5 ms·

Great decision! What is the point of insurance if they can predict your health issues.

toomuchtodo 6y ago
To properly price the product. Otherwise, people at higher risk are subsidized more heavily by people at lower risk. This isn’t about healthcare insurance (which is protected against the use of DNA data by federal statute). If you’re at higher risk of early death or needing extended long term care, even through no fault of your own, shouldn’t you have to pay more for these optional products? That’s what insurance premiums are for: to appropriately price risk.
- cure 6y ago
  > To properly price the product. Otherwise, people at higher risk are subsidized more heavily by people at lower risk. But that's the very definition of insurance: spread the risk over the entire pool. US health insurance does not work this way, and it's part of the reason that system is so messed up and super expensive.
  - toomuchtodo 6y ago
    Life, disability, and long term care are not the same as health insurance (which shouldn’t be insurance! It should be universal healthcare). You insure against risk, you pay for care, just as you pay for gas in your car and oil changes, but your insurance covers accidents (which goes so far as to charge people of different genders and ages differently because of the risk demonstrated by the data). Should I be offended that my auto insurance charged me a crazy high premium for driving a high performance sports car at 18 years old as a single male? No! I was a high risk based on the data (which distilled down to my own risk management as then owner of an 18 year old male brain). And if the data (even genetic data) shows someone to be higher risk for an insurance product (again, we’re not talking health insurance or healthcare), they should be exposed to that cost. Life isn’t fair, and this is a poor attempt at tilting the scales if your goal is to make it more fair (considering the size of your risk pools at typical private insurers offering these products). It’s an unfunded mandate.
    - perl4ever 6y ago
      Your views, while very common, or at least commonly expressed, really bother me because of what seems to me like an obvious reductio ad absurdam. You can always take any existing regime of discrimination and make it more fine grained, but at some point that has to stop or there is no insurance. If discrimination has to stop somewhere, then there's no principled reason why the discrimination you like is necessary, or natural. Even apart from the existence of protected classes in society. If an insurance company can discriminate arbitrarily, why not do it in real time? Your car could have a monitor that would tell if you are tired or drunk. Would it make sense to allow them to charge you extra minute by minute? The ultimate would be to have the decelerometer that sets off your airbag signal the insurance company, and charge you based on the projected average repair cost before you come to a stop. Sometimes people say car insurance is like health insurance and sometimes they say it's not, but both have extensive regulation that prevents the insurance company from maximizing returns, because insurance is extremely susceptible to devolving into taking in money and paying 0% out. It seems fundamentally wrong headed to me to have in your mind an ideal of an untrammeled insurance market of any type, when it has to be heavily regulated to be of any use.
  - maxerickson 6y ago
    What's the 'pool'? You are implicitly arguing that it should be the entire population, but lots of people see it as a chosen group with identifiably similar levels of risks.
    - eirini1 6y ago
      it should, obviously, be the entire population.
      - maxerickson 6y ago
        For healthcare it's pretty clear cut. For a lot of types of insurance I don't think it is clear cut at all. (Note that the law in the article is about other types of insurance, not healthcare)
      - lotsofpulp 6y ago
        That’s called taxpayer funded healthcare, but US voters don’t want that.
        jschwartzi 6y ago
        I don’t think that’s true. What US voters don’t want is the level of care you get from a doctor who takes Medicaid. A single payer system can work here but because of how bad the “poor people doctors” treat patients it’s going to require some convincing.
        lotsofpulp 6y ago
        I don’t see US voters complaining about Medicare, which is basically taxpayer funded healthcare for hospitals after you’re 65. Medicaid is intentionally handicapped since it’s a poor person program and poor people don’t have good political representation.
        dragonwriter 6y ago
        > I don’t see US voters complaining about Medicare, which is basically taxpayer funded healthcare for hospitals after you’re 65. “For hospitals” is just Part A. And, “over 65 or disabled”.
  - umvi 6y ago
    Right, but people that have gotten into a lot of car accidents pay higher premiums than people with accident-free records. Insurance is not socialism. If my risk of getting into a car accident is low, shouldn't I pay low premiums? Why should I subsidize bad drivers?
    - isbvhodnvemrwvn 6y ago
      Why should you pay higher premiums for color of skin or sexual orientation? After all you don't choose these. Same goes for your DNA. I think we already have precedents which go further. With ADA you have to provide reasonable accommodation for disabled people. Some of them are disabled purely by chance, but some are disabled because they are dumb (they dived head on and are now on a wheelchair). No difference under that law.
      - deleted 6y ago
        [deleted]
      - toomuchtodo 6y ago
        In some circumstances (life, disability, and long term care insurance are not compulsory nor necessary in all situations), you should pay for risk you incur, whether by choice or not. This isn’t about race or sex (and the discrimination argument made), but the underlying genetics that present as those traits (and any risks, such as premature death or the need for extended assisted care, that come along for the ride). Using systems like social security and universal healthcare are better models if the desire is to ignore identifying and pricing risk (as insurance does) and spread the costs across the population with less admin overhead.
    - BobbyJo 6y ago
      I think the idea is to spread risk without promoting risk taking, therefore increasing total cost to society. Pricing risky behaviors I'm all for (speeding, accidents, smoking, obesity in most circumstances), as it lowers the cost to society by penalizing the behavior and shifting the burden of the extra risk to the risk taker. With DNA, there is no change in the total cost to be made, the people with the genes will still be around and still need care whether or not you help them pay for it... Unless the goal is to make it more expensive for people with 'bad' genes to procreate. There's an argument to be made for that, but good luck making it...
  - ptero 6y ago
    > But that's the very definition of insurance: spread the risk over the entire pool. But the devil is in the details, specifically in the definition of the "pool". To keep it fair (and subscription voluntary) generally requires pooling similar risk levels. Which is why for car insurance your driving record is important; for term life, your age and smoking status; etc. But at least in the US, health insurance is not really an insurance (as in your definition of spreading the risk of rare but expensive events); it is a complex monster touching negotiated pricing, access to care, etc.
  - bassman9000 6y ago
    Why is a red Corvette more expensive to insure than a white Camry?
- d33 6y ago
  > Otherwise, people at higher risk are subsidized more heavily by people at lower risk. This is basically how it works in Europe and it's fine. I see the concept of punishing people for how their body behaves deeply unethical. We can't control this, things happen randomly to many of us. Obviously you could sell cheap health insurances to people that you know will be healthy, but isn't this essentially a scam?
  - maxerickson 6y ago
    US long term care insurance is asset protection. The payer of last resort for things like nursing home care is Medicaid. If you don't have any assets, it starts paying right away. If you have assets, those go first, then Medicaid kicks in. So long term care insurance is for people that want to preserve their assets and/or receive care beyond what Medicaid will fund.
    - Spooky23 6y ago
      Long term care insurance is mostly a harebrained financial innovation that doesn’t work financially.
      - maxerickson 6y ago
        Fair enough.
  - NeutronStar 6y ago
    > but isn't this essentially a scam? No because you pay for what you get instead of for someone else.
  - smabie 6y ago
    Not anymore than selling cheap car insurance for safe drivers. But, in general, I'm not sure health insurance would work without risk pooling. A large part of the problem is that health insurance isn't exactly insurance: paying for medication that someone takes everyday doesn't really fit the definition. If we could start over from a clean slate, I don't see any reason why a health care system without insurance wouldn't work (it works it many other countries). But, as it stands, I fear that the only way we can fix our Healthcare problem is to implement single payer.
- gruez 6y ago
  Consider the most extreme case: what if their prediction is so good that they can predict the exact amount of healthcare spending that you will incur? In that case there wouldn't be any point in getting any insurance because the insurer will charge you the exact amount that you will cost (+ their overhead, of course). You'll be better off paying everything out of pocket.
  - o-__-o 6y ago
    A single bus can change all of that. It almost never pays to self insure unless you are fabulously wealthy
- tinus_hn 6y ago
  Otherwise it’s the same as having no insurance, but with extra steps. The people who can get insurance won’t be needing it and the people who need it can’t get it.
- hedora 6y ago
  Not disagreeing; what you said is “running an insurance company 101” The problem is that the logical extreme is eugenics (and DNA testing is making that a practical reality), except we have a weird carve out for people in the US that have a “proper” job. That’s why many (most?) people think it’s time to abolish private, for-profit health insurance.

To properly price the product. Otherwise, people at higher risk are subsidized more heavily by people at lower risk. This isn’t about healthcare insurance (which is protected against the use of DNA data by federal statute). If you’re at higher risk of early death or needing extended long term care, even through no fault of your own, shouldn’t you have to pay more for these optional products? That’s what insurance premiums are for: to appropriately price risk.

cure 6y ago
> To properly price the product. Otherwise, people at higher risk are subsidized more heavily by people at lower risk. But that's the very definition of insurance: spread the risk over the entire pool. US health insurance does not work this way, and it's part of the reason that system is so messed up and super expensive.
- toomuchtodo 6y ago
  Life, disability, and long term care are not the same as health insurance (which shouldn’t be insurance! It should be universal healthcare). You insure against risk, you pay for care, just as you pay for gas in your car and oil changes, but your insurance covers accidents (which goes so far as to charge people of different genders and ages differently because of the risk demonstrated by the data). Should I be offended that my auto insurance charged me a crazy high premium for driving a high performance sports car at 18 years old as a single male? No! I was a high risk based on the data (which distilled down to my own risk management as then owner of an 18 year old male brain). And if the data (even genetic data) shows someone to be higher risk for an insurance product (again, we’re not talking health insurance or healthcare), they should be exposed to that cost. Life isn’t fair, and this is a poor attempt at tilting the scales if your goal is to make it more fair (considering the size of your risk pools at typical private insurers offering these products). It’s an unfunded mandate.
  - perl4ever 6y ago
    Your views, while very common, or at least commonly expressed, really bother me because of what seems to me like an obvious reductio ad absurdam. You can always take any existing regime of discrimination and make it more fine grained, but at some point that has to stop or there is no insurance. If discrimination has to stop somewhere, then there's no principled reason why the discrimination you like is necessary, or natural. Even apart from the existence of protected classes in society. If an insurance company can discriminate arbitrarily, why not do it in real time? Your car could have a monitor that would tell if you are tired or drunk. Would it make sense to allow them to charge you extra minute by minute? The ultimate would be to have the decelerometer that sets off your airbag signal the insurance company, and charge you based on the projected average repair cost before you come to a stop. Sometimes people say car insurance is like health insurance and sometimes they say it's not, but both have extensive regulation that prevents the insurance company from maximizing returns, because insurance is extremely susceptible to devolving into taking in money and paying 0% out. It seems fundamentally wrong headed to me to have in your mind an ideal of an untrammeled insurance market of any type, when it has to be heavily regulated to be of any use.
- maxerickson 6y ago
  What's the 'pool'? You are implicitly arguing that it should be the entire population, but lots of people see it as a chosen group with identifiably similar levels of risks.
  - eirini1 6y ago
    it should, obviously, be the entire population.
    - maxerickson 6y ago
      For healthcare it's pretty clear cut. For a lot of types of insurance I don't think it is clear cut at all. (Note that the law in the article is about other types of insurance, not healthcare)
    - lotsofpulp 6y ago
      That’s called taxpayer funded healthcare, but US voters don’t want that.
      - jschwartzi 6y ago
        I don’t think that’s true. What US voters don’t want is the level of care you get from a doctor who takes Medicaid. A single payer system can work here but because of how bad the “poor people doctors” treat patients it’s going to require some convincing.
        lotsofpulp 6y ago
        I don’t see US voters complaining about Medicare, which is basically taxpayer funded healthcare for hospitals after you’re 65. Medicaid is intentionally handicapped since it’s a poor person program and poor people don’t have good political representation.
        dragonwriter 6y ago
        > I don’t see US voters complaining about Medicare, which is basically taxpayer funded healthcare for hospitals after you’re 65. “For hospitals” is just Part A. And, “over 65 or disabled”.
- umvi 6y ago
  Right, but people that have gotten into a lot of car accidents pay higher premiums than people with accident-free records. Insurance is not socialism. If my risk of getting into a car accident is low, shouldn't I pay low premiums? Why should I subsidize bad drivers?
  - isbvhodnvemrwvn 6y ago
    Why should you pay higher premiums for color of skin or sexual orientation? After all you don't choose these. Same goes for your DNA. I think we already have precedents which go further. With ADA you have to provide reasonable accommodation for disabled people. Some of them are disabled purely by chance, but some are disabled because they are dumb (they dived head on and are now on a wheelchair). No difference under that law.
    - deleted 6y ago
      [deleted]
    - toomuchtodo 6y ago
      In some circumstances (life, disability, and long term care insurance are not compulsory nor necessary in all situations), you should pay for risk you incur, whether by choice or not. This isn’t about race or sex (and the discrimination argument made), but the underlying genetics that present as those traits (and any risks, such as premature death or the need for extended assisted care, that come along for the ride). Using systems like social security and universal healthcare are better models if the desire is to ignore identifying and pricing risk (as insurance does) and spread the costs across the population with less admin overhead.
  - BobbyJo 6y ago
    I think the idea is to spread risk without promoting risk taking, therefore increasing total cost to society. Pricing risky behaviors I'm all for (speeding, accidents, smoking, obesity in most circumstances), as it lowers the cost to society by penalizing the behavior and shifting the burden of the extra risk to the risk taker. With DNA, there is no change in the total cost to be made, the people with the genes will still be around and still need care whether or not you help them pay for it... Unless the goal is to make it more expensive for people with 'bad' genes to procreate. There's an argument to be made for that, but good luck making it...
- ptero 6y ago
  > But that's the very definition of insurance: spread the risk over the entire pool. But the devil is in the details, specifically in the definition of the "pool". To keep it fair (and subscription voluntary) generally requires pooling similar risk levels. Which is why for car insurance your driving record is important; for term life, your age and smoking status; etc. But at least in the US, health insurance is not really an insurance (as in your definition of spreading the risk of rare but expensive events); it is a complex monster touching negotiated pricing, access to care, etc.
- bassman9000 6y ago
  Why is a red Corvette more expensive to insure than a white Camry?
d33 6y ago
> Otherwise, people at higher risk are subsidized more heavily by people at lower risk. This is basically how it works in Europe and it's fine. I see the concept of punishing people for how their body behaves deeply unethical. We can't control this, things happen randomly to many of us. Obviously you could sell cheap health insurances to people that you know will be healthy, but isn't this essentially a scam?
- maxerickson 6y ago
  US long term care insurance is asset protection. The payer of last resort for things like nursing home care is Medicaid. If you don't have any assets, it starts paying right away. If you have assets, those go first, then Medicaid kicks in. So long term care insurance is for people that want to preserve their assets and/or receive care beyond what Medicaid will fund.
  - Spooky23 6y ago
    Long term care insurance is mostly a harebrained financial innovation that doesn’t work financially.
    - maxerickson 6y ago
      Fair enough.
- NeutronStar 6y ago
  > but isn't this essentially a scam? No because you pay for what you get instead of for someone else.
- smabie 6y ago
  Not anymore than selling cheap car insurance for safe drivers. But, in general, I'm not sure health insurance would work without risk pooling. A large part of the problem is that health insurance isn't exactly insurance: paying for medication that someone takes everyday doesn't really fit the definition. If we could start over from a clean slate, I don't see any reason why a health care system without insurance wouldn't work (it works it many other countries). But, as it stands, I fear that the only way we can fix our Healthcare problem is to implement single payer.
gruez 6y ago
Consider the most extreme case: what if their prediction is so good that they can predict the exact amount of healthcare spending that you will incur? In that case there wouldn't be any point in getting any insurance because the insurer will charge you the exact amount that you will cost (+ their overhead, of course). You'll be better off paying everything out of pocket.
- o-__-o 6y ago
  A single bus can change all of that. It almost never pays to self insure unless you are fabulously wealthy
tinus_hn 6y ago
Otherwise it’s the same as having no insurance, but with extra steps. The people who can get insurance won’t be needing it and the people who need it can’t get it.
hedora 6y ago
Not disagreeing; what you said is “running an insurance company 101” The problem is that the logical extreme is eugenics (and DNA testing is making that a practical reality), except we have a weird carve out for people in the US that have a “proper” job. That’s why many (most?) people think it’s time to abolish private, for-profit health insurance.