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The websites are abuzz with debate on the utilitarian calculus of whether some guy getting shot was a good thing. What are the odds that the assassination will scare the horrible greedy health insurance companies into changing their ways and fixing the system? Is it worth killing someone over? Will the fear of being blasted by some guy with stylishly-engraved bullets put the fat cats in line? Or will their greed win out over their fear, leaving the nightmarish system unchanged?

Well, what if that was totally irrelevant?

You may have seen a graph that looks like this:

I've seen a few of these going around. These are the rates at which various health insurance companies say "no, you don't get the money" when someone says "hey I need money for this medical thing". UHC, the one whose CEO got shot, is notably really bad in this respect. They've got algorithmic claims denials and all kinds of nasty things that people don't like. All that money they're saving on paying out on claims must be making them rich, right? Let's look at their own financial reports:

Whoa! Big numbers! Six percent looks like a small number, but multiply and they make like thirty billion dollars doing this! That's a lot, right?

Well hang on. They're an insurance company. We can roughly model their profit as the amount people pay them for insurance, minus the amount they have to pay out for claims. Let's look at 2023: simple subtraction, their expenses are $339.2 billion. We simplify other overhead and assume that's all claims. So... that represents those 67% of claims they don't reject. What happens if they approve all the claims?

Multiply: $506.3 billion. They don't have that kind of money. They have $371.6 billion in revenue. So okay- they have to deny some claims. That's pretty normal. But let's pretend they're extremely afraid of assassins now and want to be completely non-greedy: they're okay making zero profit. They make $32.4 billion in profit- how many otherwise-rejected claims can they now afford to approve?

...uh. Well, they can afford to pay out, at most, 73.4% of claims. Still a denial rate of 26.6%, higher than most of their competitors. Not a huge improvement. And in reality, they can't afford to make 0 profit- a company that's making 0 profit is a company investors pull out of immediately, leaving it to collapse, because they can make more money investing in the ones that aren't as afraid of assassins. They've got to at least hover around the same profit margin as their competitors. Which is...

That's average profit margins for the whole US healthcare industry. So, okay, if we match those other companies' profit margins and try to hover around 3-4%... uh. Wait. Hang on. Here's another graph with more recent data on UHC specifically:

Wait, they're still just making that little 3-4% profit margin, even with all these shady automated denials- so how are those other companies doing better on claims? They're obviously not less greedy. They must be making more money somehow, right?

(My guess, sight-unseen, would be that they charge more for their plans, or offer less comprehensive coverage, or use a network of less expensive providers, or other things that make the amount they have to pay out smaller and the amount they're taking in larger. I don't feel like doing a comprehensive consumer review of what every insurance provider's healthcare plans are, but there's always these tradeoffs to make. UHC seems to be offering the tradeoff of "better or cheaper care, on paper" for "but there's a higher risk of getting denied", which is one annoying tradeoff among many.)

Okay But That's Enough Graphs

"Yeah yeah yeah shut up about profit margins and coverage tradeoffs. Is it a good thing that the CEO got shot or not?"

Well, their profit margin at the time he was shot was 3.63%. A company can't survive making 0 or less, so whatever effect fear of assassination has on UHC's greediness, it is going to be no larger than 3.63%.

They may learn the lesson that having their denial rates too high will get them assassinated. Accordingly, they may decrease that metric- by charging higher premiums, kicking expensive doctors out of their network, or reducing their stated coverage. They will not (because they cannot, without ceasing to exist as a company) simply start approving more claims without squeezing their customers elsewhere. They legally cannot do that. No matter how afraid you make the CEOs, you cannot make them afraid to a degree larger than their profit margin.

Well What The Fuck, Then

Like, what, are we supposed to accept that things will literally never get better and that this horrorshow is the best we can hope for? That's some bullshit! If we can't scare the CEOs, who can we scare?

Man I dunno.

Like, for some reason healthcare is stupid expensive! People can't afford to pay for healthcare without insurance- it's like thousands of dollars for basic procedures! Why? Maybe...

Doctors inflate their prices 10x because they know insurance companies will use complicated legal tricks to only pay 10% of the asking price, and this is a constantly escalating price war that serves mainly to fuck over the uninsured

Drug manufacturers and health technology companies fight tooth and nail to maintain monopolies over treatment, so they can charge gazillions to make back the gazillions they had to spend on FDA approval trials

(Trials those same companies lobby to keep necessary because the more money you have to pay for FDA approval, the harder it is for competitors to enter the market since they don't already have the gazillions)

Doctors operate as a cartel and lobby to gatekeep access to medical training so that they can keep doctoring a prestigious and exclusive position, and keep their own salaries high enough to pay their medical school debt and make them rich afterwards- leading to a (profitable) shortage of medical professionals

There is no limit to how expensive things can get but how much people are physically capable of paying, because frequently the alternative to "pay a ridiculous amount for healthcare" is "die", and so healthcare is subject to near-infinitely inelastic demand

Also like a thousand other equally annoying and complicated perverse incentives and stupid situations

This is the human condition: Shit is annoying and complicated and difficult to fix, pretty much 100% of the time forever. A few bullets in some fucko's back isn't really going to make a dent.

- Doctors operate as a cartel and lobby to gatekeep access to medical training so that they can keep doctoring a prestigious and exclusive position, and keep their own salaries high enough to pay their medical school debt and make them rich afterwards- leading to a (profitable) shortage of medical professionals - There is no limit to how expensive things can get but how much people are physically capable of paying, because frequently the alternative to "pay a ridiculous amount for healthcare" is "die", and so healthcare is subject to near-infinitely inelastic demand

Not that the others aren't true, but they're mainly downstream of these, or circumventable.

It's not a scam if the thing you expect is not possible and the person you're buying from didn't offer it. It is not possible for them to pay out every claim they get, because they literally do not have the money to pay out. They never pretended they would pay out every claim. No health insurance company ever did. They may talk about having a higher acceptance rate than others but that is, inherently, acknowledging there is a rate at which claims are denied. Insurance companies deny claims because they have to, it is not possible to provide insurance without denying claims. The fact that people need health care or that health care is ruinously expensive without insurance or that it is very bad to have a claim denied does not change the constraints of material reality.

Health care in the US and only in the US is ruinously expensive. It is not a universal constant, it is only in the US. The problem is not that insurance company execs are evil and greedy. The problem is that the constraints they operate under in the US legal and regulatory system causes health care to be ruinously expensive.

If nobody offered medical insurance because that requires them to turn down claims, would that be better or worse?

I'm not denying that insurance companies will deny some claims, but one in three is a sign that something has gone very wrong somewhere.

The websites are abuzz with debate on the utilitarian calculus of whether some guy getting shot was a good thing. What are the odds that the assassination will scare the horrible greedy health insurance companies into changing their ways and fixing the system? Is it worth killing someone over? Will the fear of being blasted by some guy with stylishly-engraved bullets put the fat cats in line? Or will their greed win out over their fear, leaving the nightmarish system unchanged?

Well, what if that was totally irrelevant?

You may have seen a graph that looks like this:

I've seen a few of these going around. These are the rates at which various health insurance companies say "no, you don't get the money" when someone says "hey I need money for this medical thing". UHC, the one whose CEO got shot, is notably really bad in this respect. They've got algorithmic claims denials and all kinds of nasty things that people don't like. All that money they're saving on paying out on claims must be making them rich, right? Let's look at their own financial reports:

Whoa! Big numbers! Six percent looks like a small number, but multiply and they make like thirty billion dollars doing this! That's a lot, right?

Well hang on. They're an insurance company. We can roughly model their profit as the amount people pay them for insurance, minus the amount they have to pay out for claims. Let's look at 2023: simple subtraction, their expenses are $339.2 billion. We simplify other overhead and assume that's all claims. So... that represents those 67% of claims they don't reject. What happens if they approve all the claims?

Multiply: $506.3 billion. They don't have that kind of money. They have $371.6 billion in revenue. So okay- they have to deny some claims. That's pretty normal. But let's pretend they're extremely afraid of assassins now and want to be completely non-greedy: they're okay making zero profit. They make $32.4 billion in profit- how many otherwise-rejected claims can they now afford to approve?

...uh. Well, they can afford to pay out, at most, 73.4% of claims. Still a denial rate of 26.6%, higher than most of their competitors. Not a huge improvement. And in reality, they can't afford to make 0 profit- a company that's making 0 profit is a company investors pull out of immediately, leaving it to collapse, because they can make more money investing in the ones that aren't as afraid of assassins. They've got to at least hover around the same profit margin as their competitors. Which is...

That's average profit margins for the whole US healthcare industry. So, okay, if we match those other companies' profit margins and try to hover around 3-4%... uh. Wait. Hang on. Here's another graph with more recent data on UHC specifically:

Wait, they're still just making that little 3-4% profit margin, even with all these shady automated denials- so how are those other companies doing better on claims? They're obviously not less greedy. They must be making more money somehow, right?

(My guess, sight-unseen, would be that they charge more for their plans, or offer less comprehensive coverage, or use a network of less expensive providers, or other things that make the amount they have to pay out smaller and the amount they're taking in larger. I don't feel like doing a comprehensive consumer review of what every insurance provider's healthcare plans are, but there's always these tradeoffs to make. UHC seems to be offering the tradeoff of "better or cheaper care, on paper" for "but there's a higher risk of getting denied", which is one annoying tradeoff among many.)

Okay But That's Enough Graphs

"Yeah yeah yeah shut up about profit margins and coverage tradeoffs. Is it a good thing that the CEO got shot or not?"

Well, their profit margin at the time he was shot was 3.63%. A company can't survive making 0 or less, so whatever effect fear of assassination has on UHC's greediness, it is going to be no larger than 3.63%.

They may learn the lesson that having their denial rates too high will get them assassinated. Accordingly, they may decrease that metric- by charging higher premiums, kicking expensive doctors out of their network, or reducing their stated coverage. They will not (because they cannot, without ceasing to exist as a company) simply start approving more claims without squeezing their customers elsewhere. They legally cannot do that. No matter how afraid you make the CEOs, you cannot make them afraid to a degree larger than their profit margin.

Well What The Fuck, Then

Like, what, are we supposed to accept that things will literally never get better and that this horrorshow is the best we can hope for? That's some bullshit! If we can't scare the CEOs, who can we scare?

Man I dunno.

Like, for some reason healthcare is stupid expensive! People can't afford to pay for healthcare without insurance- it's like thousands of dollars for basic procedures! Why? Maybe...

Doctors inflate their prices 10x because they know insurance companies will use complicated legal tricks to only pay 10% of the asking price, and this is a constantly escalating price war that serves mainly to fuck over the uninsured

Drug manufacturers and health technology companies fight tooth and nail to maintain monopolies over treatment, so they can charge gazillions to make back the gazillions they had to spend on FDA approval trials

(Trials those same companies lobby to keep necessary because the more money you have to pay for FDA approval, the harder it is for competitors to enter the market since they don't already have the gazillions)

Doctors operate as a cartel and lobby to gatekeep access to medical training so that they can keep doctoring a prestigious and exclusive position, and keep their own salaries high enough to pay their medical school debt and make them rich afterwards- leading to a (profitable) shortage of medical professionals

There is no limit to how expensive things can get but how much people are physically capable of paying, because frequently the alternative to "pay a ridiculous amount for healthcare" is "die", and so healthcare is subject to near-infinitely inelastic demand

Also like a thousand other equally annoying and complicated perverse incentives and stupid situations

This is the human condition: Shit is annoying and complicated and difficult to fix, pretty much 100% of the time forever. A few bullets in some fucko's back isn't really going to make a dent.

- Doctors operate as a cartel and lobby to gatekeep access to medical training so that they can keep doctoring a prestigious and exclusive position, and keep their own salaries high enough to pay their medical school debt and make them rich afterwards- leading to a (profitable) shortage of medical professionals - There is no limit to how expensive things can get but how much people are physically capable of paying, because frequently the alternative to "pay a ridiculous amount for healthcare" is "die", and so healthcare is subject to near-infinitely inelastic demand

Not that the others aren't true, but they're mainly downstream of these, or circumventable.

It's not a scam if the thing you expect is not possible and the person you're buying from didn't offer it. It is not possible for them to pay out every claim they get, because they literally do not have the money to pay out. They never pretended they would pay out every claim. No health insurance company ever did. They may talk about having a higher acceptance rate than others but that is, inherently, acknowledging there is a rate at which claims are denied. Insurance companies deny claims because they have to, it is not possible to provide insurance without denying claims. The fact that people need health care or that health care is ruinously expensive without insurance or that it is very bad to have a claim denied does not change the constraints of material reality.

Health care in the US and only in the US is ruinously expensive. It is not a universal constant, it is only in the US. The problem is not that insurance company execs are evil and greedy. The problem is that the constraints they operate under in the US legal and regulatory system causes health care to be ruinously expensive.

The websites are abuzz with debate on the utilitarian calculus of whether some guy getting shot was a good thing. What are the odds that the assassination will scare the horrible greedy health insurance companies into changing their ways and fixing the system? Is it worth killing someone over? Will the fear of being blasted by some guy with stylishly-engraved bullets put the fat cats in line? Or will their greed win out over their fear, leaving the nightmarish system unchanged?

Well, what if that was totally irrelevant?

You may have seen a graph that looks like this:

I've seen a few of these going around. These are the rates at which various health insurance companies say "no, you don't get the money" when someone says "hey I need money for this medical thing". UHC, the one whose CEO got shot, is notably really bad in this respect. They've got algorithmic claims denials and all kinds of nasty things that people don't like. All that money they're saving on paying out on claims must be making them rich, right? Let's look at their own financial reports:

Whoa! Big numbers! Six percent looks like a small number, but multiply and they make like thirty billion dollars doing this! That's a lot, right?

Well hang on. They're an insurance company. We can roughly model their profit as the amount people pay them for insurance, minus the amount they have to pay out for claims. Let's look at 2023: simple subtraction, their expenses are $339.2 billion. We simplify other overhead and assume that's all claims. So... that represents those 67% of claims they don't reject. What happens if they approve all the claims?

Multiply: $506.3 billion. They don't have that kind of money. They have $371.6 billion in revenue. So okay- they have to deny some claims. That's pretty normal. But let's pretend they're extremely afraid of assassins now and want to be completely non-greedy: they're okay making zero profit. They make $32.4 billion in profit- how many otherwise-rejected claims can they now afford to approve?

...uh. Well, they can afford to pay out, at most, 73.4% of claims. Still a denial rate of 26.6%, higher than most of their competitors. Not a huge improvement. And in reality, they can't afford to make 0 profit- a company that's making 0 profit is a company investors pull out of immediately, leaving it to collapse, because they can make more money investing in the ones that aren't as afraid of assassins. They've got to at least hover around the same profit margin as their competitors. Which is...

That's average profit margins for the whole US healthcare industry. So, okay, if we match those other companies' profit margins and try to hover around 3-4%... uh. Wait. Hang on. Here's another graph with more recent data on UHC specifically:

Wait, they're still just making that little 3-4% profit margin, even with all these shady automated denials- so how are those other companies doing better on claims? They're obviously not less greedy. They must be making more money somehow, right?

(My guess, sight-unseen, would be that they charge more for their plans, or offer less comprehensive coverage, or use a network of less expensive providers, or other things that make the amount they have to pay out smaller and the amount they're taking in larger. I don't feel like doing a comprehensive consumer review of what every insurance provider's healthcare plans are, but there's always these tradeoffs to make. UHC seems to be offering the tradeoff of "better or cheaper care, on paper" for "but there's a higher risk of getting denied", which is one annoying tradeoff among many.)

Okay But That's Enough Graphs

"Yeah yeah yeah shut up about profit margins and coverage tradeoffs. Is it a good thing that the CEO got shot or not?"

Well, their profit margin at the time he was shot was 3.63%. A company can't survive making 0 or less, so whatever effect fear of assassination has on UHC's greediness, it is going to be no larger than 3.63%.

They may learn the lesson that having their denial rates too high will get them assassinated. Accordingly, they may decrease that metric- by charging higher premiums, kicking expensive doctors out of their network, or reducing their stated coverage. They will not (because they cannot, without ceasing to exist as a company) simply start approving more claims without squeezing their customers elsewhere. They legally cannot do that. No matter how afraid you make the CEOs, you cannot make them afraid to a degree larger than their profit margin.

Well What The Fuck, Then

Like, what, are we supposed to accept that things will literally never get better and that this horrorshow is the best we can hope for? That's some bullshit! If we can't scare the CEOs, who can we scare?

Man I dunno.

Like, for some reason healthcare is stupid expensive! People can't afford to pay for healthcare without insurance- it's like thousands of dollars for basic procedures! Why? Maybe...

Doctors inflate their prices 10x because they know insurance companies will use complicated legal tricks to only pay 10% of the asking price, and this is a constantly escalating price war that serves mainly to fuck over the uninsured

Drug manufacturers and health technology companies fight tooth and nail to maintain monopolies over treatment, so they can charge gazillions to make back the gazillions they had to spend on FDA approval trials

(Trials those same companies lobby to keep necessary because the more money you have to pay for FDA approval, the harder it is for competitors to enter the market since they don't already have the gazillions)

Doctors operate as a cartel and lobby to gatekeep access to medical training so that they can keep doctoring a prestigious and exclusive position, and keep their own salaries high enough to pay their medical school debt and make them rich afterwards- leading to a (profitable) shortage of medical professionals

There is no limit to how expensive things can get but how much people are physically capable of paying, because frequently the alternative to "pay a ridiculous amount for healthcare" is "die", and so healthcare is subject to near-infinitely inelastic demand

Also like a thousand other equally annoying and complicated perverse incentives and stupid situations

This is the human condition: Shit is annoying and complicated and difficult to fix, pretty much 100% of the time forever. A few bullets in some fucko's back isn't really going to make a dent.

- Doctors operate as a cartel and lobby to gatekeep access to medical training so that they can keep doctoring a prestigious and exclusive position, and keep their own salaries high enough to pay their medical school debt and make them rich afterwards- leading to a (profitable) shortage of medical professionals - There is no limit to how expensive things can get but how much people are physically capable of paying, because frequently the alternative to "pay a ridiculous amount for healthcare" is "die", and so healthcare is subject to near-infinitely inelastic demand

Not that the others aren't true, but they're mainly downstream of these, or circumventable.

In light of this I'm feeling especially vindicated by the reveal of Valve's new moba Deadlock, where the growing consensus among the primarily gamer dude audience is that the most wifeable member of the cast is the girl who looks like this:

"penchant for consensus" Mr Silver I would ordinarily hesitate here but for you I might recommend to you some SSC posts on the concept of the "outgroup" which could be informative as the issues with your reasoning here.

My immediate question regarding the River as a bloc:

The dark avatar of the village is a person leading an all day diversity training seminar, the dark avatar of the River is Elon Musk telling you you're fired because he heard you talking about unions.

Particularly, politically speaking there are a bunch of rich guys out there who aren't connected to more traditional right-wing thought, and in fact don't really want to consider themselves part of the traditional right, but are incredibly heavily animated by a hatred of institutional left-wing culture (Specifically political correctness and the ability to enforce political correctness through shunning, pile-ons, regulatory investigation and mid-level Human Resources bureaucracy)

This deforms their politics in a very specific way.

Like as a specific example Elon Musk continues to talk about Free Speech, and the ways that even non legal consequences can chill free expression, while he simultaneously wields lawsuits to try to punish objectively true speech he disagrees with.

Okay, I've yet to hear anybody offer a coherent example of what policy goals are now more likely to be handled *worse than Trump would handle them*.

The idea of a left-winger in a swing state staying home because Biden lost the first debate is so bizarre to me that I cannot get my head around it. There's no level at which this does anything but hurt your long-term political goals, and I just haven't heard any coherent argument otherwise.

So the candidate that would replace Biden would be someone who would have to appeal to fundamentally politically disconnected and confused swing state voters, and I'm not sure who that is or what they'd exactly be doing at this point that would make it a slam dunk.

The president isn't just a policy-chooser, he's also the place where the proverbial buck stops. If something sudden happens somewhere in the world where the United States should arguably respond immediately, it's the president who's responsible for that.

That is a pretty solid reason to not vote for Biden, even if you aren't in favor of Trump's policies. Based on the debate, Trump would be lucid and capable of making emergency executive decisions as the commander-in-chief, and Biden wouldn't be. Even if you think Trump's decisions would be bad, bad decisions in a crisis often beat no decision.

Trump has said his response to, for example, drug issues in the US might involve sending the US military to attack Mexican drug cartels *without the permission of the Mexican government*.

What the fuck would make you think Trump is "lucid" and capable of making sensible emergency decisions?

The man tried to overthrow a legitimate election. He wants to deport 15 million people from the country. He thinks Israel should be allowed to finish the job.

Everything he says and does about everything makes it clear he does not, in fact, have control of things.

For people who don't care about policy, and who don't pay much attention to politics, including whatever nonsense Trump has most recently said on Twitter, that obviously matters and most other things don't seem like they matter very much. And those people are a large fraction of the population of the United States, and a smaller but still significant fraction of US voters.

"Oops, never mind about the guy who's been President the last four years, uh, here's a random guy who hasn't been campaigning."

And these people would go, "Sure, I used to think Trump was decisive, but after seeing the Democrats panic and abandon their candidate the moment he stutters, it's clear that they're way more decisive and put together than the Trump campaign!"

I mean, given the metrics these bizarre people are using, like, doesn't changing horse mid stream also demonstrate profound indecisiveness and weakness?

Biden drops out and Kamala Harris is the nominee from here on out. When I float this idea I usually get a derisive snorting noise in response so I'm guessing this is not the scenario people have in mind

The Democrats abandon the Presidential campaign entirely and instead of campaigning, run a primary and then hope the new guy doesn't need to campaign for more than two weeks before the election.

The Democratic party just unilaterally appoints someone who hasn't been running via some kind of party fiat that I don't think has ever been tried before

But then for the party-based dungeon crawling tactical combat your party is basically your *agents*/inner circle, who are the ones you actually send out on retrieval/assassination/tomb-raiding missions (and who are your absolutely necessary bodyguards when you actually have to go in person).

As is shocking to few I have been following Hungary's fertility policies pretty closely and I really don't think this summary is missing anything; you cannot juice the birth rate with "simple" financial transfers within the current system, because people are overwhelmingly having ~approx the kids they "want" (within the confines of the life they have) and the price of having kids is very high in ways realistic quantities of money cannot compensate for.