Sutter recently bought the company that my kids' pediatrician works for. The changes so far have been sufficiently negative that I have to decide if I want to go through the pain of finding a new pediatrician or just stick it out for the next few years until my youngest switches to a GP.
>A single murderer rarely triggers societal change.
I was gonna bring up Franz but you said "rarely" not "never".
I think people are wising up to the fact that at scale modern forms of insurance, all forms not just health, is not a real product that delivers value to both parties, it's a contrived way to use government force to lighten everyone's pockets to the benefit of a few while paying out only as needed to justify the pretext and the only thing it really shares with it's free-ish market equivalents from 50+yr ago is the name. So there will probably be more murders before things change.
You can call things inevitable and on some level they likely are but +/-5yr makes a huge difference in the exact turns of events and the form that history takes because at the very least it determines who the parties involved are and/or affects the circumstances they are balancing. Do we still get Hitler if WW1 starts later or goes slightly differently? You don't get the modern world without Hitler.
Us typing this here and now with the world as it is is necessarily predicated on a ton of things who's details came down in large part to chance. And it goes back way, way, way further than that.
Note that most of his complaint is with experimental stuff. Why should insurance be required to cover experimental stuff? It's basically chasing the illusion of a solution.
Until you find yourself desperate for a malpractice suit, and Surprise! your insurer and care provider are on the same team and you already agreed to arbitration when you got that insurance.
A friend had his life wrecked by Kaiser, and none of the attorneys he consulted wanted to touch the case because according to the attorneys they had an army of lawyers and he'd already agreed to arbitration when getting the insurance. The max they claimed could be won wouldn't even cover the legal fees.
You definitely don't want insurance from the same team you're getting the insured services from. It's the conflict of interests to end all conflict of interests, especially in the context of health care.
From what you tell us, binding arbitration sounds like the actual problem. Not the insurer and provider being the same company.
To me the latter is an alignment of interests. The insurer will happily pay for preventive screenings and care to save itself costs on treatment later.
> From what you tell us, binding arbitration sounds like the actual problem. Not the insurer and provider being the same company.
No, the actual problem is that the insurer and provider want to screw over the paying customer. Binding arbitration is just one convenient method they've taken advantage of to accomplish that. Getting rid of binding arbitration is still a good idea, but you can bet they'll find some other way to screw over their customers because they clearly care more about profit than people. The actual solution would be to reform the healthcare system so that its goal is focused more on healing people than stuffing pockets with cash and so companies that only care about money are forced out of it entirely.
Since it's unlikely that anyone with the power to fix the deeply broken healthcare system will do it any time soon, the least people can do is avoid this insurer and healthcare provider since they've demonstrated themselves to be hostile to their own paying customers.
Kaiser's structure is complicated. Its health plan arm, which offers insurance, is non-profit. So is its hospital foundation, which owns and operates hospitals. Its medical offices are for-profit and owned by doctors.
I don't see a big profit motive for Kaiser because it's a non-profit. And because the same company owns the insurance provider and hospitals, they're incentivized to keep overall costs down. As long as they can't arbitrarily throw people off their plans, this means investing in preventive care and doing it cheap.
Traditional insurance providers don't care about that. They actually like it when hospitals raise prices because it allows them to charge higher premiums. Since they can only take up to 10% in premiums (or some other number, but it's a fixed %) as profits, higher costs and higher premiums are good for their bottom line.
Kaiser is how single-payer healthcare would look if it wasn't run by the government.
> reform the healthcare system so that its goal is focused more on healing people than stuffing pockets with cash and so companies that only care about money are forced out of it entirely.
What does that actually mean? What concrete steps would you take to accomplish this? Without specifics this is wooly, idealistic nonsense.
Again to take Kaiser's example: their doctors are salaried (at least the ones that work in hospitals). They have no incentive to overbill you or make you take unnecessary tests. The doctors make the same money no matter what procedures they do on you. And Kaiser owns the insurance company that's paying those bills. They also have no incentive to skip necessary tests. If they miss a problem it'll cost Kaiser more money later to treat you. Do you have a better way to "focus [only] on healing people" than that?
No one who lives (has lived) in California thinks Kaiser is a scam. You may not like Kaiser or HMOs, but they are not a scam by any measure. So its an odd or simply mistaken choice of words.
As someone with a little experience with the 'advertiser side' of Google, they also push junk to their paying clients, using every opportunity to sell terrible, worthless placements to advertisers. Which is to say that the problem is not that 'searchers' are the product, the problem is that Google is not focused on creating value for its counter-parties.
That’s strictly not true, at least for “old media” advertising.
Advertisers are selected based on being palatable for the content and the audience. It’s common for content licensing deals to has stipulations about which advertisement is acceptable. Virtually all platforms — even Google Search — has rules about the type of advertisements you see. There are of course laws that prohibit the advertising of certain types of products in certain places.
Even if these scams had the money for a full page NYT article, they wouldn’t had gotten it.
I agree that Google is benefiting from being the dominant player in a two-sided marketplace (which makes it harder to compete), but we can always choose not to use it, both as advertisers and as searchers. Google’s exploitation of its counter-parties has definitely caused me to use alternatives more and more often.
Google is my third choice for searches. I try Ecosia first, but their indexing is garbage so I typically then go to Brave. If Brave doesn’t have it then I submit to the evil overlords at Google. Thankfully Brave indexing is pretty good so it‘s had a measurable impact on the amount of search I actually put through Google.
I don't really see that Google is causing this, just showing what's out there. Search inherently selects for advertising because companies craft their sites to look good for on the search terms.
I hate to be that guy but is it Google's responsibility to police legally operating insurance companies? It's not their problem that USA has a trash insurance market and a backwards healthcare system.
Poor, powerless Google. The scrappy, ragtag outfit down in Mountain View, barely hanging on, unable to downrank predatory insurance companies. I'll say an extra prayer for them during Compline tonight.
Imagine how hard moderating a forum is. Now imagine moderating the whole Internet. Everyone always thinks it's trivial. Everyone couldn't be more wrong.
How convenient that Google gets to reap all of the benefits of that situation without bearing any of the responsibility. Oh, but it's fine, because they have a trillion dollars and "it's hard, you guuyyysss!"
"lets make private corporations responsible for policing the behavior of other corporations instead of the government and legislation" <- this is what I'm hearing
Legally? No. However, due to their alteration of search results anything that becomes the top is effectively an endorsement regardless of whether it was chosen by the black box or their employees. They already remove legally operating websites they disagree with. Since they’re selective editors with multiple lost antitrust suits, the only thing we as consumers can do is criticize. Especially as most of these companies top the charts due to SEO spam and not genuine traffic.
> Amazingly enough, these aren't even the worst kinds of garbage health plans that you can buy in America: those would be the religious "health share" programs that sleazy evangelical "entrepreneurs" suck their co-religionists into, which cost the world and leave you high and dry when you or your kids get hurt or sick:
Seems worth noting that "sleazy" and "suck their co-religionists into" are (unfounded, as far as I can tell) opinions, "cost the world" is flat-out false and the exact reason why they are an appealing option, and "and leave you high and dry when you or your kids get hurt or sick" is also an unfounded claim. His only citation for any of this is talking about someone who doesn't like morality clauses, but...picked it anyways, presumably because it didn't cost the world?
Some are better than others. I picked the one that looked the most like real insurance and has a >30 year track record of not leaving people high and dry. I've been on it for almost seven years and it's worked out well so far.
They (religious health share stuff) all have an inherent, fundamental flaw in that there is no actual insurance obligation. It's like the old days, get sick enough and you get dropped. But without even an illusion of being able to keep it. I'm not going to blame the author for failing to prove something long established.
"get sick enough and you get dropped" is a very, very different statement than "leave you high and dry when you or your kids get hurt or sick".
And if it's "like the old days", then it must not be some some uniquely sleazy thing.
I'll also add:
>these plans do not comply with the Affordable Care Act, which requires comprehensive coverage, and bans exclusions for pre-existing conditions. These plans only exist because of loopholes in the ACA, designed for very small-scale employers or temporary coverage...
He lumps sharing ministries in with this, but it's worth noting that the company I'm with was explicitly exempted by the ACA from the outset. It's not a loophole. Health sharing ministries that existed before the year 2000 could be used to satisfy the individual mandate. So he's being misleading here as well.
PSA for folks in Northern California:
The Sutter Health Network / Palo Alto Medical Foundation routinely get caught committing widespread insurance fraud.
They also offer products that seem to be junk insurance to me, but I’m not a lawyer.
Here are three examples of their alleged widespread insurance fraud:
https://allaboutlawyer.com/claim-your-sutter-health-settleme...
https://www.sfgate.com/bayarea/article/sutter-health-accused...
https://www.justice.gov/archives/opa/pr/government-intervene...
Some of those suites involve other big providers, like KP. Not sure if any of the healthcare providers around here are reputable at this point.
Sutter recently bought the company that my kids' pediatrician works for. The changes so far have been sufficiently negative that I have to decide if I want to go through the pain of finding a new pediatrician or just stick it out for the next few years until my youngest switches to a GP.
Ooc what issues do you encounter?
So Luigi Mangione had no effect, or it's too early to tell?
He never had any chance of having any effect, except maybe for an increased bodyguard budget. A single murderer rarely triggers societal change.
>A single murderer rarely triggers societal change.
I was gonna bring up Franz but you said "rarely" not "never".
I think people are wising up to the fact that at scale modern forms of insurance, all forms not just health, is not a real product that delivers value to both parties, it's a contrived way to use government force to lighten everyone's pockets to the benefit of a few while paying out only as needed to justify the pretext and the only thing it really shares with it's free-ish market equivalents from 50+yr ago is the name. So there will probably be more murders before things change.
Great powers were already on the brink by the time the archduke thing happened. It would have been some other trigger.
If Franz isn't good enough we can do Caesar.
You can call things inevitable and on some level they likely are but +/-5yr makes a huge difference in the exact turns of events and the form that history takes because at the very least it determines who the parties involved are and/or affects the circumstances they are balancing. Do we still get Hitler if WW1 starts later or goes slightly differently? You don't get the modern world without Hitler.
Us typing this here and now with the world as it is is necessarily predicated on a ton of things who's details came down in large part to chance. And it goes back way, way, way further than that.
Note that most of his complaint is with experimental stuff. Why should insurance be required to cover experimental stuff? It's basically chasing the illusion of a solution.
If Ted K. had no effect what hope did Mangione have?
Well, the woman Ted threw into Poucha Pond didn’t have any ties to health care.
Just use Kaiser if you’re down bad. It’s cheaper than the absolute cheapest scam insurances and will get you a decent level of care.
Until you find yourself desperate for a malpractice suit, and Surprise! your insurer and care provider are on the same team and you already agreed to arbitration when you got that insurance.
A friend had his life wrecked by Kaiser, and none of the attorneys he consulted wanted to touch the case because according to the attorneys they had an army of lawyers and he'd already agreed to arbitration when getting the insurance. The max they claimed could be won wouldn't even cover the legal fees.
You definitely don't want insurance from the same team you're getting the insured services from. It's the conflict of interests to end all conflict of interests, especially in the context of health care.
From what you tell us, binding arbitration sounds like the actual problem. Not the insurer and provider being the same company.
To me the latter is an alignment of interests. The insurer will happily pay for preventive screenings and care to save itself costs on treatment later.
> From what you tell us, binding arbitration sounds like the actual problem. Not the insurer and provider being the same company.
No, the actual problem is that the insurer and provider want to screw over the paying customer. Binding arbitration is just one convenient method they've taken advantage of to accomplish that. Getting rid of binding arbitration is still a good idea, but you can bet they'll find some other way to screw over their customers because they clearly care more about profit than people. The actual solution would be to reform the healthcare system so that its goal is focused more on healing people than stuffing pockets with cash and so companies that only care about money are forced out of it entirely.
Since it's unlikely that anyone with the power to fix the deeply broken healthcare system will do it any time soon, the least people can do is avoid this insurer and healthcare provider since they've demonstrated themselves to be hostile to their own paying customers.
Kaiser's structure is complicated. Its health plan arm, which offers insurance, is non-profit. So is its hospital foundation, which owns and operates hospitals. Its medical offices are for-profit and owned by doctors.
I don't see a big profit motive for Kaiser because it's a non-profit. And because the same company owns the insurance provider and hospitals, they're incentivized to keep overall costs down. As long as they can't arbitrarily throw people off their plans, this means investing in preventive care and doing it cheap.
Traditional insurance providers don't care about that. They actually like it when hospitals raise prices because it allows them to charge higher premiums. Since they can only take up to 10% in premiums (or some other number, but it's a fixed %) as profits, higher costs and higher premiums are good for their bottom line.
Kaiser is how single-payer healthcare would look if it wasn't run by the government.
> reform the healthcare system so that its goal is focused more on healing people than stuffing pockets with cash and so companies that only care about money are forced out of it entirely.
What does that actually mean? What concrete steps would you take to accomplish this? Without specifics this is wooly, idealistic nonsense.
Again to take Kaiser's example: their doctors are salaried (at least the ones that work in hospitals). They have no incentive to overbill you or make you take unnecessary tests. The doctors make the same money no matter what procedures they do on you. And Kaiser owns the insurance company that's paying those bills. They also have no incentive to skip necessary tests. If they miss a problem it'll cost Kaiser more money later to treat you. Do you have a better way to "focus [only] on healing people" than that?
I found the opposite to be true. Kaiser is worth the premium. Doctors and care has been amazing.
Oh? “amazing” is the _opposite_ of “decent”?
Maybe worth the premium was the part opposite cheap as scam insurance?
No one who lives (has lived) in California thinks Kaiser is a scam. You may not like Kaiser or HMOs, but they are not a scam by any measure. So its an odd or simply mistaken choice of words.
https://en.wikipedia.org/wiki/Kaiser_Permanente
Kaiser (Nor Cal), has been amazing. I highly recommend them. I hear lots of complaints from friends who have other providers, but Kaiser "just works".
We've been through cancer and diabetes (so far).
You actually get great level of care they suck at advertising though and most people think they are bottom tier when they are not
This Pluralistic post seems very rant-y, but it links to a Bloomberg piece that seems like a better source for backing up the claim: https://www.bloomberg.com/features/2025-obamacare-open-enrol...
As someone with a little experience with the 'advertiser side' of Google, they also push junk to their paying clients, using every opportunity to sell terrible, worthless placements to advertisers. Which is to say that the problem is not that 'searchers' are the product, the problem is that Google is not focused on creating value for its counter-parties.
It's incredible hard to build a ad business around fairness. In 99% of all cases it's going to be a highest bidder thing.
That’s strictly not true, at least for “old media” advertising.
Advertisers are selected based on being palatable for the content and the audience. It’s common for content licensing deals to has stipulations about which advertisement is acceptable. Virtually all platforms — even Google Search — has rules about the type of advertisements you see. There are of course laws that prohibit the advertising of certain types of products in certain places.
Even if these scams had the money for a full page NYT article, they wouldn’t had gotten it.
Is that not fair?
For the advertiser, not the customer. There is never and incident to show the best product instead of the best paying one.
This discrepancy is always there for everything we see and get advertised for.
Why should it? If you aren’t satisfied you can take your business elsewhere… wait never mind, there is no alternative.
I agree that Google is benefiting from being the dominant player in a two-sided marketplace (which makes it harder to compete), but we can always choose not to use it, both as advertisers and as searchers. Google’s exploitation of its counter-parties has definitely caused me to use alternatives more and more often.
Google is my third choice for searches. I try Ecosia first, but their indexing is garbage so I typically then go to Brave. If Brave doesn’t have it then I submit to the evil overlords at Google. Thankfully Brave indexing is pretty good so it‘s had a measurable impact on the amount of search I actually put through Google.
I use DDG on the consumer side but you, I and most people on HN are outliers, the other 90% don’t care enough to use something else yet.
Kagi is the correct answer, because you pay for the service you use.
I don't really see that Google is causing this, just showing what's out there. Search inherently selects for advertising because companies craft their sites to look good for on the search terms.
The problem is that these things exist at all.
It's a shame that Google is powerless to downrank websites for companies committing fraud. I wish we could help them.
To be fair, it's all "junk insurance"
"It's omnienshittified, a partnership between the enshittified search giant and the shittiest parts of the totally enshittified health industry."
Omnienshittified: May go down as the most hilarious - yet prescient - new word this century. (In the USA of course.)
[dead]
I hate to be that guy but is it Google's responsibility to police legally operating insurance companies? It's not their problem that USA has a trash insurance market and a backwards healthcare system.
I believe traditional publishers had pretty specific liability for the stuff they carry. There's no magic exclusion for ads that I know of.
Source? Specifically, examples where publishers were sued for fraudulent products they advertised?
https://en.wikipedia.org/wiki/Beardstown_Ladies is the exemplar
That's a book publisher being liable for the book it published.
We're looking for a newspaper publisher being liable for the ad it published. Not a story it published.
Poor, powerless Google. The scrappy, ragtag outfit down in Mountain View, barely hanging on, unable to downrank predatory insurance companies. I'll say an extra prayer for them during Compline tonight.
Imagine how hard moderating a forum is. Now imagine moderating the whole Internet. Everyone always thinks it's trivial. Everyone couldn't be more wrong.
Yes, we should not have built internet scale services and forums if it was not possible to moderate them effectively.
How convenient that Google gets to reap all of the benefits of that situation without bearing any of the responsibility. Oh, but it's fine, because they have a trillion dollars and "it's hard, you guuyyysss!"
"lets make private corporations responsible for policing the behavior of other corporations instead of the government and legislation" <- this is what I'm hearing
Didn't say they were powerless but you do you
Legally? No. However, due to their alteration of search results anything that becomes the top is effectively an endorsement regardless of whether it was chosen by the black box or their employees. They already remove legally operating websites they disagree with. Since they’re selective editors with multiple lost antitrust suits, the only thing we as consumers can do is criticize. Especially as most of these companies top the charts due to SEO spam and not genuine traffic.
Imagine a magazine that only had garbage ads for scam insurance, adware, and cheap Chinese $2 trinkets, would you keep your subscription?
You can't cancel google. They make sure of it
> Amazingly enough, these aren't even the worst kinds of garbage health plans that you can buy in America: those would be the religious "health share" programs that sleazy evangelical "entrepreneurs" suck their co-religionists into, which cost the world and leave you high and dry when you or your kids get hurt or sick:
Seems worth noting that "sleazy" and "suck their co-religionists into" are (unfounded, as far as I can tell) opinions, "cost the world" is flat-out false and the exact reason why they are an appealing option, and "and leave you high and dry when you or your kids get hurt or sick" is also an unfounded claim. His only citation for any of this is talking about someone who doesn't like morality clauses, but...picked it anyways, presumably because it didn't cost the world?
Some are better than others. I picked the one that looked the most like real insurance and has a >30 year track record of not leaving people high and dry. I've been on it for almost seven years and it's worked out well so far.
They (religious health share stuff) all have an inherent, fundamental flaw in that there is no actual insurance obligation. It's like the old days, get sick enough and you get dropped. But without even an illusion of being able to keep it. I'm not going to blame the author for failing to prove something long established.
"get sick enough and you get dropped" is a very, very different statement than "leave you high and dry when you or your kids get hurt or sick".
And if it's "like the old days", then it must not be some some uniquely sleazy thing.
I'll also add:
>these plans do not comply with the Affordable Care Act, which requires comprehensive coverage, and bans exclusions for pre-existing conditions. These plans only exist because of loopholes in the ACA, designed for very small-scale employers or temporary coverage...
He lumps sharing ministries in with this, but it's worth noting that the company I'm with was explicitly exempted by the ACA from the outset. It's not a loophole. Health sharing ministries that existed before the year 2000 could be used to satisfy the individual mandate. So he's being misleading here as well.
He's lumping them in because they have the same problem, not because they're actually the same thing.