As a child in the 60s I was diagnosed with osteomyelitis and spent an entire month in a hospital ward. My mother was a very unpleasant person and very materialistic. And yet I never heard a single word from my parents about how much my hospital stay cost them. If it had been punitive (or even an inconvenience), I would have been told about it endlessly as a reminder of how much I owed my parents. So fifty years ago (edit-it was really 60 years ago) a family of seven could afford to have a child in hospital for a month at Christmas time and have it not destroy the finances of the family for a decade.
As we were sorting through my parents estate, I found a hospital bill for a short stay for my grandmother. It was basically small change.
We have moneycare not healthcare. Our high cost, financialized economy and for-profit healthcare model relentlessly raises costs. Hospitals are full of administrators instead of more doctors. Just like our educational institutions are chocked full of administrators and coordinators and few actual professors.
Also, doctors from other countries cannot become doctors here very easily. US doctors have formed a cartel essentially. And now PE firms buying up practices and clinics to wring every penny out of them which always results in poorer care.
Some people focus on the high tech healthcare stuff like really high priced drugs and fancy procedures but those are like our military tech: mostly high priced garbage. Essential healthcare is not flashy - good nurses, caring healers.
Well, Peebo, I have a very close friend who is a doctor. He deals with foreign doctors ALL THE EFFING TIME (and this is in an area that is not a large metropolis) and they are not competent, generally speaking. He's constantly having to undo their work, or redo their work, or actually DO their work because they are basically nothing but technicians, do not understand medicine, and they rely on the specialists to do most of the work they ought to be doing themselves.
He also told me that the hospital have some remote company in ANOTHER F-ING COUNTRY reading the scans and X-rays and then reporting back to the hospital with the diagnosis. This should be illegal. Who knows what perverse incentives are involved in such an idiot scheme?
As for your first paragraph, definitely. It's akin to having an atelier and the paper-pushers and cleaning staff telling the artists what colors they can use and whether or not they can mix those colors to make other colors that they are denied the use of.
But it is also a problem that so many doctors were willing to sell themselves for a mess of potage. They were happy to be bought out by the big healthcare systems.
Too many doctors, foreign or otherwise, do not have a calling. They are nothing but technicians.
Health insurance companies should not be allowed to be for-profit. They should be treated like co-ops or credit unions. Same for all of the healthcare “systems” out there. Government isn’t the answer, but profit motivations are too perverse for any kind of pure market to work in cases like insurance and healthcare. Thick with bureaucracy and thin on actual services, just like the education system.
This seems like a topic that should be taken up by serious economic scholars other than those on the left. Completely inelastic demand, regardless of price, inevitably breaks a profit-motivated marketplace.
Spending huge swaths of money on the managerial class and relatively little on delivering services (e.g. insurance, healthcare, education, software industry) isn’t good either.
More seriously, we are still in recovery from the collapse of Marxism. The fact that the commies were wrong doesn't make us right. You might look at my book Out of Crisis: Rethinking Our Financial Markets. There are also a few pieces on what I've been calling "social capitalism."
You miss the point. The point is that the pricing and markets for these services are not massive unreasonable abominations. Ergo, merely being an emergency service doesn't magically make free markets unworkable.
Well said. The moral and spiritual purpose of institutions that nurture the young and care for the sick is utterly corrupted by the profit motive. Such a change requires an explicit rejection of greed and embrace of human kindness, generosity and goodwill.
If you make any organization bloated, bureaucratic, and packed full of non-value-added administration, you can reduce the profit margin to nearly zero for any value of revenue. I’m not sure profit margins tell us anything here. Truth in pricing on behalf of the healthcare industry would go a long way in addressing some of these ills too. Why can one customer walk in the door and pay $10 for a shot while another pays $200 for the same shot? That’s beyond ridiculous.
The mlr requirement in insurance is 15%. Many operate below that ratio. Companies running at 10% mlr are usually recording huge losses, Humana’s stock halved in the last year because its mlr is getting close to 90%.
Wired pricing is usually due to incentive structures. For instance, Medicare and Medicaid reward certain pricing structures and any company that doesn’t respond to those incentives loses share.
The for profit system only becomes a problem when it colludes with government to buy votes. Otherwise, the consumer will naturally tend toward efficient service providers and providers will begin to compete in a free market.
“Efficient service providers” with ranks full of administrative overhead and not a price sheet to be found. Tell me how price discovery works when the hospital can’t even tell you what you’ll be charged.
Ah, the classic backhanded socialist screed. "I believe free markets are better than socialism, but we should use socialism for all the really important stuff!"
And you're getting your way, which is why the important stuff is going so badly.
Socialism at the federal level is compulsory, so you’re setting up an uninteresting straw man. You aren’t being intellectually honest if you’re pretending the abomination of healthcare and insurance markets are anywhere near capitalistic or free.
Here in Japan, my family of seven spends more each year on dairy products from the supermarket than we do for the national health care system.
Our son’s ambulance ride + appendectomy: $0 for the under-18’s in our municipality.
My own ambulance ride + appendectomy (lightning struck twice in 2023😂): ~$300 at today’s exchange rate, roughly two months’s dairy products (because we make a lot of yogurt & kefir at home 😂).
I do have a point to make, which is about our USAian mindset (culture) toward healthcare. Simply, we betray our self-defeating mindset when we begin the discussion of healthcare **simply** in terms of price (dollars paid, services received).
Let me illustrate again, briefly with this anecdote from 1995 France, which happened to be my personal political awakening by the way:
After midnight, girlfriend’s apartment, Nowhere Special, mid-size French urban center, distraught, suffering her first (& only!) urinary tract infection, my now-Japanese wife calls 911, and a young MD arrives faster than pizza delivery (he in his turn paying his debt back to the French State for his free-of-charge medical schooling). The MD administers a shot & writes a prescription. $10. The prescription was filled the next day at walking distance from the apartment; $6(?) I believe.
*no personal automobile required (that’s also a perpetual healthcare cost, by the way). *no fear of walking to an urban pharmacy (again, the US’s necrotic urban cores are a perpetual healthcare cost, again defrayed among the suburban automobile-centric “middle class” population). *no litigious culture of malpractice (ditto, again). *no indenturing our med students to personal debt (ditto, again). *no artificial limiting of the supply of MD’s & pharmacies & etc. (ditto).
Anyway, you get the picture.
In conclusion, healthcare insanity was a major reason I decided to move the family back to my wife’s native Tokyo-metro ten years ago, after ten years in the USA, where we had started our family.
Thanks to Japanese “socialism” (as Americans would call it) (I’d call it Christian socioeconomics) (ironically, here in this atheistic nation 😂), my wife & I are are now successful small business owners (Mom ‘n’ Pop scale, no employees) - precisely thanks to “socialized medicine,” which freed us from US health insurance premiums + undefined/ infinite future potential healthcare costs liability.
Again, healthcare costs in the US are built into our psyche (mentality, cultural fear of “socialism”), and they’re built into the physical municipal infrastructure (i.e. suburbia, wealth disparities, caste distinctions).
Anyway, as our business is finally making some real money, next year we anticipate having to pay twice as much annually for the national (sliding scale) healthcare system, perhaps the price of dairy + eggs …??? 😂
We do so many things wrong in the United States. I'm 72, so I remember the exhilaration in the atmosphere the day Reagan was elected in November, 1980. Had we but known 'twas the beginning of sorrows!
I have no idea whether you're an architecture maven. I am. It's probably unrelated to our infuriating wealth inequality, but twentieth century architecture and its continuation in the twenty - first have been suspiciously in sync with the desire of The Blob to reduce all but a few of us to general racine status. I'm cheered by the existence of organizations such as The National Civic Art Society, traditionalist architects and their well wishers who are massing and evangelizing to take on the architecture Establishment.
President Trump is an ally. I urge you and all others who read this to go to the website of TNCAS.
Have you ever seen images of The Lou Ruvo Center for Brain Health, in Las Vegas? I guess the public is supposed to believe that its design is an expression of the architects' horror about traumatic brain injury, but I wonder how many people don't see it as an evil joke instead?
I ignored this topic of architecture until these past couple years, when religious-conservative commentators brought it to my attention.
Indeed, Reagan. In retrospect, the engineered undoing & reversal of the Great post-WW2 Middle Class Expansion had already been decided upon (by the supranational powers-that-be, and by our own national sociopathic Ruling Class) before my Older Boomer parents were even born 😡
I’m GenX, 51. I turned the TV off in 1990 (because it was dull), and then promptly dropped out of pop culture, spending many years overseas. I discovered podcasting in 2021. I discovered the new religious-conservative political culture. They brought me up to speed with pop cultural changes in my own USA (& the West generally) since the time I tuned out.
I was oblivious to the maoist-style transsexual cultural revolution, for example, until i discovered podcasting in 2021.
In 2021, i had the Michael Moore “Dude, where’s my country?!” 😂😡 experience, thanks to podcasters.
I was a first time Trump voter in 2024 after 20 years of 3rd party voting. I throw my political chips in with the religious-conservatives nowadays because (ironically) they’re the only ones who still believe in the miracle of Western socioeconomic liberalism in the tradition of Renaissance & Enlightenment, of the US Bill of Rights & French Revolution concepts of human rights, & of the 19th century egalitarian vision of mechanized labor + mechanized transportation + instantaneous mass communications rendering kings & servants equals in the Here ‘n’ Now, not just in the eyes of God. Again, ironically.
I recommend Matt Stoller's Friday Substack. He writes about the Founders’ awareness that they had to keep to at least try to prevent great concentrations of wealth from occurring, lest there be a bloody revolution, and that this common sense was revived by Grover Cleveland, especially, and others who might not have been populists, per se, but understood that the Populists had reality in view.
I’ve lived in a place with not-for-profit universal healthcare (the Netherlands, on the Dutch island of Saba) for the past 11 years now. I have gripes about the system, and it is certainly the case that there are accusations that people don’t always get appropriate care, and even that someone has died because of having not received appropriate care. That having been said, it’s tremendously freeing to not have to pony up about $1000/month (what it was for me, a single person with no dependents in my previous professional job with “good” health insurance in the USA when I left in 2013) and not having to fear what would happen with my healthcare if I were to lose my job, and thus my health insurance.
I think something that Americans don’t appreciate about universal health care is how it can allow entrepreneurship. There are tons of small businesses in our tiny community, and frequently you’ll hear someone say something like, “welp, quit my job; finally saved up enough money to start my garage—let me know if you want those tires replaced!” I can’t imagine so many people being willing to go into business for themselves with the sword of losing their healthcare hanging over their heads.
Requiem for Brian Thompson, CEO of United Healthcare
Brian Thompson was a good man. Good for profits, good for business, good for America. He was the best of us. Let us not fall victim to cutting the tallest poppy. He ran a tight ship sure but efficient and laden with premiums too. If you can’t handle the reams of repetitive paperwork or court costs as your child lays dying are you really a good provider? Capitalism seems cruel sometimes but it provides a good return on investment.
If the Librarian’s choice of charity seems too socialist may I suggest The Bill and Malinda Gates Foundation, The Clinton Foundation or the Pierre Elliot Trudeau Foundation. They offer a great $10,000 dinners as well as some influence in future legislation.
God speed Brian and may your destination be both warm and full of old friends
As a young, healthy, single man, I bitched under my breath every paycheck when I looked at the stub that showed the medical insurance premium I could barely afford for healthcare I never needed.
Then I got married, had seven kids, and the family plan for my company caps the premium after the fourth child. (Whew!) In the past two years, we’ve suffered one life threatening health issue and three not-so-life threatening health issues. The bills are close to $2 million, including a life flight for $50,000, and I didn’t pay a penny out of pocket after I reached the $5,000 family deductible each year. The $45,000 in premiums and deductibles was the best money I ever spent, but it’s still outrageous.
With Obamacare, what we have is a nationalized health care system. Costs have skyrocketed and the quality of care is an embarrassment for a developed country. This was all by design. If you can’t afford a Cadillac insurance policy, and fortunately I can, you’re fucked. That’s outrageous in a free country. My twins just dropped off my coverage. My hope is that Trump & Co. drastically reforms this system before my young adult children have a catastrophic accident or illness.
Kindly recall that Michelle O was paid a multiple six-figure salary for a no-show job at a Chicago medical complex and that Rahm Emmanuel earned seven figures as a board member with a private equity firm between his stints in the Clinton and Obama administrations. They think this is how capitalism works, and they just turbo-charged it for themselves and their benefactors when the woke American voters put that empty suit usurper in the White House. Twice.
I nominate Karl Denninger to work with RFK, Jr. to reform this beast. Denninger wrote the book, literally, on how to do it, starting with enforcing the laws on the books that are being ignored.
Librarian, double thumbs up on Denninger and seven kids!
The cold-blooded murder of Brian Thompson was horrific. The online cheering and hoping for more bloodshed is pathological.
Hang in there with some of the ill-founded critiques to the article. I’m a slow reader, but sometimes even that isn’t enough for me to avoid mischaracterizing an author’s perspective.
Who could guess after the 2008 debacle that the wage gaps between CEOs and employees would grow relentlessly and people would grow tired of being playthings of a few at the top. Who on Earth could predict the instability that would arise as greed grows and accountability declines?
Librarian, very nicely done hot take. Bravo. A quibble: "tragedy," like "hero," is a word that has acquired a very loose, broad meaning. I don't think the CEOs death is a tragedy in any serious sense. Tragedies require a conflict of virtues and a sense of inevitability, neither of which is present here. Tragic heroes (even putting aside the rather overdone notion of the "flaw") almost always exhibit great agency, and before their deaths, awareness. Etc. But again, a quibble on a hot take.
Librarian, elegant but I'm not buying. USA is far from out -- it's doing a lot very well, and still sports people like you. So, uhhh, no. We're not a traged,y not by a long shot and not yet. Cowboy up and don't indulge in cheap cynicism, I'd say. And if you would really believe in what you're saying, not so many daughters. So my vote on the kids and your writing, and don't think the American republic is tragic. in haste, and kudos, again.
I'll consider it a tragedy if it emerges that he'd been pushing for significant changes in the way his now former industry, or maybe only his company, did business, changes which would have benefited customers at the expense of profits.
[ This is too good not to mention: as I was typing out the previous sentence on my phone, and not paying a great deal of attention to what my right thumb was doing as it moved, somehow I hit enough wrong letters in a row that what I had intended to be the word, "business," instead registered as "nudiness." ]
As you know, some people have suggested that this was a professional hit. I must believe that the only people who take this possibility seriously are those who have always had plenty of money.
Lack of skin in the game - people offloading the consequences while reaping rewards - is a recipe for tyranny.
The elites should consider the wrath of the people they serve. They may wrap things up in legal bows that cow the decent and law abiding, until pushed too far. And at that point the pendulum swing will crash back with a vengeance like a wrecking ball.
Aside - even in feudal systems the Nobility had obligations down. As in all institutions it was imperfect, and some people are assholes, and power exacerbates these tendencies. Nevertheless, a king who wishes for a kingdom has to be a steward of it and of the people who enforce his will. Noblesse Oblige and all that.
Our "elites" who worship money and power feel no obligation to the people around them - at least those who cannot help or destroy them. And they obviously don't consider those without the "right" peerage or education to be worthy of consideration. "What's the matter with Kansas".
Excellent perspective, LoC. My first thought after watching this was someone has him "whacked." For me the insider trading charge was what caught my eye. I'd be interested to see who else dumped stock around when the 4 executives in question dumped over 100 million in stock.
I am bothered by the shell casing story, which I have also seen elsewhere. This assassin was not using a semiauto handgun. He captures each shell casing as he manually ejects the bullet after each discharge. Perhaps there's video evidence of him dropping the collected shells, but I cannot see it. Something seems suspicious about this story. With the rank corruption in the law enforcement agencies, I remain suspicious; the release of this "information", parroted by every news source, smacks of covid 19 propaganda and deliberate planting of storylines by what is still an Operation Mockingbird. There is so much psy-op/propaganda now, that one has to be reluctant to accept even the essentials. Eugyppius, a German substack contributor, just a couple days ago provided a well documented article about the "Organized Crime and Corruption Reporting Project ", a well financed US Govt cutout for CIA and intelligence interference in worldwide journalism. ..Read it and weep.
I agree. That's why I only consider the "claims revenge" theory as only one of many possibilities, and advance it only in a theoretical sense to make a broader argument.
There are lots of things about this that should cause a raised eyebrow. One is the possibility the shooter has intentionally left false evidence....ie, red herrings.
I’m similarly suspicious. This looks like the work of a professional. The fact that they’re releasing pictures of his face means it’s possible the trail has gone cold and they’re hoping the public can help ID him. That was what they did after the Boston Marathon bombing when the investigation ran into a dead end.
Given the financial shenanigans, DOJ investigation, and other details coming to light, I expect the real story is much more complicated than the media is presenting. If we don’t learn more in the next few days, we’ll probably never know what it is.
It also may mean law enforcement are setting up a fall guy for a more nefarious plot. In Nashville on christmas day 2020, there was a bomb blast downtown at an ATT building. Everything about that event is BIZARRE. The FBI had virtually every detail of the bombers identity out to multiple press outlets internationally within 24 hrs- the person allegedly blew himself up with the bomb, and there was literally almost nothing left of him. The ATT building that was obliterated allegedly had records or actual voting machines that had been possibly involved with the great election steal by the administrative state and Democrat Party operatives the month before. The whole thing was totally weird, and I bring it up because it has similarities to the United executive in its apparent randomness, 'one-off' like appearance, and the way the law enforcement and intelligence agencies selectively leak and control the media. Everything begins to look like a psy-op, so called fifth generation warfare element, once you start considering all these things.The term 'conspiracy theorist' was coined by a CIA /media agent in the Miami Herald back in the 60s, referring to the "outrageous "stretch of some of our imaginations in considering the Arlen Specter lone gunman Oswald explanation of JFKs assassination to be bullshit. And we still know nothing about the person cremated , or the event he participated in, shortly after he tried to kill Donald Trump in Butler PA. Meanwhile, its amazing: no internet trail, no motives, the family obviously cloaked in silence , no media investigation, a disinterested FBI and media.
First, I wonder about the very existence of the professional killer. It's a great idea for thousands of novels and movies, and it's true that there once was Murder, Inc, as the press called it. That was Albert Anastasia's little gang of professional Mob assassins, something which ended when the entrepreneurial Mr Anastasia was hit while being shaved by his barber in New York City, in 1957, but do freelance professional killers actually exist? We hear about murder - for - hire schemes because they're obvious and they fall apart quickly.
Second, if the killer had been that mythical professional, wouldn't he have been better disguised? Really now, a hoodie? I don't know when the CCTV photos were made, but wouldn't our pro have had at least a full beard and mustache, and glasses, and would he have been flirting on the job, as it's being reported the killer was doing when those videos were made?
I suspect this may have an Antifa or Antifa - like genesis.
Matt Stoller writes a Substack about monopolies. Friday's is unlocked. It's about the murder, and I recommend it to all.
FWIW, we belong to a religious healthshare, in lieu of traditional insurance.
That means we are out of pocket for routine things like doctor visits, medication, new glasses, and dental checkups. The healtshare kicks in if somebody gets appendicitis, gets run over by a car, needs major surgery, that sort of thing. Anything over a certain $$ amount. It costs us a little over $400/mo for the whole family. Not for everyone-- you basically have to have the financial discipline to maintain a medical emergency fund, like funding your own HSA, and it doesn't cover expenses that practicing Christians should not be incurring, such as abortions, contraception, STD treatment, maternity expenses for unmarried ladies, drug rehab, plastic surgery, sex changes, etc. Also doesn't cover chronic conditions, so obviously read the fine print and stuff. There are several such nonprofit organizations, they are completely legal, and they all have slightly different rules, requirements, and pricing... and very very little overhead.
Unfortunately, that only helps on one end of the massive medical-cost problem we have here in the US. We are still subject to the opaque and often fraudulent pricing, the predatory billing practices, the administrative bloat, the anti-competition agreements, the medical licensing rackets (they limit the number of graduating doctors, in order to keep salaries high), and the obscene cost of a medical bureaucracy that exists solely to *deal with insurance companies*, but which I still have to pay for, even if I'm not using an insurance company.
Today, let's start a new political party: the Doctors Cost Way Too Much party.
Going by the universally unsympathetic responses to the death of just one of these evil wizards... I think it'd be a smash hit. The one issue we can all agree on: Insurance companies and medical bureaucracy is an evil, obese, bloodsucking parasite on the American corpus, and it needs to die.
If you think Donald Trump is going to do anything about Healthcare, I've got a bridge to sell you in Brooklyn. The issue hasn't been on his radar at all, and the first time around he famously couldn't even repeal obamacare.
Obviously I agree with any and all calls for Christians to take care of their own, but that's only an answer that works for devout Christians, which most people aren't even on the right. The secular, individualistic majority will continue to be upset about this issue, whether justly or not. I'm not sure what to tell them, except perhaps that they're simply reaping what they've sown.
Great insights, thank you for the clarity. I always appreciate your work.
Also, you’re paying too much for insurance. Ditch what you have and join Crowd Health. They aren’t specifically Christian but share the values you wrote about here. No networks, no arbitrary claim denials, $500 deductible. It’s been great for my family.
There are many Christian-based medical sharing plans also. We still have to deal with the horrid price-gouging of medicine, but paying out of pocket gives a lot of leverage, as doctors hate Health Insurance bureaucracy also.
A couple people I know swear by Samaritan Ministries. They aren't legally obligated to pay for anything, but the people I know(one with chronic issues) have never been denied.
Not as legally binding as standard health insurance, but far cheaper and less pasasitic. For people where catastrophic illness would bankrupt them anyways, it's really a no-brainer.
I’ve used Christian based sharing plans as well and they are ok too. We left ours because the network constraints were a big problem for us. That was my only complaint.
The “legally binding” part of health insurance is a complete scam though. They don’t have to pay your bills and they know it. It’s better to compare actual claim denial rates. In this arena, health sharing companies do WAY better than health insurance.
You're probably right. I'm having trouble taking the plunge because my risk tolerance is so low given the health catastrophies that have happened in my extended family.
I currently pay $1100/month but have sky high deductibles for each member of my family. If I paid this much a month and never one bill after, that would at least be fair game but it’s only the beginning. This month my son was recommended to physical therapy for a sports injury. The PT was through a local hospital. They told me that if they put the claim through insurance it would cost $300/session. If I pay out of pocket, $181. Since it’s December and I will never come close to hitting the $3k deductible by EOY, it was better to just pay. Why are there two prices? Every aspect of this system is horrendous. Im sure all of us here can compare our insurance from fifteen years ago and see how much prices have gone up and how much less is covered.
Private equity destroyed one of the doctors I used to see and she opened her own practice because of it and now does not take insurance. This is getting commonplace. Especially with mental health care. Therapists in my area charge up to $200/45-mins and you have to submit the out of network claim and just keep racking it up.
For families who have one or more members with long term health problems, the financial hits never stop. I don’t know what the answer is. A friend works in HR for a Canadien company and she said they offer a healthcare package on top of the state run insurance. One of the employees had stage one breast cancer and was told she had to wait a year to get it operated on, so she used her own money and came to the States for the operation.
Thank you Librarian. Your writing has reminded me that I need to look away from the vicious back and forth online that this murder has aroused, and look instead to what I can do, within my control, to perhaps make care a little bit better for others. I already give to St. Jude each year and another organization here that provides low cost health care to those in between government assistance and private insurance (typically the self employed laborers). But, I can do more, and I will.
As a child in the 60s I was diagnosed with osteomyelitis and spent an entire month in a hospital ward. My mother was a very unpleasant person and very materialistic. And yet I never heard a single word from my parents about how much my hospital stay cost them. If it had been punitive (or even an inconvenience), I would have been told about it endlessly as a reminder of how much I owed my parents. So fifty years ago (edit-it was really 60 years ago) a family of seven could afford to have a child in hospital for a month at Christmas time and have it not destroy the finances of the family for a decade.
As we were sorting through my parents estate, I found a hospital bill for a short stay for my grandmother. It was basically small change.
Something has gone terrible wrong.
We have moneycare not healthcare. Our high cost, financialized economy and for-profit healthcare model relentlessly raises costs. Hospitals are full of administrators instead of more doctors. Just like our educational institutions are chocked full of administrators and coordinators and few actual professors.
Also, doctors from other countries cannot become doctors here very easily. US doctors have formed a cartel essentially. And now PE firms buying up practices and clinics to wring every penny out of them which always results in poorer care.
Some people focus on the high tech healthcare stuff like really high priced drugs and fancy procedures but those are like our military tech: mostly high priced garbage. Essential healthcare is not flashy - good nurses, caring healers.
Well, Peebo, I have a very close friend who is a doctor. He deals with foreign doctors ALL THE EFFING TIME (and this is in an area that is not a large metropolis) and they are not competent, generally speaking. He's constantly having to undo their work, or redo their work, or actually DO their work because they are basically nothing but technicians, do not understand medicine, and they rely on the specialists to do most of the work they ought to be doing themselves.
He also told me that the hospital have some remote company in ANOTHER F-ING COUNTRY reading the scans and X-rays and then reporting back to the hospital with the diagnosis. This should be illegal. Who knows what perverse incentives are involved in such an idiot scheme?
As for your first paragraph, definitely. It's akin to having an atelier and the paper-pushers and cleaning staff telling the artists what colors they can use and whether or not they can mix those colors to make other colors that they are denied the use of.
But it is also a problem that so many doctors were willing to sell themselves for a mess of potage. They were happy to be bought out by the big healthcare systems.
Too many doctors, foreign or otherwise, do not have a calling. They are nothing but technicians.
Health insurance companies should not be allowed to be for-profit. They should be treated like co-ops or credit unions. Same for all of the healthcare “systems” out there. Government isn’t the answer, but profit motivations are too perverse for any kind of pure market to work in cases like insurance and healthcare. Thick with bureaucracy and thin on actual services, just like the education system.
I teach business associations, and have been thinking a lot about this . . . will try to work out some of the technical details, maybe.
This seems like a topic that should be taken up by serious economic scholars other than those on the left. Completely inelastic demand, regardless of price, inevitably breaks a profit-motivated marketplace.
Yeah, I know, but I'm busy! :)
Spending huge swaths of money on the managerial class and relatively little on delivering services (e.g. insurance, healthcare, education, software industry) isn’t good either.
More seriously, we are still in recovery from the collapse of Marxism. The fact that the commies were wrong doesn't make us right. You might look at my book Out of Crisis: Rethinking Our Financial Markets. There are also a few pieces on what I've been calling "social capitalism."
Yeah, that's why there's no reasonable free market for plumbers, tow trucks and other... oh, wait.
Your price elasticity for a plumber is much higher than keeping your wife or child alive, I promise.
You miss the point. The point is that the pricing and markets for these services are not massive unreasonable abominations. Ergo, merely being an emergency service doesn't magically make free markets unworkable.
Well said. The moral and spiritual purpose of institutions that nurture the young and care for the sick is utterly corrupted by the profit motive. Such a change requires an explicit rejection of greed and embrace of human kindness, generosity and goodwill.
The profit margin for health insurance companies is low single digits. Eliminating it would have no effect on the healthcare system.
Large swaths of the healthcare industry operate on a non-profit basis and there seems little difference in how they operate.
Attempts to restrict admin and profit ratios have accelerated rather the slowed medical cost trend.
Health insurance is expensive because providers want more compensation and members want more coverage paid for by “somebody else”.
If you make any organization bloated, bureaucratic, and packed full of non-value-added administration, you can reduce the profit margin to nearly zero for any value of revenue. I’m not sure profit margins tell us anything here. Truth in pricing on behalf of the healthcare industry would go a long way in addressing some of these ills too. Why can one customer walk in the door and pay $10 for a shot while another pays $200 for the same shot? That’s beyond ridiculous.
There's a big game going on between insurance and health service providers, with everyone trying to optimize margins.
The mlr requirement in insurance is 15%. Many operate below that ratio. Companies running at 10% mlr are usually recording huge losses, Humana’s stock halved in the last year because its mlr is getting close to 90%.
Wired pricing is usually due to incentive structures. For instance, Medicare and Medicaid reward certain pricing structures and any company that doesn’t respond to those incentives loses share.
Yep. Pretty Much.
The for profit system only becomes a problem when it colludes with government to buy votes. Otherwise, the consumer will naturally tend toward efficient service providers and providers will begin to compete in a free market.
“Efficient service providers” with ranks full of administrative overhead and not a price sheet to be found. Tell me how price discovery works when the hospital can’t even tell you what you’ll be charged.
"Efficient service providers" assumes a free market; which we don't currently have.
Ah, the classic backhanded socialist screed. "I believe free markets are better than socialism, but we should use socialism for all the really important stuff!"
And you're getting your way, which is why the important stuff is going so badly.
Socialism at the federal level is compulsory, so you’re setting up an uninteresting straw man. You aren’t being intellectually honest if you’re pretending the abomination of healthcare and insurance markets are anywhere near capitalistic or free.
My last sentence belies your allegation.
Here in Japan, my family of seven spends more each year on dairy products from the supermarket than we do for the national health care system.
Our son’s ambulance ride + appendectomy: $0 for the under-18’s in our municipality.
My own ambulance ride + appendectomy (lightning struck twice in 2023😂): ~$300 at today’s exchange rate, roughly two months’s dairy products (because we make a lot of yogurt & kefir at home 😂).
I do have a point to make, which is about our USAian mindset (culture) toward healthcare. Simply, we betray our self-defeating mindset when we begin the discussion of healthcare **simply** in terms of price (dollars paid, services received).
Let me illustrate again, briefly with this anecdote from 1995 France, which happened to be my personal political awakening by the way:
After midnight, girlfriend’s apartment, Nowhere Special, mid-size French urban center, distraught, suffering her first (& only!) urinary tract infection, my now-Japanese wife calls 911, and a young MD arrives faster than pizza delivery (he in his turn paying his debt back to the French State for his free-of-charge medical schooling). The MD administers a shot & writes a prescription. $10. The prescription was filled the next day at walking distance from the apartment; $6(?) I believe.
*no personal automobile required (that’s also a perpetual healthcare cost, by the way). *no fear of walking to an urban pharmacy (again, the US’s necrotic urban cores are a perpetual healthcare cost, again defrayed among the suburban automobile-centric “middle class” population). *no litigious culture of malpractice (ditto, again). *no indenturing our med students to personal debt (ditto, again). *no artificial limiting of the supply of MD’s & pharmacies & etc. (ditto).
Anyway, you get the picture.
In conclusion, healthcare insanity was a major reason I decided to move the family back to my wife’s native Tokyo-metro ten years ago, after ten years in the USA, where we had started our family.
Thanks to Japanese “socialism” (as Americans would call it) (I’d call it Christian socioeconomics) (ironically, here in this atheistic nation 😂), my wife & I are are now successful small business owners (Mom ‘n’ Pop scale, no employees) - precisely thanks to “socialized medicine,” which freed us from US health insurance premiums + undefined/ infinite future potential healthcare costs liability.
Again, healthcare costs in the US are built into our psyche (mentality, cultural fear of “socialism”), and they’re built into the physical municipal infrastructure (i.e. suburbia, wealth disparities, caste distinctions).
Anyway, as our business is finally making some real money, next year we anticipate having to pay twice as much annually for the national (sliding scale) healthcare system, perhaps the price of dairy + eggs …??? 😂
We do so many things wrong in the United States. I'm 72, so I remember the exhilaration in the atmosphere the day Reagan was elected in November, 1980. Had we but known 'twas the beginning of sorrows!
I have no idea whether you're an architecture maven. I am. It's probably unrelated to our infuriating wealth inequality, but twentieth century architecture and its continuation in the twenty - first have been suspiciously in sync with the desire of The Blob to reduce all but a few of us to general racine status. I'm cheered by the existence of organizations such as The National Civic Art Society, traditionalist architects and their well wishers who are massing and evangelizing to take on the architecture Establishment.
President Trump is an ally. I urge you and all others who read this to go to the website of TNCAS.
Have you ever seen images of The Lou Ruvo Center for Brain Health, in Las Vegas? I guess the public is supposed to believe that its design is an expression of the architects' horror about traumatic brain injury, but I wonder how many people don't see it as an evil joke instead?
Thanks for your reply.
I ignored this topic of architecture until these past couple years, when religious-conservative commentators brought it to my attention.
Indeed, Reagan. In retrospect, the engineered undoing & reversal of the Great post-WW2 Middle Class Expansion had already been decided upon (by the supranational powers-that-be, and by our own national sociopathic Ruling Class) before my Older Boomer parents were even born 😡
I’m GenX, 51. I turned the TV off in 1990 (because it was dull), and then promptly dropped out of pop culture, spending many years overseas. I discovered podcasting in 2021. I discovered the new religious-conservative political culture. They brought me up to speed with pop cultural changes in my own USA (& the West generally) since the time I tuned out.
I was oblivious to the maoist-style transsexual cultural revolution, for example, until i discovered podcasting in 2021.
In 2021, i had the Michael Moore “Dude, where’s my country?!” 😂😡 experience, thanks to podcasters.
I was a first time Trump voter in 2024 after 20 years of 3rd party voting. I throw my political chips in with the religious-conservatives nowadays because (ironically) they’re the only ones who still believe in the miracle of Western socioeconomic liberalism in the tradition of Renaissance & Enlightenment, of the US Bill of Rights & French Revolution concepts of human rights, & of the 19th century egalitarian vision of mechanized labor + mechanized transportation + instantaneous mass communications rendering kings & servants equals in the Here ‘n’ Now, not just in the eyes of God. Again, ironically.
I recommend Matt Stoller's Friday Substack. He writes about the Founders’ awareness that they had to keep to at least try to prevent great concentrations of wealth from occurring, lest there be a bloody revolution, and that this common sense was revived by Grover Cleveland, especially, and others who might not have been populists, per se, but understood that the Populists had reality in view.
Ok, I’ll check it out.
Phenomenal essay, Librarian.
I’ve lived in a place with not-for-profit universal healthcare (the Netherlands, on the Dutch island of Saba) for the past 11 years now. I have gripes about the system, and it is certainly the case that there are accusations that people don’t always get appropriate care, and even that someone has died because of having not received appropriate care. That having been said, it’s tremendously freeing to not have to pony up about $1000/month (what it was for me, a single person with no dependents in my previous professional job with “good” health insurance in the USA when I left in 2013) and not having to fear what would happen with my healthcare if I were to lose my job, and thus my health insurance.
I think something that Americans don’t appreciate about universal health care is how it can allow entrepreneurship. There are tons of small businesses in our tiny community, and frequently you’ll hear someone say something like, “welp, quit my job; finally saved up enough money to start my garage—let me know if you want those tires replaced!” I can’t imagine so many people being willing to go into business for themselves with the sword of losing their healthcare hanging over their heads.
Requiem for Brian Thompson, CEO of United Healthcare
Brian Thompson was a good man. Good for profits, good for business, good for America. He was the best of us. Let us not fall victim to cutting the tallest poppy. He ran a tight ship sure but efficient and laden with premiums too. If you can’t handle the reams of repetitive paperwork or court costs as your child lays dying are you really a good provider? Capitalism seems cruel sometimes but it provides a good return on investment.
If the Librarian’s choice of charity seems too socialist may I suggest The Bill and Malinda Gates Foundation, The Clinton Foundation or the Pierre Elliot Trudeau Foundation. They offer a great $10,000 dinners as well as some influence in future legislation.
God speed Brian and may your destination be both warm and full of old friends
I hate cliches, but savage.
Beautifully written and balanced.
As a young, healthy, single man, I bitched under my breath every paycheck when I looked at the stub that showed the medical insurance premium I could barely afford for healthcare I never needed.
Then I got married, had seven kids, and the family plan for my company caps the premium after the fourth child. (Whew!) In the past two years, we’ve suffered one life threatening health issue and three not-so-life threatening health issues. The bills are close to $2 million, including a life flight for $50,000, and I didn’t pay a penny out of pocket after I reached the $5,000 family deductible each year. The $45,000 in premiums and deductibles was the best money I ever spent, but it’s still outrageous.
With Obamacare, what we have is a nationalized health care system. Costs have skyrocketed and the quality of care is an embarrassment for a developed country. This was all by design. If you can’t afford a Cadillac insurance policy, and fortunately I can, you’re fucked. That’s outrageous in a free country. My twins just dropped off my coverage. My hope is that Trump & Co. drastically reforms this system before my young adult children have a catastrophic accident or illness.
Kindly recall that Michelle O was paid a multiple six-figure salary for a no-show job at a Chicago medical complex and that Rahm Emmanuel earned seven figures as a board member with a private equity firm between his stints in the Clinton and Obama administrations. They think this is how capitalism works, and they just turbo-charged it for themselves and their benefactors when the woke American voters put that empty suit usurper in the White House. Twice.
I nominate Karl Denninger to work with RFK, Jr. to reform this beast. Denninger wrote the book, literally, on how to do it, starting with enforcing the laws on the books that are being ignored.
The Karl Denniger idea is spot on. Seven children is quite a wonderful blessing.
Librarian, double thumbs up on Denninger and seven kids!
The cold-blooded murder of Brian Thompson was horrific. The online cheering and hoping for more bloodshed is pathological.
Hang in there with some of the ill-founded critiques to the article. I’m a slow reader, but sometimes even that isn’t enough for me to avoid mischaracterizing an author’s perspective.
Who could guess after the 2008 debacle that the wage gaps between CEOs and employees would grow relentlessly and people would grow tired of being playthings of a few at the top. Who on Earth could predict the instability that would arise as greed grows and accountability declines?
Librarian, very nicely done hot take. Bravo. A quibble: "tragedy," like "hero," is a word that has acquired a very loose, broad meaning. I don't think the CEOs death is a tragedy in any serious sense. Tragedies require a conflict of virtues and a sense of inevitability, neither of which is present here. Tragic heroes (even putting aside the rather overdone notion of the "flaw") almost always exhibit great agency, and before their deaths, awareness. Etc. But again, a quibble on a hot take.
The tragedy lies not in the details of the life or death of this person or that. The great soul brought to ruin by hubris is the system- is America.
Librarian, elegant but I'm not buying. USA is far from out -- it's doing a lot very well, and still sports people like you. So, uhhh, no. We're not a traged,y not by a long shot and not yet. Cowboy up and don't indulge in cheap cynicism, I'd say. And if you would really believe in what you're saying, not so many daughters. So my vote on the kids and your writing, and don't think the American republic is tragic. in haste, and kudos, again.
This is America. Our tragedies have happy endings.
I'll consider it a tragedy if it emerges that he'd been pushing for significant changes in the way his now former industry, or maybe only his company, did business, changes which would have benefited customers at the expense of profits.
[ This is too good not to mention: as I was typing out the previous sentence on my phone, and not paying a great deal of attention to what my right thumb was doing as it moved, somehow I hit enough wrong letters in a row that what I had intended to be the word, "business," instead registered as "nudiness." ]
As you know, some people have suggested that this was a professional hit. I must believe that the only people who take this possibility seriously are those who have always had plenty of money.
Lack of skin in the game - people offloading the consequences while reaping rewards - is a recipe for tyranny.
The elites should consider the wrath of the people they serve. They may wrap things up in legal bows that cow the decent and law abiding, until pushed too far. And at that point the pendulum swing will crash back with a vengeance like a wrecking ball.
Aside - even in feudal systems the Nobility had obligations down. As in all institutions it was imperfect, and some people are assholes, and power exacerbates these tendencies. Nevertheless, a king who wishes for a kingdom has to be a steward of it and of the people who enforce his will. Noblesse Oblige and all that.
Our "elites" who worship money and power feel no obligation to the people around them - at least those who cannot help or destroy them. And they obviously don't consider those without the "right" peerage or education to be worthy of consideration. "What's the matter with Kansas".
Excellent perspective, LoC. My first thought after watching this was someone has him "whacked." For me the insider trading charge was what caught my eye. I'd be interested to see who else dumped stock around when the 4 executives in question dumped over 100 million in stock.
I am bothered by the shell casing story, which I have also seen elsewhere. This assassin was not using a semiauto handgun. He captures each shell casing as he manually ejects the bullet after each discharge. Perhaps there's video evidence of him dropping the collected shells, but I cannot see it. Something seems suspicious about this story. With the rank corruption in the law enforcement agencies, I remain suspicious; the release of this "information", parroted by every news source, smacks of covid 19 propaganda and deliberate planting of storylines by what is still an Operation Mockingbird. There is so much psy-op/propaganda now, that one has to be reluctant to accept even the essentials. Eugyppius, a German substack contributor, just a couple days ago provided a well documented article about the "Organized Crime and Corruption Reporting Project ", a well financed US Govt cutout for CIA and intelligence interference in worldwide journalism. ..Read it and weep.
I agree. That's why I only consider the "claims revenge" theory as only one of many possibilities, and advance it only in a theoretical sense to make a broader argument.
There are lots of things about this that should cause a raised eyebrow. One is the possibility the shooter has intentionally left false evidence....ie, red herrings.
I’m similarly suspicious. This looks like the work of a professional. The fact that they’re releasing pictures of his face means it’s possible the trail has gone cold and they’re hoping the public can help ID him. That was what they did after the Boston Marathon bombing when the investigation ran into a dead end.
Given the financial shenanigans, DOJ investigation, and other details coming to light, I expect the real story is much more complicated than the media is presenting. If we don’t learn more in the next few days, we’ll probably never know what it is.
It also may mean law enforcement are setting up a fall guy for a more nefarious plot. In Nashville on christmas day 2020, there was a bomb blast downtown at an ATT building. Everything about that event is BIZARRE. The FBI had virtually every detail of the bombers identity out to multiple press outlets internationally within 24 hrs- the person allegedly blew himself up with the bomb, and there was literally almost nothing left of him. The ATT building that was obliterated allegedly had records or actual voting machines that had been possibly involved with the great election steal by the administrative state and Democrat Party operatives the month before. The whole thing was totally weird, and I bring it up because it has similarities to the United executive in its apparent randomness, 'one-off' like appearance, and the way the law enforcement and intelligence agencies selectively leak and control the media. Everything begins to look like a psy-op, so called fifth generation warfare element, once you start considering all these things.The term 'conspiracy theorist' was coined by a CIA /media agent in the Miami Herald back in the 60s, referring to the "outrageous "stretch of some of our imaginations in considering the Arlen Specter lone gunman Oswald explanation of JFKs assassination to be bullshit. And we still know nothing about the person cremated , or the event he participated in, shortly after he tried to kill Donald Trump in Butler PA. Meanwhile, its amazing: no internet trail, no motives, the family obviously cloaked in silence , no media investigation, a disinterested FBI and media.
It could be anything at this point.
First, I wonder about the very existence of the professional killer. It's a great idea for thousands of novels and movies, and it's true that there once was Murder, Inc, as the press called it. That was Albert Anastasia's little gang of professional Mob assassins, something which ended when the entrepreneurial Mr Anastasia was hit while being shaved by his barber in New York City, in 1957, but do freelance professional killers actually exist? We hear about murder - for - hire schemes because they're obvious and they fall apart quickly.
Second, if the killer had been that mythical professional, wouldn't he have been better disguised? Really now, a hoodie? I don't know when the CCTV photos were made, but wouldn't our pro have had at least a full beard and mustache, and glasses, and would he have been flirting on the job, as it's being reported the killer was doing when those videos were made?
I suspect this may have an Antifa or Antifa - like genesis.
Matt Stoller writes a Substack about monopolies. Friday's is unlocked. It's about the murder, and I recommend it to all.
FWIW, we belong to a religious healthshare, in lieu of traditional insurance.
That means we are out of pocket for routine things like doctor visits, medication, new glasses, and dental checkups. The healtshare kicks in if somebody gets appendicitis, gets run over by a car, needs major surgery, that sort of thing. Anything over a certain $$ amount. It costs us a little over $400/mo for the whole family. Not for everyone-- you basically have to have the financial discipline to maintain a medical emergency fund, like funding your own HSA, and it doesn't cover expenses that practicing Christians should not be incurring, such as abortions, contraception, STD treatment, maternity expenses for unmarried ladies, drug rehab, plastic surgery, sex changes, etc. Also doesn't cover chronic conditions, so obviously read the fine print and stuff. There are several such nonprofit organizations, they are completely legal, and they all have slightly different rules, requirements, and pricing... and very very little overhead.
Unfortunately, that only helps on one end of the massive medical-cost problem we have here in the US. We are still subject to the opaque and often fraudulent pricing, the predatory billing practices, the administrative bloat, the anti-competition agreements, the medical licensing rackets (they limit the number of graduating doctors, in order to keep salaries high), and the obscene cost of a medical bureaucracy that exists solely to *deal with insurance companies*, but which I still have to pay for, even if I'm not using an insurance company.
Today, let's start a new political party: the Doctors Cost Way Too Much party.
Going by the universally unsympathetic responses to the death of just one of these evil wizards... I think it'd be a smash hit. The one issue we can all agree on: Insurance companies and medical bureaucracy is an evil, obese, bloodsucking parasite on the American corpus, and it needs to die.
If you think Donald Trump is going to do anything about Healthcare, I've got a bridge to sell you in Brooklyn. The issue hasn't been on his radar at all, and the first time around he famously couldn't even repeal obamacare.
Obviously I agree with any and all calls for Christians to take care of their own, but that's only an answer that works for devout Christians, which most people aren't even on the right. The secular, individualistic majority will continue to be upset about this issue, whether justly or not. I'm not sure what to tell them, except perhaps that they're simply reaping what they've sown.
Great insights, thank you for the clarity. I always appreciate your work.
Also, you’re paying too much for insurance. Ditch what you have and join Crowd Health. They aren’t specifically Christian but share the values you wrote about here. No networks, no arbitrary claim denials, $500 deductible. It’s been great for my family.
https://www.joincrowdhealth.com/?referral_code=GB4N8Rhttps://www.joincrowdhealth.com/?referral_code=GB4N8R
There are many Christian-based medical sharing plans also. We still have to deal with the horrid price-gouging of medicine, but paying out of pocket gives a lot of leverage, as doctors hate Health Insurance bureaucracy also.
A couple people I know swear by Samaritan Ministries. They aren't legally obligated to pay for anything, but the people I know(one with chronic issues) have never been denied.
Not as legally binding as standard health insurance, but far cheaper and less pasasitic. For people where catastrophic illness would bankrupt them anyways, it's really a no-brainer.
I’ve used Christian based sharing plans as well and they are ok too. We left ours because the network constraints were a big problem for us. That was my only complaint.
The “legally binding” part of health insurance is a complete scam though. They don’t have to pay your bills and they know it. It’s better to compare actual claim denial rates. In this arena, health sharing companies do WAY better than health insurance.
You're probably right. I'm having trouble taking the plunge because my risk tolerance is so low given the health catastrophies that have happened in my extended family.
Doesn't hurt to look into the options. I don't trust health insurance companies as far as I can throw them!
I currently pay $1100/month but have sky high deductibles for each member of my family. If I paid this much a month and never one bill after, that would at least be fair game but it’s only the beginning. This month my son was recommended to physical therapy for a sports injury. The PT was through a local hospital. They told me that if they put the claim through insurance it would cost $300/session. If I pay out of pocket, $181. Since it’s December and I will never come close to hitting the $3k deductible by EOY, it was better to just pay. Why are there two prices? Every aspect of this system is horrendous. Im sure all of us here can compare our insurance from fifteen years ago and see how much prices have gone up and how much less is covered.
Private equity destroyed one of the doctors I used to see and she opened her own practice because of it and now does not take insurance. This is getting commonplace. Especially with mental health care. Therapists in my area charge up to $200/45-mins and you have to submit the out of network claim and just keep racking it up.
For families who have one or more members with long term health problems, the financial hits never stop. I don’t know what the answer is. A friend works in HR for a Canadien company and she said they offer a healthcare package on top of the state run insurance. One of the employees had stage one breast cancer and was told she had to wait a year to get it operated on, so she used her own money and came to the States for the operation.
Thank you Librarian. Your writing has reminded me that I need to look away from the vicious back and forth online that this murder has aroused, and look instead to what I can do, within my control, to perhaps make care a little bit better for others. I already give to St. Jude each year and another organization here that provides low cost health care to those in between government assistance and private insurance (typically the self employed laborers). But, I can do more, and I will.