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Annual 'winners' for most egregious US healthcare profiteering announced

162 points by hkmaxpro 2y ago

rednafi 2y ago
America is a rich country, but the majority of middle-class Americans are poorer than people in the Southeast Asian backwater I’m from. I emigrated to the U.S. in 2022 but left after a year. Life is plenty hard for citizens there, and despite working in tech, I constantly had this fear of needing healthcare in the back of my mind. I didn’t want to risk bankruptcy because of an insurance denial, so I left quickly. Aside from the dismal state of transportation, unwalkable cities, and a self-sabotaging healthcare system, I actually kind of enjoyed my time there. Now living in Europe, I’m poorer but happier too.
- SoftTalker 2y ago
  “The place I grew up is nicer than this new different place I’m now in” is very common. I grew up in a small town. I hate big cities. There are people who feel exactly the opposite because they grew up in big cities. Also you work in tech but weren’t provided or could not buy health insurance? That seems unlikely.
- gruez 2y ago
  >but the majority of middle-class Americans are poorer than people in the Southeast Asian backwater I’m from Source? I find this hard to believe given the US leads the OECD in terms of household disposable income[1], never mind whatever "Southeast Asian backwater" country you're talking about. It's unlikely "US healthcare profiteering" would affect this. Healthcare spending in the US is 17.6% of GDP, which provides an upper limit on how much it can eat into income. Even if you assume all that's borne by households and subtract that from income figures, the US would still be in #2. [1] https://www.oecd.org/en/data/indicators/household-disposable-income.html?oecdcontrol-7be7d0d9fc-var3=2022 https://www.oecd.org/en/data/indicators/household-disposable...
  - betaby 2y ago
    > household disposable income That doesn't matter a slightest if people can't afford housing. Income is indeed disposed, without much to show off.
    - davidgay 2y ago
      Disposable income is measured after housing expenses.
      - insane_dreamer 2y ago
        Incorrect. See below.
    - dralley 2y ago
      Disposable income by definition is post-expenses, which includes housing expenses.
      - smnrchrds 2y ago
        "Disposable income" means income after taxes. The word you are looking for is "discretionary income", which means income after taxes and necessities.
        deleted 2y ago
        [deleted]
      - insane_dreamer 2y ago
        No, that's not what disposable income means. Disposable income means income after taxes. It does not include any expenses, housing, health care, or otherwise. from the OECD website: > Income includes wages and salaries, mixed income (income from self-employment and unincorporated enterprises), income from pensions and other social benefits, and income from financial investments. It is less taxes on income, wealth, social security contributions paid by employees, the self-employed and the unemployed, interest on financial liabilities, and the change in net equity of households in pension funds. A bit of a clearer explanation here: https://en.wikipedia.org/wiki/Disposable_household_and_per_capita_income https://en.wikipedia.org/wiki/Disposable_household_and_per_c... The reason why the US has such high disposable income is because Americans have to pay for so much more out of pocket than other OECD countries do. Once you factor in health care, education and other social services that are cheap or free elsewhere, Americans are generally worse off than many OECD countries.
- 01HNNWZ0MV43FF 2y ago
  Which backwater? I'm looking for LGBTQ friendly places and there are not many to be had worldwide. Things are okay at the state level for me but federally about to go to hell
  - stronglikedan 2y ago
    > but federally about to go to hell If that were going to happen, then it would have already happened. It hasn't, and it won't. It's not healthy to worry about things you have been conditioned to believe by people that don't have your best interests at heart but will say anything to get your vote.
    - VHRanger 2y ago
      [flagged]
      - dinkumthinkum 2y ago
        [flagged]
      - aiionx 2y ago
        [dead]
    - hooverd 2y ago
      It's happening. Look at Florida or Texas. It's the model that the people soon to be in power want to emulate. They're quite outspoken about it.
      - mvdtnz 2y ago
        Then why didn't they do it 4-8 years ago?
        ttyprintk 2y ago
        With the Louisiana decision, protections are noticeably, gradually being demolished.
- breadwinner 2y ago
  > middle-class Americans are poorer than people in the Southeast Asian backwater I’m from Poorer than people in Bangladesh? Unlikely. Bangladesh per capita GDP is 2,529.08. US is $81,695.19.
  - wk_end 2y ago
    Your overall point still mostly stands, but per capita GDP isn’t super helpful when talking about middle class Americans because of wealth inequality. The median US income is less than half of that. And the cost of living in Bangladesh is probably something like a quarter of the COL in the US. So while there’s still a pretty stark difference in wealth, it’s not quite as stark as you’re implying.
    - nosefurhairdo 2y ago
      Purchasing Power Parity (PPP): This adjusts for cost of living and inflation rates between countries, giving a more accurate comparison of living standards. In 2023, GDP per capita in terms of PPP for Bangladesh and USA was $8,242 and $74,578 respectively (per World Bank).
      - bruce511 2y ago
        It is hard to compare one country to another because they are different in so many ways. Each has positives and negatives. Clearly the USA and Bangladesh are different. Comparing their GDP is simplistic and doesn't really speak to quality of life in either place. Much less does it take into account that two people in each country may in turn have vastly different quality of lives. In short, using national statistics tells us very little about your life, or my life, or any specific persons life.
        nosefurhairdo 2y ago
        The person I responded to (correctly) criticized per capita GDP, citing differences in cost of living. I felt that referencing PPP would be helpful since it attempts to factor in cost of living differences. I'm not sure this "comparisons are hard" speech is adding much. Differences in wealth are real, measurable, and meaningful, even if they can't be boiled down to a single number. Obviously there are other factors to quality of life; nobody here stated anything to the contrary.
- dlkf 2y ago
  What country are you referring to? The American middle class is objectively very wealthy: https://www.noahpinion.blog/p/no-the-us-is-not-a-poor-society-with https://www.noahpinion.blog/p/no-the-us-is-not-a-poor-societ...
  - insane_dreamer 2y ago
    That article is based on 1) disposable income, which is the wrong metric to use (because it doesn't account for the fact that the US has much higher expenses in health care and education than places like the EU, Japan, etc.), 2) housing size as a metric -- which is due to population density (Western Europe has nearly 5 times the population density of the USA) and the fact that US cities are built around cars, and 3) vehicle ownership, which is both a cultural hallmark of the US and due to the fact that you can't really live without a car (2 if you're married) in the US due to the way its cities are built. In short, laziest article ever.
- dinkumthinkum 2y ago
  >America is a rich country, but the majority of middle-class Americans are poorer than people in the Southeast Asian backwater I’m from. I think this is a real case of [citation needed]. Many people will, rightly, point at a myriad of statistics to demonstrate how this can't be true, and that's fine. But, I think we can just use some common sense; what are we talking about? There is no way this is true. Why would even need an immigration policy if this was true? This is just some kind anti-Americanism or anti-capitalism nonsense; that is really the only explanation for such an assertion that I can surmise. I'm also not really sure why working in tech you would be "constant fear of needing healthcare". If that is true then if nothing else the placebo of effect of moving to Europe may have been the best treatment psychologically, certainly cheaper than seeing a therapist.
  - drewrv 2y ago
    Why would working in tech shield someone from our healthcare system? “Most bankruptcies occurred in middle-class citizens with health insurance” https://www.amjmed.com/article/S0002-93430900525-7/fulltext https://www.amjmed.com/article/S0002-93430900525-7/fulltext If you haven’t been harmed by our system, it’s not because you’re immune. It’s because you’re lucky.
  - lazyasciiart 2y ago
    > Why would even need an immigration policy if this was true? Do you think Southeast Asian countries don't have an immigration policy?
    - dinkumthinkum 2y ago
      Well, I know HN is pedantic but the issue is why would so many people be trying to flee to the U.S. if it is worse than some "backwater". It makes no sense. I would assert that in extremely impoverished Southeast Asian countries, immigration is not a central concern.
- refurb 2y ago
  > America is a rich country, but the majority of middle-class Americans are poorer than people in the Southeast Asian backwater I’m from. This is such a wonderfully HN statement to make because it's so preposterously wrong, yet the author is so confident it's right.
  - ranger_danger 2y ago
    As a rule, strong feelings about issues do not emerge from deep understanding. -Sloman and Fernbach
  - deleted 2y ago
    [deleted]
- eitally 2y ago
  Meh. I'm American and also a middle class tech worker. I've never had concerns about insurance denial and also never been denied (or anyone in my immediate family). I feel like the care we've gotten has been excellent and I don't sweat it. My anecdote is worth at least as much as yours.
  - mindslight 2y ago
    The pop discourse is myopic and sensationalist. I've never personally dealt with an outright denial. When I've called "insurance" companies, they've been generally helpful. However, this is what I have experienced: Primary care repeatedly rescheduling appointments further down the road, 2-3 months at a time. At one point it got so bad for my elderly aunt that I straight up asked if they were just trying to "run down the clock". Primary care doctors saying they will put in a referral to a specialist. Then a month later just getting a photocopied list of specialists in the mail for us to call directly. Go down the line and most are closed or not accepting new patients. Some were even straight up dead (... like rigor mortis, habeas corpus). One of the two remaining specialists booking 8 months out for an initial consult, the other 5 months. Billing departments that don't feel it necessary to do the work of completing insurance claims, yet feel entitled to still continue sending fraudulent bills to us personally instead. Medical equipment providers outright lying about the validity of their fraudulent bills even when challenged with concrete reimbursement rates, and then doubling down with bullying - aka willful fraud. Needing to put in a bunch of paperwork, then follow up with appeals, merely to see the second geographically closest in-network provider (closer one was having issues) due to living near a state border. And none of this covers the harder-to-capture dynamics of getting shortchanged on time talking to a doctor because the bureaucrats have deemed that 15 minutes is enough time for an appointment, or having to continually make sure the ball doesn't get dropped on care due to the proliferation of different moving pieces. The problem isn't all on insurance companies themselves. The real problem is the entire system is broken due to poor incentives where these gigantic entities have been allowed to pass blame back and forth instead of having to own any responsibility themselves. This puts patients in the middle (often when they're in pressing need of healthcare), to get ground up in an ever-growing runaround, rather than any of these businesses having an incentive to minimize the administrative complexity. The "approval/denial" charade for in network care is just one of the most galling games they've made up, so it gets focused on.
- glimshe 2y ago
  I'm getting tired of reading this kind of stuff on HN, maybe I should just ignore it but a few friends from other parts of the world, also HN readers, are starting to believe it... So I'll try doing my part. Yes, the worst-case scenario for health expenses is indeed bad in the US, this is true. However, this is not the average healthcare experience. It's not a matter of time until you're slapped with a bankruptcy-level bill. My wife and I, both in our 50s, have had our share of insurance annoyances and frustrating phone calls, but we've had multiple surgeries fully covered by insurance. And this is the same with friends and family members, including at least 4 cancer treatments that did not lead to bankruptcy-level or even truly notable bills. This anecdote includes many people who died of "old age". Worst-case scenario bills can be bad elsewhere too. For instance, a friend in Europe had to do a 250K GoFundMe campaign to pay for a life-saving treatment for his daughter because well, the only place in the world that performed the surgery she needed was... Guess where? The US. He faced bankruptcy for this bill, but friends and strangers were able to help him out to an extent. I think he's still recovering from the expense years later. Medical bankruptcies and financially crushing bills are a sad possibility in the US, and certainly much more likely than in most other places. We need to keep working on this. But the vast majority of people will not have to face this problem in their lifetimes. I'm also from a "backwater" place in South America that happens to be richer than most places in Southeast Asia. I've lived decades both in the "backwater" and in the US - I happen to know the US fairly well as a result. I choose to live here for a simple reason: the quality of life in this country is much superior than my comfortable lifestyle in South America. I know dozens of people from different parts of Asia, and I can only remember a couple, let's say <3%, who went back to Asia after living in the US for a significant period of time. These are not poor Asians, in fact a lot of the Asians you meet in the US were relatively well off as they were able to afford the education in Asia which allowed them to immigrate. Nonetheless, they choose to remain here. All of this said, there is nothing wrong with wanting to go to a low COL place sometime in our lives. I've done this within the US myself, and I would consider another country for a combination of weather, proximity to friends, desire of early retirement or a large property etc. But not because the US is a bad place to live, in fact its very high quality of life is what keeps me from making such move.
  - gklitz 2y ago
monksy 2y ago
UHG only got #2 .. gotta pump up those numbers.
mrbluecoat 2y ago
> if we knew about it, then we have to ask: ‘Where are the regulators? Where are the people who should’ve known better? Profiting.
- palmfacehn 2y ago
  >Nationally, this equates to $38.6 billion each year to comply with the administrative aspects of regulatory compliance in just these nine domains. Looked at in another way, regulatory burden costs $1,200 every time a patient is admitted to a hospital. https://www.aha.org/guidesreports/2017-11-03-regulatory-overload-report https://www.aha.org/guidesreports/2017-11-03-regulatory-over...
  - dehugger 2y ago
    And it's still this much of a mess! It's almost like you can't regulate sanity into a for-profit healthcare system.
    - palmfacehn 2y ago
      You can regulate away healthy competition though.
roenxi 2y ago
> In a highly competitive year, the top spot went to Steward Health Care, whose CEO, Ralph de la Torre, is accused of prioritizing private-equity profits over patient care. His financial scheming led to bankruptcy... This seems inappropriate for an award for "profiteering". I believe that profiteering requires making a profit at some point. What did they want him to do, take the company to bankruptcy faster? And just eyeballing the margins on #2 [0] it looks they don't make that much money either. Those aren't particularly impressive margins. They compare more to Walmart than Google. [0] https://www.macrotrends.net/stocks/charts/UNH/unitedhealth-group/net-profit-margin https://www.macrotrends.net/stocks/charts/UNH/unitedhealth-g...
- lotsofpulp 2y ago
  De la torre is unrelated to UNH. De la torre led a company that sucked cash out of a hospital by separating it from its real estate, and literally sailed off with a couple yachts. https://www.wbur.org/news/2024/07/11/steward-health-care-investigation-corruption-fraud https://www.wbur.org/news/2024/07/11/steward-health-care-inv... https://www.wsj.com/business/steward-health-ceo-ralph-de-la-torre-deabfe4b https://www.wsj.com/business/steward-health-ceo-ralph-de-la-... https://www.beckershospitalreview.com/finance/as-stewards-financials-stumble-spotlight-turns-to-ceos-yachts.html https://www.beckershospitalreview.com/finance/as-stewards-fi... This group tore down an institution that took decades of work by extremely smart people to build, and now tens of thousands of people will get less and worse healthcare because of their actions.
  - roenxi 2y ago
    > De la torre is unrelated to UNH. Well, obviously. He was CEO of Steward Health Care. I suspect you have misread my comment.
    - lotsofpulp 2y ago
      Sorry, I somehow thought you connected UNH’s low profit margins to De la torre not profiting. I don’t see how he didn’t profiteer from his actions regarding Seward, though. It seems pretty clear that the real estate play he led caused Seward’s financial woes, which he benefited from.
ackbar03 2y ago
What are they trying to do? Put out a hit list?
s1artibartfast 2y ago
Strange list, some of this is flat out crime, not "profiteering". Fly by night companies submitting 2 billion in false Medicare invoices isn't capitalism. It is simple fraud taking advantage of Medicare incompetence. Same for doctors giving giving people chemo for years despite them never actually having cancer.
- munificent 2y ago
  Ignore the article title. The Lown Institute describes the awards as for the "worst examples of profiteering and dysfunction in healthcare".
  - s1artibartfast 2y ago
    Is crime dysfunction? I suppose it is if Medicare is so incompetent that fraud on that scale is possible.
    - munificent 2y ago
      Yes, the system has failed if a doctor can perform so much malpractice over such a long period of time without some supervisory organization discovering it.
      - lotsofpulp 2y ago
        If you do the fraud on a big enough scale, you can even get elected to be a governor and then US Senator. https://en.wikipedia.org/wiki/Rick_Scott https://en.wikipedia.org/wiki/Rick_Scott At worst, you pay some fines: https://abcnews.go.com/Health/wireStory/settling-fraud-case-ny-medicare-advantage-insurer-ceo-117094516 https://abcnews.go.com/Health/wireStory/settling-fraud-case-... > While dozens of CMS audits have concluded that health plans overcharged the government, the agency has done little to recoup money for the U.S. Treasury. >In a surprise action in late January 2023, CMS announced that it would settle for a fraction of the estimated tens of millions of dollars in overpayments uncovered through its audits dating to 2011 and not impose major financial penalties on health plans until a round of audits for 2018 payments, which have yet to be done. Exactly how much plans will end up paying back is unclear.
WalterBright 2y ago
> Doctors for United have reported pressure to reduce time spent with patients, and make patients seem as sick as possible through aggressive medical coding tactics. This is inevitable when government is handing out money. Recipients will always game the bureaucratic rules that specify payouts.
- bandrami 2y ago
  This is inevitable when doctors bill per service. When they are paid by capitation that incentive disappears
  - WalterBright 2y ago
    Nobody has ever devised a bureaucratic rule that cannot be gamed. Here, the test providers get paid by the test. Easy enough to kick back test payments to the doctors. As for paying by capitation, why would they work extra hours to serve more patients? Or just see fewer patients and relax?
    - bandrami 2y ago
      That's generally what happens, yes. Good, fast, cheap: pick two
- ttyprintk 2y ago
  My favorite is “Ayn Rand Institute accepts $1m PPP loan from The State” https://news.ycombinator.com/item?id=23764542 https://news.ycombinator.com/item?id=23764542
- palmfacehn 2y ago
  https://www.forbes.com/sites/johngoodman/2018/10/02/employers-could-slash-their-health-costs-overnight-so-why-dont-they/ https://www.forbes.com/sites/johngoodman/2018/10/02/employer... Directly paying for cash-priced surgery has become cheaper than the heavily regulated insured coverage. Not only cheaper when including the overhead of having insurance, but cheaper in real terms of a single surgery event.

162 points by hkmaxpro 2y ago

America is a rich country, but the majority of middle-class Americans are poorer than people in the Southeast Asian backwater I’m from. I emigrated to the U.S. in 2022 but left after a year. Life is plenty hard for citizens there, and despite working in tech, I constantly had this fear of needing healthcare in the back of my mind. I didn’t want to risk bankruptcy because of an insurance denial, so I left quickly. Aside from the dismal state of transportation, unwalkable cities, and a self-sabotaging healthcare system, I actually kind of enjoyed my time there. Now living in Europe, I’m poorer but happier too.

SoftTalker 2y ago
“The place I grew up is nicer than this new different place I’m now in” is very common. I grew up in a small town. I hate big cities. There are people who feel exactly the opposite because they grew up in big cities. Also you work in tech but weren’t provided or could not buy health insurance? That seems unlikely.
gruez 2y ago
>but the majority of middle-class Americans are poorer than people in the Southeast Asian backwater I’m from Source? I find this hard to believe given the US leads the OECD in terms of household disposable income[1], never mind whatever "Southeast Asian backwater" country you're talking about. It's unlikely "US healthcare profiteering" would affect this. Healthcare spending in the US is 17.6% of GDP, which provides an upper limit on how much it can eat into income. Even if you assume all that's borne by households and subtract that from income figures, the US would still be in #2. [1] https://www.oecd.org/en/data/indicators/household-disposable-income.html?oecdcontrol-7be7d0d9fc-var3=2022 https://www.oecd.org/en/data/indicators/household-disposable...
- betaby 2y ago
  > household disposable income That doesn't matter a slightest if people can't afford housing. Income is indeed disposed, without much to show off.
  - davidgay 2y ago
    Disposable income is measured after housing expenses.
    - insane_dreamer 2y ago
      Incorrect. See below.
  - dralley 2y ago
    Disposable income by definition is post-expenses, which includes housing expenses.
    - smnrchrds 2y ago
      "Disposable income" means income after taxes. The word you are looking for is "discretionary income", which means income after taxes and necessities.
      - deleted 2y ago
        [deleted]
    - insane_dreamer 2y ago
      No, that's not what disposable income means. Disposable income means income after taxes. It does not include any expenses, housing, health care, or otherwise. from the OECD website: > Income includes wages and salaries, mixed income (income from self-employment and unincorporated enterprises), income from pensions and other social benefits, and income from financial investments. It is less taxes on income, wealth, social security contributions paid by employees, the self-employed and the unemployed, interest on financial liabilities, and the change in net equity of households in pension funds. A bit of a clearer explanation here: https://en.wikipedia.org/wiki/Disposable_household_and_per_capita_income https://en.wikipedia.org/wiki/Disposable_household_and_per_c... The reason why the US has such high disposable income is because Americans have to pay for so much more out of pocket than other OECD countries do. Once you factor in health care, education and other social services that are cheap or free elsewhere, Americans are generally worse off than many OECD countries.
01HNNWZ0MV43FF 2y ago
Which backwater? I'm looking for LGBTQ friendly places and there are not many to be had worldwide. Things are okay at the state level for me but federally about to go to hell
- stronglikedan 2y ago
  > but federally about to go to hell If that were going to happen, then it would have already happened. It hasn't, and it won't. It's not healthy to worry about things you have been conditioned to believe by people that don't have your best interests at heart but will say anything to get your vote.
  - VHRanger 2y ago
    [flagged]
    - dinkumthinkum 2y ago
      [flagged]
    - aiionx 2y ago
      [dead]
  - hooverd 2y ago
    It's happening. Look at Florida or Texas. It's the model that the people soon to be in power want to emulate. They're quite outspoken about it.
    - mvdtnz 2y ago
      Then why didn't they do it 4-8 years ago?
      - ttyprintk 2y ago
        With the Louisiana decision, protections are noticeably, gradually being demolished.
breadwinner 2y ago
> middle-class Americans are poorer than people in the Southeast Asian backwater I’m from Poorer than people in Bangladesh? Unlikely. Bangladesh per capita GDP is 2,529.08. US is $81,695.19.
- wk_end 2y ago
  Your overall point still mostly stands, but per capita GDP isn’t super helpful when talking about middle class Americans because of wealth inequality. The median US income is less than half of that. And the cost of living in Bangladesh is probably something like a quarter of the COL in the US. So while there’s still a pretty stark difference in wealth, it’s not quite as stark as you’re implying.
  - nosefurhairdo 2y ago
    Purchasing Power Parity (PPP): This adjusts for cost of living and inflation rates between countries, giving a more accurate comparison of living standards. In 2023, GDP per capita in terms of PPP for Bangladesh and USA was $8,242 and $74,578 respectively (per World Bank).
    - bruce511 2y ago
      It is hard to compare one country to another because they are different in so many ways. Each has positives and negatives. Clearly the USA and Bangladesh are different. Comparing their GDP is simplistic and doesn't really speak to quality of life in either place. Much less does it take into account that two people in each country may in turn have vastly different quality of lives. In short, using national statistics tells us very little about your life, or my life, or any specific persons life.
      - nosefurhairdo 2y ago
        The person I responded to (correctly) criticized per capita GDP, citing differences in cost of living. I felt that referencing PPP would be helpful since it attempts to factor in cost of living differences. I'm not sure this "comparisons are hard" speech is adding much. Differences in wealth are real, measurable, and meaningful, even if they can't be boiled down to a single number. Obviously there are other factors to quality of life; nobody here stated anything to the contrary.
dlkf 2y ago
What country are you referring to? The American middle class is objectively very wealthy: https://www.noahpinion.blog/p/no-the-us-is-not-a-poor-society-with https://www.noahpinion.blog/p/no-the-us-is-not-a-poor-societ...
- insane_dreamer 2y ago
  That article is based on 1) disposable income, which is the wrong metric to use (because it doesn't account for the fact that the US has much higher expenses in health care and education than places like the EU, Japan, etc.), 2) housing size as a metric -- which is due to population density (Western Europe has nearly 5 times the population density of the USA) and the fact that US cities are built around cars, and 3) vehicle ownership, which is both a cultural hallmark of the US and due to the fact that you can't really live without a car (2 if you're married) in the US due to the way its cities are built. In short, laziest article ever.
dinkumthinkum 2y ago
>America is a rich country, but the majority of middle-class Americans are poorer than people in the Southeast Asian backwater I’m from. I think this is a real case of [citation needed]. Many people will, rightly, point at a myriad of statistics to demonstrate how this can't be true, and that's fine. But, I think we can just use some common sense; what are we talking about? There is no way this is true. Why would even need an immigration policy if this was true? This is just some kind anti-Americanism or anti-capitalism nonsense; that is really the only explanation for such an assertion that I can surmise. I'm also not really sure why working in tech you would be "constant fear of needing healthcare". If that is true then if nothing else the placebo of effect of moving to Europe may have been the best treatment psychologically, certainly cheaper than seeing a therapist.
- drewrv 2y ago
  Why would working in tech shield someone from our healthcare system? “Most bankruptcies occurred in middle-class citizens with health insurance” https://www.amjmed.com/article/S0002-93430900525-7/fulltext https://www.amjmed.com/article/S0002-93430900525-7/fulltext If you haven’t been harmed by our system, it’s not because you’re immune. It’s because you’re lucky.
- lazyasciiart 2y ago
  > Why would even need an immigration policy if this was true? Do you think Southeast Asian countries don't have an immigration policy?
  - dinkumthinkum 2y ago
    Well, I know HN is pedantic but the issue is why would so many people be trying to flee to the U.S. if it is worse than some "backwater". It makes no sense. I would assert that in extremely impoverished Southeast Asian countries, immigration is not a central concern.
refurb 2y ago
> America is a rich country, but the majority of middle-class Americans are poorer than people in the Southeast Asian backwater I’m from. This is such a wonderfully HN statement to make because it's so preposterously wrong, yet the author is so confident it's right.
- ranger_danger 2y ago
  As a rule, strong feelings about issues do not emerge from deep understanding. -Sloman and Fernbach
- deleted 2y ago
  [deleted]
eitally 2y ago
Meh. I'm American and also a middle class tech worker. I've never had concerns about insurance denial and also never been denied (or anyone in my immediate family). I feel like the care we've gotten has been excellent and I don't sweat it. My anecdote is worth at least as much as yours.
- mindslight 2y ago
  The pop discourse is myopic and sensationalist. I've never personally dealt with an outright denial. When I've called "insurance" companies, they've been generally helpful. However, this is what I have experienced: Primary care repeatedly rescheduling appointments further down the road, 2-3 months at a time. At one point it got so bad for my elderly aunt that I straight up asked if they were just trying to "run down the clock". Primary care doctors saying they will put in a referral to a specialist. Then a month later just getting a photocopied list of specialists in the mail for us to call directly. Go down the line and most are closed or not accepting new patients. Some were even straight up dead (... like rigor mortis, habeas corpus). One of the two remaining specialists booking 8 months out for an initial consult, the other 5 months. Billing departments that don't feel it necessary to do the work of completing insurance claims, yet feel entitled to still continue sending fraudulent bills to us personally instead. Medical equipment providers outright lying about the validity of their fraudulent bills even when challenged with concrete reimbursement rates, and then doubling down with bullying - aka willful fraud. Needing to put in a bunch of paperwork, then follow up with appeals, merely to see the second geographically closest in-network provider (closer one was having issues) due to living near a state border. And none of this covers the harder-to-capture dynamics of getting shortchanged on time talking to a doctor because the bureaucrats have deemed that 15 minutes is enough time for an appointment, or having to continually make sure the ball doesn't get dropped on care due to the proliferation of different moving pieces. The problem isn't all on insurance companies themselves. The real problem is the entire system is broken due to poor incentives where these gigantic entities have been allowed to pass blame back and forth instead of having to own any responsibility themselves. This puts patients in the middle (often when they're in pressing need of healthcare), to get ground up in an ever-growing runaround, rather than any of these businesses having an incentive to minimize the administrative complexity. The "approval/denial" charade for in network care is just one of the most galling games they've made up, so it gets focused on.
glimshe 2y ago
I'm getting tired of reading this kind of stuff on HN, maybe I should just ignore it but a few friends from other parts of the world, also HN readers, are starting to believe it... So I'll try doing my part. Yes, the worst-case scenario for health expenses is indeed bad in the US, this is true. However, this is not the average healthcare experience. It's not a matter of time until you're slapped with a bankruptcy-level bill. My wife and I, both in our 50s, have had our share of insurance annoyances and frustrating phone calls, but we've had multiple surgeries fully covered by insurance. And this is the same with friends and family members, including at least 4 cancer treatments that did not lead to bankruptcy-level or even truly notable bills. This anecdote includes many people who died of "old age". Worst-case scenario bills can be bad elsewhere too. For instance, a friend in Europe had to do a 250K GoFundMe campaign to pay for a life-saving treatment for his daughter because well, the only place in the world that performed the surgery she needed was... Guess where? The US. He faced bankruptcy for this bill, but friends and strangers were able to help him out to an extent. I think he's still recovering from the expense years later. Medical bankruptcies and financially crushing bills are a sad possibility in the US, and certainly much more likely than in most other places. We need to keep working on this. But the vast majority of people will not have to face this problem in their lifetimes. I'm also from a "backwater" place in South America that happens to be richer than most places in Southeast Asia. I've lived decades both in the "backwater" and in the US - I happen to know the US fairly well as a result. I choose to live here for a simple reason: the quality of life in this country is much superior than my comfortable lifestyle in South America. I know dozens of people from different parts of Asia, and I can only remember a couple, let's say <3%, who went back to Asia after living in the US for a significant period of time. These are not poor Asians, in fact a lot of the Asians you meet in the US were relatively well off as they were able to afford the education in Asia which allowed them to immigrate. Nonetheless, they choose to remain here. All of this said, there is nothing wrong with wanting to go to a low COL place sometime in our lives. I've done this within the US myself, and I would consider another country for a combination of weather, proximity to friends, desire of early retirement or a large property etc. But not because the US is a bad place to live, in fact its very high quality of life is what keeps me from making such move.
- gklitz 2y ago

monksy 2y ago

UHG only got #2 .. gotta pump up those numbers.

mrbluecoat 2y ago

> if we knew about it, then we have to ask: ‘Where are the regulators? Where are the people who should’ve known better? Profiting.

palmfacehn 2y ago
>Nationally, this equates to $38.6 billion each year to comply with the administrative aspects of regulatory compliance in just these nine domains. Looked at in another way, regulatory burden costs $1,200 every time a patient is admitted to a hospital. https://www.aha.org/guidesreports/2017-11-03-regulatory-overload-report https://www.aha.org/guidesreports/2017-11-03-regulatory-over...
- dehugger 2y ago
  And it's still this much of a mess! It's almost like you can't regulate sanity into a for-profit healthcare system.
  - palmfacehn 2y ago
    You can regulate away healthy competition though.

roenxi 2y ago

> In a highly competitive year, the top spot went to Steward Health Care, whose CEO, Ralph de la Torre, is accused of prioritizing private-equity profits over patient care. His financial scheming led to bankruptcy... This seems inappropriate for an award for "profiteering". I believe that profiteering requires making a profit at some point. What did they want him to do, take the company to bankruptcy faster? And just eyeballing the margins on #2 [0] it looks they don't make that much money either. Those aren't particularly impressive margins. They compare more to Walmart than Google. [0] https://www.macrotrends.net/stocks/charts/UNH/unitedhealth-group/net-profit-margin https://www.macrotrends.net/stocks/charts/UNH/unitedhealth-g...

lotsofpulp 2y ago
De la torre is unrelated to UNH. De la torre led a company that sucked cash out of a hospital by separating it from its real estate, and literally sailed off with a couple yachts. https://www.wbur.org/news/2024/07/11/steward-health-care-investigation-corruption-fraud https://www.wbur.org/news/2024/07/11/steward-health-care-inv... https://www.wsj.com/business/steward-health-ceo-ralph-de-la-torre-deabfe4b https://www.wsj.com/business/steward-health-ceo-ralph-de-la-... https://www.beckershospitalreview.com/finance/as-stewards-financials-stumble-spotlight-turns-to-ceos-yachts.html https://www.beckershospitalreview.com/finance/as-stewards-fi... This group tore down an institution that took decades of work by extremely smart people to build, and now tens of thousands of people will get less and worse healthcare because of their actions.
- roenxi 2y ago
  > De la torre is unrelated to UNH. Well, obviously. He was CEO of Steward Health Care. I suspect you have misread my comment.
  - lotsofpulp 2y ago
    Sorry, I somehow thought you connected UNH’s low profit margins to De la torre not profiting. I don’t see how he didn’t profiteer from his actions regarding Seward, though. It seems pretty clear that the real estate play he led caused Seward’s financial woes, which he benefited from.

ackbar03 2y ago

What are they trying to do? Put out a hit list?

s1artibartfast 2y ago

Strange list, some of this is flat out crime, not "profiteering". Fly by night companies submitting 2 billion in false Medicare invoices isn't capitalism. It is simple fraud taking advantage of Medicare incompetence. Same for doctors giving giving people chemo for years despite them never actually having cancer.

munificent 2y ago
Ignore the article title. The Lown Institute describes the awards as for the "worst examples of profiteering and dysfunction in healthcare".
- s1artibartfast 2y ago
  Is crime dysfunction? I suppose it is if Medicare is so incompetent that fraud on that scale is possible.
  - munificent 2y ago
    Yes, the system has failed if a doctor can perform so much malpractice over such a long period of time without some supervisory organization discovering it.
    - lotsofpulp 2y ago
      If you do the fraud on a big enough scale, you can even get elected to be a governor and then US Senator. https://en.wikipedia.org/wiki/Rick_Scott https://en.wikipedia.org/wiki/Rick_Scott At worst, you pay some fines: https://abcnews.go.com/Health/wireStory/settling-fraud-case-ny-medicare-advantage-insurer-ceo-117094516 https://abcnews.go.com/Health/wireStory/settling-fraud-case-... > While dozens of CMS audits have concluded that health plans overcharged the government, the agency has done little to recoup money for the U.S. Treasury. >In a surprise action in late January 2023, CMS announced that it would settle for a fraction of the estimated tens of millions of dollars in overpayments uncovered through its audits dating to 2011 and not impose major financial penalties on health plans until a round of audits for 2018 payments, which have yet to be done. Exactly how much plans will end up paying back is unclear.

WalterBright 2y ago

> Doctors for United have reported pressure to reduce time spent with patients, and make patients seem as sick as possible through aggressive medical coding tactics. This is inevitable when government is handing out money. Recipients will always game the bureaucratic rules that specify payouts.

bandrami 2y ago
This is inevitable when doctors bill per service. When they are paid by capitation that incentive disappears
- WalterBright 2y ago
  Nobody has ever devised a bureaucratic rule that cannot be gamed. Here, the test providers get paid by the test. Easy enough to kick back test payments to the doctors. As for paying by capitation, why would they work extra hours to serve more patients? Or just see fewer patients and relax?
  - bandrami 2y ago
    That's generally what happens, yes. Good, fast, cheap: pick two
ttyprintk 2y ago
My favorite is “Ayn Rand Institute accepts $1m PPP loan from The State” https://news.ycombinator.com/item?id=23764542 https://news.ycombinator.com/item?id=23764542
palmfacehn 2y ago
https://www.forbes.com/sites/johngoodman/2018/10/02/employers-could-slash-their-health-costs-overnight-so-why-dont-they/ https://www.forbes.com/sites/johngoodman/2018/10/02/employer... Directly paying for cash-priced surgery has become cheaper than the heavily regulated insured coverage. Not only cheaper when including the overhead of having insurance, but cheaper in real terms of a single surgery event.