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Culture War Roundup for the week of December 2, 2024

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Some quick hits:

A) Cremieux argues that much of the gap in life expectancy between America and Europe is due to obesity. But America is good at one thing at least – spending money on health care. Combine high spending with effective weight loss drugs, and the U.S. is on track to significantly narrow its life expectancy gap with Europe.

Self-driving cars will close the gap further.


B) Drug overdose deaths are down in King County (Seattle area) this year after more the tripling between 2019–2023. This is probably because fentanyl has already killed a significant percentage of the junky population. There has also been some modest progress in cracking down on open air drug markets. In the last 2 years, about 1 in 1000 King County residents died of a drug overdose.


C) Health insurance companies have a terrible reputation. But it's hard to fix. It's a viscious cycle which goes something like this:

  • Company has bad reputation

  • Due to bad reputation, the company has trouble getting talent, so they compensate by paying a lot

  • This selects for people who care more about money than reputation

  • Money-grubbing behavior leads to bad reputation

If you were next in line at United Health, how would you fix the problem?

Note: Many societies in the past (India, Japan) created special undercastes to do necessary but unsavory work such as working with dead bodies. Should we do likewise and create a special caste of health insurance workers that are not allowed to work in other fields and we can treat like shit with impunity? Reddit probably thinks so.


D) Epistemic status: uncertain.

Many people in the China tariff post said that China is "not expansionist".

But what is today China was, 2500 years ago, just a small collection of states along the Yellow River. Gradually, over the millenia, they absorbed more and more territory into their country.

It's as if the Roman Empire still existed today and controlled all of Europe.

Genetically speaking, the Han people seem to have done much better than Rome. The Romans, the people who lived in the city of Rome circa 500 BC, essentially all died out. For centuries, Rome's population could only be sustained from continual influxes of people from the countryside, and later, far flung areas of the Roman sphere. This doesn't seem to be the case in China. Even today, there are people who can trace direct male lineage to Confucius who lived around 500 BC.

Many societies in the past (India, Japan) created special undercastes to do necessary but unsavory work such as working with dead bodies. Should we do likewise and create a special caste of health insurance workers that are not allowed to work in other fields and we can treat like shit with impunity? Reddit probably thinks so.

Seems like they’d be even more money-grubbing assholes.

Not a problem. We'll just have a pogrom every once in a while to take back our money and let off some steam.

I'm joking obviously, but the way that people on Reddit are talking about this murder is frankly concerning. These simpletons think that the reason health care is fucked up is because of insurance company profits, and if only the CEO was less evil everything would work out. Worse, they are fine with murdering this person because of their own incoherent beliefs.

if only the CEO was less evil everything would work out

Well:

The investigation revealed that in 2019, UHC's prior authorization denial rate was 8.7%. Thompson became CEO in 2021, and by 2022 the rate of denial had increased to 22.7%. For both Medicare and non-Medicare claims, UHC declines at a rate double the industry average.[11]

I don't think everything would work out for everyone if the CEO was less evil, but I think a strategy of vigorously denying claims at an exceptional rate is actually pretty evil and destroys a lot of lives in service of increasing margins. That the CEO being less evil wouldn't solve literally everything in healthcare access and funding isn't exactly a defense of the CEO being evil.

Yeah - what happens with a denial?

Well I can appeal, and often the appeal is successful, but generally what will happen is that they'll tell me we'll have a call at X time, which means I need to reschedule or be late to appointments, maybe skip my lunch or charting time, or even stay late. I'll sit on the phone for an extended period of time and then have a retired outpatient OB nurse who has no fucking clue what she is talk about go "oh yeah sure that's fine, we'll approve" or "wow I don't know about this, let's schedule another phone call with a relevant specialist, but I'm going to deny or now" or whatever other insane shit they do.

The goal is to make paying for things as inconvenient and expensive as possible. That means less time spent on actual patient care and more burnout and exhaustion in physicians.