"Not Medically Necessary": Helping America's Health Insurers Deny Coverage • Hacker News Board

Re: "Not Medically Necessary": Helping America's Health Insurers Deny Coverage

#221

Post by JohnMakin » Sat, May 16, 2026, 4:10 PM UTC

hackeraccount wrote: post #210

JohnMakin wrote: post #68

I am perplexed by the type of people that are able to stomach working in these kind of positions - how do they rationalize it? Do they really just not care? Like, in some industries that are not doing great things, or bordering on evil things, I can see sometimes how one could convince themselves they were actually doing good. But this denial stuff is nearly like, "press this button to make money, knowing you may be…

By this logic how could you ever work in Healthcare? If you're a Doctor why are you taking a day off to - of all things - go to the beach? Do you really just not care? Take this day off, knowing you may be denying someone critical care that could kill them or cause them harm? And you're comfortable doing that? Do you love the beach that much?

This type of reasoning is called a fallacy. But I guess I found one?

Re: "Not Medically Necessary": Helping America's Health Insurers Deny Coverage

#222

Post by JohnMakin » Sat, May 16, 2026, 7:53 PM UTC

ahepp wrote: post #216

JohnMakin wrote: post #215

Earlier quoted context omitted.

> But to simply say "no claim should ever be subject to review or denial, and anyone working to make the system efficient is evil" is deeply ignorant and fundamentally incompatible with the concept of insurance. I did not say this. but you do you.

I'm not sure how you could deny it when you just wrote quite a bit of detail about how you think anyone doing that work is an evil sociopath.

I have no interest debating someone who frames dishonestly what I say to their own arguments. have a good day.

Re: "Not Medically Necessary": Helping America's Health Insurers Deny Coverage

#223

Post by singleshot_ » Sun, May 17, 2026, 2:08 PM UTC

ben-johnson wrote: post #62

singleshot_ wrote: post #54

Earlier quoted context omitted.

[flagged]

Are they? I would love to hear how you would solve those problems rather than make a blythe, thoughtless remark

Did you know you spelled "unbridled" wrong because you are an idiot?

Re: "Not Medically Necessary": Helping America's Health Insurers Deny Coverage

#224

Post by anarticle » Mon, May 18, 2026, 2:19 PM UTC

nradov wrote: post #187

anarticle wrote: post #145

I think in the case of Optum + UnitedHealthCare being the Scylla and Charybdis of a healthcare situation, we should break up this style of business. Owning both sides of the equation means there is no competition if you are unlucky enough to find this combination. Feels like two wolves negotiating on how much of the sheep (the sheep is you) they get to eat. Dare I ask, who is for the "consumer"? If we should even use…

That same basic "payvider" business model has been around since Kaiser Permanente pioneered it in the 1940s. The problem isn't with the business model per se, but with consolidation that has effectively eliminated competition in some regions.

How is the payvider model better for customers?

I see why it can reduce costs in a runaway cartel based system, but how does it prevent the two wolf scenario? (It's the same wolf in this scheme.)