It's functionally isomorphic to a black box where I make a deposit, every time it denies someone medical treatment I get back monetary reward and I can withdraw my deposit at any time. If we ask ourselves, "Should this black box exist?" I cannot reasonably expect people to say, "Yes." Yet, here we are.
> It's functionally isomorphic to a black box where I make a deposit, every time it denies someone medical treatment I get back monetary reward and I can withdraw my deposit at any time. If we ask ourselves, "Should this black box exist?" I cannot reasonably expect people to say, "Yes." Yet, here we are.
I am honestly extremely baffled about what your mental model here is. When UHC doesn't deny a claim, who is paying for that treatment? You can't just look at one side of the ledger when deciding whether the system is doing good or bad! They deny some claims and they pay for others! You're leaving out the whole second half!
I omitted it because it doesn't change the calculus.
If the child were brought up into the sunlight out of that vile place, if it were cleaned and fed and comforted, that would be a good thing, indeed; but if it were done, in that day and hour all the prosperity and beauty and delight of Omelas would wither and be destroyed.
According to who? It changes the calculus for me. I pay my health insurance because it covers the services I need. I could absolutely opt out if I wanted to, but I don't.
> I pay my health insurance because it covers the services I need
I think that, aside from the cost, this is probably the biggest issue most people have with health insurance in the US. UHC makes a lot of money specifically in part by not covering services you need, for example by having accountants override your doctors's orders.
If it were as simple as getting the services you need in exchange for money, I don't think as many people would hate the system as much.
How many Go Fund Me sites were brought up because of high medical costs for some accident or cancer? Is foregoing insurance an improvement over that if it isn't even possibly one of the big causes?
And that the US is the only country in the world where hospital "deathbed divorce" is a thing, to try to avoid family being saddled with ship-anchor levels of debt.
No, it isn't, which is why people want some form of insurance, whether public or private. To mitigate risk.
I was entertaining the comment about something being as "simple as getting the services you need in exchange for money". Which one certainly could do, but imposing that on everyone would also be a bad system for other reasons.
You missed the point of my comment. The "services" I was referring to was "health insurance," and the "for money" is the monthly premiums.
In too many instances, people pay the premiums and then do not get the benefits of the insurance.
An analogy in the travel industry might be if we had a system where at random, a double-digit percentage of air travelers were denied boarding and not refunded their money. No amount of legalese would make it acceptable, and in fact Congress regulates air travel such that practices like this hypothetical are not allowed.
Yes, people should get coverage under the terms of their agreement. I'd guess that the reason this is an issue with health coverage is because the sums involved are great, and usually the people on either side of the argument are either (1) unwilling or unable to effectively argue their case or (2) nonexperts who lack full understanding of the subject matter.
These aren't really an issue with airline tickets, not because we don't regulate insurance, but because the contract is exponentially more simple and understandable.
Air travelers are not expected to have a full understanding of how to operate a jet airplane, or an airline, in order to not be cheated out of their fares. Similarly, they are not expected to plead their case in order to not be cheated by airlines.
I use the colloquial "cheat" intentionally, as it is a valid descriptor.
Notably, however: most insurance delays/denials will have in common that the patient is represented by an expert (a physician) on their case, while the insurer will be represented by a person who has typically never spoken with or examined the patient and may not have ever practiced medicine. The quality of the argument and expertise of the interlocutor are red herrings.
> Air travelers are not expected to have a full understanding of how to operate a jet airplane, or an airline, in order to not be cheated out of their fares.
Correct. But it doesn't matter because the contract of carriage doesn't hinge on that. There's no confusion about what a ticket actually entails. If a ticket covers "one ride at the airport, from Cleveland to Omaha", it's pretty understandable what you are getting. If health insurance was just as simple, and covered "one ride at a hospital, from sickness to health", it would be likewise as accessible. But it isn't that way (although maybe it should be a lot closer)
> Notably, however: most insurance delays/denials will have in common that the patient is represented by an expert (a physician) on their case, while the insurer will be represented by a person who has typically never spoken with or examined the patient and may not have ever practiced medicine. The quality of the argument and expertise of the interlocutor are red herrings.
I understand but that's not what I'm talking about here. I'm talking about a broader information and accessibility disparity.
Having a physician isn't any help if your insurer is deadlocking you on coverage you legally have coverage for, you need a lawyer. That's a contract law problem, not a healthcare problem.
But if you don't actually have coverage for what you need, having a physician argue that you need it, isn't going to help you. Most people buy their health insurance policy all by themselves, without any legal or medical help.
The system wasn't designed. There were no design choices. The entire thing is a legacy result of expectations and costs that all started snowballing from the moment FDR decided wage caps were a good way to stop inflation.
We're not in the situation we're in because anyone thought it was a good idea. We got here incrementally over ~80 years.
of course the system was designed. of course there were design choices. it's a system implemented and executed by human beings at every step, constantly. every functional atom of this implementation was a conscious choice by someone. if nothing else, a choice is constantly being made to persist with the present system.
yes the design is a result of negotiation between countless people and groups of people, who all have varying power and responsibility and subjective consequence. yes all of these choices were made in context, but they were never the only choices that could have been made in that context.
this negotiation, and these innumerable choices, these designs have been a major if not primary concern of the past twenty years of american politics, economy, and millions of individual lives.
yes we have arrived at the implementation we see today, which seems ill-conceived, over-complicated, and pointlessly cruel. but at every moment that has passed and is passing now, different choices can be made, and a different system of different design can be implemented.
we are still in this system because there is infrastructure that prevents change to a more agreeable system. negotiation tactics may have just changed.
Sure, the healthcare system is "designed and perpetuated" by all of its participants, in the same way that poor labor practices in Asia are perpetuated by Walmart cashiers.
Technically all of the participants involved are a part of the system, yes, but my key point here is that none of them have the agency to change it.
The only people who can change it are voters and congress themselves.
> The only people who can change it are voters and congress themselves.
Most of the participants in the system are eligible voters, so asserting that voters can change the system is very much asserting that nearly everyone in the system has agency to change it.
(The fact is “voters can change it” is optimistic, because the US is not a direct democracy and, due to gerrymandering, campaign finance, and other factors, only loosely a representative one, being functionally more of a plutocracy. The people who benefit from its inefficiencies and inequities have disproportionate power over its structure.)
Look, in any system, there are going to have to be arguments where patients or doctors say some treatment is necessary, and the entity paying for the treatment says it's not.
You will of course stick to your principles here? The single-payer healthcare systems in Canada and the UK are irredeemable and it's morally repugnant to look at any good they've done for anyone?
>in that day and hour all the prosperity and beauty and delight of Omelas would wither and be destroyed.
...and nothing of positive value would be lost. For a paradise predisposed on the infliction of suffering on another is ill-gotten, and taints anyone that avails themselves of it once it's true nature is known.
Our birthright is to toil to elevate one another; no more, no less. Omelas is a blight, a perversion, deserving of being scoured from the face of the Earth no matter where it pops up.
Glad to see someone else was touched by that work. Greetings fellow wanderer.
I never thought I would be defending health insurance providers yet here we are.
Do you honestly, after reflection, think this comment is fair?
They don’t only deny healthcare to people - if that was true no-one would pay them money because having healthcare would be no different to not having healthcare. Therefore they are not functionally isomorphic to a black box that collects money when it denies medical treatment.
If you want to make a mental model and then ask questions of the model you should have the confidence to make your model robust enough to approximate the “other side” of whatever argument exists on the topic.
Private health insurance in a country that has a robust public option is an entirely different thing because that baseline level of care means that the private providers have to offer something substantial above and beyond the baseline to justify their continued existence. People with medical needs can choose to tell them all where to stick it and still live without going in to debt.
Most insured individuals in America don't choose their health insurance provider, they just get it from their employer where they might have a choice of plans. The closest thing to an actual competitive insurance market we have is that provided by the ACA, and though that act did many good things the disappointment of the marketplace has been well documented.
Your argument would be stronger if your black box mental model wasn’t so obviously exaggerated.
I live in the UK where we have universal healthcare that is free at the point of need. We also have private healthcare. In most countries in Europe both private and public healthcare exist side by side. Per capita spending on healthcare (across the private and public provision) in the UK is a tiny fraction of what it is in the US and outcomes in terms of quality adjusted life years and measured in individual life expectancy and patient outcomes for given conditions were significantly better than the US last time I checked (which is admittedly a while ago).
The US healthcare system is definitely expensive and delivers a poor outcome, but you’re not convincing when you try to make a pastiche of the system that paints it as purely bad and say that health insurance simply should not exist for pure moral reasons.
If a system constantly fails to do what it was intended to do, then we should consider that what it does in reality is its true purpose. Basically this is functional structuralism.
I understand what it means. I think it is a silly maxim, because it is unnecessarily reductive. Employer sponsored healthcare insurance wasn't ever intended to be a good system for providing healthcare to people, it was popularized as a workaround for employers to raise wages during the Stabilization Act of 1942. Everything that has changed since then has been incremental changes for differing reasons. The idea that a huge system like this even has a single "intent" is ridiculous. It is made up of thousands of different actors, each in different situations with different intents and interests.
But we aren't talking colloquially, we're talking about within the maxim. I'm trying to give you the benefit of the doubt, but it feels like you're doubling down in order to prove a point.
The maxim, applied here, is an obtuse oversimplification of the problems with the health insurance system, and the barriers to changing it.
Yes, if we could wave a wand and delete the fact that it ever happened, that would be ideal. But the problem is more difficult to solve now, because we have the problem of the health insurance system, and the problem of drastic systematic and economic change.
In my experience, choices to label opposition as either reductive or overly complex are largely rhetorical. They don't pass the validity test.
Perhaps we should ask borrow the "magic wand" that seems to exist for every other country. Maybe they can lend us theirs since that's apparently how realistic a system that does not bankrupt people is.
Sadly, it doesn't seem equally possible or realistic to build a system where CEO's aren't revenge murdered.
Isomorphic in normal use means corresponding in form[1], so functionally isomorphic means “functions the same as” whereas there are other types of isomorphisms, so for example minerals form groups which are considered isomorphic because their crystal structure is somewhat different but equivalent. They’re not functionally equivalent they are structurally similar.
[1] In mathematics the meaning is somewhat stronger. In maths, two things are isomorphic if they cannot be distinguished in terms of structure in a particular context.
It's functionally isomorphic to a black box where I make a deposit, every time it denies someone medical treatment I get back monetary reward and I can withdraw my deposit at any time. If we ask ourselves, "Should this black box exist?" I cannot reasonably expect people to say, "Yes." Yet, here we are.