How three years at McKinsey shaped my second startup • Hacker News Board

Re: How three years at McKinsey shaped my second startup

#121

Post by sokoloff » Wed, May 07, 2025, 7:09 PM UTC

QuercusMax wrote: post #42

robertlagrant wrote: post #33

Earlier quoted context omitted.

You can use people to deny as well. Or non-AI automation; just some business rules in a normal system.

United Healthcare was in the news last year because they had an AI claims "approval" process with a 90% error rate, all in favor of the insurance company. It's easy to describe a business process with written down rules, and those are easy to find in legal discovery. It's much easier to obfuscate with an AI model, because "nobody knows what it's actually doing - it's AI!".

It was not a 90% error rate (or at least that’s not a claim I read). It was that 90% of appeals of those decisions were decided (at least partially) in favor of the appeal. That could be 1000 decisions, 10 appeals, and 9 reversals.

I am personally 7 for 8 in lifetime wins in my city's parking ticket appeals process. That doesn't mean that I think that 7 out of 8 tickets my city issues are incorrect.

Re: How three years at McKinsey shaped my second startup

#122

Post by pinkmuffinere » Wed, May 07, 2025, 7:35 PM UTC

n_ary wrote: post #79

johnobrien1010 wrote: post #15

Wanted to point to the startup the author seems to be running, which is to sell insurance somehow tied to Bitcoin: https://meanwhile.bm/ For the record, that strikes me as seriously improper. Life insurance is a heavily regulated offering intended to provide security to families. It is the opposite of bitcoin, which is a highly speculative investment asset. Those two things should not be mixed. Also, the fact that th…

Did I read that right? Sam Altman is funding this? If true, I am having some new perspective him.

I assume from your comment that you haven’t heard of WorldCoin, also funded by Altman.

https://world.org/

Re: How three years at McKinsey shaped my second startup

#123

Post by RankingMember » Wed, May 07, 2025, 7:39 PM UTC

lostlogin wrote: post #18

throw10920 wrote: post #6

Article is interesting on the whole (I have no experience with "professional" work, and would love for suggestions as to how to be more familiar), but I latched onto this nugget: > Our vision at Meanwhile is to build the world's largest life insurer as measured by customer count, annual premiums sold, and total assets under management. We aim to serve a billion people, using digital money to reach policyholders and a…

I agree. And then I recall my last few interactions with insurance companies. Dealing with a machine is unlikely to be worse.

While a human interaction can be awful, there's a special hellishness that is trying to negotiate with a robot to get something related to your healthcare taken care of.

Re: How three years at McKinsey shaped my second startup

#124

Post by tkluck » Wed, May 07, 2025, 7:39 PM UTC

thenewwazoo wrote: post #109

burningChrome wrote: post #80

Earlier quoted context omitted.

>> that the only way to provide dispute resolution and customer service to 1B people with only 100 employees is by depriving them of any chance to interact with a human. Real world evidence supporting your argument: United Health Group is currently embroiled in a class action lawsuit pertaining to using AI to auto-deny health care claims and procedures: The plaintiffs are members who were denied benefit coverage. The…

> 90% error rate, meaning nine of 10 appealed denials were ultimately reversed. This is a fantastic illustration of selection bias. It stands to reason that truly-unjustified (some hidden variable) denials would be appealed at a higher rate and therefore the true value is something less than 90%. That's not to say UHG are without blame, I just thought this was really interesting.

Your scientific take is useful in the case where selection bias is unavoidable and needs to be corrected for.

This case is not like that; if the insurance agency wants to dispute the 90% false denial rate, it would be trivial for them to take a random sample of _all_ cases, go through the appeal process for those, and publish the resulting number without selection bias.

As long as that doesn't happen, the most logical conclusion for us outside observers is: the number is probably not so much lower than 90% that it makes a difference.

Re: How three years at McKinsey shaped my second startup

#125

Post by nothercastle » Wed, May 07, 2025, 8:07 PM UTC

Muromec wrote: post #81

alpha_squared wrote: post #36

Earlier quoted context omitted.

> AI can (theoretically) be a lot more fair in dealing with claims Respectfully, no it can't. From a Western perspective, specifically American, and from an average middle-class person's perspective, specifically American, it only appears to be fair. However, LLMs are a codification of internet and written content, largely by English speakers for English speakers. There are <400m people in the US and ~8b in the world…

On the other hand, once the claim is mishandled by AI, one can use the normal process to discover the juiced prompt and all the papertrail that comes with implementing it.

Yeah good luck getting the company to cough up what they call “Source code” during discovery

Re: How three years at McKinsey shaped my second startup

#126

Post by ImPostingOnHN » Wed, May 07, 2025, 9:22 PM UTC

justinrubek wrote: post #118

ImPostingOnHN wrote: post #57

Earlier quoted context omitted.

> We should be providing social safety nets for people, not fake jobs. I agree with you (except in classifying the genuine effort of my fellow people to be "fake jobs" just because a computer can do some of the work) and believe making a resilient, trustworthy, proven system for the former is a prerequisite to withdrawing the latter, to avoid suffering. Unfortunately for us, the barrier to the former is ideological i…

Nobody has classified genuine effort as fake. But what good is genuine effort when it can be done much more easily without it? There's no shame whatsoever in this. At least, I don't think we should add any to the situation.

> Nobody has classified genuine effort as fake. But what good is genuine effort when it can be done much more easily without it?

This was previously stated: the good being done is 100,000 people can feed their families. What good is going without that? You'll enrich some private equity dudes and make a lot more people unemployed and a lot more families unhappy.

Re: How three years at McKinsey shaped my second startup

#127

Post by sokoloff » Wed, May 07, 2025, 9:38 PM UTC

tkluck wrote: post #124

thenewwazoo wrote: post #109

Earlier quoted context omitted.

> 90% error rate, meaning nine of 10 appealed denials were ultimately reversed. This is a fantastic illustration of selection bias. It stands to reason that truly-unjustified (some hidden variable) denials would be appealed at a higher rate and therefore the true value is something less than 90%. That's not to say UHG are without blame, I just thought this was really interesting.

Your scientific take is useful in the case where selection bias is unavoidable and needs to be corrected for. This case is not like that; if the insurance agency wants to dispute the 90% false denial rate, it would be trivial for them to take a random sample of _all_ cases, go through the appeal process for those, and publish the resulting number without selection bias. As long as that doesn't happen, the most logica…

What do you think the claim approval rate is? Less than 10%?

It stands to reason that the overwhelming majority of cases where the claim was approved were approved correctly. Unless that rate is well under 15%, it’s impossible to have the claimed “90% error rate”.

Re: How three years at McKinsey shaped my second startup

#128

Post by siliconc0w » Wed, May 07, 2025, 9:42 PM UTC

throw10920 wrote: post #6

Article is interesting on the whole (I have no experience with "professional" work, and would love for suggestions as to how to be more familiar), but I latched onto this nugget: > Our vision at Meanwhile is to build the world's largest life insurer as measured by customer count, annual premiums sold, and total assets under management. We aim to serve a billion people, using digital money to reach policyholders and a…

AI adjudication of healthcare is fine but there needs to be extremely steep consequences for false negatives and a truly independent board of medical experts to appeal to. If a large panel agrees the denial was wrong, a penalty of 10-100x the cost of procedure would be assessed depending on the consequence of the denial.

Re: How three years at McKinsey shaped my second startup

#129

Post by sokoloff » Wed, May 07, 2025, 9:43 PM UTC

sethhochberg wrote: post #96

SoftTalker wrote: post #75

Earlier quoted context omitted.

It is kind of weird. Why does a life insurer have 100,000 employees. I'm really only familiar with term life. All the "customer service" is pre-purchase. Once you buy it, you forget it other than making the annual payment. There's nothing to manage, no real customer service required until and unless you die. I suppose whole life where there is a cash value and investments being managed might have a more ongoing servi…

I work in the industry at a startup insurtech, we are a life insurance carrier (wysh.com - our flagship product is a b2b micro life insurance benefit, but we built that on top of a term life carrier and also sell d2c term life) Allianz has ~150k employees but certainly they don't all work on the term life business in the USA, they do all kinds of other insurance stuff all over the world and have hundreds of different…

> You'd probably be shocked how common it is for former-spouses to try and take out insurance policies without the other knowing during divorces.

If they were receiving spousal support (“alimony”) or child support, this seems unsurprising and sensible.

Re: How three years at McKinsey shaped my second startup

#130

Post by ImPostingOnHN » Wed, May 07, 2025, 10:36 PM UTC

patmcc wrote: post #106

ImPostingOnHN wrote: post #31

Earlier quoted context omitted.

> it directly causes suffering via creating a societal permission structure for politicians to protect interest groups with protectionist trade policy and internal pork barreling policy What part of that is suffering, if it enables 100k constituents to put food on the table?

We could employ 100k people to dig holes and then fill them back in; should we? We shouldn't employ people in economically un-viable ways just because they need income. We can just give them money directly, or redirect them to other work, or a combination of the two.

> We could employ 100k people to dig holes and then fill them back in; should we?

If that is what's necessary to provide a social safety net, then maybe so. See the works progress administration for an example of this.

> We can just give them money directly, or redirect them to other work

Ideally yes, but that isn't happening, hence the first option.

We may be straying here, though: this discussion didn't start out with someone saying what someone else should or shouldn't do. We were discussing the ethical and economic consequences of an idea.