5 ms·

The risk pool should be as large as possible, the whole country, to minimize costs for everyone. It's deeply unfair to tell someone that lost their job that th

by fsmv 2y ago

The risk pool should be as large as possible, the whole country, to minimize costs for everyone. It's deeply unfair to tell someone that lost their job that they also now have no access to healthcare.

mgh95 2y ago
> The risk pool should be as large as possible, the whole country, to minimize costs for everyone. The risk pool being larger does not necessarily improve the risk pool.
- SketchySeaBeast 2y ago
  Shouldn't insurance risk pools be trying to move towards the large and average? This allows insurance to be more resilient to sudden changes in health by accepting that people are going to get sick. I don't know how having tiers of health care with low risk pool and high risk pools would be advantageous to anyone but the young and healthy who inevitably become the old and sick, which is painfully short term thinking for the former and unfairly punishing for the latter.
  - mgh95 2y ago
    No, the risk pools should not be "trying to move towards large and average". The insurers should be utilizing their market position to incentivize both employers and employees to adopt practices that reduce healthcare needs. One instance of this is smoking. Insurers charge more towards groups with smokers, and groups signing up based upon smoking policies of the employer (prohibition on smoking) can result in significant discounts to the group. Ultimately, we are a rather unhealthy country. We really need to figure out effective ways to utilize financial incentives to either (1) get people healthier or (2) defray the increased costs due to characteristics which may be addressed through habit changes, such as smoking and obesity.
    - SketchySeaBeast 2y ago
      > The insurers should be utilizing their market position to incentivize both employers and employees to adopt practices that reduce healthcare needs. They have no need to when they can simply deny claims or coverage. It seems strange to me that we should have private corporations shaming the public by acting as the arbiters of health. I agree that people have unhealthy habits, but some of these coverage items have nothing to do with personal choices. There are conditions people are born with or develop without being able to control them. The elderly need more care, and that's not fault of their own outside of simply living long enough.
      - mgh95 2y ago
        > They have no need to when they can simply deny claims or coverage. It seems strange to me that we should have private corporations shaming the public by acting as the arbiters of health. I agree that people have unhealthy habits, but some of these coverage items have nothing to do with personal choices. You can't deny claims to an obese person for a joint replacement. If it was part of the policy, you can't deny the treatment simply because someone had a condition they could have avoided if they had adopted different practices. > I agree that people have unhealthy habits, but some of these coverage items have nothing to do with personal choices. There are conditions people are born with or develop without being able to control them. The elderly need more care, and that's not fault of their own outside of simply living long enough. This is an area I do agree with to some extent: we should be much more discerning what we consider "preexisting" conditions; congenital heart defects from birth should be covered, but eating deep fried oreos every day for and washing it down with a handle of vodka shouldn't. This is generally not controversial to most laymen, however states such as CA (see: https://leginfo.legislature.ca.gov/faces/billVersionsCompareClient.xhtml?bill_id=202320240SB1008 https://leginfo.legislature.ca.gov/faces/billVersionsCompare...) outright limit the ability of insurers to impact consumer behavior. There needs to be a much more clear-eyed view of mutable vs. immutable characteristics and how we permit insurers to underwrite risk, and how we as a society perceive things such as genetic defects verus excess alcohol consumption. (to put it in perspective, insurers made 25B in profit in '23 (see: https://content.naic.org/sites/default/files/industry-analysis-report-2023-health-mid-year.pdf https://content.naic.org/sites/default/files/industry-analys...). Alcoholism cost 249B (see https://www.niaaa.nih.gov/publications/brochures-and-fact-sheets/understanding-alcohol-adverse-impact-health#:~:text=Alcohol%20misuse%20costs%20the%20United%20States%20about%20%24249%20billion%20per%20year.&text=In%20the%20United%20States%2C%20approximately,disorder%20(AUD)%20in%202023.&text=Globally%2C%20alcohol%20misuse%20is%20the,for%20premature%20death%20and%20disability https://www.niaaa.nih.gov/publications/brochures-and-fact-sh....), obesity cost 426B (see https://hrp.net/hrp-insights/report-obesity-cost-employers-and-employees-over-400-billion-in-2023/#:~:text=Billion%20in%202023-,Report%3A%20Obesity%20Cost%20Employers%20and%20Employees%20Over%20%24400%20Billion%20in,businesses%20and%20employees%20in%202023 https://hrp.net/hrp-insights/report-obesity-cost-employers-a....)) > The elderly need more care, and that's not fault of their own outside of simply living long enough. In my view, one of the big problems with the risk pool is young (myself included) buy catastrophic instead of health because of the 3x max charge on elderly. This is a nice to say, but the costs don't pencil out and this needs to be handled out-of-band for standard healthcare. Elder care is a problem, but it is one that can't be solved by risk pooling and is a contributing factor to typical healthcare premium increases. source for this: I work in the industry owning two (small) businesses in this area, and was looking to expand into insurance directly, and am running into the fact you can only do so much to limit costs on obesity and other things. It's a real problem that insurers can't actually reflect risk accurately.

by fsmv 2y ago

mgh95 2y ago

> The risk pool should be as large as possible, the whole country, to minimize costs for everyone. The risk pool being larger does not necessarily improve the risk pool.

SketchySeaBeast 2y ago
Shouldn't insurance risk pools be trying to move towards the large and average? This allows insurance to be more resilient to sudden changes in health by accepting that people are going to get sick. I don't know how having tiers of health care with low risk pool and high risk pools would be advantageous to anyone but the young and healthy who inevitably become the old and sick, which is painfully short term thinking for the former and unfairly punishing for the latter.
- mgh95 2y ago
  No, the risk pools should not be "trying to move towards large and average". The insurers should be utilizing their market position to incentivize both employers and employees to adopt practices that reduce healthcare needs. One instance of this is smoking. Insurers charge more towards groups with smokers, and groups signing up based upon smoking policies of the employer (prohibition on smoking) can result in significant discounts to the group. Ultimately, we are a rather unhealthy country. We really need to figure out effective ways to utilize financial incentives to either (1) get people healthier or (2) defray the increased costs due to characteristics which may be addressed through habit changes, such as smoking and obesity.
  - SketchySeaBeast 2y ago
    > The insurers should be utilizing their market position to incentivize both employers and employees to adopt practices that reduce healthcare needs. They have no need to when they can simply deny claims or coverage. It seems strange to me that we should have private corporations shaming the public by acting as the arbiters of health. I agree that people have unhealthy habits, but some of these coverage items have nothing to do with personal choices. There are conditions people are born with or develop without being able to control them. The elderly need more care, and that's not fault of their own outside of simply living long enough.
    - mgh95 2y ago
      > They have no need to when they can simply deny claims or coverage. It seems strange to me that we should have private corporations shaming the public by acting as the arbiters of health. I agree that people have unhealthy habits, but some of these coverage items have nothing to do with personal choices. You can't deny claims to an obese person for a joint replacement. If it was part of the policy, you can't deny the treatment simply because someone had a condition they could have avoided if they had adopted different practices. > I agree that people have unhealthy habits, but some of these coverage items have nothing to do with personal choices. There are conditions people are born with or develop without being able to control them. The elderly need more care, and that's not fault of their own outside of simply living long enough. This is an area I do agree with to some extent: we should be much more discerning what we consider "preexisting" conditions; congenital heart defects from birth should be covered, but eating deep fried oreos every day for and washing it down with a handle of vodka shouldn't. This is generally not controversial to most laymen, however states such as CA (see: https://leginfo.legislature.ca.gov/faces/billVersionsCompareClient.xhtml?bill_id=202320240SB1008 https://leginfo.legislature.ca.gov/faces/billVersionsCompare...) outright limit the ability of insurers to impact consumer behavior. There needs to be a much more clear-eyed view of mutable vs. immutable characteristics and how we permit insurers to underwrite risk, and how we as a society perceive things such as genetic defects verus excess alcohol consumption. (to put it in perspective, insurers made 25B in profit in '23 (see: https://content.naic.org/sites/default/files/industry-analysis-report-2023-health-mid-year.pdf https://content.naic.org/sites/default/files/industry-analys...). Alcoholism cost 249B (see https://www.niaaa.nih.gov/publications/brochures-and-fact-sheets/understanding-alcohol-adverse-impact-health#:~:text=Alcohol%20misuse%20costs%20the%20United%20States%20about%20%24249%20billion%20per%20year.&text=In%20the%20United%20States%2C%20approximately,disorder%20(AUD)%20in%202023.&text=Globally%2C%20alcohol%20misuse%20is%20the,for%20premature%20death%20and%20disability https://www.niaaa.nih.gov/publications/brochures-and-fact-sh....), obesity cost 426B (see https://hrp.net/hrp-insights/report-obesity-cost-employers-and-employees-over-400-billion-in-2023/#:~:text=Billion%20in%202023-,Report%3A%20Obesity%20Cost%20Employers%20and%20Employees%20Over%20%24400%20Billion%20in,businesses%20and%20employees%20in%202023 https://hrp.net/hrp-insights/report-obesity-cost-employers-a....)) > The elderly need more care, and that's not fault of their own outside of simply living long enough. In my view, one of the big problems with the risk pool is young (myself included) buy catastrophic instead of health because of the 3x max charge on elderly. This is a nice to say, but the costs don't pencil out and this needs to be handled out-of-band for standard healthcare. Elder care is a problem, but it is one that can't be solved by risk pooling and is a contributing factor to typical healthcare premium increases. source for this: I work in the industry owning two (small) businesses in this area, and was looking to expand into insurance directly, and am running into the fact you can only do so much to limit costs on obesity and other things. It's a real problem that insurers can't actually reflect risk accurately.