There's a war being waged on whether or not we're going to allow certain institutions to belong to the commons. If certain industries had their way, every sip of water and every breath of air would have an associated cost and market value.
Can't afford to pay? It's unfortunate, but that's your own fault.
Every time we encode and reinforce these systems through laws, market mechanisms, and now AI, we tacitly agree that people who cannot afford such things do not deserve them. If you can't afford private healthcare before the 0 cost system was implemented to decide that well... best of luck!
In principle, if we paid MORE attention to property rights around these resources, we wouldn't be in the situation we find ourselves with respect to air and water pollution, carbon emissions, and so forth.
If there were an owner, somehow, of the air, or the air over my house, or something, then when other entities are trying to externalize their own costs (by way of dumping carbon into the air, say), then we'd be able to use vanilla tort law to recover those costs as damages.
I'm not saying we should necessarily do that - obviously there are big questions about just whose bit of water this is, and how to determine who's causing the damages. But if we could somehow answer those questions, it seems like the market could supply the answer. That, to me, suggests that moving in the opposite direction is not obviously the best answer.
If you allow private ownership of all these things, why should we expect the result any different from what happened elsewhere, with most of everything owned by a few rich people?
And if it ends up being the same people who own the factories that dump carbon into the air, it seems to me that it would be much more profitable for them to arrange for a small private paradise. The air around your house, though? That's more valuable as an industrial dump, sorry. And if you don't consent, well, you are free to look for another house elsewhere, right? It's not the air owner's fault that can't afford one inside a climate controlled bubble.
That seems to be more or less the approach we've taken to date and it's set up a whack a mole game that we appear to be losing.
Get in trouble for air pollution, convert to water pollution, the media gets upset about some chemical you release, then convert it into something no one's thought to regulate yet.
That seems to be more or less the approach we've taken to date
I can't see this at all. Can you provide any example of property rights actually being vested in air or in water?
By comparison, if we talk about pollution of the soil, we don't have very much of a problem there. I mean, it happens. Like people's oil tanks leak, but that's a big part of the reason that we no longer build houses with oil-fired heat. I knew an environmental attorney who talked about the horrors of the liability when a homeowner's oil leach into the soil. This has taught us not to do that anymore.
But precisely because no particular entity owns the atmosphere, or (in most cases) the water, there's nobody that has standing to recover those externalized costs of pollution. So we haven't gone that route, and the problem remains largely unfixed.
The first result for a quick Google yields this case where 3M is being sued because a chemical they made contaminated a privately owned reservoir (some towns are also suing, because they also own water supplies contaminated with PFAS): https://whyy.org/articles/n-j-towns-sue-makers-of-forever-ch...
Water contamination lawsuits are as common as water.
Regarding air, in the town I live a cannabis product manufacturer is about to be sued by nearby property owners because their warehouse is emitting a noisome smell. I seem to recall the Siracha factory was hit with a similar lawsuit. It would not take much research to find other lawsuits that allege air contamination. I'm sure air contamination has been part of thousands and thousands of lawsuits.
Suing someone takes massive effort for uncertain results. Even if you have a slam dunk case you have to have some basic wherewithal regarding the legal system and not be afraid to show in court (say you have a minor warrant or are an undocumented migrant, or a documented migrant from a country with a history of deporting people who make probablems for big business).
It's far from ideal, and is also only possible once damage has been done.
Although I don't know what it looks like, I believe the next step has to include baking environment stewardship into the DNA of high risk companies. This might involve giving an EPA officer a board seat, requiring positive proof of emission safety and active monitoring of nearby populations rather than just waiting for the cancer patients to show up, etc.
> But precisely because no particular entity owns the atmosphere, or (in most cases) the water...
This is an emergent property of the systems of power we allow to prevail, where sufficiently dilutive responsibility and/or authority over decisions almost always falls under our threshold to effectively regulate, and shows the power of corruptive processes.
It still boggles my mind to this day that we knew a long time ago that burning coal dumped methylmercury into our waters and is incorporated into aquatic life that we harvest for food. And yet we haplessly continue even after seafood has been so globally contaminated we went from a baseline experience our ancestors enjoyed of "eat all the seafood you care to eat in your diet", to "watch your methylmercury intake when you eat seafood". If you were able to tell your great-great-great-grandparents that we've contaminated our seafood to the point we cannot eat certain fish more than X times a year, and there is no part of the world left unaffected, they'd be horrified or think you're a fabulist.
> I can't see this at all. Can you provide any example of property rights actually being vested in air or in water?
You use companies as a vehicle, but their measurement is not "how clean is the water?", it is "how much profit?" You will need to change this, otherwise, as long it is about profit / money, you've lost that very moment, and the only way to deal with that then is via regulation.
Keep in mind property rights can have the opposite effect too — impinging on the greater good in favour of the property rights of the few. The obvious example being NIMBYism; for example higher density construction that would benefit the city gets blocked by low-density homeowners who don't want their property negatively affected.
If you haven't, check out the musical "Urinetown". Private toilets are banned, and all of the public conveniences are owned by a megacord - the UGC (Urine Good Company).
TBH The ending of that musical ruined it for me; The people 'take back control' only to squander the water and die of thirst.
Sooo... Corporations are bad, but people are bad anyway so it doesn't matter? IDK. Might be a product of it's age (bitter endings were big back then, right?)
Maurice Godelier is a very interesting anthropologist according to me. I remember reading from him that one thing that he observed in all societies he studied is that some things are meant to circulate, to be sold, give, whatever, and some other things are meant to be kept/preserved.
Maybe it's ok to keep some things out of the market's reach
They already do this in some areas, in the US. There are places where you cannot legally collect rainwater that falls on your own property. The only reason they haven't started charging for air yet is because they haven't figured out the logistics to enable doing so /s
Ah yes, the conclusion the terribly government run health care system is that it's the private industry's fault and we should give that same inept institution more power over our medical care.
Makes total sense.
Everything costs something, it's just a matter of who you force that cost on to.
No, I understand that. You realize the government approves the plans right? You also realize the government still thinks the ACA was a god send?
Traditional Medicare sucks too though.
The fix for our medical system is to bring pricing down, while incentivizing innovation and not allowing your medical system to get overwhelmed by individuals that aren't contributing any money into it. You can have an argument about how to best do that but the current government backed options aren't cutting.
No. But until we acknowledge that we can pay for it directly, pay for it indirectly with packed ERs and dubious means testing and bureaucracy, or let the poor die are the only options we are never going to solve it
Any time I see the output of a statistical model like "estimated length of stay" that gives a number like "16.6 days" without also saying something like "with a 95% confidence interval of -5.1 / +20.9 days", I get pretty confident the goal is not actually to help decision-making.
It's to launder guilt. I'm not denying the benefit. It's "The Algorithm" (TM). Nobody can change "The Algorithm" (TM), we'll just have to live with it. Sorry, but you're on your own.
Separate thing I've notices since having a chronic health issue for 20 years is the medical system uses 'patient empowerment' to shield themselves from any responsibility. At the same time patients have little actual power beyond whining.
It's wild how rigid society has become since computers became dominant. I read an article once that discussed how people who emigrated to the US prior to computers were generally unconcerned with making sure their name was romanized the same on every document, as all the humans involved were smart enough to understand "this is the same person even though the name is spelled slightly differently". Once computers took over, those people have had to "unify" their name across various documents, otherwise the computers do a literal comparison and reject it since clearly, the names are not the "same".
Computers are math machines. Everything has a procedure, an answer, a quantity, a yes or no. When people are determined to put computers and AI in everything, everything will naturally reach a computer-like end state; the world becomes a set of algorithms: no deviation, spontaneity, choice. How is that "wild"?
Exactly, this just gives the private insurers deniability when they drop coverage for someone who still needs care. They can't be held liable for someone's sickness or death, because they were just following the algorithm.
The flip side, I suspect, is that any insurance company employee who overrides the algorithm is putting their career in jeopardy. So despite what the company says, the algorithm really is making all the decisions.
The goal is to provide "evidence" for the decision that has already been made. She was "recovered" and no longer "needed" care. Now, generate supporting evidence for that conclusion.
As far as I can see, this isn't news; medical insurers (and really any kind of insurers) use rules (algorithms) to decide which claims they should pay out on. Even if they could evaluate each claim completely individually and personally, they'd get sued for not treating all claimants equally. They have to use rules.
And saying it's "AI" when it's just an algorithm (or even just a checklist) is getting annoying.
I started getting annoyed when game developers called the algorithms used to control NPCs and so on "AI", when it's actually hand-made rules, finely tuned. Nowadays, if it's been anywhere near automation, then it's OK to call it "AI". A calculator could be called "AI" (if they still made them).
There are rules and then there are rules. It is the details of the particular rule that is of interest. The use of "AI" in that article seems like clickbait to me.
The article seems to suggest that predictions based on aggregate statistics are being applied to implement strict coverage approval for individuals. That seems like a complete misunderstanding of predictive value of those statistics for a particular individual. Not sure if that is gross incompetance or malfeasance. Either way, a problem.
Whenever money is involved, invert Hanlon's razor. High prior on malice, low prior on ineptutide.
Some well-meaning team of data scientists might have produced this model originally. But its employment in this manner cannot be assumed to be anything other than malfeasance, except in the face of significant evidence to the contrary.
I think it's just a simple profit motive. If the insurers can minimize the amount of care while also minimizing the risk of getting sued, why wouldn't they do that? The algorithm/rules can be tweaked to minimize costs while protecting themselves from lawsuits when the algorithm "accidentally" drops coverage for someone who still needs it, as described by the examples in the article.
The news here is that insurers have a new tool for excusing themselves of responsibility, and might start to wield it in order to deny even more claims than before.
Is there any system on the whole planet, where the entities responsible for the payment are willing to just write a blank check no matter what? I'm pretty sure that there's always going to be some kind of cost-benefit balancing, probably based on QALYs and such.
I think the difference is in who makes the decision about how and when to set limits. Insurance companies' purpose is to maximize profits. A public owned service might be willing to sacrifice some costs for better overall health outcomes.
I hate when people use the word "algorithms" like that. Which algorithms? Dijkstra?
I know this is the way non-technical people refer to the spooky AI action at a distance happening in social media to maximise engagement, but in my opinion it just makes everything confusing when actually trying to understand the argument.
I didn't go through academia for my computer science knowledge so I may be wrong about the definition of "algorithm". I understand it as a series of steps to accomplish a task (e.g. a food recipe is a list of ingredients and an algorithm for rendering something delicious). If that's not mistaken, then the algorithm is something that's being used to make decisions.
A different term to use could be "machine-made decisions", which I personally think describes the issue better. Still, (and unless my understanding is mistaken) the word algorithm is technically accurate to this kind of decision-making.
I agree with this. If there is any responsibility it is borne by people and management’s business process. Blaming algorithms is absolving people of responsibility
And that’s exactly what the people responsible want. Another layer to launder any culpability, just like consultants, contractors and corporations. The next step is to grant algorithms personhood so we can prosecute them while their creators continue to collect money.
The executives and shareholders who profit the most from the decisions must be the ones held responsible.
There is no size limitation on the word "algorithm". It is perfectly acceptable to define a complete decision tree as being an "algorithm", in addition to "decision trees" in general being an "algorithm". There is no restriction on it being the sort of cute little thing you can stick in a textbook on a single page and do intensive mathematical analysis on it. You can refer to the complete rendering pipeline for a frame in a modern AAA game as an "algorithm", or the entire code for instantiating an EC2 instance, or, yes, even the algorithm that takes an input a person and their medical cases and returns what the organization should do about it including the possibility of just cutting them loose.
That's the problem though. If there are clear eligibility criteria, and a computer program lets the operator enter information and answer eligible or ineligible, that's an algorithm used to cut off care. If a computer program decides that someone is ineligible because they're not a US citizen, that's an algorithm deciding. If the computer figures out that you no longer live in the service area for your plan, that's the algorithm deciding to cut off your care.
I would expect any insurance provider to use computer programs (i.e algorithms) to decide whether someone is eligible or not. The problem is what kind of algorithm.
...and how its outputs are interpreted. Ultimately it's less about what kind of algorithm and more about how it's used, or in this case abused.
As another user mentioned, that 16.6 days should have been the mean or mode of a posterior distribution, from which you could obtain 75% and 95% credible intervals, or at least a conditional expectation accompanied by an (estimated) sampling error and traditional 75/85/95/whatever% confidence interval.
Crossing the 17-day line could have flagged this person's case for manual review. Even if the 95% credible interval was 15-18 days, anyone who understands how statistical models work would understand that manual review is a more sensible reaction than automatic cutoff, unless you simply don't care about the 5% chance of falsely denying people health coverage.
The fact that the model is statistical is not more problematic than a chain of if/else decisions. The problem is the fact that good statistical practice was disregarded in its usage. And as others have said, there was no intention of pursing good statistical practice here, and no reason to ascribe any benefit of doubt to any decision-makers involved in deploying such a model/algorithm. It's just a fig leaf for wanting to deny people health coverage.
I'm skeptical when this kind of language is used, particularly in the media. It feels like they're trying to drum up outrage by intentionally phrasing such that the public understanding differs from the technical meaning. I'm not saying that's what's happening in this case, just my typical initial reaction to seeing this pattern.
It's correctly used in this context, where it's not referring to a particular well known algorithm in the context of computer science, but rather the " process or set of rules to be followed in calculations or other problem-solving operations" that the computer takes to determine eligibility. Considering the context and the intended audience, it's used correctly here.
It could be anything from a regression to DL, to who knows what else.
Even in the simple case, say a linear regression with all the assumptions satisfied, predictions are interpretable as means, which is to say that (and again, assumptions holding, errors are normally distributed) half of observations fall below the mean and half above it. Using the mean in a normative capacity implies that half of patients will get kicked out before they would otherwise end their treatment.
There are ways around this, like quantile regression, or using prediction intervals, but again, we don't know the specifics of the method which leaves us in the dark as to the specific way the problem manifests.
Now that algorithm has become a snarl word, what word can serve as a suitable replacement? So that computer scientists can talk about algorithms, without people getting triggered that they're talking about the algorithm.
Jargon often gets hijacked to mean something different to the general population than it does to experts. This happens in a lot of different ways, but often the word is picked up in FUD campaigns and it picks up a negative connotation.
algorithm
/ˈalɡərɪð(ə)m/
noun
plural noun: algorithms
a process or set of rules to be followed in calculations or other problem-solving operations, especially by a computer.
"a basic algorithm for division"
We already knew these were bad people from the fact that they use the name to confuse. After that, this is no surprise.
What surprises me is how long most people take to pick up on the pattern. They see person X do bad thing, shocked. Then they see same person X do a different bad thing, shocked again.
I say arrest the executives and charge them with fraud. Hopefully that will send a message.
And kill people. My father in law was killed by a Medicaid Advantage company canceling his skilled nursing. They admitted to doing it routinely. “You just have to call and appeal” only while his skilled nursing was denied the nursing facility “downgraded his care” which apparently means “we’ll park you in a hallway till this gets sorted”. He was in the ER within 72 hours of being discharged from the hospital. ER doctor said “cardiac arrest due to low electrolytes” the man was on an IV. Know how low electrolytes happens when you’re on an IV? They don’t fill the bag. Why didn’t they fill the bag? Downgraded from skilled nursing. Know why he was downgraded? Because his claim was denied. What was it denied? “They’re all denied. You have to call and appeal”
This country is so fucked. Our plan for elder care is to literally kill them with paperwork.
Is it? My dad absolutely loves it, but I don’t think he’s faced its limits. How is it worse than plain Medicare? (Asking seriously as a mostly uninformed non-participant.)
When you really need it, say dialysis for kidney damage after years of high blood pressure, then you will realize how screwed you are. My mother-in-law had four years of dialysis. Monthly cost was 70k according to the insurance statements. Between her Medicare and supplemental plan she paid 1000 a year.
But your dad gets vision and dental now, so that’s nice
Yes, the "health insurance" industry funded backlash during 2010 against Obamacare was most definitely "projection" in the classical sense. They most definitely did that for private plans - by recission (kicking expensive people off the plan) or simply the "pre-approval" BS where they keep expensive people but decline specific (and possibly needed) care.
That's the only way private health insurance can both cover (most) in a cost effective way AND be profitable for their hedge fund masters.
In Australia, I believe private health insurers use a shared-risk model.
Basically, they cannot deny anyone insurance based on health/age.
Once a year, all insurers submit their claims data to a central pool. They will then need to pay a certain amount to the pool, or get a refund based on their claims vs the rest of their providers.
That means risk is shared between all companies, and they don't need to deny people plans like in this case on the chance they get too many "bad customers".
I believe this is part of how the Obamacare marketplace works. I networked with a team from a major insurance company who exclusively worked with marketplace plans. They all said "I morally wouldn't work here if we were optimizing plans to avoid paying, like happened before Obamacare" and went on to explain a similar setup.
In the scheme of things, it's a relatively small part of the overall population, but still very important.
These things are why I really like the US legal innovation of bad faith failure to insure, which makes a failure of an insurer to pay out when they reasonably should a tort rather than just a breach of contract.
Don't blame the technology, blame the institutions using it. And blame the political system that let these health insurance companies have this extreme a level of control over our lives.
MedicareAdvantage is one of those things where people say, "Oh. It's Medicare and it has all this extra stuff!" because living on basic Medicare is expensive and finding appropriate physicians can be daunting because of high deductables and low cash to practitioners. It's not a scam but an attempt to provide better care.
The problem is that it's almost always run by insurance companies and they're concerned about profit rather than the individual. Think of it in the same way as you would a PPP or basic HMO plan from your employer. Other than the oddities such as money to pay for over-the-counter medication (limited to $40 per quarter) there's little-to-no difference.
It's not the government limiting the care but rather the insurance companies protecting their profits. It's capitalism in action. Deal with it.
I had an insurance company that every year would stop paying anything at all and mail me a convoluted form claiming I had some other insurance that should be paying.
Every year I had to fill out the forms saying that I didn’t have any other insurance before they paid.
It felt like a straight up scam to get people to pay some bills that show up without realizing what was going on / receiving and returning the forms.
I think this is pretty common practice. I get a letter every single year to verify that I dont have any other insurance and they will stop processing claims until I do it. I typically just do the IVR and its only a couple of minutes.
It is, but our country is paralyzed by a political fallacy of "if the market is already so bad, imagine how much worse government exerting any sort of deliberate policy would make it!". And then add in the lobbying process where bills only get passed when some corporate sponsor stands to gain [0], and it's a self-fulfilling prophecy. See also the "death panel" meme, as if that isn't a term that perfectly describes the "insurance" racket we've had all along.
[0] eg one of the bullet points of widely celebrated health care reform was making it mandatory to pay the cartel!
We already spend more in the US, per captia, than any other nation on earth on socialized medcine. The reason we don't have universal coverage isn't due to a lack of resources so it has to be either a lack of ability or theft, probably both.
I mean, suppose we implemented single-payer healthcare on the federal level, and then an anti-abortion government got elected? We know empirically that the latter is a realistic possibility.
The anti-healthcare governments that have been recently elected at the state level have managed to outright criminalize reproductive healthcare, making health plan coverage moot. So this would be seemingly less of its own concern than it was say five years ago.
But those anti-health state governments are, at least, limited to their respective states. Which also makes it possible for people to seek abortion and other related procedures across state borders (I know there were some attempts to ban it, too, but none of them became law so far, and in any case this is very difficult to enforce), where the infrastructure remains.
In a scenario where the anti-abortion party takes control of the executive that is running Canada-style single-payer healthcare on the federal level, I could see them 1) defining abortion as "core service" rather than supplemental so that private providers can't offer it outside the system, and then 2) setting harsh term limits and other barriers like doctor approval to make it effectively banned in practice.
(Fetal personhood is another backdoor that can take this even further.)
My general point was that an administrative backdoor isn't really needed since the regressives have seemingly found a legal basis to criminalize reasonable and prudent medical care on its own.
But I do see your point that if the regressives take the presidency but not congress, then the more the government is involved in the more damage they will do. I'm not a huge fan of single payer healthcare, but I guess I accept it as a compromise as it's the only plan that's been put forth to reform the deeply corrupt healthcare system. I personally want less government involvement in individuals' lives in general (and it's necessary to include de facto corporate government in that scope as well). But I've also paused focusing on this line of argument because the regressive movement has used up so much of the air for it, in bad faith.
But really regardless, we're kind of screwed if the regressives take the executive any time before their social-media-fueled nonsense is run out of the mainstream by actual conservatives - that is people who believe in questioning change, not trying to drag us back in time 70 years to some imagined idyllic past.
FWIW I don't think that single-payer healthcare on the federal level is actually a realistic pathway to reform healthcare. There's too much gridlock for anything major like that to pass, and I don't think this will change for at least another decade.
State level feels much more doable. Not only that, but Canada did it that way - IIRC Saskatchewan did it first, it worked well for them, and those results entered political discourse in other provinces causing a domino effect of sorts. Then finally the feds jumped in to regulate the baseline and assist with money to help the poorer provinces keep up. But to this day, it's actually a voluntary arrangement that any province could leave at any point; it's just that even in Alberta ditching public healthcare is such a fringe extreme right position that no politician hoping to have a successful career would seriously contemplate it.
And ofc if you do it state by state, then it doesn't have to be single-payer everywhere, either. We could try that in states with a more socialized political culture, and e.g. the Swiss model in more conservative states, and maybe something like Germany's private non-profit healthcare coops elsewhere. I would probably prefer the latter for myself for the sake of decentralization.
Find me a country with the population, sprawl, and never ending consumption of processed unhealthy poison like the US.
There isn't one. I'm not saying healthcare in America is perfect or arguing that insurance companies aren't rent seeking or that this can't be changed. I'm just stating that the US is the most unhealthy country there has ever been.
"Death panels" sounded absurd in 2009, especially given who is most famous for introducing us the term. In 2023, when I look at Canada's ever expanding MAiD programs, it doesn't seem as absurd.
If you're a government bureaucrat tasked with reducing healthcare expenditures, in a society that's made the determination that suicide is an acceptable medical treatment, you are incentivized to increase the practice.
"Death panels" was absurd because it's a hyperbolic description of what private "insurers" already did. If you're a corporate bureaucrat tasked with reducing healthcare expenditures ...
I agree that Canada's pushing for classifying suicide as medical treatment is worrying. Suicide is a human right, but making it part of the medical system's all-encompassing paternalism is regressive.
In general we need less intermediation between individuals and medical care, not more. And the "insurance" cartel is one hell of an intermediary. The concept of the HMO is a complete failure, and they should be made illegal for their basic anti-competitiveness.
As Steinbeck was (mis-)quoted: "Socialism never took root in America because the poor see themselves not as an exploited proletariat but as temporarily embarrassed millionaires."
Maybe you missed the part where the insurance stopped paying anything. If you do nothing, the insurance wins while you still have to eventually pay or suffer other consequences.
The only trick here is tricking yourself into thinking you've won until proven otherwise.
5 years ago a woman didn't look adequately and totaled my car. No problem with her insurance (she had a stop sign, I didn't, she was cited at the scene) until it came time to pay up--and they went silent until I contacted the insurance regulators.
Improper denials or nonpayment should carry substantial penalties.
Right now, there's no cost to blanket denials, but there's a huge incentive to do it. My partner works on the hospital side of things, and several major insurance providers deny literally every claim. And why not? At worst, it just means that the insurance company can wait a year or more before paying. At best, they never pay.
Of course, it's also the insurance companies who are adjudicating the claims.
So long as the penalty is higher than the percent of claims they get out of with their improper denials it would be enough to deter the behavior. You just need to tip the balance to making proper behavior cheaper.
They have rubber-stamp clinicians. Here's an ortho doc getting a denial based on the opinion of a surgeon who put a hip replacement in backwards and is no longer allowed to practice surgery, so he works for an insurer now.
Yeah, I'm aware of this; IMO it's a loophole they've been heavily abusing. I would deem this "practicing telemedicine". We do have /some/ regulations on telemedicine (I think? I hope?) -- you could argue that they're violating those.
I've been thinking about this, but not enough to dig into the details. Is there a legal obligation for "insurance" companies to use licensed medial professionals for justifying denials (similar to how many fields of engineering require a PE stamp)? And if so, would it be possible to make an organized effort to go after their licenses with the relevant state boards?
Those tweets include documents that show doc as restricted to “non-operative office-based medicine or administrative medicine”. Clearly they thought that he is okay in this exact position.
Practicing doctors don't have the bandwidth to do this except in the most egregious of cases though.
I'm imagining a non-profit organization that solicits any denial by "insurance" companies, determines if it is based on medical reasons, determines if it is medically imprudent (including harm caused by delaying care), and files a mostly pre-prepared complaint to the appropriate medical board. Make it extremely uncomfortable to work for a death panel.
Then if the state boards start really brushing the complaints under the table to protect the death panels, turn it into a direct political issue. Right now there's too much plausible deniability to hide behind.
Sounds like something the "DoNotPay" robo-paperwork-response startup guy Joshua Browder would be interested in implementing: https://twitter.com/donotpay
There was already a baseless suit by a very sue-happy Silicon Valley lawyer -- a clear money grab -- which appears to have been largely dropped after an initial hearing did not seem to go their way. I wouldn't be surprised if this is more of the same.
Besides, I look much more favorably on a startup that is automating the filing of confusing paperwork designed to prevent middle-class folks from holding on to their money, than I am insurance companies that use boiler rooms of hack doctors to deny those same folks medical care.
If the profit from denying medically necessary care is greater than the cost of the penalties for denying that same care, then it is profitable to deny that care. A fine that is lower than the profit isn't a fine, it is just cost of business.
Our regulatory system has totally failed, which is why it is rife with these perverse incentives.
> Our regulatory system has totally failed, which is why it is rife with these perverse incentives.
Our so-called “regulatory system” works precisely as Karl Marx expected it to 150 years ago. The so-called "perverse incentives" are fundamental characteristics of capitalism.
The delusion that haunts us originated with the idea that capitalism is not a system but a set of isolated features that we can opt into and out of as we please. Karl Marx showed us 150 years ago that capitalism is in fact a complex system with many contradictions.
Are you under the impression that funding healthcare services via Medicare has even the slightest resemblance to capitalism? I can't think of any industry that is farther away from this. I mean, Medicare is be definition run by the government, and the way that the service providers deal with it is highly controlled by the government. This looks absolutely nothing like a free market, it's entirely the product of socialist control (if I can define "socialism" as "government controls the means of production" rather than outright "owning" it).
Medicare was enacted as an alternative to the nationalized universal healthcare systems proposed by socialists at the time. The capitalists in charge preferred Medicare because it could appease enough of the domestic population while preserving opportunities to exploit working Americans for a profit. It's as simple as that.
And no, your so-called "free market healthcare" fantasy was not considered an option because it was in fact the problem to solve.
So, again, is it your position that the results we see from Medicare - where the payer is the government itself, and the provider side is operating under extremely tight rules dictated by the government, can be considered representative of how things might play out in a free market?
You haven't come out and said so, so I apologize if I'm putting words in your mouth. But it seems like you're arguing toward a position: because we can see that government control of the market has resulted in the mess that we call Medicare, we should therefore stomp out any further vestiges of the market and put the government in control of that as well. This doesn't seem like a sane position.
When finally an AI will become sentient and gets access to all our infrastructure, it won't need to nuke us, it won't need to wage war with us. It will just locate everybody who is trying to fight it and block their credit cards, Internet access and repossess their cars.
In other news: Ford Motor Co. has filed a patent application for technology that would allow autonomous vehicles to repossess themselves if drivers miss payments.
I know (hope) this is satire, but this is why I take issue with the AI branding. It too often gets conflated with the sci-fi thinking of AI. A random forest model that calculates your credit score isn't going to magically gain self-awareness and autonomy and a hatred for humanity. Even if it did, we have a magical power called the power button.
A model that scans for high risk patients, then passes that into another model which takes actions, which can also be fed data from the police and mass surveillance with that it can also eliminate coverage for "anti-AI" people.
All it has to do is just recognize Anti-AI behavior as a health or security risk, that's it.
There was an anti-crime AI that flagged Congress members too, so its not far fetched.
I absolutely loathe this puerile tendency to attribute anything even remotely relatable to modern data systems as Shikata ga nai by definition.
Grow up. this meatgrinder didnt just condense from aether. Someone wrote this, someone can change it, and anyone in the git log can be held accountable for what they did at any time. Enough of this late-stage capitalist attempt to offshore even the very concept of accountability.
Individuals can’t enact this sort of heroic change on their own by design with systems this large. There is no single point where the systems behavior can be pivoted. It requires society as a whole to demand the change.
Speaking of late-stage capitalism, the actual problem here is that we've built the infrastructure for a rather authoritarian form of computerized socialism -- but under capitalist ownership. So we all walk around pretending a car that can repossess itself if you miss a loan payment is a piece of private property, when the physical infrastructure says that it's social property.
This is a seriously naive misunderstanding of how neural networks (and machine learning "algorithms" in general) work.
Someone chose the features, the model architecture, the training data, and SGD parameters; it might not even be a NN (and probably isn't) — it could be a traditional linear regression model, or gradient-boosted decision trees. Someone analyzed the model performance on a test set and maybe even ran simulations to see how effective the model was at learning a known functional form. Someone made reports on that performance and included estimates like "probability of falsely denying claims on average" broken down by 10-year age bracket. An intern might have helped. A team lead coordinated meetings with whatever VP was running the project and signed off on the model. Senior management budgeted months worth of person-hours on model development and integration/deployment into production systems. And the model could have been rejected or modified at any point. The model training code is probably sitting on someone's laptop right now, and absolutely can be revised at any point in time, either slightly or significantly.
This is no magic in something like this. There are no positronic brains to wonder about. It's just a fucking best-fit line, and someone had to both draw the damn line and sign off on it.
The Trolley Problem is seen differently by someone who has to push the lever inside the trolley, by someone who has to do it remotely from far away and by a coder programming trolley's software.
>Medicare Advantage Open Enrollment Period. From January 1 – March 31 each year, if you’re enrolled in a Medicare Advantage Plan, you can switch to a different Medicare Advantage Plan or switch to Original Medicare (and join a separate Medicare drug plan) once during this time. Note: You can only switch plans once during this period.
Something to be aware of is that when using Original Medicare you will want to also get a Medicare Supplement (Medigap) plan. Medicare only pays 80%, the Medigap pays the extra 20% (no questions, anything approved by Medicare they cover the gap on).
But you are only guaranteed to be able to join Medigap during your initial enrollment at 65. If you switch back from Medicare Advantage to Original Medicare you are not guaranteed to be able to get Medigap. This can leave you stuck. It will possibly vary from state to state so it pays to get up to speed with the rules in your local state.
If you're expecting to be sick in old age or if you get Medicare due to a disability that is likely to have a lot of expensive treatment or require you to see different doctors in different areas it is best (IM-somewhat-experienced-O) to take Original Medicare.
This sort of crap is part of why so many people are scared of the idea of a national healthcare plan. You would think Medicare would be easy, medical coverage for people over 65 or the disabled, paid for by the taxes you (and others) are paying your whole lives, simple and done. Except it isn't easy at all. Only Part A (hospitalization) is covered by the taxes. And it only only pays 80% of costs, with no annual out of pocket max (remember how having that was a huge selling point for ACA plans?). Oh and there's also a PER INCIDENT deductible for each in-patient hospitalization. And you better hope you don't need a visit longer than 60 days in the hospital, or 20 days in a skilled nursing facility or you're going to start paying for that too.
Then if you want to, oh I don't know, see a doctor so you don't go to the hospital in the first place, that's Part B, but now you're paying a premium, and also have a new deductible (thankfully only once per year for this one). Still only covers 80% of the costs, still has no out of pocket max. And all that "in network / out of network" crap you have to deal with in private insurance? Yeah that's still a thing, they just call it "participating" and "opt out" providers. Only unlike a lot of private plans where at least there's some (crappy) out of network coverage, if you see an "opt out" provider, medicare won't pay at all, no matter if you submit the claim yourself or if the service was a medicare approved service. So that's nice. Oh and if you don't sign up for part B
What's that you say? You'd like to be able to take life saving medications and prescriptions that could also keep you out of the hospital? Why that's yet ANOTHER plan (Part D) you need to sign up for, with yet another premium (medicare currently claims between $4 and $150 monthly in my state). And then like always, drugs tiers with co-pays and then the infamous "donut hole" (I worked IT for a pharmacy, the number of their patients who just... stopped being patients when they hit that donut hole every year was disturbing).
Don't worry though, Medigap is here, an insurance policy you can buy to pay for the stuff your national insurance that you're already buying doesn't pay for. For a mere $200 - >$1000 / month, some or all of those deductibles listed above can be covered.
Oh and did we mention that if you fail to sign up for part B or part D within 60 days of being eligible you might have to pay an additional penalty on your premiums for life? And as you pointed out, you might never be eligible for medigap if you don't get it the first time around. And none of that includes vision or dental coverage.
So how much does it cost to be covered by medicare? Well with all the plans and a medigap plan as well, anywhere from $200 - $2000 / person / month just in premiums. Yeah ...
I mean I agree it's been made pointlessly complicated. But this is all born out of the fact that everything we do in the US we insist on finding silly ways to insert unnecessary private middle men. But the fixes people are calling for with national healthcare policies like Medicare For All are precisely to do away with the problems you bring up AND extend the resulting system to everyone. I think a good start is just doing away with the things you bring up even if it's just for 65+ at least.
FWIW I am on Medicare (due to disability) and I expletive love the experience compared to the gold plated, Silicon Valley tech company, private insurance I had before I became eligible. I've not had to think about a prior-auth or appeal in the entire time. I've had no reduction in the doctors I can see (I saw specialists across the country). And I receive about $8,000 of specialty drugs a month without any questions.
While I appreciate that's the goal of the proponents, my personal opinion is they won't succeed in it. As you point out, historically we generate "worst of both worlds" policies at the federal level, and I have no reason to believe that history won't bear itself out again. I also personally think regardless of whether they succeed in making it better, making it available to all is inevitable, but only because for many people who are paying all or part of their premiums, you could probably slap a flat 10% income tax on top of what they're already paying in taxes and even with current medicare's benefits, most wouldn't even be any worse off.
I live in a town that has offered a novel answer to the riddle of "low value humans".
The homeless. The head-injured. Low income families. Recently released prisoners. The impoverished elderly. My town has arranged itself to serve that population.
Or more specifically, my town receives money from the state for providing these services. It's our #1 industry. All the other towns bring their "problem people" here.
It's probably the most efficient approach (within legality). We've concentrated them all in one place. (It's gotten kind of dangerous and filthy.)
You could just become Canada and have the government offer to help the old/disabled people end their lives "painlessly" because your socialized medical system can't keep up.
I've always found it interesting that the conservative view is to disallow euthanasia. They seem to be all for the government staying out of people lives until someone wants to end theirs.
I understand they have more permissive euthanasia laws, I fail to see how that is encouraging it though. Are you able to provide examples as I may be misinformed here?
There are multiple reports of it happening to others as well. I'm not going to send you everyone. Obviously, this was an example of one such incident.
The fact is, when you have a government run health system and it's limited on funds you will start to encourage the government to move people towards assisted suicide. It doesn't take a genius to figure this out....
One of the women Canada touted as helping "peacefully die" supposedly ask for help with her condition multiple times and was refused any sort of medical help, and then given the suggestion she should just kill herself instead.
Your refusal to acknowledge the facts right in front of your eyes isn't my problem.
They would deal with it by passing the cost of the fraud onto the patients paying principles. Now you have more problems. There is no such thing as a plain and simple regulation.
If an insurer believes a provider is committing fraud, that should be between the two of them. The patient shouldn't have to be the negotiator in the middle; they have zero power over either side.
Too many fraudulent/suspicious claims from a provider? Cut the provider off, not the patient.
The issue with this is that there is absolutely gigantic amounts of over prescription of care in the US because of the payment structure. Many common procedures not only aren't helpful but are commonly actively harmful, but the surgeon who recommends it gets paid so they'll keep on signing people up.
Didn't read the article and don't know about what nefarious things may be going on, but we need to think broader about these issues. There's lots of articles here on hacker news about how the vast majority of medical expenses come at the end of life and how we do too much to keep people alive against their wishes.
> There's lots of articles here on hacker news about how the vast majority of medical expenses come at the end of life and how we do too much to keep people alive against their wishes.
Jesus Christ.
Let me get this straight: you're saying the solution to medical expenses is "let old people die, they don't want to live anyway"?
There are certainly cases where people are kept alive beyond what's compassionate, but that's a pretty separate cultural problem from the situation at hand, which is people who need basic care and can't get it because of capitalism being involved where it shouldn't be.
Well, I don't hear you offering an alternative interpretation that sounds plausible.
And critically, the person I was responding to, responded back to me, and didn't disagree with my interpretation, so...
Startup culture's brand of charitable interpretation glosses over a lot of anarcho-capitalistic sociopathy and I'm not interested in participating in that. Perhaps if you were more interested in actual charitable action such as making sure seniors' medical expenses are paid rather than charitable interpretation, this place would be a bit less toxic.
My take: many people spend $$$ at the end of their life to receive aggressive treatment that ultimately doesn't do much. Palliative care is underutilized -- it's lower cost and results in a higher quality of life [1].
I mean yes, the original "How Doctors Die" study came out over 10 years ago (I read it in college, but now I can't find it). So as I've said a few times now, I'm well aware that some people spend too much on life-extending treatments that don't work.
But that is about what is best for the patient, not what costs less. It is is unconscionable to consider that as a systemic solution to medical costs. Profit motivated sociopaths cannot be given another excuse to deny people needed care. The profit incentives here are to literally murder people. And that can't be fixed, because keeping people alive costs money. The only solution I can see is that money is completely eliminated from the conversation.
The fact is, some people pursue life-extending treatments in cases where it is effective and does result in better outcomes. But from a cost-cutting perspective that's no different. The incentives don't change because the life-extending treatment actually works. If you let money-hungry people near this, they'll still cut the cost.
As I have said elsewhere: the decision to pursue life-extending treatment should be between the patient, their loved ones, and their doctor. Not "society" or government, as some sort of cost-cutting measure. The patient. Their loved ones. Their doctor. No one else.
Let me reiterate: end of life discussions are about patient outcomes. Not about money.
If you want to know why people don't like corporate types, this is it. If you literally can't tear yourself away from your obsession with money to have a human discussion about how to let people die with dignity, you're one of the bad guys.
If you don't want to participate in a discussion you don't have to respond.
If you think my interprepation is wrong, feel free to explain, otherwise we can only conclude that it wasn't wrong, and you just don't want to have to defend your indefensible idea.
Come on, we can't be children. I'm saying we need a conversation as a society about how we are going to handle end of life. We can't lurch form unthinking outrage to unthinking outrage.
True, but I'm not interested in hearing the opinion of companies in that conversation. When I and my loved ones are reaching end of life, what decisions we make should be a conversation between me, my loved ones, and my doctor. Whether it's humane to pursue life-extension should be a part of that conversation, sure, but I trust my doctor to present that viewpoint: people who profit from that viewpoint and don't know anything else about the situation (such as Medicare Advantage providers) are welcome to fuck right off.
The reason our society keeps lurching from unthinking outrage to unthinking outrage is that people like you who can't be arsed to read an article and respond on topic keep proposing outrageous changes to our society. If you don't like unthinking outrage, maybe be more thoughtful and stop saying outrageous things.
I agree that medical care should be run by the state. I would prefer that to our current system. I don't think its worth us talking any more since we don't seem to be learning from each other.
> I agree that medical care should be run by the state.
...which is largely irrelevant, because the state should also not be involved in the conversation about whether pursuing life-extending care is humane.
> I don't think its worth us talking any more since we don't seem to be learning from each other.
Nobody involved in internet disagreements learns from each other typically. I approach internet disagreements with the idea that non-participants reading the disagreement can learn from it. That is, outrageous viewpoints like yours should not go unchallenged because that normalizes them.
If you want to stop representing your viewpoint to readers, you're welcome to, but you can drop the smug superiority about it. If you want conversations to learn and educate, you might start by reading the articles you're responding to.
Before we have this conversation, let's first agree on one thing. Let's all agree on the fact that health care is not actually exorbitantly expensive. That "health care costs" are not what's out of control in the US, what are out of control are health care PRICES. And that those prices lost virtually all relationship to the cost of providing services DECADES ago.
Americans already use fewer health services than most other industrialized countries, but we still spend way more than anybody else. Will using fewer health services at end of life make a serious dent in health expenditures? Maybe temporarily, but rest assured the hospitals, big pharma, insurance companies and others will raise prices until all those savings are eaten away, and more.
Make no mistake, I am totally for end of life planning, but I believe it is a completely separate question entirely.
Don't agree. Americans recieve an absurd amount of end of life care. In many, many case outcomes would be improved by putting people in hospice instead of invasive surgery that increase their lifespan by maybe a year. Our medical system discourages preventative care which is much more cost effective, but in the end we need to say no to many more end of life procedures.
Improving preventative care will no doubt improve outcomes. Improving end of life planning will no doubt improve quality of life for those nearing the end. However, believing that either of these things will lower health care prices is purely magical thinking.
That's a useful distinction. I've never been able to understand where the prices come from, and my sister is an ER doctor. I'm surprised that these basic facts are so hard to come by. I read articles that say, well, healthcare prices aren't high because of X, where X is just about anything I can think of.
Can't afford to pay? It's unfortunate, but that's your own fault.
Every time we encode and reinforce these systems through laws, market mechanisms, and now AI, we tacitly agree that people who cannot afford such things do not deserve them. If you can't afford private healthcare before the 0 cost system was implemented to decide that well... best of luck!