Torrent of Hate for Health Insurance Industry Follows CEO's Killing(nytimes.com)
nytimes.com
Torrent of Hate for Health Insurance Industry Follows CEO's Killing
https://www.nytimes.com/2024/12/05/nyregion/social-media-insurance-industry-brian-thompson.html
274 comments
Health "insurance" companies in the US are not actually, primarily insurers. For the most part, they are not in the business of insuring rare events. Maybe they were primarily in the insurance business at some point in the past, but today they are mainly in the business of entrenching themselves in the middle of all interactions between patients, doctors, and hospitals, and extracting rents from all of them. Health "insurance" companies have become extractive businesses that produce nothing of evident value except unpleasant paperwork, and extract an economic rent for it, to the detriment of everyone else. I call them "paperwork-shuffling processors."
Accurate. They are literally middle men taking a cut without offering anything to the process. Switch to single payer, dump the middlemen, and have our taxes pay for essential services (keeping us alive and healthy). Seems simple enough but…
But regulatory capture ensures that can’t happen.
But literally every state in the country disagrees with you and so it's not going to happen.
Most Americans support a public option, which is the transition step toward a healthcare system that more closely aligns with other first world nations.
Only in the abstract. When you work out a concrete proposal that involves people paying for programs, support evaporates.
People are already paying for the healthcare one way or another, whether they understand it or not.
Oh, you can get a lot of stuff done if you just assume you know better than voters do and make the decisions for them.
You think the ruling classes in the US don't assume that they know better than the voters?
And they still get nothing done when it comes to entrenched interests. Let's not glorify the average voter either.
And they still get nothing done when it comes to entrenched interests. Let's not glorify the average voter either.
The voters are for the most part uninformed, bordering on flat out ignorant. I feel safe in saying the experts who solve problems like this do know better than voters.
(decades of propaganda and state capture by the insurance companies later...) oh I guess the people just don't want it! Too bad.
true but that doesn’t make it right when people are running these states are paid by the same people
who benefit from the current system…
The people in those states do not want it, which is why state single payer referenda fail.
Romneycare and the ACA were a pretty big step in the single payer direction. Popular enough to overcome vetos and attempts to roll them back.
I like the ACA. I think the Swiss system makes a lot of sense. Community rating, guaranteed issue, mandate, subsidy, then universal single payer at retirement, where costs are concentrated. It's a sane system. The problem isn't the system structure.
What one thing would you change in the American system?
I would drastically increase the number of residency slots Medicare funds.
I would never have expected your answer to be “spend more of other people’s money”.
all of insurance and all of healthcare is "other people's money" :) it just depends where other people's money is going.
this is amazing thing to me as European living in the United States, people want Gov to spend money for education or healthcare or ... COMMUNISM!! but corporate subsidies and 984 trillion dollars to the department of offense - oh RIGHT ON - let me get another gig job to pay more to that :)
this is amazing thing to me as European living in the United States, people want Gov to spend money for education or healthcare or ... COMMUNISM!! but corporate subsidies and 984 trillion dollars to the department of offense - oh RIGHT ON - let me get another gig job to pay more to that :)
The somewhat obvious thing you seem to be missing there is that the money isn’t being extracted by force.
> Switch to single payer, dump the middlemen, and have our taxes pay for essential services (keeping us alive and healthy). Seems simple enough but…
... But you still have group A (patients) paying group B (doctors) with group C's (taxpayers', or currently insurers'/policyholders') money.
... But you still have group A (patients) paying group B (doctors) with group C's (taxpayers', or currently insurers'/policyholders') money.
Sure - but it's a lot simpler with less middlemen and way more cost effective.
What point are you making here?
What point are you making here?
Uh, group A and group C are the same. We would see much more preventative care if such care was free at time of service.
I suppose, careful what you wish for. The NHS (UK's single payer health provider), allegedly the envy of whole wide world, is failing under the burden of insufficient funding, aging society and years of mismanagement by politicians. We're talking, properly dysfunctional, like ambulances taking hours to be dispatched to life-threatening emergencies or people dying on emergency wards due to neglect.
The NHS was properly sabotaged by the Tories, exactly because they wanted to privatise it. Starving the NHS has been per design, no accident there.
- https://tribunemag.co.uk/2023/07/defunding-the-nhs
- https://tribunemag.co.uk/2023/07/defunding-the-nhs
Same for Canadian healthcare.
Literally the same thing is true of health care providers, which is why we have artificially constrained supply of physicians, sky-high delivery of procedures other countries don't routinely do, and integer multiple compensation across the board for practitioners.
Yes. I almost added a comment about that too. In my experience, all doctors, nurses, and other caregivers with whom I have interacted at hospitals have told me they feel treated like "factory workers" who must meet stringent "quality of care" KPIs, set by hospital executives far removed from actual patient care.
So why are we putting jerseys on and taking the field against the insurers when virtually all of the actual money is going to providers? We could zero out all insurance costs, putting insurers into literal de jure indentured servitude, and get nothing more than a grocery store circular coupon discount on health costs, because insurers are not in fact where the costs are.
Shooting the messenger is a rather common hobby.
They are an integral part of the mess we're in, and they have a vested interest in the status quo.
Otherwise, I agree with you.
Otherwise, I agree with you.
I'm certainly not going to valorize insurers, but I find it deeply frustrating the providers are getting a pass here. You can see it on this thread, where there are commenters expressing surprise that I'd even suggest providers are the primary beneficiaries of the current system.
Yes, I see what you mean about the comments elsewhere on this thread/page. For what it's worth, I was only trying to avoid going off-topic ¯\_(ツ)_/¯
Regarding providers overcharging, the following article by Atul Gawande (from 15 years ago!) had a big impact on me -- it agrees with you:
https://www.newyorker.com/magazine/2009/06/01/the-cost-conun... / https://archive.ph/g8zXl
Regarding providers overcharging, the following article by Atul Gawande (from 15 years ago!) had a big impact on me -- it agrees with you:
https://www.newyorker.com/magazine/2009/06/01/the-cost-conun... / https://archive.ph/g8zXl
But why are you bringing it up, tptacek?
You’re even replying this to a comment that literally contains “I agree with you”.
It’s like stepping between your friends complaining about jet lag to talk about how your corner bodega raised the price of bubble gum.
If you just want to talk about providers then write a screed on it. People will comment their opinions on the subject you want to discuss.
You’re even replying this to a comment that literally contains “I agree with you”.
It’s like stepping between your friends complaining about jet lag to talk about how your corner bodega raised the price of bubble gum.
If you just want to talk about providers then write a screed on it. People will comment their opinions on the subject you want to discuss.
Because people are killing insurance company executives in the hopes of getting a maybe 5% savings break on their health insurance costs?
> Because people are killing insurance company executives
Then share an opinion on that.
> in the hopes of getting a maybe 5% savings break on their health insurance costs?
You were so close.
All you had to do was condescendingly presuppose a motive, and fabricate a statistic to make it about your desired topic again.
Then share an opinion on that.
> in the hopes of getting a maybe 5% savings break on their health insurance costs?
You were so close.
All you had to do was condescendingly presuppose a motive, and fabricate a statistic to make it about your desired topic again.
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The entire health care system is broken but insurance companies tend to be the pain people experience so that's what people lash out at.
But you don't expect someone dying from losing health care to shut up until they come up with rational cost management system? The point isn't that the average person needs to how to portion blame but that the health care system needs to stop treating people in the fashion it does.
But you don't expect someone dying from losing health care to shut up until they come up with rational cost management system? The point isn't that the average person needs to how to portion blame but that the health care system needs to stop treating people in the fashion it does.
That's a problem though when the blame is so screwy, because it leads people to solutions that are not solutions. Medicare itself drastically overpays for medical services compared to the G20. The biggest problem is with providers, and it's exactly stuff like anesthesiologists overbilling for surgeries.
Yes, the blame apportioned by the average person is screwy. But that should be clue to the experts with a more sophisticated view. What it should tell them is that health care reform schemes that rest on the average person exerting or responding to incentives are not going to work.
A lot of private "health insurance" at large companies is just:
- the company pays out-of-pocket for all employee health expenses
- they don't want to directly deal with bills from doctors and hospitals, so they contract that out to a third-party administrator (TPA), which purely handles paperwork and has no financial role at all
but this doesn't remove the tension between the employer wanting to pay less, and the patient wanting more to be paid for
(and for single-payer systems, you still have the tension between taxpayers wanting to pay less and patients wanting more care, although those groups at least overlap a lot more)
- the company pays out-of-pocket for all employee health expenses
- they don't want to directly deal with bills from doctors and hospitals, so they contract that out to a third-party administrator (TPA), which purely handles paperwork and has no financial role at all
but this doesn't remove the tension between the employer wanting to pay less, and the patient wanting more to be paid for
(and for single-payer systems, you still have the tension between taxpayers wanting to pay less and patients wanting more care, although those groups at least overlap a lot more)
Insurers will also sometimes contract out their claim handling to those same TPAs.
If I go to a doctor or get Lasik surgery, can't I pay them directly without using my insurance?
Yes, but unless it's literally Lasik, which has a robust private market, your provider will probably literally make a price up on the spot. That happened to me several years ago, when we needed urgently to get a CT scan for our daughter; it was late in the afternoon, the provider couldn't get the insurer on the horn, they proposed to do it the next day, I was jumpy and said "fuck it I'll pay out of pocket", they looked confused and then just made up a price: $1000.
Discussions
Americans React to UnitedHealthcare CEO's Murder: 'My Empathy Is Out of Network' (141 points, 12 hours ago, 329 comments) https://news.ycombinator.com/item?id=42327272
Moderators Delete Reddit Thread as Doctors Torch Dead UnitedHealthcare CEO (45 points, 3 hours ago, 22 comments) https://news.ycombinator.com/item?id=42332347
Americans React to UnitedHealthcare CEO's Murder: 'My Empathy Is Out of Network' (141 points, 12 hours ago, 329 comments) https://news.ycombinator.com/item?id=42327272
Moderators Delete Reddit Thread as Doctors Torch Dead UnitedHealthcare CEO (45 points, 3 hours ago, 22 comments) https://news.ycombinator.com/item?id=42332347
It's mostly not rational. For instance, much of the conversation over the last day has been about Anthem pushing back on anesthesiology pay on the East Coast. That's people angry about their insurers working to make surgeries cost less by employing the literal guideline Medicare uses, and yet people online were overtly suggesting Anthem's CEO be murdered over it. Incoherent.
This won't win me any points in this particular forum, where this opinion (that I strongly hold) is unpopular, but I'm reminded of what someone else said about Net Neutrality: it's a bunch of people suiting up and taking sides on behalf of one group of giant corporations against another group of giant corporations. That's the "health care debate" in the US, where medical staff are paid 2-3x more than they are in other countries, and expensive procedures are prescribed and delivered at drastically higher rates. It's my problem with "Medicare For All", which more or less absolves providers from their role in choking people out with health care costs, despite the leading role they have in this situation.
At any rate: there's no serious theory of change that begins with murdering health care industry people.
This won't win me any points in this particular forum, where this opinion (that I strongly hold) is unpopular, but I'm reminded of what someone else said about Net Neutrality: it's a bunch of people suiting up and taking sides on behalf of one group of giant corporations against another group of giant corporations. That's the "health care debate" in the US, where medical staff are paid 2-3x more than they are in other countries, and expensive procedures are prescribed and delivered at drastically higher rates. It's my problem with "Medicare For All", which more or less absolves providers from their role in choking people out with health care costs, despite the leading role they have in this situation.
At any rate: there's no serious theory of change that begins with murdering health care industry people.
> At any rate: there's no serious theory of change that begins with murdering health care industry people.
I dunno. This is the most publicly-united I’ve seen people against the industry maybe ever. Usually they’re separately-angry at the industry in their partisan silos (everyone hates it, more or less—hence the amazingly consistent and widespread reaction) but this has been the closest thing to a bipartisan healing moment since, like, the week after 9/11. Not particularly close to that, sure, but I can’t think of anything closer.
If this were part of a theory of change, it strikes me as no less serious than any other I’ve seen. At least.
I dunno. This is the most publicly-united I’ve seen people against the industry maybe ever. Usually they’re separately-angry at the industry in their partisan silos (everyone hates it, more or less—hence the amazingly consistent and widespread reaction) but this has been the closest thing to a bipartisan healing moment since, like, the week after 9/11. Not particularly close to that, sure, but I can’t think of anything closer.
If this were part of a theory of change, it strikes me as no less serious than any other I’ve seen. At least.
I think it is the most disgusted I have been with a broad swath of the public in a long time. I dont think anything productive will come of it.
The trouble is that nothing productive was going to come of anything else, either. That’s where these reactions come from.
Yes, there is a lot of frustrations. Voters disagree on what they want. That does not justify people to start shooting people when they dont get their way.
The thing you don’t like is that the voters do agree they want this, though.
Want what? I dont think the majority of Americans endorse vigilante murder of law abiding citizens. That is just a vocal and bloodthirsty segment of the online population.
Literally everyone I know IRL was like, “nice. More please.” I was actually surprised and heartened to see the initial HN thread, even, was overwhelmingly supportive.
This is top of my list for conversation topics to steer things toward when I’m around Republican relatives, so we’ll have something we can agree on.
Law-abiding doesn’t mean much when you can kill lots of people for money and remain within the bounds of the law. Killing one such person is definitely far less bad than killing a bunch of people arbitrarily. Yet only one of these cases is illegal, and it’s the better of the two.
This is top of my list for conversation topics to steer things toward when I’m around Republican relatives, so we’ll have something we can agree on.
Law-abiding doesn’t mean much when you can kill lots of people for money and remain within the bounds of the law. Killing one such person is definitely far less bad than killing a bunch of people arbitrarily. Yet only one of these cases is illegal, and it’s the better of the two.
More please of what? Vigilante murders?
Specifically of antisocial CEOs, board members, et c. That specific kind of vigilante murders.
Compared to CEO's directing their companies to legally murder people ("law abiding citizens") instead?
This is logic that makes sense inside of filter bubbles on the Internet that I think most people --- most people are not in any one particular filter bubble and certainly not this one --- would find absolutely repellant. To put it in perspective: it is literally the logic used by people who shoot up abortion clinics.
How do you feel about murdering doctors who demand pay for treatment, citizens that vote against single payer, or people that fail to donate to your gofundme?
All of those are extremely different situations, so what are you getting at?
Justifications are meaningless when the end result is all the matters.
I staunchly disagree with this kind of utilitarianism. The ends do not justify the means.
Okay. So other than getting mad on HN, what do you propose we do to fix the feelings people have about this situation and prevent this happening again?
I don't think we're going to fix this problem on HN, so I'm content just to point out that a lot of what people are saying about this situation is unfounded.
I don't either, but people feel this way about millionaires and healthcare execs for a reason, they're not just being cruel for the sake of it. Think about the reasons for it, and try to come up with a solution. That's a way more interesting discussion than getting mad about people being dumb on BlueSky or whatever.
People have built a frustrating system for themselves with a century of complicated and messy political decisions (and resulting regulations). They don't have the will or attention span required to solve the various problems via the slow moving & gridlocked political system. So, they take out their frustration on the highest profile participants in the system.
Solutions? I'm worried that there aren't solutions. There are only bandaids.
Solutions? I'm worried that there aren't solutions. There are only bandaids.
There is really basic stuff that we're going to have to do no matter what that doesn't involve restructuring the system, like drastically increasing the number of practicing physicians, which is capped by (you guessed) Medicare, which sponsors residencies. But all we can talk about is payer structure because of a complete fixation on insurance companies as singular villains.
Heyyy, we're starting to talk solutions after all. Good stuff. What do you think is UHG's and its executives' role in supporting or opposing the policies and politicians who could enact these fixes? I didn't verify this, but I'm going to go out on a tiny limb and guess that UHG and its execs pay for legislative seats to be filled by Republicans. Republicans famously want to reduce Medicare funding. Do you think lowered Medicare funding would result in more or fewer Medicare-funded residency positions? Certainly there's more at play in elections than UHG itself, but I'm wondering which side of the solution they're on.
This could be an opportunity for me to learn something new...
I thought the American Medical Association were the ones who artificially constrain the supply of physicians. Is that not true, or is the AMA constraint transitively related to the Medicare caps in some manner?
I thought the American Medical Association were the ones who artificially constrain the supply of physicians. Is that not true, or is the AMA constraint transitively related to the Medicare caps in some manner?
The AMA is just a lobbying group. The actual cap on the number of new physicians is residency slots, which are funded by Medicare.
Which I think itself is a bit of a red herring. Medicare subsidized residency slots are not the only way training doctors could be funded, and largely an artifact of our billing procedures and criteria.
It is just one aspect of how incredibly constrained the supply of healthcare is in the US. Medications that are over the counter in many countries requires someone with 12 years of training.
It is just one aspect of how incredibly constrained the supply of healthcare is in the US. Medications that are over the counter in many countries requires someone with 12 years of training.
It's not the only way they could be funded, but it is the only way they are funded.
Sure, and my point is that the entire bottleneck is based on a a completely arbitrary artifact of how we handle billing in the US. It is a policy choice.
Residents provide healthcare to patients with real value. This healthcare either gets attributed to the attending physician or goes unbilled. The market value of care provided exceeds what it actually costs to employ and train a resident.
https://pubmed.ncbi.nlm.nih.gov/21217491/
Residents provide healthcare to patients with real value. This healthcare either gets attributed to the attending physician or goes unbilled. The market value of care provided exceeds what it actually costs to employ and train a resident.
https://pubmed.ncbi.nlm.nih.gov/21217491/
The "arbitrary artifact" here is literally Medicare!
The notion that the providers are the ones sucking up all the money in the healthcare industry is certainly... novel.
The majority of people in this particular industry have nothing to do with actually providing health care, just as the majority of employees at a major university have never stood in front of a blackboard.
The majority of people in this particular industry have nothing to do with actually providing health care, just as the majority of employees at a major university have never stood in front of a blackboard.
Here's a 14 year-old series showing that providers are the biggest chunk of the overspending in the system:
https://web.archive.org/web/20210421025041/http://theinciden...
https://web.archive.org/web/20210421025041/http://theinciden...
In the United States, physician salaries were 6.5 times GDP per capita for specialists and 4.1 times GDP per capita for generalists.
(Shrug) I'm OK with the notion that doctors contribute somewhere between 4 and 7 times more value than your average schlub driving a bus, and I'm OK with paying them accordingly.
Now, how much do the administrators, insurance-company execs, and other noncontributors make?
(Shrug) I'm OK with the notion that doctors contribute somewhere between 4 and 7 times more value than your average schlub driving a bus, and I'm OK with paying them accordingly.
Now, how much do the administrators, insurance-company execs, and other noncontributors make?
If you look, you can find pie charts that make the point I'm making directly, so no, I don't think it's novel.
The problem with our health insurance system is that it's insidious. Our doctors spend ~25% of their time filling out information that only gets filled out to try to get insurance to not deny the claims, and hospitals have entire billing departments whose only job is dealing with the billing of our stupid ass system. The problem isn't just the ~15% that the insurance companies take directly, it's that since their percentage of profit is capped, they work to raise prices of the entire health care system so that their 15% cut is bigger. Insurance companies literally negotiate pharma companies to charge a larger amount to uninsured people so they get to take a bigger cut.
Is that why they make as much as 3x what doctors in other G20 countries make? Hazard pay for the paperwork?
That's not all of the reason (some of it is higher cost of living, compare G20 vs G7 and the gap narrows a bunch). Some of the reason is because of US education costs, and immigration policies that make it harder for people to come and work in healthcare.
Does it? Average physician cash comp in Germany is 75kEU, and average cash comp in the US is something like $350kUSD. Note here I'm using one of the largest and soundest economies as a comparison, and one with substantial uptake of private health insurance.
If I look, I can find pie charts demonstrating that the Moderna COVID vaccine provides 8 dB worse 5G reception than the Pfizer shot.
So, yeah, you'll have to do a little better than that.
So, yeah, you'll have to do a little better than that.
No, I don't.
You can't come to the conversation with "everyone else is being unreasonable" and then not cite your sources.
If what I was backing with "pie charts" was "everyone else is being unreasonable", sure, but that's not what I said. Go look it up. Zero out all insurer costs. What percentage of health care costs do we save?
There's a lot more than just "Insurer costs" and "Doctors' BMW payments" in the pie chart. Again, relatively little of it has to do with actually treating injuries and illnesses. And that's not even getting into the massive market distortions associated with forcing the concept of "insurance" into a market where virtually every single customer will eventually need to file multiple claims.
You usually come up with better arguments than this. We all have off days, I guess.
You usually come up with better arguments than this. We all have off days, I guess.
I've lost track of what you're saying. I'm saying that if you zero out the insurance companies, you don't significantly impact total health costs, because the insurers aren't where those costs are; that's the claim I made upthread you found "... novel", but it's not novel, and it's easy to go verify.
How much care costs can be attributed to providers needing and paying for departments to deal with insurance companies? How much care costs can be attributed to providers needing to spend x% of time merely documenting to ensure insurance will not deny claims/services? We can deal with going after provider fraud separately.
> there's no serious theory of change that begins with murdering health care industry people.
To be fair, we’ve never tried it.
To be fair, we’ve never tried it.
I'm honestly not sure if I should attribute this comment to disingenuity, ignorance or just bad faith.
> pushing back on anesthesiology pay on the East Coast.
Not even close. BCBS was just pushing extra charges onto patients.
> insurers working to make surgeries cost less
This is laughably ill-informed, I don't know where to begin. The only thing insurers are doing is increasing the gap between what they collect and what they have to pay out. They do this by denying claims. Making the service cheaper has nothing to do with it.
> where medical staff are paid 2-3x more than they are in other countries
Because medical school is so expensive. Also, doctors spend 3-8 years working for minimum wage (ie medical residency) and the cost of billing and administration is enormous. One study showed a primary care doctor spent $99,000 a year on billing and roughly 25% of ER income spent on the same [1].
The US spends the most per capita on healthcare than any other OECD country, by about 50% (Switzerland is #2) [2] for less coverage, worse outcomes and lower life expectancy.
Medicare spends almost all (~98.5%) of its funds on patient care and ~1.5% on admin, compared to 15-25% on admin for private insurers (including Medicare Advantage).
It amazes me how concifently wrong and ignorant about a subject can be while having such strong opinions.
[1]: https://www.fiercehealthcare.com/finance/study-billing-for-m...
[2]: https://www.oecd-ilibrary.org/sites/7a7afb35-en/1/3/7/2/inde...
> pushing back on anesthesiology pay on the East Coast.
Not even close. BCBS was just pushing extra charges onto patients.
> insurers working to make surgeries cost less
This is laughably ill-informed, I don't know where to begin. The only thing insurers are doing is increasing the gap between what they collect and what they have to pay out. They do this by denying claims. Making the service cheaper has nothing to do with it.
> where medical staff are paid 2-3x more than they are in other countries
Because medical school is so expensive. Also, doctors spend 3-8 years working for minimum wage (ie medical residency) and the cost of billing and administration is enormous. One study showed a primary care doctor spent $99,000 a year on billing and roughly 25% of ER income spent on the same [1].
The US spends the most per capita on healthcare than any other OECD country, by about 50% (Switzerland is #2) [2] for less coverage, worse outcomes and lower life expectancy.
Medicare spends almost all (~98.5%) of its funds on patient care and ~1.5% on admin, compared to 15-25% on admin for private insurers (including Medicare Advantage).
It amazes me how concifently wrong and ignorant about a subject can be while having such strong opinions.
[1]: https://www.fiercehealthcare.com/finance/study-billing-for-m...
[2]: https://www.oecd-ilibrary.org/sites/7a7afb35-en/1/3/7/2/inde...
Anthem proposed to apply the precise guidelines Medicare uses to pay for anesthesiology, including references to those CMS guidelines. Billing for anesthesiology has been a hot button issue: the search you want is [anesthesia surprise billing]. Anesthesiology is one of the highest-paid specialties in American medicine.
You cannot reasonably support Medicare and claim that Anthem was doing something unconscionable, because Anthem was adopting Medicare's own policies.
Medicare's admin cost ratio is a function of who it covers. Somewhere in the comment history on HN, there's a short writeup I did of how the math works out if you extend Medicare to the whole population; the admin overhead, for obvious reasons, shoots up --- people pay the same amount of money but require far fewer services, reversing the "advantage" Medicare has in the metric currently.
You cannot reasonably support Medicare and claim that Anthem was doing something unconscionable, because Anthem was adopting Medicare's own policies.
Medicare's admin cost ratio is a function of who it covers. Somewhere in the comment history on HN, there's a short writeup I did of how the math works out if you extend Medicare to the whole population; the admin overhead, for obvious reasons, shoots up --- people pay the same amount of money but require far fewer services, reversing the "advantage" Medicare has in the metric currently.
Insurers use the Medicare schedule as a weapon to simply reduce how much providers get paid and/or increase how much patients have to pay out-of-pocket.
The Medicare schedule is generally low because of the negotiating power of the Federal government so when Anthem (or whoever) says something like "we'll pay Medicare rates" or "we'll pay 120% of the Medicare rate" they're really just cutting payments and increasing patient costs. Nothing more.
In the recent BCBS case, all they were doing was saying "it may take 8 hours for the surgery but we're only going to pay you for 3". They haven't made the surgery cheaper to provide. They just wanted to pay out less.
Also, if we're going to simply do everything based on Medicare, why exactly do we even need private insurers? Just expand Medicare to everyone if the schedules are good, right?
The Medicare schedule is generally low because of the negotiating power of the Federal government so when Anthem (or whoever) says something like "we'll pay Medicare rates" or "we'll pay 120% of the Medicare rate" they're really just cutting payments and increasing patient costs. Nothing more.
In the recent BCBS case, all they were doing was saying "it may take 8 hours for the surgery but we're only going to pay you for 3". They haven't made the surgery cheaper to provide. They just wanted to pay out less.
Also, if we're going to simply do everything based on Medicare, why exactly do we even need private insurers? Just expand Medicare to everyone if the schedules are good, right?
You're saying "the Medicare schedule" as if it's an abstraction, but it is literally the payment process used by the largest buyer of medical services in the country. What Medicare pays matters more than what anybody else pays, because most medical services are performed for Medicare patients. So I'll ask directly: how is it unconscionable for Anthem to use those policies, but not for Medicare to use them?
You are exactly right that Anthem is demanding providers charge less for surgeries, not for surgeries to take less time. Providing "less anesthesia" is not a thing. This is entirely about preventing health providers from charging more money to Anthem and, in turn, their customers. That's why Medicare does the same thing.
You are exactly right that Anthem is demanding providers charge less for surgeries, not for surgeries to take less time. Providing "less anesthesia" is not a thing. This is entirely about preventing health providers from charging more money to Anthem and, in turn, their customers. That's why Medicare does the same thing.
The fundamental difference between Anthem and Medicare is that when Medicare cuts reimbursement, that cost isn't passed on to patients, but when Anthem does, it is. Medicare's rates are arguably too low, but low Medicare rates are getting a good deal for the country. Low Anthem rates are passing costs onto consumers and profits onto shareholders.
That is not how any of this works. Insurers and health chains are in a continuous process of rate-sheet negotiation, and the result of that negotiation is reflected in your premium costs. Most people's out-of-pocket costs are capped, and even the most routine surgeries (like a tonsillectomy) exceed the out-of-pocket cap (I checked! This is a number people report.)
This is about the trade association for anesthesiologists deputizing angry people on Twitter to go to bat for them overcharging for their services.
This is about the trade association for anesthesiologists deputizing angry people on Twitter to go to bat for them overcharging for their services.
Us republicans here don't like them facts and prefer alternative facts
we like to think we are just da best at everything
after all, I sometimes read about people coming to the US for care so it must be better?
we like to think we are just da best at everything
after all, I sometimes read about people coming to the US for care so it must be better?
maybe so but it's definitely cathartic and that counts for something
I dont think it counts for something good. I think it is giving in to one of the worst possible aspects of humanity. Like people cheering at a lynching.
I suppose though if one of my children grows up to be a CEO of a place like UHC, I'd consider myself to have failed as a parent and would disown them
if they are that successful to make it to a point where they can be hired to be CEO of UHC or Monsanto or other axis of pure evil, perhaps they would choose to take their talents elsewhere
Likely a placebo effect.
> there's no serious theory of change that begins with murdering health care industry people.
You sure about that? Show me one theory of change where the oppressed somehow rise above without violence? Even the groundwork for Ghandi's peaceful protest were laid by a strong anti-colonial military force that led assassinations of British military officers. You think Britain left because Ghandi said some profound things and changed their minds? The official position was that continued occupation of India would be met by violent resistance and they retreated.
There have been many many examples throughout history of oppressed people rising up with violence against their oppressors. The majority of the substantial changes in culture happen this way - things reach a boiling point and it spills out on the streets.
I'm not saying mob justice is an ethical or principled way to instill change. But historically it has been extremely successful.
You sure about that? Show me one theory of change where the oppressed somehow rise above without violence? Even the groundwork for Ghandi's peaceful protest were laid by a strong anti-colonial military force that led assassinations of British military officers. You think Britain left because Ghandi said some profound things and changed their minds? The official position was that continued occupation of India would be met by violent resistance and they retreated.
There have been many many examples throughout history of oppressed people rising up with violence against their oppressors. The majority of the substantial changes in culture happen this way - things reach a boiling point and it spills out on the streets.
I'm not saying mob justice is an ethical or principled way to instill change. But historically it has been extremely successful.
Yes, I'm sure, in that it's mathematically incapable of solving the problem people have.
Bullshit. Show me the proof. Given that nearly all successful revolutions against oppressive powers have been backed by violence, I'm curious what you come up with.
There is one group, the insurance companies, which have unequivocally stated that they will physically harm other people if it yields marginally higher profits. That's not up for debate, that's the stated business model. It is extra-judicial killing for profit, backed by the state. And when the state abuses their monopoly on power, history shows that people will claw it back as violently as they feel necessary.
There is one group, the insurance companies, which have unequivocally stated that they will physically harm other people if it yields marginally higher profits. That's not up for debate, that's the stated business model. It is extra-judicial killing for profit, backed by the state. And when the state abuses their monopoly on power, history shows that people will claw it back as violently as they feel necessary.
The proof is that you'd be going to war over a 5% discount in prices, and it's based on an accounting of where the money in our health system goes. Sorry, the numbers here are easy to find and they are unforgiving.
The hate was always there. It's just now newsworthy.
Definitely was already there. I'd guess that people hate insurance companies more than they hate politicians - in fact, I'd go so far as to say that at least some of the hate for politicians is sublimated hate for insurance companies and our Kafkaesque healthcare system. It's almost a bit surprising that this is the first time this has happened. And now that someone has done it, it seems likely that there will be copycat attempts.
Was it? If that's the case, why do the majority of M4A voters say their support is conditioned on them retaining access their existing private insurance?
The hate wasn't always there. Pent up frustration for the healthcare system precipitated as hate when an obvious target hit the news.
You get frustrated when your doctor is 30 minutes late. Being denied coverage by your insurance for something serious and expensive is a matter that causes hate.
Genuine question: What is so difficult about healthcare in the USA?
European countries solutions range from free to government subsidised (for those who can't afford it). The free ones vary in quality, but systems where you pay unless you can't work pretty well, and the quality is very high.
Why is this such an issue in the USA? Is it purely a "powerful people with vested interests" thing?
European countries solutions range from free to government subsidised (for those who can't afford it). The free ones vary in quality, but systems where you pay unless you can't work pretty well, and the quality is very high.
Why is this such an issue in the USA? Is it purely a "powerful people with vested interests" thing?
The US spends over 17% of GDP on healthcare while comparable countries are around 8%. There are some ways we could reduce that but at the end of the day americans consume a lot of healthcare and americans get paid a lot to provide health care so any solution is going to have cost related problems. Because theres so much money involved there are tons of special interests which makes it politically extremely difficult to change anything. Two of the most obvious things we should do are pay less for pharmaceuticals and increase the number of doctors but the pharma lobby and AMA make that impossible.
> But that did not stop social media commenters from leaping to conclusions and from showing a blatant lack of sympathy over the death of a man who was a husband and father of two children.
The journalists' tone and choice of words here, which I've italicized, isn't helping the overall feeling many Americans have of "the people running the show have active and unceasing contempt for us", which of course is what's driving the "torrent of hate for health insurance industry" that this article sets out to document.
I'm sorry, but where do these writers get off wagging their fingers and tut-tutting people who'd prefer not to spend their neurons on sympathy for someone at the helm of an inhuman system? The point's already been made, but plenty of monsters are husbands and fathers.
The journalists' tone and choice of words here, which I've italicized, isn't helping the overall feeling many Americans have of "the people running the show have active and unceasing contempt for us", which of course is what's driving the "torrent of hate for health insurance industry" that this article sets out to document.
I'm sorry, but where do these writers get off wagging their fingers and tut-tutting people who'd prefer not to spend their neurons on sympathy for someone at the helm of an inhuman system? The point's already been made, but plenty of monsters are husbands and fathers.
Unfortunately, it is the same system where journalists have bills to pay and mouths to feed, and their wages comes from advertising of these Fortune 500 companies.
There's a distinction to be drawn between challenging norms of discourse like not speaking ill of the dead, and actively cheerleading murders, like "we should boycott Starbucks for providing evidence about the murderer to police", or Taylor Lorenz calling for the assassination of Anthem's CEO by name.
The incoming President told his supporters that if he lost they’d still have to the option of shooting his opponent, when he ran in 2016. Instead of being ejected from politics forever by an outraged public, he went on to win that election. Then another one more recently.
What’s this norm you mention?
What’s this norm you mention?
Norm died in 2016.
I don't understand why you think pointing to another odious person rebuts my argument.
Another extremely popular person. Who violated that norm on camera and had it broadcast all over the place. And remained extremely popular.
What norm?
What norm?
I don't think you understand me. I'm not saying people are taking to fainting couches over norms violations. They're reacting to people like Taylor Lorenz literally calling for the assassination of people by name. In my case, past that, for Lorenz doing so based on a comically flawed understanding of what her target was doing.
I’m saying not-cheerleading-murder isn’t exactly a firm norm here anymore. Not even among the elites.
That's fine, but I'm going to push back on the idea that objecting to people publishing hit lists is "tut tutting".
"The point's already been made, but plenty of monsters are husbands and fathers."
For example, the ones establishing and profiting from so-called "social media" at the expense of organisations that employ journalists.
Advertisers choose between supporting organizations that employ journalists versus supporting ones that do not, the ones profiting instead from the "torrent of hate". NYT has plenty of paying subscribers; it is not 100% dependant on ads, unlike "social media", generally.
Indeed "the people running social media have active and unceasing contempt for us". They prefer computers over people. Surveillance over sympathy.
For example, the ones establishing and profiting from so-called "social media" at the expense of organisations that employ journalists.
Advertisers choose between supporting organizations that employ journalists versus supporting ones that do not, the ones profiting instead from the "torrent of hate". NYT has plenty of paying subscribers; it is not 100% dependant on ads, unlike "social media", generally.
Indeed "the people running social media have active and unceasing contempt for us". They prefer computers over people. Surveillance over sympathy.
I'm terribly sorry, but all of your italicized fragments, taken in isolation, do paint a stark picture of the murder of a person.
You might have beef (or whatever you call it these days) with his job and industry but in the end a man was murdered. You may not like and "hate" seems appropriate to describe how you feel about a legitimate industry in the USA. Your issue is with a deeply embedded part of the US experience - health insurance, and not with this man.
Please attack the industry that you hate and not the individual ... who was murdered. That is what the journos are doing.
You might have beef (or whatever you call it these days) with his job and industry but in the end a man was murdered. You may not like and "hate" seems appropriate to describe how you feel about a legitimate industry in the USA. Your issue is with a deeply embedded part of the US experience - health insurance, and not with this man.
Please attack the industry that you hate and not the individual ... who was murdered. That is what the journos are doing.
> Please attack the industry that you hate and not the individual ... who was murdered. That is what the journos are doing.
Depending on the shooters motivation, I think they're of the opinion that the time for dialogue has passed.
Depending on the shooters motivation, I think they're of the opinion that the time for dialogue has passed.
I wasn't talking to the shooter.
Given your spelling of dialogue, I think it's unlikely we'll ever really understand the shooter's motivation.
Given your spelling of dialogue, I think it's unlikely we'll ever really understand the shooter's motivation.
I dont find the "lack of sympathy" to be an issue.
What I do find disappointing is the lack of concern over people being gunned down in the street, and the not so subtle glee some people are expressing.
Murder should not be normalized or endorsed. It isn't healthy for a society and doesn't lead to progress.
What I do find disappointing is the lack of concern over people being gunned down in the street, and the not so subtle glee some people are expressing.
Murder should not be normalized or endorsed. It isn't healthy for a society and doesn't lead to progress.
> Murder should not be normalized or endorsed.
Sure. That includes the US health care system too.
The company that person was the key decision maker for has apparently been murdering people for years legally.
So, karma?
Sure. That includes the US health care system too.
The company that person was the key decision maker for has apparently been murdering people for years legally.
So, karma?
No, I disagree. We have a system of laws and courts to decide what is criminal.
People should not kill law abiding citizens they disagree with because everyone has a different opinion.
People should not kill law abiding citizens they disagree with because everyone has a different opinion.
I pay around $20k/year for health insurance for myself, my wife and my daughter. I need insurance coverage to save my life and it is denied and I die. Under what US Statute (any state or federal) can a prosecutor charge the people
responsible for my death? surely on the system of laws and courts you say we have there is something… I’ll wait…
also people should most definitely NOT kill law abiding citizens! we do have laws for that
also people should most definitely NOT kill law abiding citizens! we do have laws for that
I guess this is the crux of it. The law does not hold anyone responsible for your death, and nobody is responsible for providing you life saving services.
These are the laws that your fellow citizens have chosen and established.
These are the laws that your fellow citizens have chosen and established.
you know, our history says that at times, injustices may need to be fought with a touch of violence…
killing CEOs is not the kind of violence any reasonable human being can condone, but people tragically affected by someone’s actions may not be all that reasonable
killing CEOs is not the kind of violence any reasonable human being can condone, but people tragically affected by someone’s actions may not be all that reasonable
The same logic holds true for a an incel gunning down women or someone shooting up a church because they feel harmed.
that is nowhere near same logic :)
It's exactly the same logic. You can't just take your own set of issues, say you're obviously right about everything, and then factor out everybody else's big issues. If you make a consequentialist argument for murdering insurance executives, other people do in fact get to use the same moral logic to stop things you disagree with them about, like gender-affirming care and abortion.
being directly responsible for someone’s death is just not the same as having a difference of an opinion (like we are having). I will definitely not try and hunt you down… however, if you are responsible for a death of my loved one - that might be another story…
jokes aside, I am not saying this tragedy was justified in any way but we are not talking here about “opinions” and “religion” for sure
jokes aside, I am not saying this tragedy was justified in any way but we are not talking here about “opinions” and “religion” for sure
Sure. Again: if you just hate the guy and have no compunctions about saying why after he's murdered, then whatever, that's not interesting enough to argue about. But if you're literally saying "this was good and more like this would be better" --- and some people are --- that is a notably warped proposition.
If we throw up our hands and accept that each individual can be the judge of injustice, and execute whatever retribution they see fit, these individuals also meet that criteria.
By abandoning democratic law, you also abandon 3rd party discretion and control over which injustices are legitimate.
By abandoning democratic law, you also abandon 3rd party discretion and control over which injustices are legitimate.
Another person has tried to rationally explain to you why your position is unhinged and you weren’t taking it, so I’ll put this more plainly. Take up arms today to defend your ideology. Rally everyone you can and go to war. It won’t be a long war.
> We have a system of laws and courts to decide what is criminal.
We do, but unfortunately it heavily favors the party with the most money. If you want to take a health insurance company to court it's gonna cost you a lot of money in lawyer fees and you'll face a phalanx of corporate lawyers who have a lot of experience in crushing cases brought by their customers. That's not to say that people should go out and take matters into their own hands, but there is a lot of pent-up frustration out there and we really need to start addressing some of these issues before more of this happens.
We do, but unfortunately it heavily favors the party with the most money. If you want to take a health insurance company to court it's gonna cost you a lot of money in lawyer fees and you'll face a phalanx of corporate lawyers who have a lot of experience in crushing cases brought by their customers. That's not to say that people should go out and take matters into their own hands, but there is a lot of pent-up frustration out there and we really need to start addressing some of these issues before more of this happens.
The problem with this argument is that it assumes that one killing implies anarchy and and discarding of the system. It does not. Chances are, most reasonable people believe there should be a chain of justice with courts, laws, and investigations.
Someone has turned to vigilante justice here not because they believe that the courts are useless, but because they believe that this is such an extreme case that courts would not have worked in this case.
What I believe people fear is not the rise of anarchy due to one killing, but a fundamental shift in attitudes of the ordinary people in response to the unreasonable rise of the power structure. This threatens not order but the very power structure itself, which implies that a lot of people who benefit from injustice will suddenly be at risk of losing those benefits (money).
Someone has turned to vigilante justice here not because they believe that the courts are useless, but because they believe that this is such an extreme case that courts would not have worked in this case.
What I believe people fear is not the rise of anarchy due to one killing, but a fundamental shift in attitudes of the ordinary people in response to the unreasonable rise of the power structure. This threatens not order but the very power structure itself, which implies that a lot of people who benefit from injustice will suddenly be at risk of losing those benefits (money).
> People should not kill law abiding citizens they disagree with because everyone has a different opinion.
That's not what happened.
Brian Thompson isn't a "law abiding citizen I disagree with" he's a law abiding citizen who killed people. If you or your loved one died because of his actions, would you "have a disagreement with him"? Is that what you'd call that?
That's not what happened.
Brian Thompson isn't a "law abiding citizen I disagree with" he's a law abiding citizen who killed people. If you or your loved one died because of his actions, would you "have a disagreement with him"? Is that what you'd call that?
There is a massive difference between not helping and killing someone. If you attribute the deaths from healthcare denials to him, did he also save every life that wasnt denied?
How many millions of people did he save?
How many millions of people did he save?
> There is a massive difference between not helping and killing someone.
Tell that to the people whose family members died due to his actions.
I'm not arguing this with you again for you to ignore what I say again.
> If you attribute the deaths from healthcare denials to him, did he also save every life that wasnt denied?
> How many millions of people did he save?
None that wouldn't have been saved by anyone doing his job. Literally, it was just his job, and he was close to as bad at is as he could get away with. All the evidence I've seen is that this guy was an obstacle to saving lives at every opportunity he got.
Even if we somehow pretend he made any effort to saving lives, how many lives do you have to save to get a free pass for a murder in your mind? Is that how you think this works?
Honestly, I think there's something wrong with your conscience. Grow some compassion for other humans.
Tell that to the people whose family members died due to his actions.
I'm not arguing this with you again for you to ignore what I say again.
> If you attribute the deaths from healthcare denials to him, did he also save every life that wasnt denied?
> How many millions of people did he save?
None that wouldn't have been saved by anyone doing his job. Literally, it was just his job, and he was close to as bad at is as he could get away with. All the evidence I've seen is that this guy was an obstacle to saving lives at every opportunity he got.
Even if we somehow pretend he made any effort to saving lives, how many lives do you have to save to get a free pass for a murder in your mind? Is that how you think this works?
Honestly, I think there's something wrong with your conscience. Grow some compassion for other humans.
> We have a system of laws and courts to decide what is criminal.
Good when it works, but what happens when it fails?
Good when it works, but what happens when it fails?
yeah, blood in the street and mass death and destruction. Everyone killing everyone.
So, what do you propose to do to fix it? I don't think scolding people on HN is going to accomplish much.
I dont know how to talk people from normalized murder.
Forget the individuals. How do you fix the system that lead people to feel this way?
No way. Humanity since the dawn of time has always had the potential to mob when things became dire. We still have it today, only it is more controlled via technology and rationality. This killing will not start anarchy. But it does have the capability to start a resistance against existing power structures, and that is what everyone is actually (consciously or unconsciously) worried about. We are only conditioned to believe that anarchy might ensue as that is the easiest way to instill fear of rebellion against the power structure.
Yes, and mobbing often leads to mass deaths and people worse off than the state before. I dont think this is the straw that breaks the camel's back or anything. It just seems like one more incremental step in the wrong direction.
Maybe I'm sensitive because I have been reading about the french revolution, and how mob rule lead to mass murder which left everyone worse off.
Maybe I'm sensitive because I have been reading about the french revolution, and how mob rule lead to mass murder which left everyone worse off.
> mob rule lead to mass murder which left everyone worse off.
From your point of view was the "everyone left worse off" a short term thing, or did it eventually come good for most, or something else?
From your point of view was the "everyone left worse off" a short term thing, or did it eventually come good for most, or something else?
I think the french revolution left everyone worse off than if it didnt happen, The first republic didnt address any one the underlying economic issues. The failure of populist mob governance lead to first empire, and the Napoleonic wars which killed several percent of Europe's population (~6million) in France's attempt to loot its way back to economic prosperity.
Sounds like a reasonable way to look at it.
How far along the path do you reckon the US is to the same kind of thing?
How far along the path do you reckon the US is to the same kind of thing?
No clue. However if I were to speculate on a comparison, I think the us would skip the first Republic entirely and go straight to a repressive authoritarian police state fighting domestic terrorists.
I don't think any of the revolutionary elements can get enough support for governmental change, and the majority wold rather give up their freedoms than give in to terrorists.
I don't think any of the revolutionary elements can get enough support for governmental change, and the majority wold rather give up their freedoms than give in to terrorists.
That sounds pretty extreme. There's a large amount of possibility between those two positions. ;)
Jumped the shark there, dude! But some of these posts are hilarious over-the-top horseshit. Seriously...
Get a grip. For all we know the shooter was pissed b/c his girlfriend was banging the health insurance executive while babysitting for him!
[I would loooove for HN to have optionally-visible meta-threads, so onlookers like me could sit in the gallery, drink a beer, joke and remark about what is posted w/o affecting the stream of thought. Now back to y'all...]
Get a grip. For all we know the shooter was pissed b/c his girlfriend was banging the health insurance executive while babysitting for him!
[I would loooove for HN to have optionally-visible meta-threads, so onlookers like me could sit in the gallery, drink a beer, joke and remark about what is posted w/o affecting the stream of thought. Now back to y'all...]
Actually, that'd indeed be pretty funny at times. ;)
> Murder should not be normalized or endorsed. It isn't healthy for a society and doesn't lead to progress.
I guess the American revolution didn't lead to progress then. Or any of the other revolutions, many of which had assassinations. And murder is not being endorsed. Putting an end to it is.
I guess the American revolution didn't lead to progress then. Or any of the other revolutions, many of which had assassinations. And murder is not being endorsed. Putting an end to it is.
This is one of those things we state as a normative absolute in general society and you usually only see the nuance (or how it’s basically just a polite lie, in some cases) in relevant college classes or spaces dominated by certain kinds of professionals and nerds (the kind who took those college classes, usually).
People only care about this because of who he was
If this were you or I it would be a segment on the 6 o'clock news and a cold case
If this were you or I it would be a segment on the 6 o'clock news and a cold case
I actually think the murderer would have been found and either arrested or killed for resisting arrest by now, were that the case.
That the murderer, who killed someone in literal broad daylight on the sidewalk of one of the biggest cities in the world, is still on the loose speaks volumes to me about all sorts of things.
That the murderer, who killed someone in literal broad daylight on the sidewalk of one of the biggest cities in the world, is still on the loose speaks volumes to me about all sorts of things.
It speaks volumes as to how incompetent the NYPD is. NYC is one of the most policed cities with the most cameras constantly watching people, and the fact that a crime like this can happen in broad daylight and the perpetrator can remain a ghost is an indictment of that whole dystopian atmosphere and system
I feel a sense of hope in a weird way. Maybe we are farther away from living in "1984" or "A Brave New World" than I previously felt?
In a society where democratic tools no longer function effectively—due to capture by concentrated powers—people often feel powerless to address systemic harms. I can understand how the only power an individual can have in that situation is something like murder.. but it’s making many assumptions.. like this person really was working as an individual from moral grounds in the interests of majority of society.. and that we can trust this moral judgement to and individual, as in today it might be an arguably utilitarian good but tomorrow it might be a cultural or religious thing.. will this action really would have any positive affect on healthcare results for many people, or change any behaviors of people in power apart from getting more security guards..
I think most people are confusing captured democracy for the fact that the actual voting population is split on issues once people step outside their bubble.
Democracy in the US works quite well, although it is a shame that your guy lost.
>What I do find disappointing is the lack of concern
This is (was) the CEO of the largest health insurer in the country which has shown a lack of concern for paying out insurance or securing data both private and medical. Their data leak this year is second only to National Public Data's leak (also this year) of practically every single SSN on the planet and arguably worse because their leak also contains medical data.
Murder is never okay, but this guy is also about the most unsympathizable man in the country.
This is (was) the CEO of the largest health insurer in the country which has shown a lack of concern for paying out insurance or securing data both private and medical. Their data leak this year is second only to National Public Data's leak (also this year) of practically every single SSN on the planet and arguably worse because their leak also contains medical data.
Murder is never okay, but this guy is also about the most unsympathizable man in the country.
> this guy is also about the most unsympathizable man in the country.
There's no way that is true. It's only remotely possibly true if you're only talking about people who at least nominally obey the rules and laws of society. You don't actually think that he was worse than a murderer, or a rapist, or a child abuser, of which we have many, many thousands in this country.
There's no way that is true. It's only remotely possibly true if you're only talking about people who at least nominally obey the rules and laws of society. You don't actually think that he was worse than a murderer, or a rapist, or a child abuser, of which we have many, many thousands in this country.
When deciding who deserves my scorn, I genuinely do put those who are in power and commit atrocities at scale (like healthcare CEOs) above one-off violent criminals.
Even if you’re a few levels removed from the deaths you’ve caused, you still have blood on your hands imo.
Even if you’re a few levels removed from the deaths you’ve caused, you still have blood on your hands imo.
Who knows too... maybe if we have better access to affordable quality (mental) healthcare, which does not deny millions of claims in any given year, then we might perhaps have less murders, rapist, and abusers running around.
An ounce of prevention is worth a pound of cure.
An ounce of prevention is worth a pound of cure.
Would you rather have had this guy around you / your loved ones, or one of the people in the other groups I named?
What precisely is your point?
I'd rather have the Sackler family show up for a dinner than the Manson family, but if we're being honest, the former is responsible for several orders of magnitude more deaths than the latter.
I'd rather have the Sackler family show up for a dinner than the Manson family, but if we're being honest, the former is responsible for several orders of magnitude more deaths than the latter.
Wasn’t the topic scorn?
The sheer breadth of misery this person inflicted through his actions is hard to quantify, and trying to say who is worse/better will always be a judgement call. But the broad dislike for this person doesn't come from nowhere..
Our healthcare system literally shaves ~5 years of lifespan off of the country as a whole. Illegal denial of claims by his company almost certainly kill hundreds of thousands a year.
> You don't actually think that he was worse than a murderer, or a rapist, or a child abuser, of which we have many, many thousands in this country.
I think there is not much point in defining a single metric of "worse" because that is confusing. A rapist is worse if they are following your spouse. This guy is worse if he is about to make a decision that will prevent your loved one from getting medical treatment at the exact time that they need it.
I think there is not much point in defining a single metric of "worse" because that is confusing. A rapist is worse if they are following your spouse. This guy is worse if he is about to make a decision that will prevent your loved one from getting medical treatment at the exact time that they need it.
Depends how you cut it.
The acts of Murders, rapist, and child abusers are far more heinous than health insurance CEOs. However, I would argue the magnitude of damage is larger from the decisions of health care CEOs.
The acts of Murders, rapist, and child abusers are far more heinous than health insurance CEOs. However, I would argue the magnitude of damage is larger from the decisions of health care CEOs.
> You don't actually think that he was worse than a murderer ...
The difference in opinion might be many people considering the guy himself to be a murderer, and not just of one or two people?
The difference in opinion might be many people considering the guy himself to be a murderer, and not just of one or two people?
DrillShopper(2)
Like I said, I dont think it is about sympathy, but not wanting to live in a country where people are murdered in the street. That is the part that is disgusting and dangerous.
> I'm sorry, but where do these writers get off wagging their fingers and tut-tutting people who'd prefer not to spend their neurons on sympathy for someone at the helm of an inhuman system?
And what exactly is your solution?
Healthcare should be a charity from the rich?
It should be nationalized, and somehow magically all the problems go away?
And what exactly is your solution?
Healthcare should be a charity from the rich?
It should be nationalized, and somehow magically all the problems go away?
You’ve got the answer right there. It should be nationalized. And a major reason it will never be nationalized is because of lobbying by health insurance corporations.
Well that and people finding the idea repellant and voting against it.
Medicare for all is actually a very popular policy, with majority approval (across people who identify with both parties).
M4A is nationalized health insurance if not quite nationalized healthcare, but the point remains that the only reason we don’t have major steps in this direction is because of people in power who will not let it happen.
M4A is nationalized health insurance if not quite nationalized healthcare, but the point remains that the only reason we don’t have major steps in this direction is because of people in power who will not let it happen.
No, it isn't. Like many other things, it's only popular in opinion polling, not at the ballot box.
Yes. My point is exactly that. People want nationalized healthcare, but once there’s layer upon layer of media propaganda and power plays by the donor class of both parties, the people don’t end up voting for (or don’t have the option to vote for) their own interests.
Yes, there is a lot of money behind that position.
Do you have an argument that would be persuasive to someone who doesn't believe the voters in every state where this was proposed were successfully hoodwinked by "money"?
Hold on, we can come back to this, but: which states have held a vote on nationalizing (state-izing?) healthcare?
Vermont, Colorado, Washington.
Interesting, tried Vermont but couldn’t find it (a 2015 single-payer effort, but not that), will look more later, I’d love to see what a state-level law at governments taking over hospitals and such even looks like, gotta be some weird reading and I have no idea how you’d write that such that it’d have a prayer of surviving court challenge—seize poor people’s houses to give to companies (or, on behalf of a company that then backs out, and all you got was wrecking some of your own citizens’ houses, lol) you’re all good according to the courts, but do basically the reverse? No way that’d fly. Those proposals have to be crazy reads.
I’d maybe vote against state level single payer, let alone taking over healthcare entirely, because I think it’d be a ton less efficient than doing it at the federal level—enormous amounts of money already go to various federal healthcare programs and it’d be better to pool that, and also lack of state level control over their markets is likely to cause problems. I dunno, it might depend on the law, but my gut reaction is a “no” vote on that, too.
Anyway, as for the other question, I believe that the rise of the postwar think-tank industry (a mash up of k-street and Madison Avenue, but for white papers, as it quickly became) and deliberate party and industry efforts to shift public sentiment in pro-market directions, tied up with lots of government spending on anti-Soviet messaging (were they bad? Oh, yeah. Were all the things the government tried to lump in with them and decry as un-American bad? Ehhhh… I mean atheism is among those, see the change to the pledge and to our money at the time, among other things, and I think atheism’s fine) is probably why healthcare can be this incredibly messed-up and nationalization remains not just not-popular-enough-to-pass, but entirely outside the Overton window, yes.
I’d maybe vote against state level single payer, let alone taking over healthcare entirely, because I think it’d be a ton less efficient than doing it at the federal level—enormous amounts of money already go to various federal healthcare programs and it’d be better to pool that, and also lack of state level control over their markets is likely to cause problems. I dunno, it might depend on the law, but my gut reaction is a “no” vote on that, too.
Anyway, as for the other question, I believe that the rise of the postwar think-tank industry (a mash up of k-street and Madison Avenue, but for white papers, as it quickly became) and deliberate party and industry efforts to shift public sentiment in pro-market directions, tied up with lots of government spending on anti-Soviet messaging (were they bad? Oh, yeah. Were all the things the government tried to lump in with them and decry as un-American bad? Ehhhh… I mean atheism is among those, see the change to the pledge and to our money at the time, among other things, and I think atheism’s fine) is probably why healthcare can be this incredibly messed-up and nationalization remains not just not-popular-enough-to-pass, but entirely outside the Overton window, yes.
Vermont actually passed a single-payer resolution, which would have been the signature achievement of Peter Shumlin, the governor at the time. But actually executing on the resolution required a budget and tax plan to fund it, and the whole thing fell apart.
Political operative here. If you're wondering why healthcare reform has been so hard to get and so piecemeal, even though most Americans want it, the big reasons are:
1) any reform has to get past the Senate, and the Senate gives a lot of extra weight to states with conservative electorates. In 2009, this meant the pivotal Senators were right-wing Blue Dogs, an independent (Lieberman), and a former Republican (Specter). In 2024, this means the pivotal Senator will be a conservative Republican, since Dems run fewer Blue Dogs, and liberals can't win states like North Dakota and Louisiana.
2) people don't only vote on healthcare; Democrats also support much less popular stances on other issues, especially immigration.
Lobbying etc. matters some, but is much less important than those two big ones.
1) any reform has to get past the Senate, and the Senate gives a lot of extra weight to states with conservative electorates. In 2009, this meant the pivotal Senators were right-wing Blue Dogs, an independent (Lieberman), and a former Republican (Specter). In 2024, this means the pivotal Senator will be a conservative Republican, since Dems run fewer Blue Dogs, and liberals can't win states like North Dakota and Louisiana.
2) people don't only vote on healthcare; Democrats also support much less popular stances on other issues, especially immigration.
Lobbying etc. matters some, but is much less important than those two big ones.
Single-payer proposals have failed in state referenda in non-conservative states.
Yeah, the median voter position is not all the way to single payer but is still left of the status quo
Is it? Where do you see the boundaries here?
Polls consistently show the public supports Democrats more than Republicans on healthcare policy, even as they trust Republicans more on other issues like inflation and immigration
https://www.the-independent.com/news/world/americas/us-polit...
https://www.the-independent.com/news/world/americas/us-polit...
Right, I'm a pretty engaged Democrat, but I'm asking: what reforms do you think are within the boundaries of acceptable to the median voter? Clearly single-payer is not. It couldn't even survive in Vermont.
as someone from VT, VT was way too small to do single-payer on it's own The whole point of single payer is to have a monopsony that can effectively negotiate with everyone else. For it to have a chance, they would have had to join with MA.
I think the reform that would be acceptable to the median voter is a public option for Obamacare. Just let people select Medicare as an option instead of one of the private companies (and even better, let companies provide it as an option for their employees as well).
I think the reform that would be acceptable to the median voter is a public option for Obamacare. Just let people select Medicare as an option instead of one of the private companies (and even better, let companies provide it as an option for their employees as well).
thats the option that I have always preferred, provided the opt in Medicare/medicaid option is provided at cost to the general public.
If set up this way, I dont see why anyone would reject it. At worst, it would be another option amongst many.
The poison pill would be if opt-in medicare was funded from taxes on the general public who were paying concurrently for their private insurance. Medicaid funding would continue to support the poor.
However, this would only be a start. The real problem with US healthcare is a lack of spending controls. European socialized healthcare refuses to purchase treatment if the cost/Quality of life improvement is too low.
If set up this way, I dont see why anyone would reject it. At worst, it would be another option amongst many.
The poison pill would be if opt-in medicare was funded from taxes on the general public who were paying concurrently for their private insurance. Medicaid funding would continue to support the poor.
However, this would only be a start. The real problem with US healthcare is a lack of spending controls. European socialized healthcare refuses to purchase treatment if the cost/Quality of life improvement is too low.
There are two broad concerns with public-option M4A:
* The resulting customer shifts will result in private insurance becoming more expensive or, worse, exiting some markets, which violates the requirement people have that, in the worst case, their current insurance remain accessible to them.
* The resulting customer shifts will drastically increase the cost of Medicare, threatening the existing program with benefit cuts.
* The resulting customer shifts will result in private insurance becoming more expensive or, worse, exiting some markets, which violates the requirement people have that, in the worst case, their current insurance remain accessible to them.
* The resulting customer shifts will drastically increase the cost of Medicare, threatening the existing program with benefit cuts.
I agree that those are the public concerns. regarding the second bullet, this is why I suggest a separate pool offered at cost.
Regarding the first, I dont think that this is a forgone conclusion, at least immediately, but admit I haven't thought through how the transition would work. With any public option gaining members, there are bound to be insures that lose them.
Regarding the first, I dont think that this is a forgone conclusion, at least immediately, but admit I haven't thought through how the transition would work. With any public option gaining members, there are bound to be insures that lose them.
The majority of Americans believe the Federal government should provide health care [1][2].
The current Democratic Party is essentially "Republican Lite", Republican with a happy face on it. Democrats as a whole are more interested in defeating progressives and leftists than they are in defeating Republicans.
[1]: https://news.gallup.com/poll/468401/majority-say-gov-ensure-...
[2]: https://thehill.com/policy/healthcare/351928-poll-majority-s...
The current Democratic Party is essentially "Republican Lite", Republican with a happy face on it. Democrats as a whole are more interested in defeating progressives and leftists than they are in defeating Republicans.
[1]: https://news.gallup.com/poll/468401/majority-say-gov-ensure-...
[2]: https://thehill.com/policy/healthcare/351928-poll-majority-s...
This is issue polling. There are lots of problems with issue polling, but even when delivered well, the fundamental problem is it's not concrete. Poll people to see if they'd like the option to stop paying for health insurance: you'll get Assad numbers. Now write a ballot initiative for single payer, where customers see the tax price tag, and have to worry about losing their current private health insurance: the numbers fall through the floor. This isn't supposition: it's happened over and over for the past several election cycles. People do not like this idea as a concrete thing.
I'm a Coloradan who voted for the 2016 universal healthcare (aka ColoradoCare) proposal, but I understand why the majority (79%) voted against it: there was sticker shock at the additional 10% income tax (with caveats, but people saw the 10%) and an inability of proponents to answer basic questions such as "Will I be able to keep my current doctor?", "Will I be able to get an abortion?", and "Will there be additional tax increases?".
I remember polling either done at the same time or the same pollster that found different approval ratings for Obamacare and the ACA. Its like dihydrogen monoxide vs water.
Right, but the point is (I'm belaboring) we don't have to rely on issue polling at all here, because has repeatedly made it to actual ballots, which are the votes that actually count.
The public is very dissatisfied with the current situation. However, they reject any solution put forward.
Approval is high for "Something Else" but low for the alternatives.
Approval is high for "Something Else" but low for the alternatives.
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At first glance, this looks pretty similar to the Bob Lee murder last year. I find it interesting and a little surprising how different the reaction and coverage has been
Are you restricting the Bob Lee murder to first glance info also? I thought that one turned out to be a personal beef, not an assassination.
What similarity does it bear other than... stretching here... the victims were both likely wealthier than the killer?
This reminds me more of Chris Dorner. The manifesto is shorter, but this sense of injustice felt by the perpetrator is similar.
Back in the days, mainstream media had enough control over the narrative to water down the "manifesto" part and avoid copycats. This time, "rogue" social medias are much more prevalent, so there's not much of a barrier to prevent the perpetrator from becoming a hero. We can think that copycats will emerge.
I guess that billionaires around the world are dusting off their "apocalypse bunker" protocol...
Back in the days, mainstream media had enough control over the narrative to water down the "manifesto" part and avoid copycats. This time, "rogue" social medias are much more prevalent, so there's not much of a barrier to prevent the perpetrator from becoming a hero. We can think that copycats will emerge.
I guess that billionaires around the world are dusting off their "apocalypse bunker" protocol...
So, private insurance companies ripping off patients is such an injustice that we are arguing that a literal murder could be (somewhat) justified - in HN of all places, where "it's the evil billionaires" was never a popular position - as if we are in total desperation and everything is on the table.
...when it is simply a consequence of America's system and the solution (public health insurance) is implemented in every other places.
Have we all got drunk on libertarianism until we would rather see CEOs murdered on the street than admitting maybe, sometimes, government managing its own citizens' welfare is an acceptable solution?
...when it is simply a consequence of America's system and the solution (public health insurance) is implemented in every other places.
Have we all got drunk on libertarianism until we would rather see CEOs murdered on the street than admitting maybe, sometimes, government managing its own citizens' welfare is an acceptable solution?
The libertarian argument is that he should have employed better security to protect himself from weirdos. This is why the rich need more tax cuts -they need to be able to afford security.
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