11 ms·

Is this good or bad from a societal point of view? It seems like a way to try to calculate and thereby eliminate risk, would be an overall beneficial thing. Bu

Is this good or bad from a societal point of view? It seems like a way to try to calculate and thereby eliminate risk, would be an overall beneficial thing. But then it also seems to make insurance less effective overall. Let's not think about big "evil" insurance companies for a moment. Say there are 10 Amish guys who want to form a risk pool to provide emergency health care for their families. They were just about to finalize the contract when one of them proposes that they take a medical exam beforehand. It transpires that one of them has lung cancer. Why would the other nine allow the poor guy to partake in their risk pooling? If you eliminate risk you also eliminate the need for insurance. This seems like a good thing. But then you also leave a bunch of people helpless. It's an interesting ethical question.

wfo 11y ago
Before the medical exam the reasoning would have been "any of us could have lung cancer. So we'll all pay so that the one person unlucky enough to have it doesn't have their finances ruined". After the medical exam the reasoning is "we already know who rolled the dice and lost. Fuck 'em, they can suffer on their own, us lucky ones will help each other out and throw the others to the wolves". I know which society I'd prefer to live in. The more we know about who is and is not going to need care the better we are able to see past the veil of ignorance and let our selfishness and greed make our decisions rather than our sense of fairness and community. Having the information certainly helps providers become more efficient, but that efficiency comes at the human cost of throwing anyone who gets sick under the bus. I'm not so sure health insurance should be allowed to be privatized in the first place; it almost inevitably leads to disgusting moral hazard and disaster. But it currently is privatized so I'd say any information private insurers get is a net loss for society.
x5n1 11y ago
The whole point or insurance is exactly to do what you have described. To pool risk. Insurers are hoping to reduce risk to increase profit while basically destroying the concept of insurance itself. This is exactly why insurance should by law be a non-for-profit enterprise. Making it a capitalist enterprise will always lead to these sorts of games.
dTal 11y ago
It is an interesting question. But why Amish?
kspaans 11y ago
That's my favourite argument for nationalized health care (insurance)! _Everyone_ pays the insurance and so the risks can be accounted for actuarially without leaving anyone behind.
- yummyfajitas 11y ago
  The problem with this is that it creates moral hazard. There are lots of individual acts which are fun that I might engage in (e.g., gluttony, gay sex, inactivity, smoking, drugs) but which impose potential costs on others. Why is it reasonable for me to enjoy these benefits while others pay the costs? One way to mitigate this would be with Singapore-style high deductible insurance - subsidies only kick in after you've spent 10-20% of your income on medicine. See also "too big to fail", federally subsidized flood insurance, student loan guarantees, etc, all of which have the same problem.
  - elipsey 11y ago
    >> gay sex I heard promiscuous straight people can catch AIDS too! No way that's really true though, right?
    - yummyfajitas 11y ago
      They can. It's just far less likely. http://www.cdc.gov/hiv/basics/statistics.html http://www.cdc.gov/hiv/basics/statistics.html Simple division (63% of HIV infections / 2% of population) / (25% of HIV infections / 98% of population) suggests gay sex is about 120x as risky as straight sex.
      - kspaans 11y ago
        I think you mean unprotected anal sex, not "gay" sex.
  - gambiting 11y ago
    >>The problem with this is that it creates moral hazard. There are lots of individual acts which are fun that I might engage in (e.g., gluttony, gay sex, inactivity, smoking, drugs) but which impose potential costs on others. Why is it reasonable for me to enjoy these benefits while others pay the costs? Does it not work the exact same way with private insurance? If you require treatment, you increase premiums for everyone, not just yourself. Anyway, I'm personally super happy with national insurance because I simply don't have to think about it. I know that if I need an operation, I will get one. I know that if I have an accident, and they need to send a helicopter to get me, I won't even see the bill for that. If I need to stay in hospital for the next year of my life, I won't see the bill. If I lose my job and become homeless I'm still going to be covered. I don't need to worry which hospital to go to, or which doctor/dentist can see me - they all can, there's no receipt produced, it's simply not a worry I have. Right now I pay about ~$100USD a month for the national health insurance, and it's an amount I am extremely happy to pay. Why would I care that other people are having accidents or smoking?
forgotpwtomain 11y ago
> Let's not think about big "evil" insurance companies for a moment. Say there are 10 Amish guys who want to form a risk pool to provide emergency health care for their families. They were just about to finalize the contract when one of them proposes that they take a medical exam beforehand. It transpires that one of them has lung cancer. Why would the other nine allow the poor guy to partake in their risk pooling? We aren't talking about big "evil" insurance companies, we are talking only about the measure of success in a capitalist economy - and from that point of view insuring the 10th guy will constitute a loss. On the other hand as a society we actually can afford to treat the 10th guy with cancer and if that we aren't doing so is an ethical failure not an economic one.
- npsimons 11y ago
  > On the other hand as a society we actually can afford to treat the 10th guy with cancer and if that we aren't doing so is an ethical failure not an economic one. Whatever else may be said about health care and insurance, I feel it boils down to two questions: can we afford to cover everyone, and should we?
  - pavel_lishin 11y ago
    If the answer to the first question is "yes", how could it be ethical to answer "no" to the second question?
    - jrs235 11y ago
      Fair answer. The question is, what amount or level of coverage is used to determine affordability. Should we, ethically, user resources to transplant a kidney in an 80 year old which might extend their life by 5 years or should we use those resources to treat more individuals with less severe issues that will likely extend their life for a longer period of time? Time and qualified doctors are limited resources. How do we determine how to allocate then? Where are we starting the line on what and when to treat certain conditions (and to determine affordability)?
cousin_it 11y ago
From a societal point of view, I feel that healthcare should be available to everyone regardless of ability to pay. That makes it more like redistribution than insurance. Describing it as "insurance" is just a way of selling the idea to people who believe in markets, and it backfires in exactly the way you describe when insurers begin to discriminate.
- ams6110 11y ago
  Exactly. We need to stop calling it "insurance" if that's not what it is.
- lisivka 11y ago
  I will damage my health a little just to stay in hospital forever for free.
  - efes 11y ago
    I would rather allow you to do that than require you to harm other people if you want to be provided for in an institutional setting.
mkj 11y ago
Even if it is beneficial, their calculations of risk will be imprecise causing unjust penalties.
aburan28 11y ago
What happens when they get a copy of your genome?

wfo 11y ago

Before the medical exam the reasoning would have been "any of us could have lung cancer. So we'll all pay so that the one person unlucky enough to have it doesn't have their finances ruined". After the medical exam the reasoning is "we already know who rolled the dice and lost. Fuck 'em, they can suffer on their own, us lucky ones will help each other out and throw the others to the wolves". I know which society I'd prefer to live in. The more we know about who is and is not going to need care the better we are able to see past the veil of ignorance and let our selfishness and greed make our decisions rather than our sense of fairness and community. Having the information certainly helps providers become more efficient, but that efficiency comes at the human cost of throwing anyone who gets sick under the bus. I'm not so sure health insurance should be allowed to be privatized in the first place; it almost inevitably leads to disgusting moral hazard and disaster. But it currently is privatized so I'd say any information private insurers get is a net loss for society.

x5n1 11y ago

The whole point or insurance is exactly to do what you have described. To pool risk. Insurers are hoping to reduce risk to increase profit while basically destroying the concept of insurance itself. This is exactly why insurance should by law be a non-for-profit enterprise. Making it a capitalist enterprise will always lead to these sorts of games.

dTal 11y ago

It is an interesting question. But why Amish?

kspaans 11y ago

That's my favourite argument for nationalized health care (insurance)! _Everyone_ pays the insurance and so the risks can be accounted for actuarially without leaving anyone behind.

yummyfajitas 11y ago
The problem with this is that it creates moral hazard. There are lots of individual acts which are fun that I might engage in (e.g., gluttony, gay sex, inactivity, smoking, drugs) but which impose potential costs on others. Why is it reasonable for me to enjoy these benefits while others pay the costs? One way to mitigate this would be with Singapore-style high deductible insurance - subsidies only kick in after you've spent 10-20% of your income on medicine. See also "too big to fail", federally subsidized flood insurance, student loan guarantees, etc, all of which have the same problem.
- elipsey 11y ago
  >> gay sex I heard promiscuous straight people can catch AIDS too! No way that's really true though, right?
  - yummyfajitas 11y ago
    They can. It's just far less likely. http://www.cdc.gov/hiv/basics/statistics.html http://www.cdc.gov/hiv/basics/statistics.html Simple division (63% of HIV infections / 2% of population) / (25% of HIV infections / 98% of population) suggests gay sex is about 120x as risky as straight sex.
    - kspaans 11y ago
      I think you mean unprotected anal sex, not "gay" sex.
- gambiting 11y ago
  >>The problem with this is that it creates moral hazard. There are lots of individual acts which are fun that I might engage in (e.g., gluttony, gay sex, inactivity, smoking, drugs) but which impose potential costs on others. Why is it reasonable for me to enjoy these benefits while others pay the costs? Does it not work the exact same way with private insurance? If you require treatment, you increase premiums for everyone, not just yourself. Anyway, I'm personally super happy with national insurance because I simply don't have to think about it. I know that if I need an operation, I will get one. I know that if I have an accident, and they need to send a helicopter to get me, I won't even see the bill for that. If I need to stay in hospital for the next year of my life, I won't see the bill. If I lose my job and become homeless I'm still going to be covered. I don't need to worry which hospital to go to, or which doctor/dentist can see me - they all can, there's no receipt produced, it's simply not a worry I have. Right now I pay about ~$100USD a month for the national health insurance, and it's an amount I am extremely happy to pay. Why would I care that other people are having accidents or smoking?

forgotpwtomain 11y ago

> Let's not think about big "evil" insurance companies for a moment. Say there are 10 Amish guys who want to form a risk pool to provide emergency health care for their families. They were just about to finalize the contract when one of them proposes that they take a medical exam beforehand. It transpires that one of them has lung cancer. Why would the other nine allow the poor guy to partake in their risk pooling? We aren't talking about big "evil" insurance companies, we are talking only about the measure of success in a capitalist economy - and from that point of view insuring the 10th guy will constitute a loss. On the other hand as a society we actually can afford to treat the 10th guy with cancer and if that we aren't doing so is an ethical failure not an economic one.

npsimons 11y ago
> On the other hand as a society we actually can afford to treat the 10th guy with cancer and if that we aren't doing so is an ethical failure not an economic one. Whatever else may be said about health care and insurance, I feel it boils down to two questions: can we afford to cover everyone, and should we?
- pavel_lishin 11y ago
  If the answer to the first question is "yes", how could it be ethical to answer "no" to the second question?
  - jrs235 11y ago
    Fair answer. The question is, what amount or level of coverage is used to determine affordability. Should we, ethically, user resources to transplant a kidney in an 80 year old which might extend their life by 5 years or should we use those resources to treat more individuals with less severe issues that will likely extend their life for a longer period of time? Time and qualified doctors are limited resources. How do we determine how to allocate then? Where are we starting the line on what and when to treat certain conditions (and to determine affordability)?

cousin_it 11y ago

From a societal point of view, I feel that healthcare should be available to everyone regardless of ability to pay. That makes it more like redistribution than insurance. Describing it as "insurance" is just a way of selling the idea to people who believe in markets, and it backfires in exactly the way you describe when insurers begin to discriminate.

ams6110 11y ago
Exactly. We need to stop calling it "insurance" if that's not what it is.
lisivka 11y ago
I will damage my health a little just to stay in hospital forever for free.
- efes 11y ago
  I would rather allow you to do that than require you to harm other people if you want to be provided for in an institutional setting.

mkj 11y ago

Even if it is beneficial, their calculations of risk will be imprecise causing unjust penalties.

aburan28 11y ago

What happens when they get a copy of your genome?