3 ms·

Compare the costs of treating a lifetime of obesity-related health issues to one Rx. I doubt it comes out in favor of anything other than the one Rx.

salawat 3y ago
You don't get to make medical decisions for other people. That is unethical. Full stop. Don't even start on the anti-vaxx counterargument. That's them deciding to be stupid. Still does not entitle you, or make it ethical for you to force it on them against their will. Attempts at leveraging things like insurance policies is just low-key throwing money at the problem, and should be recognized as the form of class warfare that it is.
- LiquidSky 3y ago
  >You don't get to make medical decisions for other people. Welcome to the American employer-sponsored healthcare system where employers most certainly do by way of deciding what they're going to pay for covering.
- EA-3167 3y ago
  I don't understand how this is a reply to anything I said.
hendersoon 3y ago
Obviously that is true, but that isn't how insurance companies think. Imagine you're an obese 45 year old man working in a professional white collar job. You'll likely continue working for another 20+ years and switch jobs 1-3 times during that period-- switching insurance providers each time. Insurance providers are thus financially incentivized to think short-term, even though society as a whole (and that chunky guy in particular) are really obviously hurt in the long-term. That's one reason why the US healthcare system is broken. There are many others.
- shaftway 3y ago
  I don't buy that. Vasectomies are pretty much covered by every insurer, no questions asked, because it's massively cheaper than another kid. And health insurance is basically a monopoly. Anywhere you go you'll be in one out of maybe 3 insurers in your area. So in a vacuum, for each patient the prescription needs to be cheaper than maybe 50% of the cost of obesity (assuming there's a 33% chance that the patient will be yours in the future, rounded up for a few obesity-related costs in the short term). It'd have to be a really expensive drug for that to be the case. And if you make a deal with the other major players to all supply it then you go to 100% recoupment. It's far more likely that this is limited because obesity is seen as the patient's own fault. It's not like a broken arm that happened in a car accident where the other driver was drunk, you can't avoid that. But you can avoid eating another cookie, so the blame shifts to the patient.
  - nradov 3y ago
    A vasectomy is a cheap one time procedure. These drugs are expected to be taken forever. The total cost is tremendously different. Also note that while most private insurers will cover a vasectomy it isn't covered by Medicare. There has been a lot of consolidation among medical insurance companies, but they don't usually make the ultimate decisions on what to cover. Most large employers (group buyers) are self insured now and so the "insurance" companies no longer actually sell much insurance; mostly they just manage provider networks and administer claims (I am over simplifying a bit). Employers make coverage decisions based on costs, and the need to attract and retain good employees. Issues like fault or blame don't enter into it; you can't quantify fault or blame in a financial optimization spreadsheet. The extra costs of morbid obesity are heavily loaded towards older age groups. By that point many of the most expensive patients are no longer even in the labor force, let alone working for the same employer. So, it's tough for employers to justify covering many preventative treatments when the savings only show up many years later.
nradov 3y ago
Wegovy (semaglutide) and similar GLP-1 drugs are not just a one-time prescription. Most patients are likely to continue taking it forever. The trouble here is timing and alignment of incentives. The cost of those drugs is paid by medical insurers and self-insured employers (group buyers) today. But the cost savings benefits in terms of reducing type-2 diabetes and other obesity related conditions only show up years in the future. By that time the patient will have probably moved on to another employer and another insurer (maybe Medicare). So, absent some sort of legal or regulatory mandate it's going to be difficult to convince many employers to cover such drugs. (From a public policy standpoint it doesn't make much sense to tie medical insurance to employment, but that's another discussion.)

salawat 3y ago

You don't get to make medical decisions for other people. That is unethical. Full stop. Don't even start on the anti-vaxx counterargument. That's them deciding to be stupid. Still does not entitle you, or make it ethical for you to force it on them against their will. Attempts at leveraging things like insurance policies is just low-key throwing money at the problem, and should be recognized as the form of class warfare that it is.

LiquidSky 3y ago
>You don't get to make medical decisions for other people. Welcome to the American employer-sponsored healthcare system where employers most certainly do by way of deciding what they're going to pay for covering.
EA-3167 3y ago
I don't understand how this is a reply to anything I said.

hendersoon 3y ago

Obviously that is true, but that isn't how insurance companies think. Imagine you're an obese 45 year old man working in a professional white collar job. You'll likely continue working for another 20+ years and switch jobs 1-3 times during that period-- switching insurance providers each time. Insurance providers are thus financially incentivized to think short-term, even though society as a whole (and that chunky guy in particular) are really obviously hurt in the long-term. That's one reason why the US healthcare system is broken. There are many others.

shaftway 3y ago
I don't buy that. Vasectomies are pretty much covered by every insurer, no questions asked, because it's massively cheaper than another kid. And health insurance is basically a monopoly. Anywhere you go you'll be in one out of maybe 3 insurers in your area. So in a vacuum, for each patient the prescription needs to be cheaper than maybe 50% of the cost of obesity (assuming there's a 33% chance that the patient will be yours in the future, rounded up for a few obesity-related costs in the short term). It'd have to be a really expensive drug for that to be the case. And if you make a deal with the other major players to all supply it then you go to 100% recoupment. It's far more likely that this is limited because obesity is seen as the patient's own fault. It's not like a broken arm that happened in a car accident where the other driver was drunk, you can't avoid that. But you can avoid eating another cookie, so the blame shifts to the patient.
- nradov 3y ago
  A vasectomy is a cheap one time procedure. These drugs are expected to be taken forever. The total cost is tremendously different. Also note that while most private insurers will cover a vasectomy it isn't covered by Medicare. There has been a lot of consolidation among medical insurance companies, but they don't usually make the ultimate decisions on what to cover. Most large employers (group buyers) are self insured now and so the "insurance" companies no longer actually sell much insurance; mostly they just manage provider networks and administer claims (I am over simplifying a bit). Employers make coverage decisions based on costs, and the need to attract and retain good employees. Issues like fault or blame don't enter into it; you can't quantify fault or blame in a financial optimization spreadsheet. The extra costs of morbid obesity are heavily loaded towards older age groups. By that point many of the most expensive patients are no longer even in the labor force, let alone working for the same employer. So, it's tough for employers to justify covering many preventative treatments when the savings only show up many years later.

nradov 3y ago

Wegovy (semaglutide) and similar GLP-1 drugs are not just a one-time prescription. Most patients are likely to continue taking it forever. The trouble here is timing and alignment of incentives. The cost of those drugs is paid by medical insurers and self-insured employers (group buyers) today. But the cost savings benefits in terms of reducing type-2 diabetes and other obesity related conditions only show up years in the future. By that time the patient will have probably moved on to another employer and another insurer (maybe Medicare). So, absent some sort of legal or regulatory mandate it's going to be difficult to convince many employers to cover such drugs. (From a public policy standpoint it doesn't make much sense to tie medical insurance to employment, but that's another discussion.)