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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'l

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.

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.