When Private Practices Merge with Hospital Systems, Costs Go Up

Single payor system would solve a lot of problems as insurance companies and the economic system/incentives they’ve created in healthcare is the root cause of a lot of the issues. Also, it’s such a large and relatively unnecessary value extraction layer (middleman) that we’d immediately have many more dollars going towards providing care than to running of insurance companies and their owners. Even the hospitals and other providers have to employ armies of people just to understand how to bill things properly in this unnecessarily complex ecosystem. It’s a massive waste of resources in the name of capitalism that does nothing to improve the care provided.

It’s even worse when considering these companies profit more by denying care altogether.

Buddy, six figures is about 3 short of the amounts we’re talking about here.

> If you engage in behavior with known and predictable risks, which then kills somebody, it is manslaughter.

> That sometimes your behavior doesn’t kill people is immaterial — manslaughter is being intentionally risky in your actions which leads to a death.

I was thinking more about laws enacted in the last couple of years in various US states which have guaranteed a rise in pregnancy-related deaths[0].

0 - https://news.harvard.edu/gazette/story/2025/04/u-s-pregnancy...

> Or in the case of UnitedHealthcare, felony murder: their felony fraud in issuing false denials for their clients resulted in deaths — and deaths that result from a felony have a special charge.

Sadly, the insurers have a defense to this, and it has largely held up in court:

"We did not deny that person the healthcare that could save their life. We just declined to be the party to pay for it."

I want to highlight your point because you're correct and this is something that a lot of people don't understand about economic systems. We exist in a resource constrained system. There are finite medical workers, finite time, finite medicine, finite medical facilities, finite medical equipment, and just finite resources in general. There will always be shortages and surpluses in such a system as resource allocation is never perfect. If you have a shortage you must ration supply through some mechanism. It can be by prices, by queue, by need, by lot, by status, or countless other mechanisms or combinations of mechanisms but you must ration regardless. This will lead to people dying under certain conditions who may not have died if some other rationing mechanism was used, but if a different rationing mechanism was used then a different set of people would have died. The only thing that can be done is to select the system that allocates resources more efficiently than other systems to minimize this failure mode. This whole idea of "statistical murder" would just lead to the banning of medical care entirely as no system has perfect allocation at all times, although some are certainly worse than others.

Plus I have no idea what the word "statistical" even means in this context...

An insurer having an auto-deny policy for care claims (procedure/medication/etc) and then fighting a physician’s explanation/reason for their recommendation to the extent the patient expires while this battle plays out, is evil and premeditated and arguably meets the legal criteria of murder in many jurisdictions.

> Every health system in the world makes decisions that result in deaths that could have been avoided had other decisions been made.

And some of those decisions are, shall we say, justifiable homicide.

Intent and motive makes murder. “I will let these people die so I can be richer” is different than a bureaucrat who gets paid the same either way.

> Ok fine, companies have a duty to their shareholders to do as they are told, within relevant laws, which usually means maximising profits over some timeframe.

Nope. First of companies have no duties, as they are not sentient, and thus have no free will to follow order or not.

While the directors of the company often/generally follow shareholder direction, they are not legally bound to: the directors have a contract with the company and so they must do what they think is best for the company.

But if you think it is for "shareholders", then "which" shareholder? The pension fund that wants steady dividend payments for 3 decades? The hedge fund that wants a meteoric rise in share prices in 3 years? The day trader that's trying to cash in on a meme in 3 days? There is no (single) Platonic "shareholder" that a company's directors can aim to be best at: there are a variety of people holding stock. Do a search for "shareholder heterogeneity".

> These can even be clawed back, in certain situations, if the company then goes bankrupt - i.e. shareholders aren't just paid spectators, they bear responsibility for the business.

Using UK law and precedent (just because it was easiest to find quickly):

> Unlike the agency theory, corporate law does not grant shareholders the right to necessarily impose their will on the company. The case of Gramophone & Typewriter Ltd v Stanley [1908] stated that “even a resolution of a numerical majority at a general meeting of the company cannot impose its will upon the directors when the articles have confided to them the control of the company affairs. The directors are not servants to obey directions given by the shareholders as individual; they are not agents appointed by and bound to serve the shareholders as their principals”.

> Shareholders possess a piece of paper entitling them to receive future income, but do not have the right to use any of the assets held by the corporation for their personal use. Companies are legal persons and in that capacity, they can own assets and use them in accordance with the directions given by directors. If any shareholder were to attempt to possess the asset and use it for personal enjoyment, s/he will probably be accused of theft.

[…]

> Shareholders cannot use the assets of a company to satisfy their own debts. In common with other consumers, shareholders can use a company’s assets and services by paying a price, but they generally do not have any special privileges arising from their investment in shares of the company.

* https://www.pqmagazine.com/the-myth-of-shareholder-ownership...

If I own shares in AAPL, I cannot walk into the UFO HQ and start grabbing stuff because I do not own it: I'd be arrested for theft. Further, Tim Cook has a bunch of actual stock in AAPL, but if he tried transfer a bunch of money from AAPL's chequing account to his own account it would be theft/embezzlement: because as a shareholder he does not own it.

It is the corporation itself that has ownership of its own assets. And who owns the corporation? Well just like a natural person [1] ("human"), a legal person [2] ("business") owns itself.

[1] https://en.wikipedia.org/wiki/Natural_person

[2] https://en.wikipedia.org/wiki/Legal_person

Now a natural person can delegate the running of their assets (real estate, portfolio, etc) to other people (grounds keeper, CFP/CFA/CIPM), so can a legal person (President, CFO, etc). But the people hired have a responsibility to the person in question.

Shareholder do not even have the right to demand income/dividends: the directors hired by the corporation have to decide what to do with whatever assets are left over all liabilities are handled, with an eye towards what is best for the corporation.

Or Canadian law:

> In contrast to what you may have previously understood, ownership of a corporation’s share does not represent ownership of the corporation itself. Rather, it represents ownership of certain rights to the corporation, which are granted in consideration for an equity investment or past services. The three basic shareholder rights are: the right to vote, the right to receive dividends, and the right to the corporation’s remaining assets upon dissolution or winding-up.

* https://queenslawclinics.ca/node/81

> There is a basic tension inherent in the regulation of corporations between the role to be played by boards and that to be played by shareholders. Boards have the statutory responsibility to manage the business and affairs of the corporation, and owe an express duty to act in the best interests of the corporation. Shareholders, however, are the ultimate ‘owners’ of the corporation, and have the ability to elect and remove directors. […] For a number of reasons the Canadian regulatory regime has developed a shareholder-centric model, which tends to foster an emphasis on process and shareholder rights, and stands in sharp contrast to the American regime and its nuanced approach to director duties.

* https://digitalcommons.osgoode.yorku.ca/cgi/viewcontent.cgi?...

Not the quotation marks around the word owners. Also:

> Critically, both in British law and theory shareholders are not ‘owners’ of the company they have shares in, and lack many of the rights and powers typically derived from ownership. In 1948, the Court of Appeal ruled that “shareholders are not, in the eyes of the law, part owners of the company”. The House of Lords strongly reaffirmed that ruling in 2003, a judgement the EU’s recent Shareholder Directive echoed. Ownership of capital – in this case, owning shares – is therefore legally and theoretically not the same as ownership of the company.

* https://www.ippr.org/articles/who-owns-a-company

> Corporate reality, though, has proved stubbornly uncooperative. In legal terms, shareholders don’t own the corporation (they own securities that give them a less-than-well-defined claim on its earnings). In law and practice, they don’t have final say over most big corporate decisions (boards of directors do). And although many top managers pledge fealty to shareholders, their actions and their pay packages often bespeak other loyalties.

* https://hbr.org/2012/07/what-good-are-shareholders

* (2) Although they do not own corporations, which are separate legal entities beyond their full control, shareholders play a relevant role in the governance of those corporations. The financial crisis has revealed that shareholders in many cases supported managers' excessive short-term risk taking. Moreover, the current level of “monitoring” and engagement in investee companies by institutional investors and asset managers is often inadequate and too much focused on short-term returns, which leads to suboptimal corporate governance and performance of listed companies.*

* https://www.europarl.europa.eu/doceo/document/TA-8-2015-0257...

* https://blogs.law.ox.ac.uk/business-law-blog/blog/2016/11/mo...

(The post is long because I want a single place for all the references I've managed to find on the subject given how often this idea comes up and has to be debunked.)

Well now you're shifting the goal posts. There's an enormous difference between having the government buy food for a few poor people (which I support) versus being the single payer for food for everyone.

Farmers vote?

We are in no such thing.

The world as a whole is poor.

That's a different problem. The national networks have standardized APIs. Obviously the content returned will have some variations depending on the original source.