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There is absolutely no way to run an insurance scheme without denying some people coverage. No system anywhere in the world, public or private, accepts every si

by xyzzyz 2y ago

There is absolutely no way to run an insurance scheme without denying some people coverage. No system anywhere in the world, public or private, accepts every single claim. You must deny some claims, there's no way around it. This means that according to you, there's no ethical way to run health insurance system. I disagree, I think we need insurance to exist, and given that someone needs to run insurance, I don't think that taking such a job is inherently a moral error.

__MatrixMan__ 2y ago
It's really just for-profit health insurance systems that I think can't be made ethical. If you have to deny some claims based on resource availability, that's an uncomfortable necessity, but we can do insurance-like things without asking people to balance human life against shareholder greed. It seems pretty obvious that opting into a position where you'll have to do that might make you unpopular with the humans.
- xyzzyz 2y ago
  What is "resource availability"? In a non-profit healthcare systems, how exactly the amount of available resources is determined? Is there no person involved making a decision that causes the amount of available resources to change? Think about it. Consider, for example, politicians who set the healthcare tax rate. If they set it 1% higher, there will be more resources available. Does it mean that by not doing so, they deny care to some? I strongly encourage you to think very carefully about this. Once you do, you'll find that there are no simple answers: you'll always have limited resources, and you'll always have to deny care to some people, and in fact it will always include some people personally making the call to deny care to some people. Any system that actually exists, public or private, does this.
  - __MatrixMan__ 2y ago
    > In a non-profit healthcare systems, how exactly the amount of available resources is determined? You would generally count them. Like, if you have three people in need of a ventilator and you only have two ventilators, then one person is getting denied a ventilator today. > Any system that actually exists, public or private, does this. That's true, and I don't have a problem with it. Tradeoffs have to happen. What I have a problem with is incentive structures that attribute greater success for the people at the top when they create outcomes that involve more death for the people at the bottom. Plenty of systems which actually exist don't congratulate leadership for reducing quality of care.
    - xyzzyz 2y ago
      OK, but why is there only two ventilators? Who made this decision, and based on what? Try to think a couple of steps ahead.
      - __MatrixMan__ 2y ago
        Presumably somebody involved in deciding budgets, a politician perhaps, or somebody with a rather political role in the hospital. Whoever they are, in most cases they're balancing ventilators against test kits or against hiring more doctors or against letting people keep more of their paychecks, or all kinds of other things which might indeed be more important for the patients/citizens/etc... There's no fundamental reason why they have to be in a position where screwing the people who receive the care would ever be considered the ideal option. But that's how it is when you have a group of shareholders who have no stake in the quality of care. Thompson opted into a conflict of interest which need not exist in order to provide insurance.
        davrosthedalek 2y ago
        More likely they balance the need to increase healthcare taxes against their chance of being reelected.
        __MatrixMan__ 2y ago
        Sure, and that's not exactly comfortable (maybe "reelected" shouldn't be a thing, idk). But if the people reelecting you are also the patients then the particular conflict of interest I'm worried about is not present.
        davrosthedalek 2y ago
        Yes, that's why NHS is so well funded. Oh, wait, it isn't. Government-organized resource allocation is, more likely than not, bad to very bad.
xvinci 2y ago
You are right, BUT: Those denials have to follow contractual terms. I know a local (Europe) real world example where a friend of a friend (insurance company area manager) literally was told "this is your sum of money on claims that you can accept in this quarter, it cannot go above that". Which either you get lucky and make the quota, or you screw people over and hope they don't sue. And since we live in a world where the company wants "a little more" each year, well.. I don't see how this ends well. The same problem does not apply to our social services (including health insurance) as they dont have to make profits at all costs.
oneeyedpigeon 2y ago
The line is on why you are doing the denying. Are you doing so because providing the healthcare is literally impossible, or are you doing so in order to make more money?
davrosthedalek 2y ago
I think you need to specify this more. In most insurance fields, it would be possible to only deny false claims. Take insurance of your house. The rates could be calculated that they can pay out all real damages to the full amount. Because the maximum damage amount is limited. That's not true for health insurance, because the total possible damage (cost of treatments) is almost arbitrarily high, so that you cannot pay everything for everyone. I don't want to defend the US system here. But it's not a problem that any country really solved, and one could argue about advantages and disadvantages of the different systems all day long.

by xyzzyz 2y ago

__MatrixMan__ 2y ago

It's really just for-profit health insurance systems that I think can't be made ethical. If you have to deny some claims based on resource availability, that's an uncomfortable necessity, but we can do insurance-like things without asking people to balance human life against shareholder greed. It seems pretty obvious that opting into a position where you'll have to do that might make you unpopular with the humans.

xyzzyz 2y ago
What is "resource availability"? In a non-profit healthcare systems, how exactly the amount of available resources is determined? Is there no person involved making a decision that causes the amount of available resources to change? Think about it. Consider, for example, politicians who set the healthcare tax rate. If they set it 1% higher, there will be more resources available. Does it mean that by not doing so, they deny care to some? I strongly encourage you to think very carefully about this. Once you do, you'll find that there are no simple answers: you'll always have limited resources, and you'll always have to deny care to some people, and in fact it will always include some people personally making the call to deny care to some people. Any system that actually exists, public or private, does this.
- __MatrixMan__ 2y ago
  > In a non-profit healthcare systems, how exactly the amount of available resources is determined? You would generally count them. Like, if you have three people in need of a ventilator and you only have two ventilators, then one person is getting denied a ventilator today. > Any system that actually exists, public or private, does this. That's true, and I don't have a problem with it. Tradeoffs have to happen. What I have a problem with is incentive structures that attribute greater success for the people at the top when they create outcomes that involve more death for the people at the bottom. Plenty of systems which actually exist don't congratulate leadership for reducing quality of care.
  - xyzzyz 2y ago
    OK, but why is there only two ventilators? Who made this decision, and based on what? Try to think a couple of steps ahead.
    - __MatrixMan__ 2y ago
      Presumably somebody involved in deciding budgets, a politician perhaps, or somebody with a rather political role in the hospital. Whoever they are, in most cases they're balancing ventilators against test kits or against hiring more doctors or against letting people keep more of their paychecks, or all kinds of other things which might indeed be more important for the patients/citizens/etc... There's no fundamental reason why they have to be in a position where screwing the people who receive the care would ever be considered the ideal option. But that's how it is when you have a group of shareholders who have no stake in the quality of care. Thompson opted into a conflict of interest which need not exist in order to provide insurance.
      - davrosthedalek 2y ago
        More likely they balance the need to increase healthcare taxes against their chance of being reelected.
        __MatrixMan__ 2y ago
        Sure, and that's not exactly comfortable (maybe "reelected" shouldn't be a thing, idk). But if the people reelecting you are also the patients then the particular conflict of interest I'm worried about is not present.
        davrosthedalek 2y ago
        Yes, that's why NHS is so well funded. Oh, wait, it isn't. Government-organized resource allocation is, more likely than not, bad to very bad.

xvinci 2y ago

You are right, BUT: Those denials have to follow contractual terms. I know a local (Europe) real world example where a friend of a friend (insurance company area manager) literally was told "this is your sum of money on claims that you can accept in this quarter, it cannot go above that". Which either you get lucky and make the quota, or you screw people over and hope they don't sue. And since we live in a world where the company wants "a little more" each year, well.. I don't see how this ends well. The same problem does not apply to our social services (including health insurance) as they dont have to make profits at all costs.

oneeyedpigeon 2y ago

The line is on why you are doing the denying. Are you doing so because providing the healthcare is literally impossible, or are you doing so in order to make more money?

davrosthedalek 2y ago

I think you need to specify this more. In most insurance fields, it would be possible to only deny false claims. Take insurance of your house. The rates could be calculated that they can pay out all real damages to the full amount. Because the maximum damage amount is limited. That's not true for health insurance, because the total possible damage (cost of treatments) is almost arbitrarily high, so that you cannot pay everything for everyone. I don't want to defend the US system here. But it's not a problem that any country really solved, and one could argue about advantages and disadvantages of the different systems all day long.