UnitedHealth CEO Shot dead

[Wolfpack Mustachian]

I don't agree that your state of health is wholly outside your choice. Even something that is partly genetic - say lung cancer, diabetes type 2 or obesity - still has a strong lifestyle component.

I was diagnosed with a rare aggressive cancer about 2 years ago, didn't expect to be alive and in remission today. I have zero known risk factors. I was a healthy weight, exercised 3-5x/week, balanced diet, low alcohol consumption, not a smoker, no known genetic factors, and about 20 years younger than the median age for this.

So while you can reduce personal risk factors, your health *is* ultimately wholly outside your choice. You can do everything right and still end up sick. This is often extremely unsettling when sharing my story with others because people want a sense of control. This usually means I get a lot of questions as folks try to find something to blame. Early on I found this rather peculiar and annoying, but I understand now that it's driven by their anxiety.

I will add that, in my experience, the insurance+medical system in the US is broken. Thankfully I was part of a health sharing ministry, so no pre-approvals, no denials, etc. The health sharing ministry covered all but $1500 of our massive medical bills (multiple major surgeries, chemo, months in the hospital). But the cost of healthcare and the way prices are negotiated is very opaque and bureaucratic.

One thing I haven't see mentioned on this thread: The Medical Loss Ratio (MLR) for UnitedHealthcare is 85%, which is higher than the mandated 80% and in line with its peers. This means that $0.85 of every $1 in premiums is paid to cover claims. Yet apparently UHC has a much higher denial rate. Not sure what explains this discrepancy. Maybe UHC has a sicker/older than average pool, or is this initial denials with many being reversed on appeal?

While I have no love for insurance companies and think there should be a public option, due to the reality of MLR  these are not hugely profitable businesses. There are not a lot of inefficiencies to be gained at the insurance level -- even a public option or single-payer system would have a decent amount of overhead. What needs to happen is reducing the cost of healthcare, but that's a very difficult issue.

MLR is federally set at 85% for large groups and 80% for small groups with states able to adjust these numbers locally. If a insurer pays less than this amount in claims, then they have to issue a rebate to policy holders. The MLR cost percentage is intended to cap admin and profit costs relative to premiums taken in. The actual calculation of the MLR appears includes a lot of parsing and room for adjustments of the numerator and denominator. For example "quality improvement" costs are multiplied by 2 in the MLR calc to incentivize insurers to do more of that. I downloaded the UHC MLR filings for New Jersey 2022 and their large group MLR was calculated at 83.2% and 83.9% after some adjustments, which then became 85% after a rebate was issued. It appears that this calculation has the admin/profit capped at 15% of the premiums taken in, not claims paid out. I have many questions about how some of the details of physician review of claims etc are categorized, but I decided to stop going down that rabbit hole for the sake of sanity.

As a counterpoint, studies of the administraive overhead for Medicare are: Part A B D (1.35%), Part C (14.84%). Parts ABD are the public options while Part C is the Medicare Advantage privatized version discussed in some of the prior posts.

Additionally note that hospital internal administrative costs are lumped in with the claims paid, not the overall administrative part of the MLR calculation. So, the cost of the administrative burden of dealing with the byzantine health insurance system is also reflected there and could be reasonably expected to be streamlined in a broadly adopted single-payer system.

For sure, there are savings to be had. It's just that ~15% is the upper limit. This isn't nothing, totally worth doing, but it's not at big as many seem to believe. I think the bigger benefit to a public option or single-payer is getting away from the dysfunctional adversarial triangle of patient, insurer, and health care.

I agree with you on getting rid of that triangle. Or third party payer problem as I call it.

Be careful when reading about the various policies on this. Most “single payer”or “public option” proposals out there involve the government behaving as an insurance company. They don’t fundamentally change the dynamic, just replace the corporate entity with a government entity.   They don’t fundamentally solve the problems you’re getting at.

Can you clarify this part further? How is the government similar to an insurance company trying to make a profit?

[NorCal]

I don't agree that your state of health is wholly outside your choice. Even something that is partly genetic - say lung cancer, diabetes type 2 or obesity - still has a strong lifestyle component.

I was diagnosed with a rare aggressive cancer about 2 years ago, didn't expect to be alive and in remission today. I have zero known risk factors. I was a healthy weight, exercised 3-5x/week, balanced diet, low alcohol consumption, not a smoker, no known genetic factors, and about 20 years younger than the median age for this.

So while you can reduce personal risk factors, your health *is* ultimately wholly outside your choice. You can do everything right and still end up sick. This is often extremely unsettling when sharing my story with others because people want a sense of control. This usually means I get a lot of questions as folks try to find something to blame. Early on I found this rather peculiar and annoying, but I understand now that it's driven by their anxiety.

I will add that, in my experience, the insurance+medical system in the US is broken. Thankfully I was part of a health sharing ministry, so no pre-approvals, no denials, etc. The health sharing ministry covered all but $1500 of our massive medical bills (multiple major surgeries, chemo, months in the hospital). But the cost of healthcare and the way prices are negotiated is very opaque and bureaucratic.

One thing I haven't see mentioned on this thread: The Medical Loss Ratio (MLR) for UnitedHealthcare is 85%, which is higher than the mandated 80% and in line with its peers. This means that $0.85 of every $1 in premiums is paid to cover claims. Yet apparently UHC has a much higher denial rate. Not sure what explains this discrepancy. Maybe UHC has a sicker/older than average pool, or is this initial denials with many being reversed on appeal?

While I have no love for insurance companies and think there should be a public option, due to the reality of MLR  these are not hugely profitable businesses. There are not a lot of inefficiencies to be gained at the insurance level -- even a public option or single-payer system would have a decent amount of overhead. What needs to happen is reducing the cost of healthcare, but that's a very difficult issue.

MLR is federally set at 85% for large groups and 80% for small groups with states able to adjust these numbers locally. If a insurer pays less than this amount in claims, then they have to issue a rebate to policy holders. The MLR cost percentage is intended to cap admin and profit costs relative to premiums taken in. The actual calculation of the MLR appears includes a lot of parsing and room for adjustments of the numerator and denominator. For example "quality improvement" costs are multiplied by 2 in the MLR calc to incentivize insurers to do more of that. I downloaded the UHC MLR filings for New Jersey 2022 and their large group MLR was calculated at 83.2% and 83.9% after some adjustments, which then became 85% after a rebate was issued. It appears that this calculation has the admin/profit capped at 15% of the premiums taken in, not claims paid out. I have many questions about how some of the details of physician review of claims etc are categorized, but I decided to stop going down that rabbit hole for the sake of sanity.

As a counterpoint, studies of the administraive overhead for Medicare are: Part A B D (1.35%), Part C (14.84%). Parts ABD are the public options while Part C is the Medicare Advantage privatized version discussed in some of the prior posts.

Additionally note that hospital internal administrative costs are lumped in with the claims paid, not the overall administrative part of the MLR calculation. So, the cost of the administrative burden of dealing with the byzantine health insurance system is also reflected there and could be reasonably expected to be streamlined in a broadly adopted single-payer system.

For sure, there are savings to be had. It's just that ~15% is the upper limit. This isn't nothing, totally worth doing, but it's not at big as many seem to believe. I think the bigger benefit to a public option or single-payer is getting away from the dysfunctional adversarial triangle of patient, insurer, and health care.

I agree with you on getting rid of that triangle. Or third party payer problem as I call it.

Be careful when reading about the various policies on this. Most “single payer”or “public option” proposals out there involve the government behaving as an insurance company. They don’t fundamentally change the dynamic, just replace the corporate entity with a government entity.   They don’t fundamentally solve the problems you’re getting at.

Can you clarify this part further? How is the government similar to an insurance company trying to make a profit?

Part of the problem of "single payer" and "government option" is that different people take those terms to mean very different things. 

As @FINate mentioned, a key part of the dysfunction is the third party payer problem (or at least that's my interpretation of it).

Hospitals (mostly, but not always profit seeking organizations) maximize their revenue by billing insurance companies everything they can.  Insurance companies (mostly, but not always profit seeking organizations) keep insurance prices in check by denying claims and increasing deductibles/copays etc. 

Most policy proposals for "single payer" or "government option" replace the insurance company with a government led insurance plan.  The options for a government led insurance plan to keep prices in check (and to reduce fraud) are effectively the same as a for-profit company.  The overall equation only changes at the margin of admin costs, fraud, and organizational efficiency.

What many people actually want (that the policy proposals ignore) is to eliminate the need for the insurance middleman at all.  Think of the VA.  It's not a government insurance policy.  The hospital itself is government run.  Any payments or copays are between the patient and the VA, and not a third party. 

Kaiser operates in a somewhat similar fashion, while still being insurance.  You pay Kaiser your insurance premium, but you go to Kaiser hospitals.  Your insurance company and your medical provider is the same entity. 

[Wolfpack Mustachian]

I don't agree that your state of health is wholly outside your choice. Even something that is partly genetic - say lung cancer, diabetes type 2 or obesity - still has a strong lifestyle component.

I was diagnosed with a rare aggressive cancer about 2 years ago, didn't expect to be alive and in remission today. I have zero known risk factors. I was a healthy weight, exercised 3-5x/week, balanced diet, low alcohol consumption, not a smoker, no known genetic factors, and about 20 years younger than the median age for this.

So while you can reduce personal risk factors, your health *is* ultimately wholly outside your choice. You can do everything right and still end up sick. This is often extremely unsettling when sharing my story with others because people want a sense of control. This usually means I get a lot of questions as folks try to find something to blame. Early on I found this rather peculiar and annoying, but I understand now that it's driven by their anxiety.

I will add that, in my experience, the insurance+medical system in the US is broken. Thankfully I was part of a health sharing ministry, so no pre-approvals, no denials, etc. The health sharing ministry covered all but $1500 of our massive medical bills (multiple major surgeries, chemo, months in the hospital). But the cost of healthcare and the way prices are negotiated is very opaque and bureaucratic.

One thing I haven't see mentioned on this thread: The Medical Loss Ratio (MLR) for UnitedHealthcare is 85%, which is higher than the mandated 80% and in line with its peers. This means that $0.85 of every $1 in premiums is paid to cover claims. Yet apparently UHC has a much higher denial rate. Not sure what explains this discrepancy. Maybe UHC has a sicker/older than average pool, or is this initial denials with many being reversed on appeal?

While I have no love for insurance companies and think there should be a public option, due to the reality of MLR  these are not hugely profitable businesses. There are not a lot of inefficiencies to be gained at the insurance level -- even a public option or single-payer system would have a decent amount of overhead. What needs to happen is reducing the cost of healthcare, but that's a very difficult issue.

MLR is federally set at 85% for large groups and 80% for small groups with states able to adjust these numbers locally. If a insurer pays less than this amount in claims, then they have to issue a rebate to policy holders. The MLR cost percentage is intended to cap admin and profit costs relative to premiums taken in. The actual calculation of the MLR appears includes a lot of parsing and room for adjustments of the numerator and denominator. For example "quality improvement" costs are multiplied by 2 in the MLR calc to incentivize insurers to do more of that. I downloaded the UHC MLR filings for New Jersey 2022 and their large group MLR was calculated at 83.2% and 83.9% after some adjustments, which then became 85% after a rebate was issued. It appears that this calculation has the admin/profit capped at 15% of the premiums taken in, not claims paid out. I have many questions about how some of the details of physician review of claims etc are categorized, but I decided to stop going down that rabbit hole for the sake of sanity.

As a counterpoint, studies of the administraive overhead for Medicare are: Part A B D (1.35%), Part C (14.84%). Parts ABD are the public options while Part C is the Medicare Advantage privatized version discussed in some of the prior posts.

Additionally note that hospital internal administrative costs are lumped in with the claims paid, not the overall administrative part of the MLR calculation. So, the cost of the administrative burden of dealing with the byzantine health insurance system is also reflected there and could be reasonably expected to be streamlined in a broadly adopted single-payer system.

For sure, there are savings to be had. It's just that ~15% is the upper limit. This isn't nothing, totally worth doing, but it's not at big as many seem to believe. I think the bigger benefit to a public option or single-payer is getting away from the dysfunctional adversarial triangle of patient, insurer, and health care.

I agree with you on getting rid of that triangle. Or third party payer problem as I call it.

Be careful when reading about the various policies on this. Most “single payer”or “public option” proposals out there involve the government behaving as an insurance company. They don’t fundamentally change the dynamic, just replace the corporate entity with a government entity.   They don’t fundamentally solve the problems you’re getting at.

Can you clarify this part further? How is the government similar to an insurance company trying to make a profit?

Part of the problem of "single payer" and "government option" is that different people take those terms to mean very different things. 

As @FINate mentioned, a key part of the dysfunction is the third party payer problem (or at least that's my interpretation of it).

Hospitals (mostly, but not always profit seeking organizations) maximize their revenue by billing insurance companies everything they can.  Insurance companies (mostly, but not always profit seeking organizations) keep insurance prices in check by denying claims and increasing deductibles/copays etc. 

Most policy proposals for "single payer" or "government option" replace the insurance company with a government led insurance plan.  The options for a government led insurance plan to keep prices in check (and to reduce fraud) are effectively the same as a for-profit company.  The overall equation only changes at the margin of admin costs, fraud, and organizational efficiency.

What many people actually want (that the policy proposals ignore) is to eliminate the need for the insurance middleman at all.  Think of the VA.  It's not a government insurance policy.  The hospital itself is government run.  Any payments or copays are between the patient and the VA, and not a third party. 

Kaiser operates in a somewhat similar fashion, while still being insurance.  You pay Kaiser your insurance premium, but you go to Kaiser hospitals.  Your insurance company and your medical provider is the same entity.

Interesting. Do you know if one or the other is more prevalent worldwide?

[FINate]

Good points @NorCal

I view a public option or single-payer as an intermediate step, something perhaps more achievable in the medium term. This would at least remove the often for-profit entity even though the third-party remains. I still remember the panic from the insurance industry when the public option was proposed during the ACA negotiations.

[twinstudy]

This doesn't go to the heart of the point, which is that a forced acceptance of common risk treats some people unfairly and others generously.

That is kind of the fundamental foundation of society.  Some of us contribute more than our 'fair share', some less -- but we all win if the system works for everyone.

Right??

People exist. Sick people exist. Are we just supposed to go die because we're inconvenient and expensive? JFC

You're straw manning my position. I think that is quite clear.  I said earlier in this thread that a fair solution would be that health insurance be (1) required as a lifelong thing so as to satisfy the Rawls principle (and mitigate adverse selection) and (2) be adjusted for adverse behaviour.

[Metalcat]

Good points @NorCal

I view a public option or single-payer as an intermediate step, something perhaps more achievable in the medium term. This would at least remove the often for-profit entity even though the third-party remains. I still remember the panic from the insurance industry when the public option was proposed during the ACA negotiations.

Public health insurance is exactly what we have in Canada and it's a vastly different patient experience up here.

I'm in an ER as I type this. I handed over my provincial insurance card and that's it. I'll never once have to discuss whether I can get a procedure, no discussion of pre-approval, I will never know the price of anything, I won't get any bill, and I'll never need to speak to the insurer. I'm just here and the only thing I have to worry about is the health issue that landed me here and whether this tiny, rural hospital has the imaging equipment necessary or if I'll need to be transfered to the bigger hospital 1.5 hrs away.

Our system up here has its issues, largely because the provincial governments have neglected it so badly and many conservative governments have actually been trying to kill it so that they can usher in private systems.

But when it's not being run into the ground through criminal levels of neglect and/or malfeasance, it's an extremely easy system for patients to navigate even though there is technically a middle man. He's just invisible for the most part.

As someone who has many, many specialists, has had many surgeries, and countless ER visits, I can't even fathom adding worrying about the arcane billing rules while worrying about what body parts might need to be cut out of me next while sitting fucking terrified in a hospital waiting room during a medical crisis.

[twinstudy]

I agree with you on getting rid of that triangle. Or third party payer problem as I call it.

Be careful when reading about the various policies on this. Most “single payer”or “public option” proposals out there involve the government behaving as an insurance company. They don’t fundamentally change the dynamic, just replace the corporate entity with a government entity.   They don’t fundamentally solve the problems you’re getting at.

Also worth noting that the government itself doesn't necessarily have the resources (tax receipts) to fully cover all healthcare, so even with a strong public health system, a private insurance is still required. That's what we have in Australia - lower earners are covered by public Medicare, while higher earners are required to take out private health insurance which pays extra to hospitals and doctors who operate through the private health system. While it is possible for any given person to seek care only through the public gateways, as a whole, the system (i.e. hospitals and doctors) rely on private funding because there's not enough money in it otherwise. Public specialists will usually have a hybrid practice consisting of some private patients - they get extra money for treating private. Likewise hospitals. With the increasing cost of health care, a public system based solely on tax receipts isn't going to pay enough, so you need some form of public/private hybrid.

[Metalcat]

This doesn't go to the heart of the point, which is that a forced acceptance of common risk treats some people unfairly and others generously.

That is kind of the fundamental foundation of society.  Some of us contribute more than our 'fair share', some less -- but we all win if the system works for everyone.

Right??

People exist. Sick people exist. Are we just supposed to go die because we're inconvenient and expensive? JFC

You're straw manning my position. I think that is quite clear.

No, I'm not.

I honestly can't figure out what you think should be done with all of the very expensive sick people if you don't think that healthier, wealthier people should be on the hook for their care.

What should happen to them?? Serious question.

If your answer is that their care should become prohibitively expensive, then what happens to them? If they can't readily access early interventions, then their urgent care will just become even more burdensome.

Really sick people don't tend to make a lot of money, so how will they afford their more expensive care?? Unless I'm missing something, that either leads to death or very, very expensive emergency care.

[twinstudy]

This doesn't go to the heart of the point, which is that a forced acceptance of common risk treats some people unfairly and others generously.

That is kind of the fundamental foundation of society.  Some of us contribute more than our 'fair share', some less -- but we all win if the system works for everyone.

Right??

People exist. Sick people exist. Are we just supposed to go die because we're inconvenient and expensive? JFC

You're straw manning my position. I think that is quite clear.

No, I'm not.

I honestly can't figure out what you think should be done with all of the very expensive sick people if you don't think that healthier, wealthier people should be on the hook for their care.

What should happen to them?? Serious question.

If your answer is that their care should become prohibitively expensive, then what happens to them? If they can't readily access early interventions, then their urgent care will just become even more burdensome.

Really sick people don't tend to make a lot of money, so how will they afford their more expensive care?? Unless I'm missing something, that either leads to death or very, very expensive emergency care.

Health insurance fees should be paid by all adults and that should give them access to emergency/necessary procedures. Those who literally have no income can be exempted, but as soon as you cross a threshold (say the bare minimum required to sustain yourself) then you should be required to contribute. Alternatively it can be baked into the payroll/income tax system.

For elective medical treatment, there should be a second tier of private insurance that you can elect to have or not have. You are free to not pay this insurance. If you want to get this private insurance, it should not be community rated - the premium should be based on your individual demographics or claim history, same as a car insurance premium.

[wenchsenior]

This doesn't go to the heart of the point, which is that a forced acceptance of common risk treats some people unfairly and others generously.

That is kind of the fundamental foundation of society.  Some of us contribute more than our 'fair share', some less -- but we all win if the system works for everyone.

Right??

People exist. Sick people exist. Are we just supposed to go die because we're inconvenient and expensive? JFC

You're straw manning my position. I think that is quite clear.

No, I'm not.

I honestly can't figure out what you think should be done with all of the very expensive sick people if you don't think that healthier, wealthier people should be on the hook for their care.

What should happen to them?? Serious question.

If your answer is that their care should become prohibitively expensive, then what happens to them? If they can't readily access early interventions, then their urgent care will just become even more burdensome.

Really sick people don't tend to make a lot of money, so how will they afford their more expensive care?? Unless I'm missing something, that either leads to death or very, very expensive emergency care.

Health insurance fees should be paid by all adults and that should give them access to emergency/necessary procedures. Those who literally have no income can be exempted, but as soon as you cross a threshold (say the bare minimum required to sustain yourself) then you should be required to contribute. Alternatively it can be baked into the payroll/income tax system.

For elective medical treatment, there should be a second tier of private insurance that you can elect to have or not have. You are free to not pay this insurance. If you want to get this private insurance, it should not be community rated - the premium should be based on your individual demographics or claim history, same as a car insurance premium.

Never mind. Not engaging.

[Metalcat]

This doesn't go to the heart of the point, which is that a forced acceptance of common risk treats some people unfairly and others generously.

That is kind of the fundamental foundation of society.  Some of us contribute more than our 'fair share', some less -- but we all win if the system works for everyone.

Right??

People exist. Sick people exist. Are we just supposed to go die because we're inconvenient and expensive? JFC

You're straw manning my position. I think that is quite clear.

No, I'm not.

I honestly can't figure out what you think should be done with all of the very expensive sick people if you don't think that healthier, wealthier people should be on the hook for their care.

What should happen to them?? Serious question.

If your answer is that their care should become prohibitively expensive, then what happens to them? If they can't readily access early interventions, then their urgent care will just become even more burdensome.

Really sick people don't tend to make a lot of money, so how will they afford their more expensive care?? Unless I'm missing something, that either leads to death or very, very expensive emergency care.

Health insurance fees should be paid by all adults and that should give them access to emergency/necessary procedures. Those who literally have no income can be exempted, but as soon as you cross a threshold (say the bare minimum required to sustain yourself) then you should be required to contribute. Alternatively it can be baked into the payroll/income tax system.

For elective medical treatment, there should be a second tier of private insurance that you can elect to have or not have. You are free to not pay this insurance. If you want to get this private insurance, it should not be community rated - the premium should be based on your individual demographics or claim history, same as a car insurance premium.

Thanks for explaining. I could not possibly disagree with you more, but you're entitled to your extremely strong and distinctive opinions.

[Captain FIRE]

Health insurance fees should be paid by all adults and that should give them access to emergency/necessary procedures. Those who literally have no income can be exempted, but as soon as you cross a threshold (say the bare minimum required to sustain yourself) then you should be required to contribute. Alternatively it can be baked into the payroll/income tax system.

For elective medical treatment, there should be a second tier of private insurance that you can elect to have or not have. You are free to not pay this insurance. If you want to get this private insurance, it should not be community rated - the premium should be based on your individual demographics or claim history, same as a car insurance premium.

What?

So if you have a healthcare system just for urgent/emergent care, you incentivize waiting until problems become urgent - and WAY more expensive - than preventative care.

And, what is consider elective care? Is that anything where a person isn't dying in front of you without it? So it's ok to skip giving the diabetic person a nutritionist who can help them manage their diet so they minimize their health impacts, but once that person needs a limb to be amputated so they don't die you'll cover that?? Technically a surgery to remove a cancerous tumor would meet the definition of elective care, it's planned in advance and won't kill you immediately - but you'll die MUCH faster without that cancer treatment.

Or if you go by only "necessary" - that's everything that's covered now. ERISA health plans aren't actually allowed to spend health care dollars on non-medically necessary treatment. Not sure on government plans, but I'm guessing there's a reg out there requiring them to act similarly. That's why you have "wellness" plans that might offer you a few hundred dollars for lifestyle activities like joining a gym or getting a massage, and it's not directly your health plan that offers it.

[PeteD01]

Health insurance fees should be paid by all adults and that should give them access to emergency/necessary procedures. Those who literally have no income can be exempted, but as soon as you cross a threshold (say the bare minimum required to sustain yourself) then you should be required to contribute. Alternatively it can be baked into the payroll/income tax system.

For elective medical treatment, there should be a second tier of private insurance that you can elect to have or not have. You are free to not pay this insurance. If you want to get this private insurance, it should not be community rated - the premium should be based on your individual demographics or claim history, same as a car insurance premium.

What?

So if you have a healthcare system just for urgent/emergent care, you incentivize waiting until problems become urgent - and WAY more expensive - than preventative care.

And, what is consider elective care? Is that anything where a person isn't dying in front of you without it? So it's ok to skip giving the diabetic person a nutritionist who can help them manage their diet so they minimize their health impacts, but once that person needs a limb to be amputated so they don't die you'll cover that?? Technically a surgery to remove a cancerous tumor would meet the definition of elective care, it's planned in advance and won't kill you immediately - but you'll die MUCH faster without that cancer treatment.

Or if you go by only "necessary" - that's everything that's covered now. ERISA health plans aren't actually allowed to spend health care dollars on non-medically necessary treatment. Not sure on government plans, but I'm guessing there's a reg out there requiring them to act similarly. That's why you have "wellness" plans that might offer you a few hundred dollars for lifestyle activities like joining a gym or getting a massage, and it's not directly your health plan that offers it.

But if it works with car insurance it should work with healthcare as well!

After all, doctors offices and hospitals are repair shops of a sort, aren't they?

And when it's too expensive to repair, junk it no sweat.

Easy peasy, a simple world for simple souls.

[NorCal]

Good points @NorCal

I view a public option or single-payer as an intermediate step, something perhaps more achievable in the medium term. This would at least remove the often for-profit entity even though the third-party remains. I still remember the panic from the insurance industry when the public option was proposed during the ACA negotiations.

I have a different take, but neither of our positions would be taken seriously enough in policy circles to have a chance of passing.  So it doesn't matter much anyways.

I think having a publicly run insurance entity would create one of those scenarios like public utilities or the defense industry.  It would combine the worst aspects of profit run systems (as health providers are still largely profit seeking and lobbying entities) with the worst aspects of government run agencies (cronyism, lobbying, ineffective decision making).

I think the best intermediate step would be for every hospital system of a certain size to offer an integrated care option on both the ACA marketplace and for corporate buyers. 

[twinstudy]

Health insurance fees should be paid by all adults and that should give them access to emergency/necessary procedures. Those who literally have no income can be exempted, but as soon as you cross a threshold (say the bare minimum required to sustain yourself) then you should be required to contribute. Alternatively it can be baked into the payroll/income tax system.

For elective medical treatment, there should be a second tier of private insurance that you can elect to have or not have. You are free to not pay this insurance. If you want to get this private insurance, it should not be community rated - the premium should be based on your individual demographics or claim history, same as a car insurance premium.

What?

So if you have a healthcare system just for urgent/emergent care, you incentivize waiting until problems become urgent - and WAY more expensive - than preventative care.

And, what is consider elective care? Is that anything where a person isn't dying in front of you without it? So it's ok to skip giving the diabetic person a nutritionist who can help them manage their diet so they minimize their health impacts, but once that person needs a limb to be amputated so they don't die you'll cover that?? Technically a surgery to remove a cancerous tumor would meet the definition of elective care, it's planned in advance and won't kill you immediately - but you'll die MUCH faster without that cancer treatment.

Or if you go by only "necessary" - that's everything that's covered now. ERISA health plans aren't actually allowed to spend health care dollars on non-medically necessary treatment. Not sure on government plans, but I'm guessing there's a reg out there requiring them to act similarly. That's why you have "wellness" plans that might offer you a few hundred dollars for lifestyle activities like joining a gym or getting a massage, and it's not directly your health plan that offers it.

The question of what is necessary is up to doctors to determine. I don't think anyone would argue that cancer surgery is elective, for example. For what it's worth, that's how the public healthcare system in Australia is set up, and we manage to deal with the distinction. In practice, anything to do with cancer is publicly funded, but here are some examples of 'elective' operations: knee/hip replacements in a lot of cases (depends on the degree of mobility impairment), spinal surgery where there isn't radiculopathy. Publicly funded patients can still access this, but they have to go on a fairly long waiting list until a spot frees up, whereas private patients get it instantly on payment.

[PeteD01]

Health insurance fees should be paid by all adults and that should give them access to emergency/necessary procedures. Those who literally have no income can be exempted, but as soon as you cross a threshold (say the bare minimum required to sustain yourself) then you should be required to contribute. Alternatively it can be baked into the payroll/income tax system.

For elective medical treatment, there should be a second tier of private insurance that you can elect to have or not have. You are free to not pay this insurance. If you want to get this private insurance, it should not be community rated - the premium should be based on your individual demographics or claim history, same as a car insurance premium.

What?

So if you have a healthcare system just for urgent/emergent care, you incentivize waiting until problems become urgent - and WAY more expensive - than preventative care.

And, what is consider elective care? Is that anything where a person isn't dying in front of you without it? So it's ok to skip giving the diabetic person a nutritionist who can help them manage their diet so they minimize their health impacts, but once that person needs a limb to be amputated so they don't die you'll cover that?? Technically a surgery to remove a cancerous tumor would meet the definition of elective care, it's planned in advance and won't kill you immediately - but you'll die MUCH faster without that cancer treatment.

Or if you go by only "necessary" - that's everything that's covered now. ERISA health plans aren't actually allowed to spend health care dollars on non-medically necessary treatment. Not sure on government plans, but I'm guessing there's a reg out there requiring them to act similarly. That's why you have "wellness" plans that might offer you a few hundred dollars for lifestyle activities like joining a gym or getting a massage, and it's not directly your health plan that offers it.

The question of what is necessary is up to doctors to determine. I don't think anyone would argue that cancer surgery is elective, for example. For what it's worth, that's how the public healthcare system in Australia is set up, and we manage to deal with the distinction. In practice, anything to do with cancer is publicly funded, but here are some examples of 'elective' operations: knee/hip replacements in a lot of cases (depends on the degree of mobility impairment), spinal surgery where there isn't radiculopathy. Publicly funded patients can still access this, but they have to go on a fairly long waiting list until a spot frees up, whereas private patients get it instantly on payment.

That's how Medicare for all with supplemental insurance would work, and that is similar to healthcare systems elsewhere in the world.

You do not understand the US situation at all - what you are proposing here would be heresy among the libertarian/reactionary set here.

Just cut out the libertarian mumbo jumbo and the inane car insurance comparisons and you might just be up to something.

[RetiredAt63]

Sorry, this is long.

Here (I personally have experience with Quebec and Ontario) the insurance fees come out of taxes.  So you never see your insurance fees being paid.  Ontario does have a tax surcharge for very high income earners.  And yes, we know it is not free, we know we are paying for it.  The point is that it is universal, we all have access (provided one is a resident with enough days per year actually living in the province - snowbirds need to be careful).  And provinces generally honour each others health programs.

Yes older people may use it more, but we have been paying for it for a very long time.  Younger people can have issues, they are not immune.

I just look around my circle of acquaintances and am so glad they never had to worry about their health insurance when they had: kidney transplant (in their 20s), double lung transplant, gall bladder turned into pancreatitis turned into blood clots and a 3 day stay in the ICU, flesh-eating disease in the abdomen (67% mortality rate, this person survived), emergency surgery for ectopic pregnancy, cataract surgery, plus lots of knee and hip replacements, and gall bladders out (no-one talks about it, but I know so many people with no gall bladder).

Because there is no insurance penalty, people go to their GP or a walk-in clinic or their pharmacy (pharmacists have some leeway about minor prescriptions) if they are sick, so things don't get out of hand.   We don't have all the home remedies that Americans seem to depend on.

Because the province is the buyer, material costs are kept down.  Billing is simplified.  Clinics are private, they just bill the province instead of a private company.  We all take our OHIP cards with us when we go to the doctor, or for lab tests/xrays/whatever, and it is covered.

Most vaccinations are covered, but not all - childhood ones definitely, adult ones based on need - so shingles vaccine after a certain age, same with pneumonia.  Here seniors in group living get free RSV vaccine, I don't - a year too young and living on my own.  So I will be checking my private insurance to see if they cover it.  If you need hepatitis vaccination for a vacation you will pay for it.

There are limitation - OHIP will pay for testing blood vitamin D levels if the person has osteopenia/osteoporosis.  If not, they won't pay.  But they pay for bone mineral density scans. 

A provincial system also means more public health - when I lived in a rural area our local health unit subsidized rabies vaccination for dogs and cats.

We still have private insurance - it may cover drugs that our provincial insurance doesn't, it may cover a private hospital room instead of sharing a room with someone, it may cover dental/physiotherapy/other not quite medical things.

The thing is, health insurance is not usually a factor in choosing one job over another, because most of our health care is covered.

Mind you, Metalcat is totally correct about provincial governments messing around in the ways she describes.  I see it mostly in more rural areas, where hospitals are further apart and specialists are less likely to practice.  I know when a friend in Eastern Ontario broke her leg badly, the local hospital immediately transferred her to a hospital in Ottawa that could do a better job.  She went back to the local hospital once her physiotherapy needs were less.  But there was no issue with her moving from one hospital to another, the doctors decided where she would be best served.  Same for my other friend who was in a head-on collision (literally a Florida man in a pickup truck) - months in hospital, including several weeks in a coma, then more months of physiotherapy, then more months of home physiotherapy visits.  OHIP covered almost all, his car insurance covered the rest.


And I know some of the European countries do it better than we do.  We just look good because our easiest comparison is so bad

[reeshau]

I agree with you on getting rid of that triangle. Or third party payer problem as I call it.

Be careful when reading about the various policies on this. Most “single payer”or “public option” proposals out there involve the government behaving as an insurance company. They don’t fundamentally change the dynamic, just replace the corporate entity with a government entity.   They don’t fundamentally solve the problems you’re getting at.

Also worth noting that the government itself doesn't necessarily have the resources (tax receipts) to fully cover all healthcare, so even with a strong public health system, a private insurance is still required. That's what we have in Australia - lower earners are covered by public Medicare, while higher earners are required to take out private health insurance which pays extra to hospitals and doctors who operate through the private health system. While it is possible for any given person to seek care only through the public gateways, as a whole, the system (i.e. hospitals and doctors) rely on private funding because there's not enough money in it otherwise. Public specialists will usually have a hybrid practice consisting of some private patients - they get extra money for treating private. Likewise hospitals. With the increasing cost of health care, a public system based solely on tax receipts isn't going to pay enough, so you need some form of public/private hybrid.

This is similar to the system in Ireland.  Everyone has access to the medical system, but it is quite typical for high earners to have emplyoer-paid private insurance and access to a tier of so-called "high tech hospitals," with more procedure options and less of a wait.  We had to go to the A&E early in our residence there, technically before I had insurance or had even paid onto the public system,,  and paid $0 because we went on the advice of our (just selected for the occasion) primary care physician.  Our private care prescription coverage was 50% of the cost, up to (I kid you not) $25 per person, per year.  DW is the only one of us who "maxed out" her meds, and just barely, even though her meds were literally thousands of dollars in the US.

We also had a very pleasant experience at the NHS in Northern Ireland.  DW sprained, possibly broke her ankle.  Transported ourselves to the nearest A&E after the on-site medics had a look.  The staff there were quite proud to say all emergency care would be free, and profusely apologized that should we need some follow-up care, there might be a charge.  They accepted our Irish status (learned what an orange card was!)  We didn't pay a dime, and came away with souvenir crutches.

I also have European friends that have waited years for knee replacements, been "housed" in a gurney in the hallway for lack of beds (way before the pandemic) and people who talk medical tourism to Thailand, like Americans talk about Mexico.  They do it, at a proposed extra cost, to avoid the wait; somewhat the Reverse of US discussions.

Medical technology is full of miracles, with more just around the corner.  There will never be enough to pay for all the need, when expressed as everyone who could benefit, does benefit.  There are models of service, and the resources are duly prioritized and rationed.  No matter what the model is.

I also recall that it was after paying privately for her mother's end of life care that Suze Orman started saying $5M isn't enough saved for retirement.  You could say it was her private island, too, but she had that long before.

[LennStar]

I think having a publicly run insurance entity would create one of those scenarios like public utilities or the defense industry.  It would combine the worst aspects of profit run systems (as health providers are still largely profit seeking and lobbying entities) with the worst aspects of government run agencies (cronyism, lobbying, ineffective decision making).

Why do you think that would be the case in the US? What makes the US so different from all the countries that have such a system - like my Germany or, from what Metalcat wrote earlier, Canada?

FunFact: We once had a "Free Market" Add-on on our "give me the card, thank you, sit down" system where you had to pay 10€ the first time you visited the doctor in a quarter. It was meant to reduce unneeded visits.
It lasted only a few years because everyone hated it. Especially the - what would you call it in English? Doctor's helpers? Nurses? - who had to collect that money at the start of the quarter from hundreds of people.

It actually reduced the number of visits a bit - but only from a small group. Can you guess which one? Yes, the poorest. (And ER visits from that group increased, but I think it was outside statistical confidence.)

[rosarugosa]

This doesn't go to the heart of the point, which is that a forced acceptance of common risk treats some people unfairly and others generously.

That is kind of the fundamental foundation of society.  Some of us contribute more than our 'fair share', some less -- but we all win if the system works for everyone.

Right??

People exist. Sick people exist. Are we just supposed to go die because we're inconvenient and expensive? JFC

Metalcat, the point is, if you’re sick, it’s your fault. Keep up.

/s

Better go die then...oh well, it's been a good run.

At least you have a lovely selection of ice floes!

[Luke Warm]

I wonder what kind of health care the NY prison system has. When (if) this guy gets caught that will be his insurance plan.

[Metalcat]

This doesn't go to the heart of the point, which is that a forced acceptance of common risk treats some people unfairly and others generously.

That is kind of the fundamental foundation of society.  Some of us contribute more than our 'fair share', some less -- but we all win if the system works for everyone.

Right??

People exist. Sick people exist. Are we just supposed to go die because we're inconvenient and expensive? JFC

Metalcat, the point is, if you’re sick, it’s your fault. Keep up.

/s

Better go die then...oh well, it's been a good run.

At least you have a lovely selection of ice floes!

Good point

[NorCal]

I wonder what kind of health care the NY prison system has. When (if) this guy gets caught that will be his insurance plan.

I had a doctor neighbor that occasionally rotated through the hospital that treated patients from the SuperMax prison.

As he put it, he would have some very kind and lovely patients he had to treat for shank wounds.

On the bright side, prisoners are never going to get a claims denial.

[reeshau]

I wonder what kind of health care the NY prison system has. When (if) this guy gets caught that will be his insurance plan.

I had a doctor neighbor that occasionally rotated through the hospital that treated patients from the SuperMax prison.

As he put it, he would have some very kind and lovely patients he had to treat for shank wounds.

On the bright side, prisoners are never going to get a claims denial.

The wife of a colleague of mine was a dental hygienist at a State prison.  So, they have dental, too.

[Sandi_k]

I couldn't post them on FB, but the memes on this are wild:

[Zamboni]

It’s interesting that you can’t deny coverage for pre-existing conditions in the U.S.

Of all the morally reprehensible things that US insurers do, I feel that hypothetically increasing premiums or instituting a waiting period for pre-existing conditions would be nowhere near the top of the list. Forcing all insurers to cover for pre-existing conditions raises premiums, and leads to adverse selection. It would be like a car insurer having to assume that you’ve had your licence suspended in the past, when in fact most of us haven’t.

I have no doubt that some insurer practices are immoral and deceptive – including the use of AI to process claims. I work in litigation and sometimes I act against insurers (sometimes I act for them) and I see the gamut of conduct from good faith to bad faith. To the extent that they make bad faith decisions, they deserve criticism. If it's bad faith to a criminal standard, they deserve punishment. But the immorality lies in the deceptiveness of a decision or the failure to abide by terms. It doesn’t lie in the deprivation of resources as such.

You could before the Affordable Care Act in 2010.

Also, this was paired in the ACA with a requirement for universal coverage.  If you were young and fit (and invincible) and so skipped coverage, you were fined essentially the amount of premium.  This was exactly to keep the insured pool from reducing to the most sick, and making premiums spiral.  Republican efforts during the first Trump administration eventually led to that penalty being lowered to $0, in the hopes said death spiral would happen.  Only, it hasn't.  The ACA has continued to grow enrollment since then.

Universal coverage means the young and healthy subsidise the premiums of the old and chronically ill. It would be like all drivers being categorised as having the same driving history. Great for someone who's had a DUI conviction. Not so good for the person without a speeding fine in 20 years.

Not a fair comparison.  You can choose not to drive drunk but you can't really choose not to become ill or disabled. The whole point in insurance is that you can't predict who it will happen to and when.

I don't agree that your state of health is wholly outside your choice. Even something that is partly genetic - say lung cancer, diabetes type 2 or obesity - still has a strong lifestyle component.

It's true that you can't predict your future state of health, which is why you take out insurance in the first place. The question is whether the insurance premium itself should vary depending on risk factors. For one, failure to vary it means that adverse selection is more likely.

This opinion shows an extreme lack of experience with the word. For example, the 20-something tennis pro at our club had a random brain bleed stroke, and I've never ever seen a more fit and health conscious person.

[Fru-Gal]

Back to the shooter, who has apparently been apprehended at a McDonald’s in PA… I’m thinking it was a big mistake for him not to wear sunglasses. He also should have run farther away, though maybe openly crossing borders would have been impossible.

[ATtiny85]

Back to the shooter, who has apparently been apprehended at a McDonald’s in PA… I’m thinking it was a big mistake for him not to wear sunglasses. He also should have run farther away, though maybe openly crossing borders would have been impossible.

Or at least used the app to order.

It will be a large disappointment if this is him. Would make for a much better story if he simply faded away.

[ChpBstrd]

Back to the shooter, who has apparently been apprehended at a McDonald’s in PA… I’m thinking it was a big mistake for him not to wear sunglasses. He also should have run farther away, though maybe openly crossing borders would have been impossible.

Or at least used the app to order.

It will be a large disappointment if this is him. Would make for a much better story if he simply faded away.

I doubt he planned on becoming an internet sensation and meme. That development greatly increased his recognizability with the public and greatly increased the law enforcement response.

Note that people who murder poor people are not investigated anywhere near this level. Our reaction to this case is part of the reason why.

But assuming it's him, and assuming he got caught going to a McDonald's, here are some of his probable mistakes:

• Should have grown a beard before the murder and shaved it off afterward.
• Should have driven at least 500 miles after the murder, and had somewhere to hide for at least 6 months. A few of those Costco bug-out-buckets would have been a good investment. Have an abandoned house to squat in, or tent camp.
• Have someone else carry around your cell phone out of state while you commit the act. E.g. hide it in a friend's car. Take other steps to develop an alias the cops can see early in the investigation to get yourself off the suspect list.
• Always dispose of the murder weapon where it can never be found.
• Change out of your normal mode of dress for the murder. E.g. Athleisure > preppy, gangsta > suits, mainstream casual > ethnic
• Going to McDonald's was a dumb move. Do not frequent malls, stores, shopping centers, or places with cameras. If you absolutely need something that's not in your bug-out kit, consider breaking into an unoccupied home (while wearing gloves and far away from your bug out location) to obtain it. Those little donation food pantry boxes could be utilized.

[twinstudy]

The main difficulty is that if you commit a murder while being surrounded with CCTV at all points in your journey, it's going to be almost impossible to evade detection.

[MrGreen]

I'm hearing the guy at McD's had a ghost gun, silencer, and fake ID that all appear to match the items used in the shooting. For all the folks that thought this guy was doing some legendary trolling with the bookbag full of monopoly money, etc. it seems quite stupid to still be carrying around those items.

[FINate]

Back to the shooter, who has apparently been apprehended at a McDonald’s in PA… I’m thinking it was a big mistake for him not to wear sunglasses. He also should have run farther away, though maybe openly crossing borders would have been impossible.

Or at least used the app to order.

It will be a large disappointment if this is him. Would make for a much better story if he simply faded away.

Seems very likely to be the guy based on the evidence coming out. Assuming it is, I'm glad they got him because anyone that does something as cold and calculating as this is likely to do it again. Let's not forget that he murdered another human. I also hope he gets all the due process and legal protections he didn't provide to his victim.

[Kris]

I'm hearing the guy at McD's had a ghost gun, silencer, and fake ID that all appear to match the items used in the shooting. For all the folks that thought this guy was doing some legendary trolling with the bookbag full of monopoly money, etc. it seems quite stupid to still be carrying around those items.

Yeah, honestly that doesn’t add up to me. I don’t think he would be that stupid. Sets my spidey senses tingling.

[MrGreen]

Back to the shooter, who has apparently been apprehended at a McDonald’s in PA… I’m thinking it was a big mistake for him not to wear sunglasses. He also should have run farther away, though maybe openly crossing borders would have been impossible.

Or at least used the app to order.

It will be a large disappointment if this is him. Would make for a much better story if he simply faded away.

Seems very likely to be the guy based on the evidence coming out. Assuming it is, I'm glad they got him because anyone that does something as cold and calculating as this is likely to do it again. Let's not forget that he murdered another human. I also hope he gets all the due process and legal protections he didn't provide to his victim.

I saw a statement that the UHC CEO was responsible for killing more people than Osama bin Laden, given the AI that was implemented that denied 90% of claims. Ouch.

[FINate]

Back to the shooter, who has apparently been apprehended at a McDonald’s in PA… I’m thinking it was a big mistake for him not to wear sunglasses. He also should have run farther away, though maybe openly crossing borders would have been impossible.

Or at least used the app to order.

It will be a large disappointment if this is him. Would make for a much better story if he simply faded away.

Seems very likely to be the guy based on the evidence coming out. Assuming it is, I'm glad they got him because anyone that does something as cold and calculating as this is likely to do it again. Let's not forget that he murdered another human. I also hope he gets all the due process and legal protections he didn't provide to his victim.

I saw a statement that the UHC CEO was responsible for killing more people than Osama bin Laden, given the AI that was implemented that denied 90% of claims. Ouch.

Health insurance is highly regulated. Again, Medical Loss Ratio and all that. Not saying it's perfect, clearly many problems (and using AI for this should be banned). But all health care systems have to make choices about who gets treatment and for how long, because there aren't enough resources to cover every possible treatment, especially end of life stuff that can get very expensive for very marginal results. By this logic bureaucrats in government run systems that deny treatment (it happens) are also killing people. Equating this to terrorists who intentionally plan to murder others for ideological reasons is just way off.

[twinstudy]

Back to the shooter, who has apparently been apprehended at a McDonald’s in PA… I’m thinking it was a big mistake for him not to wear sunglasses. He also should have run farther away, though maybe openly crossing borders would have been impossible.

Or at least used the app to order.

It will be a large disappointment if this is him. Would make for a much better story if he simply faded away.

Seems very likely to be the guy based on the evidence coming out. Assuming it is, I'm glad they got him because anyone that does something as cold and calculating as this is likely to do it again. Let's not forget that he murdered another human. I also hope he gets all the due process and legal protections he didn't provide to his victim.

I saw a statement that the UHC CEO was responsible for killing more people than Osama bin Laden, given the AI that was implemented that denied 90% of claims. Ouch.

Health insurance is highly regulated. Again, Medical Loss Ratio and all that. Not saying it's perfect, clearly many problems (and using AI for this should be banned). But all health care systems have to make choices about who gets treatment and for how long, because there aren't enough resources to cover every possible treatment, especially end of life stuff that can get very expensive for very marginal results. By this logic bureaucrats in government run systems that deny treatment (it happens) are also killing people. Equating this to terrorists who intentionally plan to murder others for ideological reasons is just way off.

Why blame the insurer (middleman)? Blame the hospitals for not providing cheaper medical care. Blame the government for not having more universal healthcare. Blame the citizens for voting in parties that allow this to happen.

This type of reasoning is slippery and fallacious to the nth degree.

[Fru-Gal]

I'm hearing the guy at McD's had a ghost gun, silencer, and fake ID that all appear to match the items used in the shooting. For all the folks that thought this guy was doing some legendary trolling with the bookbag full of monopoly money, etc. it seems quite stupid to still be carrying around those items.

Yeah, honestly that doesn’t add up to me. I don’t think he would be that stupid. Sets my spidey senses tingling.

It’s literally got to be the rarest type of murder there is. Theatrics, engraved (?) bullets… but also, how did he find and target the victim? There’s also his review of Kazinsky’s manifesto online. Definitely way too much of a trail left by this guy, and under his own name…

OTOH it could be like those Idaho murders where the killer thought he was so smart but revisited the scene of the crime and was surveilled driving across the country. Or maybe he wanted to be caught…

[HPstache]

Back to the shooter, who has apparently been apprehended at a McDonald’s in PA… I’m thinking it was a big mistake for him not to wear sunglasses. He also should have run farther away, though maybe openly crossing borders would have been impossible.

Or at least used the app to order.

It will be a large disappointment if this is him. Would make for a much better story if he simply faded away.

Seems very likely to be the guy based on the evidence coming out. Assuming it is, I'm glad they got him because anyone that does something as cold and calculating as this is likely to do it again. Let's not forget that he murdered another human. I also hope he gets all the due process and legal protections he didn't provide to his victim.

I saw a statement that the UHC CEO was responsible for killing more people than Osama bin Laden, given the AI that was implemented that denied 90% of claims. Ouch.

Doesn't an insurance claim denial mean that the person received the care they needed, it's just not being covered by the insurance company?  I'm not trying to defend the awful practices of UnitedHealth or it's CEO, but it seems odd to say that a claim denial caused the death of the person that just received the service they needed.  Sounds more like a money problem than a killing.

[Morning Glory]

Back to the shooter, who has apparently been apprehended at a McDonald’s in PA… I’m thinking it was a big mistake for him not to wear sunglasses. He also should have run farther away, though maybe openly crossing borders would have been impossible.

Or at least used the app to order.

It will be a large disappointment if this is him. Would make for a much better story if he simply faded away.

Seems very likely to be the guy based on the evidence coming out. Assuming it is, I'm glad they got him because anyone that does something as cold and calculating as this is likely to do it again. Let's not forget that he murdered another human. I also hope he gets all the due process and legal protections he didn't provide to his victim.

I saw a statement that the UHC CEO was responsible for killing more people than Osama bin Laden, given the AI that was implemented that denied 90% of claims. Ouch.

Health insurance is highly regulated. Again, Medical Loss Ratio and all that. Not saying it's perfect, clearly many problems (and using AI for this should be banned). But all health care systems have to make choices about who gets treatment and for how long, because there aren't enough resources to cover every possible treatment, especially end of life stuff that can get very expensive for very marginal results. By this logic bureaucrats in government run systems that deny treatment (it happens) are also killing people. Equating this to terrorists who intentionally plan to murder others for ideological reasons is just way off.

Why blame the insurer (middleman)? Blame the hospitals for not providing cheaper medical care. Blame the government for not having more universal healthcare. Blame the citizens for voting in parties that allow this to happen.

This type of reasoning is slippery and fallacious to the nth degree.

There's rent seeking and monopolistic practices on the part of both insurers and hospitals. I highly recommend "Deaths of Despair and the Future of Capitalism " by Anne Case and Angus Deaton if you want to know more about the US system ( It's a much easier read than the title makes it sound).  "The Nordic Theory of Everything" by Anu Paartanen  also provides good basic comparisons f the US with other countries on healthcare and other topics.

[FINate]

Back to the shooter, who has apparently been apprehended at a McDonald’s in PA… I’m thinking it was a big mistake for him not to wear sunglasses. He also should have run farther away, though maybe openly crossing borders would have been impossible.

Or at least used the app to order.

It will be a large disappointment if this is him. Would make for a much better story if he simply faded away.

Seems very likely to be the guy based on the evidence coming out. Assuming it is, I'm glad they got him because anyone that does something as cold and calculating as this is likely to do it again. Let's not forget that he murdered another human. I also hope he gets all the due process and legal protections he didn't provide to his victim.

I saw a statement that the UHC CEO was responsible for killing more people than Osama bin Laden, given the AI that was implemented that denied 90% of claims. Ouch.

Health insurance is highly regulated. Again, Medical Loss Ratio and all that. Not saying it's perfect, clearly many problems (and using AI for this should be banned). But all health care systems have to make choices about who gets treatment and for how long, because there aren't enough resources to cover every possible treatment, especially end of life stuff that can get very expensive for very marginal results. By this logic bureaucrats in government run systems that deny treatment (it happens) are also killing people. Equating this to terrorists who intentionally plan to murder others for ideological reasons is just way off.

Why blame the insurer (middleman)? Blame the hospitals for not providing cheaper medical care. Blame the government for not having more universal healthcare. Blame the citizens for voting in parties that allow this to happen.

This type of reasoning is slippery and fallacious to the nth degree.

It's like blaming landlords for a housing crisis... which happens, so none of this is surprising to me.

[rocketpj]

Cory Doctorow has a great summary of how and why people are so callous about this particular CEO's assassination.  A few key points:

"During the most acute phase of the pandemic, the company charged the US government $11,000 for each $8 covid test:"

"UHC is a vertically integrated, murdering health profiteer. They bought Optum, the largest pharmacy benefit manager ("A spreadsheet with political power" -Matt Stoller) in the country. Then they starved Optum of IT investment in order to give more money to their shareholders. Then Optum was hacked by ransomware gang and no one could get their prescriptions for weeks. This killed people:"

"Take Navihealth, an algorithm that United uses to kick people out of their hospital beds even if they're so frail, sick or injured they can't stand or walk. Doctors and nurses routinely watch their gravely ill patients get thrown out of their hospitals. Many die. UHC kills them, for money:"

"Doctors and nurses hate UHC on behalf of their patients, but it's also personal. UHC screws doctor's practices by refusing to pay them, making them chase payments for months or even years, and then it offers them a payday lending service that helps them keep the lights on while they wait to get paid:"

No idea what the actual killer's motivations are.  I also have no idea if they actually got the guy, or if they've just picked up some random lookalike and planted some stuff on him to make the attention go away. 

I do think that when you create a system as monstrously corrupt and destructive as the US 'health' system, bend the laws and the rules to cause people unimaginable suffering, and corrupt the political system to protect the corruption - something is going to happen.  People who are dealt with at least mostly fairly generally just get on with things. 

[MrGreen]

Cory Doctorow has a great summary of how and why people are so callous about this particular CEO's assassination.  A few key points:

"During the most acute phase of the pandemic, the company charged the US government $11,000 for each $8 covid test:"

"UHC is a vertically integrated, murdering health profiteer. They bought Optum, the largest pharmacy benefit manager ("A spreadsheet with political power" -Matt Stoller) in the country. Then they starved Optum of IT investment in order to give more money to their shareholders. Then Optum was hacked by ransomware gang and no one could get their prescriptions for weeks. This killed people:"

"Take Navihealth, an algorithm that United uses to kick people out of their hospital beds even if they're so frail, sick or injured they can't stand or walk. Doctors and nurses routinely watch their gravely ill patients get thrown out of their hospitals. Many die. UHC kills them, for money:"

"Doctors and nurses hate UHC on behalf of their patients, but it's also personal. UHC screws doctor's practices by refusing to pay them, making them chase payments for months or even years, and then it offers them a payday lending service that helps them keep the lights on while they wait to get paid:"

No idea what the actual killer's motivations are.  I also have no idea if they actually got the guy, or if they've just picked up some random lookalike and planted some stuff on him to make the attention go away. 

I do think that when you create a system as monstrously corrupt and destructive as the US 'health' system, bend the laws and the rules to cause people unimaginable suffering, and corrupt the political system to protect the corruption - something is going to happen.  People who are dealt with at least mostly fairly generally just get on with things.

It's literally impossible to be the CEO of a company with that track record and not know that you are personally responsible for killing thousands of people.

[Dollar Slice]

Doesn't an insurance claim denial mean that the person received the care they needed, it's just not being covered by the insurance company?  I'm not trying to defend the awful practices of UnitedHealth or it's CEO, but it seems odd to say that a claim denial caused the death of the person that just received the service they needed.  Sounds more like a money problem than a killing.

No. A lot of things (expensive medicines, procedures, surgeries, etc.) require something called "prior authorizations" meaning the doctor has to get the insurance company's approval first. If you get denied, you will not get the surgery, test, medicine, etc. Maybe the doctor will do it if you can pay cash up front and are willing to do it. (It's hard for a lot of people to shell out that kind of money for testing if you don't know if it will show anything helpful...)

I've had to get a prior authorization for:
1. a specialty antibiotic (I waited two weeks! for an antibiotic!!)
2. a preventive migraine medication
3. an abortive migraine medication
4. surgery that had been recommended by three different doctors - denied days before surgery date, had to appeal
5. trigger point injections - this took months to get approved and I regained a ton of ROM in my shoulder
6. epidural steroid injection
7. physical therapy
8. EMG tests when I had apparent nerve damage in both hands
9. MRIs for my brain, neck, and shoulder

Probably other stuff I'm forgetting. Some insurance companies are nuts with this stuff. Just endless delays of necessary care.

[rocketpj]

Cory Doctorow has a great summary of how and why people are so callous about this particular CEO's assassination.  A few key points:

"During the most acute phase of the pandemic, the company charged the US government $11,000 for each $8 covid test:"

"UHC is a vertically integrated, murdering health profiteer. They bought Optum, the largest pharmacy benefit manager ("A spreadsheet with political power" -Matt Stoller) in the country. Then they starved Optum of IT investment in order to give more money to their shareholders. Then Optum was hacked by ransomware gang and no one could get their prescriptions for weeks. This killed people:"

"Take Navihealth, an algorithm that United uses to kick people out of their hospital beds even if they're so frail, sick or injured they can't stand or walk. Doctors and nurses routinely watch their gravely ill patients get thrown out of their hospitals. Many die. UHC kills them, for money:"

"Doctors and nurses hate UHC on behalf of their patients, but it's also personal. UHC screws doctor's practices by refusing to pay them, making them chase payments for months or even years, and then it offers them a payday lending service that helps them keep the lights on while they wait to get paid:"

No idea what the actual killer's motivations are.  I also have no idea if they actually got the guy, or if they've just picked up some random lookalike and planted some stuff on him to make the attention go away. 

I do think that when you create a system as monstrously corrupt and destructive as the US 'health' system, bend the laws and the rules to cause people unimaginable suffering, and corrupt the political system to protect the corruption - something is going to happen.  People who are dealt with at least mostly fairly generally just get on with things.

It's literally impossible to be the CEO of a company with that track record and not know that you are personally responsible for killing thousands of people.

Exactly. 

[GilesMM]

He seems to be among the better educated and "healthier" killers we have seen in a while.

[GuitarStv]

Damn!  He has prison abs pre-prison!

[Zamboni]

Wow. SNL did a bunch of weekend update jokes already and this pic and the one with the scarf in the police station are definitely going to fuel more of those.

[oldtoyota]

I'm hearing the guy at McD's had a ghost gun, silencer, and fake ID that all appear to match the items used in the shooting. For all the folks that thought this guy was doing some legendary trolling with the bookbag full of monopoly money, etc. it seems quite stupid to still be carrying around those items.

Yeah, honestly that doesn’t add up to me. I don’t think he would be that stupid. Sets my spidey senses tingling.

He graduated from Penn and was valedictorian at his prep school, so he’s not dumb. Keeping the items was not smart and quite puzzling given his intelligence.

But he had a manifesto. I imagine he wanted that to be read, and he had it on him. Maybe he expected to get caught?

[SunnyDays]

Apparently he comes from a very wealthy family, so maybe he thought they would buy his way out of trouble?

[FINate]

He's a young guy from a very wealthy family, elite schools, tons of privilege. The most likely explanation is he overestimated his abilities, figured he's smart enough to get away with it.