10 ms·

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

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...
    - andreimackenzie 2y ago
      Most people don't decide about their own medical "needs." They trust doctors, who are by and large expert and professional, yet frequently discredited by insurance companies. Insurance companies have too much power in this dynamic, and there should be limits to what they can deny once doctors deem it needed.
    - FireBeyond 2y ago
      > Who decides what care is "needed"? Everyone is going to die eventually. When the decision maker is accountant, RN, or AI versus physician, I know who _shouldn't_ be deciding it. The two experiences I've seen first hand (coincidentally both UHC): A willingness to deny vastly improved QOL for a simple surgery unless I spend an extended amount of time to determine whether somehow, a nasal spray would straighten the cartilage of a 95% deviation to the septum. As a paramedic, the realization that UHC routinely denied paying for HEMS (air ambulance) for serious car accident patients to trauma centers because of "lack of pre-authorization".
- 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?

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...
  - andreimackenzie 2y ago
    Most people don't decide about their own medical "needs." They trust doctors, who are by and large expert and professional, yet frequently discredited by insurance companies. Insurance companies have too much power in this dynamic, and there should be limits to what they can deny once doctors deem it needed.
  - FireBeyond 2y ago
    > Who decides what care is "needed"? Everyone is going to die eventually. When the decision maker is accountant, RN, or AI versus physician, I know who _shouldn't_ be deciding it. The two experiences I've seen first hand (coincidentally both UHC): A willingness to deny vastly improved QOL for a simple surgery unless I spend an extended amount of time to determine whether somehow, a nasal spray would straighten the cartilage of a 95% deviation to the septum. As a paramedic, the realization that UHC routinely denied paying for HEMS (air ambulance) for serious car accident patients to trauma centers because of "lack of pre-authorization".
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?