3 ms·
The ACA mandates that insurers spend 80-85% (depending on the particulars) on healthcare. If they don't meet that target, they have to issue rebates until they
by Meekro 2y ago
The ACA mandates that insurers spend 80-85% (depending on the particulars) on healthcare. If they don't meet that target, they have to issue rebates until they do.
What, exactly, should this man have done differently? I guess you could say he should have gone above & beyond the law, maybe pushed that up to 90%, but how do we know that this would have been enough to solve the problems people are complaining about?
- harimau777 2y agoCouldn't he have just not worked for an organization that is hurting people?
- Meekro 2y agoThat might have helped his soul, but it wouldn’t have helped the victims who had their claims wrongly denied.
- paxys 2y agoThis thinking is exactly what the article is talking about. The CEO sits in his office, looks at bunch of abstract spreadsheets saying that 80% of spending is going on healthcare, and pats himself on the back for doing a good job. But what about the single mom of 3 whose claim was falsely denied by the AI he rolled out? Whose responsibility is that, and the thousands of other cases like it?
- clipsy 2y agoTry flipping the question and asking yourself: given all of that, why did UHC have a false-denial rate more than double the industry average? For example, perhaps the issue here is that UHC was undercutting competitors knowing that the vast majority of their fraudulent denials would go unchallenged -- they still meet the requirement for minimum spending on payouts, but they attract more customers[0] and in so doing distort the health insurance market. [0]: Customers in this case are primarily businesses buying policies for their employees, rather than end users of the product.