NYC assassination news thread - Please no politics (1 Viewer)

[Max Power]

I agree 100% with Shapiro’s statement last night. I can’t believe how many keyboard warriors are coming out of the woodwork on Facebook to hail this killing. Makes you realize how ugly some of these people are inside. It’s a shame. How did everything get so crazy, and how do we get out of it? I won’t look at some of these “friends” the same way again. I truly hope these people don’t suffer tragedy and look for sympathy from me.

Cliffsnotes on the statement?

Killing people in cold blood is bad.

Killer is a coward, not a hero.

In a civil society, we resolve our differences through discourse, not vigilante violence.

In no way am I condoning the actions of that guy, but my best guess of where he was coming from stems from the quote he added to his Unabomber book review. It was something along the lines of using violence as a tool for change when civil discourse fails.

Civil discourse is a long, drawn-out process that can take decades to enact change. We have a generation coming up who has only known instant gratification. Life has always been at their fingertips. Asking them to play the long game, may not seem like a viable option to some.

I hope I'm wrong, but that's my best guess as to why some (especially younger) might see his actions as progress.

 

[El Floppo]

I agree 100% with Shapiro’s statement last night. I can’t believe how many keyboard warriors are coming out of the woodwork on Facebook to hail this killing. Makes you realize how ugly some of these people are inside. It’s a shame. How did everything get so crazy, and how do we get out of it? I won’t look at some of these “friends” the same way again. I truly hope these people don’t suffer tragedy and look for sympathy from me.

Cliffsnotes on the statement?

Killing people in cold blood is bad.

Killer is a coward, not a hero.

In a civil society, we resolve our differences through discourse, not vigilante violence.

In no way am I condoning the actions of that guy, but my best guess of where he was coming from stems from the quote he added to his Unabomber book review. It was something along the lines of using violence as a tool for change when civil discourse fails.

Civil discourse is a long, drawn-out process that can take decades to enact change. We have a generation coming up who has only known instant gratification. Life has always been at their fingertips. Asking them to play the long game, may not seem like a viable option to some.

I hope I'm wrong, but that's my best guess as to why some (especially younger) might see his actions as progress.

I'm with you on all of that.

But I hate to say- this terrible act has prompted a ton of discussion and coverage on the subject. It's not a new subject, but as I mentioned somewhere upthread- hopefully something new and better with the system can come about as a result. something more than heightened security measures for insurance executives.

 

[3C's]

I understand what you are saying, and you are making a good point. There is nothing in place form a regulatory standpoint that requires companies to track and report their denial %.

That seems like something businesses and individuals should know when they're shopping for insurance. Maybe that will change.

BTW the the denial percentages were first posted on Value Penguin in May (and updated very recently at FBI request): https://www.valuepenguin.com/health-insurance-claim-denials-and-appeals

Sometimes you don’t have a choice. I was stuck with United a few years ago through my company. It was the worst experience I’ve had with employer based healthcare in more than 25 years. I just stopped going to the doctor and getting care because even the simplest things like getting a prescriptions turned out to be a nightmare in time wasted and making you jump through hoops, etc.

We have UHC and I've not once been denied or had issues with coverage on anything. And between my wife and I we've had over $400k in surgeries, let alone the other "normal" stuff. Like them much more than Aetna.

 

[urbanhack]

I agree 100% with Shapiro’s statement last night. I can’t believe how many keyboard warriors are coming out of the woodwork on Facebook to hail this killing. Makes you realize how ugly some of these people are inside. It’s a shame. How did everything get so crazy, and how do we get out of it? I won’t look at some of these “friends” the same way again. I truly hope these people don’t suffer tragedy and look for sympathy from me.

Cliffsnotes on the statement?

Killing people in cold blood is bad.

Killer is a coward, not a hero.

In a civil society, we resolve our differences through discourse, not vigilante violence.

People's lives are being destroyed by our healthcare system either financially or physically and it's only going to get worse. For-profit businesses and industries lobbying our government for de-reregulation and protection isn't going to change. Such a naive outlook.

 

[El Floppo]

I agree 100% with Shapiro’s statement last night. I can’t believe how many keyboard warriors are coming out of the woodwork on Facebook to hail this killing. Makes you realize how ugly some of these people are inside. It’s a shame. How did everything get so crazy, and how do we get out of it? I won’t look at some of these “friends” the same way again. I truly hope these people don’t suffer tragedy and look for sympathy from me.

Cliffsnotes on the statement?

Killing people in cold blood is bad.

Killer is a coward, not a hero.

In a civil society, we resolve our differences through discourse, not vigilante violence.

People's lives are being destroyed by our healthcare system either financially or physically and it's only going to get worse. For-profit businesses and industries lobbying our government for de-reregulation and protection isn't going to change. Such a naive outlook.

this seems an odd response to the governor's comments. if discourse is out, what's a less naive outlook- other than assissinations?

 

[urbanhack]

I agree 100% with Shapiro’s statement last night. I can’t believe how many keyboard warriors are coming out of the woodwork on Facebook to hail this killing. Makes you realize how ugly some of these people are inside. It’s a shame. How did everything get so crazy, and how do we get out of it? I won’t look at some of these “friends” the same way again. I truly hope these people don’t suffer tragedy and look for sympathy from me.

Cliffsnotes on the statement?

Killing people in cold blood is bad.

Killer is a coward, not a hero.

In a civil society, we resolve our differences through discourse, not vigilante violence.

People's lives are being destroyed by our healthcare system either financially or physically and it's only going to get worse. For-profit businesses and industries lobbying our government for de-reregulation and protection isn't going to change. Such a naive outlook.

this seems an odd response to the governor's comments. if discourse is out, what's a less naive outlook- other than assissinations?

I don't know. I'm pretty cynical at this point in my life given where we are as a society...probably best just to ignore me.

 

[El Floppo]

I agree 100% with Shapiro’s statement last night. I can’t believe how many keyboard warriors are coming out of the woodwork on Facebook to hail this killing. Makes you realize how ugly some of these people are inside. It’s a shame. How did everything get so crazy, and how do we get out of it? I won’t look at some of these “friends” the same way again. I truly hope these people don’t suffer tragedy and look for sympathy from me.

Cliffsnotes on the statement?

Killing people in cold blood is bad.

Killer is a coward, not a hero.

In a civil society, we resolve our differences through discourse, not vigilante violence.

People's lives are being destroyed by our healthcare system either financially or physically and it's only going to get worse. For-profit businesses and industries lobbying our government for de-reregulation and protection isn't going to change. Such a naive outlook.

this seems an odd response to the governor's comments. if discourse is out, what's a less naive outlook- other than assissinations?

I don't know. I'm pretty cynical at this point in my life given where we are as a society...probably best just to ignore me.

I get the cynicism- I'm on the wrong end of health insurance more often than not as an independent buyer. I was hoping you had some secret next level trick to help out here...

 

[Brunell4MVP]

Since I do not know the answer ... what do the quasi -socialist govts in Europe do for healthcare denials? For instance, Sweden. I guess it's called public healthcare for them France, Netherlands, etc. I'm told you can just walk in to a hospital or doctor and they take care of you. You walk out without a bill. Obvi society is paying for your treatment with higher taxes. But do they say "nothing is wrong with you" and deny treatment. Do they determine afterwards that it was unnecessary and bill you back? Anyone lived there?

First off, I hope you realize just how complicated of a question you’re asking here. So many factors at play. Every system is different, and EVERY system rations care somehow, by someone, for something. Here in the US, for better or worse, we might have an insurance company denying you the coverage (or more technically, saying they won’t pay for it).

The UK, for instance, has the National Health Service (NHS), who uses the National Institute for Care Excellence (or NICE) to assess the cost-effectiveness of care with a system called QALYs (quality adjusted life years) to quite literally put a value on the number of expected years a person has remaining (roughly 25k pounds I believe - pounds being their currency obviously). If care is expected to give a person an additional quality adjusted life years (QALY) and cost less then ~25k pounds, it’s likely approved. Much more than that, it likely won’t be - and it’s never requested, thus can’t be rejected/denied. It’s generally accepted that it works there due to Britain’s post WW2 views of shared sacrifice, which we really don’t have here at this time. (As an aside, can you imagine AI taking over a system like that here in the US?!)

France still has a layer of health insurance in their system, with over 90% of their population having some form of private insurance (mainly for stuff that isn’t covered - copays, and dental and vision). Their universal system still leaves the individual a 20% coinsurance for inpatient hospital stays, and 30% for outpatient - and a huge range for drugs depending on their “effectiveness” (with something like insulin covered at 100%, some others only 85% or potentially not at all - there is a national drug formulary). But their costs for those inpatient and outpatient (and drugs) tend to be FAR LESS than what’s charged here.

Good info. I understand it is complex. I guess I'm trying to understand the rationale of people thinking murdering a CEO will fix the underlying problem of denials or partial coverage approvals. As you point out it happens even in health care systems that are almost 100% public. Which is the info I was after in my question because I did not know. So even the public system has a cost control mandate. So what exactly are people after? Neither public nor private health care systems to care at all about costs, and approve every request?

Look, my MIL died from a complete fiasco by a hospital. Misdiagnosed, multiple surgeries she did not need, and 9 months of hell trying to recover from it. Hospital and their docs cannot be held liable at all for a misdiagnosis. And our family had plenty of money. It wasn't an issue. But $300K of BCBS and our own money later, she died. With hundreds of denials. Heck, they denied the ambulance that took my grandmother to the hospital where she ended up dying. We had to submit it 4 times. Fact is I'd prefer to die in my chair in front of the TV than go to surgery after age 75. Odds are you aren't coming out.

Anyway, whatever system a country has is obviously going to manage costs. You just gotta be vigilant trying to get what you think it right.

 

[matttyl]

Since I do not know the answer ... what do the quasi -socialist govts in Europe do for healthcare denials? For instance, Sweden. I guess it's called public healthcare for them France, Netherlands, etc. I'm told you can just walk in to a hospital or doctor and they take care of you. You walk out without a bill. Obvi society is paying for your treatment with higher taxes. But do they say "nothing is wrong with you" and deny treatment. Do they determine afterwards that it was unnecessary and bill you back? Anyone lived there?

First off, I hope you realize just how complicated of a question you’re asking here. So many factors at play. Every system is different, and EVERY system rations care somehow, by someone, for something. Here in the US, for better or worse, we might have an insurance company denying you the coverage (or more technically, saying they won’t pay for it).

The UK, for instance, has the National Health Service (NHS), who uses the National Institute for Care Excellence (or NICE) to assess the cost-effectiveness of care with a system called QALYs (quality adjusted life years) to quite literally put a value on the number of expected years a person has remaining (roughly 25k pounds I believe - pounds being their currency obviously). If care is expected to give a person an additional quality adjusted life years (QALY) and cost less then ~25k pounds, it’s likely approved. Much more than that, it likely won’t be - and it’s never requested, thus can’t be rejected/denied. It’s generally accepted that it works there due to Britain’s post WW2 views of shared sacrifice, which we really don’t have here at this time. (As an aside, can you imagine AI taking over a system like that here in the US?!)

France still has a layer of health insurance in their system, with over 90% of their population having some form of private insurance (mainly for stuff that isn’t covered - copays, and dental and vision). Their universal system still leaves the individual a 20% coinsurance for inpatient hospital stays, and 30% for outpatient - and a huge range for drugs depending on their “effectiveness” (with something like insulin covered at 100%, some others only 85% or potentially not at all - there is a national drug formulary). But their costs for those inpatient and outpatient (and drugs) tend to be FAR LESS than what’s charged here.

This number is shockingly low. IIRC, US standards for “cost effective” are typically up to $100-150/QALY, though cancer therapeutics are sometimes several fold more expensive.

Could you imagine that conversation happening here in US?

No, but maybe it should, as we surely provide more futile care than other countries.

Of course, our system is so much more expensive than the rest of the world, so the cut-offs would have to be adjusted accordingly.

I was thinking the same on your last point. $25k goes a lot further with care there than it would here. And that’s the biggest problem.

How much do physicians in the US earn relative to other countries?

Much more. According to “world population review” - Switzerland is #1 just above USA, and we average (according to them and their math) $316k a year. #3 is Canada and they are under $200k. Also according to them France, Italy, Spain and Poland have an average Dr income less than $100k.

Statista lists US as #1 (but states they only looked at “select countries”) at $352k average. #2 for them is Canada at $273k, then a huge drop to their #3, Germany, at $169k. France, Italy and Spain all listed between 93-60k.

Keep in mind that it’s Doctors (specifically the AMA) who are against moving to a more socialized medicine model as they feel is will hurt their bottom lines.

Also bear in mind that it’s not just the doctors making money in our system, it’s the huge hospital (provider) groups. For those in northern Va familiar with the Inova hospital group (I believe 5 total hospitals around northern Va), their 2024 operating revenue is 5.7 billion, with a B. In total they have fewer than 2k hospital beds - and list nearly half a billion in “investment in new facilities”

 

[matttyl]

Since I do not know the answer ... what do the quasi -socialist govts in Europe do for healthcare denials? For instance, Sweden. I guess it's called public healthcare for them France, Netherlands, etc. I'm told you can just walk in to a hospital or doctor and they take care of you. You walk out without a bill. Obvi society is paying for your treatment with higher taxes. But do they say "nothing is wrong with you" and deny treatment. Do they determine afterwards that it was unnecessary and bill you back? Anyone lived there?

First off, I hope you realize just how complicated of a question you’re asking here. So many factors at play. Every system is different, and EVERY system rations care somehow, by someone, for something. Here in the US, for better or worse, we might have an insurance company denying you the coverage (or more technically, saying they won’t pay for it).

The UK, for instance, has the National Health Service (NHS), who uses the National Institute for Care Excellence (or NICE) to assess the cost-effectiveness of care with a system called QALYs (quality adjusted life years) to quite literally put a value on the number of expected years a person has remaining (roughly 25k pounds I believe - pounds being their currency obviously). If care is expected to give a person an additional quality adjusted life years (QALY) and cost less then ~25k pounds, it’s likely approved. Much more than that, it likely won’t be - and it’s never requested, thus can’t be rejected/denied. It’s generally accepted that it works there due to Britain’s post WW2 views of shared sacrifice, which we really don’t have here at this time. (As an aside, can you imagine AI taking over a system like that here in the US?!)

France still has a layer of health insurance in their system, with over 90% of their population having some form of private insurance (mainly for stuff that isn’t covered - copays, and dental and vision). Their universal system still leaves the individual a 20% coinsurance for inpatient hospital stays, and 30% for outpatient - and a huge range for drugs depending on their “effectiveness” (with something like insulin covered at 100%, some others only 85% or potentially not at all - there is a national drug formulary). But their costs for those inpatient and outpatient (and drugs) tend to be FAR LESS than what’s charged here.

Good info. I understand it is complex. I guess I'm trying to understand the rationale of people thinking murdering a CEO will fix the underlying problem of denials or partial coverage approvals. As you point out it happens even in health care systems that are almost 100% public. Which is the info I was after in my question because I did not know. So even the public system has a cost control mandate. So what exactly are people after? Neither public nor private health care systems to care at all about costs, and approve every request?

Look, my MIL died from a complete fiasco by a hospital. Misdiagnosed, multiple surgeries she did not need, and 9 months of hell trying to recover from it. Hospital and their docs cannot be held liable at all for a misdiagnosis. And our family had plenty of money. It wasn't an issue. But $300K of BCBS and our own money later, she died. With hundreds of denials. Heck, they denied the ambulance that took my grandmother to the hospital where she ended up dying. We had to submit it 4 times. Fact is I'd prefer to die in my chair in front of the TV than go to surgery after age 75. Odds are you aren't coming out.

Anyway, whatever system a country has is obviously going to manage costs. You just gotta be vigilant trying to get what you think it right.

So sorry to hear about your situation. If I may ask, though - when I hear “grandmother”, I’m thinking age 65+, and thus on Medicare. Was she on Medicare at the time?

 

[El Floppo]

Since I do not know the answer ... what do the quasi -socialist govts in Europe do for healthcare denials? For instance, Sweden. I guess it's called public healthcare for them France, Netherlands, etc. I'm told you can just walk in to a hospital or doctor and they take care of you. You walk out without a bill. Obvi society is paying for your treatment with higher taxes. But do they say "nothing is wrong with you" and deny treatment. Do they determine afterwards that it was unnecessary and bill you back? Anyone lived there?

First off, I hope you realize just how complicated of a question you’re asking here. So many factors at play. Every system is different, and EVERY system rations care somehow, by someone, for something. Here in the US, for better or worse, we might have an insurance company denying you the coverage (or more technically, saying they won’t pay for it).

The UK, for instance, has the National Health Service (NHS), who uses the National Institute for Care Excellence (or NICE) to assess the cost-effectiveness of care with a system called QALYs (quality adjusted life years) to quite literally put a value on the number of expected years a person has remaining (roughly 25k pounds I believe - pounds being their currency obviously). If care is expected to give a person an additional quality adjusted life years (QALY) and cost less then ~25k pounds, it’s likely approved. Much more than that, it likely won’t be - and it’s never requested, thus can’t be rejected/denied. It’s generally accepted that it works there due to Britain’s post WW2 views of shared sacrifice, which we really don’t have here at this time. (As an aside, can you imagine AI taking over a system like that here in the US?!)

France still has a layer of health insurance in their system, with over 90% of their population having some form of private insurance (mainly for stuff that isn’t covered - copays, and dental and vision). Their universal system still leaves the individual a 20% coinsurance for inpatient hospital stays, and 30% for outpatient - and a huge range for drugs depending on their “effectiveness” (with something like insulin covered at 100%, some others only 85% or potentially not at all - there is a national drug formulary). But their costs for those inpatient and outpatient (and drugs) tend to be FAR LESS than what’s charged here.

This number is shockingly low. IIRC, US standards for “cost effective” are typically up to $100-150/QALY, though cancer therapeutics are sometimes several fold more expensive.

Could you imagine that conversation happening here in US?

No, but maybe it should, as we surely provide more futile care than other countries.

Of course, our system is so much more expensive than the rest of the world, so the cut-offs would have to be adjusted accordingly.

I was thinking the same on your last point. $25k goes a lot further with care there than it would here. And that’s the biggest problem.

How much do physicians in the US earn relative to other countries?

Much more. According to “world population review” - Switzerland is #1 just above USA, and we average (according to them and their math) $316k a year. #3 is Canada and they are under $200k. Also according to them France, Italy, Spain and Poland have an average Dr income less than $100k.

Statista lists US as #1 (but states they only looked at “select countries”) at $352k average. #2 for them is Canada at $273k, then a huge drop to their #3, Germany, at $169k. France, Italy and Spain all listed between 93-60k.

Keep in mind that it’s Doctors (specifically the AMA) who are against moving to a more socialized medicine model as they feel is will hurt their bottom lines.

Also bear in mind that it’s not just the doctors making money in our system, it’s the huge hospital (provider) groups. For those in northern Va familiar with the Inova hospital group (I believe 5 total hospitals around northern Va), their 2024 operating revenue is 5.7 billion, with a B. In total they have fewer than 2k hospital beds - and list nearly half a billion in “investment in new facilities”

There are 3, formerly 4, of my wife's family who are doctors in Fairfax... Pretty sure they work in that system. They seem to do just fine, fwiw.

 

[Sparky Polastri]

Since I do not know the answer ... what do the quasi -socialist govts in Europe do for healthcare denials? For instance, Sweden. I guess it's called public healthcare for them France, Netherlands, etc. I'm told you can just walk in to a hospital or doctor and they take care of you. You walk out without a bill. Obvi society is paying for your treatment with higher taxes. But do they say "nothing is wrong with you" and deny treatment. Do they determine afterwards that it was unnecessary and bill you back? Anyone lived there?

First off, I hope you realize just how complicated of a question you’re asking here. So many factors at play. Every system is different, and EVERY system rations care somehow, by someone, for something. Here in the US, for better or worse, we might have an insurance company denying you the coverage (or more technically, saying they won’t pay for it).

The UK, for instance, has the National Health Service (NHS), who uses the National Institute for Care Excellence (or NICE) to assess the cost-effectiveness of care with a system called QALYs (quality adjusted life years) to quite literally put a value on the number of expected years a person has remaining (roughly 25k pounds I believe - pounds being their currency obviously). If care is expected to give a person an additional quality adjusted life years (QALY) and cost less then ~25k pounds, it’s likely approved. Much more than that, it likely won’t be - and it’s never requested, thus can’t be rejected/denied. It’s generally accepted that it works there due to Britain’s post WW2 views of shared sacrifice, which we really don’t have here at this time. (As an aside, can you imagine AI taking over a system like that here in the US?!)

France still has a layer of health insurance in their system, with over 90% of their population having some form of private insurance (mainly for stuff that isn’t covered - copays, and dental and vision). Their universal system still leaves the individual a 20% coinsurance for inpatient hospital stays, and 30% for outpatient - and a huge range for drugs depending on their “effectiveness” (with something like insulin covered at 100%, some others only 85% or potentially not at all - there is a national drug formulary). But their costs for those inpatient and outpatient (and drugs) tend to be FAR LESS than what’s charged here.

This number is shockingly low. IIRC, US standards for “cost effective” are typically up to $100-150/QALY, though cancer therapeutics are sometimes several fold more expensive.

Could you imagine that conversation happening here in US?

No, but maybe it should, as we surely provide more futile care than other countries.

Of course, our system is so much more expensive than the rest of the world, so the cut-offs would have to be adjusted accordingly.

I was thinking the same on your last point. $25k goes a lot further with care there than it would here. And that’s the biggest problem.

How much do physicians in the US earn relative to other countries?

Our pay structures are generally inverted compared to other countries. The practicing physicians who are applying the things discovered are paid less than the people doing the research, making discoveries etc. I think Canada is similar to us in those, but not many other places.

 

[Gjallarhorn]

Hey All, I just found this thread...had no idea this section of the site existed. Not looking to have philosophical debates, but I am more than happy to provide facts/context where I can. I am extremely close to this case in numerous ways.

Let’s hear it.

Well, I knew Brian for nearly 20 years, both personally and professionally. Maybe the single hardest working and intelligent person I have ever known. Regardless of what you hear about him, he dedicated his career, specifically the last 3 years, to making positive changes in the health care industry.

You may hear that UHC had AI bots that automatically denied claims this is not true. UHC acquired a company that did this, but this changed right away. UHC does use AI for auto-approving claims.

He, along with former CEO and current board member Steve Hemsley, were ACCUSED of insider trading. There was a large acquisition that was being held up in the courts. These executives are ALWAYS informed by the SEC, via internal counsel, when they are not allowed to sell stocks. This is not the first time C-suite level executives at UHG have been accused of this type of behavior. He was not tried, he was not allowed to answer his accusers, and he should be considered innocent.

Are you able to speak to the 2x vs other insurers denial rate that keeps getting posted?

I mean, partially, and it is not because I am being evasive, but it is not really that simple. UHC, at it's core, is a mergers and acquisitions company. They will purchase anywhere between 30-40 companies/year. These might be small 3-4 employee clinics, or the largest health care provider in Brazil, Peru, and Colombia. My point is that UHCs denials numbers could be inherited from an AE (acquired entity), regulatory requirements from local or national entities, and/or people not filling out or providing the correct information. This is not like The Rainmaker, there is no policy or AI controlled database that auto-denies every claim that comes in.

Do you think acquisition companies operating in healthcare facilitate improved patient care? Are profit-maximizing goals aligned with health outcomes?

The fact is, the healthier people are, the more money insurance companies make.

 

[mr. furley]

his "manifesto" posted to reddit:


The full manifesto reads:

“To the Feds, I’ll keep this short, because I do respect what you do for our country. To save you a lengthy investigation, I state plainly that I wasn’t working with anyone. This was fairly trivial: some elementary social engineering, basic CAD, a lot of patience. The spiral notebook, if present, has some straggling notes and To Do lists that illuminate the gist of it. My tech is pretty locked down because I work in engineering so probably not much info there. I do apologize for any strife of traumas but it had to be done. Frankly, these parasites simply had it coming. A reminder: the US has the #1 most expensive healthcare system in the world, yet we rank roughly #42 in life expectancy. United is the [indecipherable] largest company in the US by market cap, behind only Apple, Google, Walmart. It has grown and grown, but as our life expectancy? No the reality is, these [indecipherable] have simply gotten too powerful, and they continue to abuse our country for immense profit because the American public has allwed them to get away with it. Obviously the problem is more complex, but I do not have space, and frankly I do not pretend to be the most qualified person to lay out the full argument. But many have illuminated the corruption and greed (e.g.: Rosenthal, Moore), decades ago and the problems simply remain. It is not an issue of awareness at this point, but clearly power games at play. Evidently I am the first to face it with such brutal honesty."

 

[Joe Bryant]

I agree 100% with Shapiro’s statement last night. I can’t believe how many keyboard warriors are coming out of the woodwork on Facebook to hail this killing. Makes you realize how ugly some of these people are inside. It’s a shame. How did everything get so crazy, and how do we get out of it? I won’t look at some of these “friends” the same way again. I truly hope these people don’t suffer tragedy and look for sympathy from me.

Cliffsnotes on the statement?

Killing people in cold blood is bad.

Killer is a coward, not a hero.

In a civil society, we resolve our differences through discourse, not vigilante violence.

People's lives are being destroyed by our healthcare system either financially or physically and it's only going to get worse. For-profit businesses and industries lobbying our government for de-reregulation and protection isn't going to change. Such a naive outlook.

I'd ask the same as @El Floppo

"if discourse is out, what's a less naive outlook- other than assassinations?"

Is it safe to say you agree with what the Governor said?

Killing people in cold blood is bad.

Killer is a coward, not a hero.

In a civil society, we resolve our differences through discourse, not vigilante violence.

You just think we need more of the bolded and more discourse?

 

[Gjallarhorn]

his "manifesto" posted to reddit:


The full manifesto reads:

“To the Feds, I’ll keep this short, because I do respect what you do for our country. To save you a lengthy investigation, I state plainly that I wasn’t working with anyone. This was fairly trivial: some elementary social engineering, basic CAD, a lot of patience. The spiral notebook, if present, has some straggling notes and To Do lists that illuminate the gist of it. My tech is pretty locked down because I work in engineering so probably not much info there. I do apologize for any strife of traumas but it had to be done. Frankly, these parasites simply had it coming. A reminder: the US has the #1 most expensive healthcare system in the world, yet we rank roughly #42 in life expectancy. United is the [indecipherable] largest company in the US by market cap, behind only Apple, Google, Walmart. It has grown and grown, but as our life expectancy? No the reality is, these [indecipherable] have simply gotten too powerful, and they continue to abuse our country for immense profit because the American public has allwed them to get away with it. Obviously the problem is more complex, but I do not have space, and frankly I do not pretend to be the most qualified person to lay out the full argument. But many have illuminated the corruption and greed (e.g.: Rosenthal, Moore), decades ago and the problems simply remain. It is not an issue of awareness at this point, but clearly power games at play. Evidently I am the first to face it with such brutal honesty."

I find two things interesting. 1. Parasites, plural. 2. He does not specifically call out Brian.

 

[Dr. Octopus]

Hey All, I just found this thread...had no idea this section of the site existed. Not looking to have philosophical debates, but I am more than happy to provide facts/context where I can. I am extremely close to this case in numerous ways.

Let’s hear it.

Well, I knew Brian for nearly 20 years, both personally and professionally. Maybe the single hardest working and intelligent person I have ever known. Regardless of what you hear about him, he dedicated his career, specifically the last 3 years, to making positive changes in the health care industry.

You may hear that UHC had AI bots that automatically denied claims this is not true. UHC acquired a company that did this, but this changed right away. UHC does use AI for auto-approving claims.

He, along with former CEO and current board member Steve Hemsley, were ACCUSED of insider trading. There was a large acquisition that was being held up in the courts. These executives are ALWAYS informed by the SEC, via internal counsel, when they are not allowed to sell stocks. This is not the first time C-suite level executives at UHG have been accused of this type of behavior. He was not tried, he was not allowed to answer his accusers, and he should be considered innocent.

Are you able to speak to the 2x vs other insurers denial rate that keeps getting posted?

I mean, partially, and it is not because I am being evasive, but it is not really that simple. UHC, at it's core, is a mergers and acquisitions company. They will purchase anywhere between 30-40 companies/year. These might be small 3-4 employee clinics, or the largest health care provider in Brazil, Peru, and Colombia. My point is that UHCs denials numbers could be inherited from an AE (acquired entity), regulatory requirements from local or national entities, and/or people not filling out or providing the correct information. This is not like The Rainmaker, there is no policy or AI controlled database that auto-denies every claim that comes in.

Do you think acquisition companies operating in healthcare facilitate improved patient care? Are profit-maximizing goals aligned with health outcomes?

The fact is, the healthier people are, the more money insurance companies make.

Although it may seem counter-intuitive, actually the sicker society becomes the more people need health insurance.

The insurance industry is perfectly fine with Big Pharma and our poor diet and exercise.

 

[Gjallarhorn]

Hey All, I just found this thread...had no idea this section of the site existed. Not looking to have philosophical debates, but I am more than happy to provide facts/context where I can. I am extremely close to this case in numerous ways.

Let’s hear it.

Well, I knew Brian for nearly 20 years, both personally and professionally. Maybe the single hardest working and intelligent person I have ever known. Regardless of what you hear about him, he dedicated his career, specifically the last 3 years, to making positive changes in the health care industry.

You may hear that UHC had AI bots that automatically denied claims this is not true. UHC acquired a company that did this, but this changed right away. UHC does use AI for auto-approving claims.

He, along with former CEO and current board member Steve Hemsley, were ACCUSED of insider trading. There was a large acquisition that was being held up in the courts. These executives are ALWAYS informed by the SEC, via internal counsel, when they are not allowed to sell stocks. This is not the first time C-suite level executives at UHG have been accused of this type of behavior. He was not tried, he was not allowed to answer his accusers, and he should be considered innocent.

Are you able to speak to the 2x vs other insurers denial rate that keeps getting posted?

I mean, partially, and it is not because I am being evasive, but it is not really that simple. UHC, at it's core, is a mergers and acquisitions company. They will purchase anywhere between 30-40 companies/year. These might be small 3-4 employee clinics, or the largest health care provider in Brazil, Peru, and Colombia. My point is that UHCs denials numbers could be inherited from an AE (acquired entity), regulatory requirements from local or national entities, and/or people not filling out or providing the correct information. This is not like The Rainmaker, there is no policy or AI controlled database that auto-denies every claim that comes in.

Do you think acquisition companies operating in healthcare facilitate improved patient care? Are profit-maximizing goals aligned with health outcomes?

The fact is, the healthier people are, the more money insurance companies make.

Although it may seem counter-intuitive, actually the sicker society becomes the more people need health insurance.

The insurance industry is perfectly fine with Big Pharma and our poor diet and exercise.

All I am saying is that the less an insurance company pays out (healthier people), the more money they make. It is a fact.

 

[gianmarco]

Since I do not know the answer ... what do the quasi -socialist govts in Europe do for healthcare denials? For instance, Sweden. I guess it's called public healthcare for them France, Netherlands, etc. I'm told you can just walk in to a hospital or doctor and they take care of you. You walk out without a bill. Obvi society is paying for your treatment with higher taxes. But do they say "nothing is wrong with you" and deny treatment. Do they determine afterwards that it was unnecessary and bill you back? Anyone lived there?

First off, I hope you realize just how complicated of a question you’re asking here. So many factors at play. Every system is different, and EVERY system rations care somehow, by someone, for something. Here in the US, for better or worse, we might have an insurance company denying you the coverage (or more technically, saying they won’t pay for it).

The UK, for instance, has the National Health Service (NHS), who uses the National Institute for Care Excellence (or NICE) to assess the cost-effectiveness of care with a system called QALYs (quality adjusted life years) to quite literally put a value on the number of expected years a person has remaining (roughly 25k pounds I believe - pounds being their currency obviously). If care is expected to give a person an additional quality adjusted life years (QALY) and cost less then ~25k pounds, it’s likely approved. Much more than that, it likely won’t be - and it’s never requested, thus can’t be rejected/denied. It’s generally accepted that it works there due to Britain’s post WW2 views of shared sacrifice, which we really don’t have here at this time. (As an aside, can you imagine AI taking over a system like that here in the US?!)

France still has a layer of health insurance in their system, with over 90% of their population having some form of private insurance (mainly for stuff that isn’t covered - copays, and dental and vision). Their universal system still leaves the individual a 20% coinsurance for inpatient hospital stays, and 30% for outpatient - and a huge range for drugs depending on their “effectiveness” (with something like insulin covered at 100%, some others only 85% or potentially not at all - there is a national drug formulary). But their costs for those inpatient and outpatient (and drugs) tend to be FAR LESS than what’s charged here.

This number is shockingly low. IIRC, US standards for “cost effective” are typically up to $100-150/QALY, though cancer therapeutics are sometimes several fold more expensive.

Could you imagine that conversation happening here in US?

No, but maybe it should, as we surely provide more futile care than other countries.

Of course, our system is so much more expensive than the rest of the world, so the cut-offs would have to be adjusted accordingly.

I was thinking the same on your last point. $25k goes a lot further with care there than it would here. And that’s the biggest problem.

How much do physicians in the US earn relative to other countries?

Much more. According to “world population review” - Switzerland is #1 just above USA, and we average (according to them and their math) $316k a year. #3 is Canada and they are under $200k. Also according to them France, Italy, Spain and Poland have an average Dr income less than $100k.

Statista lists US as #1 (but states they only looked at “select countries”) at $352k average. #2 for them is Canada at $273k, then a huge drop to their #3, Germany, at $169k. France, Italy and Spain all listed between 93-60k.

Keep in mind that it’s Doctors (specifically the AMA) who are against moving to a more socialized medicine model as they feel is will hurt their bottom lines.

Also bear in mind that it’s not just the doctors making money in our system, it’s the huge hospital (provider) groups. For those in northern Va familiar with the Inova hospital group (I believe 5 total hospitals around northern Va), their 2024 operating revenue is 5.7 billion, with a B. In total they have fewer than 2k hospital beds - and list nearly half a billion in “investment in new facilities”

A few points to consider here.

-- Physicians in the US definitely make more than most other countries. However, they are also saddled with far more debt due to the cost and length of training. Many physicians don't start to earn a real salary (not counting salary in residency for typically less than minimum wage) until they are over the age of 30 and many finish training with over $300K in student debt. That doesn't happen in other countries.

-- Physicians count for ~8% of total healthcare money spent. You could cut salaries in half and it still doesn't make a dent in healthcare costs/expenditures. Here's a graph that gives a look at some numbers as well

-- If we want to start to change the economics of healthcare costs and spending, it's these administrative groups that you mentioned in your past paragraph that are making $$$$ and driving up costs. In fact, reimbursement has actually decreased for physicians over the last decade when taking inflation into account.

 

[Fat Nick]

his "manifesto" posted to reddit:


The full manifesto reads:

“To the Feds, I’ll keep this short, because I do respect what you do for our country. To save you a lengthy investigation, I state plainly that I wasn’t working with anyone. This was fairly trivial: some elementary social engineering, basic CAD, a lot of patience. The spiral notebook, if present, has some straggling notes and To Do lists that illuminate the gist of it. My tech is pretty locked down because I work in engineering so probably not much info there. I do apologize for any strife of traumas but it had to be done. Frankly, these parasites simply had it coming. A reminder: the US has the #1 most expensive healthcare system in the world, yet we rank roughly #42 in life expectancy. United is the [indecipherable] largest company in the US by market cap, behind only Apple, Google, Walmart. It has grown and grown, but as our life expectancy? No the reality is, these [indecipherable] have simply gotten too powerful, and they continue to abuse our country for immense profit because the American public has allwed them to get away with it. Obviously the problem is more complex, but I do not have space, and frankly I do not pretend to be the most qualified person to lay out the full argument. But many have illuminated the corruption and greed (e.g.: Rosenthal, Moore), decades ago and the problems simply remain. It is not an issue of awareness at this point, but clearly power games at play. Evidently I am the first to face it with such brutal honesty."

I find two things interesting. 1. Parasites, plural. 2. He does not specifically call out Brian.

I noted it when they first found him with the gun still on him - I think he had intentions to target others. That's the only reason I can think of that he would still have the gun on him.

Several of the next largest insurance companies are based in mid-America (St. Louis, Indianapolis) - Altoona is on the way from NYC to that area...Pure speculation, but I don't think he was done.

 

[Dr. Octopus]

Hey All, I just found this thread...had no idea this section of the site existed. Not looking to have philosophical debates, but I am more than happy to provide facts/context where I can. I am extremely close to this case in numerous ways.

Let’s hear it.

Well, I knew Brian for nearly 20 years, both personally and professionally. Maybe the single hardest working and intelligent person I have ever known. Regardless of what you hear about him, he dedicated his career, specifically the last 3 years, to making positive changes in the health care industry.

You may hear that UHC had AI bots that automatically denied claims this is not true. UHC acquired a company that did this, but this changed right away. UHC does use AI for auto-approving claims.

He, along with former CEO and current board member Steve Hemsley, were ACCUSED of insider trading. There was a large acquisition that was being held up in the courts. These executives are ALWAYS informed by the SEC, via internal counsel, when they are not allowed to sell stocks. This is not the first time C-suite level executives at UHG have been accused of this type of behavior. He was not tried, he was not allowed to answer his accusers, and he should be considered innocent.

Are you able to speak to the 2x vs other insurers denial rate that keeps getting posted?

I mean, partially, and it is not because I am being evasive, but it is not really that simple. UHC, at it's core, is a mergers and acquisitions company. They will purchase anywhere between 30-40 companies/year. These might be small 3-4 employee clinics, or the largest health care provider in Brazil, Peru, and Colombia. My point is that UHCs denials numbers could be inherited from an AE (acquired entity), regulatory requirements from local or national entities, and/or people not filling out or providing the correct information. This is not like The Rainmaker, there is no policy or AI controlled database that auto-denies every claim that comes in.

Do you think acquisition companies operating in healthcare facilitate improved patient care? Are profit-maximizing goals aligned with health outcomes?

The fact is, the healthier people are, the more money insurance companies make.

Although it may seem counter-intuitive, actually the sicker society becomes the more people need health insurance.

The insurance industry is perfectly fine with Big Pharma and our poor diet and exercise.

All I am saying is that the less an insurance company pays out (healthier people), the more money they make. It is a fact.

We can agree to disagree - as I think that's a simplistic view of it and stand by what I said.

 

[matttyl]

Since I do not know the answer ... what do the quasi -socialist govts in Europe do for healthcare denials? For instance, Sweden. I guess it's called public healthcare for them France, Netherlands, etc. I'm told you can just walk in to a hospital or doctor and they take care of you. You walk out without a bill. Obvi society is paying for your treatment with higher taxes. But do they say "nothing is wrong with you" and deny treatment. Do they determine afterwards that it was unnecessary and bill you back? Anyone lived there?

First off, I hope you realize just how complicated of a question you’re asking here. So many factors at play. Every system is different, and EVERY system rations care somehow, by someone, for something. Here in the US, for better or worse, we might have an insurance company denying you the coverage (or more technically, saying they won’t pay for it).

The UK, for instance, has the National Health Service (NHS), who uses the National Institute for Care Excellence (or NICE) to assess the cost-effectiveness of care with a system called QALYs (quality adjusted life years) to quite literally put a value on the number of expected years a person has remaining (roughly 25k pounds I believe - pounds being their currency obviously). If care is expected to give a person an additional quality adjusted life years (QALY) and cost less then ~25k pounds, it’s likely approved. Much more than that, it likely won’t be - and it’s never requested, thus can’t be rejected/denied. It’s generally accepted that it works there due to Britain’s post WW2 views of shared sacrifice, which we really don’t have here at this time. (As an aside, can you imagine AI taking over a system like that here in the US?!)

France still has a layer of health insurance in their system, with over 90% of their population having some form of private insurance (mainly for stuff that isn’t covered - copays, and dental and vision). Their universal system still leaves the individual a 20% coinsurance for inpatient hospital stays, and 30% for outpatient - and a huge range for drugs depending on their “effectiveness” (with something like insulin covered at 100%, some others only 85% or potentially not at all - there is a national drug formulary). But their costs for those inpatient and outpatient (and drugs) tend to be FAR LESS than what’s charged here.

This number is shockingly low. IIRC, US standards for “cost effective” are typically up to $100-150/QALY, though cancer therapeutics are sometimes several fold more expensive.

Could you imagine that conversation happening here in US?

No, but maybe it should, as we surely provide more futile care than other countries.

Of course, our system is so much more expensive than the rest of the world, so the cut-offs would have to be adjusted accordingly.

I was thinking the same on your last point. $25k goes a lot further with care there than it would here. And that’s the biggest problem.

How much do physicians in the US earn relative to other countries?

Much more. According to “world population review” - Switzerland is #1 just above USA, and we average (according to them and their math) $316k a year. #3 is Canada and they are under $200k. Also according to them France, Italy, Spain and Poland have an average Dr income less than $100k.

Statista lists US as #1 (but states they only looked at “select countries”) at $352k average. #2 for them is Canada at $273k, then a huge drop to their #3, Germany, at $169k. France, Italy and Spain all listed between 93-60k.

Keep in mind that it’s Doctors (specifically the AMA) who are against moving to a more socialized medicine model as they feel is will hurt their bottom lines.

Also bear in mind that it’s not just the doctors making money in our system, it’s the huge hospital (provider) groups. For those in northern Va familiar with the Inova hospital group (I believe 5 total hospitals around northern Va), their 2024 operating revenue is 5.7 billion, with a B. In total they have fewer than 2k hospital beds - and list nearly half a billion in “investment in new facilities”

There are 3, formerly 4, of my wife's family who are doctors in Fairfax... Pretty sure they work in that system. They seem to do just fine, fwiw.

If any happen to work in the children’s hospital in any capacity- I owe them a huge debt of gratitude.

 

[El Floppo]

Since I do not know the answer ... what do the quasi -socialist govts in Europe do for healthcare denials? For instance, Sweden. I guess it's called public healthcare for them France, Netherlands, etc. I'm told you can just walk in to a hospital or doctor and they take care of you. You walk out without a bill. Obvi society is paying for your treatment with higher taxes. But do they say "nothing is wrong with you" and deny treatment. Do they determine afterwards that it was unnecessary and bill you back? Anyone lived there?

First off, I hope you realize just how complicated of a question you’re asking here. So many factors at play. Every system is different, and EVERY system rations care somehow, by someone, for something. Here in the US, for better or worse, we might have an insurance company denying you the coverage (or more technically, saying they won’t pay for it).

The UK, for instance, has the National Health Service (NHS), who uses the National Institute for Care Excellence (or NICE) to assess the cost-effectiveness of care with a system called QALYs (quality adjusted life years) to quite literally put a value on the number of expected years a person has remaining (roughly 25k pounds I believe - pounds being their currency obviously). If care is expected to give a person an additional quality adjusted life years (QALY) and cost less then ~25k pounds, it’s likely approved. Much more than that, it likely won’t be - and it’s never requested, thus can’t be rejected/denied. It’s generally accepted that it works there due to Britain’s post WW2 views of shared sacrifice, which we really don’t have here at this time. (As an aside, can you imagine AI taking over a system like that here in the US?!)

France still has a layer of health insurance in their system, with over 90% of their population having some form of private insurance (mainly for stuff that isn’t covered - copays, and dental and vision). Their universal system still leaves the individual a 20% coinsurance for inpatient hospital stays, and 30% for outpatient - and a huge range for drugs depending on their “effectiveness” (with something like insulin covered at 100%, some others only 85% or potentially not at all - there is a national drug formulary). But their costs for those inpatient and outpatient (and drugs) tend to be FAR LESS than what’s charged here.

This number is shockingly low. IIRC, US standards for “cost effective” are typically up to $100-150/QALY, though cancer therapeutics are sometimes several fold more expensive.

Could you imagine that conversation happening here in US?

No, but maybe it should, as we surely provide more futile care than other countries.

Of course, our system is so much more expensive than the rest of the world, so the cut-offs would have to be adjusted accordingly.

I was thinking the same on your last point. $25k goes a lot further with care there than it would here. And that’s the biggest problem.

How much do physicians in the US earn relative to other countries?

Much more. According to “world population review” - Switzerland is #1 just above USA, and we average (according to them and their math) $316k a year. #3 is Canada and they are under $200k. Also according to them France, Italy, Spain and Poland have an average Dr income less than $100k.

Statista lists US as #1 (but states they only looked at “select countries”) at $352k average. #2 for them is Canada at $273k, then a huge drop to their #3, Germany, at $169k. France, Italy and Spain all listed between 93-60k.

Keep in mind that it’s Doctors (specifically the AMA) who are against moving to a more socialized medicine model as they feel is will hurt their bottom lines.

Also bear in mind that it’s not just the doctors making money in our system, it’s the huge hospital (provider) groups. For those in northern Va familiar with the Inova hospital group (I believe 5 total hospitals around northern Va), their 2024 operating revenue is 5.7 billion, with a B. In total they have fewer than 2k hospital beds - and list nearly half a billion in “investment in new facilities”

There are 3, formerly 4, of my wife's family who are doctors in Fairfax... Pretty sure they work in that system. They seem to do just fine, fwiw.

If any happen to work in the children’s hospital in any capacity- I owe them a huge debt of gratitude.

Not specifically. Cardiologist, neurologist, radiologist (and FIL was a neurosurgeon).. all of them will touch on pediatrics as needed, but not their focus (which sounds creepy as I've just written).

 

[Ministry of Pain]

I agree 100% with Shapiro’s statement last night. I can’t believe how many keyboard warriors are coming out of the woodwork on Facebook to hail this killing. Makes you realize how ugly some of these people are inside. It’s a shame. How did everything get so crazy, and how do we get out of it? I won’t look at some of these “friends” the same way again. I truly hope these people don’t suffer tragedy and look for sympathy from me.

Cliffsnotes on the statement?

Killing people in cold blood is bad.

Killer is a coward, not a hero.

In a civil society, we resolve our differences through discourse, not vigilante violence.

People's lives are being destroyed by our healthcare system either financially or physically and it's only going to get worse. For-profit businesses and industries lobbying our government for de-reregulation and protection isn't going to change. Such a naive outlook.

Greetings Friend, i just want to make something clear and then I can relax and get more into the conversation even just casually reading...

I keep seeing the healthcare system being introduced into a cold blooded murder, just to be clear we're not suggesting that the murder of this CEO was justified, are we?

-I know we have folks who work in the medical profession, The MoP and other family members work for the Sylvester Cancer Center in Miami, directly in fundraising with the Miami Dolphins Cycling Challenge and I would hate for someone that felt wronged to suddenly show up at Hard Rock on the day of our big event and start shooting into the crowd

And this is extremely personal because when I lost my mother in 1995 to breast cancer she was just 46, the doctor knew she was going to die and instead of letting her live out her final 2-3 months and do what she wanted, instead he convinced her to get on chemo and she went from pretty alert to lifeless and died in less than 5 months, and the doctor was paid handsomely for administering the chemo as I would later learn, I was only 21 when she died. It made me very bitter for a long time.

And none of that would be justification for any evil thoughts or actions carried out after so i do not support any of the awful things I have read online in other places or media for that matter equating the CEO murder to other high profile cases of late and I will leave it at that

This was in no way a punch at you Urb, you're a good man and we love you.
I freely admit I am ignorant on the healthcare coverage for many reasons
-First, it's just part of the pay package at work. Second, I don't go to the doctors often, Mrs had a n eye exam this morning that took a while to schedule

 

[Stoneworker]

Are profit-maximizing goals aligned with health outcomes?

Moderna and Pfizer creating the Covid vaccine far faster than anyone else in the world seemed to work out pretty well

 

[Gjallarhorn]

Hey All, I just found this thread...had no idea this section of the site existed. Not looking to have philosophical debates, but I am more than happy to provide facts/context where I can. I am extremely close to this case in numerous ways.

Let’s hear it.

Well, I knew Brian for nearly 20 years, both personally and professionally. Maybe the single hardest working and intelligent person I have ever known. Regardless of what you hear about him, he dedicated his career, specifically the last 3 years, to making positive changes in the health care industry.

You may hear that UHC had AI bots that automatically denied claims this is not true. UHC acquired a company that did this, but this changed right away. UHC does use AI for auto-approving claims.

He, along with former CEO and current board member Steve Hemsley, were ACCUSED of insider trading. There was a large acquisition that was being held up in the courts. These executives are ALWAYS informed by the SEC, via internal counsel, when they are not allowed to sell stocks. This is not the first time C-suite level executives at UHG have been accused of this type of behavior. He was not tried, he was not allowed to answer his accusers, and he should be considered innocent.

Are you able to speak to the 2x vs other insurers denial rate that keeps getting posted?

I mean, partially, and it is not because I am being evasive, but it is not really that simple. UHC, at it's core, is a mergers and acquisitions company. They will purchase anywhere between 30-40 companies/year. These might be small 3-4 employee clinics, or the largest health care provider in Brazil, Peru, and Colombia. My point is that UHCs denials numbers could be inherited from an AE (acquired entity), regulatory requirements from local or national entities, and/or people not filling out or providing the correct information. This is not like The Rainmaker, there is no policy or AI controlled database that auto-denies every claim that comes in.

Do you think acquisition companies operating in healthcare facilitate improved patient care? Are profit-maximizing goals aligned with health outcomes?

The fact is, the healthier people are, the more money insurance companies make.

Although it may seem counter-intuitive, actually the sicker society becomes the more people need health insurance.

The insurance industry is perfectly fine with Big Pharma and our poor diet and exercise.

All I am saying is that the less an insurance company pays out (healthier people), the more money they make. It is a fact.

We can agree to disagree - as I think that's a simplistic view of it and stand by what I said.

If you were the CEO of a health insurance company, how would you tackle the obesity epidemic in America? How would you get people to eat better and exercise?

 

[Sparky Polastri]

his "manifesto" posted to reddit:


The full manifesto reads:

“To the Feds, I’ll keep this short, because I do respect what you do for our country. To save you a lengthy investigation, I state plainly that I wasn’t working with anyone. This was fairly trivial: some elementary social engineering, basic CAD, a lot of patience. The spiral notebook, if present, has some straggling notes and To Do lists that illuminate the gist of it. My tech is pretty locked down because I work in engineering so probably not much info there. I do apologize for any strife of traumas but it had to be done. Frankly, these parasites simply had it coming. A reminder: the US has the #1 most expensive healthcare system in the world, yet we rank roughly #42 in life expectancy. United is the [indecipherable] largest company in the US by market cap, behind only Apple, Google, Walmart. It has grown and grown, but as our life expectancy? No the reality is, these [indecipherable] have simply gotten too powerful, and they continue to abuse our country for immense profit because the American public has allwed them to get away with it. Obviously the problem is more complex, but I do not have space, and frankly I do not pretend to be the most qualified person to lay out the full argument. But many have illuminated the corruption and greed (e.g.: Rosenthal, Moore), decades ago and the problems simply remain. It is not an issue of awareness at this point, but clearly power games at play. Evidently I am the first to face it with such brutal honesty."

At some point, "we" the people will realize the "battles" aren't between conservatives and liberals. It's between the politicians and us ("we"). This is direct evidence of this. I saw a stat some time earlier this year showing us that it makes absolutely NO difference how much support an idea/bill/philosophy has with the public. It has about a 30% chance of making it through Congress and becoming law. It doesn't matter if 5% of the electorate supports it or 95% supports it. THAT is appalling in my opinion. It should be obvious to all of us (and I don't know what I'm thinking going into the world of healthcare in the near future) that our healthcare system is pretty terrible sans areas of cancer and research. We spend trillions more than other nations and its clear that we don't get a good ROI when it comes to outcomes.

 

[Courtjester]

I know everyone is talking big picture here, but what I can't get over is how this guy knew the CEO's schedule. How did he guess that he would be coming out that door at that time? There had to be multiple entrances and exits from that building. What if the guy decided to have breakfast and came out in broad daylight? What if he came out in a big group of people? Maybe I just missed some detail in all this.

 

[Gjallarhorn]

his "manifesto" posted to reddit:


The full manifesto reads:

“To the Feds, I’ll keep this short, because I do respect what you do for our country. To save you a lengthy investigation, I state plainly that I wasn’t working with anyone. This was fairly trivial: some elementary social engineering, basic CAD, a lot of patience. The spiral notebook, if present, has some straggling notes and To Do lists that illuminate the gist of it. My tech is pretty locked down because I work in engineering so probably not much info there. I do apologize for any strife of traumas but it had to be done. Frankly, these parasites simply had it coming. A reminder: the US has the #1 most expensive healthcare system in the world, yet we rank roughly #42 in life expectancy. United is the [indecipherable] largest company in the US by market cap, behind only Apple, Google, Walmart. It has grown and grown, but as our life expectancy? No the reality is, these [indecipherable] have simply gotten too powerful, and they continue to abuse our country for immense profit because the American public has allwed them to get away with it. Obviously the problem is more complex, but I do not have space, and frankly I do not pretend to be the most qualified person to lay out the full argument. But many have illuminated the corruption and greed (e.g.: Rosenthal, Moore), decades ago and the problems simply remain. It is not an issue of awareness at this point, but clearly power games at play. Evidently I am the first to face it with such brutal honesty."

At some point, "we" the people will realize the "battles" aren't between conservatives and liberals. It's between the politicians and us ("we"). This is direct evidence of this. I saw a stat some time earlier this year showing us that it makes absolutely NO difference how much support an idea/bill/philosophy has with the public. It has about a 30% chance of making it through Congress and becoming law. It doesn't matter if 5% of the electorate supports it or 95% supports it. THAT is appalling in my opinion. It should be obvious to all of us (and I don't know what I'm thinking going into the world of healthcare in the near future) that our healthcare system is pretty terrible sans areas of cancer and research. We spend trillions more than other nations and its clear that we don't get a good ROI when it comes to outcomes.

Welcome aboard. You can literally help people. Sure, it may feel like you are walking the beach throwing starfish back into the ocean...but I have seen first hand people bein saved.

 

[Fat Nick]

If you were the CEO of a health insurance company, how would you tackle the obesity epidemic in America? How would you get people to eat better and exercise?

Honestly, my $0.02 - they'll broadly cover GLP1's for anyone who's BMI indicates a risk for other health issues. Look at Chantix, the anti-smoking drug. They initially didn't cover it until they started doing the math on whether it was cheaper to cover the drug vs. covering subsequent lung and heart issues caused by smoking. Same with weight loss - They'll realize that covering GLP1's are a lot cheaper than covering the longer term impacts of obesity for their insured.

 

[Fat Nick]

I know everyone is talking big picture here, but what I can't get over is how this guy knew the CEO's schedule. How did he guess that he would be coming out that door at that time? There had to be multiple entrances and exits from that building. What if the guy decided to have breakfast and came out in broad daylight? What if he came out in a big group of people? Maybe I just missed some detail in all this.

Knowing that he was in the city, and potentially knowing what hotel wouldn't be that hard...I do totally agree beyond that. That hotel occupies the end of that block and has exits on 2 different streets and 1 avenue - 3 sides of the block. I don't know how he knew where he would come out.

I never did confirm from the video whether he actually came out the entrance right where he was shot, or if he just walked by it. It's possible the killer simply went to the side of the block closest to his event venue and waited and got lucky.

 

[jamny]

If you were the CEO of a health insurance company, how would you tackle the obesity epidemic in America? How would you get people to eat better and exercise?

Honestly, my $0.02 - they'll broadly cover GLP1's for anyone who's BMI indicates a risk for other health issues. Look at Chantix, the anti-smoking drug. They initially didn't cover it until they started doing the math on whether it was cheaper to cover the drug vs. covering subsequent lung and heart issues caused by smoking. Same with weight loss - They'll realize that covering GLP1's are a lot cheaper than covering the longer term impacts of obesity for their insured.

Unless they find that GLP1's cause other issues down the road.

 

[Dr. Octopus]

Hey All, I just found this thread...had no idea this section of the site existed. Not looking to have philosophical debates, but I am more than happy to provide facts/context where I can. I am extremely close to this case in numerous ways.

Let’s hear it.

Well, I knew Brian for nearly 20 years, both personally and professionally. Maybe the single hardest working and intelligent person I have ever known. Regardless of what you hear about him, he dedicated his career, specifically the last 3 years, to making positive changes in the health care industry.

You may hear that UHC had AI bots that automatically denied claims this is not true. UHC acquired a company that did this, but this changed right away. UHC does use AI for auto-approving claims.

He, along with former CEO and current board member Steve Hemsley, were ACCUSED of insider trading. There was a large acquisition that was being held up in the courts. These executives are ALWAYS informed by the SEC, via internal counsel, when they are not allowed to sell stocks. This is not the first time C-suite level executives at UHG have been accused of this type of behavior. He was not tried, he was not allowed to answer his accusers, and he should be considered innocent.

Are you able to speak to the 2x vs other insurers denial rate that keeps getting posted?

I mean, partially, and it is not because I am being evasive, but it is not really that simple. UHC, at it's core, is a mergers and acquisitions company. They will purchase anywhere between 30-40 companies/year. These might be small 3-4 employee clinics, or the largest health care provider in Brazil, Peru, and Colombia. My point is that UHCs denials numbers could be inherited from an AE (acquired entity), regulatory requirements from local or national entities, and/or people not filling out or providing the correct information. This is not like The Rainmaker, there is no policy or AI controlled database that auto-denies every claim that comes in.

Do you think acquisition companies operating in healthcare facilitate improved patient care? Are profit-maximizing goals aligned with health outcomes?

The fact is, the healthier people are, the more money insurance companies make.

Although it may seem counter-intuitive, actually the sicker society becomes the more people need health insurance.

The insurance industry is perfectly fine with Big Pharma and our poor diet and exercise.

All I am saying is that the less an insurance company pays out (healthier people), the more money they make. It is a fact.

We can agree to disagree - as I think that's a simplistic view of it and stand by what I said.

If you were the CEO of a health insurance company, how would you tackle the obesity epidemic in America? How would you get people to eat better and exercise?

I don't believe it's up to the health insurance industry to take on that responsibility (I did not blame them for the health epidemic in this Country, what I said is they are perfectly happy for people to be sick, generally, which is fact).

Generally, a good start would be to get Big Pharma and Big AG lobbies out of our government and have our government educate the people better. The "food pyramid" is bogus, yet its still taught in schools. We market sugar bomb cereals, toaster pastries and orange juice as a healthy breakfast and "the most important meal of the day".

The government's childhood obesity studies was sponsored by Novo Norddisk - guess what their findings were? The report stated children as young as 12 years old should start Ozempic treatments to combat obesity - no mention of diet or exercise.

The diabetes study was sponsored by Coca-Cola and guess what, there's no mention about how bad soda is for you.

This is way off topic now though,

 

[Stoneworker]

Welcome aboard. You can literally help people. Sure, it may feel like you are walking the beach throwing starfish back into the ocean...but I have seen first hand people bein saved.

Good point. This is just the nature of choosing to tackle large social issues (e.g. climate change/clean energy).

At first there are delusions that some silver bullet is going to change the world, but at the end of the day it's a lifelong grind where 99.9% of individual contributions barely move the needle.

Need to take comfort in that somehow

 

[matttyl]

Hey All, I just found this thread...had no idea this section of the site existed. Not looking to have philosophical debates, but I am more than happy to provide facts/context where I can. I am extremely close to this case in numerous ways.

Let’s hear it.

Well, I knew Brian for nearly 20 years, both personally and professionally. Maybe the single hardest working and intelligent person I have ever known. Regardless of what you hear about him, he dedicated his career, specifically the last 3 years, to making positive changes in the health care industry.

You may hear that UHC had AI bots that automatically denied claims this is not true. UHC acquired a company that did this, but this changed right away. UHC does use AI for auto-approving claims.

He, along with former CEO and current board member Steve Hemsley, were ACCUSED of insider trading. There was a large acquisition that was being held up in the courts. These executives are ALWAYS informed by the SEC, via internal counsel, when they are not allowed to sell stocks. This is not the first time C-suite level executives at UHG have been accused of this type of behavior. He was not tried, he was not allowed to answer his accusers, and he should be considered innocent.

Are you able to speak to the 2x vs other insurers denial rate that keeps getting posted?

I mean, partially, and it is not because I am being evasive, but it is not really that simple. UHC, at it's core, is a mergers and acquisitions company. They will purchase anywhere between 30-40 companies/year. These might be small 3-4 employee clinics, or the largest health care provider in Brazil, Peru, and Colombia. My point is that UHCs denials numbers could be inherited from an AE (acquired entity), regulatory requirements from local or national entities, and/or people not filling out or providing the correct information. This is not like The Rainmaker, there is no policy or AI controlled database that auto-denies every claim that comes in.

Do you think acquisition companies operating in healthcare facilitate improved patient care? Are profit-maximizing goals aligned with health outcomes?

The fact is, the healthier people are, the more money insurance companies make.

Although it may seem counter-intuitive, actually the sicker society becomes the more people need health insurance.

The insurance industry is perfectly fine with Big Pharma and our poor diet and exercise.

All I am saying is that the less an insurance company pays out (healthier people), the more money they make. It is a fact.

We can agree to disagree - as I think that's a simplistic view of it and stand by what I said.

This is a situation where you’re both correct, technically. I’ll try to explain without getting too technical. The way things work now, a carrier HAS TO have a medical loss ratio (MLR) of at least 80% in the individual and small group market, or 85% in the larger group market.

So, to keep the math simple, let’s say it’s $1k/m per person in premiums to insure a large group with a really strong plan. 1,000 people. That’s $100k a month, or $1.2M in a year. They HAVE TO PAY at least a shade over $1m in claims for that group. Leaving at most $180k for all their overhead, taxes, fees, commissions and profit. In reality they’d likely make about $36k in profit on this group.

So on one hand the carrier is fine with the care costing $1k/m per person so that their “slice of the pie” is a bigger piece (well, same size piece, but the pie itself is bigger). At the same time, the lower the claims the closer they can potentially be to that 85% figure rather than say 87-88% - that’s would make their actual slice bigger.

 

[Dr. Octopus]

Are profit-maximizing goals aligned with health outcomes?

Moderna and Pfizer creating the Covid vaccine far faster than anyone else in the world seemed to work out pretty well

I guess you think this is some "gotcha" moment, but what you said is debatable (some would say how fast it was pushed through is a negative in the long run) and not at all relevant to what I said in the least.

I didn't say Big Pharma is completely evil or useless or should go away - but it has way too much influence on our government and our news media. What products advertise the most on CNN and FOX, do you think? Could that possibly have any influence on how Bug Pharma is reported on? Seems possible...

 

[Dr. Octopus]

what I can't get over is how this guy knew the CEO's schedule. How did he guess that he would be coming out that door at that time?

There was a Conference happening that he was expected to be at.

 

[Gjallarhorn]

Hey All, I just found this thread...had no idea this section of the site existed. Not looking to have philosophical debates, but I am more than happy to provide facts/context where I can. I am extremely close to this case in numerous ways.

Let’s hear it.

Well, I knew Brian for nearly 20 years, both personally and professionally. Maybe the single hardest working and intelligent person I have ever known. Regardless of what you hear about him, he dedicated his career, specifically the last 3 years, to making positive changes in the health care industry.

You may hear that UHC had AI bots that automatically denied claims this is not true. UHC acquired a company that did this, but this changed right away. UHC does use AI for auto-approving claims.

He, along with former CEO and current board member Steve Hemsley, were ACCUSED of insider trading. There was a large acquisition that was being held up in the courts. These executives are ALWAYS informed by the SEC, via internal counsel, when they are not allowed to sell stocks. This is not the first time C-suite level executives at UHG have been accused of this type of behavior. He was not tried, he was not allowed to answer his accusers, and he should be considered innocent.

Are you able to speak to the 2x vs other insurers denial rate that keeps getting posted?

I mean, partially, and it is not because I am being evasive, but it is not really that simple. UHC, at it's core, is a mergers and acquisitions company. They will purchase anywhere between 30-40 companies/year. These might be small 3-4 employee clinics, or the largest health care provider in Brazil, Peru, and Colombia. My point is that UHCs denials numbers could be inherited from an AE (acquired entity), regulatory requirements from local or national entities, and/or people not filling out or providing the correct information. This is not like The Rainmaker, there is no policy or AI controlled database that auto-denies every claim that comes in.

Do you think acquisition companies operating in healthcare facilitate improved patient care? Are profit-maximizing goals aligned with health outcomes?

The fact is, the healthier people are, the more money insurance companies make.

Although it may seem counter-intuitive, actually the sicker society becomes the more people need health insurance.

The insurance industry is perfectly fine with Big Pharma and our poor diet and exercise.

All I am saying is that the less an insurance company pays out (healthier people), the more money they make. It is a fact.

We can agree to disagree - as I think that's a simplistic view of it and stand by what I said.

If you were the CEO of a health insurance company, how would you tackle the obesity epidemic in America? How would you get people to eat better and exercise?

I don't believe it's up to the health insurance industry to take on that responsibility (I did not blame them for the health epidemic in this Country, what I said is they are perfectly happy for people to be sick, generally, which is fact).

Generally, a good start would be to get Big Pharma and Big AG lobbies out of our government and have our government educate the people better. The "food pyramid" is bogus, yet its still taught in schools. We market sugar bomb cereals, toaster pastries and orange juice as a healthy breakfast and "the most important meal of the day".

The government's childhood obesity studies was sponsored by Novo Norddisk - guess what their findings were? The report stated children as young as 12 years old should start Ozempic treatments to combat obesity - no mention of diet or exercise.

The diabetes study was sponsored by Coca-Cola and guess what, there's no mention about how bad soda is for you.

This is way off topic now though,

What I find appalling are all of the commercials that go, "ask your doctor if <insert patented drug> is right for you". Really? Is that how this should work? The US and New Zealand are the only two countries in the world where it is legal to directly advertise prescription drugs. This needs to change.

 

[matttyl]

Since I do not know the answer ... what do the quasi -socialist govts in Europe do for healthcare denials? For instance, Sweden. I guess it's called public healthcare for them France, Netherlands, etc. I'm told you can just walk in to a hospital or doctor and they take care of you. You walk out without a bill. Obvi society is paying for your treatment with higher taxes. But do they say "nothing is wrong with you" and deny treatment. Do they determine afterwards that it was unnecessary and bill you back? Anyone lived there?

First off, I hope you realize just how complicated of a question you’re asking here. So many factors at play. Every system is different, and EVERY system rations care somehow, by someone, for something. Here in the US, for better or worse, we might have an insurance company denying you the coverage (or more technically, saying they won’t pay for it).

The UK, for instance, has the National Health Service (NHS), who uses the National Institute for Care Excellence (or NICE) to assess the cost-effectiveness of care with a system called QALYs (quality adjusted life years) to quite literally put a value on the number of expected years a person has remaining (roughly 25k pounds I believe - pounds being their currency obviously). If care is expected to give a person an additional quality adjusted life years (QALY) and cost less then ~25k pounds, it’s likely approved. Much more than that, it likely won’t be - and it’s never requested, thus can’t be rejected/denied. It’s generally accepted that it works there due to Britain’s post WW2 views of shared sacrifice, which we really don’t have here at this time. (As an aside, can you imagine AI taking over a system like that here in the US?!)

France still has a layer of health insurance in their system, with over 90% of their population having some form of private insurance (mainly for stuff that isn’t covered - copays, and dental and vision). Their universal system still leaves the individual a 20% coinsurance for inpatient hospital stays, and 30% for outpatient - and a huge range for drugs depending on their “effectiveness” (with something like insulin covered at 100%, some others only 85% or potentially not at all - there is a national drug formulary). But their costs for those inpatient and outpatient (and drugs) tend to be FAR LESS than what’s charged here.

This number is shockingly low. IIRC, US standards for “cost effective” are typically up to $100-150/QALY, though cancer therapeutics are sometimes several fold more expensive.

Could you imagine that conversation happening here in US?

No, but maybe it should, as we surely provide more futile care than other countries.

Of course, our system is so much more expensive than the rest of the world, so the cut-offs would have to be adjusted accordingly.

I was thinking the same on your last point. $25k goes a lot further with care there than it would here. And that’s the biggest problem.

How much do physicians in the US earn relative to other countries?

Much more. According to “world population review” - Switzerland is #1 just above USA, and we average (according to them and their math) $316k a year. #3 is Canada and they are under $200k. Also according to them France, Italy, Spain and Poland have an average Dr income less than $100k.

Statista lists US as #1 (but states they only looked at “select countries”) at $352k average. #2 for them is Canada at $273k, then a huge drop to their #3, Germany, at $169k. France, Italy and Spain all listed between 93-60k.

Keep in mind that it’s Doctors (specifically the AMA) who are against moving to a more socialized medicine model as they feel is will hurt their bottom lines.

Also bear in mind that it’s not just the doctors making money in our system, it’s the huge hospital (provider) groups. For those in northern Va familiar with the Inova hospital group (I believe 5 total hospitals around northern Va), their 2024 operating revenue is 5.7 billion, with a B. In total they have fewer than 2k hospital beds - and list nearly half a billion in “investment in new facilities”

There are 3, formerly 4, of my wife's family who are doctors in Fairfax... Pretty sure they work in that system. They seem to do just fine, fwiw.

If any happen to work in the children’s hospital in any capacity- I owe them a huge debt of gratitude.

Not specifically. Cardiologist, neurologist, radiologist (and FIL was a neurosurgeon).. all of them will touch on pediatrics as needed, but not their focus (which sounds creepy as I've just written).

If the neurologist works at Fairfax I more than likely met them. If its one in particular, he may have saved my son’s eyesight, and called me back personally on my cell phone to check up on him.

 

[Ministry of Pain]

Hey All, I just found this thread...had no idea this section of the site existed. Not looking to have philosophical debates, but I am more than happy to provide facts/context where I can. I am extremely close to this case in numerous ways.

Let’s hear it.

Well, I knew Brian for nearly 20 years, both personally and professionally. Maybe the single hardest working and intelligent person I have ever known. Regardless of what you hear about him, he dedicated his career, specifically the last 3 years, to making positive changes in the health care industry.

You may hear that UHC had AI bots that automatically denied claims this is not true. UHC acquired a company that did this, but this changed right away. UHC does use AI for auto-approving claims.

He, along with former CEO and current board member Steve Hemsley, were ACCUSED of insider trading. There was a large acquisition that was being held up in the courts. These executives are ALWAYS informed by the SEC, via internal counsel, when they are not allowed to sell stocks. This is not the first time C-suite level executives at UHG have been accused of this type of behavior. He was not tried, he was not allowed to answer his accusers, and he should be considered innocent.

Are you able to speak to the 2x vs other insurers denial rate that keeps getting posted?

I mean, partially, and it is not because I am being evasive, but it is not really that simple. UHC, at it's core, is a mergers and acquisitions company. They will purchase anywhere between 30-40 companies/year. These might be small 3-4 employee clinics, or the largest health care provider in Brazil, Peru, and Colombia. My point is that UHCs denials numbers could be inherited from an AE (acquired entity), regulatory requirements from local or national entities, and/or people not filling out or providing the correct information. This is not like The Rainmaker, there is no policy or AI controlled database that auto-denies every claim that comes in.

Do you think acquisition companies operating in healthcare facilitate improved patient care? Are profit-maximizing goals aligned with health outcomes?

The fact is, the healthier people are, the more money insurance companies make.

Although it may seem counter-intuitive, actually the sicker society becomes the more people need health insurance.

The insurance industry is perfectly fine with Big Pharma and our poor diet and exercise.

All I am saying is that the less an insurance company pays out (healthier people), the more money they make. It is a fact.

We can agree to disagree - as I think that's a simplistic view of it and stand by what I said.

If you were the CEO of a health insurance company, how would you tackle the obesity epidemic in America? How would you get people to eat better and exercise?

Make veggies taste like dessert
I do find most folks do not know how to properly prepare foods of all kinds
There is a way to cook up veggies with a little olive oil, S&P and don't give me any bologna about salt, if you don't eat fast food, if you don't eat salty snacks then a little salt on them veggies is just fine. Brussel Sprouts, potatoes, carrots, onions, other things you might like into a roasting pan and sprinkled with olive oil, S&P and into the oven, about 25-30 minutes later you have some hot tasty vegetables that are probably better than what you are served at many restaurants

I implore most veggie haters to take a fresh look at them and learn how to prepare them properly and in a way that makes them pretty tasty. Even if you don't love them at first, you are likely after about a week but maybe just a couple of days, the difference in your regularity and the amount of waste you tend to expel leaving you with a much lighter feeling throughout the day tends to make one more energetic and you'll find you get a lot more done

I am terrible at eating enough veggies but I do like them when they are fresh and cooked right. And I like what they do for me

 

[Dr. Octopus]

? The US and New Zealand are the only two countries in the world where it is legal to directly advertise prescription drugs. This needs to change.

I agree completely and as I pointed out their advertising dollars may (does) impact how the news reports on Big Pharma.

 

[Joe Bryant]

Hey All, I just found this thread...had no idea this section of the site existed. Not looking to have philosophical debates, but I am more than happy to provide facts/context where I can. I am extremely close to this case in numerous ways.

Let’s hear it.

Well, I knew Brian for nearly 20 years, both personally and professionally. Maybe the single hardest working and intelligent person I have ever known. Regardless of what you hear about him, he dedicated his career, specifically the last 3 years, to making positive changes in the health care industry.

You may hear that UHC had AI bots that automatically denied claims this is not true. UHC acquired a company that did this, but this changed right away. UHC does use AI for auto-approving claims.

He, along with former CEO and current board member Steve Hemsley, were ACCUSED of insider trading. There was a large acquisition that was being held up in the courts. These executives are ALWAYS informed by the SEC, via internal counsel, when they are not allowed to sell stocks. This is not the first time C-suite level executives at UHG have been accused of this type of behavior. He was not tried, he was not allowed to answer his accusers, and he should be considered innocent.

Are you able to speak to the 2x vs other insurers denial rate that keeps getting posted?

I mean, partially, and it is not because I am being evasive, but it is not really that simple. UHC, at it's core, is a mergers and acquisitions company. They will purchase anywhere between 30-40 companies/year. These might be small 3-4 employee clinics, or the largest health care provider in Brazil, Peru, and Colombia. My point is that UHCs denials numbers could be inherited from an AE (acquired entity), regulatory requirements from local or national entities, and/or people not filling out or providing the correct information. This is not like The Rainmaker, there is no policy or AI controlled database that auto-denies every claim that comes in.

Do you think acquisition companies operating in healthcare facilitate improved patient care? Are profit-maximizing goals aligned with health outcomes?

The fact is, the healthier people are, the more money insurance companies make.

Although it may seem counter-intuitive, actually the sicker society becomes the more people need health insurance.

The insurance industry is perfectly fine with Big Pharma and our poor diet and exercise.

All I am saying is that the less an insurance company pays out (healthier people), the more money they make. It is a fact.

We can agree to disagree - as I think that's a simplistic view of it and stand by what I said.

If you were the CEO of a health insurance company, how would you tackle the obesity epidemic in America? How would you get people to eat better and exercise?

I don't believe it's up to the health insurance industry to take on that responsibility (I did not blame them for the health epidemic in this Country, what I said is they are perfectly happy for people to be sick, generally, which is fact).

Generally, a good start would be to get Big Pharma and Big AG lobbies out of our government and have our government educate the people better. The "food pyramid" is bogus, yet its still taught in schools. We market sugar bomb cereals, toaster pastries and orange juice as a healthy breakfast and "the most important meal of the day".

The government's childhood obesity studies was sponsored by Novo Norddisk - guess what their findings were? The report stated children as young as 12 years old should start Ozempic treatments to combat obesity - no mention of diet or exercise.

The diabetes study was sponsored by Coca-Cola and guess what, there's no mention about how bad soda is for you.

This is way off topic now though,

This can get way more into the Callie Means "Good Energy" area of discussion. Which I think can be useful. Although again, not sure we can keep it politics free even though I think it should be.

Although should be a different thread than this one.

 

[Stoneworker]

The government's childhood obesity studies was sponsored by Novo Norddisk - guess what their findings were? The report stated children as young as 12 years old should start Ozempic treatments to combat obesity - no mention of diet or exercise.

Hard to have a productive conversation with someone who's posting stuff that is simply not factually correct.

Conclusions**
- Among adolescents with obesity, once-weekly treatment [with semaglutide/Ozempic] plus lifestyle intervention resulted in greater BMI than lifestyle intervention alone.

- For young people, obesity management guidelines recommend multimodal lifestyle modification.

- Semaglutide is approved...for long term weight management as an adjunct to a reduced calorie diet and increased physical activity...


**New England Journal of Medicine: Semaglutide in Adolescents with Obesity

 

[Fat Nick]

If you were the CEO of a health insurance company, how would you tackle the obesity epidemic in America? How would you get people to eat better and exercise?

Honestly, my $0.02 - they'll broadly cover GLP1's for anyone who's BMI indicates a risk for other health issues. Look at Chantix, the anti-smoking drug. They initially didn't cover it until they started doing the math on whether it was cheaper to cover the drug vs. covering subsequent lung and heart issues caused by smoking. Same with weight loss - They'll realize that covering GLP1's are a lot cheaper than covering the longer term impacts of obesity for their insured.

Unless they find that GLP1's cause other issues down the road.

True - but that's a risk with everything really...Admittedly more with newer medicines.

 

[Joe Bryant]

It also may not be possible for a discussion as a primary proponent of the limiting big pharma is Robert Kennedy Jr and I'm not sure we can handle that. (even though I agree with a ton of what he and Means say - especially about pharma)

 

[El Floppo]

Since I do not know the answer ... what do the quasi -socialist govts in Europe do for healthcare denials? For instance, Sweden. I guess it's called public healthcare for them France, Netherlands, etc. I'm told you can just walk in to a hospital or doctor and they take care of you. You walk out without a bill. Obvi society is paying for your treatment with higher taxes. But do they say "nothing is wrong with you" and deny treatment. Do they determine afterwards that it was unnecessary and bill you back? Anyone lived there?

First off, I hope you realize just how complicated of a question you’re asking here. So many factors at play. Every system is different, and EVERY system rations care somehow, by someone, for something. Here in the US, for better or worse, we might have an insurance company denying you the coverage (or more technically, saying they won’t pay for it).

The UK, for instance, has the National Health Service (NHS), who uses the National Institute for Care Excellence (or NICE) to assess the cost-effectiveness of care with a system called QALYs (quality adjusted life years) to quite literally put a value on the number of expected years a person has remaining (roughly 25k pounds I believe - pounds being their currency obviously). If care is expected to give a person an additional quality adjusted life years (QALY) and cost less then ~25k pounds, it’s likely approved. Much more than that, it likely won’t be - and it’s never requested, thus can’t be rejected/denied. It’s generally accepted that it works there due to Britain’s post WW2 views of shared sacrifice, which we really don’t have here at this time. (As an aside, can you imagine AI taking over a system like that here in the US?!)

France still has a layer of health insurance in their system, with over 90% of their population having some form of private insurance (mainly for stuff that isn’t covered - copays, and dental and vision). Their universal system still leaves the individual a 20% coinsurance for inpatient hospital stays, and 30% for outpatient - and a huge range for drugs depending on their “effectiveness” (with something like insulin covered at 100%, some others only 85% or potentially not at all - there is a national drug formulary). But their costs for those inpatient and outpatient (and drugs) tend to be FAR LESS than what’s charged here.

This number is shockingly low. IIRC, US standards for “cost effective” are typically up to $100-150/QALY, though cancer therapeutics are sometimes several fold more expensive.

Could you imagine that conversation happening here in US?

No, but maybe it should, as we surely provide more futile care than other countries.

Of course, our system is so much more expensive than the rest of the world, so the cut-offs would have to be adjusted accordingly.

I was thinking the same on your last point. $25k goes a lot further with care there than it would here. And that’s the biggest problem.

How much do physicians in the US earn relative to other countries?

Much more. According to “world population review” - Switzerland is #1 just above USA, and we average (according to them and their math) $316k a year. #3 is Canada and they are under $200k. Also according to them France, Italy, Spain and Poland have an average Dr income less than $100k.

Statista lists US as #1 (but states they only looked at “select countries”) at $352k average. #2 for them is Canada at $273k, then a huge drop to their #3, Germany, at $169k. France, Italy and Spain all listed between 93-60k.

Keep in mind that it’s Doctors (specifically the AMA) who are against moving to a more socialized medicine model as they feel is will hurt their bottom lines.

Also bear in mind that it’s not just the doctors making money in our system, it’s the huge hospital (provider) groups. For those in northern Va familiar with the Inova hospital group (I believe 5 total hospitals around northern Va), their 2024 operating revenue is 5.7 billion, with a B. In total they have fewer than 2k hospital beds - and list nearly half a billion in “investment in new facilities”

There are 3, formerly 4, of my wife's family who are doctors in Fairfax... Pretty sure they work in that system. They seem to do just fine, fwiw.

If any happen to work in the children’s hospital in any capacity- I owe them a huge debt of gratitude.

Not specifically. Cardiologist, neurologist, radiologist (and FIL was a neurosurgeon).. all of them will touch on pediatrics as needed, but not their focus (which sounds creepy as I've just written).

If the neurologist works at Fairfax I more than likely met them. If its one in particular, he may have saved my son’s eyesight, and called me back personally on my cell phone to check up on him.

Pm sent... That would be wild

 

[Dr. Octopus]

The government's childhood obesity studies was sponsored by Novo Norddisk - guess what their findings were? The report stated children as young as 12 years old should start Ozempic treatments to combat obesity - no mention of diet or exercise.

Hard to have a productive conversation with someone who's posting stuff that is simply not factually correct.

Conclusions**
- Among adolescents with obesity, once-weekly treatment [with semaglutide/Ozempic] plus lifestyle intervention resulted in greater BMI than lifestyle intervention alone.

- For young people, obesity management guidelines recommend multimodal lifestyle modification.

- Semaglutide is approved...for long term weight management as an adjunct to a reduced calorie diet and increased physical activity...


**New England Journal of Medicine: Semaglutide in Adolescents with Obesity

You're correct - I should have said they make it secondary to their injections.

My bad, and sorry for the inaccuracy- I read that separately but did not confirm.

Still the bottom line is shots from 12 years on is likely not a healthy pathway to beating obesity.

 

[Nugget]

Hey All, I just found this thread...had no idea this section of the site existed. Not looking to have philosophical debates, but I am more than happy to provide facts/context where I can. I am extremely close to this case in numerous ways.

Let’s hear it.

Well, I knew Brian for nearly 20 years, both personally and professionally. Maybe the single hardest working and intelligent person I have ever known. Regardless of what you hear about him, he dedicated his career, specifically the last 3 years, to making positive changes in the health care industry.

You may hear that UHC had AI bots that automatically denied claims this is not true. UHC acquired a company that did this, but this changed right away. UHC does use AI for auto-approving claims.

He, along with former CEO and current board member Steve Hemsley, were ACCUSED of insider trading. There was a large acquisition that was being held up in the courts. These executives are ALWAYS informed by the SEC, via internal counsel, when they are not allowed to sell stocks. This is not the first time C-suite level executives at UHG have been accused of this type of behavior. He was not tried, he was not allowed to answer his accusers, and he should be considered innocent.

Are you able to speak to the 2x vs other insurers denial rate that keeps getting posted?

I mean, partially, and it is not because I am being evasive, but it is not really that simple. UHC, at it's core, is a mergers and acquisitions company. They will purchase anywhere between 30-40 companies/year. These might be small 3-4 employee clinics, or the largest health care provider in Brazil, Peru, and Colombia. My point is that UHCs denials numbers could be inherited from an AE (acquired entity), regulatory requirements from local or national entities, and/or people not filling out or providing the correct information. This is not like The Rainmaker, there is no policy or AI controlled database that auto-denies every claim that comes in.

Do you think acquisition companies operating in healthcare facilitate improved patient care? Are profit-maximizing goals aligned with health outcomes?

The fact is, the healthier people are, the more money insurance companies make.

Although it may seem counter-intuitive, actually the sicker society becomes the more people need health insurance.

The insurance industry is perfectly fine with Big Pharma and our poor diet and exercise.

All I am saying is that the less an insurance company pays out (healthier people), the more money they make. It is a fact.

I was under the impression that an insurer would have to lower their premiums if they didn't hit a certain threshold. So a company that pays out $2B in claims can have double the admin/profit than a company that pays out $1B in claims. It is kind of like real estate agents - both side want the house to sell for more as they are paid on commission.

 

[Gjallarhorn]

To all of you, I greatly appreciated this conversation. I really NEEDED this after the last week. This is where I will leave it:

Most reasonable people can agree that we do not want America to be a place where we murder people that we disagree with.

I think we can all agree that there is an opportunity for the health care to be better. Whether or not this action changes anything, I am not confident. Pitchfork Nation will move onto the next thing shortly, UHT stock will rebound, and it will most likely be business as usual. Not really sure how I feel about this as some people have made some good points about reform that is needed.

This is far from over. I am sure that there will be some Senate hearings in the next twelve months where a lot of these points will be publicly discussed.

Again, thank you for restoring my faith in this site's community. I look forward future conversations.

P.S. Jordan Love still sucks.

 

[Jaysus]

his "manifesto" posted to reddit:


The full manifesto reads:

“To the Feds, I’ll keep this short, because I do respect what you do for our country. To save you a lengthy investigation, I state plainly that I wasn’t working with anyone. This was fairly trivial: some elementary social engineering, basic CAD, a lot of patience. The spiral notebook, if present, has some straggling notes and To Do lists that illuminate the gist of it. My tech is pretty locked down because I work in engineering so probably not much info there. I do apologize for any strife of traumas but it had to be done. Frankly, these parasites simply had it coming. A reminder: the US has the #1 most expensive healthcare system in the world, yet we rank roughly #42 in life expectancy. United is the [indecipherable] largest company in the US by market cap, behind only Apple, Google, Walmart. It has grown and grown, but as our life expectancy? No the reality is, these [indecipherable] have simply gotten too powerful, and they continue to abuse our country for immense profit because the American public has allwed them to get away with it. Obviously the problem is more complex, but I do not have space, and frankly I do not pretend to be the most qualified person to lay out the full argument. But many have illuminated the corruption and greed (e.g.: Rosenthal, Moore), decades ago and the problems simply remain. It is not an issue of awareness at this point, but clearly power games at play. Evidently I am the first to face it with such brutal honesty."

Did he really copy his manifesto from someone else's reddit post? Talk about copy pasta.