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> Most large employers like Apple are already self funded and the health plans merely act as third-party administrators, assembling networks and processing tran

> Most large employers like Apple are already self funded and the health plans merely act as third-party administrators, assembling networks and processing transactions. Ha ha, “merely act as third-party administrators.” Dude, does United Health or Apple deny your claims? Anyway, it’s a simple question. Why doesn’t Apple lobby for public health?

nradov 1y ago
If there's a UnitedHealthcare plan for Apple employees (and I don't know which company Apple currently uses) then Apple sets the policy for what is and isn't covered. UHC simply enforces the policy set by Apple so blaming UHC in that scenario is simply naive and displays a total misunderstanding of how the healthcare financing system actually works. UHC would be happy to offer a custom plan for Apple employees that pays 100% of every claim with no questions asked if Apple wanted it — it would be less work for UHC and they would merely pass the costs on to Apple (plus a very small profit margin). The largest employers do have a financial incentive to maintain the current broken system. Despite the hassles, their economies of scale in running self-funded employee health plans give them a cost advantage over smaller competitors. I suspect that's part of the reason why they don't lobby for reforms but I'm not privy to internal Apple decisions.
- doctorpangloss 1y ago
  Okay. So you’re saying tax dodging giant corporations like to save money? Why does it have to be so complicated? The government HAS to pay for treatments that are FDA approved. UNH and Apple, working together, do not. Furthermore, Apple doesn’t have to cover everyone, the government would! It’s that simple! For people reading this thread: Apple gets paid a rebate at the end of the year by United. The employee whose paycheck has a cut out for “health plan” does not. It’s that simple. Apple gets to pay the employees less when it chooses United. Apple has not lost many antitrust cases, but it has lost them for paying employees less! This is their MO! Your cheaper ACA plans do not pay rebates for unused services. The government, which pays for the health costs of the people whose claims are denied, does not pay you a rebate. Your auto insurance sometimes “pays” you a “rebate,” if for some idiosyncratic reason Gavin Newsom decides that’s how it should work. So generally, Apple is not lobbying for public health because the status quo lets them save a TON of money by overcharging their own employees for “health plans.” I don’t think you should throw around “total misunderstanding” like that either. You don’t know me, or know how much I know about this stuff. Not every generalization is Wrong. It can be wrong, but not Wrong. And anyway, you have a problem with my generalizations, and then you say “total misunderstanding,” which is itself a generalization. It’s bad faith. I am choosing rhetorically to generalize, in a way that aligns very well with the truth, and you are choosing meaningless specificity that may be ever so slightly more truthful, but doesn’t align with the emotions - the anger against giant corporations, the government, etc. - at all. We’re both being intellectually honest, but only one of us is co-opted. That is my feedback to you.
  - nradov 1y ago
    No, you're not being intellectually honest. You're lying and making things up. I don't know whether that's due to ignorance or bad faith. And I don't give a damn about your condescending "feedback": save it for someone who cares. There is no credible allegation here that Apple has dodged US federal or state tax laws. Government sponsored health plans such as Medicare aren't legally required to pay for all FDA approved treatments (and much of what they do pay for are procedures which aren't subject to FDA approval at all). Commercial health plans offered by UHC and their competitors cover everything that is medically necessary (and they often cover more than Medicare does), but as with everything in healthcare the precise definition of that term gets a bit fuzzy in some edge cases.
    - doctorpangloss 1y ago
      Okay well, I think you know a lot about this stuff, and it’s worth thinking very deeply about these questions: - why does Apple prefer the status quo? How do they “make more money”? Why do they use UNH? They make software, if it’s so simple as you say, administer plans, why don’t they do it themselves? Btw, Apple Health as in Health IT does exist! So does Google’s Health (IT)? - how can health IT be the second worst performing VC sector (only Ed tech is worse), but UNH is worth whatever it is, hundreds of billions? What is UNH’s actual product? It’s not “being a middleman” - that’s health IT… - why do doctors think Kaiser sucks? Like how does Kaiser make money? - do we have “death panels” in this country? What do they look like? These are all related. In general, I don’t think health IT has the answers to rising costs. That’s the POV I’m hearing. It’s likely that greater adoption of health IT has accelerated, not slowed, the growth of costs in a way that has not improved outcomes per dollar. That’s an orthodox opinion. In my experience, the intellectual leap for a lot of engineers working in enterprise sales heavy sectors is two realizations: (1) that just because something happens, doesn’t mean it makes sense (2) and just because you give people what they ask for, such as in the context of health IT fulfilling dull consulting services asks, doesn’t mean that what people are asking for makes sense or is a net positive, maybe by any metric. And anyway, most experts agree that the middlemen in the healthcare sector, like pharmacy benefit managers and insurers, are responsible for a significant part of the cost difference per outcome here compared to Europe. To me, it is unsurprising that middlemen in general cause costs to rise for very little actual gains, even if in their POV, they are fulfilling some requirement by regulations or whatever. You know, they’re stuck in the “I did what someone asked and paid for, and therefore it makes sense” mindset.
- FireBeyond 1y ago
  > If there's a UnitedHealthcare plan for Apple employees (and I don't know which company Apple currently uses) then Apple sets the policy for what is and isn't covered. UHC simply enforces the policy set by Apple so blaming UHC in that scenario is simply naive and displays a total misunderstanding of how the healthcare financing system actually works. The reality though is that the employer generally doesn't want to pay 100% of all claims, all the time. So they're left with "well, what do we pay, how much, and how can we use the insurer's negotiated pricing, etc., etc." and they ask UHC to provide plans that largely match UHC's plans, rules and the like, potentially with one or two little carve outs or exceptions, because UHC is the one that has done the math to make sure that balances cost/benefit for Apple. So a lot of time, they just "pass through" plans. Which is why most self-funded plans look "suspiciously similar" to what you might find elsewhere in the market. I wrote software for a healthcare claims benefit management company that drove insurance for direct insureres and TPAs for 12 years.

nradov 1y ago

If there's a UnitedHealthcare plan for Apple employees (and I don't know which company Apple currently uses) then Apple sets the policy for what is and isn't covered. UHC simply enforces the policy set by Apple so blaming UHC in that scenario is simply naive and displays a total misunderstanding of how the healthcare financing system actually works. UHC would be happy to offer a custom plan for Apple employees that pays 100% of every claim with no questions asked if Apple wanted it — it would be less work for UHC and they would merely pass the costs on to Apple (plus a very small profit margin). The largest employers do have a financial incentive to maintain the current broken system. Despite the hassles, their economies of scale in running self-funded employee health plans give them a cost advantage over smaller competitors. I suspect that's part of the reason why they don't lobby for reforms but I'm not privy to internal Apple decisions.

doctorpangloss 1y ago
Okay. So you’re saying tax dodging giant corporations like to save money? Why does it have to be so complicated? The government HAS to pay for treatments that are FDA approved. UNH and Apple, working together, do not. Furthermore, Apple doesn’t have to cover everyone, the government would! It’s that simple! For people reading this thread: Apple gets paid a rebate at the end of the year by United. The employee whose paycheck has a cut out for “health plan” does not. It’s that simple. Apple gets to pay the employees less when it chooses United. Apple has not lost many antitrust cases, but it has lost them for paying employees less! This is their MO! Your cheaper ACA plans do not pay rebates for unused services. The government, which pays for the health costs of the people whose claims are denied, does not pay you a rebate. Your auto insurance sometimes “pays” you a “rebate,” if for some idiosyncratic reason Gavin Newsom decides that’s how it should work. So generally, Apple is not lobbying for public health because the status quo lets them save a TON of money by overcharging their own employees for “health plans.” I don’t think you should throw around “total misunderstanding” like that either. You don’t know me, or know how much I know about this stuff. Not every generalization is Wrong. It can be wrong, but not Wrong. And anyway, you have a problem with my generalizations, and then you say “total misunderstanding,” which is itself a generalization. It’s bad faith. I am choosing rhetorically to generalize, in a way that aligns very well with the truth, and you are choosing meaningless specificity that may be ever so slightly more truthful, but doesn’t align with the emotions - the anger against giant corporations, the government, etc. - at all. We’re both being intellectually honest, but only one of us is co-opted. That is my feedback to you.
- nradov 1y ago
  No, you're not being intellectually honest. You're lying and making things up. I don't know whether that's due to ignorance or bad faith. And I don't give a damn about your condescending "feedback": save it for someone who cares. There is no credible allegation here that Apple has dodged US federal or state tax laws. Government sponsored health plans such as Medicare aren't legally required to pay for all FDA approved treatments (and much of what they do pay for are procedures which aren't subject to FDA approval at all). Commercial health plans offered by UHC and their competitors cover everything that is medically necessary (and they often cover more than Medicare does), but as with everything in healthcare the precise definition of that term gets a bit fuzzy in some edge cases.
  - doctorpangloss 1y ago
    Okay well, I think you know a lot about this stuff, and it’s worth thinking very deeply about these questions: - why does Apple prefer the status quo? How do they “make more money”? Why do they use UNH? They make software, if it’s so simple as you say, administer plans, why don’t they do it themselves? Btw, Apple Health as in Health IT does exist! So does Google’s Health (IT)? - how can health IT be the second worst performing VC sector (only Ed tech is worse), but UNH is worth whatever it is, hundreds of billions? What is UNH’s actual product? It’s not “being a middleman” - that’s health IT… - why do doctors think Kaiser sucks? Like how does Kaiser make money? - do we have “death panels” in this country? What do they look like? These are all related. In general, I don’t think health IT has the answers to rising costs. That’s the POV I’m hearing. It’s likely that greater adoption of health IT has accelerated, not slowed, the growth of costs in a way that has not improved outcomes per dollar. That’s an orthodox opinion. In my experience, the intellectual leap for a lot of engineers working in enterprise sales heavy sectors is two realizations: (1) that just because something happens, doesn’t mean it makes sense (2) and just because you give people what they ask for, such as in the context of health IT fulfilling dull consulting services asks, doesn’t mean that what people are asking for makes sense or is a net positive, maybe by any metric. And anyway, most experts agree that the middlemen in the healthcare sector, like pharmacy benefit managers and insurers, are responsible for a significant part of the cost difference per outcome here compared to Europe. To me, it is unsurprising that middlemen in general cause costs to rise for very little actual gains, even if in their POV, they are fulfilling some requirement by regulations or whatever. You know, they’re stuck in the “I did what someone asked and paid for, and therefore it makes sense” mindset.
FireBeyond 1y ago
> If there's a UnitedHealthcare plan for Apple employees (and I don't know which company Apple currently uses) then Apple sets the policy for what is and isn't covered. UHC simply enforces the policy set by Apple so blaming UHC in that scenario is simply naive and displays a total misunderstanding of how the healthcare financing system actually works. The reality though is that the employer generally doesn't want to pay 100% of all claims, all the time. So they're left with "well, what do we pay, how much, and how can we use the insurer's negotiated pricing, etc., etc." and they ask UHC to provide plans that largely match UHC's plans, rules and the like, potentially with one or two little carve outs or exceptions, because UHC is the one that has done the math to make sure that balances cost/benefit for Apple. So a lot of time, they just "pass through" plans. Which is why most self-funded plans look "suspiciously similar" to what you might find elsewhere in the market. I wrote software for a healthcare claims benefit management company that drove insurance for direct insureres and TPAs for 12 years.