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UnitedHealth's Playbook for Limiting Mental Health Coverage (propublica.org)
93 points by cratermoon 6 days ago | hide | past | favorite | 21 comments





Yeesh, that's a risky bet. Saves them some money on mental health coverage for sure, but it's only a matter of time before someone turns murderous because of their lack of access to care. Oh well, it probably won't ever affect anyone at United.

Seemed like a hit job. Most likely the public and especially poorer folks will just keep getting screwed since their communities will most likely be exposed to armed unstable types.

Killing the CEO is like in the movie "I care a lot" which is about a sociopath business ripping old people off. Wonder whether there was some inspiration from that.

Meanwhile, at the same time, I was receiving emails as a UHC policyholder — “not intended to imply the recipient has a specific disease or condition” that heavily seemed to imply I was having mental health crises all the time.

First, “Have you been avoiding activities that you used to enjoy?”. Kinda out of left field to get but fine.

Couple weeks later, “With support, you can live an even healthier life” with a suggestion to watch some yoga video they sent me. One day later: “Stressed? Confidential help starts with a phone call” and UHC heavily suggesting I reach out to EAP.

All of these emails were still sent “not intended to imply” anything about my health. Right. I’m sure, UHC.


Mental health care is particularly difficult from an insurance perspective. You'll often find that many providers won't even taken insurance. Why? Because insurance requires a diagnosis, a treatment plan and ultimately a resolution. That's an awful lot of paperwork, whatever your condition is might not be covered and usually people need ongoing mental health care, not just dealing with an acute diagnosis.

Some years ago Foxconn put nets around their building because too many people were jumping off. 17 veterans a day take their own life. Medical residency is arguably a risk factor for suicide.

More broadly we have declining material conditions where people lack a sense of safety and security because they're living paycheck-to-paycheck. They're now working multiple jobs, some of which get propagandised as "side hustles". Why? Because an indebted worker bee working multiple jobs generates more profits.

And just now I read that one insurer is putting a time limit on anesthesia coverage for surgery [1].

We have parasitic middlemen (ie insurance companies) whose entire business model is to take money for health care and then deny providing that health care any way possible.

This, like so many other things, is an economics problem. This is capitalism.

[1]: https://www.levernews.com/big-insurer-sets-time-limits-on-an...


Limiting therapy to once a week seems reasonable. Even for patients in an inpatient program, more than once a week one-on-one is not normal.

I dislike insurance companies, and this one in particular has a deserved reputation.

But show me the foreign country that regularly provides more than 30 sessions/8 months with a highly qualified counselor.

I’ve worked with young people at risk for suicide. The most important advice is to remove access to death-dealing mechanisms: firearms, poisons, high-ledges, etc.

The more time someone in crisis has to “think again” the less likely they are to kill themselves.


I live in the US and don’t disagree with your perspective. I am genuinely curious if the average American is better or worse off in terms of mental health than 30 or 50 years ago. My guess is that people just described the symptoms differently in the past - like alcoholism or being mad most of the time. I’m not saying the situation today is good, but does it keep sucking less over time?

Impossible to quantify, but my subjective sense is...

Mental health care is vastly better in the US than 30-50 years ago.

But I think society might be sicker, or at least people perceive it to be sicker. We said goodbye to the notion that each generation would have it better than their parents did. People don't have the faith in institutions that they once did, and they don't have the social connections they once had - as examined in https://en.wikipedia.org/wiki/Bowling_Alone etc.

I don't want to fall into the dumb trap of thinking that life in the 1950s or 1980s was some kind of utopia. It was still pretty much dog-eat-dog capitalism with not much of a safety net.


So this is a mixed bag.

I definitely agree that some conditions went undiagnosed or weren't even considered a disorder. Teachers who deal with autistic children will often tell you that there's almost this game of figuring out which parent has undiagnosed autism. 20-30+ years ago someone was just really into trains.

Going back further the baby boomer generation absolutely had a host of undiagnosed and untreated mental health issues, in part because they were raised by the generation who survived the Great Depression and WW2. Generational trauma is absolutely real.

And yes, there was (and is) a lot of self-medication that creates alcoholism and addiction issues.

While all that's true, a lot of my people my age or older (who were adults in the 90s) describe the 90s as the last great decade and there's lots of reasons for this.

First, the Cold War had ended. In the 1980s and earlier you had this ever-present threat of annihilation hanging over you. Go back even further and American schoolchildren would be doing duck-and-cover drills. I guess that's been replaced by active shooter drills. Oh yeah, school shootings weren't a thing yet either (until 1999).

Second, I cannot describe how different air travel was pre-9/11 if you didn't experience it. You see this in older TV shows and movies where non-passengers go up to the gates. Of course that doesn't happen anymore but it did.

Third, the cost of living relative to your income was unbelievable better. I remember paying $80 per week for a 2 bedroom apartment. The average house price in London was 70,000 pounds (now 700,000+). A friend told me about his college friends who lived in Iowa in a 4 bedroom house for $175 per month where they all lived very comfortably on $13,000 per year.

Fourth, crime (particularly urban crime) began to recede. There's a lot of speculation on why this happened. The two leading theories I believe are either it coinciding with 18 years after Roe v. Wade was handed down or that it's related to removing lead from gasoline. Politically, the crime hysteria shows how short our memories are. Look at any charts that go back 30+ years, not 3.

There was bad stuff too. We had Reagan and Thatcher in the 1980s. The 1990s was when New Deal Democrats gave way to Third Way Democrats ending 60+ years of near-total dominance (Republicans had held the House in 1952). We saw the 1994 Crime bill and the start of mass incarceration. Clinton and Blair completed the destruction of the labor movement and embraced (disastrous) public-private partnerships. The AIDS epidemic was in full swing still.

I do wonder how different this might've been if we had the access to information we have today.

Material conditions really peaked in the 1970s and have been going downhill ever since in real terms. The crazy thing is people who fetishize the 1950s and "traditional" life seem to forget the top marginal tax rate then was 90%.


    I definitely agree that some conditions went undiagnosed or 
    weren't even considered a disorder [...] 20-30+ years ago 
    someone was just really into trains.
I always think about this.

I think we've gained much more than we've lost. I'm glad we diagnose more things. I'm glad we as a society have begun to accept neurodivergence in general.

But, I don't know, it feels like some things were lost as well. Labels and diagnoses can really hurt as well as help.


Decisions by corporate paper-pushers can kill. Might be deeply upsetting to some.

It’ll be interesting to see what motivations the murderer of their CEO had.

A lot of potential motivations could be seen as parties being unwilling to participate in the marketplace of sane solutions.



Mental health is and has been our county’s biggest issue and has lead us to our current injunction. If we cannot improve our healthcare system we will remain addicted, anxiety riddled, divided, and live more and more in disillusion. It is a tragedy the way we turn our backs on health and label healthcare as a stigma and allow it to be run as a grift on the public and people immigrating here.

[flagged]


The entire premise of insurance is that people get care for their medical issues. Mental health issues are medical issues; just because they manifest in terms of behavioral and thinking changes doesn't make them any less so.

Mental Health coverage does cover therapy, and therapy of various sorts is effective to treat or ameliorate a number of mental health issues, but it also covers psychiatric medication.

Also mental health coverage covers people's kids and dependents, not just them, your focus on the policy holder is a little narrow, I think.


> Also mental health coverage covers people's kids and dependents, not just them, your focus on the policy holder is a little narrow, I think.

Right, but as people are more and more likely to be single, more and more people are policy holders. This is not a situation where you always have a spouse with insurance or something.

> Mental Health coverage does cover therapy, and therapy of various sorts is effective to treat or ameliorate a number of mental health issues

As I said. mental illness is on the rise. We could treat all these issues and spend for it. Or we could try to trace root causes (I know people are working hard on this). The latter seems the more useful method.


> For one thing, the entire premise of insurance is that the policy holder is sound of mind.

Why?


Because they have to be sound of mind enough to hold the policy to begin with.

Also most health insurance policies (and socialized policies for that matter) require adherence to a particular protocol, to qualify for treatment, which is difficult for those who are addled.


I'm not sure what you're trying to say, at all.

1. Mental illness is on the rise. Causes are uncertain

2. It's not clear the cause is medical, unless you classify almost all human experience as a medical event (hence the parallel with marriage).

3. Insurance depends on people being of sound mind. Especially with what we have today, you have to be of sound enough mind to administer it all.

4. Maybe health insurance is not the right approach to mental problems, and maybe no insurance is. We need some other way. I don't know that way.


> Maybe health insurance is not the right approach to mental problems, and maybe no insurance is. We need some other way. I don't know that way.

Insurance is the method of paying for healthcare. We have insurance because healthcare is expensive. So insurance wouldn’t be necessary if we would lower costs by providing universal healthcare like modern countries.

You’re touching on the right idea:

Mental healthcare should be preventative not something applied after we discover an illness.

Changing any of it starts with educating people foremost so they can empower themselves.




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