site banner

Small-Scale Question Sunday for December 8, 2024

Do you have a dumb question that you're kind of embarrassed to ask in the main thread? Is there something you're just not sure about?

This is your opportunity to ask questions. No question too simple or too silly.

Culture war topics are accepted, and proposals for a better intro post are appreciated.

1
Jump in the discussion.

No email address required.

The assassination isn’t celebrated online because he worked in insurance, or because he worked in health insurance specifically, but because the company is accused of violating a life-or-death contractual commitment by “delaying” and “denying” the promised coverage, in order to extract money from people who are sick and dying. This was literally written on the bullets (now stained with the CEO’s blood), based on a title of a book about these practices. The salary, industry, etc are all side points. United was apparently the worst offender in the industry. Read the exchanges between Vinay Prasad and the numerous doctors who disagree with him and single out United as the worst offender.

A thought experiment is helpful here. Let’s say you and I become stranded on an island. I promise to hold the heavy medical supplies in case one of us is injured, and in turn you provide me with more of your rations. You gash your leg, and I renege on my commitment to provide you the promised medical supplies. If you have a weapon, what would you do? The ethical intuition of normal people is that certain things become permissible.

Now, the greatness of civilization is that you don’t need to resort to weapons because you can take a large company to court. But that’s not a silver bullet! Because our third bullet reads defend: healthcare companies can hire the best lawyers and lobby better then you. So it’s an open question whether today’s civilization provides a remedy that is sufficient to stop someone from taking the less civilized remedy. It seems most people have no problem with the less civilized remedy in this particular, very unusual instance.

Yes I understand why the general public is mad, and bloodthirsty, and titillated.

I am in the minority because I also have the curse of basic education in economics and also have worked in a different financial services industry that was widely hated, but from the inside it was clear that most of the hatred was based on magical thinking and ignorance.

They might actually be evil! But my default is to not trust these narratives.

In The Rainmaker, the villain is a CEO of a health insurance company who sells door-to-door and then denies delays defends. It culminates in a court scene where they read from the real secret manual that states their policy to initially deny every claim. What I got from it is that the incentives of the insurance business, and health insurance in particular, are horrendous. Nowhere else do we give ruthless people a nice, clear, legal chance to fuck us over for hundreds of thousands of dollars. Of course it’s immoral, but I would argue it’s also immoral to tempt your fellow man like that. And stupid.

It’s like feeding a wild beast scraps of meat for years, and then, when he’s grown to terrifying proportions, you walk into his cage and announce that not only won’t he be getting any meat going forward, but you expect him to give you most of his food now. The real question is why anyone is naive enough to expect anything but immediate disembowelment and consumption.

It culminates in a court scene where they read from the real secret manual that states their policy to initially deny every claim.

That's a movie though. No real world insurance company has such policy. Or any "secret manual" at all - how would they even keep it secret? Would they murder their ex-employees? Wipe their memories? Relocate them to the remote uninhabited islands? US Government can't keep secrets. US Army can't keep secrets. How can you expect that a "secret" policy which literally every adjuster should be familiar with - otherwise how could they deny every claim? - would be kept? Movies are fun, but they are also fiction.

Of course it’s fiction. But unlike countless other movies where the CEO sends an assassin after the hero, I find this one’s motive, means and opportunities frighteningly realistic.

As to the detail of the secret manual, I don’t find it that far-fetched. In my experience of the professional world, a lot of shit of questionable legality and morality goes on, but people have mouths to feed and everyone’s doing it, so they just get on with it. I’ve observed that most people, if their boss tells them to lie or to ignore a tax the company should pay, they do it without fuss. I'm not sure they'd put it in a manual though.

if their boss tells them to lie or to ignore a tax the company should pay, they do it without fuss.

Sure, that can happen. However, if the boss had a manual, given to every single employee that joins the company, that instructs, black on white, to not pay taxes and lie to the IRS - wouldn't you expect at least one disgruntled employee over the years to send it to the IRS (or, alternatively, the local anti-corporate crusader) and the boss get in trouble? Unethical orders are often given verbally exactly because it leaves no proof and provides plausible deniability - "I didn't mean that, he just misunderstood me!".

Government can't keep secrets. US Army can't keep secrets.

Not that I disagree with your main point, but this is only true for a given value of "can't". We didn't find out about Rachel Levine putting pressure on the WPATH to remove minimum ages for gender affirming treatments, in violation of their own procedures, because some good soul either in WPATH or in the Public Health Service decided to squeal, we found out about it through a set of improbable events that culminated in the Attorney General of Alabama getting access to internal WPATH emails.

This is without going in to more obvious things like: you can't know about secrets that stayed secret.

Sure, I don't claim every secret will be promptly revealed. I claim a secret of this magnitude - existence of a secret manual which is given to every claim adjuster in the insurance company, and plainly states every claim must be denied - is very unlikely to survive for long. I'm sure there are secrets - probably very dirty secrets - that do survive, but they are probably not as widely known and as easy to reveal.