"Slow Pay, Low Pay or No Pay": Blue Cross Approved Surgeries Then Refused to Pay

> But the insurer’s defense went even further, to the very meaning of “prior authorization,” which it had granted women like Arch to pursue surgery. The authorization, they said in court, recognized that a procedure was medically necessary, but it also contained a clause that it was “not a guarantee of payment.” Blue Cross was not obliged to pay the center anything, top executives testified. “Let me be clear: The authorization never says we’re going to pay you,” said Steven Udvarhelyi, who was the CEO for the insurer from 2016 to 2024, in a deposition. “That’s why there’s a disclaimer.

> At the trial, Blue Cross revealed that it had never considered any of the appeals — nor had it ever told the center that they were pointless. “An appeal is not available to review an underpayment,” acknowledged Paula Shepherd, a Blue Cross executive vice president. The insurer simply issued an edict — the payment was correct.

> On several occasions, though, Blue Cross executives had signed special one-time deals with the center, known as single case agreements, to pay for their wives’ cancer treatment.

What would be the point, honestly?

Calling for his assassination would, rightly in my opinion, be prosecutable.

I'm too demoralized at the moment to hope for what I'd consider an appropriate response by state or federal governments / courts.

The third most likely solution, revolution / civil war, would probably cause far more suffering than any fixes it might enable.

I'm curious if America will soon reach a tipping point where a sizeable portion of its population actually makes an effort to emigrate, rather than just talking about it.

Changing insurer's incentive landscape.

I also learned that they have a whole bureaucracy already in place for appealing of payments. (People whose job it is to field all the rejected and then appealed claims, and write multi-page letters explaining their reasoning...) So I took my complaint to my state's consumer complaints department. Let the two bureaucrats explain things to each other.

And in the end, the insurance company paid me.

Whether this will usher in a free market utopia remains to be seen, but I think the health insurance industry is going to collapse under the weight of its own greed.

If the dictator promised to round up these CEOs and send them to El Salvador without a trial, that would be one thing... but the opposite is true, and I think the electorate understood that well enough.

I'm not saying I agree with their voting decision, but I can, in part, understand their frustration.

I’m with the poster who suggested emigration. If this chaos continues, I’ll be tempted to renew my UK passport and/or apply for an Irish passport.

The moment a company capitulates as the result of murder, they’ve now incentivized more murder.

Such attacks on the people running these companies can only impede change I think by forcing companies to become more entrenched in their existing practices.

This option doesn't work because healthcare can't be a free market. Car insurance companies have to compete not only with each other but with alternatives like not owning a car at all. There is no alternative to being alive, so health insurance companies can effortlessly collude to raise prices across the industry knowing that they have the most captive customer base possible.

..and frankly they’re not wrong. No unjust system can maintain itself in the long term, the choice is “personal sacrifice” or “destroy everything” and it’s quite easy to make

Stop having employer provided insurance / benefits; just tax and then provide services. No more billing department. Just single payer (we the people) get what a patient needs healthcare.

ooor they're incentivized to force some legal resolution to make crowd "believe in system working" instead of "despair in neither system nor murder working"

That's because they negotiated and paid for such a plan.

My sister works for a similar large employer. They hired Cigna as the insurer/benefits administrator, and every interaction is a problem. Your two kids have an ear infection? Cool, we've determined that the second one is due to an auto accident. It's so bad that the company hired another company to argue with Cigna for you.

End of the day, the employer controls the purse, and the insurer is doing what the employer paid for. It's cheaper to hire another company to argue for the folks who have noticed problems than to pay for a level of service.

We’ve legalized bribery. Politicians are genuinely very cheap to buy.

It doesn’t matter who you vote for. Everyone has a price.

It might be worth reaching out to your state (local, not federal) rep and also your state’s insurance commissioner.

(b) if we had a reasonable market then some people could have an alternative like paying out of pocket

Otherwise we end up paying more anyway. Someone needs to bail out hospitals.

Not necessarily? That’s hardly within the traditional American notion of the scope of government. Core american principles focus on protecting people from the government, not the government protecting people from each other.

The American people basically legalized fraud and looting for the next four years.

Insurance companies are just doing what their clients, our employers, want which is reducing cost at every possible angle. Just like how companies cut every possible cost everywhere these days.

It's all the same problem: cost cutting across the board, at any price, by American businesses.

The Democrats have succeeded at suppressing the populist wing of their party, which led to them being defeated by the populist wing of the Republican Party.

If people could pull their heads out of their partisan asses they'd see this. The color of the dictator may as well be the result of a coin toss. This is the result of a long term trend.

But at the same time, i guess i'll be contrarian and say the other notable bit to me is that the person wants the absolute best doctors working on her, at the absolute best place possible because they pioneered the technique. I get why. But it's not necessarily reasonable. Obviously, if her cases needs that, she should get it. But it's really unclear from the article - is her case one that any competent surgeon could do, or only these surgeons can do. It does say they pioneered one technique, but that doesn't mean they are the only ones who do it or are good at it. She just says "i want the people who teach other people working on me", which certainly resonates with lots of people (i'm sure that's why it's there), but also, probably too high of a standard?

In the end - the absolute best of everything is expensive. Very expensive. I doubt a system can afford to have that happen for everyone, even if the insurers were not evil fraudsters. So even if we ever fix the insurer side, I think we will also have to fix the patient expectation side around standards of care.

President Lyndon Baines Johnson

If Medicare goes away, much of the healthcare system will simply implode rather than getting more expensive. Looking it up, the system my hospital is part of gets 36% of revenues from Medicare. I expect my hospital is slightly higher than that.

What part of "life, liberty, and the pursuit of happiness" do you think doesn't involve protecting people from each other?

Agreed.

Company wise, I’d like to see these things handled like the FDIC handles a bank failure. The Feds come in, wipe out upper management, and have another org take over as caretaker.

Otherwise these fines just get paid out of increased premiums. Which probably makes the folks responsible giggle as they immediately go and do the same thing again.

Insurance companies are not doctors and should not havd the privilege of denying any claim for any FDA approved action.

Insurance premiums have been on a steady sloped upwards march since the 1970s.

My doctor wanted to give me an MRI for a pain near the heart, and insurance told them they wouldn't cover it until they did various other forms of cheaper treatment, including taking antacids for one month, and 5 months of physical therapy. Which of course didn't work. The waiting time for the first appointment was 3 months.

It took over 9 months for my doctor, the only person to actually properly know the details of my case, to be able to give an MRI that he thought was necessary because someone at the insurance company, who I never met, who had less medical expertise than my doctor, wanted to save the insurance company money.

Anecdotally, all the people I know who live in countries with socialized medicine haven't ever had a wait time as long as that, and haven't ever had a simple MRI be delayed by their socialized insurance.

I'm definitely not paying it

You may want to go look at how all the individual attributes of the ACA poll once they're phrased that way and not as in "Obamacare"

Look at Trump’s talking points. It’s all about immigrants, foreigners and wokeism that are coming to get what you have.

The US is a wealthy, prosperous nation, and I think even lower income segments of the US population are aware they’re night and day better off than people in the same economic segment in the countries immigrants come from. Wanting more is part of it, but it’s mainly about not sharing what Americans have, even though it’s not actually under threat. That doesn’t matter, people still feel threatened.

I’m a Brit. My mother is a wealthy middle class retired woman in a safe idyllic bit of countryside, but she is utterly obsessed with foreigners coming to rape and steal and destroy British society. They’re all coming to get us. She reads in the papers (The Daily Mail) and sees it on TV (GB News) every day.

In my country which was targeted to the max by Russian propaganda, they are using the same playbook as in the US right now.

1. take any real complicated issue and blow it out of proportion so people think that it is a life and death situation.

2. heavily promote the most unfit person for the job

3. blame the worsen outcome to the predecessor

Rinse and repeat and you'll see the country drown in chaos and everyone blames everyone.

You can always argue that it is the real people, but if you look really close to the systems of promoting the divisive content - the powerhouse of it is always bot networks only followed by real people.

I think that the most of the division in western societies have to be studied from the perspective of foreign influence.

Patient primary expectation is always to have a doctor they can trust. That can be fixed only when all doctors get the decent money and comfortable work environment and that means several things: the less middlemen the better, the cost of living including housing should be affordable and put them in middle class, the treatment standards should give them enough time and flexibility, etc.

That seems disingenuous. Obama: "Vote for me and I'll bring you hope and change and healthcare and all this other stuff." Trump: "Vote for me and you won't have to bother voting again."

There is simply no room for BSAB rationalization here.

There are already large swaths of people who can't get a MRI period because they are excluded from healthcare in this country. And if your belief is that a single payer system will be hampered by measures such as austerity, then say that. Because then your issue isn't with single payer healthcare but instead with politicians who believe institutions need to be run as a business instead of what they actually are, which are public services.

https://www.noahpinion.blog/p/insurance-companies-arent-the-...

Australia has a combination of public and private health insurance, and they both work well together. The public health options provide the safety net, while the private health insurance is optional.

Where the private option makes sense is if you want to go to specific private hospitals, or if you have elective surgery (the classic example being a knee reconstruction for sports injury) and you don't want to be in a queue behind people waiting for public hospital beds for more serious conditions like heart surgery and so on.

My dad in Australia had open heart surgery 2 years ago, and is doing very well. His cost for the entire procedure? $0 and this was done by one of the very best heart surgeons in the country. He has private health insurance, but elects to go to public hospitals, which have excellent surgeons committed to the best care, because he's a patriotic sort and he's paid into the public health system through taxes for his entire life.

Meanwhile I pay > $3k per-month for not even top tier care in Upstate New York for myself, my wife and my 10 year old daughter, with no serious pre-existing conditions, and I have absolutely no guarantee that any surgery or anything that any of us need in the future will be even covered, even if my primary physician says it's medically necessary.

The rest of the world would do well to study how the combination of public and private health insurance is done in Australia.

So they are tactically not paying the doctors after agreeing to, as perhaps the best legal chance to escape payment that still avoids the primary PR focus: the patient.

The public is going to now have pity on doctors, and from a strict terms of agreement standpoint they may have a good point.

However, these aren't normal times. And what we may be seeing is a type of insurance industry early death throe.

First, lets preface any further commentary by the fact that it must be kept in mind that the sole reason that doctors make a lot of money, at least "a lot" relatively speaking from certain perspectives and in certain roles, is the insurance industry. Otherwise, they'd be paid mostly like plumbers.

And so a shifting of financial pressure to doctors, or anyone else who is both politically and legally vulnerable, may be expected during existential changes in the insurance industry.

Next, I'll suggest that when a portion of the public looks to break the system, even for noble reason in their minds, that what they finally get may be completely unpredictable. And I'm not primarily speaking of this specific tactic, but rather of an unforeseen end-point.

Some unavoidable truths:

a. The insurance industry can only remain financially solvent when it has the ability to turn down claims, specifically those that the terms allow it to.

b. A certain portion of the public wants Universal Healthcare.

c. Any future denied claims will be framed as catastrophically unjust by this portion of the public, even if insurance carriers were to significantly (somehow) adjust their models to be able to operate while paying more claims and keeping premiums the same. There is no placating this portion of the public within the current system.

d. Some within this sector of the public, like Luigi Mangione, are criminally insane. They are willing to engage in terrorism and murder to destroy the insurance industry in the hope of eventually arriving at Universal Healthcare.

e. Some of the Press is politically supporting this criminally insane contingent.

f. If the Insurance industry can no longer function, or is otherwise forced to raise premiums beyond which many can afford in order to be able to pay out virtually all catastrophic claims, what will happen is either it will cease to exist or people will go without individual insurance and then businesses will stop offering insurance.

g. There is zero guarantee that the next step is Universal Healthcare. Saying that it is inevitable, for the United States specifically and after destroying the private insurance industry, is like saying that a manned NASA mission to Mars is inevitable because private aviation is deeply flawed.

The article author is a complete piece of shit for suggesting that the Brian Thompson assassination was due to anything other than the psychosis of a maniac. Mangione is criminally insane, and so are his sympathizers. At least to the extent that they aren't too low IQ to understand what happened while somehow still having an opinion.

This is a great achievement of the American media environment: people vote for the status quo fully believing they’re voting against it. And somebody ending up in a prison in El Salvador is the sacrificial lamb that is needed to make this equation work.

Insurers will add more and more indirections instead of outright denial. First indirection: get a prior authorization(PA). Second indirection: only a particular telehealth provider has the authority to ask for a prior authorization--and this is a new trend. Expect more layers of indirections.

I understand that healthcare costs are exorbitantly high. The people who have the power to control these costs are politicians, super wealthy, and the elites (lawyers, executives) serving the super wealthy. The latter groups get the care they want without any hurdles. Others just pay all insurance premiums, only to find that they are denied care when they need the most.

I very very very very much doubt these were the same people

Emigrate where? The parts of the world where quality of life is equal or better don't just have open door policies letting Americans in freely, last I checked. I imagine it's going to get even harder.

The plan at this point is to just ignore it and hope it goes away, since they can't put it on your credit anymore.

The big insurers own the PBMs, the specialty pharmacies, the doctors, the urgent care networks. United Healthcare is the country’s single largest employer of physicians. https://www.statnews.com/2025/03/07/unitedhealth-surgery-cen...

They pay their controlled ones higher rates, even. https://www.statnews.com/2024/11/25/unitedhealth-higher-paym...

Just when I thought healthcare reached new lows...

Wow. Just wow.

We wrote out a detailed plan for jumping off a cliff, took several slow but steady and large steps toward the edge of the cliff, inched our shoes right over the edge, grabbed the railing, leaaaaaned way over, a little farther, a little farther, released finger go, then another, then completely let go. We're in free fall, the decades in which anyone could have stopped it are all in the past. There's nothing to grab, no path to turn around on, we're just falling now.

Fuck. These. Monsters. Fuck them and their friends and family. Fuck them to the moon and back. Fuck them until humans evolve to the point that we don't have genitals and then find a new way to fuck them.

But also how is that legal?

The world is filled with complexity and systems that are broken. They require thoughtful solutions, not chaos. Setting aside the moral and ethical dilemmas that arise, advocating for the murder of company leaders is essentially a roll of the chaos dice attached to a wish that somehow the resulting situation will sort itself out.

If you remove all moral/ethical considerations (not the least of which is that blame is shared by many people), it’s far from obvious that the result would resemble the thing people want. Pragmatically, it’s a poorly considered idea that introduces potential for equivalent or greater harms.

The tens or even hundreds of hours on hold with insurance providers and hospital billing departments and calling state regulatory agencies and time sorting through the fifty bills scattered over ten months from nine different entities, all for a couple days in the hospital, are a massive unaccounted-for cost of our already-record-settingly-expensive healthcare system.

People were not happy with the system. I'm old enough to remember the pre-existing condition bullshit insurance companies pulled to avoid paying out in all situations. They classified the stroke my mother had in 2004 as a preexisting condition and refused coverage sending my family into bankruptcy.

It was still a bandaid solution on a rotting wound but this revisionist history of the pre-ACA era does not exist.

It's not a question of money. If there's one person who's acknowledged as "the best" at something, that puts a hard limit on the number of people who can hire "the best" for that thing in any particular time window. Paying more won't give that one expert more hours in their day.

Some people voted for Obama because he made them hope for a better future. Some people voted for Trump because he promised them hell for other people. They are nothing alike.

But nobody had ever accused the voting public of the U.S. of being able to see the past the end of their nose.

https://www.bu.edu/sph/news/articles/2024/project-2025-could...

I don’t give a shit about Hunter Biden, he wasn’t the president. Nepotism happens everywhere, good luck stopping it. Hunter Biden is a crackhead and shouldn’t have had the position he did, but he is a sideshow to distract you. Trump himself was impeached for withholding foreign aid from Ukraine to try and boost his reelection chances, but you conveniently left that part out. I’ll admit it was partly political, but it still happened.

If the Biden family was doing corrupt things like receiving bribes, by all means prosecute them. If there’s evidence Joe Biden got kickbacks from Burisma, the DoJ should file charges. There’s not a personality cult for Biden like there is for Trump.

Trying to compare an actual convicted felon who is nakedly corrupt in public vs a guy who has a few accusations is ridiculous in the same way as presenting young earth creationism as equally valid as the universe being 13.7B years old. It’s “but both sides!” at its worst. Joe Biden is no saint, he’s a politician after all, but he’s not even close to Trump. Bob Menendez (D, NJ) is much closer to Trump than Biden, he was actually tried and convicted for corruption. I’m glad he was found guilty.

Doesn’t it say that most people post-masectomy get “a relatively straightforward surgical procedure using implants filled with silicon or another gel,” which, judging by how unusual the article makes out this surgical center to be, seems to have medically reasonable outcomes?

One big argument missing here is why the “natural reconstruction” option is different from the normal option, aside from the patient who explained that “the idea appealed” because she “felt like [she] was taking something foreign out of my body, cancer, and [she] did not want to put something foreign back in.”

So it seems like, faced with this medical need, some people want a procedure that involves “five operations” in a setting “combining the luxury feel of an upscale plastic surgery practice with the mission-driven zeal of a medical clinic,” where instead of the implants the proprietors do “lengthy and complex operations [that] can last up to 12 hours with big medical teams involved.”

It’s true that the latter probably costs more than the average—and it’s more than reasonable that, when it comes to their own care, anybody might prefer the luxury (or just humane) setting and the dozens of hours of painstaking hand-reconstruction.

It’s also obvious (and settled in court) that the insurer got up to some shady business in this particular case (not least the “for me but not for thee” stuff).

In the general case, though, I have a hard time making the case that it’s fair for a patient’s preference alone to be enough to justify bumping the cost by an order of magnitude or two—especially since insurance spreads those costs out among all the other people paying for insurance, not the dastardly execs directly.

If you can afford luxury then pay extra for luxury, fine. But the insurance feels to me like it’s there to meet the basic medical part of the requirements.

Have you never seen a movie where the bad guy gets killed?

Everyone angry about Big Tech and the like need to know that healthcare was patient zero for the monopolization and enshittification cycle that seems to have consumed everything in the world economy.

Once one industry consolidates, their vendors and customers need to consolidate too, or they don't have any negotiating leverage. If you don't consolidate, you're the deal taker, and that deal will be incredibly garbage. This cycle continues until it reaches the one place where you can't consolidate: end customers. There's no such thing as a "customer union" that can fight back against this bullshit. This turns business into a conspiracy to screw the customer, purely through normal, logical business actions that were already illegal but unenforced.

The problem with merely pinning the blame on one entity is that it doesn't fix the system. You don't care about whether or not it's the hospital's fault or the insurer's fault, you just want the problem fixed. Law enforcement actually has a solution for this: joint and several liability, which is a way of saying "I don't care who did it, someone either fixes it or I'm punishing both of you". Pin the blame on both entities if you want the shenanigans to stop.

My guess: they know they can get more money from the insurer than the individual (or a combination of both!) so they want to scare you from not allowing them to negotiate with the insurers.

That's literally the purpose of both criminal and civil laws.

That doesn’t align with what I saw. Can you provide evidence? Because it was pretty clear to me that it would go exactly as it has, which is pretty terribly for Ukraine.

- https://en.m.wikipedia.org/wiki/2025_Trump%E2%80%93Zelenskyy...

- https://www.nbcnews.com/news/amp/rcna200977

https://www.yahoo.com/news/fact-check-rfk-jr-misrepresented-...

That quote is far less damning when you consider the surrounding context. The reasoning he gave for why "authorization never says we’re going to pay you" is that there might be deductibles, and out of network deductibles might be higher. That seems totally reasonable to me?

[1] https://www.documentcloud.org/documents/25882446-steven-udva...

That's just government in a nutshell, regardless of country, party, political leanings, etc.

How does it go? "What's the difference between government and organised crime? One of them is organised."

> They acknowledged that the disclaimer was not meant as a general excuse to free the company from paying bills. A prior authorization “usually” resulted in a payment, testified Brower, who reviewed the center’s bills. He said that the notice was intended for specific situations. For instance, Blue Cross would not cover a woman who dropped out of her insurance before the operation. Nor would it pay anything if a patient had not met her deductible. But otherwise, Brower said, Blue Cross intended to compensate for a procedure that it had authorized. “It’s inappropriate for us as a company to approve a code and then turn around and deny it,” Brower said.

The only reasonable word there is "criminally". Of course assassinations are criminal.

One doesn't have to be insane, psychotic, or a maniac to kill someone, or to let someone die. All it takes is valuing other things above the life taken. This is not that uncommon.

Now, you can think Mangione is wrong about the effects, that he did not have a rational plan that would get him his desired end goal. I think that's obviously true even. But that's just how most humans act most of the time, and is not insanity.

US healthcare has to compete against cheap healthcare in mexico or whatever

But also, you might be surprised. Elections aren't decided by the bulk of partisan voters who show up to always vote for the same party and then cancel each other out. They're decided by the much smaller number of people willing to vote for a candidate instead of a party, and therefore move votes from one column to the other.

I think this misses the 'fuck it, I'm going out like a grenade' aspect. Someone facing death or long-term painful chronic illness due to lack of access to medical care, and who has the perception that this is in part or wholly due to health insurance problems, might not care that they're as you said, rolling the chaos dice. They won't be around for long to deal with those consequences. They might want to roll those dice as a desperate attempt to exert some control, to make some kind of statement, to a world they feel has trodden on them.

There's a kind of logic to it, one borne from pain and desperation. But there's a reason the cliche about a cornered rat exists.

So how would you define "insanity" then? You can nitpick about how those phrases don't match what the DSM-5 says or whatever, but the reality is that Mangione's actions are far beyond what the vast majority of people would do, even under the same circumstances.

Score voting is simple: It's the voting system the judges use in the Olympics. Voters give each candidate a score. Highest average (i.e. the one who would get the gold) gets the seat.

The flaw in first past the post is that it gives any viable third party the powerful incentive to merge with the major party they're most similar to, because otherwise they split the vote and both lose. So you get a two party system. Score voting doesn't have that, you don't have to change any other part of the system to make it work, and then the two party system everybody hates goes away.

At a systems level someone pioneering surgery techniques should probably spend most of their time researching and teaching, with surgery being a small portion of their time used to maintain the practical knowledge needed to better teach/research.

Think about how you didn't really hear about movie theater shootings until someone shot up the one in Aurora. Now they're more common. There is a huge element of social contagion because shooters are very much copying each other's work.

Which would suggest that we would see a rise in CEO assassinations over time[0]. But the thing is, it's also legitimately harder to assassinate a CEO than shoot up a school. Schools are soft targets with predictable schedules for their occupancy. A CEO might be in 20 different countries over the course of a month; you'd have to engage in a LOT of cyberstalking to even have a chance of catching a CEO in your hometown. And not to mention, they usually have security detail specifically to prevent this exact thing from happening.

But who knows. There's a lot of people pissed off about corporate power, in every country, across party lines. It only takes one security fuck-up.

[0] This is what the phrase "propaganda of the deed" refers to

So are startup founders. Many of these fail, precisely because they too did not have rational plans that would get them to their end goals.

Far better to instead wait for 11 months, spend a couple hundred hours bouncing around phone trees for my health insurance provider, and pay a few thousand dollars per month for having the privilege to do so. So much less stress for me and my doctors to get jerked around by barely medically competent insurance company employees, makes it much easier to sleep at night. Especially fun to have PA withdrawn because due to how long it's taken to get the MRI has allowed the issue to progress to the point where the kind of MRI needed is now different and requires a new PA.

For example I see on the Irish social media the misplaced efforts of Russian propaganda which doesn't make much traction because of the lack of deeper understanding of the issues and just copy-pasting the rage baits from other countries.

However, I expect that it is temporary, until more budget is allocated to it.

I would encourage everyone to study what is open from the Russian KGB archives to understand that it has a century of experience of influence, supercharged by social media, access to paid influencers and now AI.

Being wrong about the effects of (and rationale for) a crime is a symptom of criminal insanity.

For example, you think that the crime that you facilitate is "justice" for perceived wrongs but in reality it is only the execution of an innocent man with a family. Such a delusion is the definition of criminal psychosis.

>All it takes is valuing other things above the life taken.

Very seriously, see a skilled therapist. Tell them what you wrote. Hope that they are able to begin to help you.

Are you talking about the "Targeted Provider List"? The article says:

>The blocked list meant that each bill from the center received a manual scrub by payment specialists before reimbursement.

That's not the same as “lol we have no intention of paying for this ever”.

A good first step would be banning price discrimination for medical procedures. Right now you get three different prices for "I pay", "insurance pays", and "insurance denies and I pay". People can't tell you what those prices will be. The whole point of insurance is supposed to be to derisk these kinds of decisions, not increase uncertainty and risk. Attempting to use insurance and getting denied can 10x your cost, so what is the purpose of the insurance?

> Some 60% of the claims weren’t reimbursed at all.

The article gives examples of very normal billing errors that were used as the pretext for this.

It’s very clear they knew they didn’t want to pay the claims. Even in advance of the procedures.

> Then, a week or so before her surgery, Arch was wrangling child care and meal plans when she got a call from the insurer. The representative on the line was trying to persuade her to have the surgery elsewhere. She urged Arch to seek a hospital that, unlike the center, was in network and charged less.

That's incredible.

When I reach those, I’d expect them to pay the remainder. As agreed. As implied by a prior authorization.

>“SNCF was very angry. They told the state they were leaving for North Africa, which was less politically dysfunctional."

No surprise that enough people would say "we gotta do something else."

I didn’t vote for Trump but I get it and him winning doesn’t surprise me.

I do agree that a lot of people seem to believe that’s how it works. There’s some objectively correct treatment, the doctors uncover what it is, and I have an unconditional right to get that treatment no matter what it costs. But no healthcare system does or could work that way. You have to consider tradeoffs and control costs somewhere.

You can build a system that makes it seem that way to the patients; that’s why I like Kaiser. In my opinion it’s more user friendly that way. But the tradeoff is that cost controls are imposed directly on what doctors are willing to prescribe. There’s many stories of Kaiser doctors refusing to prescribe expensive treatments that other doctors would, because as a matter of policy they believe some lesser treatment would be sufficient.

>The article gives examples of very normal billing errors that were used as the pretext for this.

Are you talking about this blurb?

"Blue Cross did not accuse the center of any intentional miscoding — but the sloppy billing led to additional scrutiny, the company’s witnesses said. "

I'm not sure what the alternative is. Are they supposed to pay even though the are errors? Are they saying, "you only have one chance to file a claim, and there's a typo in it so we won't reimburse you a dime?". It's not clear from the article why exactly they're denying the claim, aside from maybe the place being overpriced.

I think this is very separate from the disturbingly popular trend to advocate for violence as a solution.

Or the Weimar Republic in 1932, say. Apparently its economy was in shambles. But that gives me no sympathy for those that installed its successor.

As an analogy, I understand why someone might not trust the Boeing 737 Max. I would consider them in need of a court appointed guardian if they determined the alternative was to jump off a building as a safer way to fly.

Except that the prevailing direction of the country is to destroy the ability of governments to function effectively. It seems like a well planned move to actively destroy the only entity capable of standing up to big business.

  Big Pharma spent big on Bernie Sanders 

[1] Blue Cross of Louisiana doesn't give a shit about breast cancer - https://pluralistic.net/2025/04/12/pre-authorization/

PR puts the party instead of the voters in control of who gets the seats or otherwise requires the voters to support a party when they want to support a specific candidate.

Score voting also thwarts gerrymandering because you can't make two 55% districts for your party and one 90% district for the other party or the districts for "your" party would go to a moderate party instead.

KGB failed to prevent catastrophic dissolution of USSR and you suggest that they are some sort of masterminds who excelled in propaganda. That’s quite an exaggeration. Since 1990s both the West and Russia have lost their expertise in each other’s affairs. Russia may still have some influence in Central and Eastern Europe, but their conservative ideological drift limits significantly what they can achieve. A lot of local political mess there is basically local politicians shooting in the leg.

Tying it to willingness to kill for some goal cannot be it -- not every soldier, cop, and security guard is insane. There has to be some degree of break from reality, not disagreement with societal opinions of morality. (And of course all societies do endorse violence -- from the proper authorities, and against the right targets).

Osama bin Laden was a religiously-driven warlord. But not only was he not insane, he was quite effective for quite some time, and had significant support from the societies he was part.

The Unabomber absolutely could plausibly be argued to be insane -- his attorneys certainly pushed for it (though he rejected that attempt). And the psychological experiments he participated in could certainly have contributed to such a break. Throw in the standard trope of living as a hermit in the woods with limited social contact (which can both be a result of insanity and decrease mental stability), and there's enough there not to reject the label. But his bombing campaign just makes him a criminal, a problem for society, not insane.

How about violating bright red line laws/norms of the society you're in?

> There has to be some degree of break from reality, not disagreement with societal opinions of morality.

Okay but surely you agree that "I want abortion but my state bans it" is not the same kind of "disagreement with societal opinions of morality" as executing a CEO because you vaguely have grievances with the healthcare system?

The outcome here was obviously what was going to happen. They promised these actions.

But of course that has been captured as well

In the 2019-20 Congressional funding cycle, Sanders received more money from people employed in the field classified by OpenSecrets as "pharmaceuticals/health products" ($1.4 million) than any other member of Congress. He also received roughly $400,000 from people employed in "pharmaceutical manufacturing."

This does not mean he received nearly $2 million from "the pharmaceutical industry," — it means the money was from people employed, in any capacity, in that field." So pharmaceutical companies cannot donate money directly to candidates, so they fact check it as false, saying it was the employees donating the money and not Pfizer directly, but acknowledging he did receive $1,400,000 from people that work in pharmaceuticals/health products, and $400,000 from people working in pharmaceutical manufacturing. Are we to presume that there is no strings attached when Bernie Sanders is receiving the money? Or are we supposed to offer the benefit of the doubt you wouldn't offer to a Republican politician who said that he didn't receive 1.4 million dollars from the NRA, but employees of the NRA, and a further $400,000 from people in Firearm Manufacturing

It is a massive amount of information and it is studied rigorously by a lot of researchers. Unfortunately, most of the information I consumed are in Ukrainian. For example there is a book in Ukrainian released just few years ago from one of those [0]. But basically any researcher can get access to the whole archive and domestic ones wrote a lot of material. I am sure that it will get more popular on the west as well, while people will get understanding of the systems at work.

As far as I know Timothy Snyder is well known for his researches into Russia in his books such as [1]. However I've read only excerpts from it as we have better material in Ukrainian.

West generally doesn't understand Russia, it overestimates its military power and underestimates its propaganda influence. It also completely misunderstands its culture. Also west have a history to dismiss the voices of countries who do know Russia very well. But it is changing bit by bit.

[0] https://www.yakaboo.ua/ua/arhivi-kgb-nevygadani-istorii.html

[1] https://a.co/d/6kMHDnJ

> For example, you think that the crime that you facilitate is "justice" for perceived wrongs but in reality it is only the execution of an innocent man with a family. Such a delusion is the definition of criminal psychosis.

"justice" and "innocent" are not facts about the world but societal judgements. Having different opinions about these is moral disagreement, not insanity, nor delusion. Expecting society to agree with you and maintaining that expectation even against evidence afterward would be delusion. Sometimes societies don't have fixed judgements. Is an abortion a medical treatment or an execution of an innocent child? Although I agree with one stance, and disagree with the other, neither is a delusion. It's a moral disagreement that remains one whether I live under laws that treat it one way, or the other.

> Very seriously, see a skilled therapist. Tell them what you wrote. Hope that they are able to begin to help you.

Don't be a dick.

Accurately describing other's morals is no reason to see a therapist. It says nothing about my morals or my sanity that I recognize a large fraction of fairly normal people do value lots of things above others' lives. Conformity and fitting in often enough, as witnessed by Hannah Aredt's phrase "the banality of evil". To the best of my knowledge I haven't contributed to excess deaths beyond the externalities of living in a first-world country, participating in its market economy, and the actions its government takes funded by the taxes I pay. I do actually value lives, so I am unlikely to attempt to take them except under extreme circumstances (and I most likely would not have the instincts to do so effectively; never been tested, and hope to never be).

Societies in general certainly don't treat lives as infinitely valuable, nor even equally valuable. They regularly make economic tradeoffs (and incoherent ones at that) that it's okay to take actions that increase the death toll as long as enough money is made from it. Society is happy to use and endorse violence -- so long as it's done by the right people to the wrong people.

Isn't the word for that "criminal"? You can add intensifiers like "serious", "hardened", "deadly", etc to emphasize how bright the line violation is.

> Okay but surely you agree that "I want abortion but my state bans it" is not the same kind of "disagreement with societal opinions of morality" as executing a CEO because you vaguely have grievances with the healthcare system?

There certainly is a greater consensus for it; 50-50 is quite different than what I would guess is about 85%. And I'm for that consensus. This kind of violence becoming common would be disastrous. But that consensus certainly seems to be a lot less solid than it was a year ago, especially when you look at the youth. (I think there are several things contributing to that, but that consensus breaking down does not mean that 41% of 18-29 year olds are insane. That's just not what insane means.)

https://www.axios.com/2024/12/17/united-healthcare-ceo-killi...

I will poke at one part:

"Patient primary expectation is always to have a doctor they can trust. "

I don't believe this was the expectation here - trust was not even mentioned. Only credentials were.

I don't disagree it should be the expectation, but it's definitely not in the US and i don't think you'll get there without changing how people think.

Even when it is, trust here seems to be often equated to "how impressive/popular a doctor they are", rather than "how effective a doctor they are" or something sane. At least in the US, the doctors patients trust the most are the ones with the most credentials, awards, etc. It's a popularity contest instead of a baseline competency contest.

If you listen to lots of people in the US talk about choosing and trusting doctors, it's about what school they went to, or what awards they've won, or who else they've treated. Not always, but lots of times. This is not a new thing.

For example - my parents (in their 80's), all of their friends, and heck everyone i've ever met in their community is the same way, and have been for at least 50 years. They don't actually trust doctors who didn't go to harvard, etc.

I think that has to change as well.

So what, the only difference between a serial killer and some guy committing tax fraud is that the former is more "serious"/"hardened"/"deadly"? You don't think mental health has any role to this? When people mean "insane", that's what they're gesturing to, not what the DSM-5 or whatever says.

>but that consensus breaking down does not mean that 41% of 18-29 year olds are insane. That's just not what insane means.)

"acceptable" isn't the same as willing to undertake the action themselves. Mangione is being called "insane" because he actually killed someone, not because he answered yes on a poll asking whether it's acceptable to kill healthcare CEOs.

Seems like if you genuinely cared about the Biden molehill you'd care even more about the Trump mountain?

To a certain extent, that’s a baseline function of every government, sure. But there is a tension between “a government big enough to protect people from each other” and a “government big enough to deprive citizens of life, liberty, and the pursuit of happiness.” The founding American principles draw the line between those two in a different place than other traditions.

To be clear, a lot of people have very valid complaints about the US healthcare system. I'm not saying everything's perfect or even that every improvement would involve a tradeoff. But every medical system on the planet, including whichever ones you have in mind as better than the US, has controls on how expensive drugs can be used when cheaper ones might work.

I do agree that the trend for the more average person to be okay with or even advocate for violence as a solution is disturbing. But a massive part of why it's disturbing is that it's a symptom. There are always fringe groups who resort to it as their primary approach, but when your regular person starts looking at violence as the way to solve things, there's some kind of broader sickness happening - a large scale societal malaise.

My great grandmother used to compare war, revolution, mass civil unrest and other such breakouts of violence as a fever for the body that is humanity; She'd lived through far too many of these fevers. They're rarely idiopathic, and while they might help fight off the current sickness, they also often killed. And even if you survive a fever, it's never a particularly pleasant experience.

Does it lead to wait times? Sure! So does the US system!

Why can the hospital in France (even the private one) tell me ahead of time how much something will cost, while American providers will scream that this is absolutely impossible to do?

This is completely wrong.

A general practicioner doctor is unlikely to be making much more than 300K, or $144/hr. But my visit to said doctor costs $450 for 15 minutes, or $1800/hr.

Many people are making a fortune out of the system, the money is not going to the person doing useful work, the doctor. Where is the other $1656/hr disappearing?

Eliminate all those grifters from the loop and I could go see this doctor for $36 per 15min visit. Heck I wouldn't even need insurance, I can pay that out of pocket.

Sure, I'm ignoring rent/utilities/supplies, so it'd be a bit more than $36 but those costs are a tiny percentage. In any case it'd be less than $50, far below the current $450.

They won't. "Out of pocket maximum" means something completely different to the insurance company than it does to any normal person.

Out of every dollar you pay out of pocket, the insurance company will decide how much they feel like counting it. Might be the full dollar, or some pennies, or nothing.

You might have paid $20K out of pocket in a year, but the insurance company will say you've only paid $1000 because just because. Good luck reaching that "out of pocket maximum".

Source: I've been there.

https://www.theverge.com/2024/10/16/24266512/jd-vance-curtis...

But in the spirit of, in your professional capacity, taking care of the people you owe a professional duty to before you take care of yourself (in the material sense, at least)…

One imagines these families in particular could afford the difference for the premium care, on their insurance-company-executive salaries.

Fortunately the jury seems to have agreed too.

1. hits the management/owners but in a way in keeping with the benefits/protections that corporation provide (government isn't directly coming after owners/management) so we keep a 'do business' friendly regulatory environment. Owners are simply diluted with less ownership and management now have the government operating from within giving the government more visibility.

2. Over time, companies that continue to break the law become government owned. Additional fine percentages should be on a increasing scale.

There needs to be rules about ownership and a time period they are held so the government doesn't just seize business but the current corporate fine structure simply doesn't work.

https://www.skadden.com/insights/publications/2024/07/us-sup...

What?

I'm sorry what kind of kaska-esque system is this?!

It is an untenable situation that would require radical restructuring at this point. I don't see it getting any better.

For non emergencies, I would much prefer we go back to patients paying cash, and getting medical loans when they need. For emergencies I would prefer the government cover them directly without any intermediary. Because of the insurance system, things cost 10x more than they should, which makes it an actively harmful system. If it were to go away, competition and efficiencies would drive down prices 10x.

FAFO of the highest order.

It's the system that us Americans are tricked into believing is the best and nOt sOciAlIsM. Certainly USA healthcare is "the best" — if you can afford it!

My personal belief is that the kafkaesque nature of so many systems is designed to keep people destitute and despondent — to quote ole TedK: "our system keeps people demoralized because a demoralized person won't fight back."

~"We'll keep them poor and tired; if they're poor they can't afford to fight back, and if they're tired they won't have energy to..."~ —Jeff (Jonestown Massacre)

Having dropped out of a US medical school (almost two decades ago), I can assure you things have only gotten worse (from a bottom 80% POV). My best method of pyhhric victory is to not reproduce, earn just enough to live minimally (i.e. lessen tax burden/revenue), and never pay for health insurance.

YMMV — I quit, a long time ago.

That would match the rough stratification of doctor salaries (accounting for specialization, etc).

The average primary care family physician earns 350k in the us. The top 10% earn 1.3 million. The top 1% earn 4 million[1].

So enough people are hiring the best, or paying the best, to get a 4x difference and 10x difference in yearly pay.

I chose family PCP's because it seemed more unlikely that the top family PCP should be worth 10x more than the average. Whereas in something like neurosurgery, maybe? It felt at least arguable. Happy to be shown i'm wrong here.

In any case, it seems like this level of stratification would not exist if people weren't trying to get to see the "top" doctors all the time.

[1] There are lots of different data sources, but they all roughly have the same relative stratification even if the exact numbers are different. Since the actual numbers don't really matter to the point i'm making, i didn't try harder. But i will say all the data I find seems a bit of a mess.

Now, it might violate Hacker News's policies and get deleted, but that's different from it being against the law.

Maybe we need more of plausible deniability.

He moved the needle, people are talking about it, maybe thinking about it a bit more.