skysight-inc/HackerNews huggingface dataset:
> insurance companies' profit margin is set by law and they can't change it.

Cigna executive-turned-whistleblower says Wall Street drives up health care costs https://www.wbur.org/hereandnow/2024/12/18/cigna-whistleblow...

> Robin Young: ...you testified before Congress during the passage of the Affordable Care Act, and at that time, that law demanded that health care plans spend 80 to 85% of premiums on patient care. This is called the Medical Loss Ratio. So what happened?

> Wendell Potter: They figured out how to work around that. For one, they've gotten more and more into health care delivery, and they now own physician practices and clinics and big pharmacy benefits middlemen, and none of that is affected by the medical loss ratio. So in other words, they've figured out how to work around it, plus it also has enabled them to jack up their premiums. So the more premiums they take in, the more money they have.

I used to do health insurance company PR. Here’s what I think the backlash is missing https://www.statnews.com/2024/12/11/wall-street-unitedhealth...

> Congress would ultimately include language in the ACA to require health plans to spend at least 80% to 85% of premiums insurers take in on enrollees’ care, known as the medical loss ratio. But big insurers have figured out if they also become health care providers — by buying physician practices, clinics, and pharmacy benefit managers — they can meet that threshold by paying themselves and avoiding payment for their customers’ care.

> An argument could be made that the medical loss ratio provision of the ACA has contributed to or even fueled the vertical integration of the big insurers, UnitedHealth especially. UnitedHealth is massively bigger and more profitable than it was on the day I first testified as a whistleblower, June 24, 2009, when it ranked 21st on the Fortune 500 list of U.S. companies. Its share price at the close of trading that day was $24.81. Hundreds of acquisitions later, UnitedHealth is now the fourth largest U.S. company — just behind Walmart, Amazon, and Apple. At the end of trading on Monday of this week, the share price was $560.62. That’s an increase of more than 2,100% since June 24, 2009. By comparison, the Dow Jones average has increased 438%.

> In the years since then, UnitedHealth, Cigna, and a handful of other New York Stock Exchange corporations have cemented their roles as unelected gatekeepers to care, and Americans are now waking up as they never have before to the consequences of that. If their rage can be harnessed and channeled with clear policy proposals, that dike the industry built might just give way without more violence.
Non-violence...lines get blurred while being cut throat and cold hearted when you do it to thousands or millions of people. I'm surprised the GFC didn't have anything like this given the damage it did.
wow. It's like cursor vs vscode movement but for browser automation and scrapping. Kudos to the author. Are there any other similar tools?
Yes it was partly toung in cheek. These were good people who acted on principle.

However... I was young and it took me too long to see the hypocrisy of their thinking. They would happily feed the chickens but I would be the person who killed them... their angel of death. I wasn't even properly shown how to kill a chicken.

One day I was present when a pig was slaughtered a process which was overseen by a vet. That animal certainly knew it was going to die and did not like the idea. I was only 19, and was somewhat badly affected by the experience. For a while I even became a vegetarian but developed health issues as a result.

In the long run what I took from the idea was that meat has a cost. Life is not sacred but it is certainly precious. For that knowing it was worth it.
Athletes get money in rough proportion to how many and how much fans are willing to pay to see them. It's as simple as that.
I think Mangione is more popular with the public than Stack Exchange.
No, that's not accurate. See https://www.healthcare.gov/health-care-law-protections/rate-...
Have you met the average person? I would highly contest this claim.

Let an average person alone in nature and they’ll starve within a month
Yes, but simple as -- Nelson Mandela is not Luigi Mangione.

This isn't apartheid. Get a hold on your horses and grow up. You live in a republic. You need to convince other people single payer health care is the right policy.
Seriously, I get that the US healthcare system is brutal and terrible, but this is not how you handle it (and I don't think insurance companies are even the root of the problem).
If you lower the bar that far from premeditated homicide, then you will get lots of 'peons' that got away with slaps on the wrist too.
I think you understand very clearly what point is being made, and are just pretending not to get it.
This is not really the point of the article. It also points out that the man has not been convicted yet. In a rule of law society, people are innocent until proven guilty, but it seems irrelevant because his unrelated contributions are preemptively stripped from him and people are being arbitrarily punished for asking about it.
Nope. You are free to establish an alternate system if you like. There are medical facilities that are flat rate and cash only, like the Surgery Center of Oklahoma, https://surgerycenterok.com/. There are also many cost sharing services, like this one https://altruahealthshare.org. Ultimately you also have the personal option of becoming a physician and setting any rate you choose for your services, including $0.
And that can be accomplished by printing a :"just don't be poor, its disgusting " poster with tax money and putting it up at all airports.
Show HN: Make 100% natural AI podcasts in seconds
Is there any kind of copyright or other protection on the generated Podcast audio? Or can it be redistributed at will?
You can’t give someone only two options, one less bad, then claim there was a free choice made.
eye roll Please.

Health care policy isn't war, isn't apartheid, isn't civil rights.
Nah. It's a general purpose computer hat has to live as a giant phone.
Eh, check out what happened in Romania recently: we had presidential elections and an independent candidate won (by quite a big margin). The second place was also not expected. They then cancelled the elections and we're doing them again in May.
'We're done': owner of Walter White's house in Breaking Bad puts it on market
> isn't worth it.

Exactly. If Valve went the native route why would that have changed?

> Which as IBM discovered

You keep repeating that in every comment but I don’t quite understand how is this some conclusive argument. Especially when you don’t elaborate on what specifically do you think could happen.
1 point by thowawatp302 0 minutes ago | root | parent | next | edit | delete [–]

Yeah I listed all of those because it’s funnier when people mistake the vigilante justice’ thing for a ‘not killing people’ thing and then I can trot out Clint Eastwood and Dirty Harry, which was so popular it gets quoted regularly and had four sequels.
> These projects misdirect talented individuals from impactful work.

My most impactful project was the one that I coded quickly in three hours for fun. It has later turned into the greatest Turkish social platform in the world, is still being used by millions of people every day 26 years after I coded it.

I'm glad that you weren't there as the self-proclaimed arbiter of real impact™ when I started writing it. :)
Frustrating that we lazily have to still copy-paste jwz.org links in 2025.

(DNA Pizza was one of my favorite things about living in SOMA in the before days)
> Any healthcare system must deny healthcare.

And a healthcare system enabled by UHC will deny healthcare at a rate 3 times that of the rest of the industry.

So is every other insurer "under-denying" healthcare?

Or is UHC choosing to deny healthcare more than it needs to?

> In any society, debts are expected to be paid off. If people could just stop paying their debts, nobody would make any loans anymore. Forcing people into bankruptcy is not violence.

Insurance is the reason that these debts are so exorbitant in the first place.

Do you really think the ER trip and a few tests cost the hospital eighty thousand dollars, and UHC, magician negotiators that they are, managed to talk the bill down to $4,000?

And yet the hospital will charge you, the uninsured, $80K. Yeah, you might be able to negotiate it down some, but not like that.

The US is the only country in the world where deathbed divorce is a thing, so families won't be burdened with medical bills[1].

But I feel like you'd find that immoral, too.

[1] Lack of legal obligation to the debt (even beyond this, to family members in general) won't stop the hospital calling your family and heavily beating on you to pay the bill of your recently departed, even if you had no financial responsibility, using everything from appealing to a sense of pride, to outright deception and claims that they can sue for the unpaid bill.
There's even ghibli fan art of Luigi:
<https://www.instagram.com/totorotuesday/p/DD9oL9oTm3V/?hl=en>
I have a sneaking suspicion that foreign agents are pushing the hero narrative pretty hard. Trying to encourage copycats causing chaos.
I mean the polls weren't really wrong re: 2024? But even if they were, wouldn't such polls, if biased re: Trump and law and order Rs, be worse for Mangione?
Climate change will result in many third world environments not being viable. Redistributing their offspring to first world environs that can afford mitigation will forestall collapse.

Alas, xenophobic and self-loathing social darwinist tendencies in the first world will probably prevent this rational solution.

Which is why the first to invent an adult daiper changing robot will be a billionaire.
And with what money would the campaign run? Your democracy has been sold....
> (US) Free speech beats the alternative(s).

Questionable.

> and that's still true when they tell you what they're saying is "the science".

Ditto "the earth is flat", "they are eating the cats", "it was a lab leak", .. etc.

These are opinions not science.
And then cries of disgust and demands of professional services 24/7 for free because someone found a bug in your hobby project which turned out to be useful for some megacorp or VC funded startup.
It's really just for-profit health insurance systems that I think can't be made ethical. If you have to deny some claims based on resource availability, that's an uncomfortable necessity, but we can do insurance-like things without asking people to balance human life against shareholder greed.

It seems pretty obvious that opting into a position where you'll have to do that might make you unpopular with the humans.
I find it hilarious that they can't even keep their power in check to save it for when it would REALLY matter... but they just cant help themselves, they love to execute the control as quickly as it is available even though this leaves a trail of erosion.

An obvious worldwide trend of complete speech control, right in the open for all of us to follow and see. Instead of just waiting a bit longer... until there was no way to stop it (maybe its already too late?) But i feel like this is too soon to pull this trigger, we still have time to stop using all these large platforms that aren't even vital to our lives, to make open and peer to peer alternatives
I did a quick search but can't find anything about the profit margin being fixed, can you point me to where I can learn more?

Also a fixed profit margin can as well translate to higher salaries and other costs that the company controls, not necessarily lower premiums?
I had an opportunity to do some industrial work while putting myself through university. I do wish there were more opportunities to do industrial work on a part time, temporary, or casual basis. There is something particularly rewarding about working with your hands as a part of a team and in combination with a large machine to produce something tangible.
As cleverly demonstrate in this famous scene from Yes, Prime Minister

https://youtu.be/ahgjEjJkZks?si=VtYSzCoD_7-kyvhs
all it takes is a quarry and a sound system .
The kids have parents who are empowered to make those decisions for them, for exactly the reason you suggest.

Of course, some parents make poor decisions - but it's a free country, but not free from the consequences of bad decisions.

Or do you suggest someone else make those decisions for the kids?
You just submitted a Show HN for this 4 days ago: https://news.ycombinator.com/item?id=42595004

25 days: https://news.ycombinator.com/item?id=42421320

3 months: https://news.ycombinator.com/item?id=41756691
We've been throwing more compute at our problems for what, 80 years?
You actually believe that? Distributed systems are simpler than monolithic? In PHP?

This business wouldn't exist if they attempted to follow your advice, because they weren't able and anyway didn't have the money to hire that many developers. There were a couple of subsystems they tried to implement the way you suggest, e.g. one for running certain background jobs.

It was a database table with one row per type of job and a little metadata like job status and a copy of the input. They started jobs by sending a HTTP request. This was a constant source of manual handling, because things started jobs and then crashed and never reset the status and things like that. You could respond that they should have used a message queue instead and so on, but the thing is, they didn't know how to build reliable distributed systems. Few developers do.
Are you kidding? It is rare for someone to deliberately break the law and also be ethically upright. I'm saying that he is not obviously compromised. His murderer on the other hand apparently is. You can imagine a world in which murdering someone you have no connection to, based on a bunch of BS, is ethical. But civilized people don't think that way. If you don't like the way insurance is done, the civilized thing to do is to lobby for better regulations or something, not go on a killing spree.

The justice system generally doesn't tolerate revenge, even when the average person might feel it justified. If someone murdered your child in cold blood right in front of you, you don't get a free pass to go out and lynch them. Civilized people know this is necessary to keep innocent people safe and ensure some kind of consistency in outcomes. How much less justified is "revenge" like this case, where there is no connection between the attacker and the victim, the perceived offense is abstract and arguable, and taking the guy out does essentially nothing to make the world a better place?
>You need to convince other people single payer health care is the right policy.

I think we've effectively already done that. What people actually want does not impact the way in which our government functions, despite popular belief.

The people in this country have absolutely no power and are tired of it. You can't vote out a parasitic system that exists only to extract as much from you as possible. The people who "represent" us only focus on culture war bullshit INTENTIONALLY, to distract from the fact that the one of two preselected candidates we have basically represent the same despicable capitalists and their same interests of stripping us of everything you have so they can have more shit they don't need, while the rest of us are fighting over their droppings.
They don't even need to do anything especially conspiratorial, I would expect those polls to have substantial anti-Mangione bias by construction.

Many people will want to avoid being on record as supporting a murderer, for fear of any consequences down the line. I know polls are almost certainly anonymous, but you need to trust the pollster to actually abide by that. If you have even an inch of worry, it's easier to just not answer (or answer insincerely) and move on.
You are right, BUT: Those denials have to follow contractual terms. I know a local (Europe) real world example where a friend of a friend (insurance company area manager) literally was told "this is your sum of money on claims that you can accept in this quarter, it cannot go above that". Which either you get lucky and make the quota, or you screw people over and hope they don't sue. And since we live in a world where the company wants "a little more" each year, well.. I don't see how this ends well.

The same problem does not apply to our social services (including health insurance) as they dont have to make profits at all costs.
“Social murder” is the term
Cops do this all the time
How many times are you going to deflect from the same simple question? Do CEOs of large corporation have any autonomy compared to other workers?
> Do you have proof of that? Look I know insurance companies are rarely eager to pay out. If they were, they would quickly go out of business or else have to charge you so much as to make the coverage pointless.

That's not how it works.

Insurances charge monthly payments in return to providing access to healthcare services for free or reduced cost. This means the bulk of their customers is people who do not need the service right away, and instead are investing in assuring they will get the treatment they need when and if they need it.

Those who do not get access to healthcare services and die will not be able to vote with their wallets. They are gone. The same holds if you are bankrupted by having to pay your treatments out if your own pocket, specially if you lose your livelihood in result of your health issues.

On top of that, there's the question of whether there's a free market on healthcare insurance. Big if.
'Rational solution' to what? The problem of perpetuating the Japanese people, or the problem of keeping the Japanese islands populated?
Link Blog in a Static Site
Ah yes the end state of society is childless nurses working their assess of caring after way too many retired old people.
> Nobody argues against that, but United Healthcare had a denial rate of more than 30%, which is the highest among the major health insurance companies in the US.

As it happens, there will always exist a health insurance company with highest denial rate among all companies. That's a simple mathematical fact: a finite set of numbers has a maximum number. You need to do more legwork to show any actual wrongdoing on anyone's part here.

> In every just society, the debtor has a responsibility as well to not lend money to people who cannot afford it. Giving somebody a loan they cannot afford and then bankrupting them is definitely non-physical violence.

This is absurd. When your debtors go bankrupt, you lose money. Nobody wants to lend money to people who cannot afford it.
Bone density, height, vocal changes, etc.

You can't just delay puberty until you're 20
If it's any help - It's a large community, and you might be just picking the areas where replies are going to be a bit blunt or dismissive - no doubt there's also members with huge egos as well ... and it's a case of YMMV.
Oh please, like if it's 1930 and you're walking behind Hitler knowing the future, you probably stab him. Or maybe if you're walking behind Ted Bundy in 1970. At least if you're a future-knowing trolley problem type person.

It's obvious that there are plenty of situations where murder in the streets is justified. Just that we rarely know of them in the moment.
Discussion (418 points, 15 days ago, 274 comments) https://news.ycombinator.com/item?id=42507312

Related:

Ruby 3.4 Highlights (204 points, 8 days ago, 83 comments) https://news.ycombinator.com/item?id=42566141

Next Generation Out of Band Garbage Collection (172 points, 67 days ago, 81 comments) https://news.ycombinator.com/item?id=42028833
There are a lot of categories of products where it still makes sense to do the manufacturing close to the customer. Take a look at the window industry for example.

There is still a lot of manufacturing in North America, both small and large. Zoom into the industrial area of any major center and start looking at names to get some ideas.

There are also some folks that are trying to break the mold entirely. Check out https://www.srtxlabs.com/
2024 election polls were wrong. Every single one had it either at a coin-flip odd between the two, or Kamala leading 1 point. It was 2 months ago, this isn't hard to remember.

How it came out, in fact, was Trump winning popular vote with 2 million more votes than kamala, and almost 90 more electoral votes. That's FAR from coin-flip odds, and don't even get me started on the swing state polls, with Trump winning every single one.

-----

Yeah, the biased nature of most people not wanting to publicly sympathize with an early political vigilante WOULD make polls regarding him worse, despite the fact they do. I completely agree with you.
People under the age of 30, who have never experienced a day of their lives in a broken or failed state which includes political violence as an everyday occurrence, think political violence is a good idea. Because... they like LARPing as downwardly mobile lefties?

Seriously, ask a few asylum seekers from Honduras or El Salvador what they think about political violence. I guarantee you not a one will tell you about how romantic it all is.

Because political violence is obviously something to be scared of, not something to "revere". Like -- we can see it happen elsewhere. We can watch it on the tube every night.

It's not "edgy", Daria. Put down the hair dye and the kitchen sheers. You're too old to play act revolutionary.
> Those 2 months were hard, [...] but also with the SO complaining that I wasn’t available to reply to messages sometimes (because I was sleeping when she was awake), which was no encouragement to keep going.

I hope it's not too personal to ask, but I'm wondering how that is working out with the SO.

My own experience thus far, as someone whose body by default seems to want to do 25-26 hour days (and can do much longer when I choose), is that an SO is one reason to force myself to stay on a 24-hour cycle.

If you're both doing grad school, hospital shifts, startups, trying to make partner, traveling a lot for work, etc., then having your schedules not always overlap might come with the territory, and you both can adapt. But if they find they're often wanting to spend meaningful time with you after their work, and you're sleeping during normal-person waking hours, they might be wondering whether this is the right long-term relationship.
> the issue is that the top-tier sports (e.g., football, volleyball, basketball, etc.) capture the majority of money/value

This, I met the daughter of a colleague who was one of the UK Olympian rowers/crew and after I fed her and got her 2 drinks in she started telling me what her 'off-season' activities consisted of: her father as much as he tried could only afford to pay a fraction of her training costs and living expenses and they were well off land owners from Cornwall.

She basically got her Captains lisc and took the affluent people from the City on everything from booze cruises, to hen nights in the English channel to France etc...

The debauchery was obscene and made her witness some of the darkest aspects of humanity to pursue this dream she had, which was admirable in a way, but I knew that after a few years when she got really injured, or aged out or the money simply ran dry this would be her REAL life.

OF wasn't a thing back then, but I wonder if given the choice she would prefer the choice of uploading anon sexy feet pics or babysitting people go into drunk or coke fueled stupors where she is psychically restraining people from falling into the water while heavily intoxicated causing her to lose her license, or livelihood or at best increase her insurance rates.

Then again OF has the same problem where the top talent takes <90% of the money, and those are often managed and curated by agencies which have been dubbed the E-pimps of OF [0].

0: https://www.nytimes.com/2022/05/16/magazine/e-pimps-onlyfans...
> killed millions

Can this be substantiated?
The political systems of other countries are irrelevant when discussing the United States.