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UnitedHealth's Effort to Deny Coverage for a Patient's Care (2023)

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Re: UnitedHealth's Effort to Deny Coverage for a Patient's Care (2023)

#71
post #55

Earlier quoted context omitted.

There’s an incredibly strong argument this particular person likely killed tens of thousand of people by his decisions to deny and delay care. This was not an employee carrying out orders from corporate, it’s the guy who is directly responsible for these deaths. This CEO is as much a mass murder as any other tyrant who commanded soldiers to commit atrocities. That will be part of the defense argument presented to the…

> That will be part of the defense argument presented to the jury. That evidence wouldn't be admitted. There's no “the guy deserved it” defense for murder, it's always illegal to kill people.

> That evidence wouldn't be admitted. There's no “the guy deserved it” defense for murder, it's always illegal to kill people.

That's where jury nullification comes in: https://en.wikipedia.org/wiki/Jury_nullification

Re: UnitedHealth's Effort to Deny Coverage for a Patient's Care (2023)

#72

Horrifying. But also horrifying that treatment costs so much. Supposedly we have to let drug companies charge extravagant prices because it costs so much to discover new treatments, but there has to be a great deal of inefficiency there. Are we getting a 99% solution for $X when we could be getting a 95% solution for $X/10?

The inefficiency is that for many pharmaceutical companies in the US, their marketing budget is much higher than (~10X) the R&D budget.

Where are you getting 10X? If I look at, say, Merck, their "sales, general, and administrative expenses" [1] trends at even or slightly higher than their R&D expenses [2]. Abbvie's ratio is around 2x [3, 4].

AFAIK, SG&A is the number that groups criticizing pharmaceutical companies look at, even though it includes a lot of money spent on things like paying lawyers, which any pharmaceutical company that actually wants to make back the billions spent on developing drugs will have to do.

[1] https://www.statista.com/statistics/269499/merck-and-co-sgan...

[2] https://www.statista.com/statistics/282738/expenditure-on-re...

[3] https://www.macrotrends.net/stocks/charts/ABBV/abbvie/sellin...

[4] https://www.statista.com/statistics/417068/r-and-d-expenditu...

Re: UnitedHealth's Effort to Deny Coverage for a Patient's Care (2023)

#73

I really don’t get why everyone involved is allowed to have hidden prices. It looks like a highway robbery. I had a relative visiting from Europe and they had to go to the urgent care for some blood and urine tests and consultation. They received a $2,500 bill! My relative told the hospital that they are leaving the country and offered to pay $250 or good luck collecting from abroad. Then something magical happened.…

I had to get a medication for a stomach bacteria called C. diff. It has bad relapse rates and its best to get it in check asap. What my doctor prescibed was the newest/best antibiotic for the issue, the other have worse recovery rates and way worse side effects.

I have very good insurance. The price of the medication without insurance was about $5000, the price with very good insurance was about $1300. After redditing i found a thread where you can find a manufacturers coupon on the manufacturers website. After knowing this seemingly secret hidden trick the medicine was $50. My doctor didnt know about that, my insurance didnt either. Absolutely insane. Absolutely arbitrary.

Re: UnitedHealth's Effort to Deny Coverage for a Patient's Care (2023)

#74
post #26
post #8

Earlier quoted context omitted.

As a New Yorker myself, I’m fairly confident.

I'm also a New Yorker and I think that most of us actually do not believe that assassinations are a net benefit to society, no matter how dissatisfied with the health care system we are.

It was actually a pretty large net positive. Anthem immediately reversed their decision to cap anesthesiology coverage:

https://www.wfsb.com/2024/12/05/anthem-backtracks-anesthesio...

Re: UnitedHealth's Effort to Deny Coverage for a Patient's Care (2023)

#75
post #55

Earlier quoted context omitted.

There’s an incredibly strong argument this particular person likely killed tens of thousand of people by his decisions to deny and delay care. This was not an employee carrying out orders from corporate, it’s the guy who is directly responsible for these deaths. This CEO is as much a mass murder as any other tyrant who commanded soldiers to commit atrocities. That will be part of the defense argument presented to the…

> That will be part of the defense argument presented to the jury. That evidence wouldn't be admitted. There's no “the guy deserved it” defense for murder, it's always illegal to kill people.

A) You literally cannot have a murder trial without presenting a motive or evidence of reckless negligence/behavior (eg drunk driving).

This is not drunk driving, ergo motive will be central to prosecution and defense alike.

B) His lawyers will be the best of the best.

C) Jury nullification.

Re: UnitedHealth's Effort to Deny Coverage for a Patient's Care (2023)

#76
post #26
post #8

Earlier quoted context omitted.

As a New Yorker myself, I’m fairly confident.

I'm also a New Yorker and I think that most of us actually do not believe that assassinations are a net benefit to society, no matter how dissatisfied with the health care system we are.

Was the man who strangled a homeless man on the subway convicted of murder, or did the jury let him go in the end? Is it judged yet?

But I agree with you, I think most new Yorkers will convict someone who killed a CEO. Also I bet they'll let go someone who killed a homeless person. I don't know a lot of new Yorkers but petty bourgeois are the same in every countries.

Re: UnitedHealth's Effort to Deny Coverage for a Patient's Care (2023)

#77
post #57

Earlier quoted context omitted.

Do you have evidence for "most new treatment research is government funded (and by governments of other countries)"? My understanding is that the opposite is true: big pharmaceutical companies foot most of the bill for developing new drugs, then US-based insurers pay high costs, and most "other countries" enjoy much lower prices because US healthcare is effectively subsidizing their drug prices.

It’s both working together- the basic research, including identifying targets and new chemistry and in some cases even the drugs themselves are mostly academia. However, clinical trials, and drug development that iterates the chemical structure itself and delivery approaches is very expensive, and almost entirely done by industry. Often the academics are working collaboratively with pharmaceutical- and can have eithe…

Thanks. Do you have some sense of the breakdown in actual expenses incurred by the basic research and subsequent industrial development? It may qualitatively be true that many governments sponsor basic research that is later productized, but if the second bit costs 1000x more than the first bit, it's not exactly a fairly shared cost.

Re: UnitedHealth's Effort to Deny Coverage for a Patient's Care (2023)

#78
post #55

Earlier quoted context omitted.

There’s an incredibly strong argument this particular person likely killed tens of thousand of people by his decisions to deny and delay care. This was not an employee carrying out orders from corporate, it’s the guy who is directly responsible for these deaths. This CEO is as much a mass murder as any other tyrant who commanded soldiers to commit atrocities. That will be part of the defense argument presented to the…

> That will be part of the defense argument presented to the jury. That evidence wouldn't be admitted. There's no “the guy deserved it” defense for murder, it's always illegal to kill people.

That this sort of mass killing is an externality to our legal system is why people have to take matters into their own hands. Our system is flawed and this a a symptom.

Re: UnitedHealth's Effort to Deny Coverage for a Patient's Care (2023)

#79
post #11

Horrifying. But also horrifying that treatment costs so much. Supposedly we have to let drug companies charge extravagant prices because it costs so much to discover new treatments, but there has to be a great deal of inefficiency there. Are we getting a 99% solution for $X when we could be getting a 95% solution for $X/10?

>But also horrifying that treatment costs so much. My mother underwent chemotherapy for her cancer. According to the statements from her insurance company, each round of chemotherapy cost as much as a new luxury car before hospital vs. insurance negotiations. Yeah. The value of health insurance isn't just the offloading of expenses, it's also their power to tell hospitals to get fucking bent with ludicrous bills.

Insurance companies have a motivation to see high healthcare costs - it justifies higher premiums, and in a broken 'public' healthcare system that entrenches insurance middlemen, and subsidizes their costs for those unable to afford them, you're just going to see costs skyrocket endlessly.

Public healthcare, of any sort, should not involve working with third party insurance companies.

In any case, this is also why medical tourism is a thing - you could go get the exact same treatment, to completion, half way around for far less than what you the cost you were quoted for a single round in the US - including housing and other costs.

Re: UnitedHealth's Effort to Deny Coverage for a Patient's Care (2023)

#80

I really don’t get why everyone involved is allowed to have hidden prices. It looks like a highway robbery. I had a relative visiting from Europe and they had to go to the urgent care for some blood and urine tests and consultation. They received a $2,500 bill! My relative told the hospital that they are leaving the country and offered to pay $250 or good luck collecting from abroad. Then something magical happened.…

I needed an adrenalectomy.

I called before hand, trying to figure out what I would owe afterwards.

No one could give me a price. It’s all vague, we don’t know answers.

It’s absurd.

I basically got stern - eventually somebody is going to send me a bill with a number on it, so someone knows what this will cost.

Still never got a solid number out of them.

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