8 ms·

Obesity is highly correlated with other medical conditions, from cancer to diabetes to heart disease. I wonder if there is a point at which it is cheaper for he

• aqme28 1y ago
  You’re thinking too highly about the incentives of the US healthcare system. Since insurance is tied to your employer (and therefore changing every few years), and most people die on Medicare, there’s not much incentive for insurance companies to pay for preventative care that won’t actually help you for several decades.
  • ethbr1 1y ago
    That’s one reason the ACA shifted it to a mandatory (in most cases) category: https://www.healthcare.gov/preventive-care-adults/ https://www.healthcare.gov/preventive-care-adults/ Minimal, but minimal progress in the US was/is still progress.
    • eru 1y ago
      It's a shame the contracts you'd need to set the right incentives are probably illegal.
  • helicalmix 1y ago
    hmm...doesn't this possibly incentivize ozempic subsidies even more? If you know a "customer" of yours (an individual employee) is only going to be with you until they either change jobs or go on Medicare, then it seems the name of the game then is to make sure that nothing catastrophic happens to them until you can hand them off to someone else. In which case, they should definitely go on ozempic. Even if the effects of ozempic immediately come off after usage, it's a short-term enough solution that benefits the insurance company, no?
    • vrc 1y ago
      Yes. For very high risk patients, payers do want this. I’ve even heard of some paying pharmacies $100/fill if done on time for select people. The problem is, prediabetic and folks who may have crossed 7.0 A1C once, and just overweight folks with docs who are willing to play fast and loose are demanding it. Skipping metformin and other first line treatment options that are way cheaper. For those folks, complications might be the next guys problem.
    • altcognito 1y ago
      If you were guaranteed 5% over the total cost of the medical services provided as profit, would you want people to have expensive or cheap medical. Are?
      • helicalmix 1y ago
        can you explain this statement to me more? I think i'm missing something
        • gangstead 1y ago
          The health insurance companies are paid as a percentage of the amount of care that flows through them. So healthier customers means their profit is 5% of SMALLER_NUMBER.
          • helicalmix 1y ago
            > So healthier customers means their profit is 5% of SMALLER_NUMBER. I don't think this is completely true right? Rather, it's more accurate to say that customers that are seen as healthier get to pay less premiums, but customers that are seen as unhealthy have to pay more. In both scenarios, you, as the insurance company, still want to be minimizing the amount of care you actually pay for. In other words, to maximize profits, it seems like the best customer is one that's high risk (high premiums), but less likely to require a catastrophic payout. In which case, it feels like an obese high risk patient on ozempic seems like a pretty solid deal.
  • Aurornis 1y ago
    > You’re thinking too highly about the incentives of the US healthcare system. Since insurance is tied to your employer (and therefore changing every few years) Most people don’t change jobs or insurance companies every few years. When they do, it’s often within similar regions and industries so the chances of ending up right back under the same insurance company are significant. Regardless, the issue is more complicated than your line of thinking. Insurance companies have very small profit margins. Current GLP-1 drugs are expensive, around $1,000 per month. So each patient on GLP-1 drugs costs an extra $12K per year (roughly) or $120K per decade. That would have to offset a lot of other expenditures to break even from a pure cost perspective, which isn’t supported by the math. So the only alternative would be to raise everyone’s rates. I know the insurance industry is the favorite target for explaining everything people dislike about healthcare right now, but at the end of the day they can’t conjure money out of nothing to cover everything at any cost demanded by drug makers. These drugs are super expensive and honestly it’s kind of amazing that so many people are getting them covered at all.
    • DrillShopper 1y ago
      I haven't changed jobs and I've had three different health insurance companies in as many years, all of which needed new prior auths for Trulicity/Mounjaro.
    • alphabettsy 1y ago
      A night in the hospital is easily $12k almost anywhere in the U.S. People with chronic health conditions spend an inordinate amount of time at the doctor and in hospitals. That could save a significant amount of money if that’s reduced or eliminated. Not to mention the time savings. I could be wrong, but all things being equal doesn’t it make sense to spend $12k/year on medication than $12/year on doctor and specialist visits in addition to medication?
      • rstuart4133 1y ago
        A one off anecdote here - I ended up in hospital for a TIA. I'm in Australia, and this is a public hospital. Free in other words. I have never seen so many seriously obese people in my life. They were all occupying hospital beds. I swear at least half the beds were use occupied by them. Meanwhile, we have ambulance lining the ramps of hospitals, with patients in them, waiting for bed to become free. To put the this in perspective, where I live spends about $10,000/yr/person on health. That's all kinds of health. I'm not sure $5,000/yr (which is about the price here) of GLP-1 would be a generate proportionate decline, but I would not write it off. The $10K is paid by everybody, the $5k would only be for the obese.
  • raldi 1y ago
    Then wouldn’t the government want to subsidize it?
    • gscott 1y ago
      Elon Musk suggested it. The fast food Industry has ppl addicted along with the lack of health education in schools.
      • eru 1y ago
        > [...] along with the lack of health education in schools. I don't think that's too much of a factor? I mean, check how much (or rather how little) people learn of the stuff that _is_ covered in school. Tweaking the curriculum would just mean that instead of not paying attention in algebra, students would not pay attention in 'health education class'.
        • Jalad 1y ago
          In my school there was a strong emphasis on what a healthy diet is baked into the curriculum. Along with my family's relatively healthy cooking, that set me up for cooking and eating well on my own through college and life after that. I would edge away from takes related to "it just wouldn't work" I mean the education system is its own mess for other reasons, but it's not a complete failure
          • eru 1y ago
            Maybe, though in your case, your family's cooking (and other background) probably already determined your fate.
      • NoMoreNicksLeft 1y ago
        The effectiveness of "health education" is somewhere between extraordinarily modest and nonexistent. It's not that people don't know what's healthy, it's that when it comes time to resist compulsion that is difficult, uncomfortable, and undesirable.
    • 1y ago
  • coredog64 1y ago
    This misunderstands how employer-provided insurance works for most people. Large employers sign up with a company like Cigna to provide a network and administrative process. But the actual healthcare is covered by the employer. So really, Cigna or BCBS don't really give a rip if you're taking a bunch of money out of the pool.
    • reverendsteveii 1y ago
      So what you're saying is when I file a claim and it's paid (precious miracle that that is) it comes from my employer and not the insurance company?
      • sgerenser 1y ago
        Most likely, if you’re in a medium to large company (not sure the cutoff, probably somewhere around 500-1000 employees). Smaller companies will generally actually need the insurance company to be the payer as well since otherwise one or two huge payouts could bankrupt them.
    • fn-mote 1y ago
      USA: That’s the case if your company is “self-insured”. Some are, some aren’t. I imagine there are financial requirements to self-insure but I’ve never looked.
  • darkwizard42 1y ago
    Actually from what I have heard, GLP-1 are maybe the first category of drugs which have impact within the median tenure of people on a medical plan (~2 years). It is so significant that you can see ROI within that window which justifies in subsidizing/encouraging patients to use it. Doesn't disagree with your original claim that there is low incentive for any private insurance to care regarding longevity, but figured I could add some color
• idontwantthis 1y ago
  [flagged]
  • hammock 1y ago
    Covered for the patient yes. For free, no.
    • idontwantthis 1y ago
      Are you disputing that the patient with insurance does not have to pay anything or raising a non sequitur about “someone” needing to pay for it?
• dragonwriter 1y ago
  > For example, my insurance covers flu shots in my community every year because it's presumably less expensive to pay for the shots compared to the increased rate of hospitalization that the flu causes. In the US, insurance companies are generally legally mandated to cover ACIP recommended vaccines at no cost to the insured, which includes flu vaccines for everyone six months or older without contraindications.
• jameshart 1y ago
  We have no idea what the long tern actuarial numbers are of 30 year GLP-1 use though.
  • alvah 1y ago
    Well no, obviously not, but we do have 20 years of data, and aside from a still-tiny-but-slightly-elevated thyroid cancer risk, there’s really not much showing up in that data.
• petesergeant 1y ago
  > I wonder if there is a point at which it is cheaper for health insurance companies to offer subsidized or even free GLP-1s to patients than pay out for other specialized medications. That the NHS is getting to a place where it’ll provide it, I’d say yes.
  • Aurornis 1y ago
    Everyone likes to bash the US healthcare system, but at the same time it’s remarkable how much subsidized GLP-1 access Americans are getting compared to much of the world. The paradox of discussing healthcare online.
    • petesergeant 1y ago
      > it’s remarkable how much subsidized GLP-1 access Americans are getting Mounjaro is between 25-50% of the US price in other countries
      • Aurornis 1y ago
        I was referring to insurance coverage. Most people aren’t paying that inflated price. Whenever you see a very large number for a medication or service in the United States, the patient doesn’t actually pay that number. Companies generally have separate coverage programs for people paying out of pocket that drastically reduces the patient pay amount. Those giant numbers attached to medications are virtually never paid by the patient.
        • petesergeant 1y ago
          It’s hard to find hard data on this but this[0] seems to think 20-30% of plans will cover for obesity. The Lily and Novo Nordisk coupons seem to have quite short availability windows, according to several years of reading the various related subreddits. The cost difference here is real. 0: https://www.goodrx.com/insurance/health-insurance/weight-loss-drugs-covered-by-insurance https://www.goodrx.com/insurance/health-insurance/weight-los...
• michaelbuckbee 1y ago
  Add heart disease and blood pressure meds to the list of "we'd be better off as a group if more people took them as preventatives".
• massung 1y ago
  I don’t know if your topic switch was intentional - if so, my apologies and this is just for people outside the US who don’t know… The article is about life insurance, which is very different from medical insurance. Medical insurance companies often already go out of their way to pay early to save in the long run (e.g. free preventative care, checkups, etc.). I can’t speak to GLP-1s, but it’s possible that right now there are still active patents when used for obesity that make them crazy expensive for a few more years. Life insurance is all about models and predictions about when you’re going to die. Any sudden change that massively impacts those models suck, because life insurers are basically gamblers with gobs of historical data they use to hedge their bets.
  • silotis 1y ago
    > Medical insurance companies often already go out of their way to pay early to save in the long run Literally LOLed when I read this. Health insurance companies might pay lip service to this and make some token gestures like free preventative care, but in my experience health insurance companies frequently shoot themselves in the foot by denying care that later ends up costing them even more when the patient's untreated condition worsens.
    • px43 1y ago
      The important part is the short term gains, and the people making them jumping away on a golden parachute before the long term consequences kick in.
    • jajko 1y ago
      Maybe true in US, but here in Europe ie my health insurance gives me rebate on my gym membership (any gym). With some more automated low cost gyms I can get back up to 50% back. This seems like a similar case.
  • _9ptr 1y ago
    It's not a gamble, it's an application of the law of large numbers. But yes, changes in the underlying assumptions (e.g. mortality rates) can make the whole calculation untenable.
• paulpauper 1y ago
  After it goes generic it will be cheaper. right now, it's not.
• DrillShopper 1y ago
  > I wonder if there is a point at which it is cheaper for health insurance companies to offer subsidized or even free GLP-1s to patients than pay out for other specialized medications Some do. My insurance requires a prior authorization due to the previous shortage, but it's $12/mo Medicaid in my state also covers it for $3/mo
• Jach 1y ago
  I don't think GLP-1s are particularly expensive, so my top preference would be to just see them easily available. While not quite the same, it's a win that Rogaine/Minoxidil were once prescription-only but for a long time now can be bought at any grocery store and taken to the self-checkout. Still, I think the subsidy approach has been done for smoking problems via nicotine products before, and e.g. nicotine gum cost never seemed that high to me (especially compared to cigarettes). But it's also worth remembering the relative risks involved. Obesity isn't quite the ticking time bomb / public menace it's often made out to be... For smoking, you'll find studies with relative risk numbers for lung cancer over 5 for casual 1-4 times a day smokers, and the number quickly exceeds 20 for heavier smokers. In contrast, with obesity, the most severe relative risks for things like heart disease or diabetes you'll find topping out around 4 to 5 for the most obese, even then often under 3, with milder 1.1 to 2 for the bulk of obese people. (Here, ~31% of the US has BMIs between 30-40, and ~9% have BMIs over 40.) For other harms, like there was a study on dementia a few years back, you'll also find pretty mild (1.1ish) relative risks, but these end up being similar with other factors like "stress", "economic status", or "low educational attainment". Just some thought for people thinking about subsidizing or providing free stuff, the cost tradeoff with paying for other things later might not work out so neatly, and there's reason to not focus solely on obesity but also do the same sort of analysis with other factors and severity of a factor as well.
  • Aurornis 1y ago
    > I don't think GLP-1s are particularly expensive On-patent GLP-1s (all of them right now) are actually extremely expensive. Right around $1000 per month. I don’t want to discourage anyone who needs them from seeking treatment, but their discontinuation rate can be somewhat higher than you’d think from a life-changing drug because many people don’t like certain effects or even encounter side effects. Weight loss drugs are also a challenging category for OTC because they’re a target of abuse. People with eating disorders and body dysmorphia already seek out black market GLP-1s at a high rate and it would be a difficult situation if they could pick them up impulsively from the medicine aisle. It’s also common for people to misuse OTC medications by taking very high doses hoping for faster results, which has to be considered. There’s a libertarian-minded angle where people say “Who cares, that’s their own problem. Medications should be free for everyone to take.” I was persuaded by those arguments when I was younger, but now I have a very different perspective after hearing about the common and strange world of OTC medicine abuse from my friends in the medical field. Just ask your doctor friends if they think Tylenol should still be OTC if you want to hear some very sad stories.
• interestica 1y ago
  Fluoridated water? Nah. GLP water.
  • jajko 1y ago
    Fuck that, not everybody here has massive self-control (on top of other mental) issues. Keep your chemical shit with bad side effects away from me and my kids, we know how to live well and raise kids similarly.
    • thefz 1y ago
      Yes, I don't want any medicine I don't need forced down on me
• bagacrap 1y ago
  https://www.cbsnews.com/pittsburgh/news/west-virginia-insurance-coverage-obesity-medications/ https://www.cbsnews.com/pittsburgh/news/west-virginia-insura... I think the short answer is that these drugs are only cost effective when applied to people actually experiencing costly diseases, rather than simply being obese. A large part of that has to do with the drugs being very expensive still.
• YetAnotherNick 1y ago
  For the first insurer for the first year, sure. But just within few years their premium will drop if population start getting less sick.
• thefz 1y ago
  What about not ingesting shit
• dlcarrier 1y ago
  It's never cheaper for insurance to buy something for everyone. There's extra administrative costs to them being the middle man, so it makes much more sense for insurance to incentivize you to buy it yourself, through premium pricing. For example, fire extinguishers and security cameras will reduce crime by more than their costs, but instead of charging you for them, plus administrative costs, and shipping them to you, your insurance provider will offer you a discount if you have them. (Really it's a price increase if you don't have them, but regulators don't like it when they call it that.) Not everyone will benefit from GLP-1, so in this case, the most beneficial solution would be to charge higher premiums for anyone that could benefit from GLP-1 but doesn't use it.