5 ms·

> Or if all medical data was public, we'd have a medical revolution in understanding. No, your insurance premium would go up. That's it

by Faaak 5y ago

misja111 5y ago
Why? It could also go down.
- nerdponx 5y ago
  Because there's no incentive for them to reduce prices.
  - lotsofpulp 5y ago
    There are many competing managed care organizations (health insurers). Healthcare cost increases slowed down after ACA: https://www.cbpp.org/blog/more-evidence-of-post-aca-slowdown-in-health-care-spending https://www.cbpp.org/blog/more-evidence-of-post-aca-slowdown... https://www.npr.org/2019/12/23/790687286/examining-health-care-spending-since-obamacare https://www.npr.org/2019/12/23/790687286/examining-health-ca...
    - nerdponx 5y ago
      I believe the research, but I doubt the ACA slowed down increases due to competition. The studies you linked don't show evidence of it either. Most people do not get to shop for insurance. Individual market plans are all similarly and eye-wateringly expensive (last I checked). And people getting health coverage through work are lucky if they have even two insurers to choose between. Therefore I don't see any reason why insurance companies would uniformly lower their "baseline" premiums when given access to more information. If they were all competing for your business like car insurance, homeowner insurance, etc. things would be very different.
      - lotsofpulp 5y ago
        My claim is that the rate of increase in healthcare costs decreasing is evidence that there is incentive to offer the lowest price possible (and health insurance premiums are a function of healthcare costs). If there was no incentive to offer lower pricing, then it does not make sense that healthcare costs would have slowed down when the number of people receiving healthcare greatly increased after ACA. Also, health insurance is not like other insurance, and it is barely insurance at all. Over a lifetime, almost everyone will need healthcare, unlike car insurance and home insurance. Due to ACA's various rules around how health insurance can be priced and who it has to be offered to (everyone), health insurance company is actually a misnomer. I prefer to use the industry term managed care organization (MCO), as it more accurately encompasses the function of what is colloquially known as a health insurance company. The price for individual market plans (which I assume you mean those on healthcare.gov) and the price for employer sponsored ones where the insurer is the one insuring the risk are all priced similarly, and they are eye wateringly expensive because healthcare is expensive. Employers also shop around for premiums with various MCOs, they don't just choose one. The self insured employers (who pay for the healthcare themselves and just pay the MCO for access to pricing and administration of the health plan itself. I have never heard of anyone choosing between different MCOs at work, that would defeat the whole purpose and really complicate the non discrimination testing requirements. Either way, MCOs certainly do have to compete with each other for business, if they're selling insurance plus managed care services or just managed care services. And so they cannot just lower or raise premiums at their whim. Bottom line is they do have an incentive to offer competitive pricing, it is not a high margin business to begin with.
lotsofpulp 5y ago
In the US, health insurance premiums are (by law) based on age, location, and smoking status only. Highest premiums (age 64) are capped at 3x the premium of ages 21 to 24.
- brianwawok 5y ago
  The 3x cap is not universal, and what it ultimately does is raise the price of insurance for younger and healthier groups. Smaller groups are exempt from that requirement. Since my company skews younger/healthier than the average company (hey we are a startup after all, new to this) - we are able to join a state commerce association and get rates calculated on our actual risk, which saves us roughly half over the national pool. I think it also takes full medical history into account, to again give us lower rates. But of course the global effect of this, is as younger and healthier groups leave the national pool - those left gets even HIGHER rates, as the super profitable healthy young people are gone. And the more the global pool rates go up, the more people pull out. Until the national pool is only sick and old groups, with insane rates.
  - lotsofpulp 5y ago
    Yes, that was one of the unfortunate compromises that had to be made to get ACA passed. We could not get taxpayer funded healthcare passed, so they tried to dump everyone on the insurance market. Then the people that work at healthy, younger white collar firms balked at subsidizing others, so they were left out. We Americans are quite good at making systems that benefit others just enough to create plausible deniability, but with enough loopholes to evade helping shoulder the burden, if you are playing with the right cards.
    - deleted 5y ago
      [deleted]
    - brianwawok 5y ago
      Yah it's just a silly system. We need full universal healthcare. These other things are just a mess.
deleted 5y ago
[deleted]

> Or if all medical data was public, we'd have a medical revolution in understanding. No, your insurance premium would go up. That's it

by Faaak 5y ago

> Or if all medical data was public, we'd have a medical revolution in understanding. No, your insurance premium would go up. That's it

misja111 5y ago

Why? It could also go down.

nerdponx 5y ago
Because there's no incentive for them to reduce prices.
- lotsofpulp 5y ago
  There are many competing managed care organizations (health insurers). Healthcare cost increases slowed down after ACA: https://www.cbpp.org/blog/more-evidence-of-post-aca-slowdown-in-health-care-spending https://www.cbpp.org/blog/more-evidence-of-post-aca-slowdown... https://www.npr.org/2019/12/23/790687286/examining-health-care-spending-since-obamacare https://www.npr.org/2019/12/23/790687286/examining-health-ca...
  - nerdponx 5y ago
    I believe the research, but I doubt the ACA slowed down increases due to competition. The studies you linked don't show evidence of it either. Most people do not get to shop for insurance. Individual market plans are all similarly and eye-wateringly expensive (last I checked). And people getting health coverage through work are lucky if they have even two insurers to choose between. Therefore I don't see any reason why insurance companies would uniformly lower their "baseline" premiums when given access to more information. If they were all competing for your business like car insurance, homeowner insurance, etc. things would be very different.
    - lotsofpulp 5y ago
      My claim is that the rate of increase in healthcare costs decreasing is evidence that there is incentive to offer the lowest price possible (and health insurance premiums are a function of healthcare costs). If there was no incentive to offer lower pricing, then it does not make sense that healthcare costs would have slowed down when the number of people receiving healthcare greatly increased after ACA. Also, health insurance is not like other insurance, and it is barely insurance at all. Over a lifetime, almost everyone will need healthcare, unlike car insurance and home insurance. Due to ACA's various rules around how health insurance can be priced and who it has to be offered to (everyone), health insurance company is actually a misnomer. I prefer to use the industry term managed care organization (MCO), as it more accurately encompasses the function of what is colloquially known as a health insurance company. The price for individual market plans (which I assume you mean those on healthcare.gov) and the price for employer sponsored ones where the insurer is the one insuring the risk are all priced similarly, and they are eye wateringly expensive because healthcare is expensive. Employers also shop around for premiums with various MCOs, they don't just choose one. The self insured employers (who pay for the healthcare themselves and just pay the MCO for access to pricing and administration of the health plan itself. I have never heard of anyone choosing between different MCOs at work, that would defeat the whole purpose and really complicate the non discrimination testing requirements. Either way, MCOs certainly do have to compete with each other for business, if they're selling insurance plus managed care services or just managed care services. And so they cannot just lower or raise premiums at their whim. Bottom line is they do have an incentive to offer competitive pricing, it is not a high margin business to begin with.

lotsofpulp 5y ago

In the US, health insurance premiums are (by law) based on age, location, and smoking status only. Highest premiums (age 64) are capped at 3x the premium of ages 21 to 24.

brianwawok 5y ago
The 3x cap is not universal, and what it ultimately does is raise the price of insurance for younger and healthier groups. Smaller groups are exempt from that requirement. Since my company skews younger/healthier than the average company (hey we are a startup after all, new to this) - we are able to join a state commerce association and get rates calculated on our actual risk, which saves us roughly half over the national pool. I think it also takes full medical history into account, to again give us lower rates. But of course the global effect of this, is as younger and healthier groups leave the national pool - those left gets even HIGHER rates, as the super profitable healthy young people are gone. And the more the global pool rates go up, the more people pull out. Until the national pool is only sick and old groups, with insane rates.
- lotsofpulp 5y ago
  Yes, that was one of the unfortunate compromises that had to be made to get ACA passed. We could not get taxpayer funded healthcare passed, so they tried to dump everyone on the insurance market. Then the people that work at healthy, younger white collar firms balked at subsidizing others, so they were left out. We Americans are quite good at making systems that benefit others just enough to create plausible deniability, but with enough loopholes to evade helping shoulder the burden, if you are playing with the right cards.
  - deleted 5y ago
    [deleted]
  - brianwawok 5y ago
    Yah it's just a silly system. We need full universal healthcare. These other things are just a mess.

deleted 5y ago

[deleted]