5 ms·

By this same logic, you are responsible for the death of every person who could have been saved by you donating all of your income beyond basic living expenses

by avalys 2y ago

By this same logic, you are responsible for the death of every person who could have been saved by you donating all of your income beyond basic living expenses (your personal "profit", if you will) to pay for their medical care. You monster! How many people could you have saved! Instead you spend your money on vacations, television, computer games, music, movies, coffee, whatever. Oh, what's that you say? _You_ (who, I presume, do not directly save any lives yourself) are morally allowed to use the profit from your labor on unnecessary things for your own pleasure, but people who actually work in healthcare must not just dedicate all of their professional energy and effort to helping people and saving lives, but also must not take any profits from it either, is that right? Healthcare can morally only be provided by charities?

aijdosaijd 2y ago
Personal income, that which sustains someones family, is vastly different then the billions made by United off the backs of those suffering. What, are you some healthcare exec or something? This is not the own you think it is.
- avalys 2y ago
  United Healthcare is a publicly-traded company which makes a 6% profit margin and pays a dividend, which means that those profits ultimately benefit people's retirement accounts, pensions and middle-class investments. The person who was killed made $10M last year, while UHC provided care to 52 million patients. So, the CEO was paid approximately $0.20 per patient treated last year. What part of all this do you believe is immoral?
  - dgfitz 2y ago
    It could have 65 million, I think it the immediate answer.
  - jonathanlb 2y ago
    Probably the part where people were denied care that they needed in order to provide profits and dividends to its shareholders.
    - avalys 2y ago
      1. Who decides what care is "needed"? Everyone is going to die eventually. I have a relative who believes they "need" ivermectin to prophylactically safeguard against contracting covid. Are insurance companies obligated to provide ivermectin to everyone who demands it, or should they apply some standard of efficacy and cost/benefit analysis? 2. Profits to shareholders and other people contributing their time and resources are also "needed", as without profits the only incentive to provide healthcare is charity, and charity has not proven to be an effective organizing principle to allocate the time and attention of millions of individuals in a complex society.
      - jonathanlb 2y ago
        Insurance companies refusing valid, evidence-based treatments != denying unproven demands. Likewise, framing healthcare as either for-profit or purely charitable ignores successful state-driven models worldwide that operate without prioritizing shareholder returns. Such false dichotomies and misdirection don’t justify profit-driven rationing of essential medical services. > Everyone is going to die eventually So why provide healthcare at all?
        nradov 2y ago
        Medicine is still more art than science. We only have clear evidence-based treatment guidelines for a limited set of conditions, and even with those there are a lot of exceptions. While health insurers do occasionally make egregious errors in denying claims or prior authorization requests, most of those fall into gray areas. Like if a patient is immobilized by severe hip pain should they go straight to joint replacement surgery or try physical therapy for a few months first? Ask 10 different physicians and you'll get 10 different treatment plans. And health insurers don't increase shareholder returns by denying claims. Due to the minimum medical loss ratio it's rather the opposite. Most of the pressure to tighten coverage rules actually comes from large self-funded employers who use those insurers not to provide insurance but rather to administer their health plans. https://www.cms.gov/marketplace/private-health-insurance/medical-loss-ratio https://www.cms.gov/marketplace/private-health-insurance/med...
  - kelseyfrog 2y ago
    The purpose of a system is what it does. It's functionally isomorphic to a black box where I make a deposit, every time it denies someone medical treatment I get back monetary reward and I can withdraw my deposit at any time. If we ask ourselves, "Should this black box exist?" I cannot reasonably expect people to say, "Yes." Yet, here we are.
    - kube-system 2y ago
      > The purpose of a system is what it does. As if systems always do as intended? If that were the case, my code would never have downtime! The interactions between intent and results in any sufficiently large system is inherently complex.
      - kelseyfrog 2y ago
        That's the opposite of what the phrase means. https://en.m.wikipedia.org/wiki/The_purpose_of_a_system_is_what_it_does https://en.m.wikipedia.org/wiki/The_purpose_of_a_system_is_w... If a system constantly fails to do what it was intended to do, then we should consider that what it does in reality is its true purpose. Basically this is functional structuralism.
        kube-system 2y ago
        I understand what it means. I think it is a silly maxim, because it is unnecessarily reductive. Employer sponsored healthcare insurance wasn't ever intended to be a good system for providing healthcare to people, it was popularized as a workaround for employers to raise wages during the Stabilization Act of 1942. Everything that has changed since then has been incremental changes for differing reasons. The idea that a huge system like this even has a single "intent" is ridiculous. It is made up of thousands of different actors, each in different situations with different intents and interests.
        kelseyfrog 2y ago
        Purpose != intent. Besides, no one is saying there is a single intent so refuting that point doesn't exactly a counter.
  - Eddy_Viscosity2 2y ago
    The immoral part is the care not provided to paying customers. Care denied, people made to hop through needless hoops at a time when they are already in distress. Delays and denials that cause suffering, they cause deaths. This is the immoral part.
  - TinkersW 2y ago
    UHC does not provide care, they are a leach on society, as all health insurances companies are.
    - hollerith 2y ago
      That's right. UHC has never done one good thing.
    - lotsofpulp 2y ago
      If UNH was approving all their claims, then people would complain about increased premiums/deductibles. People just want to complain about not being able to afford something they want (American healthcare). While UNH does some shameful things, even criminal things, the celebration of a public execution of a second in command guy is embarrassing for HN.
      - FireBeyond 2y ago
        This rather ignores the role of health "insurers", third party administrators, repricing specialists and every other middle man that contributes more significantly to the price of healthcare than the actual cost of providing that care.
        lotsofpulp 2y ago
        In the US healthcare chain, the ranking of profit margins goes (and this is public info from public financials): Pharmaceutical companies 20%+ Healthcare software companies (based on other software company margins). 20%+ Healthcare providers (doctor groups) Hospitals (HCA, tenet, etc) 10%+ Managed care organizations (MCOs, health insurers), retail pharmacies, and medicine distributors at the very bottom. ~2% Legal is also up there. Those millions and tens of millions of dollar judgments don’t come from thin air. Go ahead and get rid of MCOs, and at best you will reduce costs by 5%. Their medical loss ratios are 85% to 90%. They are just allocating the very limited resources among more and more demand. Someone is going to have to be the bad guy unless supply of healthcare is drastically increased and tort reform happens to bring down liability costs.
  - mancerayder 2y ago
    It has 52 million clients, but how much care was provided to clients is the open question that could be debated. It's certainly one of the big thoughts going around that the company denies payment for service unjustifiably and causes suffering for some number of these 52 million. Whether or not that's true is one of the questions for consideration in these debates.
  - pfannkuchen 2y ago
    On a slight tangent I’m a bit confused by Reddit type internet reaction acting like this guy is an evil mastermind of the insurance industry while he was apparently making $10M per year. Now that’s definitely a lot of money, but as far as industry masterminds go it’s not indicative of being top tier at all. Second or maybe third tier really. Is it the sort of situation where the company has 10 people all labeled “CEO” of different functions? Or was the $10M salary alone?
kelseyfrog 2y ago
"Logic" leads to black and white thinking. Quantity makes the quality.
- debo_ 2y ago
  Oh no! It's the trolley problem! https://youtu.be/33VUuu2fb1I https://youtu.be/33VUuu2fb1I
cdelsolar 2y ago
This is a specious argument. A healthcare provider has a special responsibility because of the nature of their work. By definition, their role involves providing essential care to those in need. Their professional mission and the ethical codes guiding them (e.g., the Hippocratic Oath for physicians) emphasize patient welfare above all. An average person, while still morally capable of altruism, does not have a professional, codified duty to care for others’ health as a primary function of their life. They are not the designated or societally recognized gatekeepers of life-saving services. In short, it’s not just about the availability of money; it’s about the nature and structure of the activity. Healthcare isn’t merely a commodity; it’s a critical social good. The moral expectations for an industry entrusted with people’s lives are and should be different from those applied to random private individuals. Healthcare providers, especially large corporations, control access to life-saving goods and services. When such entities profit substantially, they do so from a position of gatekeeping essential health resources. They often have significant market power and can influence prices, accessibility, and quality of care. This is categorically different from an individual’s personal discretionary spending, which does not impose direct barriers between people in need and the care required to save their lives. The moral outrage about profit in healthcare often centers on the idea that unnecessary suffering or death occurs not because of a lack of resources in general, but because of a deliberate choice to prioritize profit margins over patient well-being. When an individual chooses to keep their discretionary income rather than donate it, that is not typically a case of withholding a life-saving resource they directly control. It’s a missed opportunity for altruism, yes—but it’s not a systematic withholding of lifesaving treatment from a dependent patient population. The more direct your ability to help and the more acute the need, the stronger the moral obligation. A hospital that can provide a life-saving drug at a lower price but chooses not to, in order to maximize profit, is directly and immediately impacting patients’ lives. In contrast, an ordinary person’s failure to donate their personal entertainment budget to global health charities is morally less direct and involves a much more diffuse causal chain. The responsibility is mitigated by lack of proximity, lack of direct obligation, and lack of any professional or social contract stating that their role is to provide healthcare. Your argument tries to equate personal, optional altruism with the professional moral obligations of healthcare providers, but these are not parallel situations. The ethical landscape is more nuanced: Institutions and professionals whose entire function is to safeguard and restore health must be held to a standard consistent with that mission. This does not require expecting every individual to donate all surplus income, nor does it demand that healthcare only be provided by charities. It simply recognizes that the context and nature of healthcare services place a different and higher ethical obligation on those who profit from them.
deleted 2y ago
[deleted]
whaaaaat 2y ago
This is a ridiculous reduction. It's clear that the numbers matter here, and that one family's decisions are nothing compared to the harm this CEO can create or prevent.
aamargulies 2y ago
You’re being facetious, but Peter Singer made this exact point about “ordinary people being evil” in a famous philosophy essay in 1972. https://youtu.be/KVl5kMXz1vA?si=F__kWUXkcu4h-5iI https://youtu.be/KVl5kMXz1vA?si=F__kWUXkcu4h-5iI
BriggyDwiggs42 2y ago
> By this same logic, you are responsible for the death of every person who could have been saved by you donating all of your income beyond basic living expenses (your personal "profit", if you will) to pay for their medical care. To a degree yes, absolutely. If moral actions “improve the valence of conscious experience” in some utilitarian sense, most people take a lot of immoral actions every day. When you think of morality as more of a direction rather than an absolute “you either are or are not a sinner,” you can view the average person, and yourself, as deeply immoral, yet still get value from the understanding because you know the correct direction to move in if you want to improve yourself or society. With this definition, it’s easy to compare the morality of two people. To what degree did each exercise agency in order to either neglect a responsibility to do good, or to actively do harm? The person who deliberately did more harm could be said to be worse in their moral character. Now imagine a person chooses to become the head of a health insurance company in order to make large amounts of money, while aware of the fact that their industry produces profit by minimizing the coverage they pay out and that this will inevitably deny some people who ought to get coverage coverage; and, furthermore, that this wrongly denied proportion is much higher than it needs to be in order for their company to exist and pay its costs. Now imagine that, in response, this person actively uses their agency to worsen their company’s contribution to this situation for the gain of themselves and other relatively wealthy higher-ups at their company instead of taking any action within their means to better the situation. We can reason that this person is, when you sum up the raw quantity of harm they’ve deliberately caused, morally worse than the average person, who will likely have done vastly less deliberate harm over their life. Is an extrajudicial murder the solution? Probably not, in that it won’t directly produce the needed changes to move society in a marginally more moral direction. That being said, I sure won’t be shedding any tears, and I’ll shed much less than I would for an absolutely morally mediocre Joe Schmoe.
motorest 2y ago
> By this same logic, you are responsible for the death of every person who could have been saved by you donating (...) A healthcare provider makes a very important but simple offer: you pay us,and in exchange you grant you access to the medical treatments you need when you need it. They commit to provide that service. If you meet your end of the deal without any flaw and, in the very moment you need them to comply with their own offer, they deny you the service they promised you that you would have, do you agree the are responsible for you not having access to that treatment? Let's put it another way. Let's say you want to travel to some other place in your town to attend a meeting. You look up a taxi company advertisement, and you call them to arrange a ride. They say sure, you just need to pay us and you'll be taken from point A to B. You arrange your payment and wait for the cab. The cab arrives, but the driver tells you "well, I was looking at the travel plan and I decided I don't feel like driving you there", and drives off with your money. Is that taxi company responsible for you failing to attend the meeting?

by avalys 2y ago

aijdosaijd 2y ago

Personal income, that which sustains someones family, is vastly different then the billions made by United off the backs of those suffering. What, are you some healthcare exec or something? This is not the own you think it is.

avalys 2y ago
United Healthcare is a publicly-traded company which makes a 6% profit margin and pays a dividend, which means that those profits ultimately benefit people's retirement accounts, pensions and middle-class investments. The person who was killed made $10M last year, while UHC provided care to 52 million patients. So, the CEO was paid approximately $0.20 per patient treated last year. What part of all this do you believe is immoral?
- dgfitz 2y ago
  It could have 65 million, I think it the immediate answer.
- jonathanlb 2y ago
  Probably the part where people were denied care that they needed in order to provide profits and dividends to its shareholders.
  - avalys 2y ago
    1. Who decides what care is "needed"? Everyone is going to die eventually. I have a relative who believes they "need" ivermectin to prophylactically safeguard against contracting covid. Are insurance companies obligated to provide ivermectin to everyone who demands it, or should they apply some standard of efficacy and cost/benefit analysis? 2. Profits to shareholders and other people contributing their time and resources are also "needed", as without profits the only incentive to provide healthcare is charity, and charity has not proven to be an effective organizing principle to allocate the time and attention of millions of individuals in a complex society.
    - jonathanlb 2y ago
      Insurance companies refusing valid, evidence-based treatments != denying unproven demands. Likewise, framing healthcare as either for-profit or purely charitable ignores successful state-driven models worldwide that operate without prioritizing shareholder returns. Such false dichotomies and misdirection don’t justify profit-driven rationing of essential medical services. > Everyone is going to die eventually So why provide healthcare at all?
      - nradov 2y ago
        Medicine is still more art than science. We only have clear evidence-based treatment guidelines for a limited set of conditions, and even with those there are a lot of exceptions. While health insurers do occasionally make egregious errors in denying claims or prior authorization requests, most of those fall into gray areas. Like if a patient is immobilized by severe hip pain should they go straight to joint replacement surgery or try physical therapy for a few months first? Ask 10 different physicians and you'll get 10 different treatment plans. And health insurers don't increase shareholder returns by denying claims. Due to the minimum medical loss ratio it's rather the opposite. Most of the pressure to tighten coverage rules actually comes from large self-funded employers who use those insurers not to provide insurance but rather to administer their health plans. https://www.cms.gov/marketplace/private-health-insurance/medical-loss-ratio https://www.cms.gov/marketplace/private-health-insurance/med...
- kelseyfrog 2y ago
  The purpose of a system is what it does. It's functionally isomorphic to a black box where I make a deposit, every time it denies someone medical treatment I get back monetary reward and I can withdraw my deposit at any time. If we ask ourselves, "Should this black box exist?" I cannot reasonably expect people to say, "Yes." Yet, here we are.
  - kube-system 2y ago
    > The purpose of a system is what it does. As if systems always do as intended? If that were the case, my code would never have downtime! The interactions between intent and results in any sufficiently large system is inherently complex.
    - kelseyfrog 2y ago
      That's the opposite of what the phrase means. https://en.m.wikipedia.org/wiki/The_purpose_of_a_system_is_what_it_does https://en.m.wikipedia.org/wiki/The_purpose_of_a_system_is_w... If a system constantly fails to do what it was intended to do, then we should consider that what it does in reality is its true purpose. Basically this is functional structuralism.
      - kube-system 2y ago
        I understand what it means. I think it is a silly maxim, because it is unnecessarily reductive. Employer sponsored healthcare insurance wasn't ever intended to be a good system for providing healthcare to people, it was popularized as a workaround for employers to raise wages during the Stabilization Act of 1942. Everything that has changed since then has been incremental changes for differing reasons. The idea that a huge system like this even has a single "intent" is ridiculous. It is made up of thousands of different actors, each in different situations with different intents and interests.
        kelseyfrog 2y ago
        Purpose != intent. Besides, no one is saying there is a single intent so refuting that point doesn't exactly a counter.
- Eddy_Viscosity2 2y ago
  The immoral part is the care not provided to paying customers. Care denied, people made to hop through needless hoops at a time when they are already in distress. Delays and denials that cause suffering, they cause deaths. This is the immoral part.
- TinkersW 2y ago
  UHC does not provide care, they are a leach on society, as all health insurances companies are.
  - hollerith 2y ago
    That's right. UHC has never done one good thing.
  - lotsofpulp 2y ago
    If UNH was approving all their claims, then people would complain about increased premiums/deductibles. People just want to complain about not being able to afford something they want (American healthcare). While UNH does some shameful things, even criminal things, the celebration of a public execution of a second in command guy is embarrassing for HN.
    - FireBeyond 2y ago
      This rather ignores the role of health "insurers", third party administrators, repricing specialists and every other middle man that contributes more significantly to the price of healthcare than the actual cost of providing that care.
      - lotsofpulp 2y ago
        In the US healthcare chain, the ranking of profit margins goes (and this is public info from public financials): Pharmaceutical companies 20%+ Healthcare software companies (based on other software company margins). 20%+ Healthcare providers (doctor groups) Hospitals (HCA, tenet, etc) 10%+ Managed care organizations (MCOs, health insurers), retail pharmacies, and medicine distributors at the very bottom. ~2% Legal is also up there. Those millions and tens of millions of dollar judgments don’t come from thin air. Go ahead and get rid of MCOs, and at best you will reduce costs by 5%. Their medical loss ratios are 85% to 90%. They are just allocating the very limited resources among more and more demand. Someone is going to have to be the bad guy unless supply of healthcare is drastically increased and tort reform happens to bring down liability costs.
- mancerayder 2y ago
  It has 52 million clients, but how much care was provided to clients is the open question that could be debated. It's certainly one of the big thoughts going around that the company denies payment for service unjustifiably and causes suffering for some number of these 52 million. Whether or not that's true is one of the questions for consideration in these debates.
- pfannkuchen 2y ago
  On a slight tangent I’m a bit confused by Reddit type internet reaction acting like this guy is an evil mastermind of the insurance industry while he was apparently making $10M per year. Now that’s definitely a lot of money, but as far as industry masterminds go it’s not indicative of being top tier at all. Second or maybe third tier really. Is it the sort of situation where the company has 10 people all labeled “CEO” of different functions? Or was the $10M salary alone?

kelseyfrog 2y ago

"Logic" leads to black and white thinking. Quantity makes the quality.

debo_ 2y ago
Oh no! It's the trolley problem! https://youtu.be/33VUuu2fb1I https://youtu.be/33VUuu2fb1I

cdelsolar 2y ago

This is a specious argument. A healthcare provider has a special responsibility because of the nature of their work. By definition, their role involves providing essential care to those in need. Their professional mission and the ethical codes guiding them (e.g., the Hippocratic Oath for physicians) emphasize patient welfare above all. An average person, while still morally capable of altruism, does not have a professional, codified duty to care for others’ health as a primary function of their life. They are not the designated or societally recognized gatekeepers of life-saving services. In short, it’s not just about the availability of money; it’s about the nature and structure of the activity. Healthcare isn’t merely a commodity; it’s a critical social good. The moral expectations for an industry entrusted with people’s lives are and should be different from those applied to random private individuals. Healthcare providers, especially large corporations, control access to life-saving goods and services. When such entities profit substantially, they do so from a position of gatekeeping essential health resources. They often have significant market power and can influence prices, accessibility, and quality of care. This is categorically different from an individual’s personal discretionary spending, which does not impose direct barriers between people in need and the care required to save their lives. The moral outrage about profit in healthcare often centers on the idea that unnecessary suffering or death occurs not because of a lack of resources in general, but because of a deliberate choice to prioritize profit margins over patient well-being. When an individual chooses to keep their discretionary income rather than donate it, that is not typically a case of withholding a life-saving resource they directly control. It’s a missed opportunity for altruism, yes—but it’s not a systematic withholding of lifesaving treatment from a dependent patient population. The more direct your ability to help and the more acute the need, the stronger the moral obligation. A hospital that can provide a life-saving drug at a lower price but chooses not to, in order to maximize profit, is directly and immediately impacting patients’ lives. In contrast, an ordinary person’s failure to donate their personal entertainment budget to global health charities is morally less direct and involves a much more diffuse causal chain. The responsibility is mitigated by lack of proximity, lack of direct obligation, and lack of any professional or social contract stating that their role is to provide healthcare. Your argument tries to equate personal, optional altruism with the professional moral obligations of healthcare providers, but these are not parallel situations. The ethical landscape is more nuanced: Institutions and professionals whose entire function is to safeguard and restore health must be held to a standard consistent with that mission. This does not require expecting every individual to donate all surplus income, nor does it demand that healthcare only be provided by charities. It simply recognizes that the context and nature of healthcare services place a different and higher ethical obligation on those who profit from them.

deleted 2y ago

[deleted]

whaaaaat 2y ago

This is a ridiculous reduction. It's clear that the numbers matter here, and that one family's decisions are nothing compared to the harm this CEO can create or prevent.

aamargulies 2y ago

You’re being facetious, but Peter Singer made this exact point about “ordinary people being evil” in a famous philosophy essay in 1972. https://youtu.be/KVl5kMXz1vA?si=F__kWUXkcu4h-5iI https://youtu.be/KVl5kMXz1vA?si=F__kWUXkcu4h-5iI

BriggyDwiggs42 2y ago

> By this same logic, you are responsible for the death of every person who could have been saved by you donating all of your income beyond basic living expenses (your personal "profit", if you will) to pay for their medical care. To a degree yes, absolutely. If moral actions “improve the valence of conscious experience” in some utilitarian sense, most people take a lot of immoral actions every day. When you think of morality as more of a direction rather than an absolute “you either are or are not a sinner,” you can view the average person, and yourself, as deeply immoral, yet still get value from the understanding because you know the correct direction to move in if you want to improve yourself or society. With this definition, it’s easy to compare the morality of two people. To what degree did each exercise agency in order to either neglect a responsibility to do good, or to actively do harm? The person who deliberately did more harm could be said to be worse in their moral character. Now imagine a person chooses to become the head of a health insurance company in order to make large amounts of money, while aware of the fact that their industry produces profit by minimizing the coverage they pay out and that this will inevitably deny some people who ought to get coverage coverage; and, furthermore, that this wrongly denied proportion is much higher than it needs to be in order for their company to exist and pay its costs. Now imagine that, in response, this person actively uses their agency to worsen their company’s contribution to this situation for the gain of themselves and other relatively wealthy higher-ups at their company instead of taking any action within their means to better the situation. We can reason that this person is, when you sum up the raw quantity of harm they’ve deliberately caused, morally worse than the average person, who will likely have done vastly less deliberate harm over their life. Is an extrajudicial murder the solution? Probably not, in that it won’t directly produce the needed changes to move society in a marginally more moral direction. That being said, I sure won’t be shedding any tears, and I’ll shed much less than I would for an absolutely morally mediocre Joe Schmoe.

motorest 2y ago

> By this same logic, you are responsible for the death of every person who could have been saved by you donating (...) A healthcare provider makes a very important but simple offer: you pay us,and in exchange you grant you access to the medical treatments you need when you need it. They commit to provide that service. If you meet your end of the deal without any flaw and, in the very moment you need them to comply with their own offer, they deny you the service they promised you that you would have, do you agree the are responsible for you not having access to that treatment? Let's put it another way. Let's say you want to travel to some other place in your town to attend a meeting. You look up a taxi company advertisement, and you call them to arrange a ride. They say sure, you just need to pay us and you'll be taken from point A to B. You arrange your payment and wait for the cab. The cab arrives, but the driver tells you "well, I was looking at the travel plan and I decided I don't feel like driving you there", and drives off with your money. Is that taxi company responsible for you failing to attend the meeting?