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Do you dream of one day working on important problems and making hard decisions with no right answer?

by avalys 2y ago

ceejayoz 2y ago
Yes. I don't dream of working on ways to deny needed medical coverage to pad my pockets. https://www.cnn.com/2018/05/13/health/liver-transplant-mom-erika-zak/index.html https://www.cnn.com/2018/05/13/health/liver-transplant-mom-e... has a nice illustrative example of how silly the system UnitedHealthcare and others set up can get. https://www.nytimes.com/2024/12/05/nyregion/delay-deny-defend-united-health-care-insurance-claims.html https://www.nytimes.com/2024/12/05/nyregion/delay-deny-defen... > Earlier this year, a Senate committee investigated Medicare Advantage plans denying nursing care to patients who were recovering from falls and strokes. It concluded that three major companies — UnitedHealthcare, Humana and CVS, which owns Aetna — were intentionally denying claims for this expensive care to increase profits. UnitedHealthcare, the report noted, denied requests for such nursing stays three times more often than it did for other services. (Humana had an even higher figure, denying at a rate 16 times higher.) https://www.propublica.org/article/unitedhealth-healthcare-insurance-denial-ulcerative-colitis https://www.propublica.org/article/unitedhealth-healthcare-i... > As United reviewed McNaughton’s treatment, he and his family were often in the dark about what was happening or their rights. Meanwhile, United employees misrepresented critical findings and ignored warnings from doctors about the risks of altering McNaughton’s drug plan. > At one point, court records show, United inaccurately reported to Penn State and the family that McNaughton’s doctor had agreed to lower the doses of his medication. Another time, a doctor paid by United concluded that denying payments for McNaughton’s treatment could put his health at risk, but the company buried his report and did not consider its findings. The insurer did, however, consider a report submitted by a company doctor who rubber-stamped the recommendation of a United nurse to reject paying for the treatment.
anonymousab 2y ago
There are right answers though. Certainly far more "right" than what they currently do. They can, in fact, have their billions of profits while not putting their customers in the grave. It's just slightly less profit than they currently get. Squeezing the blood from the stone here is entirely a choice.
- avalys 2y ago
  How much profit do you think they make, exactly? How much do you think they should be entitled to make? If the answer is zero, why would anyone invest in a company that can’t make money? If the answer is that healthcare should be run by the government, why are you blaming the CEO instead of politicians?
  - ceejayoz 2y ago
    Who do you think lobbies those politicians?
    - avalys 2y ago
      Are the politicians not accountable for the decisions they make? Who has a greater moral accountability to the public - politicians or corporate CEOs?
      - ceejayoz 2y ago
        That’s a false dichotomy. The correct answer is “both, they are willing accomplices”.
- patmcc 2y ago
  A lot of this data is open: https://www.kff.org/private-insurance/state-indicator/average-gross-margin-on-the-individual-market/?currentTimeframe=0&sortModel=%7B%22colId%22:%22Location%22,%22sort%22:%22asc%22%7D https://www.kff.org/private-insurance/state-indicator/averag... That shows the gross margin of insurance companies (based on premiums vs paid claims). Note that it's negative in some states, and also that's gross margin - so all the insurance companies' costs need to be paid out of that. They are not making as much profit as you think they are.
  - bigtex88 2y ago
    Literally any profit is too much for these companies.
WD-42 2y ago
Is optimizing denial of service to increase profits what you would consider an "important problem" with no right answer?
- avalys 2y ago
  I think reducing healthcare costs in the US is an important problem with no right answers, and this sometimes involves denying care that people think they need.
  - WD-42 2y ago
    That’s not the problem being solved. If it were, the answer would be to pay out the same amount taken in. As evidenced by the fact that the company in question has investor meetings, the problem being solved is to pay out as little relative the amount taken in.
lawlessone 2y ago
>with no right answer? When the options are deny healthcare to someone that has paid you for healthcare and give them the healthcare, it's not morally grey.
happytoexplain 2y ago
"No right answer" is a very common weasel phrase - technically correct sometimes, but clearly some answers are better than others.

Do you dream of one day working on important problems and making hard decisions with no right answer?

by avalys 2y ago

Do you dream of one day working on important problems and making hard decisions with no right answer?

Yes. I don't dream of working on ways to deny needed medical coverage to pad my pockets. https://www.cnn.com/2018/05/13/health/liver-transplant-mom-erika-zak/index.html https://www.cnn.com/2018/05/13/health/liver-transplant-mom-e... has a nice illustrative example of how silly the system UnitedHealthcare and others set up can get. https://www.nytimes.com/2024/12/05/nyregion/delay-deny-defend-united-health-care-insurance-claims.html https://www.nytimes.com/2024/12/05/nyregion/delay-deny-defen... > Earlier this year, a Senate committee investigated Medicare Advantage plans denying nursing care to patients who were recovering from falls and strokes. It concluded that three major companies — UnitedHealthcare, Humana and CVS, which owns Aetna — were intentionally denying claims for this expensive care to increase profits. UnitedHealthcare, the report noted, denied requests for such nursing stays three times more often than it did for other services. (Humana had an even higher figure, denying at a rate 16 times higher.) https://www.propublica.org/article/unitedhealth-healthcare-insurance-denial-ulcerative-colitis https://www.propublica.org/article/unitedhealth-healthcare-i... > As United reviewed McNaughton’s treatment, he and his family were often in the dark about what was happening or their rights. Meanwhile, United employees misrepresented critical findings and ignored warnings from doctors about the risks of altering McNaughton’s drug plan. > At one point, court records show, United inaccurately reported to Penn State and the family that McNaughton’s doctor had agreed to lower the doses of his medication. Another time, a doctor paid by United concluded that denying payments for McNaughton’s treatment could put his health at risk, but the company buried his report and did not consider its findings. The insurer did, however, consider a report submitted by a company doctor who rubber-stamped the recommendation of a United nurse to reject paying for the treatment.

anonymousab 2y ago

There are right answers though. Certainly far more "right" than what they currently do. They can, in fact, have their billions of profits while not putting their customers in the grave. It's just slightly less profit than they currently get. Squeezing the blood from the stone here is entirely a choice.

avalys 2y ago
How much profit do you think they make, exactly? How much do you think they should be entitled to make? If the answer is zero, why would anyone invest in a company that can’t make money? If the answer is that healthcare should be run by the government, why are you blaming the CEO instead of politicians?
- ceejayoz 2y ago
  Who do you think lobbies those politicians?
  - avalys 2y ago
    Are the politicians not accountable for the decisions they make? Who has a greater moral accountability to the public - politicians or corporate CEOs?
    - ceejayoz 2y ago
      That’s a false dichotomy. The correct answer is “both, they are willing accomplices”.
patmcc 2y ago
A lot of this data is open: https://www.kff.org/private-insurance/state-indicator/average-gross-margin-on-the-individual-market/?currentTimeframe=0&sortModel=%7B%22colId%22:%22Location%22,%22sort%22:%22asc%22%7D https://www.kff.org/private-insurance/state-indicator/averag... That shows the gross margin of insurance companies (based on premiums vs paid claims). Note that it's negative in some states, and also that's gross margin - so all the insurance companies' costs need to be paid out of that. They are not making as much profit as you think they are.
- bigtex88 2y ago
  Literally any profit is too much for these companies.

WD-42 2y ago

Is optimizing denial of service to increase profits what you would consider an "important problem" with no right answer?

avalys 2y ago
I think reducing healthcare costs in the US is an important problem with no right answers, and this sometimes involves denying care that people think they need.
- WD-42 2y ago
  That’s not the problem being solved. If it were, the answer would be to pay out the same amount taken in. As evidenced by the fact that the company in question has investor meetings, the problem being solved is to pay out as little relative the amount taken in.

lawlessone 2y ago

>with no right answer? When the options are deny healthcare to someone that has paid you for healthcare and give them the healthcare, it's not morally grey.

happytoexplain 2y ago

"No right answer" is a very common weasel phrase - technically correct sometimes, but clearly some answers are better than others.