The events of the last week are just what happens when a company decides to refuse to meet its customers in the marketplace of sane ideas.
You could probably have gotten away with what UNH did if the money wasn't so ridiculous. Thompson himself had a compensation package worth $10.2 million[0] a year. It's reasonable to think that other c-suiters at the company, along with those of its parent organization, made similar amounts of money.
The company also has a 1.53% dividend yield[1].
The average American's lifetime earnings are $1.8 million for men, and $1.1 million for women[2]. That is to say, within five years, Mr. Thompson would likely have made ten times the average American's lifetime economic output, post-tax.
If you're paying a significant chunk of your yearly earnings to be covered by UNH, you expect the money you paid to go towards providing you with service. Instead, tens of millions of it goes towards a handful of individuals, and regardless of how the company does financially, participants in the equities market will get some of your money, and you'll possibly be denied the service you paid for in order to make that happen.
People will say that this is necessary to remain competitive, but it just isn't. People with severe health problems or loved ones with severe health problems aren't asking these executives or shareholders to live like paupers; they just expect the service they paid for. When there's something as life-ruining as chronic health conditions dogging you every single day, there's a chance you snap, and in the US, there's fairly trivial access to tools to help you do that.
>People will say that this is necessary to remain competitive, but it just isn't.
In other countries there are private health funds that return all of their profits to their members by simply covering more types of care and lowering premiums, all while still giving their staff very good, very attractive pay. That is clearly a win:win setting without being a government-run entity.
A person doesn't need to earn 100M-200M in a decade of company service. That is an obscene amount of money, and merely opportunistic payment from a system where the foxes are guarding the hen house. Unfortunately the US health system has this pattern repeated through it from insurers, to hospitals and beyond - the money is being funnel to those which can minimise, not optimise, care.
IIUC, UHC has a margin of 5.8% [1] with a denial rate of 32% [2]. I don't think you can offer insurance at the price that they do while having an honest denial rate.
You may argue that you shouldn't offer insurance for a rate that doesn't cover actual incidence and I would agree but it seems to be their business model.
This article is about someone getting cutting edge care beyond medical literature from the one of the leading experts in the world. I've got to imagine most health funds would simply not be able to cover that type of care for an individual?
The article notes this particular healthcare fund made billions of dollars in profit for the year and one of the parties interviewed speculates that this individual's care would represent a few minutes of that.
The gastroenterologist is not the expensive part, either, the expensive part was the manufacturing process for the drug. It would be super cool to invest the billions of profit for this insurance company into developing more efficient ways to produce this category of drug. Alas,
Instead we are investing in finding the most underhanded ways possible to deny medical care for each patient, all the while pretending we are not making medical decisions for them.
Absolutely, the insurer could sacrifice some profitability to pay for this case, but eventually health care costs have to be rationed somewhere. I don't think any health care system can afford this level of treatment for as often as it is needed, and I don't think capping the profit in the industry solves that problem.
Also I would agree the insurer is absolutely making medical decisions with its own definition of medical necessity. But the Doctor is also making financial decisions when he recommends a drug that pays him significant consulting fees every year. There's warped incentives all over.
Not sure why this is being downvoted. Universal healthcare is great, but even if you're in Sweden they're not going to fly you over to Minnesota to get experimental treatment that costs $1M/year.
The problem is that the profit making side of the business is becoming dominant. There will always be room for experimental procedures even if the US saw regulation that limited the profit-making abilities of health insurers.
The situation at the moment is that routine, basic medicine is being denied, often algorithmically, along with "pharmabro" types buying up basic medications for the sole purpose of increasing its price. That's starkly different from the development of novel medications demanding high prices to reward R&D efforts.
By far the most interesting aspect of this tale is the sudden rush of evidence (news stories, internet videos etc) that insurers have abruptly started paying claims which were previously denied or mired in paperwork. The comments of e.g. [0] and [1] are filled with people claiming this. The system is clearly rattled by the appearance of the people's justice, in a "Let them eat cake" kinda way, and is trying to make a sudden show of not being so rapacious and unjust.
I don't get it, is the implication that it's too high? Too low?
>If you're paying a significant chunk of your yearly earnings to be covered by UNH, you expect the money you paid to go towards providing you with service. Instead, tens of millions of it goes towards a handful of individuals
UNH took in 371.6 billion in revenue and made 23.14 billion in profit last year. "tens of millions" is a rounding error.
I'd bet if you deduct C-suite salaries that profit becomes a heck of a lot larger. C-suite execs and wall street raid companies for profit all while screwing the average American. This is not news--look at stock buybacks.
If these companies paid less grossly-imbalanced compensation packages to their C-suite vs. the average employee salary, and they operated like an actual company vs. a rich person's piggy bank, I'd be sure willing to bet that profit margin would be a heck of a lot higher. They'd probably be more efficient and provide better service, too.
>I'd bet if you deduct C-suite salaries that profit becomes a heck of a lot larger.
Instead of posting random conjectures with zero backing evidence, you could you know, actually do the research, because "burden of proof" and all. Anyways someone made a similar claim a few days ago, but about HP, and I debunked it with a 30 second search[1]. Unless there's reason to think that HP or united health are outliers in terms of corporate governance, I doubt the ratio between them will vary significantly.
> I don't get it, is the implication that it's too high? Too low?
Really, I think dividends should be illegal; so it's too high. They distort the true market performance of a company by guaranteeing returns when the company might not actually be making those returns in a sustainable manner.
> UNH took in 371.6 billion in revenue and made 23.14 billion in profit last year. "tens of millions" is a rounding error.
"Tens of millions" is in reference to the cost of their higher-ups' compensation.
>Really, I think dividends should be illegal; so it's too high. They distort the true market performance of a company by guaranteeing returns when the company might not actually be making those returns in a sustainable manner.
Funny, because I often see people say have similar objections for buybacks. It seems like nobody is happy with corporate profits returning to shareholders. I don't think either the anti-buybacks or the anti-dividend side has a point though. Anyone doing a modicum of finance analysis would be able subtract the value of the dividends paid from the share price, or factor it into the price of the company. Indeed, you see that share prices in companies dip after the dividend ex date, which suggests the market takes this information into account.
> Funny, because I often see people say have similar objections for buybacks. It seems like nobody is happy with corporate profits returning to shareholders
Nobody is happy with corporate profits returning to shareholders at the expense of workers and customers, at least not as transparently as it is done now.
Wages have remained flat in the US for several decades now. It’s starting to have a real impact on the economic and social conditions of the country. “But what about the shareholders?” isn’t going to be a valid excuse to someone who pays for coverage against medical costs.
There is no economic system, or business model within said system, in which there is unlimited value to be transferred. Humans will assert their rights at some point or another.
>Nobody is happy with corporate profits returning to shareholders at the expense of workers and customers, at least not as transparently as it is done now.
How can you return anything to shareholders that's not "at the expense of workers and customers"? Each dollar paid to shareholders is going to be one less dollar that can be paid to workers/customers, so almost by definition paying anything to shareholders is going to be at the expense of workers/customers. Is this supposed to be a thinly veiled attempt at stating marxist ideology?
>There is no economic system, or business model within said system, in which there is unlimited value to be transferred. Humans will assert their rights at some point or another.
The current share paid to shareholders is nowhere near "unlimited". In the US labor's share of GDP stands at just below 60%.
> Is this supposed to be a thinly veiled attempt at stating marxist ideology?
Hardly. The Friedman doctrine didn't exist prior to 1970; does that make every business venture prior to that a statist-collectivist enterprise? Are privately-owned companies the expressed goal of Marxism? Of course not.
The whole "if you don't have a bunch of free riders participating in an equities market, it's Marxism" bit is an intentionally obtuse argument.
> The current share paid to shareholders is nowhere near "unlimited".
Current schools of thought essentially dictate that management and investors treat that share as if it can be unlimited. Anything that could possibly limit returns (taxes, regulations, labor movements, consumer rights, etc.) is an externality or to be eliminated. Otherwise, it gets in the way of profit, and since most economist types have a limited ability to understand anything beyond the absolute simplest of abstractions, profit has to be the ultimate measure of social good. Therefore, those things stand in the way of social good.
> In the US labor's share of GDP stands at just below 60%.
>Hardly. The Friedman doctrine didn't exist prior to 1970; does that make every business venture prior to that a statist-collectivist enterprise? Are privately-owned companies the expressed goal of Marxism? Of course not.
>The whole "if you don't have a bunch of free riders participating in an equities market, it's Marxism" bit is an intentionally obtuse argument.
To be fair, Marxism can roughly be summarized as "workers should own the means of production, capitalists are exploiting workers by leeching off what they produce", and what you've said so far about shareholders being "free riders" and that "corporate profits returning to shareholders at the expense of workers and customers" isn't too far off from that. The fact that you refuse to directly answer my question of whether shareholders should get any money doesn't help your case either. In light of all of this, I feel like asking whether you're arguing for Marxism was totally justified.
>Current schools of thought essentially dictate that management and investors treat that share as if it can be unlimited. Anything that could possibly limit returns (taxes, regulations, labor movements, consumer rights, etc.) is an externality or to be eliminated. Otherwise, it gets in the way of profit, and since most economist types have a limited ability to understand anything beyond the absolute simplest of abstractions, profit has to be the ultimate measure of social good. Therefore, those things stand in the way of social good.
Capital and labor are both trying to get as much share as possible. I don't see how either side is any different. If anything, labor has actually been more successful, because their share is currently above 50%, and actually got their share to 100% in a few places (ie. communism). Meanwhile I'm not aware of any instances where capital's share is 100%, except maybe some edge cases where capital and labor is the same person (ie. self employment).
>We should make it higher.
Why? More to the point, what do you think is an equitable split?
As an Australian, I have no idea, but can't then a patient sue their employer if they don't receive the care they were promised? Doesn't that make the employer responsible for an employees health?
Yeah even with "good insurance", there is a high likelihood that getting cancer will mean someone's life savings will be vaporized and replaced with bankruptcy levels of medical debt. People spend their adult life paying for future use of a product every two weeks. Then when it comes time to use said product the seller tells them no.
Meanwhile, the company they paid all of this money to posts record net income and its executives make millions of dollars per year. They scare people away from socialized medicine with phrases like "death panels" while in the same breath boast about using AI to automatically deny healthcare for their customers. It's so gross and reprehensible.
> even with "good insurance", there is a high likelihood that getting cancer will mean someone's life savings will be vaporized and replaced with bankruptcy levels of medical debt
We don't have an infinite supply of health care and there is a strong demand so there is always going to be some form of rationing going on. There are always going to be people with chronic life ruining conditions that are going to get a raw deal under whatever system you propose to distribute the limited supply of healthcare. It seems like someone is always going to have a justification to kill someone whether its a CEO or some faceless bureaucrat.
That’s true, but UHC alone has $6 BILLION in profit each _quarter_. A whole lot of that could be going towards health care. In my opinion health insurance providers should not be for-profit.
There’s a huge difference between the inevitable random crazies driven to madness because they can’t handle their unfortunate but unavoidable circumstances, and abusing the entire population on such a scale that when someone murders an executive in broad daylight, the prevailing public mood is “serves him right.”
If (according to some) a woman wearing revealing clothes deserves to be raped, and (to most, hopefully) a drunk driver deserves imprisonment and paying any victims, what does someone who has knowingly and intentionally participated in a scheme leading to the deaths of thousands and suffering of millions for personal profit deserve?
I myself don't agree to the death penalty or any killing if it doesn't serve to thwart an immediate and severe danger. We shall take it as a given that this killing doesn't fall under the latter, or perhaps even a somewhat more generous definition. But at the same time, it would be infeasible to have the CEO "brought to justice". To have him sentenced in court, his assets paid out, and the company reformed. Between nothing at all happening (except protests) and the CEO being killed, which is the better choice? If, all else being equal, you could choose one world or the other, which choice is better?
Pointless question. If you do nothing at all for long enough, then people will eventually decide that the system isn’t getting it done and will start taking matters into their own hands. You can’t choose between doing nothing and violence. Doing nothing begets violence.
I don't think it can be easily cut. You have a bunch of free riders (shareholders) who are insuring that their person of choice puts them first by showering them with compensation packages. There's lots of people on that gravy train.
It's not "just what happens". That's a politically opportunistic narrative that seeks to incite violence and murder.
No one knows why the CEO was killed.
None of this type of reasoning justifies or begins to explain the murder even if this were the reason in the shooter's head. Morals aside, it's nonsensical reasoning in total.
You're justifying and providing propaganda support for domestic terrorism in the United States.
Whatever the shooter's motive was, you can't deny that the public mood is ugly. There was scarcely any sympathy for Thompson, just an avalanche of gleeful mockery and complaints about healthcare claim handling. The problems are widespread enough that having someone snap because, say, their parents' claims have been denied, is completely believable.
Everyone who doesn't sympathize with violent political extremism.
In other words everyone who isn't a bot, isn't on any number of watchlists, isn't terminally online, isn't a drug addled crazy, or isn't one of the media that exists to stir them up for political purpose.
> The gleeful mockery is largely from anonymous accounts. I remember when the same type of thing was attributed to "Russian bots" after the 2016 election.
I worked in medical-adjacent areas for a decade. I dated a doctor, and I asked him what people feel in his hospital about that.
He said that basically NOBODY has any sympathy for this CEO. The most concern is at the level of "we shouldn't condone murders". And you don't see even uglier statements because people are very much aware of medical ethics boards.
And that's an opinion from a highly-paid medical professional.
> Thompson is not responsible for the existence of the insurance industry
Surely he bears some responsibility for making UHC the worst to deal with and the having the highest rejection rate?
> What I do see is a strong push by media ...
Why would the media push a narrative against any executive if it wasn't already part of the zeitgeist? The media has consistently exhibited strong class solidarity in my experience.
> Doctors well-know this, and they become doctors knowing this.
I'm sure you are aware that doctors are not a monolith. Gp is not making things up: I'll second them with the less-than-sorrowful response elicited by the news of the CEOs demise among administrative staff in my circles (who know how the industry works and what role is performs)
> The Media last sympathized with and incited murderous violence in the 2020 election period.
Gee, I wonder if the public discontent the media and politicians tapped into in 2020 has abated or gotten worse since. It appears you refuse to acknowledge that a huge fraction of the population is unhappy with the status quo across the world (see number of governments voted out). That America has a populist president-elect isn't surprising
>Surely he bears some responsibility for making UHC the worst to deal with and the having the highest rejection rate?
If so, and barring subjectivity and narrative, then not responsibility with a penalty of death. Very obviously.
>Why would the media push a narrative against any executive if it wasn't already part of the zeitgeist? The media has consistently exhibited strong class solidarity in my experience.
Extrajudicial murder and domestic terrorism are part of the zeitgeist of most people? This is your claim?
This is some kind of new standard for a stupid statement. Aside from you being wrong in more than one aspect, I'm not going to debate your sense of media class loyalty. Which you are wrong about in a multifaceted manner.
The fact is that they are pushing the narrative. It's in black and white.
>I'm sure you are aware that doctors are not a monolith. Gp is not making things up: I'll second them with the less-than-sorrowful response elicited by the news of the CEOs demise among administrative staff in my circles (who know how the industry works and what role is performs)
I didn't say that they were. But they are largely, monolithically not insane, not murderer adjacent, and not domestic terrorist adjacent.
Your appeal to authority stories are either total bs or aberrations full of people that should probably be surveilled by law enforcement.
>Gee, I wonder if the public discontent the media and politicians tapped into in 2020 has abated or gotten worse since. It appears you refuse to acknowledge that a huge fraction of the population is unhappy with the status quo across the world (see number of governments voted out). That America has a populist president-elect isn't surprising
Trump supporters are not remotely supportive of this, barring fringe crazies and false identities.
The media didn't "tap into" anything in 2020. They wound-up a vast quasi-criminal underclass and organized domestic terrorists for nine months, and over thirty murders of innocents, running up to an election for a candidate that they were on a war-footing against for the four years prior.
They gave tacit and even direct permission to riot, and political cover for the riots, which is all that these criminals need in any given timeframe to carry out domestic terrorism and extrajudicial murders.
Now they're at it again, right after another election.
People who sympathize with this type of thing are, at the least, domestic terrorism adjacent. If not directly supportive.
> Trump supporters are not remotely supportive of this
So, the guys who brought/assembled gallows to the capital and were chanting "Hang Mike Pence" are not supportive of extrajudicial killings? We're not on the same plane of existence, you and I.
> People who sympathize with this type of thing are, at the least, domestic terrorism adjacent
I remember a chyron at a national convention stating "We are all domestic terrorists" - perhaps stoking that flame was not a great idea now, was it? What's your take on those who refuse to take any action on mass shootings at schools?
> You should be monitored.
You'd love that, wouldn't you? The Stasi would be proud. Establishing a police state with dragnet surveillance is a fantastic tool for fighting disaffection and will surely improve morale.
You're in a bubble. Four of my family members are in the medical business plus three friends. Two are doctors. Only one person has expressed sympathy and that was for the family. The rest were exactly as OP described: we don't condone murders, they hope this person is brought to justice, but they don't feel any sympathy. Emphasis on the the emotion there - no disgust, no sadness, no sympathy. Just a logical recognition that they don't condone this.
Honestly, between Gaza, Israel, Ukraine, Yemen, Ethiopia, RDC/rwanda, and the various weather event who killed thousands, my available empathy is gone. Nothing i can do. I gave money and time for a decade, nothing ever improve.
You know what i first thought when i heard this story? "At least he didn't shoot a hospital". You know what my second thought on this? "I hope there is enough hero worshiping for this killer so that mass shooters try their hand at murdering CEO instead, at least it's a single victim" (that is also because 2 days prior, a friend i've met in a youth hostel a few years back was involved in a mass shooting around Chicago).
I won't participate in the hero worship, i despise all killers. But still, am i the only one who had those thoughts?
I bet even his own family isn't too sad about this - most C-Levels I've worked with are grade A psychopaths whose family doesn't care for them besides money
this guy is probably moderately responsible for a significant amount of needless suffering and death
Insurance companies are hardly the only ones at fault here. Hospitals and Pharma companies are guilty of price gouging [1]. When insurance pays hospitals hike up the prices. When the patient pays (such as for cosmetic or plastic surgery) the prices charged by hospitals and doctors are more reasonable.
Setting prices by supply-and-demand and having insurance "pay for whatever is needed regardless of the cost" are incompatible. Insurance blocks the pricing cost signal back to the patient. Insurance also prevents better doctors that provide better service from charging more because the patients will pay for it.
An example: about 20 years ago I had just a major medical plan and I was at urgent care for a problem. After diagnosing the likely problem and prescribing the solution, they were about to run some tests "just in case." When I told them I would be paying for the tests due to the major medical plan, they explained that the tests didn't have any benefit, so we didn't run them.
I don't know of a real solution to these problems.
A partial solution is exposing some of the cost to the insured to create an incentive to save (like what I had when I was paying for the tests). At my company, we fully pay for a high-deductible plan AND a give company-funded contribution to a Health Savings Account that mostly covers the per-person out-of-pocket max. If the employee does not spend the HSA money (which is their money in their account), it can be used for retirement savings... so they have an incentive to save. But once someone hits the out-of-pocket max, there is no more incentive to save.
Patients must be incentivized to understand their care and question care that is unnecessary and wasteful. The partial solution you mention is the way to go, and if every employer adopted it, it will change the culture, and will at that point become a full solution.
Capitalist structures have a long history of pushing ownership of problems to the powerless individual, then exploiting information asymmetries (and actively obfuscating the truth that would allow for better informed decisions) for profit.
Suggesting that the average person should be able to make medical decisions and override their health care provider’s recommendation is ridiculous.
> Suggesting that the average person should be able to make medical decisions and override their health care provider’s recommendation is ridiculous.
The situation is similar to taking your out-of-warranty car to a dealer for repairs. Sometimes, you may suspect they’re not being completely honest with you. What do you do in that case? You get a second opinion before agreeing to a costly repair.
Sure, and that’s possible (at significant added cost) in a portion of cases. But not all - you might be on an operating table or in the middle of a psychiatric event, etc etc, where time does not permit second opinions, and if the system is set up to “gotcha” as a baseline, then only the most minor, time insensitive, situations will receive fair pricing.
> if the system is set up to “gotcha” as a baseline
This is what we have to change. When physicians and hospitals know that patients are scrutinizing care plans they will find a new fairer baseline. That cultural change will subsume older practices.
I'm willing to take a risk there because if my car craps out, I'll buy another.
Wish I can say the same about health. If the doctor who has my entire medical history recommends x procedure, yes I'm not going to risk potentially having irreversible damage to my body.
In my example in the grandparent post to yours, it was actually the empathy of the medical provider toward my paying the bill that prevented the unnecessary test.
The Health Industry has this lovely 3-part structural defense they run behind every time that someone questions why the health industry costs so much.
Step 1: "The other 2 entities in the health industry are to blame!"
Step 2: Profit, because no one is going to succeed a battle here that knocks down only one of these.
Every time, this is the response. In practice they are all to blame, and they could all be working to make this better. But none of them are incentivized to act in anything but their own self-interest. Insurance is definitely to blame, as are hospitals and pharmaceutical manufacturers. There's a reason the companies that ostensibly "save people's lives" are some of the most hated in the US.
I hope that Insurance companies have an epiphany from the public sentiment about this, that they're messing this up spectacularly. But honestly, they seem more likely to wait for this to blow over.
The insurance model is for catastrophic care. It is completely failing us for long-term care, but has inserted itself in that process anyway. You can indeed see prices on elective procedures are at least adjacent to sanity, because insurance refuses to pay a cent for that.
not true, Insurance Pharmacies Doctors and Hospitals all work together.
The high list prices you see are only exist there to scare uninsured/underinsured Americans and to force them to buy/pay more expensive insurance.
As soon as you get treated, these list prices magically get reduced on the backend by factor of 2-3x.
Doctors themselves cannot price gouge patients, but they can price gouge via middleman (insurance).
The same procedure that costs $50 will be billed to insurance as $500 procedure.
same with pharma drugs, there is a very complex system in place to keep the face of expensive prices, while keeping a system of rebates/discounts/pre-negotiated contracts between each big player.
Americans are simply getting taken for a ride and their money being stolen by Pharma+Hospitals and Insurance is simply acting as a financial middleman.
Also insurance literally FORCES americans to work, because thats the only way to get affordable health insurance. Aint noone is paying COBRA (list prices). If you do you are stupid and throwing money away.
American population is being squeezed and extracted of their labor due to system that forces you to work to stay alive and healthy.
for comparison, just go to Thailand or Vietnam to any of the private hospitals: you can get the same western standard treatment but for pennies (the actual cost of care). This is the healthcare that Americans COULD have, but unfortunately the American system would lose too much money so Americans are not allowed to have affordable health care.
A lot of things in America is simply regulatory capture and requires Americans to keep ignorant of what they could have, what other countries enjoy, but Americans are not allowed to
> Also insurance literally FORCES americans to work, because thats the only way to get affordable health insurance.
This is really important. This system is artificially lowering the cost of labor and preventing people from immediately leaving workplaces where they are treated poorly by the employers or the customers.
People sometimes ask why there are fewer independent artists or writers, or small artisans like in Europe.
The reason is if you want to live, you need to get healthcare, and for that you need to be employed by BigCorp (because marketplace insurance is overpriced and crappy thanks to OBAMA).
The system is set up in a way to keep extracting and exploiting people in their prime years of age
This guy's condition is tragic, but it's crazy to me that people can read this and come away thinking the insurance companies are the bad guys.
Many drugs don't work, they are expensive. If there are no voices in the room saying "we will not pay for expensive drugs that do not work", then healthcare costs will continue spiraling out of control.
Single payer healthcare will "solve" this by ensuring that the medications this guy was taking do not exist and are never prescribed in the first place.
It seems the insurance company was happy to pay for treatment that wouldn't work though (the approved treatment had already been tried), they denied a treatment that was working.
Remicade and Entyvio have both been heavily tested.
Remicade is available in (at least) these countries:
- US
- Japan
- Europe
- Turkey
- Russia
Entyvio:
- US
- Europe
- Canada
- Japan
- Australia
Biologics are the first line of defense for anything over mild IBD. The only effective treatment for above moderate that isn't a combination of other meds is Rinvoq. The small dose items like Azith and Pred are just for flare management, and aren't maintenance medications.
They haven't been heavily tested in combination, and they should be! It just shouldn't be required for insurers to pay for exotic multimillion dollar experiments. There are far better places to be spending that money if the goal is improving healthcare
If the doctor prescribed it, it shouldn’t be the insurance company’s decision to deny it. That’s how it works in most countries.
Too bad it’s expensive, but that’s why people pay a lot more than $60/yr for insurance.
In Brazil, where I’m from, insurance companies can’t just deny medically proven treatments to covered conditions because they are expensive.
For example, my father in-law had prostate cancer. His health insurance covers prostate cancer, so the doctor was able to prescribe any medically proven treatment he had access to. The first treatment they tried was the one with highest percentage of success, and then changed it to other treatments depending on how the cancer responded.
Cost was never brought up, and they never heard complaints from the insurance company.
Lots of insurances accessible to middle class families also cover in-testing treatments that have shown success in other countries, if the patient matches conditions for the trial and other approved treatments didn’t work.
The US, Canada, England, and most of Europe are beginning to embrace the use of dual biologics in Crohns disease. The FDA approved levels of a singular biological may have issues reigning in out-of-control cases of severe Crohns, and there have been tons of trials run in multiple university hospitals over the last 10 years showing that the dual biological combo can help in those instances.
That's exactly why his doctor wanted to do it, because it had worked in the past. This wasn't some insane lab experiment done by a fresh grad gastro doctor.
I’m not sure about any countries that allow untested drugs or treatments for conditions not covered by the insurance company.
I’m saying that in many countries, like Brazil, an insurance company can’t deny a treatment for a covered condition because it’s too expensive.
So, for example, if the insurance covers prostate cancer, the doctor can prescribe any medically proven prostate cancer treatment and the insurance company can’t say they’ll only pay for a cheaper treatment.
Right but that's not what happened in this case. In this case it wasn't "medically proven" in the right sense. I'm not an expert on Brazil but from what I just read these specific drugs would not be covered
So you are mischaracterizing the biologics then. They are indicated for UC in the US. It's just that the doctor thought that combined, higher doses would work better (and apparently it did).
The prednisone still had him shitting blood 20 times a day. Cheap indeed.
How do we even have a conversation if you take drugs that are approved for treating a condition and just hand wave that they are "not tested"?
Why not force society (via insurance premiums) to pay for some testing? It's not like combining drugs with different mechanisms is a stupid experiment.
The gold standard for testing the combination would be to test it against the standard of care, so it's fairly precious to complain that the doctor and patient here don't have a big enough pool.
That must be why all the stories from countries with single payer health care go, “I got my medicine without any hassle or cost” rather than “I didn’t get my medicine and I died.”
I don't think there is any country outside the US where a healthcare system would have paid for his untested two biologic combination. Do you have any examples?
Agreed that sometimes it is appropriate for insurance to say no.
After one round of physical therapy for tennis elbow, which made some progress but didn't completely clear up the issue, I got denied my insurer (not UHC) for the additional physical therapy that the PT recommended. The problem resolved itself on its own in a month without additional therapy. Seems like they may have been right that it wasn't medically necessary.
That's called prescribing off-label, and a lot of moderate to severe IBD patients essentially require it because the recommended dosages (FDA approved) aren't high enough to impact the more severe cases of things like Crohns disease. This decision should be between the doctor and the patient.
The Mayo Clinic runs different trials all the time that involve multiple biologics being used at the same time, AKA "off-label" and they can have great results for the individual. Rinvoq + Skyrizi is a newer combo, but it can be any number of them as different patient's disease can affect them more severely through different pathways.
If a medication combo is approved by a doctor for a patient, and they've even done the worthless dance that is required to try the drugs they already know aren't going to work, then the patient should be allowed it off-label. Especially so if it's proven to be working (lower c-reactive & calpro levels). Tapering off of prednisone in this situation is a massive success. You literally do not know if a biologic will work for a specific case of IBD until it is tried as each patient is different, at the same time these drugs all passed FDA approval and show stats of 40%+ remission after 12-18 weeks.
Also, medication like prednisone can't be prescribed long-term, massive health issues will follow like diabetes and bone density issues (among others highlighted by the article).
How would anyone in the US afford a treatment when the system currently supported here inflates prices of these drugs to insane prices? You're defending an inherently corrupt system that leaves the patients in the dark. This isn't supposed to be a market-system, demand is inelastic. They don't have an option to just "go without" life saving medication.
Nothing about this is exotic or an experiment. This isn't some doctor who had a crazy idea he wanted to try, these trials have been run all over the place for 10+ years and show a large amount of success in resistant patients.
The only reason the drugs cost that much is because of how it's designed in the US. Foreign countries (Europe, Australia, England) pay under $1000 per vial / shot for most of these medications, while one shot of a drug like Stelara is $50,000 in the US. Remicade is even cheaper, usually $500 a vial overseas.
The insurance companies want to play this game. They're either in the business of saving lives or they're not, and if they're not, they're actively impeding care to sick individuals. By extension, they are contributing to their deaths if they aren't able to receive the medication they require.
In the US, these pharma companies make multiple billions in revenue from one of these drugs, whereas their overseas sales are in the mid to low millions. It's just the game being played in the US, and there's no reason to let someone die over it. Can't believe someone is actually advocating for this guy, who finally after years found a drug combo that worked, to just die. As there's zero way for an average American to afford 1.2 million dollars a year. Insurance is a risk pool, that's what it's there for.
The point of single payer is to tell doctors and patients unambiguously how much they can spend. The free market puts the insurer(s), the provider(s), and the patient in a competition to see who can stick whom with the bill. The savings come more from not doing that than from the insurer's profit margin.
The report you linked was from a single healthcare organization in the UK, not the entire NHS. Also, it mainly only covers their own cases and requests, they only treated 7,000 IBD patients in the specified year.
It does state that there was a request received, and it would fund it. Dual biologics usually isn't considered until all the regular biologics have been tried by themselves. You don't seem to understand that biologics and surgery are literally the only things to combat this disease, and surgery can end up just being a bandaid:
"The only formulary identified with a policy on dual biological therapy for IBD was South-East
London which fund dual biologic therapy for severe, refractory CD in certain circumstances."
Agreed. Medicine is one area where desperate people will understandably reach for any measure that offers some hope, but insurers can't be on the hook for everything.
Did you read the article? The drugs did work, but only at the high doses prescribed.
In fact I am certain you did not read it, as no decent person could read it and say "but it's crazy to me that people can read this and come away thinking the insurance companies are the bad guys."
I read it, the drugs may have worked but it's possible that one or both were not necessary, or that some other change caused it. The relevant question is bigger than "did it work", it's "was the likely causal improvement enough to justify the cost"
These drug combinations are mostly not approved outside the US because of a lack of data
It literally says in the article: "McNaughton had tried individual biologics".
This means he most likely had already tried them alone. Remicade especially, as it's essentially been the most popular biologic (aside from humira) for the last 15 years. Do you need to see his full medical history before you have a little empathy? As a person who isn't a gastro doctor I'm sure you'll fully understand it.
Anecdotally, this type of corporate behaviour seems to have infected the US health industry.
Doctors, Nurses, service providers, entrepreneurs, etc, all routinely have to deal with these insurance companies who refuse to pay for things, negotiate rates post-hoc, and generally engage in extremely unethical business behaviour.
That seems to have become normalized and I personally won't do any work with anyone in the US Healthcare industry any more unless it's paid up-front.
I really don’t get why everyone involved is allowed to have hidden prices. It looks like a highway robbery.
I had a relative visiting from Europe and they had to go to the urgent care for some blood and urine tests and consultation. They received a $2,500 bill!
My relative told the hospital that they are leaving the country and offered to pay $250 or good luck collecting from abroad.
Then something magical happened. The hospital just told them that they found a special discount and the deal was closed at $250.
I had to get a medication for a stomach bacteria called C. diff. It has bad relapse rates and its best to get it in check asap. What my doctor prescibed was the newest/best antibiotic for the issue, the other have worse recovery rates and way worse side effects.
I have very good insurance. The price of the medication without insurance was about $5000, the price with very good insurance was about $1300. After redditing i found a thread where you can find a manufacturers coupon on the manufacturers website. After knowing this seemingly secret hidden trick the medicine was $50. My doctor didnt know about that, my insurance didnt either. Absolutely insane. Absolutely arbitrary.
Well of course. In the USA, health insurance is legally required to spend at least 80% of premiums on medical care [1]. So, if they paid for only 50$ of care, they would only be able to make at most 62.50$ of revenue. The only way to keep revenue and total profits increasing is to increase costs.
> After redditing i found a thread where you can find a manufacturers coupon on the manufacturers website. After knowing this seemingly secret hidden trick the medicine was $50. My doctor didnt know about that, my insurance didnt either. Absolutely insane.
This is GoodRx's business model in a nutshell. I used them when I didn't have insurance and saved a ton on medicine.
Some manufacturer coupons/copay programs work a little differently than GoodRx—specifically the ones that you can only use if you're insured.
Those ones work like this: HelpfulDrug costs $2000/month. Your insurance company will pay $1500/month, and wants to pass the remaining $500 onto you, but that's too expensive for you to pay.
The manufacturers of HelpfulDrug see this and would rather not lose our on a deal, so they make you an offer: as long as your insurance pays the $1500 as promised, they'll tell insurance to waive $450 worth of your portion. You only pay $50, and the HelpfulDrug manufacturer still earns $1500, most of which is pure profit anyway.
Manufacturers' discount coupons are a fairly common thing in the US. But if the patient is on any kind of government medical assistance program (Medicare & Medicaid being the two big ones), they're not eligible.
My bit of anecdata is the insured price of $1249/month for a drug whose manufacturer would sell me for $40/month - if only I weren't on Medicare. $14,988/year vs. $480/year. Sucks.
They can tell you what they'll bill (if they can't, they're idiots). They can't tell you how your insurance company will adjudicate it, which is what matters.
That doesn't change anything, but FYI it's not just doctor being shady.
I had to get some bloodwork done. I sent emails and made calls until I found a provider who would actually tell me the prices.
Then the bill came and it was 3x higher. I wanted to know if it was the doctor's error or the lab's, so I asked for any paperwork requesting services submitted by the doctor, and they ignored me and sent it to collections, where it has been for the last 2+ years.
My ex had surgery years ago. The hospital messed up something with billing so she had to go to 20 different companies to make them redo their bills. Took a year of almost full time work.
Medical providers have inflated prices because contracts with insurance providers say the medical provider must provide them with discount. There's a secret cash price which often is cheaper than what insurance pays. Everyone is ripping each other off.
Here's a good example. Duexis is a combination of two over the counter drugs except medical providers bill $2500 a month for it even though it contains less than $5 worth drugs.
I'm type 1 diabetic, so I have a lot of medical costs. I'm legitimately traumatized by decades of navigating the US healthcare system, and one of the biggest problems is never having a real idea what things are going to cost, what will be covered, or when my insurance will randomly stop covering one of my medications, or take one of my doctors out of network.
I've had the experience of buying a prescribed medication in an EU country without local insurance, so the pharmacist had to charge me full price (and sincerely apologized for doing so) yet the full price was less than my co-pay would have been in the USA.
Technically speaking, there's supposed to be an available price sheet of services posted somewhere where patients can find it. IIRC this was a law passed during the first Trump administration.
The way that healthcare companies have been dealing with this is to post indecipherable price lists in a place that's buried within their websites. [0]
The other only way a price based system will work is if providers are required to show the bill ahead of time, with full insurance coverage and noncoverage clearly laid out, that is binding to the hospital and the insurance company.
That must be signed off by a conscious capable representative.
Yeah how does that work for emergencies and other situations?
It doesn't! Just like hospitals unable to or refuse to disclose prices.
The system isn't working, it's a steadily sinking ship that the four pigs of medical care: doctors, insurance companies, drug device makers, and trial lawyers feast at while they can.
With political parties in realignment, you'd think that Republicans who are pro working class under trump (allegedly) and Democrats who are pro poor (allegedly) could enact real reform, but I stead the chaos of current politics means corporate even more control
Because corruption is definitely up on both parties since the advent of trumpism.
> Just like hospitals unable to or refuse to disclose prices.
Yep or they give an estimate which explicitly says it can change based on the procedure's outcome and then your real bill is 3x the estimate even though you have signed paperwork from a doctor saying nothing out of the ordinary happened so you call your insurance company and mention this and they immediately deny your grievance form and say you're responsible for the full amount that's not covered.
Then you bring this up with the hospital and they say "an estimate is what it is, there's nothing we can do" and then you ask for them to assign you to someone who can walk you through the itemized bill which says stuff like "Code 0234 Unknown" and explain why it costs $6,354 dollars and they don't comply.
This is all after you've called half a dozen departments ahead of time to try and get an accurate price quote but were denied by everyone. It's no surprise that bills get sent to collections.
For anyone out there in the US, I highly encourage you to record every single phone conversation you have with anything medical related. It will save you.
It's funny that if you talk about the top issues Americans worry about, health care is one of them.
What are the top issues as perceived by Republicans and Democrats? They range from gender equality, race, immigration, crime, trans issues - basically anything controversial.
Healthcare is less controversial. And there's big buy-in for change by Americans. So what's happening? Are the two parties so bribed by lobbying efforts that democracy is canceled on this topic?
It's not surprising because everything you just listed for the top issues are wedge issues
Those are the issues that will drive votes either distinctly, Democratic or Republican.
Neither are the Democrats or the Republicans are actually interested in healthcare because the powers that be and their funders don't want it to change
Travel insurance is cheap, effective, and available for europeans to purchase in their contry of residence. Using the health services of another country and refusing to pay in an asshole move.
People don't like price gouging. If you get into a taxi where somehow there's a misunderstanding about the price or opaqueness when you get in, and suddenly when it's time to get out there's some crazy price the driver is requesting, that makes you feel cheated, well you'll feel like not paying or going to the police. These things happen all the time when traveling. Why do health services somehow get a free ticket to cheat? The numbers, thousands of dollars, are astronomical and never is there an attempt to rationalize it. It just is.
> Why do health services somehow get a free ticket to cheat?
In the vast majority of western countries, a tourist would need to pay more than 250usd to receive the services described by GP. Even when a country has UHC it rarely(never?) covers tourists. A quick google suggests prices in the 1000-3000usd range for Canada, the UK, and Germany, for example (an ER visit with blood tests + follow up).
It's just expensive to provide urgent care and tests. Not having travel insurance (fairly cheap!) and then refusing to pay for services is, indeed, a dick move.
Is the shooting related to this? I have not stumbled upon any resources linking them, but it would interesting to learn more!
Saying that they are linked, then it is interesting that we are falling back on why we have a lot of regulations and protections. While you can make a legal system where exploitation is legal (as some would argue the US health care system is), there is a breaking point where it will result in civil unrest.
I am curious to see if that is the point we are reaching now.
> In an interview with NBC, Thompson’s widow, Paulette told the network that “there had been some threats” against her husband.
> “Basically, I don’t know, a lack of coverage? I don’t know details,” she said. “I just know that he said there were some people that had been threatening him.”
These words are reminiscent of the terms "delay, deny, defend", the title of a book about how the insurance company tries to avoid paying out on claims: https://en.wikipedia.org/wiki/Delay,_Deny,_Defend
So, one of the leading theories is that the shooter was motivated by some kind of case involving a denied claim. Obviously, there's not enough evidence yet to be sure of that, but that same frustration over insurers' failure to pay for necessary, life-saving treatments is part of why there's so much sympathy for the shooter and so little sympathy for the CEO who was shot.
Of course, there are also other competing theories out there; it's possible that the whole bullet casings thing is just a ruse to distract people. But anger about how health insurance companies rack in record profits by denying life-saving healthcare to people has become a large part of this story.
UHC also has the highest claim denial rate in the healthcare industry, and they're notorious for stiffing doctors on payments as well. If there was ever a health insurer who'd stoke the kind of grudge that drives people to violence, it's UHC, because they're the worst among the worst.
Don't be so sure. It's interesting how quickly the places where this ghoulish view is proliferating (Reddit) have forgotten what they learned a month ago.
The Internet is not reality and online posts are not a representative sample of the population. Instead, every survey of Americans shows around 80% are satisfied with their health coverage.
There's nothing misleading about the KFF data, which has been going for quite some time now. If you recall (I know it seems like a lifetime ago), Obama got in trouble for lying that people could keep their plan if they liked it. If so many hated their plan, why did he pay such a heavy political price? Why would he even have to lie in the first place?
Says who? For instance this source says that healthcare is near the middle of the pack when it comes to NPS (which is basically how many people are satisified minus people who aren't), and are ahead of "internet software and services".
The context is about how the jury would feel about it, which includes people who aren’t and haven’t been sick. So the other commenter’s data is more correct and your attempt to partition out a subset of demographics is what is misleading.
Ghoulish? Internet? Have you spoken to regular people not terminally online? They have no sympathy for the CEO. I had sympathy for him as a human and a worker, but his behavior was beyond the pale and unfortunately rule of law doesn’t exist in the US.
> Have you spoken to regular people not terminally online? They have no sympathy for the CEO
Everyone I have spoken to has no sympathy for him as a CEO but sympathy for him as a human. He is wrong and the healthcare system is broken. But this was also murder. If your sense of empathy is so fucked that you’re pro murder, you need to speak to a professional.
(If you’re struggling with this and don’t want to let hate turn you into a monster, consider the difference between believing someone deserved what was coming to them and supporting that which delivered it.)
> But this was also murder. If your sense of empathy is so fucked that you’re pro murder, you need to speak to a professional.
A quote comes to mind - “I do not wish death upon another human, but I have read some obituaries with great delight”. This is one of those instances.
I have more sympathy for his family than him - he did not have to choose this line of work. Do people have sympathy for Bin Laden or other terrorists? If they don’t, do they need to see a therapist?
Anecdotally, the only people that I’ve spoken to who has sympathy are other extremely well off individuals who have questionable ethics. I also think it’s interesting that because the victim is an elite, there’s a sense of justice from other elites that is not there when a common man is shot and killed.
The whole thing is a double standard on multiple levels.
> whole thing is a double standard on multiple levels
Not really. The double standard is in excusing murder as a political tactic because you don’t like the victim.
In this case, the Twitterati will hold their court. And then a real court with real people on the jury will convict. There may also be an inquiry into UnitedHealth, but it will be able to be bludgeoned into partisan death by the law and order bloc.
> only people that I’ve spoken to who has sympathy are other extremely well off individuals
The ones I’ve seen who sympathise with the killer are largely college educated, urban, active on social media and make more than the median wage. If you’re only seeing one side of this, you’re in a bubble, because the truth is it’s not top of mind for most of America.
Agree to disagree I guess. The double standard in my eyes is that because an elite was murdered there’s an outcry for justice from the wealthy. When the police shoots someone or when there is a school shooting it’s just “thoughts and prayers” or “they were probably a criminal anyway”.
I do see both sides but the opposite of what you mention though - the ones that sympathize with the CEO are wealthy people who believe almost any method to make money is legitimate, or support the existing healthcare system because it hasn’t screwed them yet. If you think the healthcare system is messed up then you tend to support the killer.
They are definitely condemned but no real action is taken to solve the issue, that’s my point. So if they do something when a CEO dies then that’s the double standard.
He was killing people though, and if his death stops that, it's a net positive. His life is not worth more than the thousands he has ended for personal profit.
One, it doesn’t. Two, this applies in loads of cases depending on your individual morality. (Intentionally-spicy takes: abortion providers. Medical researchers who experiment on animals. Farmers. Meat eaters. Anyone American because of our foreign military interventions.)
This sounds like the same way because if rich people need protection, they must be under threat of people who feel exploited by them. Just like the OP.
To paraphrase the Joker: when tens of thousands of people die because their health insurance denies needed care, nobody panics. But kill one little insurance CEO and everyone loses their mind.
I’m personally much more interested in why people are so uncaring about a bad system that kills a ton of innocent people, than in why people don’t care about the murder of someone who got wealthy making it happens.
The NYPD seems to be losing its mind over this too.
You’re right, it’s not unusual. So not unusual that this wasn’t even the only murder in Manhattan that day. There was at least one other. Only one is getting a massive manhunt and media coverage for some reason.
> Only one is getting a massive manhunt and media coverage for some reason
Yes. It’s a lower Manhattan daytime shooting of a non-New Yorker. It’s where rich New Yorkers are. It’s where most New Yorkers are. It’s where most of New York City’s economy—including vastly most of its tourism—is. (And it will keep the media’s attention because the killer is photogenic.)
I understand the reasons why this murder gets so much time, attention, and effort, while the other Manhattan murder that day (that I know of) gets so little.
My point is that there is a big fuss being made, it’s not just a narrow slice of social media. The suspect’s apprehension is the top story on every American news outlet I checked just now. And my secondary point is that the disparity is deeply fucked up.
I love this dismissive attitude that anyone who fails to empathize with someone who makes tens of millions a year AND denies health insurance claims is somehow mentally ill. Get real.
> anyone who fails to empathize with someone who makes tens of millions a year
I’m not saying feel sorry for him. I’m not even saying don’t indulge in schadenfreude. Where you should know it crosses the line is in celebrating the killing and the killer. Because I promise you that someone with equal or more conviction in their righteousness would similarly take pleasure in the murder if someone you find, if not virtuous, not deserving to be murdered.
This sounds an awful lot like “don’t have opinions, because other people will have different opinions.”
Ok, someone will take pleasure in the murder of someone I think doesn’t deserve it. So what? Obviously I don’t like that, but people think all kinds of stuff I don’t like. Why should this particular opinion change mine?
Virtually everyone would take pleasure in someone’s murder. Osama bin Laden, say. Hitler, if we were in a different time and he hadn’t done the job himself. There are some people so principled they really wouldn’t feel that way for anyone, but for most of us it’s just a question of who falls into that category. Is has been a little surprising to find out that so many Americans consider this guy to be worthy, but just a little.
> sounds an awful lot like “don’t have opinions, because other people will have different opinions.”
Not at all. Our healthcare system is corrupt. That doesn’t excuse murder. Bin Laden was offed by a state. Depending on your morals, that is or isn’t different. But those who equate a serial killer with a soldier are in the stark, stark minority.
> little surprising to find out that so many Americans consider this guy to be worthy
Worthy of wealth != worthy of life. If you think you can judge life or death for other humans, sure, fine. We are very, very different people.
Sorry, who’s the serial killer and who’s the soldier in this equation?
I don't plan on going out and killing anyone, but I don’t see what’s wrong with thinking it’s good if it happens to certain very bad people. I suspect you have some people you’d think that of too. Maybe not, but most people do.
Since I’m not acting on it, my judgment counts for essentially nothing. I don’t understand this strong reaction to it.
Right. I also know several people who know no pro-abortion people, zero gay people, and nobody who is pro-Israel and not a flaming racist. We’re each in our bubbles.
Msm won't say the quiet part out loud if it involves corporate power, because msm is a corporate power themselves.
Everyone who has stepped in a hospital as provider or patient knows an insurance executives job is to quietly kill hundreds to thousands of people a year and profit from it.
Of course there's oil companies, cigarettes, alcohol, guns, weapons, and a lot of other industries that do this.
Because the real quiet part of capitalism is that its valuation of human life is very very very small unless they have money. Have many criticisms of economics, but this is the biggest one. Capital owned/controlled by a human is all that is valued, otherwise you are zero or negative.
> Msm won't say the quiet part out loud if it involves corporate power
You have the incentives backwards. Nobody is thinking of the collective. The story that sells today is David v Goliath. If you want a speaking gig on cable television, you need to help turn this murder into a symbol. (And no judgement. Media is media.)
No, "every survey" doesn't suggest 80% of Americans are satisfied with their health coverage. Can you site this data? Every person I've ever met IRL has hated the health industry with a burning passion. As you would expect given the exorbitant prices on insurance and care. Also, no one enjoys having their employer hold so much leverage in their life as for most people health insurance is tied to their job.
There’s a huge difference between how people view health care in general, and their own health insurance. According to the linked survey, in 2023 it was notable that only 72% of people had a favorable view of their own health insurance. In recent decades that has indeed sat around 80%, as OP claimed.
Again, that’s their _own_ insurance, while views of health insurance in general are quite worse, similar to how most people think congress is a shitshow yet rank their own representatives much higher.
That's probably because 65% of people have no real chronic medical conditions and/or are on Medicare.
I'm pretty well-off, so I can just throw money at my problems, and avoid dealing with insurance nonsense (denials and delays). So I'm fine with my health care coverage.
I'm not at all fine with my insurance company. And I'm actually in a very privileged position because I helped select this insurer for my company.
You’re right, I only looked at basic graphs and confused “the quality of health care you receive” (the numbers I gave) vs “your health care coverage”.
Still, that’s a huge dissonance between personal experience and opinion on the nationwide state of things, and I find that interesting because I doubt we can fix it unless a significant majority of people find it enough of a personal priority to vote that way.
I’m not sure how meaningful that is. I’d rate my coverage as excellent. My out of pocket costs are low, lots of in network providers, etc. At the same time I do not like my insurance company at all. They have stupid issues that I’m forced to resolve, and I definitely don’t look forward to dealing with billing after a major event.
I want to see a poll specifically on “how much do you like your health insurance company?” Not your coverage, not your insurance, but specifically the company.
I suspect one complication in this type of polling is “relative to what?” I hate my insurance company with a passion and I think they are part of a perverse system of incentives that wildly inflated healthcare costs, but they are a dream compared to my last company. Am I happy? Depends on how you ask.
> Instead, every survey of Americans shows around 80% are satisfied with their health coverage.
Weird how heath coverage is the only thing in America 80% of the people are satisfied with. It's such a nice round number, too. I'm assuming it's men only, or were women polled before Roe v. Wade was dumped?
1) What else in America enjoys an 80% satisfaction rate, broadly speaking?
2) Why didn't this number change after women's healthcare took a massive hit?
I'm assuming this is like calculating unemployment rates, where you need to play around with your definitions. Like, services no longer being available can't factor into "satisfaction" in any way.
More concretely, if you have two pharmacies in town and one of them closes, will polling accurately reflect the 0% satisfaction rate engendered? Or is this where we start splitting hairs.
> Although personal life satisfaction varies based on income, age, marital status and education level, between 81 percent and 90 percent of Americans are satisfied with their own family life, current housing situation, job, education, community and personal health.
> Slightly lower levels — between 71 percent and 77 percent — said the same about the amount of leisure time they have, their household income and standard of living.
So, ya know, lots of things that aren't super politicized.
> Why didn't this number change after women's healthcare took a massive hit?
(1) This question is asking about the quality of healthcare you received, not your perception of healthcare for others. A minority of women are directly impacted through the healthcare system by Dobbs (2022) (as opposed to indirect or non-healthcare effects).
(2) Some of the novel abortion restrictions post-Dobbs happened later? The most recent point on this graph is 2022. So it may just not show up yet until 2023/2024 numbers.
(3) The 2022 satisfaction number is slightly lower than the 2021 number (72% vs 76%). You could plausibly attribute some of that to Dobbs.
What I believe he is referring to is Jury nullification. I interpret your statement of open and shut case as you believe jury must convict if what they interpret to be facts of breaking a laws written by man. By a jury choosing not to convict there is another form of justice implied…
My guess is that most people on a jury would convict, but the odds of an entire jury convicting are less than fifty percent. I don't know how much less.
Tha kind of flexibility is the point of a jury. Laws aren't purely mechanical in most countries, for good reason. There's a lot of complexity and nuance, especially when some people have political power.
I don't have enough background here to make a judgement about what a jury should do, but I do have enough background to know that things like jury nullification are important to a well-functioning justice system.
I believe he is referring to if/when the cops confront the suspect, they will claim a justification for shooting him fatally during the arrest attempt.
In which case the prosecution will have plenty of grounds to screen for that in the next trial, that next trial will happen, and then the guy gets convicted of first degree murder. Presuming he's found in the first place.
There's no world in which all twelve jurors vote not guilty if the defendant is demonstrated to be the assassin beyond reasonable doubt. That simply won't happen, it's a delusion. Hanging the first trial would merely delay the inevitable, and I don't expect that to happen either.
Kyle Rittenhouse and Daniel Perry are both walking free after unambiguously murdering people in broad daylight.
You're right, I do find it less likely that the murderer of a CEO would get the same kind of treatment as murderers of civil rights protesters, but there are examples in recent history of people walking free despite unambiguously murdering people in broad daylight for political reasons.
You need consensus either to convict, or to _declare_ someone not guilty.
In the US there is an important distinction between the presumption of innocence, and its declaration in a court of law.
Someone with a hung jury or mistrial is still presumed not guilty by the law, but may be tried again for the same crime, because the prohibition against double jeopardy only applies to those cleared of a charge, which mistrials don't do.
In this case, it's a hard guarantee that a mistrial would be tried again. So yes, you would need consensus in a jury to prevent the conviction from eventually occurring, because there's no realistic chance of it happening twice.
It won't happen once either, but even if it did, it won't happen twice.
In the UK a few years back a statue of a slave trader was thrown into the river in Bristol, and the people charged were acquitted in what is commonly considered to be a case of jury nullificaiton.
Now, it's definitely true that getting a jury to nullify a murder charge is significantly different, but I'd argue there is a lot more anger about the healthcare system and CEOs making huge profits from human suffering in the US than there was about that statue, and much more generally too.
You also have a climate where a convicted felon just got made president, and another in a long line of presidents pardoning people they have close personal relationships too with clear conflict of interest. If you wanted to pick a moment where people in the US were losing faith in the justice system, now seems like a good choice, and if you believe the system is rigged, are you going to judge it on technicalities, or how you feel?
Do I think it is likely? No.
"No world it could happen", "delusional", and "won't happen"? I wouldn't be so sure.
It's delusional to think you'll win Powerball just because you bought a ticket. But that's a case where the odds of _someone_ winning are reasonably high, due to the very large sample size.
This is like if $billionaire announced that he will publicly generate a fair signed 32 bit number, and give a specific person a billion dollars if the number is exactly 1234567. It would be delusional to think that will happen, there's no world in which it will, and it won't.
People who think otherwise are ignorant of the process of jury selection, and how straightforward it is to find twelve citizens who don't want to spit directly in the face of the judicial process (and judge) and let a bloody-handed murderer off the hook because of feelz. They're unable to separate their social media fantasies from the real world.
I think you vastly underestimate how common and strong the anger is, and how low belief in following the letter of the law is. It's unlikely, but not winning the lottery unlikely.
Is that so? For myself, I can say that if he was caught, turned out to be a vigilante, and was convicted to death, I'd pay good money to be assigned as an executioner.
Yeah, he's more of a pain in the death-for-profi... I mean... society's ass alive.
Even if a jury does convict, he's in a state with no death penalty and the notoriety and nature of his crime will likely gain him support on the inside. Plus, all the press coverage of the trial gives him a podium...
If he is found and sent to jail it would be fascinating to see how he is viewed on the inside.
If there's one thing that crosses almost all class and racial divides, it is our shitty medical care system.
My (now passed) uncle was in jail to challenge drug incarceration laws back in the 60s, since the opposition needed a case that wouldnt settle to reach the supreme court.
Indeed, but what would be worse would be giving him a platform then making him a martyr. I don't think there is any winning play for the corpos operating within the law.
I think the pro-murder caucus is quite a bit smaller than you're envisioning. Some juries wouldn't convict the shooter, sure, but willingness to convict if that's where the evidence points is something the prosecution will be considering in jury selection.
I’ve spent days reviewing comments on Reddit, Twitter, YouTube, news articles, et al and I’ve never seen such a uniformity of opinion on anything in my life.
Yep. In today's world where everything is polarized to the extreme this seems to be unifying people. I don't think anyone had it on their bingo cards for 2024.
Comments you see on the Internet are not a random sample! If there's one lesson I could drive home to everyone about media literacy, this is it. Everything you see online is intensely, competitively selected for its ability to drive engagement, and celebrating murder drives a ton of engagement precisely because it transgresses well-established and widely agreed norms. Indeed, as we've seen here, the murder drives so much engagement that people are eager to discuss it in the comments of any article that's even tangentially related!
> Everything you see online is intensely, competitively selected for its ability to drive engagement
Mostly you're seeing accounts/sites you follow and choose to view and often those accounts have a consistent set of commenters. It's not like you log and the internet shows you entirely random things every time.
If you're viewing "Reddit, Twitter, YouTube, news articles, et al", that's usually not so. Each of these platforms optimize their default views to show you the content they expect will be most engaging, although the first three apply some algorithmic filtering to try and make the content engaging to you in particular rather than the average viewer.
Equally importantly, the content that gets produced is subject to this same filter. If you think the killer was justified, or you think the impulse to justify the killer shows everything that's wrong with America, you'll be excited to go write out a banger Tweet on the topic. If you have the boring, conventional view that all murders are tragic and you hope killers are brought to justice for the sake of the victim's friends and family, it's not going to occur to you to comment on this particular one.
Let’s not forget if you go against the grain and post “people are celebrating murder, which is gross” you are probably going to get downvoted—even on this site!
This whole celebration of murder thing is so bizarre. The fact it seems to be the default “way to get upvotes” and speaking out is “downvote city” is… well… disconcerting to say the least.
It speaks to the deep and broad frustration among Americans towards our healthcare system. This isn't just executives or politicians "screwing people over" like we see in so many other realms. There's a significant number of Americans who love someone who has actually died or suffered severer/permanent physical distress for the sake of insurance company profits.
When someone's family gets blown up from the sky and that someone becomes a terrorist willing to use violence against the party they blame for their family members death, we may not like it but we don't pretend to not understand it. Similarly we can't pretend to not understand this phenomenon.
We have a good idea. Not no idea. And we know exactly how people are responding to the killing, regardless of motive, so we don't have to split hairs on that at all.
Do you not have friends? A social network of your own? People I know are responding in a similar fashion to what we are seeing all over the entire spectrum of online media.
I'm going to guess all of your friends and social network use the same sites and are in the same echo chamber as you. And please don't delude yourself into thinking that if you poll everyone on the spectrum of social media, that you will have any idea what the general American public think about a topic.
Neither here nor there, but were you surprised by Trump winning in the fashion he did?
I just don't see your point. I don't pretend not to understand this phenomenon, and the need for healthcare reform has always been one of my strongest political beliefs. But that doesn't mean murder is any less bad!
Is the implication that this kind of murder can only happen as an expression of widespread popular anger? I definitely don't think that's so. There are plenty of places in the world where corporate executives have to fear being murdered in the streets, and it does a lot more to drive accountability to criminal gangs and oppressive governments than to the common people and their interests.
Change the term "the need for healthcare reform" with "the need to stop insurance executives from killing my mother" and you may have an easier time understanding it. It's personal. Make it personal for thousands of people and some of them will inevitably be radicalized.
> Make it personal for thousands of people and some of them will inevitably be radicalized.
I fully understand the motive and can empathize with the alleged assailant but that doesn’t mean I am celebrating the fact somebody got murdered. Being able to empathize and understand the motives doesn’t make what the person who shot that dude morally or ethically right.
> This whole celebration of murder thing is so bizarre.
People are celebrating because UHC is responsible for thousands of denied coverage(ultimately murdering common people) despite paying higher chunks of paycheck.
He ran the health insurance company that holds the record in denied claims in the US. I think that's why hardly anyone sheds a tear. Right now, the culturally transgressive thing to do is, say, make youtube videos about how shocking it is for the public to have no love for this CEO, and then getting ratio'd, everywhere, all the time.
What do find troubling is the glorification of the killer. We know nothing about his motives, might be a paid hit, whatever. But I attribute part of that to being basically drunk on the fact that people really enjoy that this CEO -- as a faceless representative of a whole class of people -- got killed. And they genuinely do enjoy he did, not necessarily for noble reasons, but it's not "really about something else".
The problem boils down to the abuser reacting in shock at backlash, instead of realizing they've abused people into genuinely hating them this much.
So I "checked", so to speak, instead of just going by the random things I saw, and yes, it's everywhere. Where people can speak freely, this is what they say. There is nothing wrong with any of these people. The only noteworthy thing here are the attempts to smear or silence them.
CNN: "Some social media users seem to lack sympathy for the UnitedHealthcare CEO’s death"
> A "civilized society" doesn't allow its citizens to suffer and die needlessly so that insurance CEOs get filthy rich.
> CNN doesn't get to dictate how people should feel.
> How many people died to fund the CEO's lifestyle?
> You can see how fox and cnn suddenly have the same opinion when it comes to safety of elites
> Shut up, CNN. Your days of being relevant are running out anyways. The people have spoken.
> I love how the media, complicit in the war against the poor, tells the poor how they can and cannot express their anger.
> We're giving back the same sympathy that was given to us.
> No. You’re not going to tell me I need to have sympathy for someone who spent his life and career without sympathy for others. Not being sad a bad person died does not mean something is wrong with me.
> Finally, something all Americans can be UNITED against
> You're morale grandstanding for a mass murdering pyschopath. The CEO was a monster.
MSNBC: "What the online reaction to CEO's killing reveals about America"
> So the problem is social media? Why aren't they talking about the real problem? The appalling US healthcare system.
> Celebrate murder?? normalizing insurance companies is celebrating murder, you hypocrites.
> His $10 million salary was $10 million of healthcare that was denied. How many people had to die for that $10 million. Healthcare should not be for profit. Do you get it now?
> This clip is all the proof we need that corporate media is more out of touch with the average person than ever before.
> 3:50 So you want to censor valid public opinion rather than address the root issues leading to such opinions? Good to know.
> These elite people sitting at a round table discussing how the peasants are behaving! Not once did the hint at that just maybe the insurance companies should evaluate their policies
> The only people who are surprised by this reaction are the talking heads. The media is more out of touch than ever.
> We keep being told that the deaths of poor and middle class people (old and young) is not a problem for the system. Then a fat rich man gets killed because of his greedy actions and the upper class is shocked that we say “it is not a problem”. That is part of the problem.
> So the lesson we learned is to silence people online? Get a grip. People aren’t upset that he was murdered, because he runs a company that denies care that leads to people’s deaths. “We’re normalizing murder”… well we’ve already normalized it for companies like UHC, why is this so different? Because we don’t have it on video?
> this woman says we should be outraged at the murder of a human being, ok, then why are we not equally outraged at the murder of thousands caused by the frivolous denial of life saving care by these insurance companies? Where is the outrage at that and why are those deaths acceptable?
Have you seen Youtube or Reddit comments on anything? They don't reflect real-life. Youtube is probably the worst, most trollish comments of the "normal" internet and Reddit is a sort of progressive propaganda machine that will also call for the death penalty on a teenager that did something stupid (which lots of teenagers do) or a karen that was an asshole in a restaurant and isn't happy with her life.
I haven't visited twitter in ten years or more so can't comment on that.
Those people are probably reading the same websites as you.
I swear, users of a site have no kind of memory. Literally a month ago everyone on reddits jaw was agape as trump was declared the winner. After months of redditors telling each other Kamala would win in a landslide and Trump was floundering, and no one was coming to his rallies, etc.
And now they're doing the same thing, telling each other that everyone in America loves that a dude was murdered in the street of NY(with a gun, literally 3' away from a random individual)
Nah, this is just moving the goalposts from "it's an Internet bubble" to "it's your personal bubble". I don't buy it.
Neo-*ism ideologies share a common myth - the myth of necessary order. This forms a contradiction that if enforced by more order will self-correct with stocastic violence. Sorry, but that's simply reality.
"internet bubbles" don't exist solely on the Internet, they exist in the minds of people spending a lot of time on the internet on certain sites. They manifest on the Internet commonly. But they also manifest in the "real world" when those people communicate with others.
Go ahead and deceive yourself that you're not in an echo chamber.
I'm sure that will help you understand reality better.
You imply that you have access to some unvarnished truth, unlike the other commenters who are trapped in their bubbles. What is your justification for this belief? Is it possible for other people to have access to this higher truth, or is it something innate to you?
My justification I guess is repeatedly seeing various commenters on certain sites espousing the same things in almost the same language. Then some event happened in the real world and they all start asking themselves "how could this happen", again, commonly in similar language. Meanwhile, I'm shocked that those people didn't see X.
Sure, it's possible to acquire my magnificent skills, by just going out and interacting with a wide swath of people in the real world.
Even, instead of thinking that you're getting any kind of signal about society when you read the same meme comment on Reddit/Twitter or whatever, just imagine you actually have no idea, even if you've read the 5000th tweet expressing the same idea
But you could say that about anything including the opposite.
I see a bunch of people who say that "CEO-killing is wrong. Therefore they must be in an internet bubble." I think we should both admit that the consistency of a message isn't actually a good signal for "bubbleness" and that something like randomized polling on personal beliefs and perceptions or a similar study actually would be.
Bubbleness isn't about the viewpoint, it is about the difference between bubble perception vs global perception.
If you read reddit/twitter, a common statement was something like "The police will never be able to find him - no one will cooperate". "Must be hard to find someone when there are 150million suspects". Basically, treating him like a modern day robin hood.
When, back in real life, the news of the day seems to be that he was caught at a McDonalds after two random employees noticed him and called the police on him.
If you want to make a statement about bubbles, then you have to ground it in global perception which is operationalizable and empirically verifiable - speculation isn't epistemologically responsible.
I'm not particularly worried about verification or epistemologically responsibility when something is manifestly obvious. The same reason I'm not jumping out of an airplane without a parachute even if I haven't read a study on the relative effectiveness of parachutes vs no parachutes when jumping out of an airplane.
Sorry, I hate to burst your bubble, but social facts ESPECIALLY need to be tested before being assumed because humans are particularly susceptible to typification, legitimization, and reification.
It's easy for other people to have access to this higher truth, and most people do. Basically by definition, the sentiments which are truly "overwhelmingly shared" are the sentiments you can talk openly about with strangers without fear that you might leave a bad impression. I think the vast majority of people supporting the CEO's murder would immediately understand that they should not bring it up when meeting their in-laws for the first time or something.
I literally have a PhD in social science and studied public opinion research at the graduate level with one of the field’s most highly accomplished political scientists of his generation.
I also have a basic modicum of common sense and the ability to observe my environment.
> I’ve spent days reviewing comments on Reddit, Twitter, YouTube, news articles, et al and I’ve never seen such a uniformity of opinion on anything in my life.
I felt the same way about the American election. Yet, Trump won. Online consensus on social media means nothing.
if there is a single issue that unites all Americans, this is it. Insurance is by design an incredibly evil extractive racket that only steals from people's pockets
I'm also a New Yorker and I think that most of us actually do not believe that assassinations are a net benefit to society, no matter how dissatisfied with the health care system we are.
There’s an incredibly strong argument this particular person likely killed tens of thousand of people by his decisions to deny and delay care.
This was not an employee carrying out orders from corporate, it’s the guy who is directly responsible for these deaths. This CEO is as much a mass murder as any other tyrant who commanded soldiers to commit atrocities.
That will be part of the defense argument presented to the jury. Intent matters tremendously in the legal system (mens rea). This isn’t random, this is very, very targeted.
Likewise, the lawyers this guy can afford after his GoFundMe legal defense fund raises millions will be top tier.
> That will be part of the defense argument presented to the jury. Intent matters tremendously in the legal system (mens rea).
It does, but “he did bad-but-legal things that morally justify my client’s premeditated homicide” is only legally relevant to proving premeditation, which doesn’t help the defense, and which the prosecution will be more than happy to stipulate to rendering the evidence irrelevant.
> This isn’t random, this is very, very targeted.
That’s not a fact in the defense’s favor, legally.
The fact that evidence is likely to make the jury act on factors outside of the law, combined with it being irrelevant to any legally relevant point in dispute, weighs heavily against it being allowed to be presented at all.
> A) You literally cannot have a murder trial without presenting a motive or evidence of reckless negligence/behavior (eg drunk driving).
You literally can, You have to, of course, prove the elements of the offense, but iif the defense wants to introduce evidence whose only legal relevance is proving an element of the crime, the prosecution will be more than happy to stipulate to the legally relevant fact and render the evidence unnecessary. Generally, the defense will not wish to prove the crime, though.
> B) His lawyers will be the best of the best.
That’s an argument agasinst them spending effort proving a key element of the offense.
> C) Jury nullification.
Jury nullification exists, but evidence whose only purpose (given the facts in dispute) is to promote it is, ipso facto, legally irrelevant and will be excluded for that reason.
> Jury nullification exists, but evidence whose only purpose (given the facts in dispute) is to promote it is, ipso facto, legally irrelevant and will be excluded for that reason.
What's interesting about this is it places jurors into a position where they need to decide whether to make an adverse inference against the state. If they have reason to believe that the defense may have wanted to present such facts but the state disallowed it, then it makes sense to refuse to convict (even if they wouldn't otherwise be in favor of nullification) so as not to participate in a show trial. But they can't actually know whether this happened because explaining why you committed a crime is usually a terrible idea, so you'd usually expect it to not happen.
There is a double standard though - when a common man is gunned on the street it’s just thoughts and prayers, there’s nothing we can do, etc. But when it’s an elite somehow that death is more important. If there is no justice for them, then there should be no justice here either. Otherwise it just reaffirms that some human lives are worth more than others.
That this sort of mass killing is an externality to our legal system is why people have to take matters into their own hands. Our system is flawed and this a a symptom.
This assassination meets none of the criteria however. I suspect we'd find an amusing overlap between people who want to exculpate the assassin, and those who are opposed to the state applying the death penalty to convicts.
Whether or not the guy had it coming is an opinion, one I'm personally holding off on having until we have more information about it. That means I'm not ruling out thinking so, and harbor hope in any case that it might prompt other health insurance CEOs to consider whether providing better service to their customers might also be in their direct self interest. Then again, I'm not opposed to the death penalty either.
But regardless of where one might fall on that question, it's delusional to think that the state will not regard the assassination as first-degree murder, and that a jury would do other than convict in the event that they're persuaded that the defendant is the same person as the one who was caught on video shooting him in the back. That's not what's going to happen.
I'm not a New Yorker, but I am an American interested in societal order.
I'd much rather not have to test either of your theories. One thing I learned about civilian populations during the Iraq war, if you're going to force someone to get down off the fence, you'd better know what side of the fence they're gonna jump down on.
If you don't know, then for the love of whatever you deem divine, just leave them on the fence.
I would say that our leaders would quickly start to address some of the inequities throughout our legal system that allow people to be taken advantage of in egregious ways. But our leaders are not like that. They'll likely do nothing about a lot of the unfairness in the laws out there. There is in fact, unfortunately, a distinct possibility that many of our leaders went into politics to increase the unfairness.
I just kind of get the sense that we're at a point in our history where we're already sitting on a powder keg. We shouldn't play with fire while we're sitting here. Let's at least get rid of some of the powder first.
Yes, it is dangerous, and to be clear a very very bad direction, but here we are - the us political system is visibly collapsing in real time and this will continue.
I have a different viewpoint that when governance and the judicial systems fail time and time again to fix systemic problems, and the ultra wealthy and large corporations can literally do as they please, that violence is a very logical choice for those who seek retribution.
Was the man who strangled a homeless man on the subway convicted of murder, or did the jury let him go in the end? Is it judged yet?
But I agree with you, I think most new Yorkers will convict someone who killed a CEO. Also I bet they'll let go someone who killed a homeless person. I don't know a lot of new Yorkers but petty bourgeois are the same in every countries.
I'm not even a New Yorker, but I can tell you the vast, vast majority of the people in that city are not "petty bourgeois". There is tremendous money in the city, but it is not even close to evenly distributed.
Given his behavior it seems unlikely he's a contract killer. I wouldn't expect him to taunt the police with writing on shell casings or Monopoly money in backpacks. It seems like he's just not a complete idiot that has no plan and gets caught right away.
What a poorly designed system. If the insurer truly prioritizes client care as they claim, why on earth would the doctors contracted to review the treatments of the insured, have access to the insurance policies? Shouldn't the output of their review simply be whether or not the treatment seems appropriate, period? Why are the doctors weighing their review against the insurers policies?
Honestly, this just seems like incompetence at multiple levels in a highly complex system. All it takes is one bad apple paying more attention to the bottom line than client care, for the entire system to magnificently cascade into an absolute shitshow.
If you read through the entire article without prejudice, most of the decisions made along the way make sense, with a couple of process failures and incompetent or indifferent individuals sprinkled in along the way, and the end result is a client who has to plan bathroom stops for a 5 minute walk, being told to take a treatment they know will kill them, or pound sound.
This is the kind of systemic cascading failure that can only be addressed by the person at the top having a come to jesus moment.
> What a poorly designed system. If the insurer truly prioritizes client care as they claim, why on earth would the doctors contracted to review the treatments of the insured, have access to the insurance policies? Shouldn't the output of their review simply be whether or not the treatment seems appropriate, period? Why are the doctors weighing their review against the insurers policies?
All healthcare systems ultimately have to make cost-benefit tradeoffs, and in the US system those tradeoffs are generally represented as insurer coverage policies. I don't mean to suggest that this justifies the story in the article, where it really sounds like the treatment did fit the policy and UHC worked hard to avoid seeing that. But there's no system where a doctor dreams up an arbitrarily expensive treatment protocol and a patient gets it with low out-of-pocket costs and no questions asked.
So are you saying the doctors contracted to review the treatments need access to the clients insurance policies in order to make a decision on whether the treatment is appropriate? For what purpose? My, arguably naive, understanding is that the reviewer should only need to provide two things for the adjuster to take it from there; whether the treatment is appropriate, and alternative potentially cheaper treatment options. If there are alternative potentially cheaper treatment options available, those should be discussed with the care provider and ruled out.
I just don't understand why the reviewing doctors report is required to take into account the policies of the contracting insurance firm?
The policies consist largely of guidelines regarding what the most cost-effective treatment option for a condition is likely to be. Good insurance companies do try and discuss with providers rather than firing off denial letters willy-nilly, but of course that still ends up being a conflict where your insurance might not let you have the treatment your doctor thinks is best.
This conflict is why I've always subscribed to Kaiser when I have the option. It's much less headache for me if there's no distinction between what a doctor wants to prescribe me and what they're allowed to prescribe. (Would I feel differently if I needed some crazy custom treatment protocol? Perhaps.)
That sounds very strange to me. If the adjuster has this information, why the need for a review from a consulting doctor? And why would the consulting doctor not be expected to know the costs of these treatment options, at least in relation to alternative options?
In most states (I think all?) insurance companies are required by law to get review from a consulting doctor if they're going to challenge a claim. I don't really think we could expect a doctor to know offhand the relative costs of every treatment for every potential condition in their specialty.
The insurer is a business, its ultimate priority is the make money. Same as the hospital, the drug producer, etc. I am sure they all want to prioritize client care but that have to ration it by cost at some level.
Insurance firms have the unique benefit of being able to offload their costs to their customer base in the form of premiums. That and excess would be the appropriate level to ration in the cost. Is that not verbatim how insurance works?
Horrifying. But also horrifying that treatment costs so much. Supposedly we have to let drug companies charge extravagant prices because it costs so much to discover new treatments, but there has to be a great deal of inefficiency there. Are we getting a 99% solution for $X when we could be getting a 95% solution for $X/10?
Worse, in many cases you're getting an existing 100% solution repackaged for $X * 1000.
Anything routine is so expensive in the US because regulation's gone completely out the window.
An area I'm familiar with for example: in Canada (where I am now) Salbutamol inhalers cost about $20-25. In California I was lucky to find it less than $100. And this is for a well-known decades old generic.
See also: insulin. It's making headlines[1] that companies are finally dropping prices down to roughly in line with the rest of the world (starting in 2026). And this is after other measures have already been taken -- it used to be much worse.[2]
Worth repeating: this price gouging is for generic and old medication.
Where are you getting 10X? If I look at, say, Merck, their "sales, general, and administrative expenses" [1] trends at even or slightly higher than their R&D expenses [2]. Abbvie's ratio is around 2x [3, 4].
AFAIK, SG&A is the number that groups criticizing pharmaceutical companies look at, even though it includes a lot of money spent on things like paying lawyers, which any pharmaceutical company that actually wants to make back the billions spent on developing drugs will have to do.
the marketing expense is a legalized lobbying. What you see in marketing, is just payback scheme to Media/TV (to shut down any criticism of pharma), and doctors (for promoting/prescribing drugs)
The reason the treatment costs so much is in large part because of insurers aggressively pricing treatments down, forcing hospitals to respond by jacking prices up. It's a never-ending cycle. See e. g. https://www.fairobserver.com/economics/why-are-us-hospitals-...
The fix here would be to remove the middlemen (insurance companies) and pay hospitals what Medicare/Medicaid pay them, which is typically a much lower negotiated amount.
>But also horrifying that treatment costs so much.
My mother underwent chemotherapy for her cancer.
According to the statements from her insurance company, each round of chemotherapy cost as much as a new luxury car before hospital vs. insurance negotiations. Yeah.
The value of health insurance isn't just the offloading of expenses, it's also their power to tell hospitals to get fucking bent with ludicrous bills.
The health industry is what's wrong with a captured market and few players. Every party is trying to extract maximum value for minimum input.
That leads hospitals to 1000x every treatment price so when insurance companies come to negotiate they can negotiate down to 100x. It causes hospitals to understaff because is cheaper to pay for legal staff to handle malpractice claims than it is to not work your nurses and doctors to death.
It causes drug companies consolidate and then charge through the nose for drugs that cost them pennies to manufacturer (for example, penicillin or insulin) drugs that, everyone should be aware, all of the R&D and FDA approval has been done. The most expensive part of drug development is done.
There are solutions. It's regulations. Hospitals regulated to minimal coverage. Drug/hospitals hit with anti price gouging regulations. Insurance companies hit with coverage regulations.
That's all something doable and probably with enough political will to be done.
An even better idea is simply nationalizing medicine, top to bottom. That's unlikely to happen, but would result in the biggest drop in healthcare costs.
>An even better idea is simply nationalizing medicine, top to bottom. That's unlikely to happen, but would result in the biggest drop in healthcare costs.
In the immortal words of President Ronald Reagan: "I'm from the government and I'm here to help."
Which is to say, no. Obviously this is a long-brewing problem in need of a solution, but more government is not it.
Destruction of government is exactly what got us into this mess in the first place. Reagan, Clinton, and Obama are each to blame for the current state of American healthcare.
Every semi functioning healthcare system has more government involvement than what the US does.
Health insurance price negotiation is the primary reason those prices are so high in the first place. An insurance company gets to say it negotiated a 99% discount (or whatever) and the hospitals and pharmaceutical companies still charge prices high enough to turn a comfortable profit.
It's a lot like "Black Friday" sales where retailers jack up their shelf prices in the preceding days and weeks so they can mark them down and persuade the customers they're getting attractive deals.
Insurance companies have a motivation to see high healthcare costs - it justifies higher premiums, and in a broken 'public' healthcare system that entrenches insurance middlemen, and subsidizes their costs for those unable to afford them, you're just going to see costs skyrocket endlessly.
Public healthcare, of any sort, should not involve working with third party insurance companies.
In any case, this is also why medical tourism is a thing - you could go get the exact same treatment, to completion, half way around for far less than what you the cost you were quoted for a single round in the US - including housing and other costs.
To be fair to hospitals, some of those bills are ludicrous because of insurance. If they know that insurers will only ever pay 10% of the listed cost, they'll make the listed cost seem a lot bigger so that that 10% payout is comparatively bigger too.
>Companies providing medical Care have to spend 80% of their costs on actual medical care, not marketing and executive compensation.
That requirement was imposed on insurers in response to already-exorbitant medical costs. It does create a perverse incentive, but it cannot be the root cause of the issue.
Well, before that (and continuing), the largest customer of drugs in the United States is prohibited from negotiating price for most drugs.
The exorbitant costs arose with the provision of private medical insurance in the 1940s but only really took off when Medicare and Medicaid came in the 1969s with, essentially, a blank check for cost.
Things weren't improved in the 1980s when emergency rooms were required to provide care regardless on a patient's ability to pay, leading to another perversion that for a significant group of people the only way to get medical care was when it was too late and most expensive.
ACA is just another example of the US government doing stupid.
I firmly believe that was a poison pill put in the ACA intended to drive prices up enough where people got so upset we end up with single payer. The alternative is that the people that penned the ACA have absolutely no understanding of economics, and I’m not sure which is worse.
The sad thing is for medications all it would take would be a simple bill that says that medications in the US will cost the average of Canada, Japan, The UK, and Germany (or whatever).
Perhaps we are, but the treatment regimen described in the article sounds like one of those 4 percentage points missing from the 95% solution. A custom-made cocktail of two drugs, each requiring a special biologic manufacturing process and each far above the standard recommended dose? It seems very plausible that this would not be economical to produce for 1/10 the price.
Both of the drugs listed in the article (Remicade and Entyvio) have generic/biosimilar equivalents, too, so in theory competition should drive down the price... but this is the American healthcare system so of course it doesn't.
Unclear from the article, but it's quite possible that UHC was _forcing_ him to use the more expensive name-brand drugs due to an agreement that they made with their pharmacy benefits manager (PBM). Some name-brand manufacturers will see generics on the horizon and throw in a clause that obliges the PBM to continue exclusively covering the name-brand drug for X amount of time. UHC specifically fucked me over this way by refusing to cover a widely available generic drug, insisting that they'd only pay for the name-brand stuff, but no pharmacy on earth seems to carry the name brand stuff and couldn't even source it to order it, so UHC effectively denied me the drug altogether.
I feel for the guy in the article because the drug that UHC fucked me over about (mesalamine/Lialda) was keeping my Crohn's in check, and after the ensuing flare I had to switch to Remicade, which isn't totally working for me—I'll be switching to something else soon.
And being on Remicade myself, albeit at a lower dose (and without Entyvio like he's also taking), I was curious enough to check the EOB for how much my current insurance pays for it. I have Anthem BCBS and here's the breakdown of my last infusion. For context, this is a drug where you have to go to an infusion clinic for administration because it's delivered intravenously.
Doctor/facility charges:
$21,420.70
Your discounts: -19,563.26
Due to your doctor/facility (max allowed): $1,857.44
Anthem paid: $1,857.44
So the "cost" was 20k for a single infusion, but Anthem negotiated that down to 2k. (I didn't pay anything since I'd met my out-of-pocket limit for the year.) Here's the itemized breakdown of that 20k cost:
Drugs
Provider charges: 21,020.70
Plan discounts: 19,226.20
Anthem paid: 1794,50
Infusion center
Provider charges: 400.00
Plan discounts: 337.06
Anthem paid: 62.94
So the drug cost $1.8k, and they only paid $60 to have someone stick it in me.
And for reference, that's name-brand Remicade too, because it's what Anthem's PBM requires. I'm on 7.5mg/kg every 8 weeks, and the highest approved dose is 10mg/kg every 4 weeks. So even if he was on, e.g., 20mg/kg every 4 weeks, that would be maybe $4k worth of drugs once a month, which is $48k a year. Unless Entyvio is way more expensive than I realized, I have no clue how that would add up to a million dollars a year in costs, unless they're sending him to an infusion center that charges crazy high prices (which, if it's part of UHC's Optum network rather than an independent clinic... maybe they do :P)
Do you have evidence for "most new treatment research is government funded (and by governments of other countries)"? My understanding is that the opposite is true: big pharmaceutical companies foot most of the bill for developing new drugs, then US-based insurers pay high costs, and most "other countries" enjoy much lower prices because US healthcare is effectively subsidizing their drug prices.
It’s both working together- the basic research, including identifying targets and new chemistry and in some cases even the drugs themselves are mostly academia. However, clinical trials, and drug development that iterates the chemical structure itself and delivery approaches is very expensive, and almost entirely done by industry. Often the academics are working collaboratively with pharmaceutical- and can have either government or pharmaceutical funding for these projects. I’m an academic PI that has discovered and patented new drugs and licensed them to industry.
Thanks. Do you have some sense of the breakdown in actual expenses incurred by the basic research and subsequent industrial development? It may qualitatively be true that many governments sponsor basic research that is later productized, but if the second bit costs 1000x more than the first bit, it's not exactly a fairly shared cost.
I don’t know the numbers off the top of my head, but most likely substantially more of the money is from industry. However, just answering that requires really carefully defining the question- because much academic research that happens to lead to new drugs or drug targets is basic medical and biology research- do you also include all biological research that does not turn out this way? On the industry side do you include all biotech startups hoping to sell to big pharmaceutical companies including the majority that do not?
Clinical trials are incredibly expensive but also comparatively straightforward and require a very different set of facilities and skills from basic research. Pharma mostly could not recruit away the people with these skills from academia- they can’t offer the same freedom and job security, but the academics often found startups they work for on the side and ultimately sell to pharma if it works out. So comparing money spent isn’t the entire picture of relative contribution- as they are each doing parts the other is not equipped for.
Your employer wouldn’t be on the hook for the costs, so I can’t see why they’d care. The legal and social risks would be gigantic for both your employer and the insurance company.
I imagine insurance companies have other easier tricks to delay or deny treatment before considering something like this.
It’s bullshit like this that makes me realise how lucky we are in countries that have public health care. Sure it has problems but private systems seem to have zero advantage for the average person. Pay more for less effectiveness AND a bunch of people get nothing.
There are people here on HN that no doubt make a lot of money working for Google. The idea that they are treated equally to a homeless man is not something they would want.
It is no coincidence that universal healthcare was introduced during a time when the elite were recovering from WW2.
> The idea that they are treated equally to a homeless man is not something they would want.
Au contraire. In America, homeless people are afraid of going to the hospital lest they accidentally recieve the same quality of care as a Google employee without the Google copay.
I’ve been on two different medications that simply weren’t available to people in the UK.
I’ve also been to the Mayo Clinic quite a few times as just a standard appointment and any time you go there you’ll see people from other countries coming for better care than they can get.
In Brazil, health is a constitutional right. Brazil has free, universal, and unlimited healthcare. Public hospitals in large cities are on the same level as private hospitals, and both are excellent.
If you want faster non-emergency care from a private hospital, you can purchase health insurance. Doctors don’t need approval from the insurance company to perform treatments or prescribe drugs. If the drug or treatment is listed on the insurance’s website as covered, it’ll be covered if prescribed by a doctor.
Since public hospitals offer almost all treatments and drugs for free, private hospitals and insurance companies are forced to offer lower prices and support more treatments to compete.
Non-essential surgeries like LASIK are very rarely supported by health insurance in the US, but are covered by most in Brazil.
Despite all of that, the average Brazilian only pays 27.5% in income taxes vs 37% in the US. The US government’s health expenditure per capita is $12k, versus $1.2k in Brazil.
It isn’t perfect, but people in Brazil don’t go bankrupt because of health problems. They don’t have to fight the insurance companies for coverage, they don’t die untreated of cancer, they aren’t afraid of calling an ambulance, and they pay less taxes for it.
That’s not what the article says. It says patients have access to the treatment for free, but sometimes delivery can be delayed by a few months due to shortages. The study only considered people without health insurance and says people with health insurance don’t face the same supply shortages.
> Most patients (n = 172, 83.9%) reported at least one failed delivery of biological medicine in the last year, with a single shortage in forty-two patients (24.4%), at least two shortages in forty-seven patients (27.3%), and three or more shortages in seventy-eight patients (45.3%). The average time to regularize the distribution was up to 1 month in 44 cases (25.6%), up to 2 months in 64 cases (37.2%), and more than 3 months in 56 patients (32.6%)
"In CD, the PCDT does not offer any biologic other than anti-TNF drugs. Despite being approved in Brazil, new biologics such as ustekinumab and vedolizumab are not available for these patients [28,29]."
> I've had a broken bone that was visible in an xray and told to go home.
Please tell us more. Which country would this be in? What bone was broken?
The idea that a state engages in some grand conspiracy to spare the expense of a gypsum cast is ludicrous to me. Yes states engage in cost-benefit analysis of treatments but the contentious bits are not around broken bones. More along the lines if particular cancer treatments are worth it or not, or if the state can pay for super expensive advance treatments.
If you sympathize with or outright support this, you are either clinically diagnosable as a psychopath or are under the sway of one or many.
If you are a psychopath yourself, your worldview is rejected in-full by anyone with normal psychology. Stuff your psychopathic attempts at persuasion.
If you are generally a normal person but found yourself swayed by the techniques of psychopathic people, many of whom exist in society's institutions and who do not have your best interests at heart, you should take some time, deeply rethink this, and then reject it.
If you do not reject this, ultimately, you belong on a number of watch lists, full stop, as you are a supporter of domestic terrorism that seeks to murder people in cold blood.
But reject it.
This pseudo-hysteria is a criminal trap, and beyond that its logic is complete nonsense.
If this man was guilty of anything, then the law would have held him accountable. He was not guilty in terms of how he delivered service, and anything further that he may have been guilty of his murderer deprived society of finding out. Officially, he's innocent.
Every time that a citizen is "removed" by psychopaths by reason of their perceived arbitrary complaints, immediately there is another person who meets the same or arbitrarily adjusted criteria. The criteria will be adjusted to target people. There will never be even-ground for the psychopaths, and their follower-victims, who are justifying this.
In this discussion, I was asked if the murdered CEO didn't share responsibility for the supposed fact that UH is "the hardest to deal with and rejects the most claims". For one second, let's ignore that denying claims is a part of the root health insurance business model that every single payer advocate wants: only to be run by the government. For one moment, let's ignore that the CEO did not invent the health insurance industry, nor is he responsible for its continuity. Let's assume that UH soon "reforms" and is no longer "the worst". Immediately, there will be a new "worst". Is the CEO of than new low ranker the next target? Now model this situation across other industries.
Brainless, soulless psychopaths do not serve logic, morality, nor society's interests. They serve their own bloodlust. Which can manifest in any number of ways, but sometimes it manifests in actual murder.
Stop being persuaded by their nonsense.
This is a crazy thread to have on HN. It's widely supportive of domestic terrorism and murder, seeks to perpetuate support for it, and the Mods should take it down. It's shameful, horrific shit and HN should be fully embarrassed to host it.
3-7-77 is a symbol originally used by the Montana Vigilantes, a 19th century vigilance committee in Virginia City, Montana, United States. https://en.wikipedia.org/wiki/3-7-77
You could probably have gotten away with what UNH did if the money wasn't so ridiculous. Thompson himself had a compensation package worth $10.2 million[0] a year. It's reasonable to think that other c-suiters at the company, along with those of its parent organization, made similar amounts of money.
The company also has a 1.53% dividend yield[1].
The average American's lifetime earnings are $1.8 million for men, and $1.1 million for women[2]. That is to say, within five years, Mr. Thompson would likely have made ten times the average American's lifetime economic output, post-tax.
If you're paying a significant chunk of your yearly earnings to be covered by UNH, you expect the money you paid to go towards providing you with service. Instead, tens of millions of it goes towards a handful of individuals, and regardless of how the company does financially, participants in the equities market will get some of your money, and you'll possibly be denied the service you paid for in order to make that happen.
People will say that this is necessary to remain competitive, but it just isn't. People with severe health problems or loved ones with severe health problems aren't asking these executives or shareholders to live like paupers; they just expect the service they paid for. When there's something as life-ruining as chronic health conditions dogging you every single day, there's a chance you snap, and in the US, there's fairly trivial access to tools to help you do that.
[0] https://www.msn.com/en-in/health/health-news/the-salary-bonu... [1] https://www.nasdaq.com/market-activity/stocks/unh/dividend-h... [2] https://www.theknowlesgroup.org/blog/average-american-lifeti...
reply