hook for copyright infringement as well.

You can respond and refuse, but you have to authenticately dox yourself to do so, and you assume liabilities.

You're conflating two things: a DMCA counter-notice by an alleged infringer, and the refusal of an intermediary to honor a DMCA takedown notice. Your statement is a mixture of claims that are true about one or the other of those separate things.

DMCA counter-notice:

* Sent by an alleged infringer (in this case, that would be the artist) to an intermediary (in this case, TeePublic) asserting that a takedown notice the intermediary received was invalid.

* Requires the alleged infringer to provide information about themself ("authentically dox").

* Can enable the intermediary to restore access to the material without losing their liability shield.

* Doesn't affect the alleged infringer's copyright infringement liability in any direction (though as with takedown notices, there's the potential for perjury). If the alleged infringer committed copyright infringement, they were already liable for it, and remain so; if they didn't, then they never were liable and still aren't.

Intermediary refusal:

* Simply a lack of action on a takedown notice by the intermediary to whom it was sent.

* Doesn't require anyone to dox themselves, or to do anything in particular. The intermediary can throw the takedown notice in the garbage and go about their day.

* Removes the intermediary's liability shield; the intermediary can potentially be liable for infringement, when they would otherwise would have been immune.

Provider has to take it down. The vendor making the shirt can simply file a dmca counterclaim (basically stating that the dmca claim is invalid) Then the provider puts the content back up and the courts decide.

One side note: the provider is not required to put the content back up, it is at their discretion.

I don't believe that's true. I think they must make the material available after a proper counter-notification, or they lose their liability shield as per the exception here. IANAL, just reading the text of the law at face value.

(g) REPLACEMENT OF REMOVED OR DISABLED MATERIAL AND LIMITATION ON OTHER LIABILITY.—

(1) NO LIABILITY FOR TAKING DOWN GENERALLY.—Subject to paragraph (2), a service provider shall not be liable to any person for any claim based on the service provider’s good faith disabling of access to, or removal of, material or activity claimed to be infringing or based on facts or circumstances from which infringing activity is apparent, regardless of whether the material or activity is ultimately determined to be infringing.

(2) EXCEPTION.—Paragraph (1) shall not apply with respect to material residing at the direction of a subscriber of the service provider on a system or network controlled or operated by or for the service provider that is removed, or to which access is disabled by the service provider, pursuant to a notice provided under subsection (c)(1)(C), unless the service provider—

(A) takes reasonable steps promptly to notify the subscriber that it has removed or disabled access to the material; Applicability. PUBLIC LAW 105–304—OCT. 28, 1998 112 STAT. 2883

(B) upon receipt of a counter notification described in paragraph (3), promptly provides the person who provided the notification under subsection (c)(1)(C) with a copy of the counter notification, and informs that person that it will replace the removed material or cease disabling access to it in 10 business days; and

(C) replaces the removed material and ceases disabling access to it not less than 10, nor more than 14, business days following receipt of the counter notice, unless its designated agent first receives notice from the person who submitted the notification under subsection (c)(1)(C) that such person has filed an action seeking a court order to restrain the subscriber from engaging in infringing activity relating to the material on the service provider’s system or network.

They lose their liability shield for the act of taking the content down, but that liability shield is of limited value to begin with because they'd typically be well within their rights to take any content down for any reason (or no reason).

I'm not sure how DMCA enforcement isn't a clear violation of the 1st amendment. If you are connected you can use the government to stop speech? Isn't this the kind of thing that US feels very strongly is not okay?

When the government does it, it's bad. When the Free Market™ does it, that's innovation.

The 1st amendment applies to the government, so it wouldn't apply unless the DMCA request is to a government website.

The DMCA is a law that restricts the ability of people to make speech. The government is the one doing the restricting, even if the place the speech is being done isn't controlled by the government.

The argument you're making is applicable when a website decides not to publish your speech (they're not the government, so the 1st amendment is irrelevant), but the DMCA is different.

The 1st amendment only applies to freedom of speech that the government can control/affect directly.

Using the DMCA like this is censorship by copywrite, and it does go against freedom of speech in society at large, but it's not a 1st amendment issue.

https://en.m.wikipedia.org/wiki/Censorship_by_copyright

Lots of arguing around the point, perhaps.

Freedom of speech is an American ideal. It's in the Bill of Rights because it was so important. Not as a tool to restrict this right to just government infringements. It is supposed to be a universal right.

I often wonder at those arguing that it's 'ok' somehow in some circumstances because, not protected except for the govt! Somehow they've lost sight of the ideal.

My dude, it's restricted to just government infringements (Congress) in the Bill of Rights.

> Congress shall make no law respecting an establishment of religion, or prohibiting the free exercise thereof; or abridging the freedom of speech, or of the press; or the right of the people peaceably to assemble, and to petition the Government for a redress of grievances.

https://en.m.wikipedia.org/wiki/United_States_Bill_of_Rights

If it was supposed to be a universal right for everyone/everything, it would be something like "no one shall make a law..."

Kid, that's what I said.

American ideals are not restricted to the Bill of Rights. My entire point.

That's not what you said.

> It's in the Bill of Rights because it was so important. Not as a tool to restrict this right to just government infringements.

In the Bill of Rights, it's restricted to just government infringements.

Interesting, thanks for clarifying. I guess the fact that people can counter claim means the ability of someone to truly limit someone else's speech is probably limited, and it's on websites to support that (which I don't think all do, but it's up to them?)

Almost makes me wish it was mandatory for companies to support counter claims and to treat a customer no differently if they've filed a counter claim. (E.g., GitHub can't close your repos as long as you file a counter claim, unless they would have regardless of the DMCA claim.)

It's the other way around. The 1st amendment protects public speech from the government, not the government from the public. Since DMCA is a law made and enforced by the government it is used illegally against the public in violation of the 1st amendment.

Yes and no. The governments powers wrt speech are limited, but certain things like threats, yelling fire in a crowded theater, and other crimes/regulations do not have 1st amendment protections.

The DMCA is an exception because it's a law, just like a threat or any other illegal material/etc would be and removal of that thing can be mandated by law without it being a 1st amendment issue.

> 1st amendment applies to the government, so it wouldn't apply

Eh, the DMCA is still a law providing for civil and criminal sanctions based on speech. There are probably fundamental First Amendment problems with copyright.

The answer to why the DMCA—and copyright as a whole—can exist is the Copyright Clause [1].

[1] https://en.m.wikipedia.org/wiki/Copyright_Clause

Also the seventh amendment (the content is removed without any trial by jury, and that can sometimes have considerable monetary harm to the content creator) and the fifth amendment (there is a process but it is very questionable, with basically no requirement of evidence of infringement, and no presumption of innocence).

> fifth amendment (there is a process but it is very questionable, with basically no requirement of evidence of infringement, and no presumption of innocence)

There is also no “capital, or otherwise infamous crime,” “criminal case,” or taking of private property “for public use, without just compensation” [1].

[1] https://en.m.wikipedia.org/wiki/Fifth_Amendment_to_the_Unite...

I will admit that the fifth amendment case isn't as clear cut as the others, by the letter of the law, but:

> nor be deprived of life, liberty, or property, without due process of law

I would argue that at least in some cases dmca takedown notices can deprive people of property, either by preventing them from making an income from their content, or causing them to lose access to a service for which they paid money, or have access to something of value.

I also think it deprives the poster of some degree of liberty.

Even if it isn't against the letter of the law it is against the spirit.

> Even if it isn't against the letter of the law it is against the spirit

By that notion YouTube has the right to call a jury if I decide to cancel.

Where we agree is in the sanctions. For the safe harbor to be removed there should be more process, and it should be explicit.

Except you don't have a legal right to post content on a private platform, that private company can do whatever they want, they aren't required to give you freedom of speech.

DMCA is a legal mechanism that the platform has to comply with. This isn't a case of a private company removing something that violates the ToS, it is a law that can be easily be abused by a third party to cause content to be taken down.

It's like if there was a law that said if you send a notification to a storage or logistics company that you think one of their customers has counterfeit goods in their storage, the storage company is legally obligated to destroy the suspect property, regardless of whether there is any evidence that it is actually counterfeit. Or even just, that company is no longer allowed to provide service to that customer, and is allowed to seize and keep any property they currently have control over.

I could also talk about how many of these platforms have too much power, and the lack of competition makes it problematic if they have control to censor as they please, but that is really a different topic.

IANAL but I think this justification sits on very shakey ground when the private company is doing it in the name of the law (DMCA). For the same reason, I of course think the government demanding encryption backdoors by private companies violates the fifth amendment.

Section 8 of the Constitution explicitly allows Congress to protect copyright.

> To promote the Progress of Science and useful Arts, by securing for limited Times to Authors and Inventors the exclusive Right to their respective Writings and Discoveries;

The 1st amendment didn't repeal this.

Yeah, but current practise isn't in any way promoting the Progress of Science and useful Arts.

SCOTUS has ruled multiple times that Congress has the authority to determine policy that they believe best fulfills this part of the clause.

Meaning the words of your constitution are worth nothing, gotcha.

This actually kinda makes sense, and the argument goes like this. It is rather obviously subjective what constitutes "promoting science and useful arts" (including the very definition of "useful" etc). So when it comes to enforcing this clause, you need some body to decide on what these translate to in practice. And this can be either the courts or the legislature. Between the two, the legislature is the one that citizens have more control over, so giving it the ability to decide is intended to make these kinds of abuses easier to rectify (just vote for the right guys!) as opposed to dealing with obstinate courts.

Let me assure you that you haven't discovered something hundreds of years of legal scholars didn't yet realize. You are simply mistaken as to how that clause is interpreted within the context of the rest of the document ... part of which outlines the division of roles and responsibilities for judging and executing that clause.

All of that aside, "science and useful arts" never referred to the little guys. This always referred to the interests of commercializing those endeavors.

Correct, just as section 8 didn't repeal the 1st amendment. Congress does not have power to enact legislation that violates the 1st amendment.

Since section 8 exists DMCA is nearly entirely redundant. Repealing DMCA would do nothing to strip copyright owners of their rights.

DMCA has withstood a lot of 1A tests in court, even some very specific and narrow fair-use claims. The suggestion that the entire law is infringing is simply unfounded. There are many limitations that the court allows on speech under the 1A, and most of those aren't even listed as exceptions in the Constitution, as copyright is in section 8. As unpopular as it may be, the constitutionality is pretty solid.

> Repealing DMCA

Be careful what you wish for. Repealing DMCA would mean repealing Safe Harbor provisions, which would just make it just about impossible to run websites with user-submitted content. DMCA might have some problems, but do you really want website owners to be held liable for everything a user posts on their site?

> Since section 8 exists DMCA is nearly entirely redundant.

Absolutely not. There is zero overlap between the two. Section 8 doesn't establish any copyright law at all. It merely establishes Congress's right to regulate it.

> Repealing DMCA would do nothing to strip copyright owners of their rights.

That's a pretty loaded statement to make. There are obviously things that rights owners couldn't do if the DMCA was repealed. I think what you're really arguing that those things don't matter? That could be a valid opinion, but it's still irrelevant. If Congress has the power to regulate something, they also have the power to regulate it ineffectively.

I worked front line technical support at a web hosting company in the early 2010s. We were told to just immediately shut down any site when receiving a DMCA takedown request. We were barely paid above minimum wage, and received no training on how to handle legal requests like this - the rule was just "shut the site down".

Before anyone reacts negatively to this - you’ve never seen how much spam, and how many DMCA requests, are completely real. I would personally estimate 90%+.

It doesn't matter. A 10% false positive rate means grave injustices are being inflicted on people on a daily basis. They are being censored by the government at a corporation's whim for bogus reasons. The corporations exploit the fact people will not fight their claims because it costs time and a small fortune to do so.

Spam? Infringement? Irrelevant. Small issues compared to corporate censorship. Let it happen. Not a single person should be censored over it.

> you’ve never seen how much spam, and how many DMCA requests, are completely real. I would personally estimate 90%+

Source?

There are abundant claims to the contrary [1][2]. (I can't find any quality data either way.)

[1] https://www.plagiarismtoday.com/2019/01/10/youtubes-copyrigh...

[2] https://www.businessinsider.com/youtubers-channels-are-being...

Years ago we had an opsec competition called "Karmageddon". The goal was to get as many upvotes on Reddit on an account in one day, with absolutely no ethical limitations to achieving that.

I was winning against 10-20 people by posting a lot of random "f this politician" garbage in the political subreddits (this was in late 2016 and it was a feeding frenzy), until someone posted a "check out this picture of me and my brother I haven't seen in 10 years wearing the same Ghostbusters shirt!" post. It wasn't his brother, he found it somewhere, but it was going viral and I was about to lose.

So I filed a DMCA takedown request with Reddit, and they deleted the post and the picture very quickly after, no questions asked. I ended up winning the competition, but I think we ended up giving the prize to the Ghostbusters guy anyways.

The DMCA is 100% an attack strategy, it works.

I know someone working for UHC legal.. they're in a vendetta mode over there from what I've been told.

You mean a vendetta against the murder suspect, or an actor impersonating UHC sending DMCAs?

Are they concerned that after their CEO was gunned down in broad daylight over his supposed unethical behavior, and the killer is being celebrated as a folk hero. That by doubling down and doing unethical things they may be putting targets on their own back?

I know if I were at UHC I’d be looking to leave before I ended up on a hit list.

> I know if I were at UHC I’d be looking to leave before I ended up on a hit list.

UnitedHealth has half a million employees. If you think individual employees are at risk of getting on a hit list then you don’t really understand the scale of the company.

I’m constantly amazed by how some people adopt the uninformed narratives that sprang up in the wake of this murder. I’ve asked multiple people to guess how much cheaper our healthcare would get if we forced insurance company profits to zero and redistributed their C-suite’s compensation to their covered patients. The answer is always off by orders of magnitude.

It’s all very strange. The narratives around this murder and, by extension, the health care system are being invented by people informed about both yet widely accepted as fact. Even details about the scale of UnitedHealth seem lost on people. This is a very large publicly traded company with scores of employees.

> asked multiple people to guess how much cheaper our healthcare would get if we forced insurance company profits to zero and redistributed their C-suite’s compensation to their covered patients. The answer is always off by orders of magnitude

The media is conflating the far-right and -left wing fringes who are celbrating Mangione as a person and his literal crime with those holding him as a symbol for their frustrations with our healthcare system.

If you're celebrating the person and the crime, you need to speak to a professional. (You're also in a minority. No, your subreddit isn't the world.) If you're upset about the system, it's reasonable to not care if you're being fucked by Bob or Alice.

> You're also in a minority

[citation needed]

"A majority of voters (68%) think the actions of the killer of the United Healthcare CEO, Brian Thompson, are unacceptable. Seventeen percent find the actions acceptable, while 16% are unsure" [1]. Also [2].

[1] https://emersoncollegepolling.com/december-2024-national-pol...

[2] https://d3nkl3psvxxpe9.cloudfront.net/documents/econTabRepor... page 12

That seems like most people who are healthy and military age are atleast somewhat OK with it. Its also excluding people who don't vote and have had their voting rights taken away.

> seems like most people who are healthy and military age are atleast somewhat OK with it

About a quarter of under-30 men and a fifth of under-30 women. For comparison, about 20% of Americans "think holding neo-Nazi views is" acceptable [1].

> excluding people who don't vote and have had their voting rights taken away

Where do you see the 2% of Americans [2] who have had their voting rights taken away being excluded by either poll? (Not challenging. That's just methodologically impressive.) Either way, none of what you're citing is material to an 80/20 margin.

I have friends in that 17%. But I also know people who thought Kari Lake was a shoe in, "defund the police" would work or that every guy is an incel. Echo chambers are powerful, especially online, where they can convince a quarter of a single demographic that they're in the majority on celebrating a dude capping a stranger in broad daylight.

[1] https://www.the-independent.com/news/world/americas/us-neo-n...

[2] https://www.sentencingproject.org/reports/locked-out-2022-es...

You're selectively moving groups around with your statistics to try and use simple numbers to make it seem like you're always right. 20% of every single person in the US being sort of into Nazis has very little to do with the vast majority of people under 40 (military age) finding it ok with Brian getting shot. The first group includes people who are getting government funded healthcare on top of not having spent most of their lives dealing with insurance companies run by MBAs

Edit: Just noticed statistical manipulation is your job and you're maybe in a similar tax bracket

>> Trade private equity. Former aerospace investment banker, and before that, algorithmic equity derivatives trader. FinTech + Space + B2C angel & seed investor. Jackson Hole local; frequently in New York and the Bay Area.

> 20% of every single person in the US being sort of into Nazis has very little to do with

I’m saying 20% of Americans can be found who believe almost anything. 20% of Americans supporting something is basically background.

> selectively moving groups around with your statistics to try and use simple numbers to make it seem like you're always right

I’m slicing the data to present a number bigger than 17%. I’m trying to find a group in which a majority support Mangione who aren’t on the far fringes of society. If you’re upset about the slicing and dicing you’re confirming my point.

> the vast majority of people under 40 (military age) finding it ok with Brian getting shot

Where do you see this?

18 to 29 is the most favourable bloc for Mangione, and there favourability is 39%. Not a majority let alone a vast majority. And that’s being generous by combining in somewhat favourable.

> I’m saying 20% of Americans can be found who believe almost anything. 20% of Americans supporting something is basically background.

The Lizardman's Constant is lower than 20%, more like 4% for the survey result that gave rise to the name — and also, despite the name, not constant: https://gwern.net/note/lizardman

Sadly, this also means that your chosen example, instead of illustrating your claim, actually has something to say about the state of the American Overton Window when it was taken.

> The Lizardman's Constant is lower than 20%, more like 4%

Lizardman’s Constant is, per Gwern, “‘jokester’ or ‘mischevious responders’.” They’re being disingenuous; think: “deez balls” voters.

I don’t think the 17% of respondents who think favourably of Mangione are trolling. I don’t think the 10% flat earthers (or, including those who are “unsure” about the Earth’s roundness, 19%) are bullshitting [1].

There is simply about a fifth of the population—and it’s a moving fifth, there isn’t a permanently-braindead section—that tends to respond one way in just about any survey about fringe or stupid theories. So 17% supporting Mangione (while making it seem like it’s everyone online) isn’t particularly surprising. (Even if a good fraction of them are responding provocatively for fun.)

[1] https://carsey.unh.edu/publication/conspiracy-vs-science-sur...

Why do people keep quoting "military age" here? There's no a priori reason why the next CEO shooter might not be underage (common in school shooters) or retired (with time, pain, and guns on their hands)?

Indeed. Claiming DMCA on something should require KYC for the claimant. If KYC is so easy and un-burdensome that it's being applied everywhere else in our lives surely in such a legal context where 2-parties are central to the dogma the initiating party in a legal case should have to prove it is who it says it is.

Of course this will not happen because the DMCA as used in practice has nothing to do with law or justice and is just a mechanism for corporations to attack humans.

That's not to say there's nothing good in the DMCA as written. The safe harbor provisions are now vital to the continued existence of independent communities on the internet. But in practice safe harbor is often ignored too.

I'm really not sure what you mean. Nobody argues that KYC is easy or non-burdensome, which is why it's not being applied everywhere else in our lives. A company like "Print-on-demand merch retailer TeePublic" would find it procedurally difficult and probably economically infeasible to rigorously verify the identity of everyone who sends it a notice of copyright infringement.

It sounds like you may be envisioning a system where the burden is offloaded onto the people sending a notice, but that's just not possible. If you get an email from some person Alice you've never heard of before, you fundamentally cannot know just from reading the email whether it was sent by the actual Alice, or someone pretending to be Alice, or whether there's even such a person as Alice in the first place. To tell the difference, you would have to research Alice and find some independent way to corroborate her identity.

If we fundementally cannot know then why are we believing these claimant "persons" at all? These days it's more likely than not that a DMCA claim is not from the copyright owner (or anyone associated with the owner) of what is claimed. It seems like DMCA is broken in practice and no longer operates in the spirit of the law.

I'm envisioning a system where someone has to prove they actually own the thing before they can claim it, yes. And if proving identity is so hard then maybe there shouldn't be take-downs at all. Let the legal system where identification is required take over. Stop the hundreds of millions of automated para-legal attacks and make it a more managable flood of hundreds of thousands of actual legal actions.

And yes, KYC is extremely burdensome. I suppose when a DMCA claim arrives the recipient should then send back an email with a link to some third party corporation dedicated to KYC (out of a set of government approved companies) which the DMCA claimant will sign up with and pay a small fee to. Most likely the claimaint will have to have a webcam conversation with the KYC company and upload their identifying documents. The result of the identity and ownership check would then be sent to both parties and the process could proceed as per normal.

This would strongly discourage illegal false claims which currently have no mitigation and make up the majority of DMCA actions.

> If KYC is so easy and un-burdensome that it's being applied everywhere else in our lives

If by everywhere else you mean finance. Which means you want to burden every single website in America that accepts user-generated content with a banking-style compliance department.

The article puts ‘United Healthcare’ in quotes and opens with a statement mirroring this same possibility, because the first-pass response to DMCA requests is as you describe: An assumption that it’s legitimate until proven otherwise.

This is very well known and the technique is often abused. Even the source article is presenting this information with a huge grain of salt.

This did bring up a copyright question I haven't been able to resolve - is footage from a private security camera somehow owned by the owner of the camera? AFAIK copyright is reserved for works of creative expression, so footage taken for non-creative purposes shouldn't be protected - is there some other mechanism to demand someone cease and desist sharing a video or an image once the cats out of the bag? IMO we could use something more flexible than revenge porn laws, that prevent noncensual use of your likeness, inc. impersonations of your face and voice. Fair use exceptions would obviously have to apply for newsworthy events otherwise Luigi could demand the cops take down his image during the manhunt :)

(Similar question for Internet comments , since the bluesky-huggingface-kerfuffle I haven't been able to find a definitive answer if internet commentary is copyrighted creative expression or some other public domain shaped thing)

Is ‘creative expression’ somehow defined? I could creatively express myself by wiring up a camera and filming a public place, no?

Edit: I do think it would be good taste to censor death/murder footage in some cases such as this, I’ve not thought about it a tonne because I assume there’s a legitimate public interest case in some scenarios (political oppression footage, etc)

> I could creatively express myself by wiring up a camera and filming a public place, no?

Certainly. My layperson view is it would depend on intent. If you were to use trafficcamphotobooth.com to take a selfie on 14th Street, I think the fact that you went out in front of a particular surveillance cam and hit the save button would count as a copyrighted photo even tho the camera belongs to some other entity and was going to take the photo with or without you.

(Edited) Edit: going back to remind myself of the basics, creative expression is not the basis for copyright, but "original works of authorsbip', although '''The Supreme Court has said that, to be creative, a work must have a “spark” and “modicum” of creativity.''' - this in the case determining that phonebooks are merely collections of facts and therefore not protected works.

https://www.copyright.gov/what-is-copyright/

>Is ‘creative expression’ somehow defined? I could creatively express myself by wiring up a camera and filming a public place, no?

Not tested in court.

>Security cameras, webcams, camera traps and other pre-positioned recording devices capture whatever happens to take place in their field of view. This raises the question as to whether their recordings are an original and therefore copyrighted work. For example, "[i]f a security camera mounted in a lobby, recording 24 hours a day, captured a dramatic event, the video could be uncopyrighted."[2]

>This question remains untested in the United States. In the 2008 United States district court case Southwest Casino and Hotel Corp. vs Flyingman, the casino filed suit for copyright infringement on the use of their surveillance video, but the defendant argued in a motion that the surveillance video lacked the sufficient creativity needed to secure copyright protection.[3][4] However, the case was never heard as a separate tribal court ruled that the tribes, rather than the casino, owned the footage.[4]

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

Well that settles it, the matter is unsettled! Thanks for the pointer.

Southwest v Flyingman sounds like a parody case from the Grand Theft Auto universe.

Probably the fact that police released the footage to the media would be enough to remove copyright. Just a guess.

That doesn't follow. The police wasn't the author of the work (ie. the footage), so the copyright belongs to whoever created it. The police also can't unilaterally seize the copyright of a random work to help a manhunt, so I'm not sure how the act of them distributing the work puts it in the public domain.

Copyright can belong to the author but still be redistributed on the evening news, fair use makes an explicit carve out for news reporting - whether surveillance footage is 'authored' in the first place is my question, I would argue it lacks originality.

>Copyright can belong to the author but still be redistributed on the evening news, fair use makes an explicit carve out for news reporting

The parent commenter was actually arguing for stronger than that, ie. "remove copyright". That implies the work loses all copyright protections, not just granting news organizations permission to redistribute.

>The police also can't unilaterally seize the copyright of a random work to help a manhunt

if the suspect is armed and dangerous and public safety is at stake, or they want to use the footage in court, yes they can use the footage without worrying about copyright (which is not seizing the copyright)

Seems consistent with what I would expect. Trying to memory hole all of this bad PR is very much how they normally operate. For example United has tried really hard to bury all mention of the incredibly damaging breach of change healthcare, which is a subsidiary. Over 100 million Americans had their private medical details leaked. All united has done is offer some basic credit monitoring. They won’t even tell you what data specifically got leaked and refuse to cooperate with such requests.

Yeah that ChangeMD ransomware kinda broke healthcare in the US for a week or so.

A lot longer than that. Many pharmacies and affected healthcare providers were not able to get back to a functioning state for several weeks. The result of canceled and delayed procedures created impact that still continues. Some businesses literally ran out of cash. And of course, everyone has suffered severe damage and harm from the data that was exposed.

There's no way there aren't at least a dozen of deaths attributable to that, but of course zero consequences for anyone responsible. Luigi proven right once again.

> zero consequences for anyone responsible

Who is responsible?

With Mangione, there is one person singularly and unambiguously responsible. That makes meting out punishment easy. With a hack, the hackers are obviously responsible. But we haven’t found them. After that, IT at UHC? Who? Are they civilly liable, or criminally?

I think you'd enjoy talking on this topic with a professional ethicist - they exist (although surely an endagered species), we had one at our last company, brilliant guy to talk to - or listen to a modern seminar on philosophy. Not being snarky.

If one is ambiguous, so is the other, of course. And you probably know this as well, having applied this logic many times in your daily life.

Let's suppose that Luigi gets the death penalty. Is the person who administers it solely responsible for this "murder"?

How about if a parent abuses a child in all possible ways since birth. Josef Fritzl is a good example, let's take him, you can look him up if you're not familiar though it's a harrowing read. Suppose his daughter murdered him afterwards. Is she "solely and unambiguously responsible" much more so than, say, the hackers, or IT at UHC?

This isn't clear cut whatsoever.

> Are they civilly liable, or criminally?

Now you're talking law, which is a whole different discussion, and I never brought up. You're probably aware that the whole premise of the support behind Luigi is that US law as it is currently applied has enormous issues, so arguing what is and isn't law is not a productive avenue in the first place. I also find it not very interesting, but I'm sure e.g. certain lawyers would.

> If one is ambiguous, so is the other, of course

Not really. Criminal and moral respopnsibility aren't the same, and we don't necessarily want them to be the same--that's why we hold the former to a high standard (e.g. innocent until proven guilty).

> Is she "solely and unambiguously responsible" much more so than, say, the hackers, or IT at UHC

Yes, she is solely and unambiguously responsible for the crime and so should be punished. There is ambiguous and shared responsibility for the offence, but that doesn't mean everyone who slighted her should be punished--that's why these are usefully distinct questions.

> Now you're talking law, which is a whole different discussion, and I never brought up

You brought up "zero consequences for anyone responsible." Brian Thompson is dead, so that's N = 1 consequences. But you said zero. Which means you're presumably talking about lawful consequences.

> You brought up "zero consequences for anyone responsible." Brian Thompson is dead, so that's N = 1 consequences. But you said zero. Which means you're presumably talking about lawful consequences.

I did not bring that up, I brought up more, including

> Luigi proven right once again

Which means "Without doing what he did, there would have been zero consequences".

I also just brought this up, which is context you'll definitely be aware of, meaning it's even less likely anyone would be talking about law in this context:

> You're probably aware that the whole premise of the support behind Luigi is that US law as it is currently applied has enormous issues, so arguing what is and isn't law is not a productive avenue in the first place.

I don't think that in good faith, given the context and the entirety of my comment, you could reasonably come to the conclusion I was talking about law.

FYI, this is a really handy website for identifying these breaches. https://ocrportal.hhs.gov/ocr/breach/breach_report.jsf

Insurers are required by law to submit breach information to this site. It doesn't have all the information you want, but it's at least a system of record.

Copyright has always been a cover story for legitimizing censorship, ever since it was about preventing people from printing the wrong kind of bible. Of course they're using it that way.

> Copyright has always been a cover story for legitimizing censorship, ever since it was about preventing people from printing the wrong kind of bible

Source?

https://wikipedia.org/wiki/Censorship_of_the_Bible

Plenty of info here starting from the section From the Printing Press until the Revelation.

https://en.m.wikipedia.org/wiki/History_of_copyright

> The origin of copyright law in most European countries lies in efforts by the church and governments to regulate and control the output of printers.

I'll confess to assuming that that's why they wanted to regulate the output of printers. But what non-cenaorship reason could they possibly have had for wanting to do so?

When someone tells you something, they're they source.

Its already memefied as Nintendo Luigi, so taking it down is futile. People will just wear Luigi TM shirts and there is nothing all the PR might of cooperate wealth can do. Reality be a hard wall and reality is the masses loath their overlords.

Streisand effect comes to mind. Also it seems too late to try to stop it now.

Original source was from 404 media: https://www.404media.co/copyright-abuse-is-getting-luigi-man...

A lot of providers don't even require it to be a statutory DMCA complaint. Just a simple "I own the copyright, please remove it." These are private sites and can remove material on a whim with no legal recourse.

That's why it sucks to have to rely on hosting your content on other people's territory.

Maybe they should hurry up and approve more claims. Seriously, my son’s insulin pump is sitting in “prior authorization” just so they can fuck me into paying the full deductible come Jan 1. Fuck United Healthcare.

Dude, that’s horrible. I’m sorry you have to deal with that.

It ought to be the law that approved claims should be backdated to when the initial claim was made. UHC pulled this exact trick on me, denying something that ought to have been approved in order to push the date into the new plan year with a reset deductible.

It ought to be the law that every in-network claim must be automatically approved. In network providers have already jumped through hoops to have that contract with the "insurance" company, including the creation of documentation to satisfy the "insurance" company of their judgement. It's disingenuous for an "insurance" company to then claim to be second guessing the very professionals' judgement they've already examined and approved of.

Ro Khanna said something similar a week or so ago. You all get that this would basically be the biggest corporate giveaway in the history of American politics, right? The reason you're getting health care denials is that providers are trying to rip your face off. I'm pleading with people on this site to go look at where the dollars in health care spending actually go. CMS, the government organization that manages Medicare (and somehow got vilified a few weeks ago when Blue Cross tried to adopt Medicare's anesthesia billing rules), tracks this stuff in a set of documents called the National Health Expenditures. They're spreadsheets, they're easy to go read, please, for the love of all that is holy, go look at them before designing policy.

I can see where the money goes. That doesn’t absolve the insurance industry of being a festering sore worthy of every bit of scorn sent their direction.

  and somehow got vilified a few weeks ago when Blue Cross tried to adopt
  Medicare's anesthesia billing rules

LOL

That is absolutely fucking NOT why Blue Cross Blue Shield got vilified. Please stop making disingenuous arguments.

BCBS attempted to weaponize Medicare statistics and set a hard cap on anesthesia coverage based on the average time Medicare says a procedure takes. This is NOT how Medicare reimbursement works. Medicare pays anesthesia providers for the entire time a patient is under. Full stop.

No, from everything I understand about the situation, this is the opposite of the truth. Feel free to cite a source saying otherwise! I'll read it!

Yeah, go read the rules set forth by CMS. Medicare pays for the entire cost of anesthesia.

So here's why I'm so dismissive of your garbage argument. From Medicare's policy manual:

https://www.cms.gov/files/document/chapter2cptcodes00000-019...

  A unique characteristic of anesthesia coding is the reporting of time units.
  Payment for anesthesia services increases with time. In addition to reporting
  a base unit value for an anesthesia service, the anesthesia practitioner reports
  anesthesia time. Anesthesia time is defined as the period during which an
  anesthesia practitioner is present with the patient. It starts when the anesthesia
  practitioner begins to prepare the patient for anesthesia services in the operating
  room or an equivalent area and ends when the anesthesia practitioner is no longer
  furnishing anesthesia services to the patient (i.e., when the patient may be placed
  safely under postoperative care).

Compare this to BCBS's policy (which they've tried to scrub from the internet):

https://www.asahq.org/about-asa/newsroom/news-releases/2024/...

  Anthem will arbitrarily pre-determine the time allowed for anesthesia care during a surgery or procedure.
  If an anesthesiologist submits a bill where the actual time of care is longer than Anthem's limit, Anthem
  will deny payment for the anesthesiologist’s care. With this new policy, Anthem will not pay
  anesthesiologists for delivering safe and effective anesthesia care to patients who may need extra attention
  because their surgery is difficult, unusual or because a complication arises.

There's a vast gulf between those two approaches. Medicare pays for the time a procedure takes, BCBS does not. BCBS deserves every ounce of vitriol they got over that.

Your entire argument appears to be that doctors are corrupt and cannot be trusted which is entirely orthogonal to the the issue with pre-determining the amount of time a procedure will take. Meanwhile BCBS overcharged (a.k.a. fraudulently charged) the federal government for over $100 million. Doctors are not the problem with health care in the United States.

https://www.reuters.com/legal/anthem-must-face-us-government...

UHC? $7.5 billion (with a b) in fraudulent Medicare charges.

https://www.startribune.com/report-unitedhealth-group-tops-l...

Cigna? They settled their fraud cases for $200+ million.

https://www.justice.gov/opa/pr/cigna-group-pay-172-million-r...

https://www.justice.gov/usao-sdny/pr/united-states-reaches-3...

Independent Health Association? $100 million.

https://kffhealthnews.org/news/article/medicare-advantage-fr...

Private insurance is one of the biggest drivers of the obscene cost of health care in this country.

No, they do not. This was a whole controversy last year.

https://www.asahq.org/about-asa/newsroom/news-releases/2023/...

Lots of stuff to go find at this search:

[medicare anesthesia upcoding]

Reiterating: this is exactly why Blue Cross was vilified, and people angry about it were getting played by a lobbying group of some of the best-compensated professionals in America. Anesthesiologists getting paid more is not a consumer protection policy; it is the opposite of that, and it's wild that people think it might be otherwise.

Did you read what you posted? Because all you've cited is a bunch of complaints about the conversion factor and not the time factor. Medicare pays for the entire duration of the procedure. BCBS does not want to do that.

Again. Go through the CMS regs and show me where Medicare puts a hard cap on payment like BCBS was trying to do. I know that's a tall ask because, simply put, they do not.

Here's r/actuary on it:

https://www.reddit.com/r/actuary/comments/1h70wic/does_anyon...

I don't believe you're coming to this with a detailed understanding of the policy CMS has today or that Anthem was proposing. Sorry, at this point, unless you can cite a comparably specific source, I simply don't believe you, and we're probably at an impasse.

And you're coming at this from a profit doesn't drive up the cost of medical care which is in and of itself a pretty gross misunderstanding of what profit is. Again, did you read what you cited? That redditor is justifying the cap that BCBS wants to implement, not disproving that Medicare does not implement a time cap.

I'm not here to do your research for you. CMS regs and guidelines are a matter of public record. If you don't want to actually cite the comparable regs you claim exist that's not my problem.

  fleeing to abstraction.

You're citing an insurance actuary who posted to reddit claiming no, it's not the for-profit insurance companies that are the problem, it's the corrupt doctors. That's absolutely fucking asinine. What next? A fox claiming it's the chickens that are the problem?

Unlike private insurance companies, the rules and regs that Medicare puts forth are a matter of public record and you're still unable to cite anything supporting your claim that Medicare puts a hard time limit on anesthesia reimbursement. So go ahead, stop waving your hands and start citing something. You do understand what time units are, right?

www.cms.gov

What's that? You're going to continue tilting at windmills and railing against the evils of overpaid doctors instead of showing anything that supports your specious claims about Medicare? Okay then.

You haven't presented any research at all, so it's not clear to me how that could a valid rebuttal to anything I've said. You're talking about how "profit" distorts this system --- I agree, for what it's worth --- and it looks to me like you're just fleeing to abstraction.

It is a giant pain in the ass to pull up Anthem's original proposed policy, since it's been memory-holed everywhere, but if I manage to do it, I'll post it.

You're on HN right now campaigning against reference pricing! Like I said: this whole situation is wild. You've taken the side of people making like 20x more money than the insurers. Why?

Like: the whole system of Medicare reimbursement for anesthesia is based on a catalog of procedure-by-procedure base units. Medicare sets reference prices for procedures. You can just go look it up. I've got the XLS open right now. I don't understand what you're trying to argue here.

You get that, at the end of the day, this is about how much money anethesiologists take home, right? People on Twitter were talking about anesthesiology being withdrawn in the middle of procedures. Obviously, that's not a thing.

Of all the players in this system, the insurers are the only ones who have their profits capped by statute, across the board. If anesthesiologists make more money from a procedure, that comes out of your hide: it's reflected in your premiums and co-pays. Please, help me understand, why are you making a moral crusade out of paying your doctors more money? They don't need the money! America pays doctors 3-5x more --- THREE TO FIVE TIMES --- than Europe does.

Following this thread all I see is you aggressively asserting a certain viewpoint, with no substantiation. I have no stake in the game but if you're going to come out swinging with aggressive naysaying but zero substantiation, all I'm thinking is: "citation needed".

> Go through the CMS regs and show me where Medicare puts a hard cap on payment like BCBS was trying to do

Where does it say CMS blanket approves? Because I’ll tell you this: if it does, I’m buying up some anaesthesiology practices. (They’re subcontracted within most hospital systems.)

After Anthem backed down I'd invest no matter what you find. Clearly: they run the health care system, and the public (including Kathy Hochul) is on their side!

  Where does it say CMS blanket approves?

It doesn't, and I've never made that assertion. However, Medicare and Medicaid both deny claims at a lower rate than private insurers. How frequently depends on where and when you look.

The guidelines however are important. BCBS wants to reject any claims for anesthesia out of hand if they exceed the average length of a procedure. Medicare does not. Because we all know that unexpected things never happen in the operating room.

(this comment was extensively edited since I responded to it)

You haven't rebutted anything I said, and the source you quoted about Anthem's proposed policy is the summary from the lobbying group for anesthesiologists. As I pointed out downthread: CMS maintains a catalog mapping procedures to units of anesthesiology billing.

later

And again, edited, everything after "your entire argument".

Private insurance literally can't be the primary driver behind health care costs in the country. Again: look at the NHE. The numbers are right there.

  Private insurance literally can't be the primary driver behind health
  care costs in the country.

They literally can and literally do. They drain billions of dollars annually in fraudulent claims with UH accounting for $7+ billion in Medicare fraud in 2023 alone. UnitedHealthCare (the insurance arm) sucks in $4 billion (with a 'b') in earnings each quarter.

Doctors are not the problem.

https://www.unitedhealthgroup.com/content/dam/UHG/PDF/invest...

Provider costs are over 2 trillion dollars.

I've read similar comments of yours in other threads, and have thought them on point. I certainly don't see "insurance" companies as the single source of bad of the whole system. Personally, I just got done dealing with an 11 month billing headache spearheaded by entitled "providers" double billing, and shamelessly telling me that they don't have the resources to follow up on claims I told them needed to be followed up on, while still continuing to send me fraudulent bills with fake amounts and fake due dates. Meanwhile, despite their "bucket of stomach fluid" bureaucracy, the "insurance" company straightforwardly communicated what I should (not) be responsible for (at least until the rep I was emailing back and forth ghosted me because he got memory-holed). Heck I'm not even really a proponent of single payer versus reforming the industry so it has to abide by the common sense norms of commerce like every other industry. So the "you all" grouping falls a little flat here.

But read what I wrote again - the point is that every "in network" provider of an HMO is already accountable to the HMO while providing care to their members. If an HMO wants to limit certain types of care, then that needs to be expressed to providers (through their contracts), who can immediately tell patients "As a doctor I would recommend you get this type of treatment, but while working for $HMO I cannot provide it as your plan doesn't cover it". My initial comment was phrased in terms of insurance companies, but this double approval blame game is actually more a problem with the entitlement of doctors never wanting to deal with the reality of what services cost.

I know you're getting at a specific point. And I'm aware that health insurers are not the only moneymaking component in the health care pipeline.

I don't think eliminating profit is doable. Capitalism is the worst system other than all the rest. But surely we can agree that health insurers that are publicly traded do not prioritize human outcomes.

The profit motive needs to be tempered, if not entirely removed, from health insurance. Profit motive should be tempered in the basic healthcare space. Excessive testing and treatment are a thing too, I understand.

What I guess I'm saying is, I know it's complicated, but no amount of nuance absolves UHC and others for the kinds of denial stories that people have been telling.

(I don't work Monday... I may be rambling).

They're not just "not the only" moneymaking component; they're an order of magnitude and another integer factor away from being one of the most significant. The problem in American health care is (1) how much providers charge and (2) how many procedures and services are prescribed.

> Capitalism is the worst system other than all the rest.

This isn't anything to do with capitalism. It's all to do with Republicans bizarre obsession with 'small government'.

These kind of healthcare horrors don't happen in most western countries, because they have reasonable regulations and socialized healthcare in place.

Well, that, and they pay their doctors 3-5x less.

One reason you may need to continually plead with people about this is because so many of us have had lived experiences with valid medical claims that should be covered under our policy, denied outright. Not a health insurance company saying “oh, that’s too expensive, go here for less,” but outright denial of coverage. And if we eventually succeed in having these claims covered, it is because we were willing to spend countless hours combing through paperwork, initial delays, and denials.

Also, the same CMS statistics you cite can be combined with other reports to conclude that 500 billion dollars of excess administrative costs PER YEAR are attributable to our lack of a single payer system — something UHC has lobbied heavily against in order to protect their profits over the improved health care of the average American. You can read the numbers here:

https://www.peoplespolicyproject.org/2024/12/10/health-care-...

“private insurers currently have administrative costs that are 1,000 percent what they would be under single-payer while hospitals currently have administrative costs that are 158 percent what they would be under single-payer. The excess administrative expenses of both the payers and the providers are because of the multi-payer private health insurance system that we have.

When you add it all up, excess administrative expenses — defined as administrative expenses we have under the current system that we would not have under single-payer — are equal to 1.8 percent of GDP, or $528 billion per year.”

Another reason your pleading falls on deaf ears is that, sure, provider payments can be reduced (and this addressed in the above article), but at the end of the day, private insurance is a purely rent-seeking enterprise that provides no value to Americans while these “overpaid providers” are actually delivering the care.

2.21 trillion dollars per year of provider costs, against 279 billion dollars net cost of health insurance.

But yeah, the one player in this market that has its profits capped statutorily, they're they're the whole problem, no matter what the numbers say. Sure.

I'm not telling you there's no problem. I'm saying that you've been conned into believing the problem is something it isn't.

The article I posted did not claim they were the whole problem, nor did I.

They are, however, a large part of the system that no one likes to deal with and can be fully eliminated without obvious negative consequences.

Health insurance doesn’t provide health care and is a purely extractive rent-seeking business. The article I posted even explains how single payer can help drive health care provider rates lower, as you now have a single, powerful entity (Medicare) negotiating against doctors, hospitals and drug companies.

And this “one player” (health insurance companies) heavily lobby against the implementation of single payer health care system. And their profit caps ensure that their goal is to grow the cost of medical care so they can take an ever higher profit in absolute dollars.

Yes. They're a part of the problem. Specifically: they are less than 10% of the problem. If you replaced them with Medicare, you would get somewhere between 1-5% off your health care bills, if everything went optimally.

Meanwhile: we are commenting on a story about someone murdering a health insurance executive.

> Meanwhile: we are commenting on a story about someone murdering a health insurance executive.

Is this surprising? Motive is always of interest after a high profile crime. And apparently it requires assassination with manifesto to bring these robber barons into the spotlight. The only thing I find surprising is the use of a 3D printed gun instead of just buying one from a show or local gun store.

The article I posted makes a case that eliminating private health insurance will be VASTLY more than 5% savings and people can read the article to see why.

You’re choosing to avoid all of the other cost savings that will come from eliminating private health insurance and having a single payer who can effectively negotiate with providers without the goal of taking a slice of profits from an ever bigger pie.

You're citing Matt Breunig's figures about how much more efficient Medicare would be than private insurance. But the truth is, mechanically, the opposite. Medicare's efficiency is a statistical illusion. Administrative overhead is a simple ratio of fees paid to services rendered. The more services you render, the better your admin costs look. And Medicare's look good indeed, because virtually everyone in America over the age of 65 is covered by Medicare --- that's the point of the system, to do single payer at the point where costs suddenly ramp up. If you let people enroll in Medicare at age 25, they would incur lower service costs, while paying the same in fees. If you do the math, Medicare for a 25 year old looks a lot like private insurance for a 25 year old.

Meanwhile: all insurance costs, in the whole economy, across all of national health expenses, total less than 10% of costs overall. Providers drive all the costs in our system, not insurers. But Breunig is fixated on his preferred solution, so he's not telling you that. But the numbers are right there if you want to see them; just search [National Health Expenditures by Type of Expenditure and Program: Calendar Year 2022].

I honestly don't care if you want Medicare vs. private insurance. I don't love my insurer. But if you zero out the total cost of insurance, public and private, you barely make a dent in our health costs. There is no way around it; the numbers are stark.

Personally, I think the balance we've struck in our payment system --- private markets until age 65, at which point the state steps in --- is pretty smart. Our system is fucked, of course, but that's because health provider chains have been ripping people off for decades.

> Providers drive all the costs in our system, not insurers.

I like your proposed solution that the state somehow engineer a way to drive down the costs billed by providers. Perhaps if the state operated a (pseudo-)monopsony wherein they exercise their leverage as the payer to drive down costs.

It could have a snappy name like if you combined medical and care? Or maybe medical and aid?

Anyway I also cannot fathom why anyone would hold ill will towards an industry that lobbies to stop that from happening. They are simply smol beans and the fact that there is no single payer monopsony means they are splitting a measly fraction of a trillion dollars per year. The fact that somebody else makes money too is proof that they couldn’t be a problem uwu

You are fighting a losing argument created by health insurance companies because they've created years of self-inflicted wounds. Everyone believes health insurers are the problems because almost everyone has dealt with the nightmare of valid claims being denied.

Health provider chains rip people off because that's how they maximize earnings from insurance companies. Insurance companies maximize denials because that's how they maximize profit. You remove one side from the equation and the problem of provider costs becomes easier to solve.

And as an aside, I dealt with my mother being denied healthcare from her insurance provider because they determined her stroke was a pre-existing condition.

There is simply no logical argument you can ever make that will change my opinion.

It is, obviously, exactly the other way around: the system is rigged to maximize earnings for health provider chains. I honestly don't see how you can look at the numbers and come to the other conclusion.

'Won't someone think of the poor rent seekers' is not nor will it ever be a compelling argument. The only way this problem can be solved is in the same way every other country solves it: Either tearing out private insurance and fully socializing healthcare or strongly limiting private insurance and having a public option which negotiates and keeps prices low.

You can argue that health providers charge too much and that's true. But the core of the rot comes from the health insurance scheme we've cooked up. And people rightfully blame the insurers for this problem.

Maybe if they dislike it so much they can put a fraction of the billions they're earning towards bribing politicians for a public option rather than constantly spiking things like that whenever they get a chance.

Health insurers make an order of magnitude less than providers, and our providers charge 3-5x more than European providers, but somehow insurance is "the core of the rot"?

Correct. See: my experience with pre-existing condition denial.

OP said the "health insurance scheme we've cooked up" is the core of the rot - not insurers' on their own, but rather the whole regulatory environment ("we") that enshrines the dynamics of HMOs, imaginary prices, and whatnot.

I agree with a lot of what you are saying. Trying to demonstrate some common ground - my (somewhat shallow) reading of the Anthem Anesthesia issue aligns much more with your analysis than the pop narrative.

But how exactly is the denial of care suppose to function as a price feedback mechanism to form a working market between providers and insurers? Is an MRI provider supposed to be thinking that if they lower their prices by 10%, the insurance companies will increase the number of approved MRIs to make up for it? And this still ignores that prices are not the same as profit margins, which is a huge hand wave here. Also if those denied MRIs were truly unnecessary, then how would paying for them merely because they cost a little less make sense?

Which is the crux of where my original comment was coming from. The responsibility of deciding necessary medical care needs to be laid at one decision maker (eg the treating doctor serving the patient per their code of professional ethics while fundamentally still working for the insurance company), rather than this split-brain blame game between the patient-facing doctor having little downside to saying yes, and the back office "doctor" at an insurance company having little downside to saying no. An insurance company shouldn't really even have its own opinion on something decided by a medical professional they're already contracting with, especially when that opinion has been created purely based on formulaic paperwork processing. At most they should be able to refer the patient to a different provider to perform the service, or withhold some payment for the service per their contract with the provider (but invisible to the patient).

This is obviously not the only reform we need to get any sort of price signals and sane division of responsibility in this industry. Because yes, provider costs are the main problem and they've been marching ever upwards. But every one of these terrible dynamics that has been allowed to fester is in need of its own reform, especially if you aren't advocating for the blanket approach of single payer.

That is how Kaiser works- the doctors have internal guidelines, e.g. a set criteria for a diagnosis, and every treatment that is ordered is automatically approved. This isn't a perfect solution either though- the guidelines are often unreasonably strict, and still deny people treatments they very much need.

The difference being that in the Kaiser system, the doctors work for Kaiser, and not for health provider chains.

> ought to be the law that every in-network claim must be automatically approved

This almost certainly requires vertical integration between providers and insurers. That or shifting approval/denial to the provider level, i.e. your doctor can fall off the approval list from month to month for submitting too many claims.

If not, providers will become the most profitable business on the planet right until every health insurer goes bankrupt. (We’ll probably get to blame it on PE-run hospitals, even if everyone is doing it.)

Providers are liable for malpractice if they approve un-needed treatments, and all drugs have side effects.

And they meanwhile have their own liability insurance to pay, as well as medical student debt. So not going to be profitable either. Unless they start prescribing Carnival Cruise therapy or stiff like that.

> Providers are liable for malpractice if they approve un-needed treatments

There is a lot of grey area between necessary to the point of malpractice if not provided and unnecessary to the point of malpractice.

Like, you’re not going to win a malpractice case because your doctor prescribed too many non-invasive tests and MRIs. And if my insurer is forced to approve every MRI, I'm probably going to ask my doctor for an MRI.

It is simply naive to think that the threat of malpractice discipline by state medical boards would deter bad actors from delivering wasteful or unnecessary care. The fee-for-service financial system heavily incentivizes over treatment. If you don't believe me then read "The Price We Pay" by Dr. Marty Makary. It documents many such incidents for which the providers were never punished.

https://www.bloomsbury.com/us/price-we-pay-9781635575910/

I mean, it was fine for 50 years.

I don't see why it would have to be every month, instead of say a statutory minimum of at least six months notice with such changes only taking effect after an open enrollment period. The doctors and insurers can sort out how to handle the resulting dynamics in their professionally-negotiated contracts, instead of just falling back to blasting individual patients with fraudulent bills.

And yes, if we're going to continue to limp along with these "insurance" companies being the supposed market dynamic, the healthcare industry desperately needs more integration so responsibility can actually be taken and absorbed, rather than just continually punted. The whole industry has fallen into a state where each player passes the blame to someone else, including you as they tell you its now your new unpaid job to make many hours worth of phone calls as you get ground up passing messages between mutually-hostile bureaucracies.

As both the payer and provider sides of the industry have consolidated to gain more negotiating power this sort of "payvider" vertical integration is inevitable. Kaiser Permanente has operated like that for many years and they only rarely authorize referrals to outside providers. UnitedHealth Group is moving in a similar direction by expanding provider groups under their Optum subsidiary.

https://www.optum.com/en/care.html

The other approach is to to shift from the current fee-for-service financial model to a capitated value-based care model. Under that model, claims basically disappear and payers hand over a set fee per member per month to a health system which then becomes responsible for doing whatever is necessary to keep that patient healthy. Early trial VBC pilot programs have been encouraging but it's tricky for providers to get the actuarial calculations right.

For providers with a history of high quality PA requests and high approval rates, there is something similar. See https://www.uhc.com/news-articles/newsroom/gold-card

Other insurers have similar programs.

Sounds like another layer of "gotchas" to pin more work and blame on patients, while still not providing any guarantee. "Your healthcare was denied because while you may have checked the provider was 'in network', you did not also check to see if they have earned a gold star. I can email you a list of our highest quality providers that have earned gold stars"... Then most aren't taking new patients, and the one or two that do are booking out the better part of a year for a new patient visit.

I'll go out on a limb and say that the proliferation of these punt-the-problem administrative layers (in lieu of straightforwardly owning and solving problems) is one of the main things driving the medical industry's cost disease. A few years from now this "gold card" program will likely be administered by a newly spun out "third party" vendor that doesn't publish updated lists very well, but if you feel you were treated unfairly you can always file an appeal with them...

In terms of annual deductible, claims are always dated to the date of service regardless of when they were submitted or adjudicated. I think what you're asking for is that if a prior authorization request is submitted in one plan year then all claims linked to that request should be counted towards the deductible in that plan year regardless of the date of service. That might help some plan members but would hurt others depending on timing.

Health plans covered by the CMS-0057-F final rule are generally required to issue decisions on prior auth requests within 7 days. But that rule doesn't apply to most private commercial health plans.

https://www.cms.gov/newsroom/fact-sheets/cms-interoperabilit...

It's very hard to have any compassion for architects of this company's system.

Congress claims this is what we the people want.

I believe that some people really needs that. Ironically the ones which need it most.

*really believe not need

Congress has a 17% approval rating.

But they’re still employed, still getting paid, and still getting bribed.

Sure, but I don't think they are meaningfully speaking for "the people" in any sense (even assuming that we even have such a singular entity in US, which I personally don't think is true anymore).

How is this legal?

Lawmakers need campaign money and shakedowns are profitable.

It's not in many jurisdictions. The AMA tracks laws on prior authorization, and in an increasing number of states insurers must make a decision within 5 calendar days. (https://www.ama-assn.org/system/files/prior-authorization-st...)

Many of the shenanigans pulled by health insurers aren't legal, but they know a significant number of people will just pay or file bankruptcy instead of appealing or lawyering up.

How would OP know that is the reason?

Think of all the times you've seen a news headline that reads "Company X settles with [regulatory body], does not admit guilt". Corporate malfeasance rarely reaches the courtroom, so their wrongdoing is not entered into public record in a way that can be cross-examined.

I, as a male, have a 4.5k medical bill from a breast cancer biopsy center. I had surgery on December 8th. They billed me for the biopsy on January 3rd, and of course UHC isn’t covering it.

Turns out joke is on them, I’m not paying it.

Males can/do get breast cancer, unless I am missing your point?

Ask me how I know!

"It is illegal to file DMCA notices if you don’t own the copyright (or at least have a good faith belief that you do). The idea that UHC now owns every depiction of the guy accused of killing their employee is laughably frivolous and one hopes that its legal department understands this and these requests are coming from a third party troll impersonating the carrier."

Wasn't UHC the company that decided to deny claims with an AI that was wrong 90% of the time? I assume they did do this. False DMCA claims are nothing to them.

Yet another egregious abuse of a law that has zero real consequences for a false report. I wonder why this happens so often?

Insurance company employees have among the lowest productivity to pay ratios of nearly any industry. They harbor a workforce that is low skill, low effort, and high profit, largely via nepotistic hiring.

Insurance companies have low profit margins, 2% to 3% in most cases.

UNH is worth more than 5x its nearest insurance competitor (Elevance) because of its large healthcare provider arm, not because of its insurance business.

Otherwise, they are all sub $100B businesses, which indicate not a lot of juice to squeeze.

I agree they’re not especially big in terms of profit. However, that doesn’t mean they are not evil. These companies increase profit margin by denying coverage. They try really hard to pretend like they are providing a particular service level and will happily collect your money with that expectation. And then, at a later point, they deny coverage, often in a fraudulent way, in order to create their higher margin. To me the low profit margin is therefore not really relevant. If they provided the product that everyone expects that they are paying for, their margin would be lower and that is exactly what should happen.

How much lower can profit margin get than 2% before a business stops being a business and becomes a charity?

Why would it even have shareholders at that point?

Surely, even someone who hasn’t operated a business can see why revenue should exceed expenses by a couple percent to survive volatility, much less make it worth investing in.

Maybe it should be near 0% for this business because that is the end result of competition and a functioning market. Or maybe they should just become better at operating more efficiently. But what they shouldn’t do is artificially create profit margin by stealing from their customers and handing them death sentences instead of providing the care that is paid for. When you deceive and defraud customers and literally cause them harm when they’ve paid you to avoid harm, that does seem evil. That’s what I’m pointing out.

The business model contains dark patterns incentivizing patient deaths in many cases. It’s not that they’re turning a profit, it’s that they’re profiting off of death. If it was a break-even org (I.e. non-profit), people would likely have less of an issue with it.

The regulations on profit margins incentivized maneuvering to higher prices to increase absolute profit

7+ different publicly listed companies and myriad mutual/non profit companies as well as self insured businesses all colluding to pay more so they can collect higher premiums?

And simultaneously, health insurers denying coverage left, right, and center to pay less so they can profit more? (See adjacent comment by blackeyeblitzar)

Make it make sense.

There’s definitely precedent for public companies (even international ones!) colluding to artificially increase prices in a sector. Also a hilarious movie with Matt Damon.

https://en.m.wikipedia.org/wiki/Lysine_price-fixing_conspira...

https://en.m.wikipedia.org/wiki/The_Informant!

Has there ever been precedent for companies to collude to increase the prices they pay their vendors?

I’m seeing a lot of big claims, but no evidence.

My guess, stated without evidence:

1. Profits are capped as a percent of health care expenditures.

2. Employers (and people in the Marketplace) purchase insurance mostly based on price, which incentivizes lower prices.

3. (I'm guessing) Medicare advantage pays a flat annual rate to insurers.

4. Insurer denies large claims on Medicare Advantage accounts, turning annual rate directly to profits.

5. Insurer's denial of claims for other classes of policy lowers the price of the policy, increasing competitiveness.

6. Providers fight with insurance policy and fall back to billing patients, who can only pay pennies on the dollar.

7. The providers raise future rates to compensate for the costs and losses incurred by denials.

7. Increasing prices for all customers yields the desired absolute profits, without penalizing the company doing the denials.

> regulations on profit margins incentivized maneuvering to higher prices to increase absolute profit

Source?

(On one hand, it makes sense. You see the same effect in fixed-price contracting with mandated margins. On the other hand, higher prices seems to describe the providers. Not insurers. If insurers wanted to boost the cost line, they'd approve every claim.)

I saw it in a vision.

How do I get a low skill high pay job? That sounds awesome.

> How do I get a low skill high pay job

Why are you assuming high pay? Claims adjusters make like $50k per year for semi-skilled work.

Where I live that's a pretty good salary.

Source?

Not denying what you're saying, just curious about the data.

Just personal experience and that of people close to me. Sorry, I have nothing concrete to offer here.

>Wasn't UHC the company that decided to deny claims with an AI that was wrong 90% of the time?

Source?

  Source?

Google it. UHC's use of AI was very much in the news and in fact an article about it was posted to HN back in November.

So far as I can tell the "90%" figure was from the complaint in a class action lawsuit filed in 2023, and there's no indication how the plaintiffs arrived at that figure.

https://cdn.arstechnica.net/wp-content/uploads/2023/11/class...

I wouldn’t be surprised if their legal theory is that they will win the rights to Mangione’s likeness in a future civil suit. If a judge is willing to claim to believe that, then I could see an injunction being issued.

Does that sound ridiculous? Sure, but we’ve seen some absolutely crazy stretching of the law these past few years.

Can a corporation CLAIM civil damages over their CEOs murder ? I'd think that would be his "estate" perhaps ? (Far from being a lawyer)

> Can a corporation CLAIM civil damages over their CEOs murder

Maybe not murder. But if Mangione is inspiring death threats against others, maybe.

IIRC a landmark trial in early post-WW2 years resulted in it being impossible for third party to own complete rights for someone's natural likeness or other natural features (like voice, which was specific case involved).

So they can't win the right to prevent distribution, they can win the right to use the likeliness, but for distribution they would need to have active contract with Mangione that they are representing him for that, which I somehow doubt being the case.

"I'm going to own it in the future" gives you exactly zero rights over something today.

But IANAL, so what do I know.

But it may convince the court to side with you on a seize and desist sort of a motion.

IANAL either though

Perhaps they legitimately bought the rights from the original producers? Doesn't seem impossible, although would certainly be a strange strategy to say the least.

> idea that UHC now owns every depiction of the guy accused of killing their employee

Hmm, no evidence this is happening, but could Thompson's family claim ownership of his likeness?

I guess they’re claiming it was an inside job?

So did Mangione, etc. pierce the corporate veil, or does limited liability apply like it usually does when United Healthcare kills someone?

I don't think he did it. The guy on the camera in NYC didn't have a unibrow and Luigi clearly does. I think they have a scapegoat that they are trying to pin it on.

> guy on the camera in NYC didn't have a unibrow and Luigi clearly does

Wat. Mangione has a light unibrow. That will obviously show up more clearly head on (as it does in the taxi photo) than from above looking at the tippy tops of the hair.

Not saying that's impossible. Certainly a ghost gun has an advantage to corrupt government agents just as it does to criminals.

But it's going to be difficult to make it stick against a patsy.

What will be very suspicious is if he dies in custody before trial. Otherwise, at trial, I expect:

* He has no alibi

* The ballistic evidence matches the gun.

* He has possession of additional ammunition from the same lot.

* He was in fact a client of UHC with a substantial claim denial history

* His computers/phone show that he was cyber-stalking

If they have all that, I don't think a reasonable person could believe that the FBI crime lab and Google can be coerced in a grand conspiracy into fabricating evidence.

If it turns out that the gun is a "2nd ghost gun", and the prosecution claims that he ditched the 1st gun and the ammo, and his alibi is "weak", and he cleared his digital history, that would be a much weaker more suspicious case.

> he was in fact a client of UHC with a substantial claim denial history

It doesn't appear he was [1].

[1] https://apnews.com/article/luigi-mangione-united-healthcare-...

This is really peak capitalism and peak class warfare

The previous peak in class warfare involved guillotines. I don't think we've surpassed that one just yet.

Not yet, but when CEOs are getting shot and people cheer the shooter, I think it's not that far off.

Hey look on the bright side. If this is legit, then it will inevitably become a reference in the bill to overhaul the DMCA when it (finally) gets introduced!

The beginning of the end, the moment when thr DMCA jumped the shark (for the broader world, not us tech geeks)

Scrub the internet ? Good luck with that. Streisand joined the chat.

Bill Burr is right. https://youtu.be/OILUHHtZt4c?si=TS159SY_VVAHrGnN

Yeah f that

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