[HN Gopher] Medicare Advantage plans use algorithms to cut off care
___________________________________________________________________
Medicare Advantage plans use algorithms to cut off care
Author : danso
Score : 202 points
Date : 2023-03-13 14:11 UTC (8 hours ago)
(HTM) web link (www.statnews.com)
(TXT) w3m dump (www.statnews.com)
| msm_ wrote:
| I hate when people use the word "algorithms" like that. Which
| algorithms? Dijkstra?
|
| I know this is the way non-technical people refer to the spooky
| AI action at a distance happening in social media to maximise
| engagement, but in my opinion it just makes everything confusing
| when actually trying to understand the argument.
| groffee wrote:
| [dead]
| stronglikedan wrote:
| It's correctly used in this context, where it's not referring
| to a particular well known algorithm in the context of computer
| science, but rather the " process or set of rules to be
| followed in calculations or other problem-solving operations"
| that the computer takes to determine eligibility. Considering
| the context and the intended audience, it's used correctly
| here.
| cheeze wrote:
| It's a simplification for folks who don't understand the
| nuances past "an algorithm"
|
| The intended audience here isn't computer scientists... it's...
| the public.
|
| It's pretty obvious what they mean by "algorithms", no? I feel
| like this is just being "akshyually" guy
| mrWiz wrote:
| I'm skeptical when this kind of language is used,
| particularly in the media. It feels like they're trying to
| drum up outrage by intentionally phrasing such that the
| public understanding differs from the technical meaning. I'm
| not saying that's what's happening in _this_ case, just my
| typical initial reaction to seeing this pattern.
| netsharc wrote:
| Ah, so just like people wanting to avoid "chemicals" in what
| they eat?
| kelseyfrog wrote:
| It could be anything from a regression to DL, to who knows what
| else.
|
| Even in the simple case, say a linear regression with all the
| assumptions satisfied, predictions are interpretable as means,
| which is to say that (and again, assumptions holding, errors
| are normally distributed) half of observations fall below the
| mean and half above it. Using the mean in a normative capacity
| implies that half of patients will get kicked out before they
| would otherwise end their treatment.
|
| There are ways around this, like quantile regression, or using
| prediction intervals, but again, we don't know the specifics of
| the method which leaves us in the dark as to the _specific_ way
| the problem manifests.
| WediBlino wrote:
| algorithm /'alg@rId(@)m/ noun plural noun: algorithms a process
| or set of rules to be followed in calculations or other
| problem-solving operations, especially by a computer. "a basic
| algorithm for division"
| whitemary wrote:
| > like that.
|
| Like what? Correctly?
| jerf wrote:
| There is no size limitation on the word "algorithm". It is
| perfectly acceptable to define a complete decision tree as
| being an "algorithm", in addition to "decision trees" in
| general being an "algorithm". There is no restriction on it
| being the sort of cute little thing you can stick in a textbook
| on a single page and do intensive mathematical analysis on it.
| You can refer to the complete rendering pipeline for a frame in
| a modern AAA game as an "algorithm", or the entire code for
| instantiating an EC2 instance, or, yes, even the algorithm that
| takes an input a person and their medical cases and returns
| what the organization should do about it including the
| possibility of just cutting them loose.
|
| It's a perfectly sensible use of the term as is.
| mort96 wrote:
| That's the problem though. If there are clear eligibility
| criteria, and a computer program lets the operator enter
| information and answer eligible or ineligible, that's an
| algorithm used to cut off care. If a computer program decides
| that someone is ineligible because they're not a US citizen,
| that's an algorithm deciding. If the computer figures out
| that you no longer live in the service area for your plan,
| that's the algorithm deciding to cut off your care.
|
| I would expect any insurance provider to use computer
| programs (i.e algorithms) to decide whether someone is
| eligible or not. The problem is what kind of algorithm.
| nerdponx wrote:
| > The problem is what kind of algorithm.
|
| ...and how its outputs are interpreted. Ultimately it's
| less about what kind of algorithm and more about how it's
| used, or in this case abused.
|
| As another user mentioned, that 16.6 days _should_ have
| been the mean or mode of a posterior distribution, from
| which you could obtain 75% and 95% credible intervals, or
| at least a conditional expectation accompanied by an
| (estimated) sampling error and traditional 75
| /85/95/whatever% confidence interval.
|
| Crossing the 17-day line could have flagged this person's
| case for manual review. Even if the 95% credible interval
| was 15-18 days, anyone who understands how statistical
| models work would understand that manual review is a more
| sensible reaction than automatic cutoff, unless you simply
| don't care about the 5% chance of falsely denying people
| health coverage.
|
| The fact that the model is statistical is more problematic
| than a chain of if/else decisions. The problem is the fact
| that good statistical practice was disregarded in its
| usage. And as others have said, there was no intention of
| pursing good statistical practice here, and no reason to
| ascribe any benefit of doubt to any decision-makers
| involved in deploying such a model/algorithm. It's just a
| fig leaf for wanting to deny people health coverage.
| lcnPylGDnU4H9OF wrote:
| I didn't go through academia for my computer science knowledge
| so I may be wrong about the definition of "algorithm". I
| understand it as a series of steps to accomplish a task (e.g. a
| food recipe is a list of ingredients and an algorithm for
| rendering something delicious). If that's not mistaken, then
| the algorithm is something that's being used to make decisions.
|
| A different term to use could be "machine-made decisions",
| which I personally think describes the issue better. Still,
| (and unless my understanding is mistaken) the word algorithm is
| technically accurate to this kind of decision-making.
| groffee wrote:
| [dead]
| guestbest wrote:
| I agree with this. If there is any responsibility it is borne
| by people and management's business process. Blaming
| algorithms is absolving people of responsibility
| jkestner wrote:
| And that's exactly what the people responsible want.
| Another layer to launder any culpability, just like
| consultants, contractors and corporations. The next step is
| to grant algorithms personhood so we can prosecute them
| while their creators continue to collect money.
|
| The executives and shareholders who profit the most from
| the decisions must be the ones held responsible.
| jmugan wrote:
| Didn't read the article and don't know about what nefarious
| things may be going on, but we need to think broader about these
| issues. There's lots of articles here on hacker news about how
| the vast majority of medical expenses come at the end of life and
| how we do too much to keep people alive against their wishes.
| kerkeslager wrote:
| > Didn't read the article
|
| Then don't comment. It's not complicated.
|
| > There's lots of articles here on hacker news about how the
| vast majority of medical expenses come at the end of life and
| how we do too much to keep people alive against their wishes.
|
| Jesus Christ.
|
| Let me get this straight: you're saying the solution to medical
| expenses is "let old people die, they don't want to live
| anyway"?
|
| There are certainly cases where people are kept alive beyond
| what's compassionate, but that's a pretty separate cultural
| problem from the situation at hand, which is people who need
| basic care and can't get it because of capitalism being
| involved where it shouldn't be.
| cr1895 wrote:
| > Jesus Christ. Let me get this straight: you're saying the
| solution to medical expenses is "let old people die, they
| don't want to live anyway"?
|
| That's quite an uncharitable take, and plainly not what they
| meant to express.
| kerkeslager wrote:
| Well, I don't hear you offering an alternative
| interpretation that sounds plausible.
|
| And critically, the person I was responding to, responded
| back to me, and didn't disagree with my interpretation,
| so...
|
| Startup culture's brand of charitable interpretation
| glosses over a lot of anarcho-capitalistic sociopathy and
| I'm not interested in participating in that. Perhaps if you
| were more interested in actual charitable action such as
| making sure seniors' medical expenses are paid rather than
| charitable interpretation, this place would be a bit less
| toxic.
| jmugan wrote:
| Your interpretation is too off the mark require an
| explicit response.
| kerkeslager wrote:
| If you don't want to participate in a discussion you
| don't have to respond.
|
| If you think my interprepation is wrong, feel free to
| explain, otherwise we can only conclude that it wasn't
| wrong, and you just don't want to have to defend your
| indefensible idea.
| potatoman22 wrote:
| My take: many people spend $$$ at the end of their life
| to receive aggressive treatment that ultimately doesn't
| do much. Palliative care is underutilized -- it's lower
| cost and results in a higher quality of life [1].
|
| [1] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6610551/
|
| Other interesting articles:
| https://www.nursing.upenn.edu/details/news.php?id=848
|
| https://med.stanford.edu/news/all-news/2014/05/most-
| physicia...
| jmugan wrote:
| Come on, we can't be children. I'm saying we need a
| conversation as a society about how we are going to handle
| end of life. We can't lurch form unthinking outrage to
| unthinking outrage.
| kerkeslager wrote:
| True, but I'm not interested in hearing the opinion of
| companies in that conversation. When I and my loved ones
| are reaching end of life, what decisions we make should be
| a conversation between me, my loved ones, and my doctor.
| Whether it's humane to pursue life-extension should be a
| part of that conversation, sure, but I trust my doctor to
| present that viewpoint: people who profit from that
| viewpoint and don't know anything else about the situation
| (such as Medicare Advantage providers) are welcome to fuck
| right off.
|
| The reason our society keeps lurching from unthinking
| outrage to unthinking outrage is that people like you who
| can't be arsed to read an article and respond on topic keep
| proposing outrageous changes to our society. If you don't
| like unthinking outrage, maybe be more thoughtful and stop
| saying outrageous things.
| jmugan wrote:
| I agree that medical care should be run by the state. I
| would prefer that to our current system. I don't think
| its worth us talking any more since we don't seem to be
| learning from each other.
| kerkeslager wrote:
| > I agree that medical care should be run by the state.
|
| ...which is largely irrelevant, because the state should
| also not be involved in the conversation about whether
| pursuing life-extending care is humane.
|
| > I don't think its worth us talking any more since we
| don't seem to be learning from each other.
|
| Nobody involved in internet disagreements learns from
| each other typically. I approach internet disagreements
| with the idea that non-participants reading the
| disagreement can learn from it. That is, outrageous
| viewpoints like yours should not go unchallenged because
| that normalizes them.
|
| If you want to stop representing your viewpoint to
| readers, you're welcome to, but you can drop the smug
| superiority about it. If you want conversations to learn
| and educate, you might start by reading the articles
| you're responding to.
| jewayne wrote:
| Before we have this conversation, let's first agree on one
| thing. Let's all agree on the fact that health care is not
| actually exorbitantly expensive. That "health care costs"
| are not what's out of control in the US, what are out of
| control are health care PRICES. And that those prices lost
| virtually all relationship to the cost of providing
| services DECADES ago.
|
| Americans already use fewer health services than most other
| industrialized countries, but we still spend way more than
| anybody else. Will using fewer health services at end of
| life make a serious dent in health expenditures? Maybe
| temporarily, but rest assured the hospitals, big pharma,
| insurance companies and others will raise prices until all
| those savings are eaten away, and more.
|
| Make no mistake, I am totally for end of life planning, but
| I believe it is a completely separate question entirely.
| jmugan wrote:
| That's a useful distinction. I've never been able to
| understand where the prices come from, and my sister is
| an ER doctor. I'm surprised that these basic facts are so
| hard to come by. I read articles that say, well,
| healthcare prices aren't high because of X, where X is
| just about anything I can think of.
| mikece wrote:
| Death Panels via "AI" processing of approval for service?
| r00fus wrote:
| Yes, the "health insurance" industry funded backlash during
| 2010 against Obamacare was most definitely "projection" in the
| classical sense. They most definitely did that for private
| plans - by recission (kicking expensive people off the plan) or
| simply the "pre-approval" BS where they keep expensive people
| but decline specific (and possibly needed) care.
|
| That's the only way private health insurance can both cover
| (most) in a cost effective way AND be profitable for their
| hedge fund masters.
| nine_zeros wrote:
| Plain and simple regulation - Coverage cannot be defined by
| insurance. It has to be defined by providers.
|
| But what about fraud? Well, maybe don't start a health insurance
| company if you can't deal with it.
| fallingknife wrote:
| What do you mean don't start an insurance company if you can't
| deal with it? Your first sentence says they shouldn't be
| allowed to deal with it.
| ceejayoz wrote:
| If an insurer believes a provider is committing fraud, that
| should be between the two of them. The patient shouldn't have
| to be the negotiator in the middle; they have zero power over
| either side.
|
| Too many fraudulent/suspicious claims from a provider? Cut
| the _provider_ off, not the patient.
| macinjosh wrote:
| They would deal with it by passing the cost of the fraud onto
| the patients paying principles. Now you have more problems.
| There is no such thing as a plain and simple regulation.
| sdfghswe wrote:
| We already knew these were bad people from the fact that they use
| the name to confuse. After that, this is no surprise.
|
| What surprises me is how long most people take to pick up on the
| pattern. They see person X do bad thing, shocked. Then they see
| same person X do a different bad thing, shocked again.
|
| I say arrest the executives and charge them with fraud. Hopefully
| that will send a message.
| ImHereToVote wrote:
| The advantage is for the shareholders. Keep up poors.
| jjoonathan wrote:
| Private, for-profit death panels. Innovation!
| dylan604 wrote:
| This is just a stop gap until they can invoke the rite of
| Carrousel
| wyldfire wrote:
| We will all try for renewal!
| dylan604 wrote:
| I'd rather take my chances on my own making a run for
| sanctuary, but I've never really fit in with the sheeple
| toast0 wrote:
| Yeah, but I hate outside!
| dylan604 wrote:
| good, you can come with me, and I can use you as a
| distraction when meeting Box. you'll never have to go
| outside again!
| toast0 wrote:
| Works for me, but I'm keeping my clothes on, thanks ;)
| [deleted]
| twawaaay wrote:
| When finally an AI will become sentient and gets access to all
| our infrastructure, it won't need to nuke us, it won't need to
| wage war with us. It will just locate everybody who is trying to
| fight it and block their credit cards, Internet access and
| repossess their cars.
| astrea wrote:
| I know (hope) this is satire, but this is why I take issue with
| the AI branding. It too often gets conflated with the sci-fi
| thinking of AI. A random forest model that calculates your
| credit score isn't going to magically gain self-awareness and
| autonomy and a hatred for humanity. Even if it did, we have a
| magical power called the power button.
| jacooper wrote:
| It doesn't technical have to be one model.
|
| A model that scans for high risk patients, then passes that
| into another model which takes actions, which can also be fed
| data from the police and mass surveillance with that it can
| also eliminate coverage for "anti-AI" people.
| potatoman22 wrote:
| You're being ridiculous. Are you saying that computer
| system could gain sentience?
| [deleted]
| nimbius wrote:
| I absolutely loathe this puerile tendency to attribute anything
| even remotely relatable to modern data systems as Shikata ga
| nai by definition.
|
| Grow up. this meatgrinder didnt just condense from aether.
| Someone wrote this, someone can change it, and anyone in the
| git log can be held accountable for what they did at any time.
| Enough of this late-stage capitalist attempt to offshore even
| the very concept of accountability.
| lovich wrote:
| Individuals can't enact this sort of heroic change on their
| own by design with systems this large. There is no single
| point where the systems behavior can be pivoted. It requires
| society as a whole to demand the change.
| eli_gottlieb wrote:
| Speaking of late-stage capitalism, the actual problem here is
| that we've built the infrastructure for a rather
| authoritarian form of computerized socialism -- but under
| capitalist ownership. So we all walk around pretending a car
| that can repossess itself if you miss a loan payment is a
| piece of private property, when the physical infrastructure
| says that it's social property.
| voytec wrote:
| The Trolley Problem is seen differently by someone who has to
| push the lever inside the trolley, by someone who has to do
| it remotely from far away and by a coder programming
| trolley's software.
| koboll wrote:
| >Someone wrote this, someone can change it, and anyone in the
| git log can be held accountable for what they did
|
| Uh, not really, no. The whole point of neural nets is they
| independently discover novel and unexpected ways of
| predicting the probable answer.
| nerdponx wrote:
| This is a seriously naive misunderstanding of how neural
| networks (and machine learning "algorithms" in general)
| work.
|
| Someone chose the features, the model architecture, the
| training data, and SGD parameters; it might not even be a
| NN (and probably isn't) -- it could be a traditional linear
| regression model, or gradient-boosted decision trees.
| Someone analyzed the model performance on a test set and
| maybe even ran simulations to see how effective the model
| was at learning a known functional form. Someone made
| reports on that performance and included estimates like
| "probability of falsely denying claims on average" broken
| down by 10-year age bracket. An intern might have helped. A
| team lead coordinated meetings with whatever VP was running
| the project and signed off on the model. Senior management
| budgeted months worth of person-hours on model development
| and integration/deployment into production systems. And the
| model could have been rejected or modified at any point.
| The model training code is probably sitting on someone's
| laptop right now, and absolutely can be revised at any
| point in time, either slightly or significantly.
|
| This is no magic in something like this. There are no
| positronic brains to wonder about. It's just a fucking
| best-fit line, and someone had to both draw the damn line
| and sign off on it.
| psychlops wrote:
| Sounds nice, what other improvements might we expect?
| yamtaddle wrote:
| We'll willingly turn over control to an AI for competitive
| advantage. If we don't, our adversaries will.
| nostromo wrote:
| > repossess their cars
|
| In other news: Ford Motor Co. has filed a patent application
| for technology that would allow autonomous vehicles to
| repossess themselves if drivers miss payments.
|
| https://thehill.com/homenews/3880884-future-fords-could-repo...
| pc86 wrote:
| That's almost certainly what the comment is referencing.
| netsharc wrote:
| A nicer AI would just get their targets addicted to...
| something and make them mostly hate themselves instead of the
| attacking AI.
|
| For "something" you can substitute drugs, or social media,
| porn, or calling others idiots on the Internet.
|
| Wait a minute...
| mywittyname wrote:
| So, do we train AI on Brave New World or 1984?
| Retric wrote:
| Why not both?
| Ekaros wrote:
| Throw Fahrenheit 451 in mix and we also get to get rid of
| non-AI generated content...
| originalcopying wrote:
| they're there to run a business first, and look out for your
| health second; budgetary constraints permitting, of course.
| fortran77 wrote:
| The problem is people duped into switching into Medicare
| Advantage, which they can't undo. See
| https://www.newsweek.com/how-medicare-advantage-scams-senior...
| tpmoney wrote:
| What do you mean you can't undo it?
|
| https://www.medicare.gov/sign-up-change-plans/joining-a-heal...
|
| >Medicare Advantage Open Enrollment Period. From January 1 -
| March 31 each year, if you're enrolled in a Medicare Advantage
| Plan, you can switch to a different Medicare Advantage Plan or
| switch to Original Medicare (and join a separate Medicare drug
| plan) once during this time. Note: You can only switch plans
| once during this period.
| erentz wrote:
| Something to be aware of is that when using Original Medicare
| you will want to also get a Medicare Supplement (Medigap)
| plan. Medicare only pays 80%, the Medigap pays the extra 20%
| (no questions, anything approved by Medicare they cover the
| gap on).
|
| But you are only guaranteed to be able to join Medigap during
| your initial enrollment at 65. If you switch back from
| Medicare Advantage to Original Medicare you are not
| guaranteed to be able to get Medigap. This can leave you
| stuck. It will possibly vary from state to state so it pays
| to get up to speed with the rules in your local state.
|
| If you're expecting to be sick in old age or if you get
| Medicare due to a disability that is likely to have a lot of
| expensive treatment or require you to see different doctors
| in different areas it is best (IM-somewhat-experienced-O) to
| take Original Medicare.
| denton-scratch wrote:
| As far as I can see, this isn't news; medical insurers (and
| really any kind of insurers) use rules (algorithms) to decide
| which claims they should pay out on. Even if they could evaluate
| each claim completely individually and personally, they'd get
| sued for not treating all claimants equally. They _have_ to use
| rules.
|
| And saying it's "AI" when it's just an algorithm (or even just a
| checklist) is getting annoying.
|
| I started getting annoyed when game developers called the
| algorithms used to control NPCs and so on "AI", when it's
| actually hand-made rules, finely tuned. Nowadays, if it's been
| anywhere near automation, then it's OK to call it "AI". A
| calculator could be called "AI" (if they still made them).
| CWuestefeld wrote:
| Is there any system on the whole planet, where the entities
| responsible for the payment are willing to just write a blank
| check no matter what? I'm pretty sure that there's always going
| to be some kind of cost-benefit balancing, probably based on
| QALYs and such.
| gwright wrote:
| > They have to use rules.
|
| There are rules and then there are rules. It is the details of
| the particular rule that is of interest. The use of "AI" in
| that article seems like clickbait to me.
|
| The article seems to suggest that predictions based on
| aggregate statistics are being applied to implement strict
| coverage approval for individuals. That seems like a complete
| misunderstanding of predictive value of those statistics for a
| particular individual. Not sure if that is gross incompetance
| or malfeasance. Either way, a problem.
| nerdponx wrote:
| Whenever money is involved, invert Hanlon's razor. High prior
| or malice, low prior on ineptutide.
|
| Some well-meaning team of data scientists might have produced
| this model originally. But its employment in this manner
| cannot be assumed to be anything _other_ than malfeasance,
| except in the face of significant evidence to the contrary.
| nerdponx wrote:
| The news here is that insurers have a new tool for excusing
| themselves of responsibility, and might start to wield it in
| order to deny even more claims than before.
| NovemberWhiskey wrote:
| Any time I see the output of a statistical model like "estimated
| length of stay" that gives a number like "16.6 days" without also
| saying something like "with a 95% confidence interval of -5.1 /
| +20.9 days", I get pretty confident the goal is not actually to
| help decision-making.
| thomascgalvin wrote:
| The goal is to provide "evidence" for the decision that has
| already been made. She was "recovered" and no longer "needed"
| care. Now, generate supporting evidence for that conclusion.
| Espressosaurus wrote:
| It's to launder guilt. I'm not denying the benefit. It's "The
| Algorithm" (TM). Nobody can change "The Algorithm" (TM), we'll
| just have to live with it. Sorry, but you're on your own.
| NovemberWhiskey wrote:
| Or, as the TV show Little Britain put it: "Computer says no"
| Gibbon1 wrote:
| Separate thing I've notices since having a chronic health
| issue for 20 years is the medical system uses 'patient
| empowerment' to shield themselves from any responsibility. At
| the same time patients have little actual power beyond
| whining.
| steve76 wrote:
| [dead]
| MilnerRoute wrote:
| Earlier discussion about "Medicare Advantage" plans.
|
| https://news.ycombinator.com/item?id=35001728
| gaterin wrote:
| The two most inefficient groups in our society are children and
| retirees. The natural progression is to put the children to work
| and kill off the retirees.
| swayvil wrote:
| I live in a town that has offered a novel answer to the riddle
| of "low value humans".
|
| The homeless. The head-injured. Low income families. Recently
| released prisoners. The impoverished elderly. My town has
| arranged itself to serve that population.
|
| Or more specifically, my town receives money from the state for
| providing these services. It's our #1 industry. All the other
| towns bring their "problem people" here.
|
| It's probably the most efficient approach (within legality).
| We've concentrated them all in one place. (It's gotten kind of
| dangerous and filthy.)
|
| It used to be a nice college town.
| tmpz22 wrote:
| So ghettos?
| l_theanine wrote:
| [dead]
| danielrpa wrote:
| https://en.wikipedia.org/wiki/Escape_from_New_York
| poorbutdebtfree wrote:
| The decision makers never live with these decisions. Sound
| the bell and you're a white nationalist transphobe.
| thinkingkong wrote:
| There's a war being waged on whether or not we're going to allow
| certain institutions to belong to the commons. If certain
| industries had their way, every sip of water and every breath of
| air would have an associated cost and market value.
|
| Can't afford to pay? It's unfortunate, but that's your own fault.
|
| Every time we encode and reinforce these systems through laws,
| market mechanisms, and now AI, we tacitly agree that people who
| cannot afford such things do not deserve them. If you can't
| afford private healthcare before the 0 cost system was
| implemented to decide that well... best of luck!
| alexpotato wrote:
| > If certain industries had their way, every sip of water and
| every breath of air would have an associated cost and market
| value.
|
| For those of you who think this isn't happening with basic
| resources like water, let me point you to:
| https://en.wikipedia.org/wiki/Cochabamba_Water_War
| CWuestefeld wrote:
| In principle, if we paid MORE attention to property rights
| around these resources, we wouldn't be in the situation we find
| ourselves with respect to air and water pollution, carbon
| emissions, and so forth.
|
| If there were an owner, somehow, of the air, or the air over my
| house, or something, then when other entities are trying to
| externalize their own costs (by way of dumping carbon into the
| air, say), then we'd be able to use vanilla tort law to recover
| those costs as damages.
|
| I'm not saying we should necessarily do that - obviously there
| are big questions about just whose bit of water this is, and
| how to determine who's causing the damages. But if we could
| somehow answer those questions, it seems like the market could
| supply the answer. That, to me, suggests that moving in the
| opposite direction is not obviously the best answer.
| jrumbut wrote:
| That seems to be more or less the approach we've taken to
| date and it's set up a whack a mole game that we appear to be
| losing.
|
| Get in trouble for air pollution, convert to water pollution,
| the media gets upset about some chemical you release, then
| convert it into something no one's thought to regulate yet.
|
| We don't have infinite time to play like this.
| CWuestefeld wrote:
| _That seems to be more or less the approach we 've taken to
| date_
|
| I can't see this at all. Can you provide any example of
| property rights actually being vested in air or in water?
|
| By comparison, if we talk about pollution of the soil, we
| don't have very much of a problem there. I mean, it
| happens. Like people's oil tanks leak, but that's a big
| part of the reason that we no longer build houses with oil-
| fired heat. I knew an environmental attorney who talked
| about the horrors of the liability when a homeowner's oil
| leach into the soil. This has taught us not to do that
| anymore.
|
| But precisely because no particular entity owns the
| atmosphere, or (in most cases) the water, there's nobody
| that has standing to recover those externalized costs of
| pollution. So we haven't gone that route, and the problem
| remains largely unfixed.
| zukzuk wrote:
| Keep in mind property rights can have the opposite effect too
| -- impinging on the greater good in favour of the property
| rights of the few. The obvious example being NIMBYism; for
| example higher density construction that would benefit the
| city gets blocked by low-density homeowners who don't want
| their property negatively affected.
| philjohn wrote:
| If you haven't, check out the musical "Urinetown". Private
| toilets are banned, and all of the public conveniences are
| owned by a megacord - the UGC (Urine Good Company).
| mort96 wrote:
| I love that pun. It's pronounced exactly the same as "you're
| in good company".
| cassepipe wrote:
| Maurice Godelier is a very interesting anthropologist according
| to me. I remember reading from him that one thing that he
| observed in all societies he studied is that some things are
| meant to circulate, to be sold, give, whatever, and some other
| things are meant to be kept/preserved.
|
| Maybe it's ok to keep some things out of the market's reach
| LorenPechtel wrote:
| This sort of garbage will not be fixed until there's a real
| penalty for denied claims. Not merely pay the claim, but enough
| to deter misbehavior.
| whoomp12342 wrote:
| There is a real penalty? I mean, even if you implemented this,
| they would fight the penalty just like all the claims they
| fight today
| darkarmani wrote:
| Make the penalty increase exponentially each time they lose.
| Eventually, they will stop fighting it all.
| mywittyname wrote:
| Right now, there's no cost to blanket denials, but there's a
| huge incentive to do it. My partner works on the hospital
| side of things, and several major insurance providers deny
| _literally_ every claim. And why not? At worst, it just means
| that the insurance company can wait a year or more before
| paying. At best, they never pay.
|
| Of course, it's also the insurance companies who are
| adjudicating the claims.
| elliekelly wrote:
| It reminds me of this thread[1] from a few weeks ago. The
| article was so infuriating to read.
|
| [1]https://news.ycombinator.com/item?id=34639988
| Wingman4l7 wrote:
| How much is the fine for practicing medicine without a license?
| This is basically what they're doing by denying claims.
| ceejayoz wrote:
| They have rubber-stamp clinicians. Here's an ortho doc
| getting a denial based on the opinion of a surgeon who _put a
| hip replacement in backwards_ and is no longer allowed to
| practice surgery, so he works for an insurer now.
|
| https://twitter.com/generalorthomd/status/163034936649709568.
| ..
|
| https://twitter.com/generalorthomd/status/163207481760743833.
| ..
| Wingman4l7 wrote:
| Yeah, I'm aware of this; IMO it's a loophole they've been
| heavily abusing. I would deem this "practicing
| telemedicine". We do have /some/ regulations on
| telemedicine (I think? I hope?) -- you could argue that
| they're violating those.
| mindslight wrote:
| I've been thinking about this, but not enough to dig into
| the details. Is there a legal obligation for "insurance"
| companies to use licensed medial professionals for
| justifying denials (similar to how many fields of
| engineering require a PE stamp)? And if so, would it be
| possible to make an organized effort to go after their
| licenses with the relevant state boards?
| hypothesis wrote:
| Those tweets include documents that show doc as
| restricted to "non-operative office-based medicine or
| administrative medicine". Clearly they thought that he is
| okay in this exact position.
| mindslight wrote:
| Well sure, but since he continues to damage people's
| health even in that limited role, it would seem there is
| a new cause for action.
| ceejayoz wrote:
| Yes; the doc in this case filed a complaint. https://twit
| ter.com/generalorthomd/status/163207481637850726...
| mindslight wrote:
| Practicing doctors don't have the bandwidth to do this
| except in the most egregious of cases though.
|
| I'm imagining a non-profit organization that solicits any
| denial by "insurance" companies, determines if it is
| based on medical reasons, determines if it is medically
| imprudent (including harm caused by delaying care), and
| files a mostly pre-prepared complaint to the appropriate
| medical board. Make it extremely uncomfortable to work
| for a death panel.
|
| Then if the state boards start really brushing the
| complaints under the table to protect the death panels,
| turn it into a direct political issue. Right now there's
| too much plausible deniability to hide behind.
| ceejayoz wrote:
| This doc _is_ licensed. He 's just not allowed to touch
| patients any more.
|
| Perfect candidate for an insurance company; he's got no
| other prospects, so he'll do what he's expected to. Which
| is deny, deny, deny.
| duxup wrote:
| I had an insurance company that every year would stop paying
| anything at all and mail me a convoluted form claiming I had
| some other insurance that should be paying.
|
| Every year I had to fill out the forms saying that I didn't
| have any other insurance before they paid.
|
| It felt like a straight up scam to get people to pay some bills
| that show up without realizing what was going on / receiving
| and returning the forms.
| eppp wrote:
| I think this is pretty common practice. I get a letter every
| single year to verify that I dont have any other insurance
| and they will stop processing claims until I do it. I
| typically just do the IVR and its only a couple of minutes.
| lawn wrote:
| As a Swede, this sounds so ridiculous.
| mindslight wrote:
| It is, but our country is paralyzed by a political
| fallacy of " _if the market is already so bad, imagine
| how much worse government exerting any sort of deliberate
| policy would make it!_ ". And then add in the lobbying
| process where bills only get passed when some corporate
| sponsor stands to gain [0], and it's a self-fulfilling
| prophecy. See also the "death panel" meme, as if that
| isn't a term that perfectly describes the "insurance"
| racket we've had all along.
|
| [0] eg one of the bullet points of widely celebrated
| health care reform was making it mandatory to pay the
| cartel!
| willcipriano wrote:
| We already spend more in the US, per captia, than any
| other nation on earth on socialized medcine. The reason
| we don't have universal coverage isn't due to a lack of
| resources so it has to be either a lack of ability or
| theft, probably both.
| vuln wrote:
| Find me a country with the population, sprawl, and never
| ending consumption of processed unhealthy poison like the
| US.
|
| There isn't one. I'm not saying healthcare in America is
| perfect or arguing that insurance companies aren't rent
| seeking or that this can't be changed. I'm just stating
| that the US is the most unhealthy country there has ever
| been.
| RichEO wrote:
| How about Australia? Not the same population, but
| otherwise the criteria fits.
| jewayne wrote:
| > I'm just stating that the US is the most unhealthy
| country there has ever been.
|
| More unhealthy than England during the Black Death?
|
| Also, Mexico has already passed the US in obesity, and
| tons of countries have more smoking that the US.
|
| But that rant wasn't supposed to be fact-based, was it?
| NovemberWhiskey wrote:
| As Steinbeck was (mis-)quoted: "Socialism never took root
| in America because the poor see themselves not as an
| exploited proletariat but as temporarily embarrassed
| millionaires."
| nsxwolf wrote:
| "Death panels" sounded absurd in 2009, especially given
| who is most famous for introducing us the term. In 2023,
| when I look at Canada's ever expanding MAiD programs, it
| doesn't seem as absurd.
|
| If you're a government bureaucrat tasked with reducing
| healthcare expenditures, in a society that's made the
| determination that suicide is an acceptable medical
| treatment, you are incentivized to increase the practice.
| mindslight wrote:
| "Death panels" was absurd because it's a hyperbolic
| description of what private "insurers" already did. If
| you're a corporate bureaucrat tasked with reducing
| healthcare expenditures ...
|
| I agree that Canada's pushing for classifying suicide as
| medical treatment is worrying. Suicide is a human right,
| but making it part of the medical system's all-
| encompassing paternalism is regressive.
|
| In general we need less intermediation between
| individuals and medical care, not more. And the
| "insurance" cartel is one hell of an intermediary. The
| concept of the HMO is a complete failure, and they should
| be made illegal for their basic anti-competitiveness.
| triceratops wrote:
| If we're going to have death panels either way, I'd at
| least prefer the panelists don't get bonuses for choosing
| death thank you very much.
|
| Better if those bonuses go into reducing deaths.
| duxup wrote:
| Personally I think many later in life decisions can both
| save money and benefit the individual.
|
| Do not do not resuscitate and forgoing treatment can make
| people's lives better, reduce suffering.
| jkaptur wrote:
| We know.
| duxup wrote:
| It is ridiculous too many Americans too.
| duxup wrote:
| My thing is why should I have to do it at all?
|
| They know I have their insurance... I have it so they
| pay... do the thing...
| sidewndr46 wrote:
| The trick is never to fill out the forms unless sent via
| registered mail. Just say you were unaware.
| neura wrote:
| Maybe you missed the part where the insurance stopped
| paying anything. If you do nothing, the insurance wins
| while you still have to eventually pay or suffer other
| consequences.
|
| The only trick here is tricking yourself into thinking
| you've won until proven otherwise.
| duxup wrote:
| Then I just get billed by the provider directly.
| whitemary wrote:
| How would a penalizing denied claims generate a profit?
| jgeada wrote:
| If the profit from denying medically necessary care is
| greater than the cost of the penalties for denying that same
| care, then it is profitable to deny that care. A fine that is
| lower than the profit isn't a fine, it is just cost of
| business.
|
| Our regulatory system has totally failed, which is why it is
| rife with these perverse incentives.
| whitemary wrote:
| > _Our regulatory system has totally failed, which is why
| it is rife with these perverse incentives._
|
| Our so-called "regulatory system" works precisely as Karl
| Marx expected it to 150 years ago. The so-called "perverse
| incentives" are fundamental characteristics of capitalism.
|
| The delusion that haunts us originated with the idea that
| capitalism is not a system but a set of isolated features
| that we can opt into and out of as we please. Karl Marx
| showed us 150 years ago that capitalism is in fact a
| complex system with many contradictions.
| CWuestefeld wrote:
| Are you under the impression that funding healthcare
| services via Medicare has even the slightest resemblance
| to capitalism? I can't think of any industry that is
| farther away from this. I mean, Medicare is be definition
| run by the government, and the way that the service
| providers deal with it is highly controlled by the
| government. This looks absolutely nothing like a free
| market, it's entirely the product of socialist control
| (if I can define "socialism" as "government controls the
| means of production" rather than outright "owning" it).
| whitemary wrote:
| Medicare was enacted as an alternative to the
| nationalized universal healthcare systems proposed by
| socialists at the time. The capitalists in charge
| preferred Medicare because it could appease enough of the
| domestic population while preserving opportunities to
| exploit working Americans for a profit. It's as simple as
| that.
|
| And no, your so-called "free market healthcare" fantasy
| was not considered an option because it was in fact the
| problem to solve.
| CWuestefeld wrote:
| So, again, is it your position that the results we see
| from Medicare - where the payer is the government itself,
| and the provider side is operating under extremely tight
| rules dictated by the government, can be considered
| representative of how things might play out in a free
| market?
|
| You haven't come out and said so, so I apologize if I'm
| putting words in your mouth. But it seems like you're
| arguing toward a position: because we can see that
| government control of the market has resulted in the mess
| that we call Medicare, we should therefore stomp out any
| further vestiges of the market and put the government in
| control of that as well. This doesn't seem like a sane
| position.
| whoomp12342 wrote:
| penalization fee goes straight to a competitor
| forgetfreeman wrote:
| You misspelled "will not be fixed until insurers are entirely
| eliminated from the healthcare market".
| PaulHoule wrote:
| Medicare 'Advantage' is a scam transparent to everyone except
| your congressman.
| nkrisc wrote:
| > everyone except your congressman.
|
| Oh, your Congressman knows. It's not members of Congress
| they're trying to deceive with that name.
| christophilus wrote:
| Is it? My dad absolutely loves it, but I don't think he's faced
| its limits. How is it worse than plain Medicare? (Asking
| seriously as a mostly uninformed non-participant.)
| ineptech wrote:
| It might be helpful to read this recent HN submission and its
| comments:
|
| > Stop the Medicare "Advantage" Scam Before Medicare Is Dead
| https://news.ycombinator.com/item?id=35001728
| treeman79 wrote:
| You're giving many congressmen too much credit. Many believe
| the scam they perpetuate.
| whitemary wrote:
| Ironically, this is the most naive comment in the entire
| thread.
|
| The many private corporations who profit from Medicare
| Advantage know exactly how it works. In fact, they hired the
| congressmen!
|
| The Libertarian Fallacy is a stubborn one!
| [deleted]
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