5 ms·

Insurance companies should be paying people to take this considering the other costs it reduces.

by jmward01 10mo ago

jl6 10mo ago
I think their desired cash flow direction is: customers should be paying to take this in order to avoid the punitive deductible for being overweight.
- lotsofpulp 10mo ago
  The ACA makes it illegal for insurers to make the “punitive deductible” a function of one’s probability of needing healthcare, hence the financial incentive is for the insurer (who can bring down cost of claims, and hence be able to sell insurance at lower premiums). Of course, the insured has the quality of life incentive of not having to deal with complications from consuming excess calories.
xxpor 10mo ago
You're missing the time aspect: Obesity mostly causes expensive problems years later. People stay in their jobs for an average of something like 3-4 years. By the time anyone has an issue, it's the next guy's problem (or ideally, Medicare's).
antisthenes 10mo ago
The incorrect assumption here is that insurance companies want costs to be reduced. They don't. Because despite being labeled as not-for-profit, they will always scale up their "cost" to match their revenues, and live on the 1-2% difference. They want the absolute nominal dollar values for care to be as high as humanly possible.
- lotsofpulp 10mo ago
  I love the two claims about health insurance companies: simultaneously denying coverage for needed healthcare, and "scaling" up their healthcare costs to increase profit.
  - antisthenes 10mo ago
    There's no inconsistency in those statements, because there are also for-profit health insurance companies (that deny coverage) and not-for-profit ones (that balloon costs) Is that what you meant?
    - lotsofpulp 10mo ago
      That premise must be invalid because if true, no one would buy insurance from for profit insurance companies. Their prices are all basically the same, approved by the same state government employees. Plus the out of pocket maximums are a pittance compared to what complicated healthcare costs can be, so paying more for premiums to ensure you are not denied coverage would be a no brainer. Alas, that is not the case, so the reality must be different from the premise. Also, here's a non profit health insurance company denying coverage: https://www.theguardian.com/us-news/2024/sep/29/louisiana-hospital-blue-cross-blue-shield-underpaying-claims https://www.theguardian.com/us-news/2024/sep/29/louisiana-ho... https://lailluminator.com/2025/04/12/blue-cross-2/ https://lailluminator.com/2025/04/12/blue-cross-2/
      - antisthenes 10mo ago
        None of that invalidates what I said as a general rule for health insurance company behaviors that are also very well documented in media, so I'm not sure what you're trying to clarify for me here. > That premise must be invalid because if true, no one would buy insurance from for profit insurance companies. What premise? That companies balloon costs or aim to provide less care if they can get away with it? It's a complete non-sequitur if you think so.
        lotsofpulp 10mo ago
        This premise: >because there are also for-profit health insurance companies (that deny coverage) and not-for-profit ones (that balloon costs) The claim that for profit health insurance companies deny coverage to save money and non profit health insurance companies balloon costs to maximize healthcare expenses is obviously wrong (as demonstrated in previous comment). The claim that health insurance companies in general both deny coverage to reduce healthcare expenses and maximize healthcare expenses to increase profit is obviously wrong, because it's inherently contradictory. >behaviors that are also very well documented in media I don't see any documentation of this behavior. The documentation that does exist is the whole business limps along on a knife's edge, lagging SP500, while have no power to set their prices (the government has to approve their prices). They certainly do engage in outsourcing and underemployment, perhaps to intentionally delay and deny care, but probably leading to just as many incorrect approvals as incorrect denials (obviously you won't hear about the former in the media).
maherbeg 10mo ago
I wouldn't be surprised if this paves the way for differing insurance rates on health markers given how magical glp-1s seem to be, and how much of modern disease is based on lifestyle factors.
cameldrv 10mo ago
They should. Unfortunately a lot of incentives are not aligned. Due to the profit cap as a percentage of premiums, generally higher medical spending increases health insurance profits rather than reducing them. It's the same thing with PG&E -- the only way for them to make more money is to increase costs. It's exactly the opposite of a normally functioning market, and you see the same result in both cases.
- estearum 10mo ago
  There are more powerful forces than the profit caps, namely that the big insurers now actually also own the doctors. And capped or not, the pay-vider structure allows intra-company eliminations to bury arbitrary amounts of money as "not profit" even though it effectively is. And even if that weren't true, the expected coverage term for a US patient is ~4 years due to it being tied to employment, so there is quite literally zero incentive to address any health issue that won't materialize as cost in the next few years (obesity being one such type of health problem).
  - jmward01 10mo ago
    I hadn't thought about the 4 year aspect. That is a great insight. I am against the current US healthcare system in general but I wonder if decoupling healthcare from employment (slightly) could help. Maybe employers should be required to pay for coverage that an employee selects? (clearly a lot of hand waiving of the exact mechanism here but..) This would incentivize healthcare plans to actually compete for someone to sign up with them and to give them an incentive to keep that person healthy since they would likely stick around longer with them.
  - lotsofpulp 10mo ago
    > And capped or not, the pay-vider structure allows intra-company eliminations to bury arbitrary amounts of money as "not profit" even though it effectively is. Source? There are 7 large publicly listed health insurers with public financials, all underperforming SP500 for more than a decade. There are myriad other non profits such as Kaiser/Cambia/Premera/Providence/various BCBS/etc, all with public financials as well. Where is all this fraud going? And it’s happening across hundreds of executive offices across the country? And getting past 50 state insurance regulators that have to approve prices for insurance? That would be remarkable levels of corruption and collusion.

Insurance companies should be paying people to take this considering the other costs it reduces.

jl6 10mo ago

I think their desired cash flow direction is: customers should be paying to take this in order to avoid the punitive deductible for being overweight.

lotsofpulp 10mo ago
The ACA makes it illegal for insurers to make the “punitive deductible” a function of one’s probability of needing healthcare, hence the financial incentive is for the insurer (who can bring down cost of claims, and hence be able to sell insurance at lower premiums). Of course, the insured has the quality of life incentive of not having to deal with complications from consuming excess calories.

xxpor 10mo ago

You're missing the time aspect: Obesity mostly causes expensive problems years later. People stay in their jobs for an average of something like 3-4 years. By the time anyone has an issue, it's the next guy's problem (or ideally, Medicare's).

antisthenes 10mo ago

The incorrect assumption here is that insurance companies want costs to be reduced. They don't. Because despite being labeled as not-for-profit, they will always scale up their "cost" to match their revenues, and live on the 1-2% difference. They want the absolute nominal dollar values for care to be as high as humanly possible.

lotsofpulp 10mo ago
I love the two claims about health insurance companies: simultaneously denying coverage for needed healthcare, and "scaling" up their healthcare costs to increase profit.
- antisthenes 10mo ago
  There's no inconsistency in those statements, because there are also for-profit health insurance companies (that deny coverage) and not-for-profit ones (that balloon costs) Is that what you meant?
  - lotsofpulp 10mo ago
    That premise must be invalid because if true, no one would buy insurance from for profit insurance companies. Their prices are all basically the same, approved by the same state government employees. Plus the out of pocket maximums are a pittance compared to what complicated healthcare costs can be, so paying more for premiums to ensure you are not denied coverage would be a no brainer. Alas, that is not the case, so the reality must be different from the premise. Also, here's a non profit health insurance company denying coverage: https://www.theguardian.com/us-news/2024/sep/29/louisiana-hospital-blue-cross-blue-shield-underpaying-claims https://www.theguardian.com/us-news/2024/sep/29/louisiana-ho... https://lailluminator.com/2025/04/12/blue-cross-2/ https://lailluminator.com/2025/04/12/blue-cross-2/
    - antisthenes 10mo ago
      None of that invalidates what I said as a general rule for health insurance company behaviors that are also very well documented in media, so I'm not sure what you're trying to clarify for me here. > That premise must be invalid because if true, no one would buy insurance from for profit insurance companies. What premise? That companies balloon costs or aim to provide less care if they can get away with it? It's a complete non-sequitur if you think so.
      - lotsofpulp 10mo ago
        This premise: >because there are also for-profit health insurance companies (that deny coverage) and not-for-profit ones (that balloon costs) The claim that for profit health insurance companies deny coverage to save money and non profit health insurance companies balloon costs to maximize healthcare expenses is obviously wrong (as demonstrated in previous comment). The claim that health insurance companies in general both deny coverage to reduce healthcare expenses and maximize healthcare expenses to increase profit is obviously wrong, because it's inherently contradictory. >behaviors that are also very well documented in media I don't see any documentation of this behavior. The documentation that does exist is the whole business limps along on a knife's edge, lagging SP500, while have no power to set their prices (the government has to approve their prices). They certainly do engage in outsourcing and underemployment, perhaps to intentionally delay and deny care, but probably leading to just as many incorrect approvals as incorrect denials (obviously you won't hear about the former in the media).

maherbeg 10mo ago

I wouldn't be surprised if this paves the way for differing insurance rates on health markers given how magical glp-1s seem to be, and how much of modern disease is based on lifestyle factors.

cameldrv 10mo ago

They should. Unfortunately a lot of incentives are not aligned. Due to the profit cap as a percentage of premiums, generally higher medical spending increases health insurance profits rather than reducing them. It's the same thing with PG&E -- the only way for them to make more money is to increase costs. It's exactly the opposite of a normally functioning market, and you see the same result in both cases.

estearum 10mo ago
There are more powerful forces than the profit caps, namely that the big insurers now actually also own the doctors. And capped or not, the pay-vider structure allows intra-company eliminations to bury arbitrary amounts of money as "not profit" even though it effectively is. And even if that weren't true, the expected coverage term for a US patient is ~4 years due to it being tied to employment, so there is quite literally zero incentive to address any health issue that won't materialize as cost in the next few years (obesity being one such type of health problem).
- jmward01 10mo ago
  I hadn't thought about the 4 year aspect. That is a great insight. I am against the current US healthcare system in general but I wonder if decoupling healthcare from employment (slightly) could help. Maybe employers should be required to pay for coverage that an employee selects? (clearly a lot of hand waiving of the exact mechanism here but..) This would incentivize healthcare plans to actually compete for someone to sign up with them and to give them an incentive to keep that person healthy since they would likely stick around longer with them.
- lotsofpulp 10mo ago
  > And capped or not, the pay-vider structure allows intra-company eliminations to bury arbitrary amounts of money as "not profit" even though it effectively is. Source? There are 7 large publicly listed health insurers with public financials, all underperforming SP500 for more than a decade. There are myriad other non profits such as Kaiser/Cambia/Premera/Providence/various BCBS/etc, all with public financials as well. Where is all this fraud going? And it’s happening across hundreds of executive offices across the country? And getting past 50 state insurance regulators that have to approve prices for insurance? That would be remarkable levels of corruption and collusion.