[Exofunctor]

While I think health insurance shouldn't be attached to employers, I don't really have an objection to insurance companies using genetic testing. This is certainly an unpopular opinion here, but as someone who believes that medical care is a service, not a right: I think it's unfair to force people to subsidize the healthcare of other people, regardless of the mechanism used.

When you have car insurance, the insurance companies are allowed to use statistical techniques to predict how much you are going to cost them. Competition between insurance companies involves treading the line between beating the price of other insurance companies while charging slightly more than the customer is expected to cost.

If we let health insurance companies do this, then yes, healthcare would get substantially more expensive for very risky/unhealthy people. Of course, it would also get drastically less expensive for healthy people. From a moral perspective, I think this is preferable, but obviously not everyone will agree.

Now, from a utilitarian perspective, these two possibilities seem roughly equivalent at first glance. However, I'd argue that the latter (where insurance companies are allowed to set prices like car insurance) has a number of (significant) positive side effects.

The largest side effect is that it incentivizes customer health improvement. A lot of health risks, including at least the top 6 causes of death worldwide (heart disease, stroke, lung infections, COPD, respiratory cancers, diabetes) can be substantially mitigated by personal choices such as diet and exercise. If you had to pay an extra $200/mo to your insurance company because you were morbidly obese, one would expect that this would encourage a lot of people to start eating better. Let the market do the heavy lifting! This is exactly the sort of thing that the market excels at. Society benefits from healthier people, but in almost all countries rich enough to have insurance (including the US and nations with socialized healthcare), there is no mechanism to incentivize this! An actual insurance market would do the job.

[electricEmu]

> I think it's unfair to force people to subsidize the healthcare of other people, regardless of the mechanism used.

This is literally car insurance in the United States. You buy insurance, put money up front for your own health, or risk paying a penality. It's also literally the ACA.

> If let health insurance companies do this, then yes, healthcare would get substantially more expensive for very risky/unhealthy people.

Unaffordable. My mother in law died from cancer recently. Coverage was impossible before; in America's free market that constantly pays out dividends. The ACA was the first time any insurance was affordable.

I'm sorry, but the views you've put forth appear to diminish the plight of others who aren't young and healthy. Those views and policies would kill my friend afflicted with an autoimmune disorder.

_Edit: spelling_

[Exofunctor]

I can't imagine how people have such an incorrect view of how insurance works.

No, car insurance is not you subsidizing other people. Car insurance is you paying in proportion to your own estimated risk. That means if your expected costs are 5x higher (nicer car, young driver, etc.) you pay 5x more.

Medical insurance in the US emphatically does not work this way. More expensive people don't pay proportionately more than cheap people, meaning that the expensive people are being subsizidized. You should be alarmed at the fact that you apparently fundamentally misunderstood the way insurance works in an open market, or what the ACA is. The only part of the ACA that is even reminiscent of car insurance is the individual mandate, which is actually way worse than car insurance because you don't need to buy car insurance just for being alive. You only need car insurance if you drive on public roads.

It's too bad that your friend has a disease, but I'd rather have them pay for it than pass the bill off to a bunch of innocent people who aren't sick. If you choose to have tunnel vision and focus on health alone, it's worth noting that the second-order effects of making other people's lives more expensive will also include worsened health from poorer nutrition, increased stress, less frequent medical consultation, etc.

[mnm1]

"It's too bad that your friend has a disease, but I'd rather have them pay for it than pass the bill off to a bunch of innocent people who aren't sick."

His friend can't pay for it, so what you're essentially saying is you'd rather have his friend, and people who can't afford their medical care in general, die rather than have others subsidize healthcare through their taxes (or any other way). In other words, because of the current cost of healthcare, only the obscenely-rich get to live while the rest die off. That's just incredibly cruel, vile, and disgusting, but sadly, hardly a minority opinion.

[nisa]

> If you had to pay an extra $200/mo to your insurance company because you were morbidly obese, one would expect that this would encourage a lot of people to start eating better.

That homo economicus myth is still going strong? Mental issues and addiction don't exist?

> Let the market do the heavy lifting!

What if the market decides it's not worth the risk and costs to cover the unhealthy? What do we do with the disabled that need more medical supervision?

> This is exactly the sort of thing that the market excels at.

...in some idealised simplified textbook version of reality with simple linear algebra.

[DanBC]

Look at people who need an organ transplant.

Before transplant they have low quality of life. Their treatment is very expensive. They struggle to get an organ. They go through extensive support to help them realise that after the new organ they'll need to take meds for the rest of their life.

They have a very expensive operation that usually requires someone else to die and donate an organ.

After the surgery they need to take medication for the rest of their life.

This medication is the thing that prevents their new organ from being rejected; the thing that stops them going back to that expensive and painful life with a failed organ.

Currently the biggest caused of failure in transplanted organs is that people do not continue to take the meds.

This is the case in the UK where people don't pay for the surgery, and it's the case in the US where people pay considerable amounts for the surgery.

The money that people pay or the consequences for non-compliance don't seem to do much to change behaviour.

[mantas]

> If let health insurance companies do this, then yes, healthcare would get substantially more expensive for very risky/unhealthy people.

Which is more risky/unhealthy - obese couch potato or mountain biker?

The only cheap way of living would be sitting on a couch and doing nothing. But then you gotta work out. Infinite loop :)

[icebraining]

A lot of health risks, including at least the top 6 causes of death worldwide (heart disease, stroke, lung infections, COPD, respiratory cancers, diabetes) can be substantially mitigated by personal choices such as diet and exercise

That's true, but genetics is literally the opposite: it's the one thing you definitively can't choose to change. So your argument doesn't work in the case being discussed.

If you had to pay an extra $200/mo to your insurance company because you were morbidly obese, one would expect that this would encourage a lot of people to start eating better.

One would expect that all the existing drawbacks of being morbidly obese would encourage a lot of people to start eating better. Why would this specific drawback work when others haven't?

[ohstopitu]

Because spending $200/m hits you more than just the thought of future illness.

I don't support this bill, I do want this idea explored / discussed - as in, why should healthy people subsidize costs of insurance for the unhealthy? (as in, is not fair is it?)