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Nothing is shocking about the insurance industry anymore since they’ve been pulling this kind of thing for years. To me the most shocking thing is the people w

• acchow 2y ago
  How do you respond to people that say the profit motive is what drives innovation, and in the long term we’d rather have better, novel treatments sooner
  • jsheard 2y ago
    Even if that's true for the actual pharmas, how are insurance companies like UHC innovating? They're just middlemen.
    • prettyStandard 2y ago
      They prevent unnecessary treatments! /s
    • nozzlegear 2y ago
      I'm not sure about UHC specifically, but insurance companies do innovate. Some insurers have invested pretty heavily in biotech and wearables, and they're also a big driver behind telehealth/remote health monitoring tech. We can cynically say that they're just in it because they want to reduce costs – and that's probably true – but it'd be simplistic to say investing to reduce costs is purely selfish.
      • franktankbank 2y ago
        > biotech and wearables Tracking and data harvesting, excellent!
        • nozzlegear 2y ago
          Or encouraging healthier lifestyles by blending technology with behavioral health incentives. Or both.
      • ceejayoz 2y ago
        > they're also a big driver behind telehealth/remote health monitoring tech Until COVID, insurers in my area wouldn't cover telehealth at all. They opposed it tooth and nail.
  • daveguy 2y ago
    Profit motives for medical / biotech research, yes. What innovations have insurance companies made in the last 100 years besides to squeeze out more profit?
    • NickC25 2y ago
      A lot of that research is primarily done in university labs, mind you. On the taxpayer dime. Somehow the research escapes a lab and Pfizer manages to put some stupid name on it and reaps billions in profit.
      • baq 2y ago
        I guess they have their own labs, you just never learn about their failed experiments.
        • ChrisMarshallNY 2y ago
          > failed experiments Wasn't that what Milla Jovovich was called in to deal with?
      • shpongled 2y ago
        It requires billions of dollars and a decade+ to translate academic research into a clinical outcome. Most academic research is not reproducible or robust enough to even be replicated outside of the lab that performed it - and this will only be discovered after spending millions of dollars of private funding.
        • NickC25 2y ago
          I get that completely - and you're completely correct: most research isn't ready for clinical trials let alone commercial distribution. And even then, only a small amount of reproduce-able work matures into a finalized product. Yes, there needs to be financial incentives for the private sector to find promising work, and funding the next steps once it escapes the University ecosystem. I'm all for that. But as a society we need to be clear about where the initial funding comes from, and who those are who pay for that first round of funding are.
  • bb88 2y ago
    Profit motive can also drive profiteering.
  • bogwog 2y ago
    Competition is what drives innovation. There are many ways to chase profits without innovating.
    • pyrale 2y ago
      Xerox parc is a good counter-example.
  • pyrale 2y ago
    They're totally wrong. War is what funds innovations. Imagine all the innovation we're missing on every day a country isn't being invaded!
  • 1024core 2y ago
    What "innovation" is UnitedHealth doing, pray tell me?
  • flatline 2y ago
    We are talking about delivering care, not innovative medical technology. The biggest single target for innovation in care delivery is to get rid of private insurers. I think the graph at the top of this article really says it all: https://www.economist.com/graphic-detail/2019/05/22/republicans-are-struggling-to-fix-americas-dysfunctional-health-care-system https://www.economist.com/graphic-detail/2019/05/22/republic...
  • oneplane 2y ago
    By informing them that most of that is funded by taxes and students doing all the work, not corporations and not based on their revenue. If anything, they have an incentive not to make better treatments because better often means less profitable.
  • antisthenes 2y ago
    You don't, because they are trolls. You can't possibly argue in good faith that being able to provide less than 0.1% of novel treatments is somehow more valuable than providing good, standard healthcare with already existing drugs and treatment protocols to the other 99.9% at a sane cost.
  • adamc 2y ago
    I'd say we have an unsustainable system, and innovation that makes it less sustainable is not particularly helpful.
• brightball 2y ago
  Does anybody defend them? I’ve been on the selection side as an employer and several others will probably echo what I’m about to say. Virtually every insurance provider is going up 15-20% / year to the point that it’s completely unsustainable. United was quoted to me as almost 20% lower than current rate for our provider (before they are about to go up 20%). On premium alone they will save some people close to $500 / month for what is…”on paper” the same coverage. I’ve read all of the same stuff about United that everybody else has but the finances put employers in a very difficult position.
  • segfaltnh 2y ago
    I feel people defend them by opposing any other approach to solving this. Politicians in particular say things like "preserving customer choice", which I think just means having the ability to select among all the terrible insurance companies who will treat you poorly.
    • jsheard 2y ago
      That excuse doesn't even hold up because in places like the UK which have universal healthcare, private health insurance still exists alongside it as a "premium" option. That's more choice!
    • Kon-Peki 2y ago
      > Politicians in particular say things like "preserving customer choice" But that’s not shocking. Lobbyists and campaign donations make such behavior expected.
    • wlesieutre 2y ago
      And shouting about "death panels" in public healthcare systems, as if the private insurance companies don't have people whose whole job is denying as many claims as possible
      • kstrauser 2y ago
        Yeah. The biggest difference is you can elect the public healthcare death panels, or call your senator or representative to lean on them. There's not a thing you can do about the private insurers' death panels. Medicare may turn you down for an organ transplant because there are only so many to go around and you're not the best candidate. Private insurance may turn you down because "shareholder value".
• baggy_trough 2y ago
  Setting aside human health and agreeing that it should be outside capitalist endeavor would be incredibly damaging to human health. I can hardly imagine any policy that would reduce life years more than that.
  • LPisGood 2y ago
    Why then do countries with socialized healthcare have linger life expectancy than countries with capitalist-only healthcare system?
    • baggy_trough 2y ago
      Do those countries use any practices or innovations developed by non-socialist entities, or are they entirely socialist-based?
• onlyrealcuzzo 2y ago
  I don't particularly care if health insurance is public or private. DIRECT health care labor costs (doctor's, nurses, etc) are ~40-60% of TOTAL healthcare spending. Smart people try to figure out ways to make our system better every day. If there was a silver bullet, we'd have already taken it. Health insurance profits are ~1.2% of total health care spending, the cost of running it is approximately ~4% more. It's always going to cost SOMETHING to run - whether you move it to the private or public sector is largely a rounding error. If you take all those insurance jobs and pop them into the Federal Government - you're unlikely to see much efficiency gains (the most pro-medicare articles state it's 37% more efficient - that's an improvement of ~1.5% in total spending). UHC had a net margin of 6.1% in 2024. Sure, if all 6.1% of that went to spending instead of profits - health care would be slightly better. But it's mostly a rounding error. Private health insurance profits are only ~1.2% of total spending. Maybe you're focused on a ~6.1% margin, or ~$60B in total profits. You're not going to get substantially better outcomes by simply having ~1.2%-2.7% more money to spend. You'd need to bring down the actual cost of healthcare substantially - which isn't going to happen unless you pay doctor's and nurses way less money. Pharmaceuticals are only about 9% of total US healthcare spending - even if you nationalize that (never going to happen) - you're still not getting substantially better / cheaper outcomes. Profits on pharmaceuticals is <2% of total spending as well. The only way you're getting significantly cheaper service is by reducing your biggest cost significantly - i.e. paying less for direct patient healthcare (doctor's, nurses, etc), and that's probably not a great strategy for getting better outcomes. Who knows? NHS pays doctors dirt, and their system isn't obviously worse than ours. Some people think it's way better, others way worse.
  • AlienRobot 2y ago
    I have good news! If you move it to the public sector, you will effectively pay doctors less money for the same work. That's because the way it works currently is that the doctors have to deal with private insurance bureaucracy. By freeing them from this responsibility, they have more time to take care of patients, which should effectively gets you more medical bang for your buck.
    • onlyrealcuzzo 2y ago
• m3kw9 2y ago
  The incentive drives them to do sht like that.
• bastardoperator 2y ago
  The problem with greed is it has no limits. These people are happily dancing on graves all the way to the bank, and we allow it.
  • walrus01 2y ago
    "chart goes up and to the right!" seems to excuse just about anything in some peoples' political philosophy. much shareholder value was increased, I'm sure.
    • lotsofpulp 2y ago
      Why would anyone expect it not to go to the right? I wonder if places that read right to left also chart things so that 0 is on the right side and the positive numbers are on the left.
  • monkeycantype 2y ago
    What I believe has broken in the US, UK and is well on the way to breaking in Australia, is the confidence that principles will win over greed. If you believe there is a critical mass of good principled people who will stand against selfishness, then being principled is a smart choice. If you do not have that belief, being principled feels like a foolish extravagance. As many have said before, it's got to the point people have more faith in a zombie apocalypse than in citizens cooperating for their own common good.
    • deleted 2y ago
      [deleted]
• slibhb 2y ago
  Insurance isn't a good industry to "get insanely rich". It doesn't have high profit margins. For one thing, the ACA mandates that insurance companies can't keep profits past a certain point. My sense is that people expect too much from their health insurance. Subconsciously, we expect to experience no pain and live forever. When this inevitably doesn't happen, we blame insurance companies for not bankrolling infinite healthcare.
  • throwway120385 2y ago
    Clearly with Private Equity entering healthcare this is patently false.
  • realce 2y ago
    The article is about insurance company malfeasance, but this boils it down to mis-aligned consumer expectations about living forever in total bliss. That feels like a strange disconnect.
  • com2kid 2y ago
    There is a max % take insurance companies can have. The easy as hell solution to this is insurance companies collude with hospitals to charge patients more. 5% of 5000 is more than 5% of 2000. In some cases insurance companies just buy up hospital chains and then bill themselves whatever the hell they want to.
  • ta_1138 2y ago
    The miracle of US healthcare is how at every step, work is done to minimize every party's ability to either use market power to lower costs, or to make people cost-conscious about their own expenses. Insurance, in a vacuum, detached from an industry is a perfectly sensible way to try to spread risk. And as you say, this fair, reasonable insurance isn't about getting extremely rich, but about being the best at identifying where the risks are, and using market power to lower costs. But with healthcare, and especially with the US peculiarities, we manage to get minimal value out of it. People getting care don't know their options, and how different the pricing can be. Insurers are capped by a percentage of services paid, so they really are happy if everything is very expensive. Providers band together into conglomerates that make sure it's hard for insurers to lower reimbursement rates. Pharmacy benefit managers build complicated schemes that let them take a bigger piece of the pie. They even purchase pharmacies, and restrict the expensive purchases for themselves, while the local pharmacy is squeezed. All in all, it gets very expensive, with minimal control of spiraling prices, and nobody that can lower costs is incentivized to do so. We blame insurers because that's the people that get paid first, but yes, it's not really a matter of just insurers. It's a kafkaesque system that is basically impervious to significant reform. And for good reason: Every dollar we overpay is someone else's salary. A decrease in costs per person for the same care to match, say, Spain would involve a whole lot of people making a lot less money, including many losing their jobs. Not exactly a political winner, even though the country would be better off with more efficiency
• baq 2y ago
  It shows that the US never had a world war on the continent. All the other countries treat health care as a matter of national security. The US’s primary concern is mark to market in pension funds.
  • tredre3 2y ago
    > It shows that the US never had a world war on the continent. All the other countries treat health care as a matter of national security. You seem to be making a weird connection here, but maybe I misunderstand you. Are you truly suggesting that countries who have socialized health care do so because they've been affected by war on their territory at some point?
    • lnxg33k1 2y ago
      Extremists came from misery, and misery is what drives united states today
    • dylan604 2y ago
      It's not just you.
    • jldugger 2y ago
      I seem to recall John Cleese or some other british person suggesting that the NHS was a given after so many had been through ww2. Wikipedia[1] on the NHS suggests the same, through quotes by politicians. [1]: https://en.wikipedia.org/wiki/National_Health_Service#History https://en.wikipedia.org/wiki/National_Health_Service#Histor...
  • JumpCrisscross 2y ago
    > shows that the US never had a world war on the continent. All the other countries treat health care as a matter of national security I forgot about the world-class healthcare the populations of Africa, the Middle East and the war-ravaged parts of Asia enjoy. I agree there is probably a link between war and healthcare. But the link flows through civic pride and identity, and population-wide familiarity with the horrors of war, more than it does from any sense of military preparedness. (That said, I've never seen an American politician try to sell universal healthcare as a national security imperative. Hmm...)
• deleted 2y ago
  [deleted]
• mindslight 2y ago
  In many ways, the problem is that we do treat health care different. What other industry will actively reject attempts to ask about prices? What other industry just sends out bills with no contractual basis and exaggerated fraudulent amounts made up after the fact? What other industry do you need to buy "insurance" to even be able to financially communicate with service providers? What other industry does the government provision social services by telling businesses that they must serve some of the most expensive customers for free, and then ensures monopolies so those large losses can be made back from every other customer? What other industry is it impossible to obtain services until a professional declares that you "need" them, at which point it's supposed to be close to free? These massive profits are because of the so-called "regulation" that has continued to keep market dynamics away, new entrants out, and the industry supremely entitled (from doctors to billing departments). The political debate continues to be sidetracked by doubling down on this mistaken idea of thinking constructive outcomes can simply be declared in law. What needs to happen is to focus on making healthcare a competitive market where patients have agency, while also providing direct financial subsidies when people need them.
  • wat10000 2y ago
    The problem is that it is different. What other industry sells a product that you might need in order to survive or to not be disabled which requires the dedicated efforts of multiple professionals with a decade of post-secondary education? What other industry sells a product that you might suddenly need at a moment’s notice that is the only way you’ll survive the day, that requires sophisticated equipment, dedicated facilities, and a team of the aforementioned highly educated professionals? Most industries are either optional things you want to have but can live without, or necessities you need on an ongoing basis that need more than a few minutes of individual attention. There’s a lot more to medicine than emergencies and lifesaving treatments. But I think those are the original sin from which the rest flows. The basic question is this: should people be left to die if they have a sudden life-threatening event (heart attack, hit by a bus, shot) and they can’t demonstrate an ability to pay for treatment? (Note, not the same as not being able to pay for treatment. This would potentially apply to a rich person who got mugged and left for dead, for example.) Few will answer “yes.” And everything else flows from the “no.” The US’s universal health care system is built around it. We pretend we don’t have universal health care, but we do. It’s just tremendously shoddy and weird. The one place with universal care is the hospital emergency room. Those have been required to treat everyone regardless of ability to pay since 1986. Once you start doing that, the rest flows from there. People start saying, what if it’s not critical to survival but they’ll be crippled without it? What if it’s life critical but there’s time to verify payment? Can we do better without removing that? No doubt. But we’ll have a hard time getting to a proper competitive market. Other industries with these characteristics (police, firefighting, rescue, ambulance if you count that separately from medicine) are usually handled by the government or at least contracted by them.
• AtlasBarfed 2y ago
  Businesses are immortal unkillable people, per the Supreme Court. If they kill people, they pay (small to them) fines. Oh wait, the have special tax laws, depreciation, and deductions that real people can't use. It's almost like he only recourse is to print out a gun and (censored) Happy capitalism everybody.
• yadaeno 2y ago
  Medical Loss Ratio (MLR) is capped at 85% in the US which means 85% of revenue must go to patients. This is roughly inline with other countries with universal healthcare (MLR ranges from 85-95%). The fundamental problem is that we don’t have enough resources to take care of everyone. Insurance companies are faced with the impossible task of allocating resources and making care/nocare decisions. I don’t get the “endless profiteering” angle against insurance companies. If anything it’s the providers who are screwing over patients by gaming insurance and taking more than is necessary from the shared insurance pool of money.
  • fatbird 2y ago
    The more revenue an insurer brings in, the larger that 15% slice of the pie. The fact that they have a capped MLR is beside the point.
  • criddell 2y ago
    But when UnitedHealth requires medications to be purchased from Optum health (with whom they share a parent company), they can jack up the price of a drug and keep some of that 85% too.
    • ceejayoz 2y ago
      They own the physicians, too. https://www.statnews.com/2024/07/25/united-health-group-medicare-advantage-strategy-doctor-clinic-acquisitions/ https://www.statnews.com/2024/07/25/united-health-group-medi... To whom they pay higher "medical loss": https://www.statnews.com/2024/11/25/unitedhealth-higher-payments-optum-providers-converts-expenses-to-profits/ https://www.statnews.com/2024/11/25/unitedhealth-higher-paym...
  • herrkanin 2y ago
    so by increasing the cost of patient care, they can take out more profits.
  • awongh 2y ago
    I’m not an expert but I’m wary of anyone who has a simplistic view of what seems to be a complex system. This, plus looking at the profit margin of UHC paints a more nuanced picture (net profit margin is not that high. the dollar amount is high because the scale of the company is big). (Not that I want to make money from denying people healthcare, no matter how much internal logic there is to it…) But it does seem like there’s a serious prisoners dilemma type situation going on in American health care. It’s easy to point fingers at someone else. The situation is also coupled with a toxic political environment where a Trump voter can simultaneously be against “Obamacare” and think that Trump is going to improve access to healthcare, and a Harris voter can be pro Obamacare and ignore regulatory capture by pharmaceutical companies- e.g., both sides so convinced they’re right and the other side is wrong they won’t be seen to agree on anything common sense.
• bloppe 2y ago
  I'm going to go ahead and defend them because private insurance is actually far from the most broken thing about US healthcare, yet they seem to shoulder all the blame. Average health insurance profit margin in US is ~3%. That's not a greedy profit margin. It's the health care that's expensive, not the insurance. Health care is much more expensive in the US than in similar countries. I'm not an expert on why, but there are all sorts of misaligned incentives on IP and drug pricing that need to be fixed. It's not the insurers.
  • jandrese 2y ago
    The army of middlemen the doctors and hospitals need to hire to deal with the insurance companies adds a lot to healthcare costs in the US. Not to mention the armies of middlemen hired by the insurance companies themselves. While every healthcare system has administrators, the US system with its thousands of different systems interacting with thousands of other individuals makes for a nightmarishly complex problem. Doctors in countries with socialized medicine complain about the government administrators too, but at least they only have one system to deal with.
    • bloppe 2y ago
      That may be true. I can only assure you that the army of government bureaucrats who do that work in countries with universal healthcare tend to be less efficient.
      • fellowniusmonk 2y ago
        Why provide personal assurances on the internet? That seems like a "trust me bro" approach. So tell me, what is the relative cost efficiency of the U.S. Healthcare System vs France/GB/etc..? People like to use the term government bureaucrat as a thought stopping term, when combined with trust me bro "assurances" it seems extremely hollow. Give me a data/financial analysis instead of something that sounds like the advice two old dudes sitting in front of a five and dime pre-internet.
      • ceejayoz 2y ago