I was a software engineer in America's largest company for healtcare payment transactions and let me tell you, as stated in the article, we will justify our existence and do anything in order to continue existing so that the cash flow can continue. We automate the writing of templates that say, "Sorry Mr/Mrs. Smith, your insurance claim includes x-y-z specific services which make this claim invalid, so you must experience financial turmoil as a result." Sometimes the eligibility period would close with a hard deadline, despite healthcare delays. I also wrote code to reject or approve financial transactions for claims.

The justification for this company specifically is that paper payments need to move to digital and make it as efficient as possible because if not, someone else might get it wrong, and _they_ could make it even harder for Americans to get their finances processed in a timely manner. At the same time, digital payments and notifications makes it much easier to obscure who the point of contact should be when things go wrong and you want to make an appeal. Upwards of 80% of expenses for some healthcare transactions companies come from things related to paper checks, but I don't think anyone would point their finger at those fees and say "this is the reason why US healthcare is much more expensive than the rest of the world".

Especially during this pandemic, when we didn't want to dirty our hands further or deal with legacy healthcare IT code, we tossed it over the offshore wall in Taiwan and handed it to their armies of software contractors, some of whom even coming from India to live in Taiwan in order to have this opportunity.

The patients (called "consumers" or "members" in IT insurance parlance) are not actually the customer. The customer is the insurance companies like Aetna ("payers")

At some point you have to question if you want your career to be built on automating the rejection of millions of people and know that your code contributes to perpetuate current existing healthcare system in US. However, the thing is that the skills of a software engineer is becoming fairly routine and common, so unless you are something like Director of AI or Mr/Mrs. Design-Lead-for-Rare-Skillset, you are also fairly replaceable. Software engineers are told what tasks need automation, and they implement it. If not, hire a different one.

I'm also aware of and have lived under the Japanese healthcare system, and perhaps like the Canadian system, I know how much more reasonable it is despite the lesser amount of private access. It's also a myth that the US contributes far higher to medical R&D than the rest of the world, as Japan has close to the same proportion of R&D, yet Japan doesn't have nearly the same consumer costs as high as the US. Consider that ≈0.65% of American economic output (measured by GDP) goes toward healthcare R&D, while ≈0.40% of Canada’s economic output goes toward healthcare R&D, and Japan ≈0.50 (page 79) [1]. Every Japanese/Canadian citizen, on average, can afford to pay more proportion per capita on healthcare R&D than the US. Still, on some rankings, America ranks as one of the least efficient healthcare systems: 50 out of 55 on a Bloomberg index for developed nations [2]. The US has the highest healthcare spending, but does it at least have a return? Life expectancy says no [3]. Yes, it is arguable that life expectancy is too simple, but it is a simple way to intuitively compare healthcare system outcomes across different countries.

It makes me happy to know that Americans like Potter in the article are trying to find redemption for their past participation. I hope to find the same and find better ways to use my skills

[1] World Health Organization, World Health Statistics 2016: Monitoring Health for the SDGs Sustainable Development Goals. 2016: World Health Organization. https://apps.who.int/iris/handle/10665/206498

[2] Du, L. and W. Lu U.S. Health-Care System Ranks as One of the Least-Efficient. 2016. https://www.bloomberg.com/news/articles/2016-09-29/u-s-healt...

[3] https://ourworldindata.org/grapher/life-expectancy-vs-health...