They made a ridiculously complex and obscure system because it was insanely profitable. It's not really stupidity or maliciousness that's responsible, but simple greed.

Yea, we need a corollary to Hanlon: Never attribute to malice OR stupidity that which can be explained by greed.

Even a stopped clock is right twice a day. Stupidity can't explain why everything is wrong. The American healthcare system is so totally broken, and broken in ways which so consistently benefit the rich at the expense of everyone else, that I can't see any way it could come about by accident.

Never attribute to malice that which is adequately explained by stupidity. In this case stupidity is not adequate - obviously insurance companies know how to make this data usable, otherwise they couldn't exist. They have just chosen not to make the public format usable.

A little of column A, a little of column B.

If it’s stupidity, then I would assume they wouldn’t be making so much freaking money.

Healthcare software systems: the home office printers of software systems?

It's absolutely intentionally malicious, despite the individual employees not having much say... have you ever tried to bounce between calls to get information for an insurer from a hospital billing department? they can make vogons look efficient

I've spent hours trying to get an estimate for a inpatient surgery only to find out afterwards that the surgeon used a different billing code than the billing department gave me

then the insurance company won't cover it because it's not the billing code they cover, and the hospital won't change the billing code

I think there's plenty of malice in the system, for example https://www.propublica.org/article/cigna-pxdx-medical-health...

I agree, but is the design of the system malicious? I don't think so. It's just stupid, and exploited by malicious people.

There rarely are systems designed in a malicious way. Most malicious systems slowly get shaped actors to their advantage. In some cases (insider trading or corruption) the government steps in and stops the abuse by laws and regulation. In the healthcare system they aren’t doing this and are letting profit oriented players shape the system.

I don't think the billing system is malicious. But at the end of the day, each "provider" is given incentives to bill. They get promotions based on this. So the maliciousness is a distributed system that does not get codified at all.

It's the exact same thing as cops getting incentives for speeding tickets. Then you start getting more speeding tickets for 5 over instead of 10 over.

The amount of human labor involved in the US healthcare system, that has nothing at all to do with medical professionals helping patients, is astonishing.