Humans really struggle with identifying fault past one step. If you shoot a CEO, it's national headlines, but thousands die due to denial of proper treatment and there's no outrage. It seems this shooting made bridging the gap a mentally easier task for many people - Hence why there is very little public support for the late CEO.
That there is no outrage is a deeply questionable proposition. Folks generally don't get whacked in broad daylight for no reason. Social media turning one's murder into a block party likewise signals pretty deep seated animosity.
Anecdotally I find this to be the case with team-based online gaming. For example, if you fail to secure your lane in a Moba because your support left you to fight against two of the enemy alone, people will blame you, when the blame should rest on the shoulders of the person who abandoned you. Or, if one of your team decides not to play, which makes you 4v5 against the enemy, and you make a mistake that loses you the game, people will blame you, rather than the teammate that put you in the 4v5 situation. Very frustrating.
I would expect that, politically, the insurance companies are just entering their time in the barrel.
The mantle of populist, anti-establishment hero is up for grabs now that the group who campaigned as anti-establishment are the establishment. Their stated position is that private insurance companies are good, actually, and we should be moving more people out of government funded health care and into the waiting arms of UnitedHealthcare and other private insurers.
This shooting, and popular acclaim for it, are a bright red signal that there is a huge tailwind for anyone who campaigns to burn these companies down, and the new establishment is going to be forced into opposing that popular demand.
The problem is that populism doesn't have to be ideologically consistent. Supporters of privatized healthcare can and do simply agree that there's a problem and insist that more privatization will fix it.
I had expected this to come down to "Hey, a guy is dead, could we take a moment here?"
But no, they really seem to be complaining about the attention paid to policies that really should have gotten attention a long, long time ago.
He is right, though: refer journalists to the media department. If you're not authorized to speak on behalf of the company, don't. Even if you are, deflection is the safe thing to do, because the press is not your friend and dealing with them is best left to the people who make a living at it.
His company is going to get beat up for a few media cycles. And then it will go away. His media department knows this, because that's what they do.
Someone just showed (on national TV) it is possible to murder a CEO of one of the top 10 companies in the US, during broad daylight of downtown New York, and get away with it well long enough to escape the country.
Columbine inspired all sorts of copycats despite far worse social signals from the public and much quicker demise of the instigators.
Every health insurance executive is shitting bricks right now.
What country before ever existed a century and half without a rebellion? And what country can preserve it’s liberties if their rulers are not warned from time to time that their people preserve the spirit of resistance? Let them take arms. The remedy is to set them right as to facts, pardon and pacify them. What signify a few lives lost in a century or two? The tree of liberty must be refreshed from time to time with the blood of patriots and tyrants. It is it’s natural manure.
I think it says that they don't respect Ken Klippenstein, nor should they. I like some of his stuff and he's a good snooper, but of course UnitedHealth won't respond to his questions: he is a ginormous asshole who was openly gloating about the death of their CEO! He's completely unprofessional, he has a long history of dishonest trolling and sexist bullying, and AFAICT the only reason he left The Intercept was that he got tired of editorial standards and wanted that sweet Substack money.
Dishonest trolling? As opposed to honest trolling? Talk about padding the list.
And people who are fine with hundreds and thousands of people suffering horribly or even dying, so they can have some more money they have no real use for, draw the line at sexist bullying? Or is the issue is that he wasn't gloating behind closed doors, as professionals would? (note the "long laugh" bit)
> On the 2021 phone call, which was recorded by the company, nurse Victoria Kavanaugh told her colleague that a doctor contracted by United to review the case had concluded that McNaughton’s treatment was “not medically necessary.” Her colleague, Dave Opperman, reacted to the news with a long laugh.
One of the best examples of bad policy and misplaced incentives is how the Affordable Care Act limits the amount of profit as a percentage of premiums that health insurance companies are allowed to make. Sounds great, right? If they make too much as a percentage (profit margins) they have to give money back to customers.
However, all it has done is incentive costs to up for them so they can charge higher premiums (since they have to now) and pocket the same percentage of premiums which is of course a larger number overall. How could an insurance company ever even consider lowering premiums by striking better deals with providers?
The dead CEO is a symbolic thing for people to direct their anger at, and with some justification (anger, but not wishing death), but really the frustration is with how bad policy and regulations of the healthcare industry in general is. There's a reason there's very few startups in the space as regulatory capture is all over the space. Between tort law, regulations, and poor policy it's no wonder the space is a mess.
Countries with functional and affordable healthcare got there by making a policy judgment that healthcare ought to cost less. In the US, any cost reduction that might reduce payments to providers is a political non-starter, so we end up nibbling around the edges and staring at the most abusive insurers.
Seems there was lots turmoil at the CEO's company
Resentment for Thompson was widespread at the company, the employee said, citing an internal company announcement about his death that only garnered 28 comments despite being seen by 16,000 employees.
Also accusations? of insider trading by CEO in the linked pages. And complaints these accusation's are not mentioned by most media
- Why are employment and insurance connected?
- Why can't you select an insurance company?
- Why are there no standardized 3 levels of insurance with a legal mandate for the coverage to be the same across all insurers (so they cant play games with denies). You can't have an efficient and competitive market if nobody understands what they are buying
- Costs are inflated due to legal and administrative fees...
- Costs are inflated due to high educational fees...
- Why are we effectively subsidizing research and medicine for the rest of the world?
- Food and health is a major part of what increases the costs
Yes, the system is weird. Obviously if we were designing a healthcare system from scratch it wouldn't look anything like what we have today. What everyone needs to understand is that the system was never really designed as a cohesive whole but instead evolved over time under what economists call "path dependence". It's not even really a "system" at all in the sense of a unified entity working towards a common goal, but rather a collection of disconnected entities each pursuing their own interests. In particular tying healthcare access to employment seems crazy but it's mainly a result of wage controls that were imposed during WW2. Fixing this is politically difficult because due to economies of scale it actually gives larger corporations a competitive advantage over their smaller rivals.
Many people forget the history of health insurance in America. Prior to 2010, you could be a good and loyal customer, always paying your premiums, but if you had a heart attack or got cancer, your health insurance company would refuse to renew your policy - for any amount. Then, once your policy lapsed, they would agree to issue you a new policy that excluded from coverage the very condition you developed that caused them to refuse to renew.
Laws were passed (in the 1990s I believe) to appease the public that banned the insurers from refusing to renew a policy just because the policy holder got sick. However, the law was a joke because it permitted the insurer to set the premium on the renewal at any price they wanted. So, it was effectively the exact same situation. You have insurance. You have a heart attack or get cancer, and when it comes time to renew your policy, the health insurance company raised the premium so high that nobody could possibly afford to renew. The policy would then lapse and the insurer would immediately offer the insured a brand new policy that excepted from coverage the medical condition in question.
It wasn't until the Affordable Care Act in 2010 that health insurers were finally required to keep offering the insured coverage after they got sick. They can no longer raise your rate just because you get sick (after all, what good is health coverage if it doesn't cover you when you get sick?).
But health insurers HATE the Affordable Care Act and are paying lots and lots of money to elected officials to change the Affordable Care Act so insurers can once again refuse to renew policies if the insured gets sick with an expensive illness. So, hold onto your hats everyone.
Nonsense. Health insurers LOVE the Affordable Care Act. Major parts of that legislation were basically written by industry lobbyists. It essentially mandated that everyone get coverage, which greatly expanded their customer base and revenue stream. Now that most employers have self-funded health plans the insurers no longer sell much insurance (in the sense of bearing financial risk) and mainly just provide administrative services while passing the bills on to employers. This is guaranteed stable profit. Zero large health insurers are lobbying to repeal the ACA. Why would they kill the golden goose?
> It essentially mandated that everyone get coverage
Given that for the four tax years for which there was an actual penalty associated with that provision, the average penalty paid ranged from less than half (2014) to less than double (2017) the average monthly cost of individual health insurance, it essentially did nothing of the sort, even for the brief period where it might superficially have seemed to if you didn’t examine the details much.
> Now that most employers have self-funded health plans
Most employers (either by count of employers, or by count of employees) do not have self-funded health plans. Most large (>500 employees) tend to have at least one self-funded health plan, but smaller employers generally don’t, and large employers employ only about 1/4 of the workforce.
It's crazy that insurance companies are (rightfully) viewed so negatively that the killing of a CEO is responded to positively in a lot of circles. No doubt the jokes on twitter have been great, and it is a good release like I've heard people say about breaking a window with a brick during a protest. It (edit: represents) a lot more than just property damage. It's unlikely but maybe some good will come of this from insurance companies.
Many people, especially in a certain political class, have confused their movement's rhetoric with reality.
The rhetorical tactic is to make yourself the victim, always, all the time. If you're criticized or prosecuted or bad news comes out, you're being persecuted. You can see it all the time, yet few seem to notice the pattern.
It also fits other rhetorical tactics: 1) Always stay on the offensive, no matter what; keep the intiative. Attacking the critics is the offensive; responding to criticism is not. 2) Attack the opposition with your own weakness: If you're a liar, call them liars; if you persecute people, call them persecutors. This confuses the issue and disarms them.
Rationally and factually, the victim narrative is usually BS. There is all the difference in the world between bad news, etc. based on facts and that based on falsehoods, and especially there is all the difference between attacks on established powers and attacks on the vulnerable. Punching up is an essential social function, to protect society and hold the established powers accountable; punching down is oppression (and true victimization).
But the rhetoric works because everyone has embraced the post-truth way, abandoning post-modernism (which is fundamentally a distrust of power) and its tools, and have very effectively disarmed themselves.
Ironically, their denial of insurance is also aggressive, inappropriate and disrespectful. It’s unbelievable how tone deaf these people are. Instead of being introspective, other insurance companies are simply removing leadership pages, and calling for armed guards.
> their denial of insurance is also aggressive, inappropriate and disrespectful
It's not. Objectively, people get sick and die and there's often not anything that can be done about it. Throwing money at treatments that will not help does nothing but raise costs for everyone.
Individuals (understandably) get very emotional when grandma can't get the $100,000 therapy that might prolong her life for a few months because the big bad insurance company denied it, and it makes a great story to promote on social media. Do insurers sometime err in their denials? Probably. But so do public health plans, and there is no health care system in any country that does not draw the line at some point and say "no, we are not going to pay for that."
> The Stat investigation noted specific instances that troubled United employees, like when an older woman who had a stroke was only covered for half the nursing days typically required for recovery....
> A 2023 story from ProPublica dived deep into the experience of one United patient, a college student who racked up $2 million in medical claims a year to treat a severe case of ulcerative colitis. The story showed United disregarding an internal report finding the expensive treatment to be necessary. The patient eventually sued United and received an undisclosed amount in a settlement.
> Insurance denials are rarely appealed, with some studies finding appeal rates of roughly 1 percent.
Hello, a person from a country with a public health care system here. There is no concept of a per incident denial. There is a list of procedures that are covered, and if the doctor decides you need a procedure from that list, it is covered, they don't send a request to some suits for acceptance, they just schedule the procedure and that's it. There is no "line", there is a list, and the list is applied equally to everyone.
Respectfully, you are woefully misinformed or you’re lacking in empathy for people who need medical help. Even doctors complain to UHG because they deny care that their patient needs.
I suggest you do some research before making such comments because it makes you look like an asshole.
America sure is funny. They just happily elected an oligarchy that can't wait to very aggressively cut anything social spending they can (most government spending is pensions and healthcare, ACA subsidies are also expiring in 2025 and there's 0% chance they get extended), but they're also kinda gleeful about the murder of a CEO that is merely operating a company within the environment they so happily voted back in? It's just an absurd situation all around.
Politics aside, the system is fundamentally broken when you have for-profit companies whose priority is maximizing shareholder value. Patients will always be second.
Donald Trump won the election 77 million to 74 million, and that's only counting voters. 74 million is a lot of people who voted against that oligarchy and are likely ideologically aligned with being gleeful with health insurance CEO murder.
You can't elect an oligarchy. They have a four year term, and almost no one in the incoming administration has a long-term career in government. It's literally the opposite of an oligarchy, it's a republic.
Also, United Healthcare has no place in the incoming administration. Bobby Kennedy Jr is Trump's selection for Health Secretary, if anything is a spurn to the pharmaceutical companies and the insurance industry.
You might benefit from a closer examination of what an oligarchy is and how the US political system functions in the context of campaign finance, lobbyist groups involvement with drafting legislation, and the conveyor between the legislative branch and private industry jobs. If you have the constitution for rummaging through tweedy academic thickets you might also consider reviewing the Princeton papers that deconstruct the US political apparatus and indicate pretty vividly that the US is, in fact, an oligarchy. Lastly, given the combination of wealth inequality in the US and the Supreme Court rulings on money == speech and political influence == speech it's pretty trivial to conclude that money == political influence and the top 0.1% has more of both. To be clear, this is an indictment of both major political parties in the US, as they operate functionally identical campaign finance strategies.
Growing up in a very conservative household, I was always told to look at what people do, not at what they say all my childhood. Now those same people are ranting about what Trump and his cronies say, completely ignoring what they do. It'll always amaze me how easy it was to convince people to ignore actions, and only pay attention to words.
RFK will only be able to propose plans within what Trump will allow; the overlap between their ideas is only bad things. If he tries to go any further he'll just end up like Tom Price did, and resign in six months.
The complete inability for anybody in any of these companies, in the past few days, to ask themselves, "Well, okay, are we the baddies?" and instead just doubling down on rhetoric like this and beefing up their own personal security is just... fascinating.
For well over a decade, public sentiment has largely been against healthcare companies. They go to sleep at night knowing the populace hates them. And yet there's a complete inability to look inward.
I think it's important to recognize that a lot of Americans (most? nearly all?) simply don't have a choice in health insurance. If you are on United, it's probably because that's what your employer has offered as a benefit. I don't remember how much choice I had when I purchased my own health insurance through the ACA, but that was also almost a decade ago and the market has likely changed. In light of that, I think this
> They go to sleep at night knowing the populace hates them. And yet there's a complete inability to look inward.
is because they go to sleep thinking, "what are our customers going to do about it? They're a captive audience. We only have to treat them as well as we are legally obligated to." And they are wholly unprepared for how many Americans are currently thinking, "hmm, I suppose murder is something we could do about it."
> I think it's important to recognize that a lot of Americans (most? nearly all?) simply don't have a choice in health insurance. If you are on United, it's probably because that's what your employer has offered as a benefit.
As a non-American, this was indeed a big surprise when someone here recently replied to me to make that exact point.
All the disadvantages of a monopoly, none of the advantages of a free market.
Kinda like the UK rail network and water systems, neither of which the British hold in high regard.
>> All the disadvantages of a monopoly, none of the advantages of a free market.
Yes. One thing I hate is the coupling of insurance and employment in the U.S. These things don't belong together. Most employers offer different "plans" but all through the same insurance company. A good question to ask in an interview is "who is your insurance provider?" Some really are better or worse. But again, it's wrong that this can even be a consideration in finding work.
Keep in mind that many/most medium size and larger companies will self insure and pay for administration of the plans.
I suppose the management contract probably won't really include terms about how aggressive the manager should be in rejecting terms (so you get what you get).
>is because they go to sleep thinking, "what are our customers going to do about it? They're a captive audience. We only have to treat them as well as we are legally obligated to." And they are wholly unprepared for how many Americans are currently thinking, "hmm, I suppose murder is something we could do about it."
This is obviously incorrect. Simply being hated has never been cause for finding fault with oneself . Most people think they are misunderstood. Half of America hates the other half, and vice versa.
>> They go to sleep at night knowing the populace hates them. And yet there's a complete inability to look inward.
> is because they go to sleep thinking, "what are our customers going to do about it? They're a captive audience.
I doubt they go even that far. Most nights, if not all, they probably don't even think about whatever harm they're doing. People have massive capabilities for self-justification, cherry-picking, and avoiding uncomfortable thoughts. Their whole ego is working full-time to make themselves the good-guy hero of their story.
I was surprised yesterday to discover that this awful "United Healthcare" company which everyone apparently loves to hate was in fact my own health-insurance provider for the last year. I had not noticed, because my employer routinely switches insurance plans, for reasons which presumably make sense somewhere far above my pay grade. (They switched us all to Regence last week. Is that bad? Is that good? I have no idea, and it doesn't matter, because there's nothing I can do about it anyway.)
Your assumption is wrong. The Affordable Care Act (Obamacare) imposed a minimum medical loss ratio on health plans. If they pay out less than that on claims then the excess is refunded to customers.
Most large employers now have self-funded health plans where they bear most of the financial risk and indirectly pay most of your claims. Thus HR departments have a major incentive to switch carriers to lower costs. Regence probably negotiated lower rates with their network providers.
But if you really think it's a scam then you're free to opt out of coverage during open enrollment.
I do think that any sufficiently consumer-hostile system becomes morally indistinguishable from a deliberate scam, but that part of my comment was a distraction and I deleted it. Sorry to have left you replying to a ghost.
The important point is that the patients are almost always not the customers.
Health insurance in the US is like a twisted version of the stilted app that corporate IT forces on employees, only different in that if it breaks it could kill or maim you or one of your loved ones.
I had a lesson in this 25 years ago. I think it was National Semiconductor. They had an early website that was engineering focused and really good for the time. You could do parametric search, compare products, ask questions of their sales engineers, ask for samples. Download datasheets.
One day it was completely replaced by a site extolling the virtues of National Semiconductor stock and the CEO, CFO, and the board. With smiling head shorts and bio's of each. WTF? A few months later the old site reappeared as a link down in the lower right corner.
The lesson. I thought of National Semiconductor as a company that designed and sold mixed signal semiconductors. And the CEO and Board thought of National Semiconductor as a company that sold stock. And they didn't care at all about the people buying semiconductors, they cared about their real customers.
I think that's what happens when you hire from outside the company and the people brought in have no relationship with the people that buy the products.
I think it's really worse than that. I'm always surprised how much psychological buy in you can get out of people with the right social incentives. It seems difficult for people surrounded by people with cultural attitudes and way of thinking to not slowly become corrupted by it.
The thing is, even though I know where I stand on this issue as someone with a chronic condition that’s required routine care and occasional intervention since birth…
I can see how they think they’re right. Our institutions built them to only equate success with income, and flooded their social networks with others of the same mind. They fought to join the ranks of the elites, and believe themselves to be deserving of every fortune and success associated with their status. Their entire world is an echo chamber, where money can - quite literally - isolate them from the rest of the world. They never have to see the people they fire, or know their hardships, or understand their grievances. They are, in effect, a completely different society separate from our own, yet dependent upon us and our sacrifice for their fortunes.
If it weren’t for the fact the ruling class are literally killing us to increase profits for themselves, I’d pity them for willingly staying within Plato’s cave, ignorant of how the real world works.
It's really not that hard to do. There are huge portions of the population that hate police officers, athletes, teachers/professors, politicians, etc... I think their ability to seemingly not look inward is because they fundamentally believe that people aren't trying to even understand what they're doing.
I'm sure the execs at health insurance companies feel like they are doing good work within the context of a for-profit business. The first thing to note is they acknowledge they are for-profit. And within that context they probably feel like they're trying to do the right thing against overzealous hospitals, doctors, fraud, and people don't sloppy work filing claims (even if not fraudulent).
I just don't see how you can't do trade-offs in a for-profit where costs can be almost effectively unbounded. So I think in aggregate all of these things can convince themselves that they're doing the best they can and the market will help ensure they do a good job.
Costs are bounded. The Affordable Care Act (Obamacare) imposed an 85% minimum medical loss ratio on most health plans.
Many commercial health insurers are non-profit. That includes such large organizations as many of the Blue Cross Blue Shield Association licensees, HighMark, EmblemHealth, etc. Their coverage and claim processing policies are pretty similar to the for-profit companies.
The way I read it is that costs are unbounded, not profits are unbounded.
The health insurers are responsible for negotiating, checking and denying costs. If not them, you would have a state bureaucrat in charge of denying claims. Many will argue this is better, but it still isn't a blank check.
As you point out, health insurance companies make money as a percentage of bills approved, not bills denied. The vast majority of Americans don't understand this.
The completely different and more insidious problem is that this provides an incentive to approve claims, but drive their prices up, like any government regulated cost plus contractor.
Cost Plus contracting only works when there is a competitive market and high transparency.
Government laws tying healthcare to employers mean there is almost no competition, and healthcare costs are inherently opaque due to their complexity.
I mention this elsewhere but there is a hidden other incentive that is less obvious: which poor bastards to offload the remaining 15% from. There is no guarantees that is done evenly, and there is high moral hazard to do it strategically.
That is a very fair point. Healthcare usage is nowhere close to even or consistent. It is a diverse collection of non-fungible treatments and services. Denial, even when performed with crystal clear justification, will not land evenly on subscribers.
> Many commercial health insurers are non-profit. That includes such large organizations as many of the Blue Cross Blue Shield Association licensees, HighMark, EmblemHealth, etc. Their coverage and claim processing policies are pretty similar to the for-profit companies.
This may lend even more weight to them being able to sleep well at night -- their company behaves in a way consistent with notable non-profits, so you can't accuse them of profit mongering.
My spiciest take is that "executives being gunned down in the street" is the natural consequence of the philosophy that corporations are amoral and have no duty but distributing profit to their shareholders.
My spicy cake is that it is the natural consequence of several decades of telling Americans that they have no Democratic agency and any policy or laws they disagree with are clearly illegitimate.
Selfishness is the opposite of compassion, and when one has chosen to prioritize money over human beings, they have left the Path of Loving Wisdom. The heartless CEOs of these corps are chosen for a deliberate set of reasons and after serious backgrounding. For that kind of money, they're not taking any chances, those selfish, callously cruel fools.
So long as they don't kill anyone or break any laws, we must let our local criminal justice systems perform their duties. Our criminal justice system here in America has all the processes we need to justly maintain society, where each person can be prosecuted for their crimes in an honest and honorable system without regard to station in society or wealth. That is all possible and it's the stated design.
Remember that until one decides to improve oneself's capability and desire to be compassionate, one only sees others in a predatory way, either with selfish desire or callous disregard. But we are not lions of the Serengeti, we are human beings with the capability for humanity, being a humanitarian, caring for others, as our highest human potential.
If only our economic system rewarded such people with positions of influence and power, then the world could change for the better, but under democracy -- the best system we know of -- the govts always reflect the amorality of the populace, often shrunk down to a very select group of citizens. I believe in a person having to earn my trust, just as I believe the same for me with respect to them.
It’s as the old punk lyric goes, “the guilty don’t feel guilty, they learn not to”.
It’s wild how much of the cyberpunk we read in the 80ies and 90ies are coming to pass though. This assassination was done in person, but how long will it take before someone flies a drone into their target instead?
To me, it feels facile, even cruel, to put so much blame on the the insurers when US laws and regulations have created every incentive for insurers to behave exactly as the they do and no incentive not to. Their behavior is entirely predictable.
Why is there not more criticism and blame put on our legislators and regulators who have done so little for the suffering public?
Is there any area of the market where we would expect that participants will all routinely act against their own self-interest and for the benefit of others? Markets have to be structured and regulated so that participants are incentivized to behave well. The US has not done that.
I'd be more inclined to sympathy if it were not for the well-documented fact that the overwhelming majority of healthcare-related legislation is drafted by lobby groups working on behalf of the health insurance industry. They literally designed the legislative framework that incentivizes shit medical outcomes. Hell, the mere existence of their business model creates moral hazard.
It is par for the course that businesses will lobby for their interests. That doesn't excuse our representatives for selling us out for a steak dinner and a first class flight to the Bahamas or whatever. We must holder our leaders to a higher standard than that.
The anger here on HN seems focused on the greed of the insurance companies, but that corporations tend to optimize for profit should surprise exactly no one. Where's the anger at our corrupt government?
To be be 100% clear, I'm not saying don't blame or criticize insurance companies executives. I'm saying that only blaming the insurance companies implicitly gives a free pass to our representatives who pass laws written by lobbyists. That is both unfair and counter productive, since the government is actually in a position to fix these issues.
>The anger here on HN seems focused on the greed of the insurance companies, but that corporations tend to optimize for profit should surprise exactly no one. Where's the anger at our corrupt government?
I imagine the anger is on them because one of them was murdered this week. I think a lot of us recognize that this isn't a black-and-white issue and that there's a lot of blame to go around. But when something like this happens to a specific part of the issue, of course we're likely to hone in on that in the immediate short-term.
The hatred is largely misdirected, based on an outdated misunderstanding of how the health insurance industry works. A lot of people still have the mental model that health insurance works something like auto insurance, where they pay in premiums every month and the insurer bears financial risk for paying claims — and thus has a financial incentive to deny claims. But most health plans no longer operate that way. The bulk of the industry has now moved to large self-funded employer-sponsored plans in which the health "insurance" companies no longer provide any real insurance or bear any risk. Instead they act as administrators, constructing provider networks and processing claims. The actual risk has been transferred to employers who pay the claims. Large employers prefer this model because it ends up being cheaper for them.
In the short term at least, health insurance companies have no direct financial incentive to deny any claims. In fact, due to the minimum medical loss ratio imposed by the Affordable Care Act (Obamacare) they actually make more profit by approving more claims. The coverage policies which lead to denied claims, step therapy, and prior authorization are really set by employers in order to hold down their costs. In other words, health insurers are really just doing the bidding of their customers.
If you don't like your health coverage then the fault most likely lies with your employer's HR department. To explain it another way, if a large company wanted to they could ask a health insurer to offer a custom plan which would pay every claim for any service, no questions asked. This would be enormously profitable for the insurer, but no employer wants to pay that much.
This is one of the reasons why tying healthcare access to employment via tax incentives was a bad idea. Unfortunately, for historical reasons it's politically difficult to move away from that coverage model.
HR departments generally have no authority over individual claims. Rather they work with insurers and independent employee benefits consultants to construct a health plan with certain benefits and coverage rules which they think will minimize costs (based on predictive analytics) without hurting employee retention too much. Large insurers offer employers a menu of options with various provider networks (narrow versus wide), negotiated rates, deductible / co-insurance / co-payment amounts, carve outs, special extra benefits, etc. Once the plan rules are set at the beginning of the year, the insurer just enforces the rules as written and passes the claim charges on to the employer.
Of course, sometimes health plans just make errors in claim processing and deny a claim that should have been approved. Or the provider makes an error and submits a claim with incorrect codes or lacking the necessary documentation to establish medical necessity as per coverage rules. Or there are gray areas where it's not always clear whether a certain service should be covered or not, and it comes down to a judgment call by a nurse or doctor employed by the insurer (medicine is still more art than science and the best treatment plan isn't always clear). This can be a huge hassle for patients dealing with serious medical conditions.
I think this gets to part of the issue at UHC. People are filing claims, thinking it is covered, but it gets denied.
I have read anecdotal reports that people working in government roles with UHC insurance have switched to identical plans in the private sector and got much worse denial rates with UHC plans offering the same coverage.
This fuels a completely speculative view that UHC might shift the 85% required healthcare costs towards favoring places where they may gain more market share and really shafting hard in other parts of the market. They can shit-can something like 15% of premiums so unequal allocation of that could lead disproportionately to some very pissed off people, even working within a system where profit is bounded by accepted claims. All of this would fit in well with a profit optimization strategy.
I'm not an expert on this but my understanding is that CMS enforces the MLR for each insurer on a per-state basis. So insurers don't have much opportunity to chase market share by shifting claim costs around between plans.
Regular federal government employees are all on private insurance plans, unless they're in the military or old enough to be covered by Medicare. So your comment about "switched to identical plans in the private sector" makes no sense. But the different private insurance plans offered to federal employees do have different benefits and different claim processing policies.
This sounds pretty good but there's still some friction between what you're describing and observed reality. If all if this is accurate what incentives exist for insurance providers to even consider policies like this: https://www.cnn.com/2024/12/05/health/anthem-blue-cross-blue...
So I'm obviously not privy to internal Anthem discussions but I'll speculate on what happened there based on industry trends. There has been a huge increase in anesthesia costs over the past several years and I suspect that Anthem's self-funded employer customers are pushing Anthem to find ways to cut those expenses. Most anesthesiologists work in private practices rather than as employees of hospitals or surgery centers. Private equity firms have been buying up those practices and establishing effective monopolies in some regions, then jacking their rates up. Anthem handled the messaging around this issue horribly but I kind of understand why they tried to impose some limits. It's not like patients would be denied necessary care or anesthesiologists wouldn't be paid, the insurance would just cap the maximum charges for certain procedures.
Ultimately only a small percentage of the total money in the healthcare system goes to payer (insurance company) profits. Much larger portions flow to providers, pharmaceutical companies, and device manufacturers. So as far as reforming the system we can maybe get a little savings by squeezing insurers but it's not going to solve any of the fundamental problems.
Your point about insurance industry profits is well-made, but I feel it slides rather smoothly past the gargantuan overhead the industry's mere existence demands. Given the industry does not provide healthcare services it seems straightforward to me that every penny spent either on insurance premiums or maintaining headcount to manage claims is money wasted.
Managing claims is a waste in the sense that it contributes nothing to patient care. But every modern healthcare system needs some mechanism for allocating resources and preventing waste / fraud / abuse by providers. There's a lot of room to improve efficiency around claims but even fully socialized healthcare systems incur a lot of administrative cost on those functions.
One alternative approach is to shift away from the current fee-for-service payment model towards a value-based care model. Financial risk is shifted from employers and consumers to provider organizations who receive a fixed capitated payment per member per month from the insurance company. Then the provider org has to do whatever is necessary to care for those patients. The participating providers no longer need to submit claims for payment, just report on what they did for each covered patient that month. It's not clear yet whether this model will work at scale but pilot programs have been encouraging.
A majority of the public are dissatisfied with the American healthcare system in general, but a majority are satisfied with their insurance provider and doctors.
What can they do, they have a fiduciary responsibility to their shareholders, that's the system as designed. They offloaded any and all moral scruples in order to become effectively cogs in the machine, and will be replaced by someone who's willing to ignore those pings of guilt to get the line moving up and to the right if necessary.
I don't think it's particularly fascinating and I'm incredibly confused why anyone would expect a different response. If a public figure you support got assassinated, is there even the slightest chance that you would take it as an opportunity to introspect on whether their critics might have a point?
I am struggling to come up with a way you could run a health insurance company and NOT be hated. Can anyone come up with examples of successful, beloved health insurance companies?
Their role in the system is to more or less to do rationing / make resource allocation decisions (or at least be the "administrative face" of rationing policies) and this is always going to be unpopular. While "look inward" is always good advice, I think these companies understand that some percentage of customers will hate them simply because that is the nature of the business.
They have to say "no" to some things. The more things they say "yes" to the higher your premiums are. If they say yes to way too many things (like public health care systems will tend to do) then you will see rationing by waitlist rather than price. They are also subject to the laws of large companies and so will make both random and systemic mistakes (just like every other large organisation) for the usual bureaucratic reasons.
Even if major systemic change is made, whatever entity is left with the responsibility of saying "no, you don't get that care" will still be hated.
I could be wrong but the first article I looked up on profits says United Healthcare Group made 22B, in profit in 2023. B, as in billion. Profit, not revenue. I’m not sure if they have any incentives to reduce that even if they could/should.
The number is large because they are a large entity with 350k employees and something like 400B revenue. They're also a public company with all the financial obligations and market expectations that come along with that.
There's another way to look at this. That's 22B removed from the larger economy ostensibly earmarked for healthcare that provided exactly none of that. That they are a public company is not in question. That the health insurance industry should even exist is certainly up for debate.
If we don't do single payer which seems like something that won't happen anytime soon in this country given the political climate, then at the very least we should force health insurance to be either non-profit or public benefit companies. then there won't be this well they have to deliver prophets to shareholder bullshit excuse about why they aren't giving money to the people they are supposed to insure.
They're a component of the S&P 500 / various indexes, so what is weird is that to some extent the drive for returns from people's own 401ks is the source of the oppression. The human centipede of capitalism.
Every country's healthcare system rations care. Demand is effectively infinite and resources are limited. Socialized systems tend to ration by restricting supply, forcing patients to wait for expensive treatments or simply not offering certain treatments at all. That might be a net improvement over private insurance but there are certainly some downsides.
Because to most of the people who work there - it's a job. It's their livelihood and most people will set aside a good chunk of their morals for a paycheck which is sad.
There's an extra level of indirectness. Dude was assassinated, there is almost no sympathy and it's this they are outraged by.
Sure, getting the top man assassinated isn't a reason to change what you do - it was one guy with a gun - but that no one is rushing to their defence is another matter.
I too find people celebrating some dudes assassination pretty gross. It’s not justice. The dude who did it slunk away never to be seen again. At least man up and turn yourself in.
Two forms of justice are being referred to but using the same notation which fails to convey meaning.
There's justice as she is implemented justice; likely being referenced by follow on poster as being impossible to fight for for a poor/normal man.
Then there is Justice as she Ought to be. Referenced by both people, but first poster is only seeing as it applies to the murder of a single man, by a single man but second poster sees as the sum total of injustices perpetrated against many under the guiding hand of the man murdered.
First poster can't believe that Justice as she Ought could accommodate the one man killing the other and the killer going free. Second poster sees the killer going free as a necessary precondition as a result of Justice as she Ought needing to find an instrumentality to elicit Justice as she Ought; the doer, in this sense, doesn't matter, as their behavior is the inevitable outcome of a greater force manifesting through them. If it weren't the case that were happening, there wouldn't be as much harmony and catharsis being undergone at the outcome.
Basically, poster 2 is arguing on a cosmic scale, poster 1 is primarily operating in a more highly constrained scope encompassing only the murder transaction. Poster 1 may, be understandably upset, particularly if they are of a proclivity to not understand where this is all coming from.
They know that eventually this will fade from the news and people will forget how bad the company is. They probably want to keep quiet until then. Hopefully, this attention will lead to some positive changes so that Americans can get better health insurance.
The public reaction around this reminds me a lot like shinzo abe's assassination given the reaction, although the former ceo wasn't a political figure. The public really seems gleeful around it, to be frank. The abe analogy is the general public reaction is sympathy towards the assassin and antipathy to the murdered.
Please. The media have been nothing but sympathetic and have continued to push the bullshit narrative that this came entirely out of the blue. My favorite quote was from Fox: "as so many try to process the why of it all". Why? I'll give you one guess.
The shooter is being hailed as a hero by a lot of people on Reddit (shocking, I know). When they catch him, if he puts up a gofundme for his defence, he's going to collect millions.
There's lots of speculation out there that the shooter was motivated by some failure at United. If so, UHC's PR people are probably in for some long hours during the trial when their dirty laundry gets aired.
> There's lots of speculation out there that the shooter was motivated by some failure at United. If so, UHC's PR people are probably in for some long hours during the trial when their dirty laundry gets aired.
I kinda doubt a judge would let the murder trial turn into a trial of UHC's policies.
I'd be surprised if none of the particulars of the person's case come out (if there are any relevant details). There's the trial in the courtroom and then there's the trial in the court of public opinion. There are people on Reddit calling for potential jurors to know about jury nullification because they seem to think the killing was justified. There's a lot of very angry people there.
> There's the trial in the courtroom and then there's the trial in the court of public opinion.
And the judge is going to want to keep those as separate as possible.
> There are people on Reddit calling for potential jurors to know about jury nullification because they seem to think the killing was justified.
What people say on Reddit doesn't really have any significance. IIRC, the entire legal system is pretty hostile to the concept of jury nullification, and I'm pretty there will be giant roadblocks in front of what those Redditors want.
It's not hard to find 12 citizens who have spent their whole lives on government VA / Medicaid / Medicare health plans and have no direct experience with private health insurance companies. Furthermore if this case actually comes to trial then the judge will likely sequester the jury and prohibit any testimony about the victim's line of work as being legally irrelevant.
Did you find the celebration over bin Laden's death similarly disgusting? How about someone who has been convicted for murder in a court of law and given the death penalty?
I'm not one to revel in vengeance, but it's awfully hard to argue that our society as a whole doesn't. Modulo that the discussion is about our means of justice and inadequate legal system, not the killing itself.
What is implied here is the use of AI will enable these claims to be processed more cheaply. I note there is nothing about claim fairness. The Industry regulators should be auditing claim fairness , both of the present system and any AI austomation. Any method of lowering the cost of claim processing, should also be shared with customers in form of CHEAPER insurance or better claims payments ????
> Any method of lowering the cost of claim processing, should also be shared with customers in form of CHEAPER insurance or better claims payments ????
Is that really how you think capitalism in America works in 2024 in practice?
I do not understand words - why included ....consider that some of the people who'd die in that scenario would also be CEOs.
reply..... Would the writer be meaning ... people are going to get more angry so these murder cases will increase ...?
Society is made up of the individual people. It makes little sense to blame it without looking at ones self. Almost everyone who holds society to blame, holds themselves blameless.
Can you expand on why you think this is a relevant point to make in response to my anecdote? Did I come across as trying to blame society here? That's not at all the point I was trying to make.
Sure. I saw you say that society had failed the other person, and that society had failed the main character of the story. Accusations of failure are generally viewed as accusations of blame. Many people use the concept of society to externalize fault. This isn't always the case, so I tried to frame my post as a point of clarification not necessarily one of negation
Ahhh, yeah I mean I think everyone holds some of the blame, both in my story and in the real world assassination situation.
My hope was to provoke people who would read my hypothetical story and think "that's justified" but also believe that killing a CEO is horrible and bad to rethink whether those things are really so far apart and who is to blame.
As a society we should strive to eliminate situations where people are dying, both from lack of healthcare and as retaliation for profiting off denying people care. Great power should come with great responsibility, and shirking of that responsibility should come with great consequences. We shouldn't be letting people stab eachother in the streets (or assassinate CEOs) but to profit off denying care to people should aslso have consequences. Assassination is an overcorrection, but it is perhaps closer to justice than a Manhattan penthouse.
FWIW I regret saying that I would expect the jury to acquit. I don't really. I just think that the context here is complex and we have to wrestle with it in order to be consistent in how we judge the act of killing.
