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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 doubli

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. Fascinating.

block_dagger 2y ago
If "fascinating" were "repulsive" I'd be aligned with your post.
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VyseofArcadia 2y ago
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."
- ben_w 2y ago
  > 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.
  - VyseofArcadia 2y ago
    > All the disadvantages of a monopoly, none of the advantages of a free market. Just wait until someone tells you about Comcast.
    - throwaway48476 2y ago
      Comcast executives would be in real danger if their customers got working internet.
  - phkahler 2y ago
    >> 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.
    - maxerickson 2y ago
      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).
- s1artibartfast 2y ago
  >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.
- jnwatson 2y ago
  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.
  - onewheeltom 2y ago
    The patients are the fuel that drive revenue
- tivert 2y ago
  >> 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.
- marssaxman 2y ago
  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.)
  - deleted 2y ago
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  - nradov 2y ago
    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. https://www.cms.gov/marketplace/private-health-insurance/medical-loss-ratio https://www.cms.gov/marketplace/private-health-insurance/med... 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.
    - marssaxman 2y ago
      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.
- ryandvm 2y ago
  > We only have to treat them as well as we are legally obligated to They don't even do that. They only treat you as well as your state's AG is inclined to be interested in your situation.
- Gibbon1 2y ago
  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.
  - throwaway48476 2y ago
    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.
    - Gibbon1 2y ago
      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.
stego-tech 2y ago
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.
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fullshark 2y ago
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.
- MrMcCall 2y ago
  10/10 no notes, well done, indeed.
kenjackson 2y ago
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.
- nradov 2y ago
  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.
  - s1artibartfast 2y ago
    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.
MrMcCall 2y ago
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.
rich_sasha 2y ago
> are we the baddies? https://youtu.be/ToKcmnrE5oY?si=4qjTyltGXoq0mkJZ https://youtu.be/ToKcmnrE5oY?si=4qjTyltGXoq0mkJZ
tzs 2y ago
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.
SpicyLemonZest 2y ago
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?
- s1artibartfast 2y ago
  Exactly! Feeling simply doesn't trigger introspection and it is an absurd expectation.
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ugh123 2y ago
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.
duped 2y ago
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.
- s1artibartfast 2y ago
  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.
devjab 2y ago
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?
nradov 2y ago
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.
- capybaraStorm 2y ago
  This is a fascinating insight. Can you walk me through, at what point the HR department has the power to delay and deny claims for medical care covered under the insurance contract? It is my understanding the hatred doesn't extend so much in the denial of claims but rather the denial of claims for covered events.
  - nradov 2y ago
    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.
cyanydeez 2y ago
Looking at trumps nominations of billionaires theyre rightfully confused. Didnt america just elect business super heroes...
xyzzy123 2y ago
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.
- silverquiet 2y ago
  > I am struggling to come up with a way you could run a health insurance company and NOT be hated. Perhaps this is a sign that a health insurance company is inherently a poor way to provide health care to a country. > Their role in the system is to more or less to do rationing / make resource allocation decisions And they increase their profits by rationing more. And as is so often pointed out to me, the highest priority of a private company is profit.
  - nradov 2y ago
    That is simply false. Due to the minimum medical loss ratio, rationing care doesn't increase health insurer profits. Rather the opposite. https://www.cms.gov/marketplace/private-health-insurance/medical-loss-ratio https://www.cms.gov/marketplace/private-health-insurance/med... 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. https://peterattiamd.com/saumsutaria/ https://peterattiamd.com/saumsutaria/
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jaredklewis 2y ago
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.
- forgetfreeman 2y ago
  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.
  - jaredklewis 2y ago
    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.
    - forgetfreeman 2y ago
      We're in violent agreement here.

block_dagger 2y ago

If "fascinating" were "repulsive" I'd be aligned with your post.

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VyseofArcadia 2y ago

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."

ben_w 2y ago
> 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.
- VyseofArcadia 2y ago
  > All the disadvantages of a monopoly, none of the advantages of a free market. Just wait until someone tells you about Comcast.
  - throwaway48476 2y ago
    Comcast executives would be in real danger if their customers got working internet.
- phkahler 2y ago
  >> 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.
  - maxerickson 2y ago
    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).
s1artibartfast 2y ago
>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.
jnwatson 2y ago
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.
- onewheeltom 2y ago
  The patients are the fuel that drive revenue
tivert 2y ago
>> 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.
marssaxman 2y ago
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.)
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- nradov 2y ago
  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. https://www.cms.gov/marketplace/private-health-insurance/medical-loss-ratio https://www.cms.gov/marketplace/private-health-insurance/med... 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.
  - marssaxman 2y ago
    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.
ryandvm 2y ago
> We only have to treat them as well as we are legally obligated to They don't even do that. They only treat you as well as your state's AG is inclined to be interested in your situation.
Gibbon1 2y ago
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.
- throwaway48476 2y ago
  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.
  - Gibbon1 2y ago
    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.

stego-tech 2y ago

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.

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fullshark 2y ago

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.

MrMcCall 2y ago
10/10 no notes, well done, indeed.

kenjackson 2y ago

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.

nradov 2y ago
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.
- s1artibartfast 2y ago
  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.

MrMcCall 2y ago

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.

rich_sasha 2y ago

> are we the baddies? https://youtu.be/ToKcmnrE5oY?si=4qjTyltGXoq0mkJZ https://youtu.be/ToKcmnrE5oY?si=4qjTyltGXoq0mkJZ

tzs 2y ago

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.

SpicyLemonZest 2y ago

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?

s1artibartfast 2y ago
Exactly! Feeling simply doesn't trigger introspection and it is an absurd expectation.
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ugh123 2y ago

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.

duped 2y ago

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.

s1artibartfast 2y ago
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.

devjab 2y ago

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?

nradov 2y ago

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.

capybaraStorm 2y ago
This is a fascinating insight. Can you walk me through, at what point the HR department has the power to delay and deny claims for medical care covered under the insurance contract? It is my understanding the hatred doesn't extend so much in the denial of claims but rather the denial of claims for covered events.
- nradov 2y ago
  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.

cyanydeez 2y ago

Looking at trumps nominations of billionaires theyre rightfully confused. Didnt america just elect business super heroes...

xyzzy123 2y ago

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.

silverquiet 2y ago
> I am struggling to come up with a way you could run a health insurance company and NOT be hated. Perhaps this is a sign that a health insurance company is inherently a poor way to provide health care to a country. > Their role in the system is to more or less to do rationing / make resource allocation decisions And they increase their profits by rationing more. And as is so often pointed out to me, the highest priority of a private company is profit.
- nradov 2y ago
  That is simply false. Due to the minimum medical loss ratio, rationing care doesn't increase health insurer profits. Rather the opposite. https://www.cms.gov/marketplace/private-health-insurance/medical-loss-ratio https://www.cms.gov/marketplace/private-health-insurance/med... 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. https://peterattiamd.com/saumsutaria/ https://peterattiamd.com/saumsutaria/

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jaredklewis 2y ago

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.

forgetfreeman 2y ago
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.
- jaredklewis 2y ago
  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.
  - forgetfreeman 2y ago
    We're in violent agreement here.