Feds help health insurers hide their dirty secret: denials on the rise

Original Article ↗ Hacker News Discussion ↗

Rising claim denials by U.S. health insurers are prompting anger over how for‑profit carriers ration care, override doctors, and hide denial rates despite Affordable Care Act transparency requirements. Commenters describe being refused coverage for routine or lifesaving procedures, argue over whether such denials amount to homicide, and contrast the U.S. model with systems in Europe and Japan that more tightly regulate pricing and coverage. Proposed remedies range from stricter audits and legal liability for wrongful denials to single‑payer or heavily constrained insurance limited to catastrophic events.

Murder, ethics, and cognitive dissonance

  • Heated debate over the line “no industry malfeasance could ever excuse murder.”
  • Some argue killing can be ethically justified (e.g., self‑defense, wartime, death penalty), so the statement “nothing excuses murder” is inconsistent with US practice.
  • Others distinguish murder (unlawful killing) from lawful homicide (death penalty, self‑defense), saying that’s why people can oppose the CEO killing while supporting capital punishment.
  • Several point to US wars, police killings, and extrajudicial assassinations as evidence that society already accepts large‑scale killing while condemning this one.

Is denial of care a kind of killing?

  • Many argue that knowingly denying life‑saving treatment (or coverage) is morally akin to homicide, possibly even premeditated.
  • Counter‑view: disease/injury kills; insurers only withhold financial support, so calling it “murder” is sophistry.
  • Others emphasize omissions and “duty of care”: neglect can be negligent homicide in law and a serious moral wrong in ethics and religion.

Claim denials and their rise

  • Cited figures: denials around ~1–2% in 2013 vs ~15% on average by 2022, with some payers approaching ~50% (sources in thread).
  • 41% of appealed denials reportedly get reversed, suggesting many are incorrect or abusive, but appeals are rare and burdensome.
  • Some denials are due to coding errors; others come from automated systems and aggressive prior auth.

Patient experiences

  • Multiple anecdotes of denials for colonoscopies or anesthesia, preventive tests, imaging, and cardiac monitoring.
  • People describe large surprise bills, debt collection, and hospitals having entire “denial teams.”
  • A few note that colonoscopies without sedation are common elsewhere and medically acceptable; others report severe pain and insist sedation is necessary care, not luxury.

Root causes and blame

  • One camp blames profit‑driven insurers: incentives to deny, complex rules that manufacture “errors,” vertical integration, and AI‑driven claim rejection.
  • Another camp stresses provider overbilling, unnecessary treatments, and constrained physician supply as major cost drivers; insurers often only administer self‑funded employer plans under medical loss ratio caps.
  • Several argue that all systems ration care; in other countries, rationing is more centralized and less visible to patients.

Reform ideas

  • Proposals include: single‑payer or strong public option; nonprofit insurers with national fee schedules; catastrophic‑only insurance plus transparent cash prices; strict audits and penalties for wrongful denials; or criminalizing harmful denials and piercing corporate liability.
  • Broad frustration that meaningful reform is blocked by bipartisan lobbying, partisan gridlock, and public resistance to concrete trade‑offs on taxes, coverage, and limits.