[mgh95]

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.

[SketchySeaBeast]

> 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.

[mgh95]

> 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.

(to put it in perspective, insurers made 25B in profit in '23 (see: https://content.naic.org/sites/default/files/industry-analys...). Alcoholism cost 249B (see https://www.niaaa.nih.gov/publications/brochures-and-fact-sh....), obesity cost 426B (see https://hrp.net/hrp-insights/report-obesity-cost-employers-a....))

> 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.

[piva00]

> 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.

[mgh95]

> 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.

[piva00]

> 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.

Which is absurd since everyone will need healthcare in their lives, spreading the risk pool across the whole society and providing the service as an averaged out resource for the benefit of all is the most logical way of doing it.

> 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.

Yes, this is simply American values, which individualism is a paramount one. And probably the value which may bring down American society one day as you can see from the erosion of empathy in American society.

> 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.

For all accounts in the society I live in I'm still in the "young" cohort, mid-30s is not old and if you are younger than that you haven't contributed much to society yet, you basically sucked up resources for growing up and now wants to deny resources for others who have contributed to the society they helped build and which you live in.

> 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.

There are finite resources but human ingenuity has found ways to make resource usage more and more efficient through technology.

It's not because there's a public healthcare system that there aren't options in the private sector, a lot of European countries have a hybrid system (including in Sweden where I live). The public healthcare is available even if with deficiencies but it doesn't mean that you don't have access to treatment if you can pay for it... The system you live under is the worst of both worlds, extremely expensive, bureaucratic and selecting people's lives by how much money they have, I'm baffled you can't see that as anything other than absurd.

> 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.

And I grew up in Brazil, with much worse schools than even your disadvantaged public school district. I didn't qualify for any disadvantaged program, the better ranked colleges in Brazil are public ones and only accessible through standardised entrance exams where the rich can go through a year or two of prep school to get into. I clawed my way up and moved to Sweden some 10 years ago after a brief sting living in the USA, all on my own, and I still believe in everything I said about hyper-individualism...

The social mobility engine of the USA only benefits a few, it's a pipe dream sold to make the masses believe that they can make it if only they are good enough. It's never brought up as "you can make it if you work a lot and are lucky enough" because that would tear up the American Dream as a whole, the belief one is in complete control of their destiny is the big fat lie needed for such an individualistic society to not tear itself apart.

> I 100% prefer this over the sirens song of socialized care which simply doesn't exist, even in Europe.

You simply don't know how socialised care works, you said yourself that you are young so you lack any life experience on that, and you only lived in the USA so you can't really know what you prefer, you just have a feeling based on your own American Exceptionalism bias.