Why are Insurance Companies Evil?
And Why Some Assassinations Are Justified
Recent events have resulted in this recent article of mine - a scathing critique of the medical system - getting a lot of exposure. It’s fair to ask me “Alex, you criticize the existing system a lot, but do you have any solutions? Or are you just a more grown-up Greta Thunberg, who gets really angry about Current Year problems but then insists ‘it’s not our job to offer solutions’?” It’s a fair point, and my explanation of what a good solution would look like also addresses the question of why I sympathize so much with the assassin rather than with the murdered man.
Let’s start with asking ourselves “Why do private insurance companies even exist - as opposed to a public system like the NHS?” After all, it seems like they’re just the middleman, taking a cut of profit unnecessarily (which a government run organization wouldn’t be allowed to do). We don’t have to allow them to exist: the only reason we do is because they benefit the public. So how did they even come into being in the first place, and why do they routinely achieve better outcomes than the NHS? There are two major reasons.
Because governments tend to be inefficient, so even WITH their cut of profit people tend to get better outcomes from private insurance. From that perspective, the profit isn’t seen as unnecessary usury, but simply “fair payment rendered for a valuable service.”
Because who else will exert pressure on medical providers to keep costs down? If this function was run by unionized government bureaucrats they would have no incentive not to waste taxpayer money by paying the hospitals whatever they wanted. Unfortunately this pressure on medical providers comes primarily in the form of denying claims, which typically has blowback on patients.
Based on these two factors, we can conclude that the existence of private insurance companies is a good thing, but ONLY in situations where at least one of the above factors holds true. Therefore we should ask the question: how much do both of these factors still hold true? With the modern technology and advancements at our disposal, is it necessary for government-run healthcare to be as inefficient as it was in the past? That leads to two other questions related to the original reasons for private insurance companies being created.
Why are governments inefficient at this insurance stuff? In a word, UNIONS. When you can’t fire people for failure to achieve results - or promote them unless they have seniority - government bureaucrats generally don’t give a shit about getting good outcomes. The employees of health insurance companies typically have more incentive to be good at their jobs, since they can be fired for their failures, and also promoted for their successes. Therefore if we create any new government office to oversee health insurance, we must ensure that the employees aren’t unionized. This is not hard. In a worst-case scenario where government workers are threatening to strike unless the new department is unionized, their complaints can simply be avoided by having the future employees organize as a nonprofit consulting company, having the government hire them (with a work-for-hire IP agreement so that all of their software and hardware development belongs to their client - the government) and making the government their only client. On paper, the company would be independent, but in principle, they would have to promote or fire people as the government demanded, since the government would control their entire cash flow.
How can governments exert additional pressure on medical providers to keep costs down, without punishing the insured patients by denying claims? The short answer is: replace all the low-cost medical providers who are ineffective with government manufacturing. As I learned from my time analyzing contracts in the healthcare industry, there are a ton of medical systems and journals which any 100 IQ midwit could run, and yet these companies routinely charge hospitals exploitative prices for their products. Furthermore these products aren’t even particularly high-quality. Subscription journals routinely cost hospitals up to a hundred thousand dollars (or more!). How often do these journals have useful information that has been thoroughly scrutinized with replication studies, and how often is it just politicized nonsense or worthless fluff designed to enhance some academic’s resume? Another great example is maintenance contracts on medical equipment, an expense that easily cost millions of dollars. Most of the replacement parts needed to fix medical equipment that has broken down are made of cheap plastic or rubber and are designed to degrade over time as part of the medical provider’s fanatical devotion to the principle of planned obsolescence. These parts are not expensive to manufacture or replace, but the reason medical providers charge such extortionate pricing is simply because they can. If we were hypothetically to create a government office charged with offering a public payer insurance option, then I think government negotiators should be empowered to tell exploitative companies “Hey, if you keep charging hospitals $80 for a piece of plastic, we can spin up some 3-D printing operations and provide these parts to the hospitals at cost. Consider lowering your prices or we’ll just replace you.” I think that would be a very effective threat to the medical providers. Frankly, the government should have a 3-D printing division anyway because if we’re ever in another situation like Covid where hostile geopolitical enemies like the CCP are squeezing our medical supply chain, we need to be able to print emergency replacements for critical equipment as quickly as possible. Having such a division would also benefit private insurance providers because when manufacturers lower their prices, everybody benefits - the hospitals, patients, and insurance companies alike. The only people who don’t benefit are the medical companies, and I’ve seen them price gouge far too much to have any sympathy for them.
I feel like both of these complaints would address the main issues with a public payer option. Please note that I’m not saying a public payer option should replace the private health insurance companies: I’m simply saying that we should have one to offer them some worthwhile competition, incentivizing them to be more effective. Some might say that having a nonprofit government agency compete with private sector companies is unfair to the private health insurance companies. But that argument doesn’t hold water because part of the reason that we originally allowed private insurance companies to exist in the first place is because they’re supposedly more efficient than government-run behemoths. If that still holds true, then why would the private health insurance companies complain about a little competition? And if that isn’t true any longer, then why are we allowing the private health insurance companies to continue existing when one of their most significant raisons d’etre is no longer valid?
OK, you’re probably thinking. That’s all well and good, but if medical providers are the real villains, then why are you blaming insurance companies? Just get a few friends together and persuade legislators to spin up this kind of public sector (or nonprofit) option, and you can solve the problem without bothering the big health insurance companies at all. Hell, you might even lower their costs too.
That’s an excellent question. The reason I’m blaming the health insurance companies because every time we try to make any fundamental changes in the way healthcare works, these fucking assholes use their lobbyists to block and hinder us at every turn. We can’t persuade legislators to make the necessary changes we want because private health insurance lobbyists are constantly fearmongering about a public option - to the point where it really makes the healthcare companies they represent sound like they’re afraid of a little healthy competition. The health insurance companies may say that they’re trying to drive down costs and make health insurance more efficient for the patients, but if their actions don’t match their words, then we should assume that they’re the enemy and deal with them accordingly. If they genuinely want to help patients improve care rather than greedily lining their own pockets, then why do they spend so much money on lobbyists to interfere with those of us who represent that same alleged goal? Clearly their actions don’t match up to their words - so until these people learn to stop actively making themselves obstacles to our goals, they are an active threat to our well-being and should be considered valid military targets. To be clear, the private health insurance companies don’t have to be our enemies: they choose to be our enemies by lobbying to block the kind of change that we’d like to see. That’s an unhealthy choice (quite literally) for the suffering patients, and we should make this choice equally unhealthy for the health insurance executives, until they learn to change their behavior. I see absolutely no difference between executing somebody with a bullet or executing them with the stroke of a pen, and when the lobbying decisions made by greedy health insurance executives cost lives, I am fully on board with claiming their own lives in retaliation, because we are at war with anybody who values profit over our own lives. That’s why I proudly support Brian Thompson’s assassination, as well as the assassination of any other health insurance executives who lobby against a public option. The narcissistic CEOs of these companies are primarily motivated by fear and greed, and we haven’t thrown enough fear into the equation. They need to learn that when they hurt us, we hurt them back, and every one of these bullets represents a valuable teaching moment.
