[lotsofpulp]

In the US, it has been 13 years since the PPACA restricted premium pricing to only a handful of factors:

https://www.healthcare.gov/how-plans-set-your-premiums

>Under the health care law, insurance companies can account for only 5 things when setting premiums.

>Age: Premiums can be up to 3 times higher for older people than for younger ones.

>Location: Where you live has a big effect on your premiums. Differences in competition, state and local rules, and cost of living account for this.

>Tobacco use: Insurers can charge tobacco users up to 50% more than those who don’t use tobacco.

>Individual vs. family enrollment: Insurers can charge more for a plan that also covers a spouse and/or dependents.

>Plan category: There are five plan categories – Bronze, Silver, Gold, Platinum, and Catastrophic. The categories are based on how you and the plan share costs. Bronze plans usually have lower monthly premiums and higher out-of-pocket costs when you get care. Platinum plans usually have the highest premiums and lowest out-of-pocket costs.

[paws]

As a generally healthy person it's very disappointing that catastrophic plans are only available for under 30s. [0] For me it makes the most financial sense to pay out of pocket for incidentals/annuals, but be covered for catastrophes e.g. get hit by a bus and wake up in a hospital.

What magical event happens to people at age 30 that led the legislators to ban catastrophic? Would love to see the actuarial data on that. I have no knowledge/evidence of the reasoning but to me it definitely smells like lobbying.

[0] https://www.healthcare.gov/choose-a-plan/catastrophic-health...

[lotsofpulp]

I imagine this was a political compromise to let politicians advertise the availability of low cost insurance plans for low earners like young people in jobs without health insurance so they were not hit with the tax penalty that used to exist for not having health insurance.

Over 30 is likelier to be making more money and in jobs that do subsidize health insurance so they are likelier to buy it. And since the whole scheme is actually a mechanism to tax, you cannot let everyone opt out of the tax.

[everybodyknows]

>>Tobacco use: Insurers can charge tobacco users up to 50% more than those who don’t use tobacco.

Wondering what fraction of smokers know that, and are lying to their doctors about it. Inappropriate testing or treatment being a possible result.

[xxpor]

It's pretty hard to hide cigarette usage (smell, color of teeth). Vaping is likely to be much easier to conceal though (does that count as "tobacco" though?)

[bugglebeetle]

The age one is completely insane considering the amount of unchecked age discrimination that American employers engage in. We decided to fire Bob because he’s 51 and it’s cheaper to employ a 27 year old. Oh Bob, sorry, BTW your market place plan is now also $1500 a month.

[lotsofpulp]

Bob, however, did not have to pay for older people’s healthcare during the 1990s and 2000s.

Also, as an fyi, New York and Vermont do not allow age as a factor in pricing, and Massachusetts restricts the age rating factor to 2 instead of 3.

[bugglebeetle]

Everyone pays for everyone else’s healthcare, whether it be insurance pools, Medicaid, CHIPS, Medicare, etc. In America, we just do it in an especially dumb, cruel, and expensive way because it makes some assholes a lot of money.

[lotsofpulp]

We do it that way so “we” can have lower taxes.

We is in quotes because various demographics/political tribes want to pass the hot potato.

The beauty of the health insurance system is it allows you to deliver differing qualities of healthcare to different voter groups.

For example, high voter participation groups like old people can get Medicare that pays providers more and hence more providers are available. And Medicaid for poor people on the other end that pays much less and has stricter rules on prior authorizations. And you can give Senators healthcare that pays providers more than other federal employees, and so on and so forth.

I actually find it impressive in some sense.

[bugglebeetle]

No, we do it that way because both political parties are bought and sold by the assholes who run insurance companies. They use this corruption to impose a private tax on everyone. No one in the US is saving money. We spend more than most wealthy country for worse outcomes.

[lotsofpulp]

The insurance companies are not that powerful. Pharmaceutical companies are far more profitable, as are healthcare software, other tech, doctor groups, hospital groups, etc. You may want to look into liability laws and tort reform for other big reasons for why healthcare in the US costs a lot.

[tossawayone23]

Life insurance doesnt apply to obamacare mecs.

[lotsofpulp]

The comment I replied to specific medical insurance.

When governments restrict insurers underwriting criteria, they are providing a subsidy from one subset of the population to another. I think those are best accounted for as taxes and government benefits.