You know why I don't work for a trapping and pest control company? Because structurally they kill animals. They go around with tools of destruction and end the lives of animals. Its the function of their existence.
Do you know why I don't work for a _for profit_ health insurance company, who's stated goals are explicitly to make profit by slicing out some amount of premiums that are not spent to provide healthcare in a world in which total health expenditures can be* effectively infinite? Same reason.
I could not agree more. Where does the buck stop? From what I can tell United has almost double the national average for denials. They do what they do for the almighty dollar. Padding shareholder pockets has a direct effect on peoples lives and definitely results in at least some deaths.
If the highest level of executive is not held responsible then who is? The regulation and law in the US is heavily influenced by these companies lust for money and power via lobbyists. They are effectively a cartel. Do people honestly think this dude lost a wink of sleep over all the people who suffered from their wanton greed? I think not. As barbaric as it seems, he got exactly what he deserved.
“Those who make peaceful revolution impossible will make violent revolution inevitable."
If your definition of responsibility is so broad, wouldn't every Head of Government for every country be deserving of assassination? Even more broadly, every police chief in every large city, along with all military officers, most mayors, governors, and premiers would also be 'natural targets'. This seems a bit drastic to me, is it your view?
I think in philosophy there's something to be said for the difference between action and lack of action when it comes to culpability. Is a surgeon responsible for not being good enough to save a persons life? No, I don't think so. Is a surgeon responsible for not being sober for a planned surgery? In our society, yes. I think a lot of responsibility is determined by mens rea, and when you run a health insurance company you have good numbers for exactly how many lives you're going to effect when denying coverage.
You think this CEO had more 'mens rea' than a city police chief (or the other examples I listed)? The police chief is literally responsible for purchasing guns, distributing them to officers, and telling the latter to use the former to coerce people!
if you're saying they actively decide denial rates at management level to hit profit targets, I don't buy it.
He has much closer culpability to the CEO of the company that sells me cigarettes than the guy who murdered my grandma. The world is a fallen place.
I thought the example up thread re: not being an animal trapper was a Jonathan Swift-esque send up of the whole idea though, so I might be missing a screw or two.
> if you're saying they actively decide denial rates at management level to hit profit targets, I don't buy it.
To believe in that, first you need to believe that somehow any executive of a company has no control over the company, does not have a duty to make certain things are done a certain way, nor is accountable for how the company is managed.
> If your definition of responsibility is so broad, wouldn't every Head of Government for every country be deserving of assassination?
I don't agree to the radical formulation "every Head of Government for every country is deserving of assassination", but I do believe that the weaker statement "for most Heads of Government of most country, there exist quite some people (even among the citizens) who would like them them to be dead" is very plausible.
This is my view for sure. Every one of those examples is responsible for more deaths than an above average serial killer, they just do it through some degree of abstraction and distance that for some reason means it doesn't count. I disagree, it still counts.
I am unaware of any heads of government who are not offered salaries above a minimum wage. Further, having such connections gets you invited to the upper crust society events and networking connections.
Their direct role in the deaths of others is usually more concrete than that of any CEO.
By this same logic, you are responsible for the death of every person who could have been saved by you donating all of your income beyond basic living expenses (your personal "profit", if you will) to pay for their medical care.
You monster! How many people could you have saved! Instead you spend your money on vacations, television, computer games, music, movies, coffee, whatever.
Oh, what's that you say? _You_ (who, I presume, do not directly save any lives yourself) are morally allowed to use the profit from your labor on unnecessary things for your own pleasure, but people who actually work in healthcare must not just dedicate all of their professional energy and effort to helping people and saving lives, but also must not take any profits from it either, is that right?
Healthcare can morally only be provided by charities?
Personal income, that which sustains someones family, is vastly different then the billions made by United off the backs of those suffering. What, are you some healthcare exec or something?
United Healthcare is a publicly-traded company which makes a 6% profit margin and pays a dividend, which means that those profits ultimately benefit people's retirement accounts, pensions and middle-class investments.
The person who was killed made $10M last year, while UHC provided care to 52 million patients. So, the CEO was paid approximately $0.20 per patient treated last year.
It's functionally isomorphic to a black box where I make a deposit, every time it denies someone medical treatment I get back monetary reward and I can withdraw my deposit at any time. If we ask ourselves, "Should this black box exist?" I cannot reasonably expect people to say, "Yes." Yet, here we are.
> It's functionally isomorphic to a black box where I make a deposit, every time it denies someone medical treatment I get back monetary reward and I can withdraw my deposit at any time. If we ask ourselves, "Should this black box exist?" I cannot reasonably expect people to say, "Yes." Yet, here we are.
I am honestly extremely baffled about what your mental model here is. When UHC doesn't deny a claim, who is paying for that treatment? You can't just look at one side of the ledger when deciding whether the system is doing good or bad! They deny some claims and they pay for others! You're leaving out the whole second half!
I omitted it because it doesn't change the calculus.
If the child were brought up into the sunlight out of that vile place, if it were cleaned and fed and comforted, that would be a good thing, indeed; but if it were done, in that day and hour all the prosperity and beauty and delight of Omelas would wither and be destroyed.
According to who? It changes the calculus for me. I pay my health insurance because it covers the services I need. I could absolutely opt out if I wanted to, but I don't.
> I pay my health insurance because it covers the services I need
I think that, aside from the cost, this is probably the biggest issue most people have with health insurance in the US. UHC makes a lot of money specifically in part by not covering services you need, for example by having accountants override your doctors's orders.
If it were as simple as getting the services you need in exchange for money, I don't think as many people would hate the system as much.
How many Go Fund Me sites were brought up because of high medical costs for some accident or cancer? Is foregoing insurance an improvement over that if it isn't even possibly one of the big causes?
And that the US is the only country in the world where hospital "deathbed divorce" is a thing, to try to avoid family being saddled with ship-anchor levels of debt.
No, it isn't, which is why people want some form of insurance, whether public or private. To mitigate risk.
I was entertaining the comment about something being as "simple as getting the services you need in exchange for money". Which one certainly could do, but imposing that on everyone would also be a bad system for other reasons.
You missed the point of my comment. The "services" I was referring to was "health insurance," and the "for money" is the monthly premiums.
In too many instances, people pay the premiums and then do not get the benefits of the insurance.
An analogy in the travel industry might be if we had a system where at random, a double-digit percentage of air travelers were denied boarding and not refunded their money. No amount of legalese would make it acceptable, and in fact Congress regulates air travel such that practices like this hypothetical are not allowed.
Yes, people should get coverage under the terms of their agreement. I'd guess that the reason this is an issue with health coverage is because the sums involved are great, and usually the people on either side of the argument are either (1) unwilling or unable to effectively argue their case or (2) nonexperts who lack full understanding of the subject matter.
These aren't really an issue with airline tickets, not because we don't regulate insurance, but because the contract is exponentially more simple and understandable.
Air travelers are not expected to have a full understanding of how to operate a jet airplane, or an airline, in order to not be cheated out of their fares. Similarly, they are not expected to plead their case in order to not be cheated by airlines.
I use the colloquial "cheat" intentionally, as it is a valid descriptor.
Notably, however: most insurance delays/denials will have in common that the patient is represented by an expert (a physician) on their case, while the insurer will be represented by a person who has typically never spoken with or examined the patient and may not have ever practiced medicine. The quality of the argument and expertise of the interlocutor are red herrings.
> Air travelers are not expected to have a full understanding of how to operate a jet airplane, or an airline, in order to not be cheated out of their fares.
Correct. But it doesn't matter because the contract of carriage doesn't hinge on that. There's no confusion about what a ticket actually entails. If a ticket covers "one ride at the airport, from Cleveland to Omaha", it's pretty understandable what you are getting. If health insurance was just as simple, and covered "one ride at a hospital, from sickness to health", it would be likewise as accessible. But it isn't that way (although maybe it should be a lot closer)
> Notably, however: most insurance delays/denials will have in common that the patient is represented by an expert (a physician) on their case, while the insurer will be represented by a person who has typically never spoken with or examined the patient and may not have ever practiced medicine. The quality of the argument and expertise of the interlocutor are red herrings.
I understand but that's not what I'm talking about here. I'm talking about a broader information and accessibility disparity.
Having a physician isn't any help if your insurer is deadlocking you on coverage you legally have coverage for, you need a lawyer. That's a contract law problem, not a healthcare problem.
But if you don't actually have coverage for what you need, having a physician argue that you need it, isn't going to help you. Most people buy their health insurance policy all by themselves, without any legal or medical help.
The system wasn't designed. There were no design choices. The entire thing is a legacy result of expectations and costs that all started snowballing from the moment FDR decided wage caps were a good way to stop inflation.
We're not in the situation we're in because anyone thought it was a good idea. We got here incrementally over ~80 years.
of course the system was designed. of course there were design choices. it's a system implemented and executed by human beings at every step, constantly. every functional atom of this implementation was a conscious choice by someone. if nothing else, a choice is constantly being made to persist with the present system.
yes the design is a result of negotiation between countless people and groups of people, who all have varying power and responsibility and subjective consequence. yes all of these choices were made in context, but they were never the only choices that could have been made in that context.
this negotiation, and these innumerable choices, these designs have been a major if not primary concern of the past twenty years of american politics, economy, and millions of individual lives.
yes we have arrived at the implementation we see today, which seems ill-conceived, over-complicated, and pointlessly cruel. but at every moment that has passed and is passing now, different choices can be made, and a different system of different design can be implemented.
we are still in this system because there is infrastructure that prevents change to a more agreeable system. negotiation tactics may have just changed.
Sure, the healthcare system is "designed and perpetuated" by all of its participants, in the same way that poor labor practices in Asia are perpetuated by Walmart cashiers.
Technically all of the participants involved are a part of the system, yes, but my key point here is that none of them have the agency to change it.
The only people who can change it are voters and congress themselves.
> The only people who can change it are voters and congress themselves.
Most of the participants in the system are eligible voters, so asserting that voters can change the system is very much asserting that nearly everyone in the system has agency to change it.
(The fact is “voters can change it” is optimistic, because the US is not a direct democracy and, due to gerrymandering, campaign finance, and other factors, only loosely a representative one, being functionally more of a plutocracy. The people who benefit from its inefficiencies and inequities have disproportionate power over its structure.)
Look, in any system, there are going to have to be arguments where patients or doctors say some treatment is necessary, and the entity paying for the treatment says it's not.
You will of course stick to your principles here? The single-payer healthcare systems in Canada and the UK are irredeemable and it's morally repugnant to look at any good they've done for anyone?
>in that day and hour all the prosperity and beauty and delight of Omelas would wither and be destroyed.
...and nothing of positive value would be lost. For a paradise predisposed on the infliction of suffering on another is ill-gotten, and taints anyone that avails themselves of it once it's true nature is known.
Our birthright is to toil to elevate one another; no more, no less. Omelas is a blight, a perversion, deserving of being scoured from the face of the Earth no matter where it pops up.
Glad to see someone else was touched by that work. Greetings fellow wanderer.
I never thought I would be defending health insurance providers yet here we are.
Do you honestly, after reflection, think this comment is fair?
They don’t only deny healthcare to people - if that was true no-one would pay them money because having healthcare would be no different to not having healthcare. Therefore they are not functionally isomorphic to a black box that collects money when it denies medical treatment.
If you want to make a mental model and then ask questions of the model you should have the confidence to make your model robust enough to approximate the “other side” of whatever argument exists on the topic.
Private health insurance in a country that has a robust public option is an entirely different thing because that baseline level of care means that the private providers have to offer something substantial above and beyond the baseline to justify their continued existence. People with medical needs can choose to tell them all where to stick it and still live without going in to debt.
Most insured individuals in America don't choose their health insurance provider, they just get it from their employer where they might have a choice of plans. The closest thing to an actual competitive insurance market we have is that provided by the ACA, and though that act did many good things the disappointment of the marketplace has been well documented.
Your argument would be stronger if your black box mental model wasn’t so obviously exaggerated.
I live in the UK where we have universal healthcare that is free at the point of need. We also have private healthcare. In most countries in Europe both private and public healthcare exist side by side. Per capita spending on healthcare (across the private and public provision) in the UK is a tiny fraction of what it is in the US and outcomes in terms of quality adjusted life years and measured in individual life expectancy and patient outcomes for given conditions were significantly better than the US last time I checked (which is admittedly a while ago).
The US healthcare system is definitely expensive and delivers a poor outcome, but you’re not convincing when you try to make a pastiche of the system that paints it as purely bad and say that health insurance simply should not exist for pure moral reasons.
If a system constantly fails to do what it was intended to do, then we should consider that what it does in reality is its true purpose. Basically this is functional structuralism.
I understand what it means. I think it is a silly maxim, because it is unnecessarily reductive. Employer sponsored healthcare insurance wasn't ever intended to be a good system for providing healthcare to people, it was popularized as a workaround for employers to raise wages during the Stabilization Act of 1942. Everything that has changed since then has been incremental changes for differing reasons. The idea that a huge system like this even has a single "intent" is ridiculous. It is made up of thousands of different actors, each in different situations with different intents and interests.
But we aren't talking colloquially, we're talking about within the maxim. I'm trying to give you the benefit of the doubt, but it feels like you're doubling down in order to prove a point.
The maxim, applied here, is an obtuse oversimplification of the problems with the health insurance system, and the barriers to changing it.
Yes, if we could wave a wand and delete the fact that it ever happened, that would be ideal. But the problem is more difficult to solve now, because we have the problem of the health insurance system, and the problem of drastic systematic and economic change.
In my experience, choices to label opposition as either reductive or overly complex are largely rhetorical. They don't pass the validity test.
Perhaps we should ask borrow the "magic wand" that seems to exist for every other country. Maybe they can lend us theirs since that's apparently how realistic a system that does not bankrupt people is.
Sadly, it doesn't seem equally possible or realistic to build a system where CEO's aren't revenge murdered.
Isomorphic in normal use means corresponding in form[1], so functionally isomorphic means “functions the same as” whereas there are other types of isomorphisms, so for example minerals form groups which are considered isomorphic because their crystal structure is somewhat different but equivalent. They’re not functionally equivalent they are structurally similar.
[1] In mathematics the meaning is somewhat stronger. In maths, two things are isomorphic if they cannot be distinguished in terms of structure in a particular context.
The immoral part is the care not provided to paying customers. Care denied, people made to hop through needless hoops at a time when they are already in distress. Delays and denials that cause suffering, they cause deaths. This is the immoral part.
This rather ignores the role of health "insurers", third party administrators, repricing specialists and every other middle man that contributes more significantly to the price of healthcare than the actual cost of providing that care.
Managed care organizations (MCOs, health insurers), retail pharmacies, and medicine distributors at the very bottom. ~2%
Legal is also up there. Those millions and tens of millions of dollar judgments don’t come from thin air.
Go ahead and get rid of MCOs, and at best you will reduce costs by 5%. Their medical loss ratios are 85% to 90%.
They are just allocating the very limited resources among more and more demand. Someone is going to have to be the bad guy unless supply of healthcare is drastically increased and tort reform happens to bring down liability costs.
> They are just allocating the very limited resources among more and more demand.
Are you saying that the same populations are getting more and more sick and ill? Citation needed for that. Or are they costing more and more money? And if so, why?
Wouldn't be health insurers setting up middlemen of their own (PBS, etc.) to get around legal caps on their own profit margins, would it?
> Legal is also up there. Those millions and tens of millions of dollar judgments don’t come from thin air.
Malpractice payouts are by and large a boogey man. Texas has had them capped for years and shockingly, malpractice insurance costs are effectively identical to what they were before. As an aside, malpractice insurance in itself isn't typically as onerous as people believe it to be. What is onerous, and what that industry does differently to most other insurance segments is "tail insurance".
Tail insurance is the concept that major malpractice suits may appear well after your claims-made liability policy has ended. In most cases it's actually DOUBLE the premium you're paying for malpractice insurance, implying the insurer believes that your coverage is less than one-third of the claims they expect to pay. What -should- happen is that you carry "claims-made and prior acts" coverage. The challenge there is that in many cases your employer will cover claims-made as part of your compensation or part of their insurance, but don't elect prior acts coverage (and because of the way they do it, I suspect it's not as simple as "let me pay the difference").
But in general capping malpractice payouts has done nothing to offset malpractice coverage costs, let alone flow-through to end consumer costs.
> Are you saying that the same populations are getting more and more sick and ill? Citation needed for that. Or are they costing more and more money? And if so, why?
The citation is the population pyramid flattening out and turning upside down eventually. That means more and more old (and hence sick) people, and fewer and fewer care providers (young people). Also, there are a lot more treatment option, and sick people being kept alive longer.
> Wouldn't be health insurers setting up middlemen of their own (PBS, etc.) to get around legal caps on their own profit margins, would it?
No, absent enormous fraud, all revenue and expense is reflected on a company’s 10-K. UNH/Elevance/Cigna/Humana/CVS/etc all have multiple lines of business (like most other large businesses), but the final profit margin figures are what they are including all lines of business.
Thanks for the info on tail insurance, I didn’t know that.
1. Who decides what care is "needed"? Everyone is going to die eventually. I have a relative who believes they "need" ivermectin to prophylactically safeguard against contracting covid. Are insurance companies obligated to provide ivermectin to everyone who demands it, or should they apply some standard of efficacy and cost/benefit analysis?
2. Profits to shareholders and other people contributing their time and resources are also "needed", as without profits the only incentive to provide healthcare is charity, and charity has not proven to be an effective organizing principle to allocate the time and attention of millions of individuals in a complex society.
Insurance companies refusing valid, evidence-based treatments != denying unproven demands. Likewise, framing healthcare as either for-profit or purely charitable ignores successful state-driven models worldwide that operate without prioritizing shareholder returns. Such false dichotomies and misdirection don’t justify profit-driven rationing of essential medical services.
Medicine is still more art than science. We only have clear evidence-based treatment guidelines for a limited set of conditions, and even with those there are a lot of exceptions. While health insurers do occasionally make egregious errors in denying claims or prior authorization requests, most of those fall into gray areas. Like if a patient is immobilized by severe hip pain should they go straight to joint replacement surgery or try physical therapy for a few months first? Ask 10 different physicians and you'll get 10 different treatment plans.
And health insurers don't increase shareholder returns by denying claims. Due to the minimum medical loss ratio it's rather the opposite. Most of the pressure to tighten coverage rules actually comes from large self-funded employers who use those insurers not to provide insurance but rather to administer their health plans.
> Who decides what care is "needed"? Everyone is going to die eventually.
When the decision maker is accountant, RN, or AI versus physician, I know who _shouldn't_ be deciding it.
The two experiences I've seen first hand (coincidentally both UHC):
A willingness to deny vastly improved QOL for a simple surgery unless I spend an extended amount of time to determine whether somehow, a nasal spray would straighten the cartilage of a 95% deviation to the septum.
As a paramedic, the realization that UHC routinely denied paying for HEMS (air ambulance) for serious car accident patients to trauma centers because of "lack of pre-authorization".
Most people don't decide about their own medical "needs." They trust doctors, who are by and large expert and professional, yet frequently discredited by insurance companies.
Insurance companies have too much power in this dynamic, and there should be limits to what they can deny once doctors deem it needed.
On a slight tangent I’m a bit confused by Reddit type internet reaction acting like this guy is an evil mastermind of the insurance industry while he was apparently making $10M per year.
Now that’s definitely a lot of money, but as far as industry masterminds go it’s not indicative of being top tier at all. Second or maybe third tier really.
Is it the sort of situation where the company has 10 people all labeled “CEO” of different functions? Or was the $10M salary alone?
It has 52 million clients, but how much care was provided to clients is the open question that could be debated. It's certainly one of the big thoughts going around that the company denies payment for service unjustifiably and causes suffering for some number of these 52 million. Whether or not that's true is one of the questions for consideration in these debates.
This is a ridiculous reduction. It's clear that the numbers matter here, and that one family's decisions are nothing compared to the harm this CEO can create or prevent.
> By this same logic, you are responsible for the death of every person who could have been saved by you donating (...)
A healthcare provider makes a very important but simple offer: you pay us,and in exchange you grant you access to the medical treatments you need when you need it. They commit to provide that service.
If you meet your end of the deal without any flaw and, in the very moment you need them to comply with their own offer, they deny you the service they promised you that you would have, do you agree the are responsible for you not having access to that treatment?
Let's put it another way. Let's say you want to travel to some other place in your town to attend a meeting. You look up a taxi company advertisement, and you call them to arrange a ride. They say sure, you just need to pay us and you'll be taken from point A to B. You arrange your payment and wait for the cab. The cab arrives, but the driver tells you "well, I was looking at the travel plan and I decided I don't feel like driving you there", and drives off with your money. Is that taxi company responsible for you failing to attend the meeting?
A healthcare provider has a special responsibility because of the nature of their work. By definition, their role involves providing essential care to those in need. Their professional mission and the ethical codes guiding them (e.g., the Hippocratic Oath for physicians) emphasize patient welfare above all. An average person, while still morally capable of altruism, does not have a professional, codified duty to care for others’ health as a primary function of their life. They are not the designated or societally recognized gatekeepers of life-saving services.
In short, it’s not just about the availability of money; it’s about the nature and structure of the activity. Healthcare isn’t merely a commodity; it’s a critical social good. The moral expectations for an industry entrusted with people’s lives are and should be different from those applied to random private individuals.
Healthcare providers, especially large corporations, control access to life-saving goods and services. When such entities profit substantially, they do so from a position of gatekeeping essential health resources. They often have significant market power and can influence prices, accessibility, and quality of care. This is categorically different from an individual’s personal discretionary spending, which does not impose direct barriers between people in need and the care required to save their lives. The moral outrage about profit in healthcare often centers on the idea that unnecessary suffering or death occurs not because of a lack of resources in general, but because of a deliberate choice to prioritize profit margins over patient well-being. When an individual chooses to keep their discretionary income rather than donate it, that is not typically a case of withholding a life-saving resource they directly control. It’s a missed opportunity for altruism, yes—but it’s not a systematic withholding of lifesaving treatment from a dependent patient population.
The more direct your ability to help and the more acute the need, the stronger the moral obligation. A hospital that can provide a life-saving drug at a lower price but chooses not to, in order to maximize profit, is directly and immediately impacting patients’ lives. In contrast, an ordinary person’s failure to donate their personal entertainment budget to global health charities is morally less direct and involves a much more diffuse causal chain. The responsibility is mitigated by lack of proximity, lack of direct obligation, and lack of any professional or social contract stating that their role is to provide healthcare.
Your argument tries to equate personal, optional altruism with the professional moral obligations of healthcare providers, but these are not parallel situations. The ethical landscape is more nuanced: Institutions and professionals whose entire function is to safeguard and restore health must be held to a standard consistent with that mission. This does not require expecting every individual to donate all surplus income, nor does it demand that healthcare only be provided by charities. It simply recognizes that the context and nature of healthcare services place a different and higher ethical obligation on those who profit from them.
> The more direct your ability to help and the more acute the need, the stronger the moral obligation. A hospital that can provide a life-saving drug at a lower price but chooses not to, in order to maximize profit, is directly and immediately impacting patients’ lives. In contrast, an ordinary person’s failure to donate their personal entertainment budget to global health charities is morally less direct and involves a much more diffuse causal chain. The responsibility is mitigated by lack of proximity, lack of direct obligation, and lack of any professional or social contract stating that their role is to provide healthcare.
"Proximity". What evasion. Apparently healthcare workers are responsible for dedicating their entire lives to saving others, profit be damned, but you aren't culpable for depositing money into your savings account becuase you went into software. Hahaha, how absurd. At least the EA people/Peter Singer are consistent.
We have moral concepts to figure this stuff out and to avoid worrying about a "diffuse causal chain". Concepts like an "action" or "intent". When you apply these concepts to this situation, it becomses clear that neither insurance companies nor healthcare providers are going around murdering people. But the guy waiting outside a conference with a gun did.
So you are subject to a looser standard of ethics and morality since you didn't go into healthcare, but you are entitled to demand that the people who did go into healthcare practice a higher standard of ethics than you would hold yourself to?
In that case, I don't care about your opinion very much.
Food is even more essential than healthcare. It's a critical social good. Do farmers and grocers therefore have a special responsibility because of the nature of their work?
Do you remember a couple of years ago when grocers were still operating when everything else was shut down because they were considered critical workers during a global pandemic?
I mean come on, it wasn't even that long ago did you forget?
> By this same logic, you are responsible for the death of every person who could have been saved by you donating all of your income beyond basic living expenses (your personal "profit", if you will) to pay for their medical care.
To a degree yes, absolutely. If moral actions “improve the valence of conscious experience” in some utilitarian sense, most people take a lot of immoral actions every day. When you think of morality as more of a direction rather than an absolute “you either are or are not a sinner,” you can view the average person, and yourself, as deeply immoral, yet still get value from the understanding because you know the correct direction to move in if you want to improve yourself or society.
With this definition, it’s easy to compare the morality of two people. To what degree did each exercise agency in order to either neglect a responsibility to do good, or to actively do harm? The person who deliberately did more harm could be said to be worse in their moral character.
Now imagine a person chooses to become the head of a health insurance company in order to make large amounts of money, while aware of the fact that their industry produces profit by minimizing the coverage they pay out and that this will inevitably deny some people who ought to get coverage coverage; and, furthermore, that this wrongly denied proportion is much higher than it needs to be in order for their company to exist and pay its costs.
Now imagine that, in response, this person actively uses their agency to worsen their company’s contribution to this situation for the gain of themselves and other relatively wealthy higher-ups at their company instead of taking any action within their means to better the situation. We can reason that this person is, when you sum up the raw quantity of harm they’ve deliberately caused, morally worse than the average person, who will likely have done vastly less deliberate harm over their life. Is an extrajudicial murder the solution? Probably not, in that it won’t directly produce the needed changes to move society in a marginally more moral direction. That being said, I sure won’t be shedding any tears, and I’ll shed much less than I would for an absolutely morally mediocre Joe Schmoe.
They both do and don't simultaneously. Schrödinger's Responsibility. When the company makes money or does something good, it's because of the CEO's leadership...they are responsible because they are in charge. When the company loses money or does evil/bad, then the CEO has nothing to do with it, and instead it's either the fault of government, lone wolf low-level employees, customers, external factors, "economic trends", anything but themselves
I used to work for a company that wrote software for health insurers to run their businesses, from determining financial responsibilities and amounts, all the way through cutting checks to providers, handling repricing, everything.
I wish I could say I got out of there for ethical reasons (there were good reasons, but if that was the only...)
We did a LOT to be ethical. The amount of requests we turned down from our customers - "If we have a database of familial relationships (who knows what, or from where, be it public records or 23andme), how can we mine the database with that information to determine people's predisposition to certain conditions based on familial diagnoses?"
"You can't."
"Why not, it's in the database?"
"Yes. But that is federally illegal for you to do. And if it's illegal for you to do, we are not going to facilitate it either."
But the writing was on the wall, I'm sure at some point there would be more and more "grey areas".
The assumption by insurance commissioners (elected officials) is that private insurance will result in better outcomes in the long term, and profit margins are regulated and this is the will of the voters.
... Now that doesn't mean it is true, and health insurance in the US is completely broken, but it is not at all obvious who is at fault here.
Do you know why I don't work for a _for profit_ health insurance company, who's stated goals are explicitly to make profit by slicing out some amount of premiums that are not spent to provide healthcare in a world in which total health expenditures can be* effectively infinite? Same reason.
Also this tends to do it for me: https://arstechnica.com/health/2023/11/ai-with-90-error-rate...
Do CEOs run companies or don't they?