That “distressed baby" Tim Armstrong blamed for benefit cuts? She’s my daughter
slate.com
slate.com
The whole point of insurance is that a middle-class family can afford to pay $12,000 or $18,000 in premiums per year, but they can't easily afford a $1M black swan medical event. So the insurance company spreads the risk out over a large pool. The system breaks down, of course, if the pool is too small. A company with 10 employees probably can't absorb a $1M expense either. But AOL has 5,600 employees and it had $1.05B in net income in 2012. They can afford it to cover expenses, even if they decide to self-insure.
Of course, another solution is to make the risk pool as big as humanly possible and to get employers out of the insurance business completely, so that no startup needs to worry about medical expenses. The AMA is a messy political compromise to do exactly that. But Tim Armstrong is also upset about the AMA. So I'm not quite sure what his ideal outcome is here.
Did he say that?
Setting aside the fact that the post above is obviously not quote from Armstrong, we can't say for certainty what he said because all we have is a reported quote in the press with the sources cited as an unnamed AOL employee's transcript of the call.
The alleged quote from the transcript is:
>“Two things that happened in 2012,” he said, according to a transcript provided by an AOL employee. “We had two AOL-ers that had distressed babies that were born that we paid a million dollars each to make sure those babies were OK in general. And those are the things that add up into our benefits cost. So when we had the final decision about what benefits to cut because of the increased healthcare costs, we made the decision, and I made the decision, to basically change the 401(k) plan.”
If you believe the quote is accurate, Armstrong is clearly singling out these two babies as contributing to the reason why the 401k plan was changed.
But we lack all of the surrounding context, and the quote above wasn't even continuous. It does, however, fit the mold of televised arguments he gave on the subject. Obamacare and rising health care costs were cited and a decision to not completely absorb those and pass some of the increase to employees in the form of other benefit reductions was the argument he made in a few different places.
A poor comment to make considering the whole point of insurance and how it works, as well as the size of AOL's insurance risk pool IMHO, but then, I don't know if he even made that comment or qualified it with something like "But this is exactly the kind of worthy benefit and cost we believe should be prioritized above certain other existing benefits."
Given his response, it gives me the impression that he made a comment to this effect, and that it was a poor one to make, but that's just an impression. And it's even harder to say where his heart is on the matter. At the very least he has mentioned in interviews that they actively prioritized their benefits package in light of costs, and clearly healthcare was a higher priority than the 401k benefits that were cut. So for the poster to conclude that Armstrong deems covering the costs of these sick babies "unacceptable", I don't see it. The opposite, if anything. Whether or not he used the sick babies to rhetorically deflect from the fact that AOL is choosing not to absorb all of the rising costs and is passing them on to employees...well that is another story in my mind.
Whether or not it's absolutely unacceptable to him is debatable, but it is clearly acceptable to use the cost of preserving the lives of his employees' children as a scapegoat, when many other expenses (large engineering salaries, "digital prophets" [1]) could have been noted as examples of excessive expenditures. What ekidd is mad about, and I think reasonably so, is that the attitude of "oh, our employee's child almost died which was costly, so let's cut some benefits" as an acceptable mindset to Armstrong is very troubling. In so doing, he is passing on the price of expensive healthcare costs from AOL to his employees, in the form of a slashed 401k. Now that seems to be pretty close to ekidd's paraphrase -- Armstrong does consider it unacceptable for AOL to pay for his employee's child's healthcare, because he wants to pass on that cost to his employees vis-a-vis 401k cuts.
Now at least in my view, I'd hope my employer would place employees' wellbeing first, and consider cutting benefits as a last possible option, but maybe you have a different view.
[1] http://www.businessinsider.com/shingy-aol-digital-prophet-20...
I still have deep problems with his statement, and I haven't figured out how to articulate them better yet. But for now, my apologies to Tim Armstrong—whatever he said does not justify my hasty and unacceptably uncharitable reading.
http://www.capitalnewyork.com/article/media/2014/02/8539961/...
He shouldn't have mentioned specific cases. If he felt the company had to cut elsewhere to compensate for high medical costs, he should have left it at that level of detail. But I don't see how you get from what he actually said to
I'm utterly appalled at Tim Armstrong's attitudes towards
the lives of his employee's children. Apparently it's possible
to pay a programmer $100K/year, but spending ten times that to
save the life of one of his employee's children is absolutely
unacceptable.
And people should certainly be allowed to react when those in positions of power say appalling things. Whether he thinks that is absolutely unacceptable is doubtful, but he clearly thinks that the $7.1M in healthcare spending is something that should have to come out of the workers' 401k. The OP wasn't quoting Armstrong, but what Armstrong actually said/did clearly mirrors OP's paraphrasing -- that health spending shouldn't be the duty of AOL, because it should be passed on to the employees through the form of a 401k cut.
[1] http://online.wsj.com/news/articles/SB1000142405270230454950...
Getting universally criticized for a statement is not a qualification for assuming "lynch mob" victim status.
> I meant the forces that drive lynch mobs are driving people here.
This particular statement can be interpreted in so many different ways that it remains meaningless as it stands.
> Did he say that?
Did anyone lynch him?
Which is utterly reasonable. AOL has allocated $X for employee compensation. The law mandates health care go up by $7.1M, so something else must be cut by $7.1M.
This is certainly bad for workers who prefer the 401k benefits to whatever Obamacare benefits are costing $7.1M (and it seems like this is many workers). But that's a problem with the ACA - blaming TA for that is silly.
Have you been reading the comments on the many political articles that now cross the front page of this site? The quoted comment is fairly tame stuff compared to some of the opinions expressed in those threads.
We don't like to think about the reality that life or death situations we have no control over are being weighed on a balance sheet by people who's primary goal is making profits for shareholders.
Posting a photograph of a victim of a lynch mob http://upload.wikimedia.org/wikipedia/commons/d/d5/Lynching2...
I think Armstrong might be discomfited by the well deserved online education in social etiquette and the priority of life (of poorer people) over money. He sorely needs it and he will be the better for it, though a complete cure for him seems impossible.
> Did he say that?
Did I call you an ignorant money peddler, who thinks he is very smart because he can micro analyze statements and completely ignore the context in which the statement was made, as per his convenience?
Of course, I did not!
I call you no such thing.
This may be a good thing for the company's bottom line, but the optics are horrible. Even if the policy was sound (and I'm not sure it is), the delivery ruined it. It will be hard to say how he can be an effective leader at this point.
Regardless of what benefits were cut, citing specific instances of medical care as a cause for the cuts is such a horrendous mistake that it will be difficult for him to effectively lead. That was my addition. When your employees turn against you, and you have made such a blunder publicly so as to make potential employees not want to join AOL, it will be hard to lead. And the worst part is, it's not necessarily the cut itself that is the issue, but how it was presented and rationalized. Had he just said that healthcare costs are increasing, so to avoid cutting health benefits we are reducing (marginally) your retirement benefits, he might have been okay.
I mean, look at the way this sounds: Why is my 401k contribution lower this year? Because your coworkers had babies.
That may not be what he said, but that's where the story went.
1. People often attack you for some belief they mistakenly attribute to you.
or
2. What you actually say or believe doesn't matter. If people want to make up some belief to attribute to you in order to attack it, that's fine.
If you mean 1, I agree. But I would hope that here, at least, we wouldn't sink to that sort of mob behavior.
Seems, if nothing else, a poor way of handling things. Even if you're a "tight-fisted homo-economomicus shareholder" the end result is bad, because in the end his gaffe and the subsequent publicity meant that he reversed the cuts, so the company won't get to keep that money.
I'm not against high pay for executives or that kind of thing, so I'm fine with him making oodles of money if he's doing a good job. Part of doing a good job in that position, though, is not sticking one's foot in one's mouth.
Also: I think there are certainly times when people just try and twist words to score political points, whatever the actual facts. This case doesn't strike me as one of those, really.
He announced the company would be giving the same money to employees but the distribution would change: more healthcare (as mandated by Obamacare), less 401k.
If I brought political biases to my reading, they had more to do with a pre-modern conception of loyalty: true authority is built on loyalty towards those who are led. And I looked at this from the perspective of a parent, and from that perspective, the lives of children often weigh heavier than things like self-survival.
AOL absolutely did not desert these parents, and that's where my post was is undeniably in the wrong—and where I wanted to revise it shortly after posting, before I got caught by noprocrast.
Now, I've said things in my life which were dumb and out-of-place. (In this thread, even.) And upon re-reading, I'm willing to extend Tim Armstrong the benefit of the doubt: he may have hit upon a spectacularly poor way to explain why employees were losing benefits, despite having the best of intentions. But his remarks could be easily and predictably de-anonymized, with obvious consequences:
On Thursday, within minutes of Armstrong’s utterance, my husband began fielding questions from colleagues: Wasn’t the CEO talking about his baby?
And not did these remarks effectively single out a specific employee, they also singled out a specific 1-year-old girl—who already has significant problems—and they linked her to the company-wide benefit reductions (at least for those coworkers who knew the parents). And this is where I got too angry to read Tim Armstrong's actual words accurately. Which I regret.
Where exactly did he do that?
"We had two AOL-ers that had distressed babies that were born that we paid a million dollars each to make sure those babies were OK in general. And those are the things that add up into our benefits cost. So when we had the final decision about what benefits to cut because of the increased healthcare costs, we made the decision, and I made the decision, to basically change the 401(k) plan."
It's not unacceptable according to TA. AOL insurance (pre-Obamacare) did pay for it:
"Two things that happened in 2012. We had two AOL-ers that had distressed babies that were born that we paid a million dollars each to make sure those babies were OK in general. And those are the things that add up into our benefits cost. So when we had the final decision about what benefits to cut because of the increased healthcare costs..."
http://www.businessweek.com/articles/2014-02-07/aol-ceo-blam...
Its not AOL's or his responsibility. If anything you can put the cost onto society as a whole. This is the type of insurance the ACA should have been instead of the crap we got. It should have covered catastrophic care, which means million dollar babies provided they can be saved.
No company should feel guilty not keeping up benefits because one or two cases blew the bank. They are not there to fix everything. Insurance is a benefit and benefits can be exhausted or become so costly that the cost of doing business means not being in business.
So yeah, it sucks. Welcome to the world. The solution is to put catastrophic care into the hands of government and let them decide who gets the care. Let employers and everyday people shop for the best care for non catastrophic care and do it across state lines. Put them all on equal footing.
So summary. 1) Government takes care of catastrophic care. They set the limits, the decide who. If you want more you buy it on the secondary market. 2) Individuals and business buy insurance from any/all provides regardless of state. The only rule is, preexisting conditions do not disqualify you. They can however put you into rule #1
Edit: couldn't find data for premies at 25 weeks, but at 37 weeks and below, survival rate in the US is higher than European countries. http://www.cdc.gov/nchs/data/databriefs/db23.htm
In fact, France still does not allow withholding of nutrition and fluids from an infant not on a ventilator, a practice that is permissible in the US when care is deemed futile.
If you want an example of a state that practices more aggressive withholding of care in the NICU, look at the Netherlands, which has a private insurance model more akin to the US. According to the Nuffield report on neonatal medicine, "In the Netherlands, a consensus had been reached by 2003 that ... Dutch perinatal centers should not normally resuscitate and treat extremely premature babies born before 25 weeks of gestation, because of poor outcomes."
According to the report, the difference between the US model and the Netherlands could be seen in that twice as many premature infants born in the US survived to the age of two, but in the US five times as many premature infants had disabling cerebral palsy.
France: 3.34 US: 5.90 (Per 1000 live births)
Source: https://www.cia.gov/library/publications/the-world-factbook/...
UPDATE: And as we see from this paper from the WHO, live birth in the US is not what it means in France, for example. In the US it's any sign of life, in France and Belgium it's living for some period of time: "it has also been common practice in several countries (e.g. Belgium, France, Spain) to register as live births only those infants who survived for a specified period beyond birth"
For instance, some countries (like France) ignore births before x weeks whereas most countries (including the U.S.) include all births.
Beyond that, the U.S. leads the world in premature birth survival despite also leading the world in assisting people with fertility problems to become pregnant and add to the statistics that on the surface seem problematic for the U.S.
Go back to Fox News where people don't actually care about facts if you want to make sensational arguments with zero evidence.
Can't go back to watching Fox News because I don't have a TV. Nice, red herring, though.
Do you have a cite for the French system, specifically that withdrawal of care in NICU? English or French will be fine.
I cannot fathom that people accept "12 to 18 $K" as a reasonable amount of money for health care.
Do you have any source for these claims?
http://pediatrics.aappublications.org/content/120/3/519.full...
It sounds like 23 weeks and 500 grams are (were in 2007?) important benchmarks.
All he said is they changed the 401k plan because of unexpectedly high medical expenses. He didn't say or imply he wished they didn't save the baby. I can give the kid's mother a pass on two pages of disjointed emoting, but I don't understand why a disinterested observer would write something like you've written.
Do you really think it's possible to have a comprehensive understanding of "Tim Armstrong's attitudes towards the lives of his employee's children" based on this one little blurb? I mean, seriously... I can't help but think people are constructing a caricature of the man, based on a very limited understanding, and heavily influenced by their own preconceived biases and generic "Robber Barrons, evil, muwahahahaha" stereotypes.
I'm not saying that Tim Armstrong is a good person, as I don't know him. But I am very suspicious of this rush to judgment that seems to be going on here.
I'm saying we shouldn't be rushing to judgment, and creating this caricatured images of Armstrong (or anybody else) and basically screaming "off with his head", without sufficient information.
Again, I don't know him... never met the guy in my life. He may be a complete douchebag and a total jackass for all I know. But it would be premature to conclude any of that from this story.
I do not see how the logic follows there.
That it's reported in the news or published on his blog or written in a memoir or whatever is not the relevant fact here. The relevant fact is that it is something that he carefully planned to say and said, and that is sufficient information to have high confidence that it is what he meant to say and therefore what he thinks.
I do not see how the logic follows there.
Then there really isn't anything more to say. If you really think a person's attitude (which was the original issue under discussion in this sub-thread) can be thoroughly identified and analyzed and dissected based on one example of their speech, then so be it.
I happen to think human beings are far more complex than that, that context matters, that there are huge issues of subjective interpretation and nuance in play, and that it's a mistake for anybody to assume that they have some kind of deep insight into this guy, based just on this.
That it's reported in the news or published on his blog or written in a memoir or whatever is not the relevant fact here.
Nobody is claiming that. What I'm claiming is "insufficient data".
The relevant fact is that it is something that he carefully planned to say and said, and that is sufficient information to have high confidence that it is what he meant to say and therefore what he thinks.
The problem is going from "what he said" to "what you think he thinks". He said something very specific, and I see a lot of people making radical inferences and generalizations based off of that. What he said is what he said yes, but people aren't just talking about that, they're talking about their own interpretation of what he said, which is colored by their own biases and preconceptions... and, in this case, probably just a little bit of mob psychology.
Rmember : Slate opinion blogs != journalism
The next Question is are the employees 401k's safe and accounted for or is Aol like Maxwell?
I'm also surprised that his statements aren't "suable" in some form in the lawsuit happy country that is the United States of America. A friend of mine immediately pointed out to the numerous healthcare privacy laws in place; and another HN commenter pointed out on the original thread the possibility that the employees with the distressed babies would get discriminated against by their coworkers, after Armstrong's statements, due to the fact that they're probably identifiable internally by their team members.
This is the same guy who fired an employee publicly during a company talk for (apparently) taking pictures. (http://www.sfgate.com/technology/businessinsider/article/AOL...)
What a sad, sad man. I hope that he gets scared and lonely as he gets older and older, when his billions won't change anything and when he realizes that all of his misery stems from his own choices.
It very well may be a suable violation. HIPAA laws prohibit the "misuse and disclosures of PHI", and PHI includes a person's payment history, not just their medical records[1]. Such a breach by a covered entity is a criminal offence that can result in jail time by the offending employee[2]. As AOL isn't a covered entity (e.g. healthcare provider, insurance company, etc), I'm not sure whether it could be applied directly to Armstrong. You can probably push a HIPAA violation to the insurance company, however, as Armstrong most likely was told of these cases as the basis for group rate spikes during their insurance contract re-negotiation.
And those are just justifications related to violating patient privacy laws. I'm sure a lawyer could also make a pretty strong case against Armstrong personally for defamation.
[1]: http://en.wikipedia.org/wiki/Protected_health_information [2]: https://www.ama-assn.org/ama/pub/physician-resources/solutio...
However, AFAIK that would make them a covered entity. As a payor, they would have direct access to their employee's medical records. Whereas under normal circumstances, the payor/insurer only provides the employer non-PHI data such as enrollment/disenrollment info and summary data (at an aggregate level) to support pricing discussions, which is why they aren't usually a covered entity. You can find a good write-up on HIPAA requirements for self-funded insurance plans here[1].
[1 - pdf] http://www.nixonpeabody.com/files/155838_Benefits_Alert_20MA...
I know the word "sociopath" gets thrown around a lot when we're talking about CEOs, but I really really think this guy fits the bill. And so, in all likelihood, he sadly will not feel or realize a thing even as he gets older.
You realize that will only exacerbate his mistakes, yes?
Fortunately Google is run by good people, and they were never anything other than supportive. I'm grateful for having had access to the best care for her. I do think our medical system needs some rethinking though.
My daughter also had an extraordinary birth, and was saved by the incredibly expert care of a dedicated team of medical professionals at multiple hospitals in Seattle and Bellevue. The bill I saw was north of 250K and I paid the max of that (which was a few thousand)
It occurred while I was at a startup which i had co-founded (and currently employs over 100 people). I tend to go from startup to startup, with some contract / FTE work in between, and have swung from COBRA to COBRA to keep my health insurance consistent.
Because of ACA, this is the first year that I didn't have to "get a real job" in order to keep pursuing startups.
You probaby don't want to hear it, but if I were running a medical system I'd decree that gestating one-and-a-half-pound globs (from the article: "One doctor, visibly shaken, described [the fetus's skin] as 'gelatinous'") outside the womb is a waste of resources. To me, if miscarriages aren't the end of the world, neither are "babies" that die of natural causes within a few minutes of being delivered.
There's just no way spending a million dollars to raise a fetus up to the age of zero passes any kind of cost-benefit analysis. The cost of replacing the thing is much, much lower.
Another way to look at this: the government has various estimates for the value of a human life. It averages about $7MM. The "extraordinary" expense of this child actually only requires a 14% increase in value over the average citizen to make sense.
Most importantly though, we must recognize that the actual cost is actually just the cost of risk spread across society, so instead of one person taking the brunt of this cost, we as a society take it together. As a whole, it is negligible on all of us, and it's a risk that any of us can fall into. The value of having a system that supports each other is invaluable. Way more valuable than a measly $1MM. We have strength in numbers and we all benefit when a society supports each other. If we ostracize the statistical outliers in this support system, then the support system itself (the one which we all benefit from) falls apart.
In short, more important than the economic argument (which I argue, still makes sense to spend $1MM on a baby), is the argument that the value to society from supporting each other results in a negligible cost for individuals and a near-priceless benefit to everyone within that society. It's exceptionally difficult to put a price tag on that, and it's orders of magnitude higher than $1MM.
In this particular case, the 'instead money' was pure profits for a company (and some taxes for the government).
Do you really think that the 'instead money' would have been a better choice?
Money is just money and is completely replaceable. Actually, we have machines to make it: it's printable. Actually, we don't even have to physically print the money to 'print the money'... It's a number in a computer file.
Every dollar is the same as every other dollar.
Each and every life, on the other hand, is unique.
Maximizing number of total person years is not sufficient because a population 100x as large but living 1/5 as long would be superior to a population of the current size but living twice as long.
I'd argue in favor of maximizing population size and average lifespan. Of course this ultimately leads to the requirement that humanity moves off of this little rock of ours.
While we can afford to maintain* 11 individuals in the world. There reaches a point where over that entire population, we need to triage the medical issues in that population into the people whose issues maximize human-hours-lived given the X*Y healthcare dollars available to spend treating those issues. Maybe it's not the first person that requires treatment costing a million dollars we need to triage, but you eventually will run out of money if you don't triage because we simply don't pay unlimited premiums to meet the unlimited demand for healthcare.
The issue about overpopulation is a red herring, and in this case isn't just of function of helping people live longer. Many countries once they reach a level of prosperity stop having children at the necessary replacement rate of 2.1 children per couple once that society becomes affluent. The dropping replacement rate often correlates with societies ability to spend more money on helping their population live longer through spending on medical treatment.
No, that's not correct. You're not thinking at the margin.
> The "extraordinary" expense of this child actually only requires a 14% increase in value over the average citizen to make sense.
Ok, fair enough, we'll ignore the question of whether average really makes sense, but there's a bigger problem: there's absolutely no reason to expect this hugely premature baby to have >14% increase of value. Why? This is completely unfounded, completely unjustified. In fact, as a premature baby with massive expensive health problems, wouldn't we expect the opposite? Early childhood trauma seems like it'll matter to their future prospects: https://en.wikipedia.org/wiki/Preterm_birth#Prognosis (As makes sense. If babies could be born months premature with no negative effects, why aren't they being born that way already so they can start growing up quicker?)
It was one of three points made, the last point being the most significant. Our humanity should take priority over negligible costs.
> there's absolutely no reason to expect this hugely premature baby to have >14% increase of value
Without a standard deviation on the average, there is no way to say whether or not 14% is reasonable. Regardless, I was simply pointing out that it's a small fraction rather than orders of magnitude greater. Even if the child winds up providing 50% of the value of an average person, it can still be a net gain.
Economic reasoning is just one (minor) aspect to this situation though. There is very real value in simply helping a fellow human survive.
> as a premature baby with massive expensive health problems, wouldn't we expect the opposite?
The stats you cite are for extreme cases on the edge of viability and the odds still slightly favor normal or near-normal development.
This particular baby was born with a 66% chance of living and deserves more than a quick dismissal.
> If babies could be born months premature with no negative effects, why aren't they being born that way already so they can start growing up quicker?
That's horrible reasoning. The human body has evolved over millions of years for birth. It is the optimal gestation machine. We're working on approximating this optimal machine with artificial machines and continue to rapidly make progress. In the rare situation where the human body fails for some reason, we attempt to augment it with the best artificial machines we've got. Nobody claims that premature births are better, but a hiccup during pregnancy shouldn't mean the end of a life if we can avoid it.
Humanity progresses when a society looks out for each other. In particular, without bias. That starts at birth.
What you're proposing is barbaric and borderline infantcide.
There is no reason to expect the expectation of preemies to be above average, never mind 14%, never mind standard deviations. And there is substantial empirical evidence which I linked you to expect it to be far below average. Rescuing a preemie, even if it were free, would be a bad idea compared to alternatives like simply trying again.
> Even if the child winds up providing 50% of the value of an average person, it can still be a net gain.
And we're right back to your original problem: you are not thinking on the margin. The alternative to spending millions on premature babies is not no babies ever. (And even if it was, there's still superior alternatives: for example, lobbying for Open Borders. Think of all the millions of immigrants who'd love to come to the USA, for free! We wouldn't even have to pay them! Why, even if they're 99% below average, it's still a gain!)
> The stats you cite are for extreme cases on the edge of viability and the odds still slightly favor normal or near-normal development.
Which is what we are discussing, is it not? Or do even slightly premature babies come with million-dollar pricetags...?
> That's horrible reasoning. The human body has evolved over millions of years for birth. It is the optimal gestation machine. We're working on approximating this optimal machine with artificial machines
I'm not seeing any disagreement here. Yes, the human body is the optimal gestation machine. That's why premature babies come with all the penalties. (And note that those citations are just the penalties sufficient to be documented with small samples; there's not much reason to expect the penalty to abruptly cut off somewhere, it's just the long-term effects shrink enough to be hidden by noise and methodological problems and researcher careers' limits.)
> That starts at birth.
An arbitrary line is not a good basis for a system of ethics and governance.
> What you're proposing is barbaric and borderline infantcide.
I'm happy to own to that. It is infanticide. Premature fetuses are not humans in the moral sense: they have no hopes, they have no dreams, they have no desires or preferences, they do not think, and they have the moral status of a puppy or kitten. Given the disabilities they come with, throwing away hundreds of thousands of dollars in heroic medical measures is a crime against society and the person the parents could have raised instead.
What do you intend to do about them ?
Consider who you're talking about when you say, "The cost of replacing the thing".
I am hopeful that this is not a zero-sum game...
And for the record, I think this is the wrong battle, health care is entirely too expensive in the first place.
I totally agree that health care is too expensive at the moment.
This kind of attitude is why articles like this get written: http://online.wsj.com/news/articles/SB1000142405270230366140...
If you look at the cost in dollars per QALY, it's not that bad. That million dollar treatment probably produces 40 QALYs, for a cost of $25,000 per QALY; Americans typically pay $50-100k per QALY.
Yes, this has implications for abortion. I support abortion rights, but the "its just a ball of cells" is a rationale that isn't convincing after week 6-9. And lines drawn on intellectual abilities don't justify in a principled way why it isn't okay to abort full term babies. Lines based on viability are susceptible to the progress of medical technology. The typical 24-26 week line we use is fairly arbitrary in all three regards.
At the end of the day, you need to value all person-years-lived equally, and determine who gets treatment and for what based on what maximizes the number of person-years lived over the entire pool of people.
I have no numbers to back this up, but I would expect the greatest benefit from a fixed amount of healthcare dollars spent will be on people between the ages of 4 and 20.
Once you've figured out roughly the cost per medical issue, frequency per capita of each medical issue, and a distribution graphing that issue against the age at which most people are afflicted and number of years left in their lives given their demographic, you can probably come up with a reasonable algorithm for maximizing person-years-lived at a certain health premium per person per year (assuming all dollars go back into the system).
Then the only remaining question that is left for society and individuals to answer is what level of premium will be paid and the medical issues that will be covered at that premium.
Furthermore, I think it would be interesting if we gave people in medical situations the following choice:
"The procedures necessary to save this person's life are estimated to cost 1 million dollars. You can choose to save this person's life, or you can choose to donate $800 thousands dollars to save X number of lives by donating it to procedures that maximize the number of lives saved."
People choosing to exercise their right to spend healthcare dollars on a lifesaving procedure for one individual are the ones that should have to face that philosophical and ethical dilemma of deciding to value one life over many.
If I were running a healthcare system, I would make it policy that everyone put in such a position would have to knowingly have to make that hard decision. It's the only sane way that would put the burden of callousness on the people with the right to to those health services. Just because you have the right to those services, doesn't mean you should exercise them in a not-for-profit healthcare system.
It's difficult to discuss these things as people tend to get emotionally involved, but be discussed they must.
http://www.mcvoy.com/lm/photos/1999/04/16.html
It's easier to make the calls before you have a kid, they are calls in theory. After you have a kid you are changed, what was an obvious call becomes much much more complex.
If you can make that call after holding your own kid, wow.
I don't have children of my own. When I was 16, my mother gave birth to twins, so I have more parenting experience than the typical childless American, including that of holding closely-related infants.
> It's easier to make the calls before you have a kid, they are calls in theory. After you have a kid you are changed
Very true, but I don't see myself reversing on this.
After having the first one? Things changed. Downs really didn't seem that bad compared to a life. I'm still pro choice and I don't think you could pay me enough to judge someone else's decision, that's their choice and it's hard enough without my irrelevant opinion in the mix. But for me personally? The bar on where I would go with an abortion went WAY up after having a kid. Way up.
Just trying to say having a kid really changed my thinking and I suspect I'm not that unusual in that respect.
BTW, we already knew you didn't have kids. We knew that both from your beliefs, and moreso from the the hurtful language you chose to use.
We all already knew you were childless. And single. And white. And male. And a programmer. And an asshole.
Now do the world a favor, and shut up. Forever.
If this was a dinner party, I'd quietly ask him to excuse himself, and he'd never be invited again. His choice of language was pointlessly cruel and outrageous.
I guess the point is don't assume he's being an asshole, a real asshole would troll harder. I think he believes what he is saying. Yeah, it's rude but I'm not sure I'd be willing to write the guy off.
(My dinner party would welcome both paul and thaumasiotes, as people able to speak about a difficult topic calmly, with strong and contrasting perspectives based on real experience. In contrast, yscale would be asked to apologize or leave for content-free name-calling.)
It was pointlessly rude and provocative. It was an indefensible way to express his underlying opinion.
And if you were paying attention, you would've realized I emphasized his method of expressing the opinion far more than the opinion itself.
Ok, asshole childless person is at least mildly related to the topic at hand, but the rest of these just seem like irrelevant ad hominems.
>Now do the world a favor, and shut up. Forever.
Why do I get the feeling your tumblr is full of equally venomous "go kill yourself"s?
Consider this: We as a society have more than enough wealth to give ICU care to every infant that needs it. Our medical system is what makes it expensive.
> We as a society have more than enough wealth to give ICU care to every infant that needs it.
I'm not particularly informed here, but this is a claim I'm willing to accept.
> Our medical system is what makes it expensive.
This isn't right. Giving intensive care to extremely premature infants is inherently expensive, in much the same way that mining is expensive because you have to move tons and tons of dirt. It's difficult, and it requires a very large quantity of dedicated resources; it will not be cheap at any point in the foreseeable future no matter what organizational changes we make. We'd need technological changes.
The most "direct" cost of NICU care is 24-hour supervision by a nurse. In the best (cheapest) case, this will cost the same as 12 hours of minimum wage per day, as nurses might be in a 1:1 or 1:2 ratio with patients. More realistically, the nurse will be making higher than minimum wage.
The NICU fee also covers the amortized cost of three major pieces of capital: the ventilator, which causes the baby to breathe, the incubator, which keeps it at an appropriate temperature, and the negative pressure room. A particular infant may or may not need the negative pressure room, but it exists as a (physically separate) part of the NICU, the hospital must have one, and it's hugely expensive to create.
Additionally, the baby is expected to suffer various bodily failures which will require treatment. Diagnosis and treatment of these will be charged separately; they are not covered in the NICU fee. But they do reflect that these babies would really rather die, and it's difficult and expensive to get them to live.
My mother says (paraphrased), "if you are the army, you buy all the machines yourself, you pay everyone army salaries, and you just assign them 'you'll do this job, you'll do this job', etc., I don't know what it would cost to run an NICU. There's definitely room for it to be cheaper."
"Is there room for it to be cheap?"
"No."
From what I've read, it is the very nature of the beast (purely private, for profit health insurance) that causes the costs to be higher.
As I said in another comment, an earlier claim of "13 to 18 $K" for health insurance seems ridiculous, coming from a country where $6k gets top-level private insurance (to cover electives, get a private room vs shared, etc) on top of "free" health care) for a family.
I mean, would you personally pay a million dollars to save my child? I'm no more attached to a new nonviable fetus than you are to my (imaginary) 11-year-old.
Of course this perspective is easy to take from the UK where we don't have to face tough financial decisions over healthcare.
Sure. But you don't; we've never met.
This kind of event is super rare. However,it's not nearly so rare to have an older person go through tons of procedures and spend months in the hospital.
Second-order emotional (and nth-order social and monetary) costs are part of a comprehensive cost-benefit analysis.
The cost of even thinking in terms of "replacing the thing" is predominantly the cost of complete societal ostracism.
Who knows what these children could end up being or doing as adults? Who knows what value they could end up bringing the world? What they might invent? What health issues they could solve? What priceless works of art they may create?
Who knows what those other children who didn't get treatment so that this one could end up being or doing as adults? Who knows what value they could end up bringing the world? What they might invent? What health issues they could solve? What priceless works of art they may create?
What if this couple had been given the choice to forgo saving their own child's life and instead donate that $1 million to saving many children's lives in some other country that don't have the resources we have here in the US. Every time society chooses to save one life at considerable cost, it is also choosing to condemn others. What if you had to make the same choice, what would you do?
This is a human being we are talking about. A child.
I like to think of myself as someone who can usually empathize with folks who hold a different point of view, but I have never been able to understand someone who looks at a human life in terms of a "cost-benefit" analysis.
This glob we're talking about has less in common with a (prototypical) human being than does a 29-week fetus still implanted in the womb. You're taking a strong stand here in the abortion debate; is that intentional?
Are you kidding me? If it was a question of saving my child's life, I'd spend every last cent I had and then go sell a kidney.
> If it was a question of saving my child's life, I'd spend every last cent I had and then go sell a kidney.
there is no distinction between being unable to raise a child, and being unable to survive the attempt. If you survive, the child will get raised. The only way to fail is by dying (or killing the child).
And they're just lumps of cells that have never had a coherent thought.
I can understand a sense of loss in losing an infant at birth. You make plans for the child and are excited to meet the person they will become. It's a miscarriage. A similar loss is learning that your spouse can't get pregnant in the first place. It's not the same as losing a child of 3, 6, 12 or 24.
You often interact with children in utero before they are born. Also, at about 4 - 5 months (it'll vary from jurisdiction to jurisdiction) a miscarriage becomes a stillbirth and requires a birth and death certificate.
And while I have not lost a child at 3/6/12/24, I have lost a child at 6 months into a pregnancy, and it was quite probably the worst experience of my life - worse than my experiences during this: http://en.wikipedia.org/wiki/2011_Christchurch_earthquake - and I was trying to dig crushed people out from underneath rubble.
Births are (these days anyway), normally a joyous event wherein a new life comes into the world. A stillbirth is the polar opposite - especially if the baby died sometime before the birth was induced.
It is quite obvious on the 23rd day that fetuses are swimming around and exploring their environment purposefully. They are at least as alive and coherent at that time.
The reason for this is that your DNA does not contain a plan for a human being. It contains a plan for a bilobite (an very old and presumed extinct form of life), and a way to transform a bilobite into a trilobite, a trilobite into something that resembles a fish, that fish into something very similar to a frog larva, and so on and so forth until you get a human. Other species have the same evolution in the womb/egg, except it diverges at some point.
The fish has a working brain (and it is unknown whether the trilobite does, it grows active neurons), generally referred to as a neural tube. That brain is working during the whole gestation period.
Um well it isn't a fetus at 23 days its an embryo...
None of this is incompatible with saying that the "clump of cells" is precious and worth preserving, and that parents should have support before, during, and after pregnancy to help this child.
I take it you don't have a child?
He makes around $4 mil/year.
Granted, he does sometimes stay at the hospital for two weeks at a time with only very brief visits home but at this point he also owns apartment complexes, office buildings, a gentleman's ranch with a few dozen horses and staff and on and on.
I think it is shameful, personally, that he profits so much. He works hard and he saves lives, it's true, but how much is enough?
I think they both earn somewhere between 2 to 5 mil/year, but they spend it extravagantly and handsomely -- that's a very good thing. They're spending it on boats, cars, houses, nannies, restaurants, vacations, etc. etc. They're keeping the money going, they're spreading it out. They save lives, get money, and then help the economy by spending this money.
Now, what IS shameful is what the salaries of these social-app CEOs are. Why is Zuck worth some 20 BILLION? He's just going to sit on it, unlike my uncles he's not going to spend the majority of it. Zuck isn't helping the economy, Uber isn't helping the economy (it's externalizing costs, privatizing profits -- if they didn't exist that'd be a good thing). What is shameful is the profiting from rent-seeking, from making a killing on capital gains, etc. etc. Getting a few million per year isn't that bad, because believe it or not, in the large scheme of things that's little money -- most importantly, it's money that one can realistically spend from year to year. Spending a billion -- that's a challenge.
Spreading money out, ie redistribution of previously existing funds through service based consumption industries, is a very mediocre example of "keeping the economy going." Production is what bolsters an economy, not consumption. The faltering US economy has been demonstrating how that works in practice for decades, while China's production-centric economy demonstrated the exact opposite (and the same principle that the US economy was originally built on: production creates wealth, consumption destroys wealth, which is easy to deduce logically).
And sitting on wealth is a tremendously benevolent thing: it removes that purchasing power from circulation, boosting the net purchasing power of every other person holding, for example, dollars. If Zuck puts his $28.8 billion in a bank account, it does two wonderful things for the economy: it becomes available to be lent out by the bank in question, to help fund businesses or similar, and it temporarily removes $28.8 billion worth of dollars from the economy, increasing what other people's dollars can buy.
I am sure those people would be happy to spend that money and keep it flowing as well.
But large incomes for people like Zuck is a problem. That makes no sense to me.
Profits from saving human lives. Can a price be really put on a human life? Sure you can cite economics and a number like $7MM or whatever, but would you, personally, decide against paying that amount (assuming you had the money) to save your or your loved one's life, push come to shove?
And of course, it is always about resource availability, in this case the resource being money.
He works hard and he saves lives, it's true, but how much is enough?
Demand and supply. He works at a level of specialization that is a cluster of "black swan" events. Hence also, his crazy hours and most importantly, responsibilities. Do you have experience working at a position that is a nexus of similar conditions? Have you ever felt responsible for the life of not one but multiple human beings? And have that responsibility extend over your entire career, each day, every day? Now tell me, how much money would be enough to do work like that and keep doing it well?
Note: I am specifically focusing on money, because that is the question that was raised. Let's not divert the conversation into job satisfaction or humanity and all that, in this particular discussion.
This is the crux of the problem. You can't really.
The interesting thing is that his brother is a physician with very similar training in the UK (they both went to Trinity in Dublin). Does he get $4 million a year? Not by a long shot. Is he hurting for money? No. He has a large house and equally large family, travels all over the world and in general has a wonderful life. Granted he's never bought a yacht on a whim 6 states away, neglected the insurance and have it sink in a hurricane before he ever got it out of the marina (true story) but he is not hurting. Is he any less responsible or hardworking than his brother? Were any fewer lives saved under his care?
You can't measure these things in terms of widgets and currency.
To do so is mere rationalization as if the current state of affairs isan economic inevitability. It clearly is not.
Of course not. And I don't blame my father in law for taking the money either. Why wouldn't he?
I understand your confusion. I was not clear.
I don't think it is personally shameful for my father in law to accept the money. I think it is shameful that we, as a society, have allowed a system to function where he is offered that kind of money. You can cite 'market forces' as the reason that state of affairs exist but the truth is that the market doesn't exist in a vacuum. It is shaped by regulations, standards and bureaucracy put in place by intention or by accident by human beings. No place is that more true than healthcare.
Whether it is doctors that own a hospital or surgical center that, on paper, operate at razor thin margins while paying their principal shareholders, who happen to be employees, exorbitant amounts of money or urine testing companies charging thousands of dollars for a single drug screening while giving kickbacks to doctors in the form of leasing office space in their clinics for far more than market rates for their representatives, or medical supply companies that charge more for refilling oxygen tanks than the tanks themselves cost new and filled then we have some inefficiencies that could use the light of day below the surface.
None of these things are crippling in and of themselves. All of them together are creating a crisis that affects almost every person in the United States.
I think you, like many people, misunderstand the reimbursement regime as it works in American hospitals currently. A patient in an ICU will typically have a DRG associated with him/her. This DRG relates to the acuity, and these in turn, impact the reimbursement level. This is because the complexity of care, as indicated by the acuity level, implies higher resource utilization. For instance, the patient-nurse ratio in a typical hospital room is somewhere right around 4:1. In ICUs this ratio is, more often, 1:1. The ICU also needs an array of techs for a patient... highly specialized techs capable of analyzing and acting on information coming off of the monitor that the tech is responsible for.
So hospitals are not saying, "Hey... we have these people here who we can get a lot of money out of!" The system, as it currently stands, is "volume based", so money comes in for ICU care regardless of what the hospital wants. One of the issues with being volume based in this fashion, is that money does NOT come in for things like data analytics, nutrition departments and occupational therapy for instance. Now here's the rub... how do you offer comprehensive ICU care without due consideration of nutrition? Without the ability and expertise to analyze the data coming off of what could very well be an extensive array of monitoring equipment?
It actually goes further than that... Most hospitals MUST have a clinical equipment department for which they are not reimbursed at all. Of course, the creation of an ICU withOUT a clinical equipment department is out of the question.
So while there do exist cross subsidies in any given hospital, it misses the mark to view the departments on the receiving end of the subsidies as "money losing". This sort of thinking has led the industry to all of the issues we see presently. A good example is the poor reimbursement of primary care... and so primary care becomes "money losing" when viewed in that manner. Instead, I think these departments would better be viewed in the fashion that they are viewed in the "value based" reimbursement regime that the industry is currently transitioning to.
Not only will care delivery facilities be in a better position to provide care to families like your own and others, but the quality of care will increase across that enterprise. Your family was given high quality care because the hospital took money from a "volume based" reimbursement system, and distributed those monies based on the judgement of what were probably some very clever "value based" administrators. I can pretty much guarantee you that they did not view Clinical Equipment, Data Analytics or Nutrition as "money losing" departments.
One of the things that has been missing in the discussion about the health care system is the education of the typical citizen about the tradeoffs and compromises that, for example, hospitals are making internally to deliver the quality of care that they do. I think if the citizenry had a more full understanding of the nuances of things like the reimbursement system, we could have a more productive debate on the issue of healthcare.
The underlying topic, however, is fascinating. I do healthcare analytics for a living so I see how often a single neonatal ICU incident can consume 30% of an entire company's healthcare budget for the year (note: if you don't really understand healthcare, e.g. what self insuring means, please don't respond with comments that the insurance company pays the bills, this is what insurance is for, etc.).
The economics of healthcare combined with the inability to have a rational discussion on how to allocate resources means that doctors / researchers will apply their research efforts where they will be rewarded. The race to keep younger and younger babies alive is fueled with ego and dollars.
No one wants to talk about scarce resources and how to allocate dollars to have the most impact. I wish conversations stemming from idiotic comments like Armstrong's ended up being productive but they always end up with non-actionable ranting around taking executive pay and giving it to sick people. Unless someone proposes a mechanism to achieve that, it's just a dream / rant.
If you actually look at the global data on neonatal mortality [1], that doesn't seem to be true.
Countries like Finland, France and Cuba perform better than the United States on this metric. These countries offer completely free healthcare to babies and pregnant mothers.
Frankly, I find your assumption borderline offensive. Maybe you should take your USD-tinted healthcare analytics glasses off for a while and contemplate the possibility that human lives are worth saving.
Here fucking here.
What do we want to accomplish with the most advanced civilization history has ever seen? Advertising? A flourishing human condition? Fart apps? All? None? Anarchic meritocracy? It's all on the table.
Did we come all this way so that we could buy a second SUV for 25 people, or do we instead want to save a human being with a life full of potential (and spare incredible grief from at least two other persons in the process)? We should do a cost benefit analysis! [0]
>> Maybe you should take your USD-tinted healthcare analytics glasses off for a while and contemplate the possibility that human lives are worth saving.
FYI - I've dedicated the last 10 years of my life to the cause of saving and improving as many lives as possible. Haven't had a paycheck for going on 4 years. Personal attacks like yours don't bother me but are frustrating because it's an example of the difficulty we face as a nation in our effort to improve our healthcare system. We all (myself included) get emotional over individual stories (e.g. Armstrong's comments over 2 lives) but have a much harder time seeing the invisible wreckage and thousands of people dying because of our distorted economic incentives.
From 2008: http://pjmedia.com/blog/the-doctor-is-in-infant-mortality-co...
Some (OK, rather extensive) points from the link:
> In the United States, all infants who show signs of life at birth (take a breath, move voluntarily, have a heartbeat) are considered alive.
> In Belgium and France — in fact, in most European Union countries — any baby born before 26 weeks gestation is not considered alive and therefore does not “count” against reported infant mortality rates.
The baby at issue here would have been just under 22 weeks. (France changed their standard in 2008-2009; their page defining stillbirth ( http://www.insee.fr/en/methodes/default.asp?page=definitions... ) now includes a warning that French numbers cannot be compared to other European neonatal mortality numbers, so it seems safe to assume the rest of Europe has carried on as before.)
> According to the way statistics are calculated in Canada, Germany, and Austria, a premature baby weighing <500g is not considered a living child.
The article baby weighed well over 500g. But this is quite relevant to the question of who has better neonatal mortality.
> In Switzerland and other parts of Europe, a baby born who is less than 30 centimeters long is not counted as a live birth. Therefore, unlike in the U.S., such high-risk infants cannot affect Swiss infant mortality rates.
This baby's length is not reported, so this is of questionable relevance to this particular baby. But, again, it remains very relevant to the question of "do countries like Finland, France, and Cuba have better neonatal mortality than the US?"
> If a child in Hong Kong or Japan is born alive but dies within the first 24 hours of birth, he or she is reported as a “miscarriage” and does not affect the country’s reported infant mortality rates.
This could be a non-premature, 8-pound baby!
> Efforts to salvage these tiny babies reflect this classification. Since 2000, 42 of the world’s 52 surviving babies weighing less than 400g (0.9 lbs.) were born in the United States.
Still think "USD-tinted healthcare analytics" biases you against saving premature babies?
Full disclosure: I'm with your parent; I consider spending so much pumping life into these very premature "babies" a self-aggrandizing waste of time, effort, and money. But your comment seems to be grotesquely misinformed.
You can verify this by looking at the Tiniest Babies Registry [1], which was also mentioned in the article (those 52 surviving babies -- but the toll today is already at 155). The numbers are not so skewed towards the US as they were in 2008. In recent years, about half of these tiny babies were born in Europe, Japan or South Korea.
If the company didn't put aside enough money to account for unexpected cases, such as this, arn't they just being negligent (or at the very least causing their own financial problems)?
No, the point of insurance is to enrich the stockholders of the insurance company. This might sound like a leftist rant, but it's actually the singe most important thing to understand about the insurance business.
If a policy term doesn't contribute to the bottom line, it's changed to disfavor the policy holder. If a deductible amount eats too much into corporate profits, it's changed to disfavor the policy holder. These facts explain why some companies and individuals choose to self-insure.
If you buy an insurance policy, the policy's payments go into a corporate investment pool that benefits only the company's stockholders. If you self-insure, the funds you set aside to pay claims go into a personal investment pool that benefits you. For the life of me, I can't understand why more people don't know this.
I was more saying the point of insurance in general to those buying the insurance is to protect against outliers.
Not debating the point that insurance companies are there to make a profit rather than to service people. Agree with what you're saying but it doesn't address what I was asking.
Edit: Also since AOL 'self insured' there wasn't an insurance company at the heart. AOL just decided to cut corners and 'put away money for a rainy day', and was shortsighted on how much to put away, to put it simply
Yes, and the basic principle of an insurance pool is to use the pool's size to absorb the impact of an outlier event. The larger the pool, the better it is able to absorb such an event. This means a small company can be a risky place to set up a self-insurance scheme on which the employees depend.
> since AOL 'self insured' there wasn't an insurance company at the heart. AOL just decided to cut corners and 'put away money for a rainy day', and was shortsighted on how much to put away, to put it simply
Yes, and that's a surprisingly common outcome -- it's the downside of self-insurance plans -- often a company or an individual doesn't actually have the resources to deal with an outlier, or a sudden surge in claims is synchronized with a business reversal.
People need to understand that insurance is a kind of gambling -- a bet that claims won't wipe out the fund pool, that a random act of nature won't undermine the actuarial assumptions on which the pool is designed.
That said, I'm pretty happy with health care here in Europe, even though it's certainly not perfect.
Could you explain more about how self insuring works?
In normal insurance, the policy payments go into an investment pool that benefits the corporation's stockholders. In self-insurance, the set-aside funds go into an investment pool that benefits you (or your company).
The drawback to self-insurance are outlier claims that can more than wipe out the set-aside (as in the case under discussion). Obviously an insurance corporation has (or should have) a larger pool to deal with outliers than an individual or small company.
This is not to say that big insurance companies aren't sometimes wiped out by a sudden unexpected uptick in legitimate claims. In that case, the company may simply declare bankruptcy and the policy holders are left out in the cold -- just as though they had self-insured. But that's a rare occurrence.
You could make the same argument against having home or medical insurance, that it erodes the advantage of having the totality of your take home pay. But it seems responsible to have home insurance and medical insurance, and it would seem responsible for a self-insurer to reinsure.
> it would seem responsible for a self-insurer to reinsure.
Reinsuring is sort of like being married, and not being married, at once. Many people think that sounds pretty cool -- until they try it.
The biggest issue is the principal-agent problem - it costs some amount to insure against once-every-20-year claims, and by that time the CEO is likely to be retired, so why buy the coverage?
That's one of the reasons why insurance companies per se are highly regulated.
I don't have any figures at my fingertips, but I know it's more often than insurance corporations, which are highly controlled by governmental oversight to prevent that very thing.
> When that occurs, do their employees simply go without health care?
Yes, that's exactly what happens. Sometimes instead, a company will stop offering in-house insurance and require employees to seek insurance elsewhere.
Yes, but at risk of civil lawsuits from the insured, who might have a different perception of their coverage. This kind of thing actually happens, often based on an implied contract between the employer and the staff that may have never been fully committed to paper.
What about progressive taxation and nationalized healthcare, like most wealthy countries do?
UK perspective: I'm interested in the concept of 'health analytics' as our present government are sort of dancing round the edges of the NHS (knowing that any form of direct privitisation/move to insurance based benefits would result in prompt removal from office).
The CEO could conclude that these outlier events create too much unpredictability for the bottom line, and thus move the company to an external healthcare provider. Heck, they could even fire the CFO or whoever made the cost-benefit analysis if it was wrong. But blaming the employees, who didn’t create this situation? Unacceptable.
I can't find the link right now but I read somewhere that it is common for large companies that self-insure to buy reinsurance to cover themselves against large payouts like in Armstrong's mythical example. The company will typically have an insurance policy for their insurance policy.
The fact that apparently AOL is on the hook for medical claims by its employees indicates they've made a reasoned judgement that their risk pool is diverse enough that it's worthwhile to self-insure, or they're incompetent.
Either way, it's crazy to set yourself up as an insurer and then complain about having to pay claims. That's kind of the point.
I expect Anderson understood this but had to look for a reason to cut 401K matching in a profitable quarter, and increasing executive compensation didn't sound quite right, so... the high cost of saving babies! Whadda guy.
In addition to the horrible way this was handled by management, this is clearly the failure of the AOL benefits team, who exposed AOL to more risk than it was actually prepared for.
“How many distressed babies does AOL pay this guy?”
In normal first-world countries you have some form of socialized healthcare with bioethics committees that decide what should society should pay for. You can have reasoned arguments about end-of-life care and very premature babies.
But in America with the crazy system of employee-provided coverage it's the CEO that sets coverage limits, and generally speaking a company's interests are not aligned with society in general.
If not for Obamacare, AOL would have provided a insurance plan that wouldn't have covered this child, and instead left her to die and her family in a permanent state of medical bankruptcy.
ETA: For the record, I think most insurance policies have covered this for awhile. But Armstrong's either very confused, or, more likely, just struggling to find a way to point fingers at anything who's not him.
Regarding what most insurance policies cover, there are actually several scenarios that would leave AOL on the hook. First, they could have a policy that has an Annual or Lifetime payment limit, which would leave the company (or individual) responsible for anything over. Alternatively, if the number of incidents was significantly higher than average for the carrier, AOL could see a significant premium increase due to the higher utilization of their plan. Or, they could actually be running a self-funded insurance program, which means they are managing the risk instead of relying on a separate insurance carrier.
Either way, there are several situations in which AOL's costs could be significantly impacted by the situation.
But I agree, if you can't use your insurance when you need it, whats the point of insurance?
You mean the people encouraging people to use proper fire-safety techniques, "baby-proof" their homes, eat more healthful foods, exercise regularly, etc?
Of course every insurance company knows they will have to pay some claims at some point, it's a cost of doing business. So their entire purpose isn't to avoid paying claims, it's to charge enough in premiums to cover those claims while still making a profit.
left her to die and her family in a permanent state of medical bankruptcy.
I'm not a fan of the US system either, but I live in a country with State-run healthcare, and cost decisions like those are made every day.
People love saying that about America, but it's not true and never has been.
For cases like that there is government insurance. It's called Medicaid, or Chip, or a bunch of other names, and it's available everywhere.
(And it doesn't help that the person you replied to is doubly confused and combined two unrelated things to confuse him even more. The CEO was saying that Obamacare was an added expense - it had nothing to do with the babies.)
> Let’s set aside the fact that Armstrong—who took home $12 million in pay in 2012
Assuming the above is factual (and I have no reason to doubt it), he wanted to cut the 401(k) plan for everyone because of an expense that was one twelfth the size of his own pay that same year.
Just a wee bit hippocritical there on his part.
[Yup, Armstrong is despicable]
paraphrage (v): to paraphrase in a way to maximize outrage
Tim Armstrong has been widely paraphraged as saying, "we're cutting your 401(k)s because two AOLers had distressed babies last year".
Paraphraging not only brings many profitable clicks, but it removes complicating details that interfere with an audience's offensertainment.
offensertainment (n): amusement or enjoyment felt by taking offense, and expressing moral indignation, usually in solidarity with some larger group
The isolation and individual disempowerment of modern online life has driven many people to seek a compensating sense of joy, purpose, and belonging through offensertainment. Leading offensertainment providers include Gawker, the Huffington Post, and Slate, but the full participatory experience also requires forwarding, commentary, and button-pushing through services like Reddit, Facebook, Twitter – and HN.
It's not like CEOs of large companies are selected for being empathetic, but in this case I'll predict that he doesn't survive the publicity surrounding his statements. Children are (and should be) important to a civilized society regardless of their present capabilities or future expectations.
1. The costs of the procedures involved are wildly inflated by the private sector healthcare system we employ. 2. Regardless of 1 the effort involved in keeping the child alive was extraordinary. 3. The effort involved was disproportionate to the benefit to society.
It's unlikely the reader will agree with 3. That's ok. But I would ask anyone who disagrees with 3 to think carefully about if there is a line where the effort to save a child's life is too great, and if that line exists, how would you determine where it is, and given that method where is that line for you?
I think this article isn't important because one person happened to say something rude about somebody's daughter. It's important because it's a peek into how a lot of people are actually thinking about the world, and that's pretty scary.
And I think it's very useful for our empathy muscles to occasionally listen to "biased" people like this mother.
No, I don't think you lack empathy, although I can see how my comment could be taken that way. Apologies.
However, i do also think her bias in the matter let the article drift from the costs of cost-cutting in health care (losing faith in a business), and slide into fearmongering. A harsh word, yes, but she has a platform, she has our attention, and she has experience where it counts, but instead of showing what we can learn from it, she decided to pull our heart strings at every turn.
I didn't read it as trying to make any point other than "this is awful and unfair and my daughter is innocent of wrongdoing."
I don't know that it's as calculated as it seems like you think it is.
Same here, the emotional toll and frustration derived from the comments (again, which were completely uncalled for) overly influenced the article. There is no reason for her to not be frustrated and angry, and putting that into her writing is important. It should not, however, be the primary driving force of the article, otherwise it's just plain manipulation.
> I didn't read it as trying to make any point other than "this is awful and unfair and my daughter is innocent of wrongdoing."
My point exactly. To reiterate, she had a platform, she had us listening, and she knows what she's talking about, but she missed the opportunity to spark a real discussion of how to prevent this from happening again. Instead she only focused on relating her frustration to every other parent reading, which in my opinion, can be very manipulating. Using the anger that her daughter was a target, and the fear that even though they're innocent they were punished is manipulative. "Won't somebody please think of the children?!"
It's a demand that society fight a bogeyman that poses no real threat to children: Sonic the Hedgehog or communists or "gay propaganda" or saucy pop videos.
Asking that one's health insurance cover the delivery of one's baby seems a pretty legitimate demand.
Blame the law for this: clearly those employees who abuse the system should be fired outright, preferably on a conference call with 1000 people in attendance. Sadly, due to government overreach, it is considered illegal.
"The third stage, based on findings from Europe between around 500,000 and 40,000 years ago, sees humans such as Homo heidelbergensis and Neanderthals developing deep-seated commitments to the welfare of others illustrated by a long adolescence and a dependence on hunting together. There is also archaeological evidence of the routine care of the injured or infirm over extended periods. These include the remains of a child with a congenital brain abnormality who was not abandoned, but lived until five or six years old. The researchers also note that there was a Neanderthal with a withered arm, deformed feet and blindness in one eye who must have been cared for, perhaps for as long as twenty years."
http://news.discovery.com/human/neanderthals-were-compassion...
A large company like aol would have already provided pretty good health benefits. It is very unlikely that the ACA's provisions about mandatory coverage for procedures (such as birth control) would have cost aol anything significant.
Is this how health insurance works? Maybe AOL is "self-insured"? I don't understand AOL having anything to do with paying directly for medical treatment. Except, by virtue of making claims and costing an insurer money, the premiums increase. It's as if the insurers, ever-faithful capitalists they are, want to sell us insurance and can't believe we have the gall to make claims against our policies, and have convinced our employers to be equally appalled.
http://www.uproxx.com/technology/2014/02/meet-david-shing-ak...
http://finance.yahoo.com/news/listen-to-aol-ceo-tim-armstron...
I would also like to know how much costs would be in France, UK, Germany, Japan.
Seems to me they very simply not good enough at crunching the numbers then.
Also, I think even insurances tend to have insurances against very high insurance claims. Maybe they should look into that kind of thing.
1. Baby born Medical cots $1 Million, INSURANCe COStS $250,00 and yet Tim decides to eliminate 401ks to balance benefits costs over something that does not increase insurance costs? You have to have a significant amount of $250,000 in an insurance pool of AOL employees before that happens..one is not the number that triggers it.
@. He also cited Obamacare. Obamacare is by design to get businesses to pay healthcare for those at-risk employees in the low income brackets so that that preventive health care spent on them decreases the huge medacaid expenses seen later by THE FEDeral Government.Lets not even mention the productivity studies that state employees are more productive when not worrying about uncovered medical expenses.
Seems tome the AOL board shold remove this CEO for gross lacking of clear thinking skills
The mean-spirited worldview shouldn't be a surprise. What is a bit brazen is the "turn the poors on each other" behavior. Usually, it's not so obvious. He had hoped that the rank-and-file employees would, as a response to this phony scarcity (health benefits OR 401k, when the real problem is executive overcompensation) imposed from above, turn their frustrations and gripes at colleagues who get sick a lot (or have sick children, or sick parents) and that the environmental change would, perhaps, prune the company of a few sick people. It didn't work. Now everyone hates him. Good. I hope he dies alone, broke, and miserable. (The "broke" part probably won't happen, but one can dream.)
Whenever the upper class tries to turn the rest of us against each other (say, Mission lifers vs. Google bus riders, who are on the same side even if they don't know it) we should always recognize it for what it is, and attack the real enemy with our combined force.
#1 - Tim Armstrong is an ugly man and doesn't speak for the upper class.
#2 - Many many many readers on HN are upper class.