If a shitty system treats 95% of the people terribly and the lowest 30% of the people worse, the latter is not a surprise. Nor would I oppose reforms that address the 95% problems, but set aside problems facing the lowest 30% exclusively.
Pharma is problematic, but ISTM that the health insurance industry has some very bad actors. The ACA addresses this, but apparently not sufficiently given the vast disparities in and poor coverage of denial rates.
As for cold blooded murder, I’m not sure how this plays out but I would guess that it ends with a problematic but more defensible CEO being murdered and Fox News blaming liberals for it. Left on the cutting floor would be distinctions between killing the CEO of the most rapacious and dishonest mega-company in an oligopolistic industry vs killing the head of an organization selling a commodity traded on international exchanges. UHC management has a lot more discretionary consequential power than Exxon or Shell.
I mean, so what? How else do revolutions gain momentum? Look at the histories of revolutions—when the bazaari (commercial) class feels the pinch and joins up with the revolutionaries, it’s game over for the ancien régime.
Yes I include the latter, the (not exact quotes) “the victim was a mass murder so while I do not condone murder I feel no sympathy” and “the suffering that drove the shooter to this, the fucked up system, is the point” (nevermind the killer was not someone on verge of bankruptcy due to denials or unable to get the care he desired, albeit it had a poor outcome) posts in my spectrum.
First group of posters in this thread anyway, three celebrating, four of how evil the victim and the industry is as the point but of course they don’t condone murder, three that this was murder, full stop, no excuses understanding the reasons for the action be it personal or an act of political terrorism.
I’m not going to keep counting but my sense skimming is more posters of the the self-defense, no sympathies, CEOs being afraid will cause positive change yea, than anything else.
@Measure_for_Measure I don’t know about your “most” claim but I am hoping I misunderstand you. Are you saying you are among those who are okay if the 30% who are the most negatively impacted systematically don’t get much relief as long as the larger upper group gets reform that helps them/you? That’s how it reads to me and is what I think most do think whether or not they admit it.
No more or less than any industry. Pharma is I think actually a bit worse IMHO, but bad actors (meaning the bottom line now and future are the guiding stars, not public goods) are more the norm than the exception across all industries.
Nowhere close. UHC is huge and they are IMHO likely the worst, have been long before their murdered CEO took the top job, but many other current companies in other industries are worse. Come on.
Sorry but these are not revolutionaries. They are the entitled complaining the occasional long line applies to them. At “best” they are spectators at Collosseum enjoying some blood sport.
Yes there will be copycat murder or so of some other figure that someone blames for a societal ill. But if there is a healthcare system result of this news cycle focus on healthcare coverage it will be the public endorsing the belief that the ACA isn’t as good as they were thinking it was and agreeing with Trump trying to repeal it. Not better regulation. Not single payer. Not Medicare for all. Just throw the whole thing out and Make Healthcare Great Again.
Was Mangione ever denied coverage of treatments or procedures that might have cured his chronic back pain?
Or did he receive treatments that were ultimately unsuccessful? (A Washington Post article claimed this was the case.)
If the latter, he seems as confused as he is disturbed. He’s apparently blaming corruption in the health insurance industry for the non-corrupt shortcomings of medical science.
I’m reminded of Rodney Dangerfield’s great-grandfather. During the Civil War, he fought for the West.
PS: If Mangione was denied coverage for something that might have helped, why didn’t his wealthy family foot the bill?
He might also have been angry because he’s having to devote 10 hours a week of frustration on the phone with insurance agents while in severe pain in order to receive coverage.
He might have been angry because he was denied pain medication because so many OTHER young men seek pain medication for recreational reasons.
There are so many possibilities for anger at the system that I’m not sure speculation will get us anywhere until we know his specifics. Has anyone read his manifesto?
What we know from several sources is that he was NOT ever a customer of United Healthcare, and that whatever company did provide his insurance coverage he DID have a spinal fixation procedure, which he initially was posting had worked wonders online.
My impression from what has been reported of his posts is that some surgeons at least were advising against the procedure for him but he either found or convinced someone to do it, and that some point after his initial reports of how great something changed. (He had been posting online encouraging others to push back against doctors who encouraged living with the pain instead of doing the surgery, and later about how he’d never be able to function, including intimately.)
Clarification: the UHC CEO was a swell guy, but UHC’s corporate behavior was way worse than average. Giving insurance then yanking it away is reprehensible. UHC’s behavior was worse than average because of the difficulty of regulating their industry.
This is a good question. Rawls says you can judge a society based on how it treats its least well off member. That’s a pretty extreme position. Let’s say you can judge a society based upon how it treats its bottom 30% (with bottom portions receiving a heavier weight). This is somewhat more moderate than Rawls. I seriously doubt whether that take would receive majority support even among Democratic voters. Nor (I claim) could you get even half of the 30% to turn out and consistently vote for such policies.
So there’s a strong case for building a political coalition from the center out, rather than from the bottom up. The alternative in the US is building it from the top down, also politically viable.
What about me? I’m of more than one mind on the subject. Rawls makes a compelling case. My general take is that I’m a centrist by European standards, which means I’m for a substantially more generous safety net in the US and that conservative objections to that are wildly misplaced given living examples in the remainder of the world. If I was a European voter, I’d given proposals to cut the safety net a respectful hearing.
All that said. There’s a lot of research in the medical field directed at disparities in the delivery of health care, of varying quality. I opine that a lot of it is pretty lazy. For example, the most compelling question here is would be to trace the link between screwed up insurance policies and health outcomes. But that’s hard to measure. Showing the effects on particular demographic groups in contrast is straightforward: you don’t even need to discuss causality.
Take the Aug 2024 paper I quoted. It was well funded, and based on survey data that established that yes the poor are being screwed over. What a shock. The author appeared on NPR, but AFAICT didn’t bother to post the goddamn working paper online. So their work is paywalled. OTOH, it was an excellent exercise in virtue signalling: top marks.
Here’s a better 2023 effort by NBER researchers.: “A Denial a Day Keeps the Doctor Away”. Medicaid is the worst for denials, with Medicare and Private Insurance trailing. At least on claim is denied in 24% or Medicaid cases, 7% of Medicare cases, and 4.1% of commercial insurance.
Holy crap. Combine that with datasets showing substantial disparities within commercial insurance, ranging from 5% to 34% IIRC, and it begins to look like UHC’s bait and switch approach could make some of its paying customers worse off than what Medicaid has on offer. Maybe. The quality of the denial data is fairly spotty and the NBER paper used a narrower dataset.
At any rate I was unable to find the paper-we-wanted among the references in the 2023 paper. It did demonstrate some harms of Denial of care policies: they tend to make physicians refuse to accept medicaid patients. Interestingly, once the patient is in the room, denial rates don’t appear to affect the probability of a procedure taking place. (Appendix A.4) So as far as that study is concerned, the consequences of UHC’s denial policies on health appear to be blunted, or so we might conjecture.
“The CEO of the most rapacious and dishonest mega-company within the oligopolistic health care insurance industry,” was the claim I intended to make.
I’ll also opine that UHC is worse than the ethically bottom 100 of the S&P 500, but that’s a separate matter. I say this because UHC has been an innovator in profitable dishonesty, baiting its clients with gym coupons and yanking away payment for care when they need it most, all the while obscuring the nature of their policies. Consumer Reports needs to declare jihad on the big care deniers.
ETA: Typo above: “At least one claim is denied in 24% or Medicaid cases, 7% of Medicare cases, and 4.1% of commercial insurance.”
I wont fight that claim, but stating they are mass murderers? On that I will need a cite.
As I pointed out- if you are in the hospital, and you NEED something to save your life- they generally give it to you, insurance or no. A huge bill will be forthcoming of course.
I’ve been grappling with the epistemological issues without complete success. Sure, if you’re bleeding out you get emergency room care. The same can’t be said if you come down with a disease requiring repeated visits such as cancer or diabetes. Right? (Or no: I’m fortunate enough to be healthy with good insurance, outcome wise).
I think there’s a problem in asking for statistical evidence when the underlying study apparently doesn’t exist. At that point I think the discussion should shift from, “Cite!” to “What is a reasonable conjecture?” I do think there’s a need for some humility at that stage: I’m not sure how much.
Accurate. Now let’s discuss some moral philosophy, hypothetically. Let’s say you had a health condition - say it involves crippling back pain - and let’s say you had a health insurance plan - we’ll call the health insurer “Anthem”.
Say “Anthem” issued denials along the lines of the hypothetical book “Deny, Delay, Defend”. Our vic wants revenge and decides to… drain the air from the CEO’s tires. Now that’s wrong. But the vic decides to do it anyway.
The vic takes care to be sure that he doesn’t deflate a third party’s tire. But which CEO should the vic target? Should it be the worse of the two CEOs or should it be the one that affected him personally? I say the vic should drain neither the Anthem CEO’s Bentley nor the UHC CEO’s Lamborghini, but if he absolutely had to choose, the UHC CEO was a superior target. Because that’s where public attention is properly directed. The “I take it personally” shtick is pure Hollywood, and terrible ethically. Punish the CEO most worthy of punishment, not the one that happens to affect you the most, via lawful means of course.
Obviously they’re not directly murdering people. But the US doesn’t have an average life expectancy 4 years lower than the OECD average by happenstance. It hasn’t become a ridiculous outlier on charts showing life expectancy vs healthcare expenditure accidentally. That has happened because the gatekeepers of health care in the US (i.e., those setting policy in the health insurance industry) have consistently prioritized profits over positive health outcomes.
Approximately 3 million die in the US every year, and on average those people die 4 years younger than they would if they were from another randomly chosen developed country. So I’d put the toll of private health insurance policy in the US at somewhere around 12 million person years per annum, which is roughly 150k human lifetimes.
Compared to the Nazis, those are rookie numbers, but they’re sure as hell not nothing.
Personally I think a basic level of healthcare is best considered if not a human right then at least a right to our residents. I am open to discussion about what is within that definition of “basic” but I’d rather have care that is rationed than irrationed. This however goes afield.
No question that many physicians and healthcare systems refuse or limit their panel size of Medicaid (and many refuse Medicare as well). Poor payment. Ethically is that much different than what these insurers are doing? We are choosing to care for more of those whose care will profit us, and to limit the care of those who do not. To the extreme in some cases of boutique practices who cater only to the very well off. Why should we get a pass on looking out for our business’ profit over the greater good?
Gym membership (which is in many Medicare Advantage, MA, plans) not dishonest. The MA model incentivizes keeping the covered panel of patients healthy. Making exercise easier to accomplish and stick with promises decreased future expensive illness. Prevention is a smart investment. I recall something about payment structure incentivizing it too but don’t recall details.
When these articles cite many other adverse outcomes associated with the denials process, a rational conclusion is that data showing deaths increase (at least to a statistically demonstrable level) has also been looked for and simply not found. I cannot imagine those looking for adverse outcomes not looking at that one.
The distinction you are making is between a crime motivated out of a sense of personal revenge vs one motivated as an act of political terrorism. Indeed Mangione is charged with terrorism. Of course he may just be a person who psychiatrically broke when pain recurred after a procedure he had thought had fixed it …
No it hasn’t. Not primarily anyway. More drug overdoses, gun violence, lack of exercise, crap nutrition choices, traffic fatalities partly attributed to our monster sized vehicles which are safer for its driver but much more likely to killer others on the road pedestrians included, poor government regulation.
Even the aspect that is healthcare related is not primarily due to the insurance companies. We have structural and institutional racism and classism that would exist with major impacts even if we poof had single payer.
I’m not an apologist for our very flawed system, but using the insurance companies as the big bad avoids addressing bigger elements.
FTR, I didn’t locate any articles citing many adverse outcomes associated with the denials process. They might exist. I would be sympathetic to your inference if I could locate a solid paper addressing the health outcomes of the denials process. Admittedly, google doesn’t produce as many good links with site:*.edu as it used to. It’s about time for me to revamp my search vendors.
As for the morass that is the US health care system, I think this chart indicates that there are a few bad players that need to be curb-stomped by Consumer Reports. A public option would also help, but the stars align for health care reform only once in a couple of decades.
The US is not unique in any of those things - except maybe gun crime, but that simply isn’t common enough (thankfully) to significantly sway life expectancy. But fine, since you’ll start bringing up Japanese obesity rates or average European car size, just compare with Canada, which is culturally almost identical to the US, right down to the institutionalized racism. And you shouldn’t have made this argument, because I was doing you a favour comparing the US against the OECD average life expectancy, where Canada’s a bit above average, so now we have a 5 year life expectancy discrepancy to explain.
I read somewhere that she Shkreli went to trial, they had trouble finding jurors because even people who had never heard of him said, upon seeing a picture of him, that it would be very difficult to give a fair trial to someone who looked like him.
Real life revolutionaries often are the entitled. They have the resources to try and aren’t as beaten down. People who don’t feel entitled seldom revolt, they are too crushed down. Revolutions seldom come from the bottom tier of society. (Not that I think this is a matter of revolution, it’s just an isolated incident)
I mean, just look at the people who led the American Revolution; not exactly the poorest of the poor. But they thought they were entitled to more.
