It is hard to feel sorry when their own business implied throwing thousands of ill people into hardship and reneging on their contract to pad the bottom line. Murder is wrong, but the way these insurance work is very much not right either and when there is no relief valve like fair regulations, pressure is bound to mount.

Asserting that murder is wrong without caveats or discussion, and that the problem’s root is the murder is also bound to increase pressure even further. The future government won’t do anything to help, so pressure will keep increasing and things will get more volatile.

I don't need to feel sorry for anyone to assert that murder is wrong. Morals (and laws) don't depend on how sympathetic the victim is or isn't. The fact that there's a sizable chunk of American society which doesn't see this is scary as hell, and speaks very poorly of those people.

Nevertheless, the person I was replying to has 100% voted for murderers assuming they live in the US, unless they never voted for anyone who won. They consume products by businesses who murder. I strongly doubt they're a pacificism absolutist, given how extremely rare those are nowadays, as most people understand how quickly that falls apart when someone shows up with a big stick who can't be reasoned with.

I assume the answer is yes, but I'm sure you see the issue with letting laws define one's own personal code. This isn't a 'gotcha' or anything. I myself have lots of cognitive dissonance on this issue, and am just genuinely curious what your take would be.

I've never understood people who say this, insurance companies' profit margin is set by law and they can't change it.

And reduction in claims paid just goes into lower premiums. And more claims paid equals higher premiums. In no case does their profit change.

Also a fixed profit margin can as well translate to higher salaries and other costs that the company controls, not necessarily lower premiums?

Yah, that's not really true. Sure if they can increase healthcare costs, then they can increase premiums, but that also makes them less competitive.

But the bigger reason it's not true is that insurance companies don't set the reimbursement rate for drugs in the first places. Instead that's set by PBM's, which are separate companies. Insurance companies hate PBM's because the PBM's prevent the insurance companies from doing exactly like you describe.

(This hate translates into a lot of badmouthing which I'm sure you'll find if you lookup PBM's. They get called "middlemen" who take money and don't provide a service - this is just propaganda by insurance companies.)

The whole hero worship of Luigi is based on a complete misunderstanding of who actually causes healthcare costs to be high. It's not insurance companies or PBM's! It's actually Dr's and hospitals.

It's not trendy to hate those though.

I doubt that it has much affect, for two reasons.

1. Looking at graphs of US health care costs over time I don't really see much change in the growth of health care costs during pre-ACA times and post-ACA times.

2. Looking at health care costs of other first world countries, their health care costs over the 50 years have been growing fairly similarly to the way US health care costs having been growing.

This suggests that the reasons for most health care cost increases in the US are neither things we do differently than most other first world countries (e.g. more heavily relying on private for-profit insurance companies) nor any relatively recent changes to how we regulate things.

Those expenses are internal and increasing them doesn't change the above at all, those expenses affect profit and that it.

Insurance companies profits come from reducing expenses. Reducing claims doesn't change the profits in any way.

Reducing claims means lower premiums, and that's it.

Cigna executive-turned-whistleblower says Wall Street drives up health care costs https://www.wbur.org/hereandnow/2024/12/18/cigna-whistleblow...

> Robin Young: ...you testified before Congress during the passage of the Affordable Care Act, and at that time, that law demanded that health care plans spend 80 to 85% of premiums on patient care. This is called the Medical Loss Ratio. So what happened?

> Wendell Potter: They figured out how to work around that. For one, they've gotten more and more into health care delivery, and they now own physician practices and clinics and big pharmacy benefits middlemen, and none of that is affected by the medical loss ratio. So in other words, they've figured out how to work around it, plus it also has enabled them to jack up their premiums. So the more premiums they take in, the more money they have.

I used to do health insurance company PR. Here’s what I think the backlash is missing https://www.statnews.com/2024/12/11/wall-street-unitedhealth...

> Congress would ultimately include language in the ACA to require health plans to spend at least 80% to 85% of premiums insurers take in on enrollees’ care, known as the medical loss ratio. But big insurers have figured out if they also become health care providers — by buying physician practices, clinics, and pharmacy benefit managers — they can meet that threshold by paying themselves and avoiding payment for their customers’ care.

> An argument could be made that the medical loss ratio provision of the ACA has contributed to or even fueled the vertical integration of the big insurers, UnitedHealth especially. UnitedHealth is massively bigger and more profitable than it was on the day I first testified as a whistleblower, June 24, 2009, when it ranked 21st on the Fortune 500 list of U.S. companies. Its share price at the close of trading that day was $24.81. Hundreds of acquisitions later, UnitedHealth is now the fourth largest U.S. company — just behind Walmart, Amazon, and Apple. At the end of trading on Monday of this week, the share price was $560.62. That’s an increase of more than 2,100% since June 24, 2009. By comparison, the Dow Jones average has increased 438%.

> In the years since then, UnitedHealth, Cigna, and a handful of other New York Stock Exchange corporations have cemented their roles as unelected gatekeepers to care, and Americans are now waking up as they never have before to the consequences of that. If their rage can be harnessed and channeled with clear policy proposals, that dike the industry built might just give way without more violence.

But it has nothing to do with the claim that "denying claims increases profits", which is simply not true.

Well, it's kind of transparently true. If the worst-case scenario is that you need to return some premiums, then you should always deny enough claims that you're always returning some amount money, as you should always hit your profit cap. The second reason issue is that an approved claim has Opex costs. The platonic ideal of an insurance company in the current system is one that collects (# of patients * annual premium), and approves 0 claims. If you don't approve any claims, you'll have the lowest possible Opex costs, because there's no processing to do, no fraud to check for, no follow up visits that might take you below the profit cap, etc.

Strawman. Your goal is to prove that there is full alignment between ethics and law in our current system. If there isn't, then we cannot use one's adherence to the law as an indicator of their ethical standing.

The Holocaust was legal once. Harboring Jewish political refugees was not.

The Palestinian genocide is legal now (according to the US, not the ICC). Speaking out about it at univerities is met with extreme police action.

Slavery used to be widespread in the West, and freeing/harboring escaped slaves would land you in prison or a grave.

> The justice system generally doesn't tolerate revenge

That's an idealistic take. The reality is that the justice system is frequently used to make examples out of political dissidents.

This has been true for millennia. My patron saint, Joan of Arc, was burned to the stake for essentially wearing pants. Are you going to sit here and try to tell me that burning a 17 year old at the stake for not being "womanlike" is ethical?

You would think on a forum called Hacker News that people here would be more sensitive to how Corpgov warps society's perception of political dissidents, given the history of our own kind.

The comparison of violent vigilantism over what is really a financial issue to a peaceful civil rights movement is so classy. You don't know what you're really supporting, and if things continue in this uncivilized trajectory, you will regret it.

This is the real straw man. Have you ever heard of a generalization? Of course we can and do use adherence to the laws of the land as an indicator of general moral character. They rarely deviate far from the moral demands of society, and are in fact the only rules that we all have in common with our compatriots.

>That's an idealistic take. The reality is that the justice system is frequently used to make examples out of political dissidents.

That has nothing to do with vigilantism, and in our country dissidents are almost never murdered like this.

>Are you going to sit here and try to tell me that burning a 17 year old at the stake for not being "womanlike" is ethical?

I think notions of what is ethical change over time, and so do the laws. Your example is way off topic and misses the point. This guy was a boring bureaucrat who was probably doing his best to run an upstanding business that inherently pisses people off sometimes. You can't be a terribly evil person in modern times without breaking some laws. There is no way to see this random act of violence as "eye for an eye" no matter how much you hate insurance companies. There is no equivalence between walking up to someone unprovoked and shooting them dead versus making necessary financial decisions that might give people vaguely worse health care. Even if you could calculate that a specific change in policy that this CEO did result in some deaths, the nature of the business makes such things inevitable (short of gross negligence or evident malice for the customers). It certainly isn't as contemptible as armed robbery, murder, felony theft, or burning someone alive for bad fashion.

Your argument IS a straw man. You literally put words in my mouth. Try learning what a straw man is before using the expression.

>Society does not have moral demands, it has one or more ethical consensus. Please learn the difference between the two before trying to argue with authority on them.

You should try using a dictionary. The first definition of "moral" on dictionary.com is this:

> of, relating to, or concerned with the principles or rules of right conduct or the distinction between right and wrong; ethical:

If you go to 'ethic' then all two of the definitions are here:

> the body of moral principles or values governing or distinctive of a particular culture or group:

> a complex of moral precepts held or rules of conduct followed by an individual:

So you're wrong, plain and simple. I don't care about some philosophy class attempt to split hairs here. The distinction is really a red herring that you're getting obnoxious about.

>What are you talking about?

You said that the state would retaliate against dissidents, in response to me saying that the state will not tolerate acts of revenge in general even in the face of popular support for the offender. Again, it will not suffer people who are following the law to be murdered. You brought up the dissident thing presumably to relate Mangione to a dissident. But dissidents don't murder people. MLK, Malcolm X, all the dissidents most people admire, are not murderers.

>This sentence does a lot of hand-waving. Vaguely, indeed. I think, if you look for it, you will find the quantification you're looking for.

Perhaps I would find it, but the real numbers are discovered through trial and error and are not at all straightforward to interpret. You really want to get people in a frenzy over some unintentional policy mistakes with outcomes that can only be understood with advanced statistics and a mountain of data?

>The difference is one act of direct violence vs tens of millions of every day acts of indirect violence, in a system where the class perpetrating the latter acts of violence continually gain the upper hand incrementally over time, like a political ratchet.

Apparently you don't understand the definition of "violence" either. Unfortunately the word has been so abused that the dictionary now has totally wrong definitions in it.

>Our forefathers would have revolted over much, much less than we put up with today.

This much I agree with. I don't think they would tolerate income tax or gun laws. As for health insurance I think they'd just say, nobody is forcing you to buy it, so you don't get to just go on a murder spree as revenge against the industry.

Friend, I'm not going to use the literally lowest common denominator dictionary.com as a source of the distinction between the concepts of morality and ethics. This is the definition of cherry-picking on your part. There are centuries of philosophical literature on the subject. Google "morality vs ethics" and actually spending some time to understand what you're talking about.

> Try learning what a straw man is before using the expression

No, my argument was not a straw man. It is literally the basis for the original discussion, but you can't seem to comprehend that.

Now you're just sarcastically parroting back things that were said to you. This is just immature, you're arguing in bad faith and becoming increasingly vitriolic, so this conversation is over. Please review HN guidelines, and learn to argue in good faith and without a bad attitude.

I’m laughing from the back of the bus on this one. I mean if I sat in the front that might not be allowed, it might be breaking the law. OMG.

- Martin Luther King, Jr.

This quote is painted onto one of my lockboxes and I have read and internalized it daily for over a decade now. Such a powerful sentiment, and I wholly agree. In my pursuit of accountability of law, I have come to understand just how much I respect the importance of law, as an anarchist.

Thank you for the kind words. Adding them to the pile of inspiration to finally start blogging. I'll be on the lookout for your account. Currently my bluesky feed is garbage and I need to train the algorithm.

Doctors themselves make a lot of potentially questionable choices that may be seen as costing lives. We have a fairly high bar for proving malpractice because any given patient could choose to blame the doctor personally. A business guy who is not egregiously messing things up on purpose or through gross negligence deserves some benefit of the doubt as well.

I think you've drank the Kool aid straight from the firehouse.

The general reaction to the assassination of a health insurance exec in protest to depriving people from life-saving healthcare treatment is not endorsing it but completely understanding and even sympathizing why anyone would do it.

The very fact that you're framing this issue as "murder of the people" instead of wondering why anyone would cheer when someone targets a health insurance exec speaks volumes to how effective the propaganda around this has been.

I know what you’re trying to do, but mixing phrases only works when the combination makes sense, this one doesn’t.

>HealthPartners, a major health care provider (...), has announced its decision to leave UnitedHealthcare's Medicare Advantage network (...), HealthPartners says the decision stems from the insurer’ high rates of coverage denials and payment delays, which adversely affect patient care. (...) The health system highlights that >UnitedHealthcare's denial rate is up to ten times higher than other insurers in the market. [0]

Different source:

> in 2023 UHC claim denial rate was flat out highest in the industry, 1.2x more than the second highest rate, and twice as high as industry average. [1]

[0] https://www.wha.org/vv-08-01-2024/4 [1] https://www.valuepenguin.com/health-insurance-claim-denials-...

That's not how it works.

Insurances charge monthly payments in return to providing access to healthcare services for free or reduced cost. This means the bulk of their customers is people who do not need the service right away, and instead are investing in assuring they will get the treatment they need when and if they need it.

Those who do not get access to healthcare services and die will not be able to vote with their wallets. They are gone. The same holds if you are bankrupted by having to pay your treatments out if your own pocket, specially if you lose your livelihood in result of your health issues.

On top of that, there's the question of whether there's a free market on healthcare insurance. Big if.

While I agree with most of what you said, if the insurance company lets a person die, then that person no longer pays them for insurance and never will again - essentially "voting with their wallet", even if not directly. While that may be an insignificant amount of money to the insurance company, if their policies led to many people not getting the treatment they needed, the people would either die or seek other insurance, and either way stop paying the company for insurance. Though this can be problematic if the insurance is supplied by an employer, as they don't always offer a choice of insurance companies.

But the real problem with the US medical system is the medical treatments costing far, far far more than is reasonable. In other countries medical care costs are way more reasonable. People don't get bankrupted by medical expenses. And there's too many stories out there about hospitals and doctors billing insurance ridiculously high costs, and if the bill isn't being paid by insurance companies then the price is lowered substantially.

It's a fucked up system, through and through. Many/most hospitals are for-profit ventures, and they really do try to extract the most money that they can, however they can get it - and that usually means sending a ridiculously high bill to the insurance company and then insurance tries to negotiate it down. A routine operation should not cost over $100,000, but that is often what the insurance company gets billed.

But if their basic business model is to collect premiums while denying coverage as much as possible (which evidence suggests is the case), that's basically murdering and bankrupting people for money.

And it's hard to say it's not the case when you're denying claims at 2x the industry norm.

Private health insurance exists as a pure "middle man", and hence 100% of their profits are at the cost of less health care being delivered by the actual supplier of medical help. Hint: Not them.

United Healthcare was notorious for having the highest refusal rate, about one third of all claims: https://www.forbes.com/sites/amyfeldman/2024/12/05/unitedhea...

That's insane.

Imagine if a car insurance company simply refused to pay for a third of all accident claims!

"I see that you car was totalled, but you can clearly see a scratch in a previous social media post you made, so that's a pre-existing condition, and based on that we're required to reject your insurance claim. Have a nice day!"

PS: The USA is the only western country with this kind of madness going on. Whatever your follow-up argument will be, just consider that nobody else in the modern, developed world is so stupid as to simply give a bunch of billionaires 15% of all money expended on medical services.

Much better than breaking the law by going 10 mph over the limit!

For what it's worth, there's 0 chance that the CEO had been a "law-abiding citizen" for their whole lives. Far too many laws open to interpretation for that to be the case for anyone.

This is not pro-murder content. This is pro-access to life-saving healthcare content, whose absence causes death and extreme despair.

It's worth noting that being law-abiding is doing the bare minimum. You can be a horrendous person doing evil things and still be law-abiding.

German people still have this mentality btw - that if you follow the law you are good. They think since the Holocaust is no longer the law and the constitution says there shall never be another one, that means they are safe.

It's a testament to the staggering weight of antipathy the lower classes bear towards the CEO class.

Let's not delude ourselves by pretending Brian Thompson was just a normal law abiding citizen. He was living a lavish lifestyle funded by his company's industry-leading rate of coverage denials, which bankrupted families.

If there exists a definition of social parasite, I suspect "health insurance executive" fits. Is it any wonder why Americans, living under their dystopian healthcare system where one essentially spins the roulette wheel to decide between being bankrupted by cancer or being able to afford to send one's children to college, might feel some schadenfreude?

It's really astonishing how many people believe this. But actually in the US the higher the coverage denials the LOWER the company profits. What actually happens is more denials reduces premiums, making the insurance cheaper to buy.

See this full thread: https://news.ycombinator.com/item?id=42642405 if you want to try to understand more.

Like consider: if this was as popular as people think, then it should be straightforward to run a political campaign on this basis.

Instead it's barely not a vote loser.

Gangsters kill each other all the time — boohoo, so sad.

I support the government indicting criminals to prevent further street violence though.