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> 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 withdr

> 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. I am honestly extremely baffled about what your mental model here is. When UHC doesn't deny a claim, who is paying for that treatment? You can't just look at one side of the ledger when deciding whether the system is doing good or bad! They deny some claims and they pay for others! You're leaving out the whole second half!

kelseyfrog 2y ago
I omitted it because it doesn't change the calculus. If the child were brought up into the sunlight out of that vile place, if it were cleaned and fed and comforted, that would be a good thing, indeed; but if it were done, in that day and hour all the prosperity and beauty and delight of Omelas would wither and be destroyed.
- deleted 2y ago
  [deleted]
- kube-system 2y ago
  According to who? It changes the calculus for me. I pay my health insurance because it covers the services I need. I could absolutely opt out if I wanted to, but I don't.
  - kelseyfrog 2y ago
    Except we're not talking about the choice of being a customer or not. We're talking about the design choices of the system.
    - kube-system 2y ago
      The system wasn't designed. There were no design choices. The entire thing is a legacy result of expectations and costs that all started snowballing from the moment FDR decided wage caps were a good way to stop inflation. We're not in the situation we're in because anyone thought it was a good idea. We got here incrementally over ~80 years.
      - ruined 2y ago
        of course the system was designed. of course there were design choices. it's a system implemented and executed by human beings at every step, constantly. every functional atom of this implementation was a conscious choice by someone. if nothing else, a choice is constantly being made to persist with the present system. yes the design is a result of negotiation between countless people and groups of people, who all have varying power and responsibility and subjective consequence. yes all of these choices were made in context, but they were never the only choices that could have been made in that context. this negotiation, and these innumerable choices, these designs have been a major if not primary concern of the past twenty years of american politics, economy, and millions of individual lives. yes we have arrived at the implementation we see today, which seems ill-conceived, over-complicated, and pointlessly cruel. but at every moment that has passed and is passing now, different choices can be made, and a different system of different design can be implemented. we are still in this system because there is infrastructure that prevents change to a more agreeable system. negotiation tactics may have just changed.
        kube-system 2y ago
        Sure, the healthcare system is "designed and perpetuated" by all of its participants, in the same way that poor labor practices in Asia are perpetuated by Walmart cashiers. Technically all of the participants involved are a part of the system, yes, but my key point here is that none of them have the agency to change it. The only people who can change it are voters and congress themselves.
        dragonwriter 2y ago
  - runako 2y ago
    > I pay my health insurance because it covers the services I need I think that, aside from the cost, this is probably the biggest issue most people have with health insurance in the US. UHC makes a lot of money specifically in part by not covering services you need, for example by having accountants override your doctors's orders. If it were as simple as getting the services you need in exchange for money, I don't think as many people would hate the system as much.
    - kube-system 2y ago
      > If it were as simple as getting the services you need in exchange for money, I don't think as many people would hate the system as much. That's exactly how simple it is to be uninsured. The problem is the risk is not something people can absorb.
      - mancerayder 2y ago
        How many Go Fund Me sites were brought up because of high medical costs for some accident or cancer? Is foregoing insurance an improvement over that if it isn't even possibly one of the big causes?
        FireBeyond 2y ago
        And that the US is the only country in the world where hospital "deathbed divorce" is a thing, to try to avoid family being saddled with ship-anchor levels of debt.
        kube-system 2y ago
        > Is foregoing insurance an improvement over that No, it isn't, which is why people want some form of insurance, whether public or private. To mitigate risk. I was entertaining the comment about something being as "simple as getting the services you need in exchange for money". Which one certainly could do, but imposing that on everyone would also be a bad system for other reasons.
        2y ago
- salawat 2y ago
  >in that day and hour all the prosperity and beauty and delight of Omelas would wither and be destroyed. ...and nothing of positive value would be lost. For a paradise predisposed on the infliction of suffering on another is ill-gotten, and taints anyone that avails themselves of it once it's true nature is known. Our birthright is to toil to elevate one another; no more, no less. Omelas is a blight, a perversion, deserving of being scoured from the face of the Earth no matter where it pops up. Glad to see someone else was touched by that work. Greetings fellow wanderer.
- enoch_r 2y ago
  Look, in any system, there are going to have to be arguments where patients or doctors say some treatment is necessary, and the entity paying for the treatment says it's not. For example, in Canada, the Ontario government refused to cover a cancer treatment that her doctors said could extend her life by a year or more: https://globalnews.ca/news/927721/milton-mother-devastated-after-ohip-fails-to-cover-cancer-treatment/ https://globalnews.ca/news/927721/milton-mother-devastated-a... In the UK, two Cystic Fibrosis drugs were rejected for not being cost-effective even though they were clinically effective. https://www.cysticfibrosis.org.uk/news/nice-rejects-orkambi https://www.cysticfibrosis.org.uk/news/nice-rejects-orkambi https://www.fiercepharma.com/pharma/nices-trikafta-snub-could-portend-another-pricing-standoff-between-vertex-and-uk https://www.fiercepharma.com/pharma/nices-trikafta-snub-coul... You will of course stick to your principles here? The single-payer healthcare systems in Canada and the UK are irredeemable and it's morally repugnant to look at any good they've done for anyone?

kelseyfrog 2y ago

I omitted it because it doesn't change the calculus. If the child were brought up into the sunlight out of that vile place, if it were cleaned and fed and comforted, that would be a good thing, indeed; but if it were done, in that day and hour all the prosperity and beauty and delight of Omelas would wither and be destroyed.

deleted 2y ago
[deleted]
kube-system 2y ago
According to who? It changes the calculus for me. I pay my health insurance because it covers the services I need. I could absolutely opt out if I wanted to, but I don't.
- kelseyfrog 2y ago
  Except we're not talking about the choice of being a customer or not. We're talking about the design choices of the system.
  - kube-system 2y ago
    The system wasn't designed. There were no design choices. The entire thing is a legacy result of expectations and costs that all started snowballing from the moment FDR decided wage caps were a good way to stop inflation. We're not in the situation we're in because anyone thought it was a good idea. We got here incrementally over ~80 years.
    - ruined 2y ago
      of course the system was designed. of course there were design choices. it's a system implemented and executed by human beings at every step, constantly. every functional atom of this implementation was a conscious choice by someone. if nothing else, a choice is constantly being made to persist with the present system. yes the design is a result of negotiation between countless people and groups of people, who all have varying power and responsibility and subjective consequence. yes all of these choices were made in context, but they were never the only choices that could have been made in that context. this negotiation, and these innumerable choices, these designs have been a major if not primary concern of the past twenty years of american politics, economy, and millions of individual lives. yes we have arrived at the implementation we see today, which seems ill-conceived, over-complicated, and pointlessly cruel. but at every moment that has passed and is passing now, different choices can be made, and a different system of different design can be implemented. we are still in this system because there is infrastructure that prevents change to a more agreeable system. negotiation tactics may have just changed.
      - kube-system 2y ago
        Sure, the healthcare system is "designed and perpetuated" by all of its participants, in the same way that poor labor practices in Asia are perpetuated by Walmart cashiers. Technically all of the participants involved are a part of the system, yes, but my key point here is that none of them have the agency to change it. The only people who can change it are voters and congress themselves.
        dragonwriter 2y ago
- runako 2y ago
  > I pay my health insurance because it covers the services I need I think that, aside from the cost, this is probably the biggest issue most people have with health insurance in the US. UHC makes a lot of money specifically in part by not covering services you need, for example by having accountants override your doctors's orders. If it were as simple as getting the services you need in exchange for money, I don't think as many people would hate the system as much.
  - kube-system 2y ago
    > If it were as simple as getting the services you need in exchange for money, I don't think as many people would hate the system as much. That's exactly how simple it is to be uninsured. The problem is the risk is not something people can absorb.
    - mancerayder 2y ago
      How many Go Fund Me sites were brought up because of high medical costs for some accident or cancer? Is foregoing insurance an improvement over that if it isn't even possibly one of the big causes?
      - FireBeyond 2y ago
        And that the US is the only country in the world where hospital "deathbed divorce" is a thing, to try to avoid family being saddled with ship-anchor levels of debt.
      - kube-system 2y ago
        > Is foregoing insurance an improvement over that No, it isn't, which is why people want some form of insurance, whether public or private. To mitigate risk. I was entertaining the comment about something being as "simple as getting the services you need in exchange for money". Which one certainly could do, but imposing that on everyone would also be a bad system for other reasons.
        2y ago
salawat 2y ago
>in that day and hour all the prosperity and beauty and delight of Omelas would wither and be destroyed. ...and nothing of positive value would be lost. For a paradise predisposed on the infliction of suffering on another is ill-gotten, and taints anyone that avails themselves of it once it's true nature is known. Our birthright is to toil to elevate one another; no more, no less. Omelas is a blight, a perversion, deserving of being scoured from the face of the Earth no matter where it pops up. Glad to see someone else was touched by that work. Greetings fellow wanderer.
enoch_r 2y ago
Look, in any system, there are going to have to be arguments where patients or doctors say some treatment is necessary, and the entity paying for the treatment says it's not. For example, in Canada, the Ontario government refused to cover a cancer treatment that her doctors said could extend her life by a year or more: https://globalnews.ca/news/927721/milton-mother-devastated-after-ohip-fails-to-cover-cancer-treatment/ https://globalnews.ca/news/927721/milton-mother-devastated-a... In the UK, two Cystic Fibrosis drugs were rejected for not being cost-effective even though they were clinically effective. https://www.cysticfibrosis.org.uk/news/nice-rejects-orkambi https://www.cysticfibrosis.org.uk/news/nice-rejects-orkambi https://www.fiercepharma.com/pharma/nices-trikafta-snub-could-portend-another-pricing-standoff-between-vertex-and-uk https://www.fiercepharma.com/pharma/nices-trikafta-snub-coul... You will of course stick to your principles here? The single-payer healthcare systems in Canada and the UK are irredeemable and it's morally repugnant to look at any good they've done for anyone?