The people that should be blamed are the politicians that created this mess in the first place, not the people administering the broken system that they can’t change unilaterally.
The system was created at their behest specifically not to reduce their profitability. If you didn’t follow the debate 15 years ago, the ACA was the compromise adopted after the healthcare industry plowed money into advertisements, lobbying, and astroturf to kill the idea of a public option. The concept traces back to the Heritage Foundation’s proposal offered after the healthcare industry killed the Clinton healthcare plan in 1993, but the Republicans immediately switched to opposing that as soon as it had any chance of passing because literal billions were on the line as soon as insurers couldn’t drop the most expensive customers from their pools.
The ACA caps health insurers' profits. When you say "the healthcare industry", you're confusing insurers and providers, who are not allied.
Doctors (the AMA) killed the public option because it would save money by lowering their salaries. American healthcare is expensive because of providers.
(Another example is that we banned opening new hospitals unless nearby competing hospitals approve of it. This is called "certificate of need".)
It’s wrong to state this as a binary. This isn’t mutually exclusive and all of the parties profiting from the status quo had a common interest in preventing reforms - those don’t overlap perfectly so the groups fissured on different lines but they lobbied independently and as part of joint groups like this one:
There are significant generational issues, too. For example, older doctors who owned highly profitable private practices took a very different position from younger doctors who are employees of huge companies, and the pharmaceutical lobby wasn’t opposed to the ACA as long as it didn’t involve cutting their profit margin to what Medicare or the VA pay.
This is a factually incorrect statement, Joe Lieberman killed the public option not "doctors."
At least blame the right people.
Also FWIW every doctor I know supports universal healthcare, granted most of them are under the age of 40 but you're foolish if you all doctors believe the same thing.
> The ACA caps health insurers' profits. When you say "the healthcare industry", you're confusing insurers and providers, who are not allied.
I see you didn't look up the relationship between UnitedHealthcare (the single largest insurer in the country) and Optum (the single largest healthcare provider in the country), did you?
I'm aware, they run the prescription side of my employer health plan. But if they denied care for me, that would actually be my employer doing it. Most employers self-insure and set how much they want to pay. The insurance company is more like a fall guy for them.
I of course have a nice tech employer plan, but they won't do early refills on medication which means I have to pay cash (well, GoodRX) for that anytime I travel for more than a week. Not a life changing expense but an annoying one. (Maybe my fault for choosing the HSA/HDHP plan?)
Also, I was talking about hospitals and don't believe Optum controls those. Here the plan that runs everything including hospitals would be Kaiser, and as far as I know people are happier with them, but I haven't tried it. Haven't tried ACA marketplace plans either.
Nope, you're not aware. The part running your prescription side is yet another part of the UHG business. That one is OptumRx.
Optum doesn't own hospitals specifically because they have strategically chosen to own almost every other type of clinic, including wiping out thousands of independent practices and small groups in just about every medical specialty (including primary care) that you can name.
Kaiser is an example of a much-less-bad version of this same pattern (called a pay-vider). They're non-profit so they don't have nearly the same incentive to leverage one side of their business to benefit the other.
Seriously: go do some research on how UnitedHealthcare, Optum, and OptumRx all coordinate to wipe out competition in local clinics and pharmacies.
I'll look into it if I get the time. Though, would be pretty easy to defeat monopolies in local clinics if we simply had a lot more local clinics, eg by increasing the supply of doctors to what other countries have.
> They're non-profit so they don't have nearly the same incentive to leverage one side of their business to benefit the other.
Most US hospitals are nonprofits, but that doesn't make them behave better. You can still earn and pay out a lot of revenue as a nonprofit.
I'm all for increasing supply of doctors but uhh yeah, you really don't understand the dynamics at play here if you think "would be pretty easy to defeat monopolies in local clinics."
Here's a quick primer: You're a doctor in Podunk, Pennsylvania. UnitedHealthcare is the largest insurer in your region, like it is in most regions. Optum wants to move into your town. UnitedHealthcare will cut your reimbursement rates by 70%, requiring you to see far more patients per day, cut your staff, downgrade your equipment, and generally run a shittier business. Once you're finally on the edge of burnout and fully strangled, Optum will come in with a buyout offer. After the buyout (or after you go bankrupt and they just replace you), suddenly UnitedHealthcare is able to restore rates mostly to where they were previously.
Ta-da!
Note if you take the buyout and then regret it and want to break free: too bad. This deal came with an extremely rigid non-compete clause that they will absolutely actually enforce. FTC tried to get rid of these, in large part for this specific use case, but thankfully the American people (read: megacorps) have the GOP looking out for them so that was struck down.
What exactly does marginal doctor supply fix in this particular scenario? Pretty much nothing. All of them have to accept insurance and the vast majority of their potential customers are insured by the same very few insurers.
Re non-profits: I didn't say it "makes them behave better." I said it subjects them to different incentives. Don't strawman. Kaiser in particular is an exceptionally strong organization in pretty much every way except its financial performance. If you think being non-profit isn't a factor, you're just playing dumb.
What role did the CEO who was killed play in that debate 15 years ago?
Why are you still shifting blame from the politicians who created this system? They didn’t have to listen to the healthcare industry. They are accountable to the public. They got voted into office and they put this system in place. Of course the healthcare CEOs are going to argue in their own interest - but they don’t call the shots here! The politicians do.
A better question would be why you’re trying so hard to exonerate some of the richest and most powerful people in the country. Trying to blame nebulous politicians without thinking about how they got elected or what they were asked to do legislatively, or how much public opinion is shaped by mass communications and the status quo, feels like a joke about a physicist trying to say another field shouldn’t exist because their “assume a perfectly spherical cow” thought exercise wasn’t too complicated.
The guy who was killed, with annual compensation of $10M, is one of the richest and most powerful people in the country? There are FAANG ICs making more than that.
Do those FAANG ICs set policy for the largest healthcare company in the world? I don’t know why you’re so committed to trying to dismiss the idea that the policies his company sets have produced many angry customers but it’s not unreasonable for people to think that a CEO has some control over policy in a way that those ICs at adtech companies do not.
There may be a few IC's who make that amount but they do not wield nearly the same amount of power as the CEO of one of the largest healthcare companies in the country.
I'm not the GP and in fact I don't agree with the GP, but I really don't think anyone should have to explain why they are defending someone who they think is innocent, regardless of how much money that person does or does not have.
This isn’t a criminal case. They’re trying to say this is just like any other unhappy customer, ignoring the life-altering outcomes healthcare problems have unlike most other industries or how much more Americans pay for lower-quality, high-stress service. Trying to understand why so many people were conflicted about a murder without understanding that context is like trying to explain what’s going on in Gaza while refusing to consider the role religion played.
If you are willing to shift the blame from the CEOs, why stop by shifting it one level? Why not shift it all the way to the top, to the voters who voted in the politicians?
The health insurance industry is a modern example of the banality of evil, and there is enough blame to go around.
Hey, why not blame the shareholders. If you own a mutual fund that may be you! ... or me. The irony of people funcking themselves over via this route is kinda funny.
People do blame the politicians, but they rightly also blame anyone who has a hand in and nexus to furthering the rotten system. CEOs, AI algorithms people who write algorithms to deny coverage, software developers who ship it to production, etc are all culpable to some degree. The bigger the nexus, the more the culpability.
Night janitor? Probably not enough nexus to be blamed. The Tech Lead on the “Deny Healthcare for Corporate Profits” initiative? Probably as culpable as the CEO.
The idea that a business is morally blameless to act in any way as long as it A. improves profit, and B. is within the law; and that everybody must limit themselves to voting with their patronage and are somehow wrong to e.g. voice criticism; is obviously, intuitively false.
Closely related: The idea that a market-priced transaction is fundamentally neutral and creates a moral and ethical firewall between both halves.
Satirical example: "Okay, so maybe we knowingly sold guns and mustard-gas to the Elbonian death-squads which they used to kill millions during the genocide, but it's not our fault they were the highest bidder. You can't blame us for a perfectly moral transaction because all parties made a voluntary agreement to exchange goods. In fact, it's people like you who are the real evil ones here, trying to infringe on my right to do whatever I want with my property!"
The execs of these companies aren't just hapless administrators plodding along in a broken system of someone else's design. They very clearly to everything they can to extract as much value as they can from the situation.
No, it's not that black-and-white. The politicians are to blame, as are the corporations and business interests who continue to take advantage of the system for financial gain, as opposed to working to fix it from within.
If "just following orders" wasn't already completely null and void, i.e. if it was possibly to come up with an even worse defense, "just following incentives" would be that defense.
And "politicians" didn't create that mess either, corrupt politicians who acted on behalf of their donors, rather on behalf of the people they represent, did that. It's not mainly politicians profiting off this after all, some of them kinda just read from the teleprompter. Does that make them blameless? Of course not. Every single person in the chain, be it a chain of command or incentives, is responsible for not refusing to participate.
well that shows why you're not aligned with those out there who are frustrated with Healthcare. We weaken universal healthcare almost the moment the administration shifts. It may as well be unilateral.
Execs of companies beyond a certain size are part of the political elite - in fact they probably have more political strength then the average politician.
The people administering these broken systems who are being paid huge salaries are totally innocent, they had no other alternative, they wanted regular salaries and to do good to their customers but were forced into these jobs.
