I Was a Health Insurance Executive. What I Saw Made Me Quit. | Hacker News Reader

I Was a Health Insurance Executive. What I Saw Made Me Quit.

nytimes.com

30 pointsbookofjoe13 comments

"some had health insurance but did not have enough money in the bank to cover their out-of-pocket obligations"

Gosh! Well, doesn't that show out of touch these company execs are? Ordinary people having to choose between scraping by surviving and paying medical bills. How very quaint.

> I saw the unrelenting pressure investors put on insurers to spend less paying out claims

Once your org has made bank, owns a chunk of the market, margins are stable, and things are coasting and self sustaining push the rent collecting investors out.

See how Disney recently dealt with Nelson Peltz.

Thats the playbook. Don't be a Robot reciting but but I have to please the investor till the heat death of the universe.

It's not easy considering most F500's have Blackrock, Vanguard, State Street and JP Morgan as their largest investors, simply by virtue of being a constituent of their index funds.

This comment is simply uninformed and reflects a misunderstanding of how the health insurance industry operates.

Many of the largest commercial payers such as some of the Blue Cross Blue Shield Association licensees are non-profit. They literally have no investors. The non-profit and for-profit insurers have similar claim approval rules.

Due to the minimum medical loss ratio rule, insurers can actually make more profit by paying out more claims. The actual pressure to reduce total medical expenses comes primarily from large self-funded employers, not from investors. If we can break the link between employment and health plan coverage that would help to better align incentives.

https://www.cms.gov/marketplace/private-health-insurance/med...

https://www.sensible-med.com/p/the-entire-healthcare-system-...

'i was in the upper part of health insurance and instead of doing all i could to change it for the better, i quit'

The main factors that cause health insurance to be problematic are beyond the control of even top executives. Sure, they can do some things to slightly improve processing of prior authorization requests and claims. But any real change would have to come at the public policy level, such as breaking the link between employment and coverage. That will take a sustained effort to build political consensus.

https://www.cnbc.com/video/2024/12/12/oscar-health-ceo-on-fi...

It's a sad thought to say no real change can be made by the people doing the harm and it needs to be fixed from above.

It is certainly possible to turn off the orphan crushing machine. Yes, there are consequences but I don't think we should act like it isn't possible. At the end of the day corporations are people and we choose these things.

Lose the hyperbole. No one is crushing orphans. Actual orphans are mostly covered by Medicaid or CHIP plans, not by private commercial insurance.

https://www.healthcare.gov/medicaid-chip/childrens-health-in...

Many things are possible. What would you like health insurance executives to do specifically? For example, would you prefer that they pay every claim that comes in with zero denials? They can offer health plans to do that, but employers and consumers keep insisting on lower premiums instead.

“Orphan crushing machine” is a colloquial term used by the modern working class to describe situations where media spin attempts to make a “heartwarming” story out of someone correcting sociopolitical injustice.

A recent example is a dying child using their make-a-wish foundation wish to feed the local homeless people for a year.

>What would you like health insurance executives to do specifically?

Be poor! I don’t think health insurance is an industry that should have high returns. I genuinely believe every dollar that goes to healthcare insurance executives or investors is a dollar taken away from sick and dying people.

Well then you'll be glad to learn that the health insurance industry doesn't have high returns. The for-profit insurance companies have an average profit margin of only 3.3%.

https://content.naic.org/sites/default/files/industry-analys...

There are also many non-profit insurance companies which have no investors. This includes some of the largest ones such as several of the Blue Cross Blue Shield Association licensees, Kaiser Permanente, EmblemHeath, etc. You're free to purchase a health plan from one of them.

There are a lot of problems with the US healthcare system and while reforms are needed on the insurance side it's hardly the worst problem.

https://www.sensible-med.com/p/the-entire-healthcare-system-...

>You're free to purchase a health plan from one of them.

I do, thank you :)

I love the way Kaiser Permanente operates and I think a larger, nationwide Kaiser Permanente would be really ideal.

Something like the Bank of North Dakota but for healthcare.

Considering this quote from another comment:

> I saw the unrelenting pressure investors put on insurers to spend less paying out claims

I would be interested to know what we think management can do when the only goals of a for-profit healthcare business are driven by "fiduciary responsibility".

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