McKinsey and Providence colluded to force poor patients into destitution | Hacker News Reader

McKinsey and Providence colluded to force poor patients into destitution

pluralistic.net

150 pointscolinprince34 comments

Also recently in Providence Health:

Claiming a $500M operating loss to get it back in federal COVID relief funding while sitting on a $100B reserve generating $1B in investment income, as a non-profit[1]

Refusing to treat a life-threatening miscarriage by calling it an abortion, in 2019[2]

Inspiring the Oregon state legislature to protect access to reproductive health services when religious-based providers like Providence buy them out;[3] unlike secular hospitals, they're exempt from state law mandating free reproductive health care[4]

[1] https://www.nytimes.com/2020/05/25/business/coronavirus-hosp...

[2] https://rewirenewsgroup.com/2019/09/25/miscarriage-catholic-...

[3] https://www.opb.org/article/2022/07/06/oregon-hospital-merge...

[4] https://oregoncapitalchronicle.com/2022/06/22/health-insurer...

Reading about the absolute scumbag behavior of these firms is not surprising when the incentives push firms toward poor behavior.

It feels like acting against one's own interests for the benefit of others is becoming less common. Or I'm spending too much time on the internet.

What I don't understand is why nobody seems to care and there are never any long term repercussions. They still get their big contracts and nobody questions anything.

Ernst & Young was a party in the Wirecard theft and they just turned around and said sorry we didn't know and everything was fine.

All the grifters that participated in the Theranos just walked away and blamed it on one dude.

Is there seriously any wonder why our societies are getting more and more corrupt, when everyone is constantly reminded that they can get away with it?

> why nobody seems to care and there are never any long term repercussions

Because we decided that a perk wealthy people have is never having to go to prison.

When the law no longer protects the average citizen...

I agree that this behavior is deplorable, its not unique to Providence or McKinsey - https://www.propublica.org/series/st-judes-unspent-billions

As much as I might agree with the thrust of the article, I strongly dislike the leading purple prose. It's bad writing, and doesn't make the case - its just moralizing - the fact that I agree with this particular moralizing doesn't make it any good.

Moralizing generally just feeds the boiler of the outrage machine - it makes the reader feel good for agreeing - and gives the general impression that just talking about the issues are enough to have contributed, but does little to solve the underlying issues that plague our societies.

If you're curious what I mean - the language gins up outrage, but it's wantonly short on conclusions or suggestions to repair the problem, the reader is left to figure that out on their own.

You’re engaging in exactly the thing you’re complaining about, but you’re doing it while undermining interest in addressing the problem you say you find deplorable, and moralizing about raising concerns about actual problems. If you find the practices deplorable, maybe you’d find it more valuable to offer some suggestions of your own instead of attacking people bringing it to your attention.

I did - the bulk of my commentary was on the writing of the article itself. Not the topic of said article.

Also I linked to a wonderful series that goes into great depth of what should be done. One which I've read, it even covers the state level investigations into such practices.

Largely I think it needs someone watching these organizations, and probably a minimum number spent on delivering services based on endowment size to retain non-profit status.

> I strongly dislike the leading purple prose. It's bad writing, and doesn't make the case

> Providence is a health giant whose anchor is a network of Catholic hospitals. They colluded with McKinsey to steal from their poorest patients, by deceiving them about their eligibility for free care, saddling poor, sick people with crushing debts:

This part?

Does not seem matches your "equally moralizing" writing.

I wonder if we should hold the church accountable because those were Catholic hospitals and this kind of behavior goes against their teachings.

I don't know if that's just me, but the fact that this was coordinated under the umbrella of someone offering ethical and moral guidance makes this even more evil.

It's the Catholic Church you're talking about...

Economists talk about "the theory of the second best" - that the second best global minima might not be close to the best minima. The classic example is a union and a monopoly is better than either a union and a free market of employers, or a monopoly and no unions.

Theoretically, a free market is best. But if a free market isn't possible (and in the case of healthcare, it's nothing like a free market - there's all kinds of red tape, subsidies, and these aren't going away) then simply being more like a free market might not be the most effective solution.

The US healthcare seems to be a system where the private market makes most of its money by outsmarting regulators rather than doing what regulators actually want. The US also spends far more than almost any other country (per capita) on health, but gets fairly bad outcomes. Worse, it even seems to spend more tax dollars (Medicare and Medicaid cost an unbelievable amount) than countries with universal healthcare, on top of what is essentially a hidden tax on the companies that provide healthcare and private spending.

> Theoretically, a free market is best.

What "theory" would this be? What metric for "best" are you using?

It's like some religious cult, this blind faith in the "free market".

I like Corey and what he's doing at pluralistic. I admit, I've never read deeper into any of his posts, it would be interesting to review a couple for completeness and or bias, but I think I would still enjoy the site even of there was a little bias.

Aside, as I understand it, he was one of the first and most prolific posters over at boing boing too.

One of his best recent work was his post on Audible.

https://pluralistic.net/2022/09/07/audible-exclusive/#audibl...

You guys delegate your healthcare to McKinsey?! Perhaps try Google and Apple?

the ethical fix: "The MBA Oath"

"Over 10,000 students representing more than 100 schools around the world have taken the MBA Oath, creating a community of MBAs with a shared standard for ethical and professional behavior. The MBA Oath aspires to:

- Inspire and support MBAs who commit to creating value responsibly and ethically;

- Challenge all MBAs to work with a higher professional standard, whether or not they sign the MBA Oath;

- Create a public conversation about professionalizing and improving management.

The MBA Oath

As a business leader I recognize my role in society.

My purpose is to lead people and manage resources to create value that no single individual can create alone.

My decisions affect the well-being of individuals inside and outside my enterprise, today and tomorrow. Therefore, I promise that:

-I will manage my enterprise with loyalty and care, and will not advance my personal interests at the expense of my enterprise or society.

-I will understand and uphold, in letter and spirit, the laws and contracts governing my conduct and that of my enterprise.

- I will refrain from corruption, unfair competition, or business practices harmful to society.

- I will protect the human rights and dignity of all people affected by my enterprise, and I will oppose discrimination and exploitation.

- I will protect the right of future generations to advance their standard of living and enjoy a healthy planet.

- I will report the performance and risks of my enterprise accurately and honestly.

- I will invest in developing myself and others, helping the management profession continue to advance and create sustainable and inclusive prosperity.

In exercising my professional duties according to these principles, I recognize that my behavior must set an example of integrity, eliciting trust and esteem from those I serve. I will remain accountable to my peers and to society for my actions and for upholding these standards. This oath I make freely, and upon my honor.

https://mbaoath.org/

https://en.wikipedia.org/wiki/MBA_Oath

https://hbr.org/2009/06/why-we-created-the-mba-oath

debate: https://knowledge.insead.edu/leadership-organisations/why-mb...

Oaths are worthless. Better, swifter, and heavier prosecutions and consequences for advisory and finance institutions should be the norm.

Kind words don't matter in a world of contracts and legal tenders.

> Oaths are worthless.

Oaths must be part of the solution - along with many other things. The Hippocratic Oath has an effect and can be applied to other areas. ( like The Iatrogenics of Money )

but the life is more complex; see more:

https://www.edge.org/conversation/nassim_nicholas_taleb-ten-...

like:

"2. No socialisation of losses and privatisation of gains."

"4. Do not let someone making an “incentive” bonus manage a nuclear plant – or your financial risks. Odds are he would cut every corner on safety to show “profits” while claiming to be “conservative”. Bonuses do not accommodate the hidden risks of blow-ups. It is the asymmetry of the bonus system that got us here. No incentives without disincentives: capitalism is about rewards and punishments, not just rewards."

If the Hippocratic oath had any sort of standing, the US wouldn't have the healthcare system it has, where the first questions often are "are you insured?", "are you in network?", "please insert your credit card here." I am barely caricaturing.

Much more heavy-handed actions are needed with swift legal consequences in industries which have such an impact at a financial and legal level.

Unfortunately, laws ( e.g. on universal health insurance - similar to the EU ) are made by politicians, not doctors, and they too do not have to follow strict moral ethics.

Without hippocratic ethical principles, it could be much worse than it is now.

I think the answer is some sort of licensing body (like the bar for layers), an oath or cannon of conduct are important too, but as a basis to regulate.

Capitalism is evil.

Yes but it's less evil than communism. Capitalism at least has the virtue that it can scale but it also has to be regulated. Regulated capitalism is far from perfect but it's the best thing we've come up with so far.

Come on! Incentives are what gets enough people to get up in the morning! What makes capitalism evil is regulatory capture, but many other forms of organisation have regulatory capture as their founding principle...

So get rid of oversight, employ 'self regulation' and end up in a universal 747 Max situation?

Well no. Regulatory capture typically leads to some self-regulation scenario being proposed. So: ensure the regulator is truly independent from the regulated, and make the regulator accountable for outcomes. You can even have competing regulatory regimes to see what comes out, but usually (and sadly) this gets coupled with geography.

I don’t accept the concept of evil, but I do think capitalism has me on the philosophical ropes.

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