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…
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.
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.
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)
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.
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.
> 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.
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.
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.
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.
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.
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.
> 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.
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?
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?
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 blatantlack 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.
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.
"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.
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.
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.
> 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.
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..
>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.
> 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?
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.
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.
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.
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.
Readit News
... But you still have group A (patients) paying group B (doctors) with group C's (taxpayers', or currently insurers'/policyholders') money.
- 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)
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
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.
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.
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.
https://web.archive.org/web/20210421025041/http://theinciden...
To be fair, we’ve never tried it.
> 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...
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.
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?
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.
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 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.
What’s this norm you mention?
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.
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.
Depending on the shooters motivation, I think they're of the opinion that the time for dialogue has passed.
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.
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?
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.
If this were you or I it would be a segment on the 6 o'clock news and a cold case
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.
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?
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.
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...
Approval is high for "Something Else" but low for the alternatives.