That's Right: It's Another Hot Take About That Dead Healthcare CEO
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.
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?
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.
(But like, sure, fuck that guy. He probably sucked, as do the hundred other identical suits in line to replace him. Just... don't expect this to help.)