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PaperclipPerfector  20d ago (text post)   30955 thread views

Culture War Roundup for the week of December 2, 2024

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Culture war going hot: https://www.cnn.com/2024/12/04/us/brian-thompson-united-healthcare-death/index.html

A gunman has killed the CEO of United Healthcare this morning, and has disappeared into the city. I’m somewhat surprised this isn’t more common, especially given the nature of healthcare company’s profit motives. I could imagine “we denied your wife’s medical claim and are sorry for her death. Also your bill is past due and we are sending you to collections. Thank you understanding.” might be a story that exists in a lot of people.

Expect to see more private security, more private flights, more underground parking and armored cars and so forth for a while.

This was clearly an assassination.

Anthem has walked back their controversial decision to cap anaesthesia coverage. While it's likely just a timing thing, there's a kind of weirdness where it might seem like they walked it back due to the assassination - no one wants to get got. The last thing anyone needs is to seem like assassination works.

Taleb has a great commentary on the topic.

Skin in the Game is back.

https://x.com/nntaleb/status/1864661227206480247

More often than not lately I have felt that the mortality among the IYI, Purple Blob, Village, PMC, and their attachments trough political violence is at suboptimal for society levels.

If there was more risk to being one of them, they would probably behave differently

The killer left behind bullet casings, which was at first viewed as “oh, this was an amateur – what kind of professional doesn’t police their brass?” even with the suppressor on the gun. Then it was revealed the three bullet casings each contained a different word: one said deny, one said defend, one said depose. Some speculated it was related to a book titled “Delay, Deny, Defend” about the evils of insurance companies, although the title doesn’t quite add up.

Other speculate the word “Depose” has to do with the recent DOJ probe into Brian Thompson for insider trading.

I was stunned watching many on social media celebrated the murder like they were celebrating the death of a terrorist. UHC is the largest provider of Medicare advantage in the country. We need better insurance, absolutely - but insurance is the only reason many can even afford basic care in the first place. UHC isn't even one of the insurance companies that yesterday decided to stop covering anesthesia in the middle of surgeries if the surgeries took too long (although UHC has the highest percentage of denied claims, in part because of their share of the Medicare advantage market).

If people don't like denials of coverage now, I think they'd hate rationed healthcare under a "Medicare 4 All" system even more; the government-run V.A. shows exactly how bad we are at those kinds of systems. Some coverage and cheaper procedures is better than wait times or tribunal refusals due to resource shortages or determined societal need.

Although I can't expect the people celebrating his death to understand that. Most Americans have a loose grasp, at best, of how health insurance works; I had recently seen an Xcretement with the following sentiment:

A Starbucks worker on the @organizeworkers call saying that working in a union Starbucks in the South could become the only way for some young people to get gender affirming care under Trump has me crying in the club 😭

Which is... bafflingly incorrect. Insurance covering a surgery doesn't suddenly make that surgery legal in whatever state? It's just... not how any of this works, although I don't know why I expected a Starbucks unionization attempt to know any better.

Does the United States have it in us to engage in vigilantism? Will all CEOs, billionaires, etc., start to show up on the chopping block? Is "eating the rich" leaving electoral politics behind and instead taking matters into their own "hands?" Will this change the gun control debate at all? How dystopian are we about to get? Or, like everything else, is this tapping the sign of "nothing ever happens?"

I believe it's the latter; this will get forgotten about quickly. Billionaires et. al. can afford private security, but there's been a recent movement attacking small business owners as the "petit bourgeois," who are less likely to be able to afford that kind of stuff. Those grievances are likely more local, though, and less likely to make the news. Local level "activism" doesn't generate attention, so maybe it's less of a concern. Idk. I don't think Americans have it in us to truly seek a revolution. Even the "Insurrection" would have continued the status quo of the government system, just with a different person at the top.

Then it was revealed the three bullet casings each contained a different word: one said deny, one said defend, one said depose.

Now I am wondering if he had an entire magazine of bullets with words carved on them in case he missed the first few.

I was stunned watching many on social media celebrated the murder like they were celebrating the death of a terrorist. UHC is the largest provider of Medicare advantage in the country. We need better insurance, absolutely - but insurance is the only reason many can even afford basic care in the first place.

I think the principal evil is that health care providers are selected by employers, not employees. This creates a principal-agent problem. The employer is forced by law to provide health insurance, but their incentives are to go cheap without asking how they can offer health care so cheap.

As an intuition pump, suppose that federal law required employers to provide employees with a vehicle. Car makers specialize to provide cheap, shitty vehicles. Often they don't start, in any accident they become burning death traps, et cetera. The employees who can afford it pay through their nose for a solid car. Some go into debt to afford a private vehicle which meets their basic needs.

And then here you come along and say "CrapCars is the reason why many Americans are mobile in the first place." You might be technically correct, but you are missing the bigger picture.

Don't trust me, read Scott:

The Muslims claim Mohammed was the last of the prophets, and that after his death God stopped advising earthly religions. But sometimes modern faiths will make a decision so inspired that it could only have come from divine revelation. This is how I feel about the Amish belief that health insurance companies are evil, and that good Christians must have no traffic with them.

This is a medical professional who at that time was making his livelihood from health insurance. Often his world view clashes with random people on the street, who have reflected less on issues than him. Here, they happen to align.

So yes, your typical health care company is somewhere between a slum lord and a peddler of CSAM, morally speaking. All the jokes about 'unfortunately, my thoughts and prayers were not pre-authed' and system coverage are totally on point.

I would think that "depose" was reference to the common meaning of the term: "to remove from a throne or other high position". Thus "Delay, Deny, Defend" is followed up with "Deny, Defend.... Depose". Sort of a "sic semper tyrannis" for the modern age.

It's also very possible there was a fourth bullet in the gun labeled "Delay" that jammed or otherwise wasn't fired.

Or maybe omission of it was meant as a message of no longer delaying the "depose" part.

The killer left behind bullet casings, which was at first viewed as “oh, this was an amateur – what kind of professional doesn’t police their brass?”

The focus on collecting brass has always seemed odd to me, especially for a professional (not saying this was) hit. Who cares if you leave brass? In a "professional" hit I would think the gun would be untraceable from the start and then the gun is going to be disappeared. It's trivially easy to get untraceable ammunition.

Billionaires et. al. can afford private security, but there's been a recent movement attacking small business owners as the "petit bourgeois," who are less likely to be able to afford that kind of stuff. Those grievances are likely more local, though, and less likely to make the news. Local level "activism" doesn't generate attention, so maybe it's less of a concern. Idk.

I know nothing about this recent movement, but it reminds me of dekulakization in the USSR roughly a century ago, which led to some pretty bad results for almost everyone involved, so, at first blush, I hope this movement dies a quick death.

If this indeed was revenge for family being denied insurance leading to death, my only regret is the shooter didn't go for his wife and two children instead of him. Yeah you can kill a guy, but what's worse would be to delete his legacy.

  • -29

my only regret is the shooter didn't go for his wife and two children instead of him.

Advocacy for the cold-blooded murder of women and children is not an example of the sort of conversation we are trying to foster here. Advocacy for the murder of anyone is not the sort of conversation we are trying to foster here. This is a place for conversation, not for calls to war; we aim to discuss the culture war, not wage it. If you cannot do that, this place is not for you.

You have a lot of warnings and one tempban in the log, and no QCs. I am banning you for a week, and if the other mods think that duration too short I encourage them to lengthen it. If you continue to post things like this on your return, the bans will escalate rapidly. Please do not do that.

What an absolutely ghastly comment.

What an absolutely ghastly comment.

I have taught you ways to kill a mortal, Kratos, flesh that burns, bones that break, but to break a man's spirit is to truly destroy him.

I'm curious why going for the family is somehow justified if the guy's company denied insurance to someone the killer cared about, but not justifiable otherwise?

Indeed it makes no sense why you'd care about the killer's motivation before deciding whether such an act was acceptable or beyond the pale. "God I wish his wife and children were killed, slowly and agonizingly, right in front of him so he could live a tortured existence going forward, but ONLY IF my preferred justification is present."

I find the moral reasoning on display there hideous, by the way.

I'm curious why going for the family is somehow justified if the guy's company denied insurance to someone the killer cared about, but not justifiable otherwise?

The GP is talking about revenge not justice. There is irreconcilable conflict - the guy deserves terrible things to happen to his family(that's the assumption), but the family doesn't deserve anything to happen to them because they are innocent. Now family ties are powerful connection trough which to channel pain, but because they are terminated in human beings, you have to hurt the humans.

But what happens if we have roko's basilisk type situation. We put this guy in VR and then we torture the figments of his family, while he doesn't know he is in VR?

I'm curious why going for the family is somehow justified if the guy's company denied insurance to someone the killer cared about, but not justifiable otherwise?

"Do unto others" just about covers it, I think, and considering that's practically the most basic morality in existences, I bet you could have come to that conclusion yourself. This also explains why the killer's motivation matters. If this was a professional hit because of something to do with mergers or corporate warfare, then there's no "justice," but if this is someone whose wife or child was denied care by this insurance company, then yes, doing unto others as they have done unto to you means killing the man's wife and children.

God I wish his wife and children were killed, slowly and agonizingly, right in front of him so he could live a tortured existence going forward

Nobody is saying this. What's being said is that there exists a better target. Of course that ignores that the kind of person who would do something like this probably has more honor than to target women and children.

"Do unto others" just about covers it, I think

... but the wife and kids didn't do anything unto him, so he CAN'T be justified in doing unto them.

Like, killing innocent bystanders in the course of seeking revenge is among the most basic of taboos I can imagine. Its the one thing you're supposed to avoid if you want your cause to remain righteous.

It justifies some crazy shit if you want to take it that far:

"UHC denied my next-door neighbor coverage for cancer meds and he died, which made me sad and angry. So I stalked and murdered the CEO's neighbor to make it equal." This is psychopathic and utterly inconsistent, to boot.

CEO consigned man's wife to death. Man kills CEO's wife.

Makes perfect sense to me. You can disagree with the morality, but don't claim it doesn't make sense.

This is psychopathic and utterly inconsistent, to boot.

Yes, because it's the neighbor, not the wife.

Yes, I'm suggesting that if "Do unto others" justifies murdering a man's wife because your wife died (Which is changing the facts, so its not even what happened here!) then it justifies murdering a man's neighbor because your neighbor died.

My whole point is when you bring in third parties who DON'T have blame for the outcome, now you're the one 'doing unto others' by bringing innocent parties into it.

And that demolishes your moral standing, whatever it was.

A man's wife and children directly benefit from his actions, and are an extension of him in a way that his neighbor is not.

You are saying they are unrelated third parties, I'm saying that's not true, but the neighbor actually is an unrelated third party, so your comparison is simply false. If I accepted your premises, I'd accept your conclusions, but your premises are nonsensical.

A man's wife and children directly benefit from his actions, and are an extension of him in a way that his neighbor is not.

I want you to be specific. How much 'benefit' does one have to receive for the connection to be close enough to justify a revenge killing. If the neighbor borrowers his mower, is that enough? If he lent some money to the neighbor and allowed him to afford life-saving surgery, is that enough?

You're adding epicycles. It used to be just "do unto others," but now you're adding in "Do unto others, and do unto those who benefited from those others." I'm happy to chase this to whatever extremes you like, but understand that it will probably lead me to conclude that under your moral code, it is acceptable to kill you.

This is basically a slightly more sophisticated Gangland mentality. "You send one of ours to the hospital, we send one of yours to the morgue." At least in gangland everyone is (sort of) willingly participating.

You are saying they are unrelated third parties

Bullshit. I said they are innocent third parties, having committed no action worthy of blame, and certainly not death. 'Related' parties is a completely different question, and a harder one.

And that goes double for the kids, who almost certainly has no conception of why their father would be considered bad.

your premises are nonsensical.

Please, state what you believe my 'premises' to be.

More comments

I'm going to say something controversial and suggest there is absolutely a niche for a short barreled folding stock rifle (legally required to identify itself as a handgun with a Disability Brace), with a (integral?) suppressor, a sub/supersonic cartridge, and a good optic for easy holdover.

Small enough to fold into a gym bag or use from a car. Far zero of around 100m for shots up to 125-150m, only halfway decent mechanical accuracy required. Maybe stick a little bipod on it for firing from a window sill or van.

It honestly wouldn't be an awful general purpose carbine either. People underestimate the importance of short, handy hearing-safe guns for home defense.

In a world where most high value targets are surrounded by drones in an environment full of shot-spotters, your choices are a) full kamikaze, b) car bomb, c) mortars, d) American Sniper 360 noscope, or E) stealthy mid-range shooting with an escape plan.
E is going to be the most practical option I should think. But if people get angry enough, option A of whipping out a giggle switch Glock and dumping the mag is going to be pretty popular too.

But maybe I'm overthinking this and most people are just gonna keep strolling up on a roof and wave to the secret service before lobbing a few rounds at the president.

You have, without knowing it, described this gun exactly.

This is the FK Brno PSD. There was a more expensive metal-framed version of this some time ago but this is the more reasonably-priced one.

It fires a modernized version of .30 Carbine (7.5FK performs on par with it; it's just a smaller case so it actually fits in the grip, contrast the Automag III) with mechanical accuracy sufficient to take advantage of the 100+ meter effective range of the cartridge. It can defeat IIIA soft body armor. As its parent cartridge is .30 Remington 10mm Auto, powerful subsonic rounds may be used by affixing a second barrel that came standard with the gun. (.40 S&W can be used when expedient.) Unfortunately, this barrel does not come threaded for a suppressor.

Comes standard with a sight meant for longer distances but naturally is cut for an optic. Can also use an optional brace, and a bipod may be affixed at any time.

It is, at least allegedly, used by some security services in the Middle East for those reasons- where shooting someone at 100 meters can be defensive. That's a harder sell to the average American because they're generally too busy buying more general-purpose equipment (and high powered pistols in the US are more oriented towards being a way to delete much larger 4-legged animals, as opposed to the 2-legged ones), to the point where most of the sales literature emphasized its alleged similarity to .44 Magnum and being "a good gun for bear defense".

a giggle switch Glock with a brace and dumping the mag

The objectively correct Eastern European gangster version of this is the vz. 61 Skorpion, the ultimate successor to the sawn-off double-barrel shotgun. Trivially suppressable, stock folds over the top, and doesn't need 1000 rounds of practice to use effectively like 9mm full-auto pistols do. .32 ACP is equivalent to a single pellet of #00 buckshot (from a gun that's 1/5th the size of a typical shotgun); you dump half the mag, that's equivalent to one shotshell. As soon as the Fosscad people figure out how to put a forced reset trigger in their printable lower...

@ThisIsSin @SteveKirk

...So, uh, is this how the weekly Motte GunGuy threads start? I'm totally in, BTW.

I would read with interest but contribute little of value.

I know approximately nothing about guns, but doesn't the KelTec Sub CQB (variant of the non-silenced Sub2000) match that description? Or does it not count because it uses a pistol cartridge?

It's pretty close! The big problem is lethality of subsonic ammunition at long ranges, especially pistol cartridge hollow points that are designed for expansion at much closer to their starting muzzle velocity (at typical 0-25 yard handgun ranges)

If you were only going to get a few shots off, the guy probably has an 80-90% chance of surviving (single gunshot wounds are down to 13% fatal, vs 19% for multiple, almost all from handguns ofc). And that's before all the targets start wearing low profile IIIa business suits.

Honestly it might be best to give up on the subsonic requirement outside of a very dense city, especially because the area they need to search for you scales with the range^2 xπ. A 400m shot means a .5 km^2 circle they have to search, vs .03 km^2 for a 100m shot. Pretty huge difference in the number of candidate cars and windows, giving much more time to escape the search area before they narrow it down.

Course, a 400m shot means a much better shooter with a much better rifle. At the very least a skill level that requires buying enough practice ammo to make you light up the map when they check who was in the area. Especially if you're visiting NYC from Idaho, and are already on a terrorist watchlist for asking your school board why "Dr Diddles Yeets The Teat" is in the kindergarten storytime rotation.

These things are never as they seem. People way overestimate indignation as a motive, when in the vast majority of cases it's mental illness or nihilism. Maybe he saw an easy getaway and a chance at infamy. This was the case with the Trump shooter...the guy had no coherent worldview. It's interesting how he got away way like that making such a brazen kill like that and fleeing into the darkness of the city.

the guy had no coherent worldview

Don't spread that shit. That's definitely not true. The one that got his ear was def in the orbit of globo-alternative-sexual-lifestyle and the other one was literally recruiting for Ukraine.

Uh, hate to break it to you, but this guy’s plan was way to functional and well thought out for him to be a random schizo.

It's interesting how he got away way like that making such a brazen kill like that and fleeing into the darkness of the city.

This is why the Inner Party fears weapons in the hands of the Outer Party, by the way. There’s very little you can do to prevent being murdered like this other than not be worth killing, and that’s a tall order for Inner Party members for reasons inherent to being Inner Party.

There’s very little you can do to prevent being murdered like this other than not be worth killing, and that’s a tall order for Inner Party members for reasons inherent to being Inner Party.

Depends on who you consider "Inner Party members." Nobody tries to assassinate, say, the Commissioner of Internal Revenue, despite the IRS's unpopularity.

I remember reading a thread on Tumblr discussing how we remember the assassination of Archduke Ferdinand that launched World War I, but we forget that political assassinations were not uncommon in turn-of-the-century Europe, compared to after the World Wars, mostly of people we would consider rather "mid-level" in the government — not notable enough for the sort of fame-seeking that motivates most assassination attempts on heads of state. The question was raised of why this changed, and the general answer was that in Europe (or at least parts outside Western Europe) back then, even ministry heads and upper-level bureaucrats were members of the hereditary aristocracy — personally important beyond their government office, and not readily replaceable.

Nowadays, though, such jobs are held by interchangeable human cogs in the bureaucratic machine. Take out the Commissioner of Internal Revenue, and his or her #2 will be in their office within the week, and the operation of the IRS will proceed without the slightest hiccup. Hit the J. Edgar Hoover building with a truck full of explosives*, and the rest of the FBI continues with business as usual.

This is why I disagree with our own @KulakRevolt's Substack piece "Assassination War & the Death of Bureaucracy," because, long before assassinations of IRS agents "cause a Johnstown style 2/3 flight from the profession," (which even he estimates would take "merely 100 IRS agents" being killed annually), you'll long since run out of assassins willing to die to take out utterly-replaceable human cogs, only to see the machine grind on undaunted.

Sure, the mostly-figurehead merely-elected politicians whose names and faces are known to the public might have to worry, but then, see the "mostly figurehead" part.

*Example inspired by Vox Day's claim in this post that the Oklahoma City attack was a "false flag" precisely because it was in Oklahoma City:

In other words, a real terrorist attack on the FBI isn’t going to be in some random field office; the Oklahoma City truck could have just as easily have been parked in front of the J. Edgar Hoover Building. If there is a false flag attack in London, it would probably be on some trivial, but vaguely symbolic structure that was already scheduled for demolition. An aging football stadium scheduled for replacement would make an ideal candidate.

McVeigh picked the Murrah Building as a target because that was the field office where the Waco raid was planned.

Sure, which puts paid to Vox's "false flag" narrative. But it instead highlights another weakness of assassination and terrorism as political tools in this sort of modern context: the choosing of the symbolic over the effective. To borrow Max Weber's terms, it's favoring "values rationality" (Wertrationalität) over "goal rationality" (Zweckrationalität); that is, what "sends a message" or embodies a particular value over what actually achieves a concrete end.

But the point of both terrorism and many partisan actions is to create fear, provoke a vast overreaction by the victim, and to inspire further action from others through what 19th century Russian nihilist social revolutionaries called “Propaganda of the Deed”. If Osama Bin Laden had secretly bought the Hostess company and increased the amount of sugar and trans fats in each Twinkie by 10 percent, he could have killed far more Americans than 9/11 did, and he would probably still be alive. But I doubt that would have fulfilled any of his political or strategic goals.

and to inspire further action from others through what 19th century Russian nihilist social revolutionaries called “Propaganda of the Deed”

Except when has this ever actually happened? My understanding, from what I've read on the topic, is that "Propaganda of the Deed" never actually worked, not like the revolutionaries hoped, and was in fact counterproductive.

(If I thought such an act would inspire others on the same side to follow suit, well…)

the vast majority of cases it's mental illness or nihilism

Have you seen the video? It's not a crackhead deciding to go off his rocker. This is someone who is relatively practiced with firearms and cool under fire.

Maybe he's a vet with PTSD or something, but this is different from the vast incompetence exhibited by both trump assasins.

I also allowed the possibility that the shooter was motivated by factors that does not readily map to the left/right-spectrum, similar to Thomas Matthew Crooks. Crooks planned the shooting well enough to come within an inch of killing Trump. I would say that is demonstrative of competence, having scouted an opening and having a ladder ready

Thomas Matthew Crooks' plan involved walking along a rooftop, openly carrying a rifle, in front of a crowd pointing and shouting his location and in direct view of at least two secret service snipers, taking a position, and then firing more than a half-dozen shots at a VIP while the snipers assigned to protect that VIP did nothing.

His attempt demonstrated a number of things. "Competence" was not one of them.

"Competence" was not one of them.

Well, in absolute terms sure. But in relative term he only had to be more competent than the secret service. Something that in the wake of his attempt does not seem nearly as high a bar as it seemed prior.

Well, in absolute terms sure. But in relative term he only had to be more competent than the secret service.

Tallest midget. Fastest quadriplegic. Most gentlemanly at the gangbang.

If you're retreating to relativism in an argument, you're sliding down the hill fast. Cede the field, re-group, and come back better.

But in relative term he only had to be more competent than the secret service.

If Ree Tardy Oswald had bought even a cheap magnified optic we would, most likely, be having a different conversation.

Exactly. Even without considering the possibility that the murder is non-ideological, assassins often have incoherent worldviews that do not cleanly map to tribal politics as normally understood by the non-insane. Perhaps he believed the insurance company to be responsible for implanting a mind-control device in his brain or some other similarly schizo reason. Time will tell presumably

Like most actual assassins, I think his motive was money.

He's too cool under pressure. I don't think the gun malfunctions three out of three times, I think it was a homemade silencer or subsonic rounds that fuck up the cycling of the gun. This means he trained to do the manual cycling. He dumps a phone at the scene; I'd be willing to bet it's scrubbed of anything and this is either an explicit "fuck you" to someone or just excellent evidence hygiene with a burner. And then uses a public bike service that is known to have GPS trackers on them to escape in the most densely populated city in the US. And, as of this morning still, he has not been caught. This is a pro's pro.

And that's why the motive is probably shocking in its brutal simplicity - my money is on some internal shit at United Healthcare or something with a competitor. Tens of billions on the line etc. Remember, the CEO was in town for an investor meeting. That's a symbol and message all on its own.

Somebody went ultra greedy and decided to do this using a spreadsheet and a slide rule. That's far more terrifying that "random schizo goes bang bang"

I'm not usually conspiratorial but I wouldn't be at all surprised if this were a hit disguised as a revenge killing. The detail of the slogan scratched on the bullet casings is just that bit too melodramatic, it doesn't fit the stone cold killer vibe.

This isn’t an insane person, though.

Insane people flail wildly in the general direction of their targets and neglect to bring the proper equipment.

This is very much not that (this person doesn’t seem surprised their pistol doesn’t cycle on its own, and that may even be on purpose since doing that makes it even quieter) especially considering the authorities haven’t caught him yet.

(And, I’m not sure they want to reveal the ability to catch him if they could do it. NSA probably could, but this was only a quasi-government actor so maybe not worth burning the latest in AI classification tech to do it; if this guy is caught, that’s going to be one hell of a parallel construction case.)

It might not be as hard to catch him as you think. The stories that broke throughout the day were kind of scattershot, but I just saw one on CBS that had a more complete reconstruction of the events. Initial reports said that the shooter escaped on a Citi bike. Assuming at the time that it was a regular pedal bike, you could probably track him down based on that, though it might take quite a lot of legwork. The CBS story said, though, that he arrived to the scene on foot, shot the guy, then ran to a docking station and picked up an ebike, which he then used to escape. These require either an app or a credit card to use, and you can already nail down the station it was taken from and the window of time when it was rented. It gets better, though. While the regular bikes don't have any kind of tracking, the ebikes do. You know know where he returned the bike to, along with the exact escape route. This can be invaluable information if you're looking for clothing, the murder weapon, or any other evidence he may have ditched along the way. I guess there's a chance he could have used a stolen credit card that wasn't cancelled yet, or a stolen phone that happened to have a Citi bike account on it, or some other way of getting the bike, but for all this guy seems to have done right, the getaway plan was fairly stupid.

You can buy stolen or cloned credit cards pretty easily, ditto for burner phones.

Would you even need to do that? Would a pre-paid card bought with cash not be able to do the trick?

Lyft, who operates Citibike, is now saying it wasn't one of theirs. I would surmise he pre-staged a bike that looked like a Citibike and used that.

Mark David Chapman killed John Lennon in very similar fashion in New York City and was undeniably insane with incoherent and deeply personal motives. Alternatively at times he has described the motives as due to Lennon's blasphemous statements, Lennon's hypocritical lifestyle, or to promote the book Catcher in the Rye. He had attempted suicide on numerous occasions. Despite his insanity he had planned the murder over a month in advance and flew all the way from Hawaii to do it, located John Lennon and waited outside his home until the opportunity presented itself.

agree. insanity does not mean what people often think it does . it does not mean a total lack of composure or forethought

Expect to see more private security

I'm placing a prediction that the shooter will end up being private security, and possibly recently fired private security at that.

To shoot this man the way the perpetrator did, you'd need to have:

  • Familiarity with the area
  • Some knowledge of the victim's travel plans and schedule. (While investment info could do this, firsthand knowledge seems simpler)
  • Firearms training sufficient to clear multiple malfunctions
  • Some measure of physical fitness to haul ass to central park
  • A rough idea of where cops and cameras are
  • Enough know how to either build a suppressor or buy parts for one in the gray market

Somebody with all those qualifications in New York City seems like they would cluster somewhere around law enforcement, private security, or extreme /k/-type autists, and /k/ommandos generally aren't in shape and don't go outside.

Surely a private security guy would have a regular gun/silencer so he doesn't need to cycle the gun manually each time?

Why would a private security guy have a silencer? It seems pretty much completely antithetical to security to have the gun be quieter.

All legally-owned silencers are registered with the federal government, and I believe part of the regulation involves consent to searches at the ATF's discretion. There's workarounds that might or might not work, but racking the slide isn't nearly great enough an inconvenience to override the advantage of disposability and untracability. Making a suppressor is also very simple.

It’s entirely possible he traveled in to New York City.

Firearms training sufficient to clear multiple malfunctions

The shooter was using subsonic ammunition that did not have the necessary oomph behind it to work the action - he knew the slide was going to need to be racked after each shot.

He also either stole the suppressor (unlikely) or passed a very rigorous background check by the ATF to acquire it. Recently, wait times for suppressors have dropped from ~6 months to just a couple of days, a rare instance of a government org suddenly getting more efficient.

The shooter was using subsonic ammunition that did not have the necessary oomph behind it to work the action - he knew the slide was going to need to be racked after each shot.

Or he was using a homemade suppressor that did not incorporate a Nielsen device.

Because most semi-automatic pistols for sale utilize a moving barrel of one type or another, adding a suppressor (or any 9mm muzzle device) to the end of that barrel can have a detrimental effect to the firearm’s reliability, even in some cases to the point of preventing the gun from cycling at all. To remedy this, handgun suppressors commonly use a Nielsen device, also sometimes referred to as a piston or booster. This device increases the amount of energy that is directed rearward into the firearm’s barrel, counteracting the weight of the suppressor at the end and aiding in unlocking the action during the firing cycle.

I would be very surprised if he acquired this suppressor legally, and fairly surprised if he stole it.

It's also possible he bought a solvent trap off eBay.

You can go on a road trip and get them with cash:

https://jkarmament.com/find-a-dealer/

He also either stole the suppressor (unlikely) or passed a very rigorous background check by the ATF to acquire it.

Building a suppressor is not difficult.

This is true. I'm not sure I would necessarily trust the success of an assassination attempt to one I made myself, but there are obvious reasons to DIY of course

You can test the suppressor before using it in your assassination attempt lol. That's not a real issue.

Sure. It's a simple device. I haven't done it, but I'd be surprised if the average joe's DIY can is as quiet as the products other people develop. This one, if DIY, failed to return the gun to battery multiple times. Like I said - not a compromise I would make, even against a soft target.

It's very easy with the partially made kits you can get for cash. They sell a overpriced guide so you can't mess up with a hand drill if you don't feel confident enough to free hand it or have a drill press. Buy a few and practice; most of the baffles are interchangeable.

The itinerary of these things are online or otherwise public or can be obtained with some phone calls.

Here's a camera recording of the shooting (4chan link).

You know those disappear right?

https://filebin.net/dkspyfwxiwi4qv5x/1733341922491406.webm

Looks like a suppressed semi-auto pistol. my guess would be a home-made suppressor, which is why he's having to rack the slide between shots. Suppressors mount to the barrel, and the added weight throws off the physics of the most common forms of delayed-blowback actions, turning your semi-auto into a manually-operated single shot. Factory versions usually have a free-float mechanism that decouples the suppressor long enough for the weapon to cycle, but a homemade device is almost certainly not going to have one of those. The shooter seems to be pretty clearly practiced with this particular weapon; I see two clean operations with no hint of surprise at the failure to cycle and then what looks like a failure to enter battery that he efficiently taps the slide to clear for the third shot.

Concur on this clearly being an assassination.

[EDIT] - Video is now down.

Looks specifically like a pistol with an integrated suppressor and manual action, in the vein of the B&T Station 6, and 9mm casings were recovered at the scene.

Video demonstration: https://youtube.com/watch?v=n8XHxUlg0F8

The shooter in the video manipulates the back of the barrel (rather than racking a slide) after each shot and makes the same sort of jerking motion required to eject spent cartridges from the Station 6. He also does indeed appear to clear a misfire, but not a serious one as he was able to eject the cartridge and chamber and fire another.

I don't know about a paid hit. When was the last time an American exec was killed like this? I asked Grok for examples from the last 40 years, it pulled only the 2001 murder of Federal Prosecutor Thomas Wales. Other than it being suspected as a paid hit, I don't see these as exactly analogous, and on that note, today, isn't every online-classified-tor-bitcoin-assassin a fed? Who has the means to find a guy like the shooter but lacks the means to, say, cover their wife's cancer treatment? Major league corporate shadowiness also doesn't feel right, again I'd wonder where are the other examples, and I'd think at that level they just have the guy killed on his yacht and that sends whatever message they want.

Revenge seems simplest. Tech, energy, banking, all those could have myriad motives. Health insurance CEO, revenge crushes everything else on probability. So ex-SF guy loses his wife to cancer after she was denied coverage, decides to kill the CEO of their insurance company. As ex-SF he would have the skill, and to have made it through SF selection for whichever branch, he'd have outlier motivation and resolve. Everything necessary to coldly decide to kill another man, and then kill that man in such a manner as we see in the video. And probably get away with it.

Looks specifically like a pistol with an integrated suppressor and manual action, in the vein of the B&T Station 6, and 9mm casings were recovered at the scene.

Screwing a home-made suppressor onto the average semi-auto handgun turns it into a manual action. Most handguns use a delayed-blowback system where the delay is provided by tilting the barrel to disengage some form of locking lug. Adding an extra pound or so of weight to the front of the barrel throws this system off, causing the gun to fail to cycle properly, which means you need to cycle it by hand. But don't take my word for it, here's Gun Jesus making the same point. The video alone should be sufficient, though, since on the first shot you can clearly see the slide moving and the large puff of gas exiting the ejection port as the gun partially cycles. Manual actions like the B&T do not do this.

Factory suppressors generally incorporate a Nielsen device, a small spring-loaded device that bypasses this issue, allowing suppressed semi-auto fire. Dedicated suppressed pistols sometimes use a slide lock to disable the semi-auto function completely. But what we see in the video is highly consistent with a semi-auto pistol mounting a simple, home-made suppressor that is compromising its semi-auto function.

My bet is that this is left-wing terrorism by a competent, motivated individual. No particular bet on a military or law-enforcement background; nothing here screams super-special operator to me.

The only definitive point I see in the video is the visible gas on first discharge. The Station 6 demonstration video shows it releasing gas only when the bolt is cycled, but that video is in daylight and what appears to be warm weather. There is a moment where it's possible he was racking the slide, but there aren't enough pixels to say that definitively, same with when he first fires and it's possible the slide was moving back, or it was just recoil. In the typical circumstance I would trust Ian's assessment, here I don't know what he sees in that blur to call speculation about it being a Welrod-type "conclusively wrong." He just says he watched the surveillance video, and maybe he's seen the actual source video, that would still leave an explanation needed for why the NYPD thinks it's a Station 6.

Police believe the shooter used a B&T Station Six, known in Great Britain as a Welrod pistol, according to police sources. The gun doesn't have a silencer but does have a long barrel that enables the 9 mm to fire a nearly silent shot. The gun requires manually cycling ammunition from the magazine.

Leftist terrorism seems very unlikely. Why an insurance exec and not oil? Why either of those and not a politician? If he had the patience to learn a gun, make a suppressor, go in with a plan, not freak out — why not do all that with a rifle against a comparatively hardened target? Or why not use a bomb like the Red Army Faction and Alfred Herrhausen? There's no objective, no real victory, and that applies to revenge, but the widower motivated by the death of his wife gives us something specific, the leftist looking for someone who "needs killing," why would he ever start with insurance? The target and method say vendetta, not politics.

re: the gun, your train of thought seems reasonable, but goddamn do I hate the media.

Police believe the shooter used a B&T Station Six

I can believe that a police officer said this to a journalist at some point. I have no reason to consider this as having any weight until they explain exactly why "police" think that. Unique extractor markings on the cases left at the scene? Witness testimony? I do not believe that "police" generally know more about guns than I do. Many of them know considerably less, and the journalists passing the message know nothing at all.

known in Great Britain as a Welrod pistol, according to police sources.

I call bullshit, completely off the cuff. I do not believe the B&T Station Six is "known in Great Britian as a Welrod pistol". I do not believe that there are enough Station Sixes in Great Britian to be "known" as anything. I am confident that what is "known in Great Britain as a Welrod" is the Welrod, which was developed there in WWII. The S6 is a modernized version of the concept built in Switzerland.

The gun doesn't have a silencer but does have a long barrel that enables the 9 mm to fire a nearly silent shot.

This statement is a perfect example of why you should never, ever listen to journalists about anything to do with firearms, or indeed on any technical matter, or indeed in any way at all. But at least it's not a lie, RITE GIYZ!? The S6 does have a silencer. Moreover, a barrel long enough to act as a silencer for 9mm parabellum would be... impractically long. At a guess, a couple dozen yards long at least, and that's a very conservative guess.

The gun requires manually cycling ammunition from the magazine.

C-c-combo breaker! This is the only sentence in this paragraph that is not egregiously wrong.

As for the rest of your post:

Why an insurance exec and not oil?

For the same reason that hundreds of thousands of people are publicly celebrating the murder right now. Health Care costs are peak culture war.

If he had the patience to learn a gun, make a suppressor, go in with a plan, not freak out — why not do all that with a rifle against a comparatively hardened target?

Because this is easier and far more survivable. The part where he does this and gets away with it makes it incredibly effective from a propaganda perspective.

Or why not use a bomb like the Red Army Faction and Alfred Herrhausen?

To put it a bit reductively, bombs are much harder on a whole variety of axes. This was very, very, very easy to do, and required resources that are a rounding error even to someone working minimum wage.

There's no objective, no real victory, and that applies to revenge

The last several years are best understood as a massive, distributed search for the best way to hurt the outgroup without getting in too much trouble. This is a search result popping into the hopper. That's the objective and the victory, when you get down to it.

The target and method say vendetta, not politics.

Then why are people who have no possible connection to this vendetta openly celebrating its execution?

When you say "homemade", do you mean the general case of "didn't buy it from a licensed FFL"?

The paranoid part of me assumes this is going to be one of those "totally a solvent trap" models that you can buy on AliExpress.

yeah, that general sort of thing would be my guess, but it could just as easily be a scratch-built baffle stack or a tube packed with steel wool or a 3d-printed plastic toob. The actual muffling components of suppressors are not complicated. The dingus that makes them compatible with a tilting-block semi-auto pistol action is much more so.

The dingus

Love learning new technical jargon!

(Just kidding, this really is a fascinating conversation to someone with only a bit of gun knowledge)

I added a new link but it might get taken down in the near future too.

Download, share and backup.

Surprisingly, or perhaps unsurprisingly, this has not dented the stock of United Healthcare Group.

Seems to have rectified today with a ~30% drop

30 percent? It looks like 5 percent to me—from 611 dollars to 579 dollars.

The leadership vacuum will be quickly filled, but there was nothing remarkable about his leadership

Inside you are two wolves investors: the first sells the stock on the expectation that a short-term leadership vacuum will hurt profitability; the second buys the stock because the first sold on basis that the long-term fundamentals are unchanged. And they're both bewildered that the price seems unmoved, I suppose. I guess that means this isn't a taxable event.

Culture war going hot

I don't understand. Where's the culture-war angle? AFAIK this guy wasn't a notable CW figure, and while the left is friendlier to going single-payer they're not TTBOMK specifically murderous as a group toward private insurance companies (the way some of them are toward the fossil fuel industry, or some religious-right types are toward abortion clinics).

Or are you more concerned that there might be a rash of copycats with more CW-loaded targets, due to this guy apparently getting away with it?

Maybe not intentionally going hot but it seems very culture war just going based off of reddit's reaction. The response is either shrug, "good", "more of this", or "I don't wish violence on anyone but..." and those are just the ones that aren't removed by the mods. But this is nothing new for reddit, there's a fair number of subs dedicated to anti-capitalism sentiment and they post often about killing rich people in the same way that pol would post about the day of the rope or whatever. I've seen many conversations on reddit that all boil down to:

Eat the rich.

Okay, but you don't mean kill them so how do we solve this problem?

I meant what I said.

Then it sort of just devolves into people agreeing with the sentiment that wealth inequality's only solution is violence. You can say this isn't culture but class but it seems to me the lines have already been drawn where being rich is always bad unless the person is sufficiently left. The CEO being despised for being in Healthcare seems like a fig leaf that just fits better than most for people from the outside looking in, but if this was an oil exec or a finance exec, the talking points would be different but the people celebrating would be just as fine with it.

I tend to avoid the anti-capitalist subreddits and whatever overflow they might have into the many left-wing subreddits. So, I imagine, there's more than I think. A decade ago there wasn't any specifically large anti-capitalist subreddits, then things like /r/antiwork and /r/workreform started, now there's stuff like /r/fluentinfinance and other hydra heads that are all the same thing, when they're not celebrating or justifying events like this they're just posting the same things that they must know are lies, whether they pretend that profit is revenue or that rich people's net worth represents the amount of currency they can spend at any moment. It seems clear that the celebration isn't coordinated by the left but the overlap between the tail and the head is pretty hard to figure at this point. There were memes in /r/adviceanimals about the killing and at some point it became a specifically left wing subreddit, but /r/pics, which also became a specifically left wing subreddit, doesn't have anything about it which leads me to believe the sentiment is organic, to the extent that its possible to be on Reddit anymore.

Hatred is lifeblood in the culture war and if the rhetoric is constantly "nothing will change unless poor people decide to rise up and kill their oppressors" and something like this happens where it's no big deal to kill a CEO, comments are talking about how they'd get off with jury nullification, "it's literally the same thing as killing a nazi," or venerating Shinzo Abe's assassin because he deserved to die for being conservative in a thread about this killing, then it's definitely going to either give the culture war fuel or become another overt part of it even if it turns out that the culprit was a hired assassin by a rival company.

It reminds of Trump's assassination attempt and how, whether or right or wrong, it was claimed that it wasn't political. Just because something is done absent a culture war motive doesn't mean that there isn't a culture war angle.

90% of the Facebook reactions to the company's post about the death were laugh emojis. It's not just the Reddit kids. This guy is gonna be a folk hero.

or some religious-right types are toward abortion clinics

Aside from a lone schizo mass shooting in 2015, the last case of an actual murder against an abortion clinic was before Obama.

Actually, both energy executives and abortion doctors have to worry about harassment from people who don’t like them for ideological reasons, but I haven’t heard of energy executives actually getting assassinated either, despite their apparent need for heavy security.

I said "some" and I meant more the people with terrorist-friendly ideologies than specifically the terrorists. We had someone taking this position in the QCs for last month.

agree. people are reading into or assigning a motive that fits their worldview.

Yes to the latter.

Reddit’s “There Was An Attempt” subreddit is for failed attempts at doing simple or easy things. This news article was posted there as “To stay alive as a PoS who made millions off the suffering of others.” As of now, approx 8000 upvotes and 1000+ comments, most of them cheering on the assassin.

It’s culture war because the Democrats forced the country’s insurers via the ACA to stop offering all healthcare except “Cadillac plans,” and to cover all pre-existing conditions, and reduced the employer-provided requirement down to 30 hours.

Then they successfully blamed Republicans and the profit motive for increasing the percentage of 29 hr/wk jobs with no healthcare, making all healthcare costs skyrocket, making doctors and nurses quit and new people not want to go into the field, and making Big Pharma rich.

Then they successfully blamed Republicans and the profit motive for increasing the percentage of 29 hr/wk jobs with no healthcare, making all healthcare costs skyrocket, making doctors and nurses quit and new people not want to go into the field, and making Big Pharma rich.

I get the 29 hr/wk thing, assuming it's basically a variation on the minimum wage leads to less jobs argument.

Why does skyrocketing healthcare costs drive doctors and nurses to quit?

How does Big Pharma specifically benefit?

I wrote that as a list of individual things the ACA did, not a causal sequence. Sorry for the misunderstanding.

I get the 29 hr/wk thing, assuming it's basically a variation on the minimum wage leads to less jobs argument.

Sorry you read too much into this. The main effect of 29 hr workweeks for low income labor was to shift their healthcare from partial plans (now illegal) to Medicaid, being meta-insured by taxpayers in higher brackets.

Why does skyrocketing healthcare costs drive doctors and nurses to quit?

Again, a list of things the ACA did, not a causal sequence. Medical professionals leave the field for a variety of reasons. One of the big ones is the bureaucracies both public and private (their own business insurance, for one) which turn their days into endless paperwork, and turn the brightest and kindest of humanity into overburdened cogwheels.

How does Big Pharma specifically benefit?

Per Google’s search AI: “the ACA mandates that all health plans cover essential health benefits, including prescription drugs, which means more people can afford to purchase their medications.” It wasn't specifically caused by the lack of personnel.

Agree with all of this.

Many people don't realize just how expensive health insurance is now because somebody else is paying it for them.

A bronze plan for a family of four is now over $20,000 a year and covers essentially nothing. Obamacare was an abomination.

I'm seeing it reported that the guy was wearing a black hoodie, black pants, black sneakers with a white trim and a gray backpack used suppressed pistol and rode off on a bike.

That's like exactly what I've come up with for assassinating someone. The hard part is finding a good place to ditch the bike and change your look so they can't rewind the images from the loitering drones and follow you home.

Also needs to ditch the weapon

If it's made from untraceable parts I would consider that to be at about the same level as disposing of the clothes. Edit: Clothes might even be more important since they would more likely have DNA.

He rode to central park. Good place to dump clothes and weapon in a lake to destroy DNA evidence, and switch into new clothes.

Cory Doctorow called it I guess. All the way back in 2019 he wrote a short story about a man, radicalized by reading online stories of heartless insurance companies, doing some retaliatory terrorism. It was a pretty good story too! I also see the Wikipedia article for the book has already been updated to reference the shooting.

https://www.imdb.com/title/tt0629482/

Law and Order did it back in 2002, probably stolen from a headline or some other piece of fiction prior. Guy kills the insurance company rep who denied his daughter's cancer coverage. I remember the dramatic courtroom scenes. Was my first thought when I saw this news, somebody really got mad about UNH's treatment.

Wasn't there also a Denzel Washington movie in which he takes a hospital hostage over something similar?

Yes the title is John Q

John Q. yea. Though in that case it's going a bit more to the source of healthcare provision, rather than the intermediaries like insurance.

Odds are the shooter has a more personal connection than that, no?

The main character in Doctorow's story also has a personal connection. His initial entry to the content that radicalizes him is his insurance company denying an experimental treatment that could cure his wife's cancer.

Ah, Mr. Freeze for the modern era.

Mr Freeze is for the modern era, he uses technologically complex equipment such as an ice-gun and has the yet-unperfected technology similar to alcor, to keep his dying wife ins stasis.

I saw this about an hour ago. Then just now I see that the stock is up over 1% since the shooting (other health insurance stocks are level or lower, so this isn’t some broader-market phenomenon).

Did he suck as a CEO? Imagine being the guy’s wife rn.

Of note, United is known to be pretty much the most scummy one, which moves the needle a bit towards what we are all thinking.

This this would imply that other companies are leaving money on the table out of generosity? There is always a tradeoff

It's common for insurance companies to do things like randomly deny clearly indicated treatment for no apparent reason, this costs the doctor and health system time, as they have to schedule an appeal, during the appeal you almost always get a rubber stamp but its massively inconvenient to cancel appointments, skip your lunch break (which is typically just catching up on documentation anyway), etc.

This is legal even though it is practically speaking fraud, and I have no idea how they accomplish this on the training end at the insurance companies, but some of them are way worse than others.

Which are the not-scummy ones?

I have had pretty good experiences with Premera Blue Cross Blue Shield. My employer actually just started offering a United plan to us this year, though I did not elect to use it.

TriWest was a southwestern US insurer for veterans and their families. Valid claims just sailed through with minimal administrative overhead because their claims system was well automated and optimized.

They were good and not-scummy.

UnitedHealth bid a lower cost for the contract, won it, and promptly started denying most claims on the first pass. Only clinics which sent appeals would get paid, and almost always did.

UnitedHealth bid a lower cost for the contract, won it, and promptly started denying most claims on the first pass. Only clinics which sent appeals would get paid, and almost always did.

The scummy behavior isn't just on the insurance companies: [redacted] went to a medical provider that decided to code every (scheduled!) specialist office visit with an ER facility fee, and the insurer just shrugged and said it wasn't their problem and wouldn't do anything about it until the out-of-pocket maximum, even though they would have covered such fees for a real ER visit (conveniently, this happened to save them money). Not really much you can do unless you have a competent HR department on your side, which I've been fortunate enough to personally have in the past, except pay it, call and complain until they reduce the charges, and/or leave poor reviews.

I'm not sure I'm qualified to make good suggestions about how to improve medical billing, but it's pretty clearly a mess of opaque charges. Trump in 2019 forced providers to publish price lists, which I'd have though might improve things, but it doesn't really seem to have. Active price-fixing is generally bad for all the well-known reasons even if more uniformity in prices for, say, appendectomies would make arbitrage easier. Are there any real proposals with a sound economic basis for improving things? As much as I don't like throwing up my hands in not understanding complex systems (and deferring to Chesterton on the subject of fences), I don't exactly have a better suggestion at hand.

Trump in 2019 forced providers to publish price lists, which I'd have though might improve things, but it doesn't really seem to have.

Price transparency is always better because it cuts down on asymmetric info and makes the market more efficient, but I think the effect from these is mostly going to be behind the scenes, from the perspective of the average consumer.

For one thing, you can't pick and choose which insurance company pays for which service. If Walmart is charging less for a product that I usually buy at Target, I can just buy that one thing at Walmart and keep buying my other stuff from Target. I can't do that with medical services.

Also, even with a publicly-available price list, I can only use that list if I know exactly which line on the massive spreadsheet actually applies to me. And then, what do I do with that info? If my open enrollment period is coming up and I know I have a major procedure after that, I could do the research and switch plans, but how many people are in that position?

looks around furtively

Yeah.

But United has a particularly bad rep.

That was actually a serious question!

Unfortunately that was a serious answer, even public options like medicare and medicaid are pretty awful.

Which puts United having an even worse reputation in an uncomfortable place.

I don't support killing people, but if I did support killing people, "health insurance company CEO" would be right at the top of the list of people I wouldn't feel sorry for.

Honestly, fuck this sentiment and this expression of it. I’d be fine if this one joined your mountain of deleted comments.

It’s this mind-killing hatred (reminiscent of the shrieks of greed-flation when straightforward market mechanics and a hostile political environment drove up gas prices a couple years ago) that

  1. got this husband and father killed in cold blood and

  2. is preventing the levelheaded disentangling of the completely fucked incentives created by the current level of intervention currently being inflicted on a service industry that otherwise could have been commoditized by now.

straightforward market mechanics

Shutting down the economy and fucking the global economy over "covid", trash anti-fosil fuel economy politics isn't "straightforward market mechanics".

There are a lot more people closer to power than "health insurance company CEO", I would wish grave bodily harm to.

This guy was killed for "personal" reasons, not hatred of people in power.

I feel the exact amount of sympathy for this guy as he felt for any of the thousands of people who died or went without needed medical care due to the rejections the company he ran sent due to spurious reasons.

Now now bud, if you're going to ACTUALLY mean this, you better also account for the thousands or hundreds of thousands of people whose medical care was covered and lives were saved because the company paid for the necessary treatment or cure.

If you're already saying they're responsible for the lives of customers, have to give them credit just as much as blame.

you better also account for the thousands or hundreds of thousands of people whose medical care was covered and lives were saved because the company paid for the necessary treatment or cure.'

You build a thousand bridges and no one calls you bridge builder but fuck one kid.......

Now now bud

Sir Isaac Newton

as if killing him will fix healthcare. Sharehodlers would have to agree to reducing profits, which would not happen. the stock would crash and he would be ousted and replaced by someone else.

If the next CEO is scared of comeuppance, it doesn't matter what the shareholders think or do.

You see the same sort of logic in Meixco's political class. Somebody has to want to be in charge, and if being in charge puts a target on your back, it gets harder to find people willing to lead.

Yeah money is pretty useless if you are in that position unless you're getting the kind that spends in hell.

To play devil's advocate an argument could be made that shareholders are probably only important to a CEO or any major corporate leader if they don't believe their lives are in danger it is Maslow's hierarchy of needs. Any CEO they could hire would just choose to screw the shareholders to mitigate even a perceived 10 or 20 percent chance they would be killed. Once you're already a multimillionaire, it is extremely difficult to induce someone to risk there lives for more money.

I feel the exact amount of sympathy for this guy as he felt

So, an amount you're completely ignorant of?

What did the insurance company that you manage do to save these people you're fantasizing about?

So, an amount you're completely ignorant of?

I guess this is true but I would also guess that if the amount were quantifiable and would be made known to the public in a weeks time there would be a pretty healthy prediction market over the next 7 days with "absolutely none at all" being by far the odds on favorite.

Thank you for quoting it, I know it's distasteful but I think it's necessary to maintain coherence and trust.

Honestly, fuck this sentiment and this expression of it. I’d be fine if this one joined your mountain of deleted comments.

Fair enough. I regretted posting it any way, the sentiment was unacceptable. We have profound disagreements as to the problems with the healthcare system, but I should have expressed them more constructively.

Glad to see you acknowledge the utility of deleting regrettable comments, even if just this one time.

Your other comments are great and valuable which is why I get frustrated when you delete them.

I mean, it seems like it’s common knowledge that you can just say ‘I’m not paying that, eat it’ and get away with it.

Anarcho-tyranny, a penniless gang banger or homeless psycho can and will pay nothing (and in most cases the company will barely even pursue the claim because they know repayment is very unlikely), an ordinary middle class person who has worked hard will be taken to court and lose much of what they have.

Absolutely not. Hospitals are happy to negotiate down payments to zero or very little. I've known many people who aren't penniless gangbangers who've done this.

No they will not. They’ll be offered a gigantic discount to settle it out and eventually wind up paying Pennies on the dollar. In a U.S. context protections on medical debt prevent middle class people from getting dragged by hitting defect.

In a U.S. context protections on medical debt prevent middle class people from getting dragged by hitting defect.

Do you mean they won’t hit defect because of those protections?

No, I mean middle class people who hit defect will find that the medical system is legally obligated to keep hitting cooperate.

I've heard this, yet remain quite sure that except in the most ruinously-expensive cases the consequences of not paying will be much worse for me than simply paying.

Though it's true that a couple of times now I've been hounded by debt collectors for surprisingly-small medical debts which I'd somehow never been informed of at all, and in those cases it was easy to roll my eyes and ignore them.

Your anger at health insurance companies is misplaced. If the profit motive is the problem, a public option is a solution, but American voters (especially right-leaning ones) have been pretty emphatic about refusing it.

Companies have to deny some claims or else premiums would have to rise for everyone. UHC's profit margins are actually far lower than e.g. Apple's.

a public option is a solution

It's not. You need to reduce expenditure on the medical system. And way way too much of it ends one way or another as someone's salary there. so there is great resistance to any reform that will make anyone in the medical industrial complex earn less.

If you reduce expenses hundredfold it will be trivial to cover costs no matter with insurance, out of pocket or taxes. If you tipple them - the system will go bust, no matter how it is financed.

Your anger at health insurance companies is misplaced.

The insurance companies, the AMA, and the feds are locked together in a perverse cycle that produces a system that somehow spends even more on healthcare than socialized medicine countries...but the lion's share of the extra money goes to doctor's salaries (artificial scarcity driven by the AMA, med schools, and residency limitations) and ever-increasing administrative costs (additional regulations and insurance bureaucracy).

but the lion's share of the extra money goes to doctor's salaries

Doctor's salaries are not a significant percentage of healthcare spending. What percent of spending would be required for you to consider "lion's share" to be an accurate description?

I said the lion's share goes to higher salaries and higher admin costs. The abstract of the study I linked in my comment:

The United States far outspends Canada on health care, but the sources of additional spending are unclear. We evaluated the importance of incomes, administration, and medical interventions in this difference. Pooling various sources, we calculated medical personnel incomes, administrative expenses, and procedure volume and intensity for the United States and Canada. We found that Canada spent $1,589 per capita less on physicians and hospitals in 2002. Administration accounted for the largest share of this difference (39%), followed by incomes (31%), and more intensive provision of medical services (14%). Whether this additional spending is wasteful or warranted is unknown.

31% + 39% = 70% - over two thirds of the U.S.'s increased per capita physician and hospital spend over Canada's is down to those two things. That's "the lion's share" by any measure.

Current physician salaries are 8.6% of healthcare costs per Stanford. Looking closer at your data, it seems to be very old - it's missing 15+ years of physician salary pay cuts (which have been going on yearly for decades) and 15+ years of increased administrative bloat and other factors (such as increased excess services).

If you cut physician salaries in half across the board (which simply isn't possible, if you did that some specialties would be making less than nurses, and specialties like OB with an immense malpractice burden would be financially impossible), then you would barely make a dent in total expenditures and introduce significant new problems - who is going to work weekends and holidays and nights after such a massive pay cut?

Increased administrative costs are unnecessary, expensive, and much easier to reduce.

The ACA was designed to make private health insurance so onerous a hassle and so hideous an expense that the public would overwhelmingly approve Hillary’s single-payer she’d been working on since the 90’s.

Then Trump won, tried to kill the ACA, and was stopped by McCain’s spiteful deathbed vote. So it endures.

So break the doctors' cartel. What do insurance companies have to do with this?

The ACA mandates that insurers have to spend at least 80% or 85% (based on size of market) of premiums on actual provision of healthcare.

Cost cutting is of little use to them. If they take in $100M, currently spend $85M on medical, but are able to cut medical costs by 30% to about $60M, then they'd also have to cut that $15M allocated to other stuff down to about $10.5M. And give up about $30M in premiums.

With this regulation becoming more efficient hurts your bottom line.

But if they can grow the amount spent total, then the 15% or 20% they're allowed to use on other things also grows.

It's basically cost plus contracting, which is apparently popular when you're spending other people's money.

Story in healthcare same as everywhere - you have an increasingly rich populace with a rivalrous good that is non-discretionary (housing, education, childcare, healthcare), and the Government/private actor response is to subsidize demand and regulate supply than go shocked-pikachu-face.jpg when costs skyrocket.

Insurance companies aren't allowed to be insurance companies anymore. To the degree they have a profit motive, it's highly dysfunctional.

Case in point, under the ACA the profit a health insurance company is allowed to make is capped proportional to their operation expenses. Off the top of my head, I think they are only allowed 20% overhead. So 80% of all premiums collected need to be paid out to claims. I've actually gotten refunds from my health insurance (albeit only once) when they were in violation of this law and had to give some money back.

So really, health insurance companies can't just deny claims and keep the money. They only way for them to make more money is to let the cost of everything skyrocket, raise premiums sky high, and then keep 20% of a much larger pot. Which is more or less what has happened the last 15 years since the ACA was passed.

They only way for them to make more money is to let the cost of everything skyrocket, raise premiums sky high, and then keep 20% of a much larger pot. Which is more or less what has happened the last 15 years since the ACA was passed.

Do you have any data to support that argument? I'm not an expert, but 5 minutes on google makes it look like premiums have been increasing in a straight line since at least the late 90s.

See figure 1.12 and also this reference.

I honestly don't know how to square those charts with my personal expenses, and the expenses of those around me, any more than I know how to square the official rates of inflation with the same. I don't know how well those indexes capture people's plans getting phased out and replaced with entirely new plans that cost twice as much. I don't know how well those indexes capture the plans raising copays, deductibles, etc so you are getting less and less despite paying more and more. I don't know how well those indexes are capturing the shrinking pool of health service providers that even accept certain plans. Pre-ACA I had zero issue with any doctor I wanted to goto accepting my insurance. Post-ACA they started getting a lot pickier about which plans they take.

Basically, I gotta plead "Lies, damned lies, and statistics".

Premiums are only one component of healthcare costs. A "straight line" is one thing, the slope of the line is what matters. Family premiums are up 89% since 2008, compared to ~43% cumulative inflation.. Outcomes and features have degraded since ACA, I'd argue.

Your point (the overall rate of change pre-and-post ACA) seems valid. However, I don't think "things continued to get way worse at the same rate" counts as a victory.

Obamacare accelerated the inevitable failure of this healthcare system and was only engineered to be a pernicious trojan horse for single-payer.

Premiums are only one component of healthcare costs. A "straight line" is one thing, the slope of the line is what matters. Family premiums are up 89% since 2008, compared to ~43% cumulative inflation.. Outcomes and features have degraded since ACA, I'd argue.

The initial argument was:

So really, health insurance companies can't just deny claims and keep the money. They only way for them to make more money is to let the cost of everything skyrocket, raise premiums sky high, and then keep 20% of a much larger pot.

I agree, the slope of the line is what matters. If your argument is that Obamacare increased premiums, you would expect to see the slope of the line increase after the ACA was passed, correct? Do you agree that that is not what we see, and that the post I was replying to was incorrect, pending them making some kind of rebuttal?

Do you have any data about outcomes deteriorating? That doesn't seem like a straightforward thing to measure.

However, I don't think "things continued to get way worse at the same rate" counts as a victory.

It doesn't, it counts as Whiningcoil being wrong. You're making a new argument and moving the goalposts.

Obamacare accelerated the inevitable failure of this healthcare system and was only engineered to be a pernicious trojan horse for single-payer.

Maybe. No offense, but I'll believe it when I see data.

WhiningCoil is correct in that the ACA means insurers make more money through larger claims. There's no downward pressure to reduce costs from insurance companies. When they destroy last year's plans and remake new ones (to get around ACA's maximum cost increases!) they just make them more expensive. There's no consequences for introducing a massive headache to everyone, every year, forever.

If your argument is that Obamacare increased premiums, you would expect to see the slope of the line increase after the ACA was passed, correct?

That's actually not my argument. I agree that the data shows premiums have continually outpaced inflation at the same horrific rate for the past 30 years. Obama promised that the ACA would reduce premiums. The CBO - which is trotted out as "non-partisan" by every NPC every time we're ramming through another enshittification mechanism through our legislature - predicted Premiums would drop by 13% by 2016.

Do you have any data about outcomes deteriorating?

The market competition we were promised was a lie. Instead we've watched massive mergers and regional monopolies emerge. Longer wait times, fewer services at urgent care, the death of the family practice, monopolies on software and technology, deductibles have tripled.

You can't just ask for data as a rebuttal - you would have to be blind to think the system is providing any more value for the money today then it did in 08.

In that vein, you and I both know that there's no "data" to point directly to a trojan horse, but the level of incompetence that the ACA has exhibited could easily count as malice. Almost every single promise was an outright lie, with perhaps the exception of covering the obese smokers who didn't have insurance. It's genuinely difficult to think of a more destructive force in the average american's health and wealth in my lifetime.

How much of the change in family premiums is due to more elderly dependents?

The rate increase is only slightly higher for family than individuals. They're essentially the same.

He's definitely right that the ACA puts that cap on non-benefit expenses (including profit), but I would tend to agree that I'm not sure how much that raised premiums. The main thing the ACA did was put the onus on paying for chronically ill people not on medicare/medicaid/Employer insurance on the taxpayer (via APTCs) and the unsubsidized making more than 250% FPL (to some extent) and 400% FPL (to a very large extent).

Not sure why we didn't just put those chronically ill in Medicare like the dialysis population....though eventually you run into the problem that Medicare rates don't sustain providers - commercial population subsidizes. Tricky little issue we have here.

No, a “public option” is not the solution. The solution is deregulation. Medical treatments that were perfected 40 years ago should be basically free, and administered (if that’s even necessary) by a low wage technician.

A “public option” is just a shift of control from private companies to the government.

A solution is less preventive care, which does not save money despite the hype. how about a return to people only seeking healthcare when actually sick.

Ah, the medishare option.

The solution is deregulation. Medical treatments that were perfected 40 years ago should be basically free, and administered (if that’s even necessary) by a low wage technician.

Most of medicine is based on prescribing drugs, for which a person needs to understand drug interactions, risk-benefit ratios, and basic biochemistry. And most of the other part is surgery, which requires an experienced hand. You know, like a doctor.

So who's going to pay for the drugs people need? And who's going to pay for the drug development? And who's going to cut your appendix out when you have appendicitis? A "low wage technician"?

All of that could be handled by a technician with a good GPT bot

I've been waiting for decades for laser eye surgery to be perfected and standardized to the point that I can get my severe nearsightedness corrected to 20/20 or better, forever, by a robot at my local CVS for $9.95.

Laser Eye surgery today is miles better than the procedure was even 20 years ago. Here in the UK you can get the full procedure done on both your eyes for $2000 combined as an outpatient case. If you're willing to spend $2500+ you can get some of the fancy bells and whistles where each little patch of your cornea gets corrected exactly rather than a uniform correction being applied all over (this is something you couldn't get done in the year 2000 for example).

Lasik is unironically used as an example of a field that insurance doesn't touch that has in fact gotten orders of magnitude better and cheaper over the years.

I realize you’re likely joking but you should def get lazik, my vision is now better than 2020. Very much worth it

who is going to tell you about drug interactions

The same people who do now: pharmacists.

Drug development

Keep developing. Somehow every other industry seems to be developing new and interesting things without needing a protection cartel to allow them to do so.

Surgeries

This is what insurance should be for.

If the profit motive is the problem, a public option is a solution, but American voters (especially right-leaning ones) have been pretty emphatic about refusing it.

Yeah, and they're dumbasses for doing that, which is my biggest disagreement with the Republican party. I was a single-issue on this for several years in the 2010s before I realized the Democratic party would never spend political capital on solving the problem -- which they do, largely, because of lobbying by the health insurance companies, for which reason I hate them.

May I ask why you think conservatives are stupid for denying public insurance options? As someone who has experience in both (consumer side) private and public insurance, the only reason why public insurance is affordable is because expenses are shifted to taxpayers instead of the individual insurer. The actual price per service is no different: collective bargaining does not give the government any particular advantage in negotiating prices for services. Almost all public health services have massive budget overages and increased costs which are expected to increase as time continues as well as having issues with patient backlogs.

In the US, Medicare (for elderly and for certain qualified disabilities) accounts for 17% of the national budget. Once again, the only reason for affordability is due to the taxpayer shouldering the costs whose base is dwindling. This isn't even accounting for standard government inefficiency as the US government is incoherently cost insensitive and unable to make sensible budgetary decisions.

So while I agree that private health insurance has many issues, it at least is self-maintaining and doesn't have the large macro issues that government health programs are currently facing.

Let me apologize for the tone of my recent posts on this topic, which were really dumb Twitter-tier reactions and don't reflect either my values or the standards of this place.

the only reason for affordability is due to the taxpayer shouldering the costs

Yes, and I'm saying this is a good thing, and the percentage should be higher. It's a fair point that the public option is unlikely to increase efficiency, but increasing efficiency isn't really the goal for me. I like the idea of a public option because it means giving money to the government that is constrained by the Constitution, the courts, administrative procedure, etc... while giving money to a private insurer, while they absolutely are regulated to death, means giving money to a party whose entire purpose is to take as much of your money as it can legally get away with while giving you as little in return as they can legally get away with. It's the alignment of incentives I find disconcerting, not the level of efficiency.

I don't agree with the "healthcare is a human right" thing, but I do believe that it's right for society as a whole to shoulder the burden to take care of people who are vulnerable, struggling, chronically ill, etc. I put social welfare policies, particularly surrounding healthcare, in the same basket of public goods as roads, bridges, police officers, defense -- it's part of the fundamental social fabric that enables people to live at all, and shouldn't be subject to the whims of the market.

To be clear, my view on the Republican party on this issue is not that conservative voters examined the evidence closely and made a cost-benefit analysis, it's that conservative voters hate the idea of the public option because it's the government doing stuff, and there's an axiomatic belief among Republicans that the public sector is inherently inferior that is just as dogmatic as the belief among Democrats that the private sector is always exploitative.

Despite what my strong feelings on healthcare may suggest, I'm not actually particularly dogmatic on economic issues: except to say that I believe what should be done is the option that empowers ordinary people to live the best and most fulfilling lives as is possible. There are some areas where giving people more choices and the freedom to make decisions in a free market gives them the most power -- but likewise there are other areas where the amount of knowledge and wisdom a person would have to accumulate to make a judicious choice is so ludicrously high that people do need government officials to regulate away bad choices and build a system where people have the legal right to be treated fairly.

If that means trickle-down in one case, fine, if that means government monopoly in another, great, if that means single payer in one context, sure, if that means tax breaks at one point, I'm all for it. I'm apparently being an economic progressive today, so I'll throw some meat to the fiscal conservatives in the audience and say I think most concerns about corporate greed are silly, and price increases usually reflect underlying economic variables. Price fixing in particular is the worst possible solution to any economic problem.

I'm happy to agree with the more libertarian side of the fence that our current system is regulated to death and has the worst aspects of both private and government-run healthcare, but I don't see the solution being deregulation and turning healthcare into a McDonald's menu where people have to price-match and pay for add-ons in times of extreme time-pressure, information asymmetry, and profound emotional and physical stress. If there's any time whatsoever where we can be absolutely sure people aren't Homo economicus, it's when they have to make serious decisions that affect the life, death, and serious suffering of themselves or a loved one.

30% of US health expenses are attributed to administration, which in the US context usually means the armies of secretaries hired by hospitals to not mess up billing and to argue with insurance providers, who have their own armies of secretaries hired to deny claims. If there were a public option in the US, it would (hopefully) make clear what is covered and what is not in an unambiguous way, which would make these armies of secretaries redundant.

But who am I kidding? Health care inefficiency is a jobs program for millions of white-collar PMC employees of extractive middlemen, and it will remain popular to kvech about high prices while doing nothing to bargain down prices as long as we rely on "employers" to pay for our medical expenses. Meanwhile kickbacks and bribes are legal as long as the people being bribed are responsible for buying health care equipment for us (hospital administrators) and buying drugs for us (group purchasing organizations). The corruption has been normalized.

What’s so telling is that in multiple group chats and other social media places this is the explanation people came to immediately.

Probably says something about how the world thinks about the health insurance companies.

Probably says something about how the world thinks about the health insurance companies.

How the US thinks about health insurance. The rest of the developed world doesn't really feel... anything when you ask them about their insurance provider. Maybe it feels a bit expensive, and - unsurprisingly, since its mandated by law - they always pay your bills.

Like it or not the world does think about the goings on of Americans and how Americans interact with the world.

Reddit, twitter, this site, etc. are all extremely American-centric. I think if you asked an average European to give their opinion on American healthcare companies it would be a negative one.

What makes you think it was an assassination? He was obviously the intended target, but why couldn't he have been killed for typical murder reasons, jealous lover, financial gain etc? I mean we will surely find out in time.

Because it was in the morning before most criminals would be awake, because the suspect laid in wait for him, because he shot and fled without looting the body, and because the victim was a CEO of a healthcare company. It's quite unlikely it wasn't an assassination. Jealous lover is a possibility, I guess, stranger things have happened.

As I said, I agree that it was obviously targeted and not a random mugging-gone-wrong or random psychopath. But that just suggests that killing him was the specific intent. How often are CEOs assassinated by aggrieved customers or for political reasons? It surely happens, Red Army Faction stuff in Germany in the 70s comes to mind, but I would venture a guess that Bayes' should still favor personal reasons as being overwhelmingly more likely.

I also wouldn’t rule out Cyberpunk style inter-corporate glowie warfare.

I mean, IME oil company executives travel with tight security, and that’s surely for a reason. You don’t become a CEO by being too stupid to understand risk.

You don’t become a CEO by being too stupid to understand risk.

Well, you don’t become a successful CEO without doing that.

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