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.
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.
> 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.
> 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/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.
> 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.
> outright limit the ability of insurers to impact consumer behavior.
As it should be, why should we defer to corporations only following a profit motive the freedoms you have? You open a can of worms by allowing companies to control people's behaviour through how much they can pay for it. There's a limit where pricing is not about efficient markets but social control by corporations and you are leaning into it without a second thought, to me this sounds scary as fuck.
You need to balance freedoms with its costs, I'd much rather have the government using taxes to incentivise/disincentivise consumer behaviour rather than corporations controlling what freedoms you are allowed by pricing you out of them.
> 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.
And one day you expect to be old, imagine if you don't make it, or lose it all, and now requires care without being able to pay for it. Is that humane? I prefer as a young person to pay my taxes knowing that the ones in need have access to universal healthcare where I live rather than the thought that my society allows disadvantaged people to die because they didn't make enough money so their life is worthless.
A society exists to make all of our lives better, it doesn't make sense to live in a society while being a hyper-individualistic freak; nothing you've achieved in life would be possible without the help of others, to educate you, to transport you, to grow the food you eat, to deliver that food, so on and so forth. Paying back to all of these other people, even if they don't make as much money and/or cost more to the system, averaging out through society is the fairest way to ensure everyone in it can have dignity.
Denying dignity as a society to save some cash is a frankly absurd thought to hold for me.
> As it should be, why should we defer to corporations only following a profit motive the freedoms you have? You open a can of worms by allowing companies to control people's behaviour through how much they can pay for it. There's a limit where pricing is not about efficient markets but social control by corporations and you are leaning into it without a second thought, to me this sounds scary as fuck.
> You need to balance freedoms with its costs, I'd much rather have the government using taxes to incentivise/disincentivise consumer behaviour rather than corporations controlling what freedoms you are allowed by pricing you out of them.
I don't quite understand this argument: nobody is obligated (federally) to purchase insurance, or otherwise participate in a particular health care plan. This isn't about "efficient markets"; this is about incentivizing healthy behavior for socially mandatory programs.
As far as "government intervention for consumer behavior": you wind up with the same problem with sugar taxes begin "inequitable" and opposed by many rights groups or academic publications. See https://nutr.uw.edu/wp-content/uploads/2022/08/UW-Tax-Equity.... In many cases, people simply don't want it because they feel government impacting behavior by mandatory taxes is worse than opt-in programs, but this may simply be American values.
> And one day you expect to be old, imagine if you don't make it, or lose it all, and now requires care without being able to pay for it. Is that humane? I prefer as a young person to pay my taxes knowing that the ones in need have access to universal healthcare where I live rather than the thought that my society allows disadvantaged people to die because they didn't make enough money so their life is worthless.
I'm going to be real: reading through your profile you hardly fit the definition of "young person" (you literally recall living through events before I was born) so I'll lay it out in plain terms: young people have zero guarantees, both in the US and EU nations. The elderly have benefitted from policies which have poorly invested the monies for social security in treasuries earning 3%. They have fought against building housing, resulting in inflated values. They vote themselves generous benefits, mortgaging the future to allow them to "age in place" -- which usually fails anyway -- rather than relocating to elder care communities for more efficient service delivery. So realistically, realize the youths' last benefit in society is their youth, and saying "sacrifice more" rings hollow.
> A society exists to make all of our lives better, it doesn't make sense to live in a society while being a hyper-individualistic freak; nothing you've achieved in life would be possible without the help of others, to educate you, to transport you, to grow the food you eat, to deliver that food, so on and so forth. Paying back to all of these other people, even if they don't make as much money and/or cost more to the system, averaging out through society is the fairest way to ensure everyone in it can have dignity.
This is just a thin veneer over reality: at any given point in time there are finite resources. If there aren't enough resources to address the issue in its totality (as it is with healthcare, where we spend massive money on obesity and alcoholism) nothing we do will make "enough", even at 17% of GDP. In the us, this manifests as price rationing; those can can pay, receive. In the EU, this manifests as physician bedside rationing (see https://pmc.ncbi.nlm.nih.gov/articles/PMC1831659/). Nothing you have stated ameliorates the rationing: it simply ignores the fact that it is already happening, even in socialized health systems.
And -- as far as a "hyper-individualistic freak" -- I grew up in a "disadvantaged" school district (I just checked) to immigrant parents. I didn't qualify for disadvantaged grants to attend better ranked colleges because I wasn't a URM, so I just went to a state school and worked in research labs during the year and local engineering firms to pay my tuition. That's my life. In the US, you can absolutely claw your way up. Technical skills and entrepreneurship are absolutely the engine of social mobility Europe wishes it has, and why we can actually provide immigrants integration and social mobility. I 100% prefer this over the sirens song of socialized care which simply doesn't exist, even in Europe.