[crmd]

There is another real-world version of this in the US healthcare system, where doctor offices are using domain-specific LLMs to craft multi-page medical approval requests for procedures that cover every known loophole insurer’s use to deny, which are then being reviewed by ML-powered algorithms at the insurance company looking for any way to deny and delay the claim approval.

In other words we have a bona fide AI arms race between doctors and insurers with patient outcomes and profits in play. Wild stuff and nothing I could have ever imagined would be an applied use of ML research from earlier in my career.

[dataviz1000]

Interesting. My next door neighbor ten years ago was a lawyer a couple years out of law school. He discovered that he could pour through hundreds of medical charts a day and find cases where the doctor under billed the insurance company. He would then sue the insurance company, settle, and split the profits with the doctor. More or less he was mining the charts.

He would sometimes pull up next door with a half dozen tote boxes overflowing with medical records. He would say "hey, dataviz1000, can you help me get these into the house?" He once asked me if I wanted a new job helping him go through all the charts. I don't get involved with illegal activities and I was earning more not breaking the law elsewhere. He did hire a young woman who graduated law school and was still working on passing the bar. Since they have married and started a family.

Yes, HIPAA laws got broken! Yes, this guy made 10s of millions in a few short years.

There are no good guys in this story.

Probably would make a good start up using LLM and bringing the process into compliance with HIPAA. There is probably several billion dollars in insurance companies that have been under billed.

[nradov]

You have garbled that story. When a provider under bills an insurer that is not grounds for a lawsuit. At most the provider can submit a revised claim if it's still within the time limit.

And it's not necessarily a HIPAA violation to outsource medical billing and chart review as long as there is a proper BAA in place, and everyone follows the Security/Privacy Rules. Many small provider organizations pay outside services to ensure they bill at the highest allowable level.

[ec109685]

Are you sure it was illegal?

HIPPA carves out this exception for using your health records:

“To pay doctors and hospitals for your health care and to help run their businesses”

[dataviz1000]

With HIPAA you have to track and store the information every person who touches or reads the medical chart. The issue was more to do with random people reading medical charts.

It isn't difficult to bring the process into compliance. I offered to make an app which would have been easy because there was a predefined workflow that can be diagrammed on a sequence chart in about 10 steps. There were a couple interactions between the lawyer and the doctor. Then a step where the insurance company is notified. Then a lawsuit filed if not paid. At one point, I was researching how to store data in HIPAA compliance in the cloud. It was about 2 years later when AWS provided HIPAA compliant EC2 instances. I offered to build the app for $10,000. Having random people pour over private medical charts and undocumented and haphazard communication between the lawyers, insurance company, and doctors through email and text messages was a mess.

[griomnib]

This almost definitely falls under Business Associate in hipaa and is totally fine.

https://www.hhs.gov/hipaa/for-professionals/privacy/guidance...

[thayne]

The lawyer looking over the records was probably fine. Him paying his neighbor to help him look through them is more questionable.

[lelanthran]

> The lawyer looking over the records was probably fine. Him paying his neighbor to help him look through them is more questionable.

I don't think so. The "paying" part is important - the neighbour becomes an employee for the duration of the work, which is fine, as then there's a contract between the employer and employee which includes, even if only implicitly, that the employers data is not to be exfiltrated.

If he were simply sharing it with his neighbour for shits and giggles that would be a different story.

[dataviz1000]

If there is anything true in this article "What Are The Requirements For Storing Physical HIPAA Documents"[0], laws were broken. But, I'm not a lawyer, what do I know?

[0 https://www.medicaltranscriptionservicecompany.com/blog/what...]

[ec109685]

Yup: “An attorney whose legal services to a health plan involve access to protected health information.”

[lotsofpulp]

So many parts of this story makes no sense.

[refulgentis]

Honestly no piece of this makes any sense, from the thinking this is illegal somehow, to the lawyer jumping to sue because a doctor underbilled (judges would tired of this very quickly, court isn't an automated process to use to threaten people after youve made a mistake)

Checked with a doctor and they said the same and couldn't puzzle out a benign misunderstanding that was right - they pointed out that even if you meant the lawyer sued if the insurance company refused to pay, the economics would be all fucky on the splitting, because now the lawyer does have to go to court, no automated easy money, much less millions.

[dataviz1000]

There was a discrepancy in medical coding. The lawyer was looking for something very specific in the medical charts.

I searched for "how long does a doctor have to bill you in florida" and the a top result was this gem, "A doctor in Fort Lauderdale I saw in 2020 contacted me to tell me that there was a /"billing error/" 3 years ago that they now want paid. What can I do?" That sounds about right.

I don't know the specific details about the lawyer was doing.

[CoastalCoder]

What really grinds my gears is the CO2 emissions and power-grid load that's being used for this stupid arms race.

I realize that there's no magic solution to perverse systems like this, but it really bothers me nonetheless.

[jnwatson]

Inference uses hardly any compute. You should be complaining about computer games for real compute use.

[ranger_danger]

I'm pretty sure they meant emissions/load from inference and/or training TIMES all the current LLM users on the Earth...

[ethbr1]

Yes, but you've got to balance that against the equivalent human processing time. Meatbags are notoriously carbon-intensive to feed.

[tsimionescu]

Humans use tiny amounts of energy compared to even a smartphone. And they consume the vast majority of that energy regardless of whether they're lounging in bed or pouring over medical records.

[jlebar]

A human burns say 2000 kcal / day. That's about 2.3kW hours / day.

An iPhone 16 pro battery appears to have about 18 watt hours. So approximately 100x less then a human uses.

[squarefoot]

What about crypto?

[z3c0]

It will take me some time to dig up with all the noise around AI, but this reminds me of a paper published around 2018 or so that explored the possibility of two such AI forming an accidental trust by optimizing around each other. For example, if the denying AI used frequency of denied claims as a heuristic for success, and the AI drafting claims used the claim amount for the same, then the two bots may unknowingly strike a deal where the AI drafting claims lets smaller claims get frequently denied to increase the odds of larger claims.

Note: not saying these metrics are what would be used, just giving examples of antithetical heuristics that could play together.

[0_____0]

I feel that this sort of autonomous agent co-optimization may happen more often over time as humans step farther away from the loop, and lead to some pretty weird outcomes with nobody around to go "wait what the f---- are we doing?"

[z3c0]

Agreed, and I'm even further worried about the plausible deniability these situations would create.

[asdf147]

Wow, that sounds very interesting, do you have some link to that paper?

[z3c0]

I'm on the hunt, but no luck. I've tried a myriad of search terms to dig it up, but none are able to surface the paper through all the vaporware and blog pieces on competitive AI.

[jiggawatts]

It’s so bizarre to me that this uniquely US phenomenon of for-profit-middlemen inserted into the healthcare system has resulted in an adverserial relationship between the sick person and the “healthcare provider”.

I put that air quotes because insurance companies don’t actually provide health care. They provide insurance. That’s a financial product, not a medical one.

[beezlebroxxxxxx]

> That’s a financial product, not a medical one.

It often goes unsaid, but America, on a cultural and political level, is really ideologically fixated on a distinction between working and non-working individuals, and, in a far deeper sense, whether an individual "deserves" healthcare or not. This makes access to healthcare intricately connected to class, wealth, and income, in America. That's why access to healthcare is seen as a product in and of itself. You can either afford it ("you've earned it"), or you go into debt for it ("you have to earn it"), or you simply have no expectation of ever paying for it ("you cheated the system").

The entire conversation is often dominated by these ideas in a way that often makes talking about healthcare with Americans baffling to people that come from many single-payer or universal systems.

[somerandomqaguy]

To a degree. You have to keep in mind that a hospital emergency room isn't legally permitted to turn you away even if you can't pay under the Emergency Medical Treatment and Active Labor Act.

So the wealthy and insured are covered. The lowest rungs and those that don't care and will just run away are covered. It's mostly lower / middle lower class that this really hurts, ironically.

[FireBeyond]

> The lowest rungs and those that don't care and will just run away are covered.

They're really not. They are only entitled to "stabilizing care".

I work as a paramedic. We have had situations with "frequent fliers" where when we've called the hospital to give a report as we are transporting, the hospital will say "let us know when you're here", and when we've done so, there's literally been a physician come out to the ambulance.

"Hey, X, what's happening?"

"I got a lot of fluid in my gut (he had ascites)."

"Okay, well, that's not new, and it looks like you have an appointment for having that fluid drawn in two days."

"Oh, okay."

"Anything else bothering you?"

"Nope."

"Alright, we're good then." Gives us a nod.

"We're going in then?"

"Uh, no. You have been by a physician, you're stable, you're good to go, you can jump off their gurney and head home now."

Which is harsh - but also this person at this point was being transported 4+ times _per day_.

But EMTALA only requires acute stabilizing care, not definitive management.

[coffeecat]

I think your premise is flawed. In America, the access-to-healthcare versus income curve is U-shaped.

If you have literally no income (or your income is entirely "off the books"), then you qualify for medicaid; everything is covered with no premiums, copays, or deductibles. At a middle-class level of income, you're probably looking at either a comparatively shitty ACA marketplace plan, or a comparatively shitty employer-provided HDHP plan. At an upper-class level of income, you can afford top-of-the-line healthcare.

[xdfgh1112]

I get this feeling a lot. For example the UK typically has unlimited paid sick days for salaried jobs, while I have heard of US employees pooling together and "donating" sick days to someone. The UK has a ton of benefits for the sick, unemployed, single mothers, carers etc. in the US I am sure those exist but I get the sense that charity is supposed to play more of a role.

[xp84]

FYI it’s not common to allow sick days to be transferable.

TBH I think in the US it’s more than anything about how much more competitive industries here are vs in the UK. If X company feels it’s worth the extra cost by allowing unlimited PTO and 2 years of parental leave, etc. the worry is that X will be trounced by Y Company, who is ruthless enough to not offer those things and as such has much cheaper labor costs.

If you take an industry like retail, those companies have a point - Walmart and Amazon offer low benefits compared to what companies once offered. Their lower prices are part of how they killed off most of the department stores and put the rest on life support.

And if you think about a highly paid job, even though our fringe benefits suck compared to Europe style, my impression is that US salaries are higher for equivalent jobs, enough that it makes up for it. So we value the money more than we would the benefits, apparently. Only problem is you can’t use all that money to buy more time with your family (except for by taking breaks between jobs, if you’re good at saving!)

[miki123211]

Be aware that in many single-payer systems, insurance is also tied to working (or unemployment / retirement / pensions).

In my opinion, this is actually the reason for why we have so little innovation in Europe.

Mandatory, single-payer insurance very significantly raises the cost to be self-employed / have a sole proprietorship, which you practically need to run any side project that you want to eventually make money from. This means that if you launch a startup, you either need it to be profitable on day one, or you're vasting significant amounts of your money, not just your time.

[tsimionescu]

> Be aware that in many single-payer systems, insurance is also tied to working (or unemployment / retirement / pensions).

This is true.

> This means that if you launch a startup, you either need it to be profitable on day one, or you're vasting significant amounts of your money, not just your time.

This is a false dichotomy. First of all, even ignoring health-care, you're still spending money on housing, food, electricity etc. If you're not employed and your startup is not profitable, you're paying money out of pocket to live.

Second of all, even in the USA, you are still going to pay for health insurance even if you are currently founding a startup. You could argue you are allowed to gamble that our health is good enough that you don't need health insurance for a few years, but that's just tossing coins. You could just as well not pay your taxes in the EU for a year or two, and gamble that the authorities will not catch on right away.

[xp84]

I don’t get it, why is a self-employed person paying so much more than others for single payer healthcare where you are? That sounds exactly like the USA where those not employed as a normal full-time employee pay the most for equivalent insurance, so people here definitely do stay at their regular jobs instead of quitting to found a startup. Insurance outside of those group plans is even more expensive than the already shocking normal cost, and of course normal full time employment (what we call W-2 jobs) usually provides a generous healthcare subsidy.

[miki123211]

Because healthcare is often paid per "working relationship", so if you work for a company and are doing something on the side, you have to pay twice, and the second fee comes out of your pocket.

[thayne]

Living in America, I have never met anyone who doesn't think our health care system is a complete mess. That includes doctors, nurses, people who work in HR, and people on both sides of the political spectrum. There is however disagreement about how it should be fixed. But from what I've seen that disagreement isn't about whether people who don't get insurance from their employer "cheated the system", it's about whether the system should be controlled by the state or private companies.

[LtWorf]

You can praise/blame the puritans for this weird idea.

[rscho]

Not unique to the US. This develops to a certain extent everywhere private insurance is sold. It is a completely logical consequence of the insurance company raking in the most when selling you insurance for everything that won't happen, and deny you any coverage for stuff that will happen. At that point, it is a mystery to me why so many people still think free market theory works for healthcare.

[LtWorf]

It doesn't work at all for anything without strong regulations.

[nox101]

in Japan where the government sets the prices, dentists do things over 3 visits that dentists in other places would do in 1 because then they can bill the government set price 3 times instead of one

[josephg]

There are certainly problems in the healthcare systems in other countries. I don’t think there’s any perfect system. But if you ask me, “you have to go to the dentist 3 times” is a much better problem than “even people with health insurance go bankrupt regularly as a result of getting ill and needing medical care”.

The US government spends a similar amount of money per person on healthcare as other western countries do. But unlike Europe, Australia, Canada, Japan and so on, people don’t even get free healthcare in exchange for all that tax money. The system is deeply flawed. I don’t know anything about the Japanese healthcare system, but I’d still choose to be sick in Japan than America any day of the week.

[hattmall]

I'm sure you could offer the Japanese dentist 10% of what the procedure would cost in the US and they would do it in one trip.

It cost about 25% of US prices to fly to Costa Rica, stay at a resort, and get the procedure done in a top notch facility. And that's if you just need 1 root canal and crown. If you need even more done the savings move closer to 90%.

And that is a really nice places. You could drive to Mexico and get it done at a decent place for comparatively nothing.

[FireBeyond]

My dental work in Cancun was under $30K including flights from Seattle and 10 days at a higher end hotel (Westin), for work I was quoted up to $65K for in the US.

[hattmall]

Honestly that seems high but I can see Cancun being a lot more expensive because people are comfortable going there.

[FireBeyond]

The actual dental work was $23K, so about 35% of the US quotes.

[pilotneko]

Well, that seals the deal. If it doesn’t work for dentists in Japan, there is no point changing anything at all for US healthcare policy.

[throw16180339]

No system is perfect, but Japanese healthcare administrative costs are under 2% as compared to 30+% in the US.

[nightshift1]

that's crazy ! Do they at least schedule the 3 visits back to back in the same day ?

[crmd]

In my view, the root cause of the bizarreness is that medical care is one of a few enterprises that are inherently social in nature, and is therefore a prima facie exception to the common wisdom that free markets create the most positive outcomes for the largest number of people. Because in the US we are taught from a young age that private sector capitalism is "all there is", we end up tying ourselves into knots trying to solve medical care using the wrong toolset.

[superq]

True! Really, it's a three-way relationship:

customer - insurer: the govt (or, far more rarely, the employer) is the customer

insurer - recipient: the recipient is you. You're really just a necessary but unwelcome side-effect.

[wat10000]

Once AI is able to replace patients, the industry is really going to take off.

[saxonww]

I think the industry terminology separates the provider (a doctor) from the payer (or payor; an insurance company in this case).

[matheusmoreira]

Somebody is paying for it. If not insurance companies, then the people through the government.

As a citizen of a country with socialized health care, I will tell you the politicians promise the world but when the bill comes they can't seem to find their way out of the room fast enough.

The only way to avoid this adversarial relationship is to pay for it yourself. No insurance, no government, nothing. That means vast amounts of people will not be able to afford even a doctor's private practice.

It's sad but the bitter truth is nobody really wants to pay for other people's health care either. They only say they do because it wins them votes or clients. They all can't leave the room fast enough when the bill actually comes. Politicians have other far grander things they'd rather do with all that taxpayer money, and that's when they're not corrupt and pocketing it. Insurers obviously want profit. They're all betting you won't actually need all that fancy schmancy health care they promised you. They're literally banking on it.

In my experience, people barely want to pay for their own health care. They "want" to but start appealing to the altruism of their fellow man the second the bill comes. In my country, doctors are shamed every day because of our "oath" to help others. People act like we are their slaves, not even entitled to payment for services rendered. The good doctor is the one who pursues medicine as a hobby, who walks the earth helping others in need, with no needs of his own to tend to. The good doctor somehow absorbs the costs of it all. Including the costs of the cures involved. Especially the opportunity costs.

People are not prepared for the soulless utilitarianism of public health care. The bitter truth is there aren't enough medical resources for everybody. You must pick and choose who gets that fancy MRI scan. If you pick right you kill people. If you pick wrong you kill even more people. You have hundreds of millions of citizens, how do you help as many as possible as much as possible with the resources available? Decentralization via hundreds of basic clinics and hospitals turns out to be better than centralizing everything into one well equipped giga hospital. It's not about any one guy. It's about saving costs now so that you can help more people later. That's what primary care is all about. Saving costs, by promoting healthy lifestyles which means less sick people later in life where treatment is more expensive. It's about money, about resources.

But people don't want that. Good lifestyles are hard to lead, they require sacrifices. They want to do whatever they want, then go to the doctors when they get sick, then they want others to pay for whatever's necessary to fix it, and they want it fixed good as new. They are like consumers who don't want to pay for the services they need. Nobody wants to pay for it, even the people who directly need the services.

[egypturnash]

Death panels.

[olddustytrail]

What about them?

[thephyber]

The political boogeyman was that government bureaucrats would be the members of “death panels” if we went full socialized healthcare industry, but in practice we already have death panels in health insurance claims adjusters and (less maliciously) doctors on transplant review boards.

[_DeadFred_]

My mother beat cancer. Insurance paid for follow up testing every 2 years. I tried to convince her to pay out of pocket and do it every year but she said 'they know best'. My mom did not beat cancer the second time when it came back and too much time elapsed between screenings.

I know 'pro status quo' people will say online anecdotes are all lies and not relevant, but there are a heck of a lot of people with a lot of animosity to the current system and it's 'for profit death panels'. I think it would be easier to swallow if it were societal chosen death panels over failed doctors (that can't make it so they go work for the insurance company) or random AIs doing the decision making.

[herewulf]

I'm sorry for your loss. I'm also sorry it now has to serve as a warning for others. Thank you for sharing.

[jopsen]

With a socialized healthcare system the system would have delays and you'd get the screening every 2.5 years, even if it was scheduled for every 2 years. Because of wait lists.

To be fair, it's impossible to know of it matters :)

I moved back to Europe from the US. And I can certainly feel that healthcare is slower, less eager to jump and investigate everything.

But on the other hand, in the US you most certainly risk talking your self into procedures you don't need!

[datavirtue]

People need to be reasonable and know when to DNR. 85 yrs old with massive health problems has a stroke and falls over...DNR. Not here. We jump them back to life, deny their claim and stick them in a facility. Now they are babling and drooling all day and the trust fails to kick in so the people grandma was taking care of financially wait patiently while someone with POA drains grandmas bank accounts and sells off her houses that said people were going to live in (all in violation of her wishes and planning) to pay medicare.

[rscho]

Well, docs have seen this coming from miles away. I don't think anyone having substantial experience in clinical medicine is surprised by those developments, unfortunately. But it doesn't stop here. Insurance companies will be (are) building models to overcome legal barriers. Imagine: you're 20 and healthy, but located somewhere suggesting a higher risk of developing some chronic disease in the future ? Then no insurance covering this particular condition, for you specifically. A real-world application of the 'fuck you in particular' meme. This of course extends to all sorts of sensitive matters, such as your ethnicity, sexual preferences, etc.

Now this is a really scary application of AI, but you won't hear those wanting AI regulation such as Musk complain about that, right?

[ethbr1]

That's one reason (among many) the preexisting condition part of ACA is so important.

Without it, health insurance companies would have every incentive to do what car insurance companies do -- buy profiles and records from third parties and use those to adjust rates and willingness to insure.

E.g. the obvious step of buying genetic information from 23andme, because it isn't covered by HIPAA

[nradov]

GINA prohibits health insurance companies from using genetics to deny coverage or set premiums.

https://www.hhs.gov/hipaa/for-professionals/special-topics/g...

[ethbr1]

I'd feel a lot better with customer-centric privacy protections around the collector and storer, a la HIPAA.

Instead of regulating only some of the uses.

HHS already had to administratively extend to cover gaps (we'll see how that goes, post-Chevron) and Congress attempted to repeal it for workplace purposes in 2017.

And there's still the gray market question about 23andme -> Equifax-alike packaging it into a blended proprietary risk score -> insurance companies using that (of course 'without knowing that genetic information was included').

[fallingknife]

The year is 2035. To cut costs, both insurance companies and providers removed the human from the loop long ago setting off an adversarial process between the LLMs on both sides. Medical insurance claims are now written in an ever changing format that resembles no human language. United Healthcare has just announced a $10 billion project including a multi gigawatt data center to train its own foundational model to keep ahead in the arms race. UNH stock is up 5% on the announcement.

[YurgenJurgensen]

The naïveté of I Have no Mouth and I Must Scream is that it would be something as pedestrian as nuclear war that the globe-spanning hate machine would be built to manage. Now we know what AM would really have been built to do.

[starkparker]

lmfao: https://www.reddit.com/r/healthIT/comments/1eblbk1/comment/l...

[vjk800]

The real fun starts when they start writing the insurance contracts that are only meant to be readable by ML algorithms. Imagine thousands (millions?) of contract pages written in practically incomprehensible language, designed by an ML algorithm to contain clever loopholes that are difficult to detect by an adversarial algorithm.

[dpflan]

Interesting. Do you have any examples to share?

[mancharface1]

Agree. I'd love to see an example of this, or read more about it.

[starkparker]

This piqued my interest too. I found a few adjacent papers but couldn't find a source that made as comprehensive of a claim.

The closest were:

- "In constant battle with insurers, doctors reach for a cudgel: AI" from NYT (via Salt Lake Tribune), 2024 July, which is mostly on doctors using law-compliant LLMs to draft prior authorizations and has a passing one-graf mention of insurers likely doing the same: https://www.sltrib.com/news/nation-world/2024/07/11/constant...

- "The AI arms race over your medical bill" from Politico, 2024 Jan., summarizing LLM use in coding, billing, and fraud prevention: https://www.politico.com/newsletters/future-pulse/2024/01/05..., linking to https://www.politico.com/news/2023/12/31/ai-medical-expenses... and https://govciomedia.com/how-health-tech-leaders-use-ai-to-co...

Aside from that:

"Large Language Models to Help Appeal Denied Radiotherapy Services" from JCO Clinical Cancer Information, 2024 Sept. (abstract only; full-text paywalled) https://pubmed.ncbi.nlm.nih.gov/39250740/

"The potential of large language models in the insurance sector", 2024 Feb. (commercial white paper), largely focused on "fraud detection" in claims: https://www.milliman.com/en/insight/potential-of-large-langu...

"IQVIA NLP Risk Adjustment Solution (undated commercial white paper), marketing pitch on using AI to improve coding accuracy and reduce chart review times: https://www.iqvia.com/-/media/iqvia/pdfs/library/fact-sheets...

[crakenzak]

Interesting! Source?

[IG_Semmelweiss]

This is coming and there's a very simple fix.

Make healthcare insurance be actual insurance: as in, not a gateway to treatment conditions that are entirely lifestyle driven.

Once patients are responsible for the bill and the large middle layer admin crud is taken off the table, medical inflation almost disappears. Take this example of a for-profit facility vs non-profit hospitals [1]

Ideally this happens once environmental factors are fixed or drastically reduced so diet and lack of time are "choice-driven" instead of "needs driven" as health determinants (you do have subsidies at the lowest end, but that cannot go on forever).

https://www.openhealthpolicy.com/p/cash-providers-cheaper-su...

[6ix8igth]

How do you delineate between conditions that are "lifestyle driven" and not? When you develop a problem with your body it doesn't come with a receipt listing the cause.

I've personally had postural issues that were for many years simply attributed to poor discipline. It later turned out that I have a connective tissue disorder that was destroying the joints in my body.

All you I can see your proposition doing is giving insurures another reason to decline potentially legitimate claims. Your case would be more rational if you were arguing for no insurance at all.

[brigandish]

Medical authorities make a list, and people applying for insurance answer lifestyle questions like "do you smoke?", "do you exercise?" etc and they have an initial exam.

It's not that hard. In the example you've given you could sue the doctors for misdiagnosis, or if research showed that a condition had been mislabelled, people would receive compensation. It doesn't seem any more onerous than any of the other negotiations over conditions and treatments that go on in any medical industry and legislature anywhere in the world.

[gorgoiler]

I believe it’s pretty widely accepted that some component of addiction and substance abuse is genetic / hereditary. The same is true of depression.

I personally feel uncomfortable labeling these as lifestyle choices to drop insurance liability. Alcoholism isn’t really the same as skiing.

[brigandish]

> Alcoholism isn’t really the same as skiing.

Statistical methods can be used to assess the risk of each.

> I believe it’s pretty widely accepted that some component of addiction and substance abuse is genetic / hereditary. The same is true of depression.

High risk people should:

a) have most costly insurance against those things

b) be given help to avoid those things, which

c) could be used to reduce the cost of their premiums

Men are more prone to violence and also more likely to be victims of violence, and this is largely biological (hence the huge disparity between the sexes) - would that be some sort of excuse? Should men and women pay the same for the same relevant insurance even though they present wildly different risks of both perpetrating and befalling violence? That would be unfair.

I'm firmly in the "you are responsible for your life as an adult" camp. From a family of smokers thus making you more likely to be a smoker? Don't smoke. History of alcoholism in your family? Don't drink… need I go on?

[6ix8igth]

One can smoke and have a condition that is not caused by smoking, just like one can avoid exercising and have a condition that is not caused by insufficient exercise. You can't compile a list of facts about a person's life and use that to deterministicly attribute the cause of given conditions.

Does having one vice deny a person for life from having coverage for any disease which my potentially be caused by that vice? How long must a person partake in this vice to be denied coverage for life (i.e. is it okay to smoke for a few years then quit?)

Your example also has the problem of measuring the "lifestyle questions" being presented. How would you prove a person isn't exercising enough? If I know it will get me denied I'm not going to self report. We would need some sort of invasive "health audit" industry to insure compliance with insurance requirements. A physical exam at the start of insurance doesn't solve this, because like I said, the existing issues could have been caused by any number of problems.

Your dismissal of my specific example is silly - I don't want to sue a doctor for misdiagnosing a relatively common issue. Connective tissue disorders are not that rare, and I'm far from unique. Do you want to live in a society where we have to fight tooth and nail to get basic care for problems on the basis that we might have caused them ourselves?

[brigandish]

> You can't compile a list of facts about a person's life and use that to deterministicly attribute the cause of given conditions.

That is just not the case, and I shouldn't have to point out such basics on HN.

> A physical exam at the start of insurance doesn't solve this, because like I said, the existing issues could have been caused by any number of problems.

And yet I have to… People do a thing called "collecting data", on a large scale, and then they apply the lessons learnt from that data to calculate statistical risk. An imperfect system but, strangely enough, very effective (when not interfered with, as in the US health system).

Of course, you are welcome to open a car insurance company and offer everyone the same insurance for the same price and watch as young men and previously uninsurable people flock to your service. Maybe you'll get lucky and won't have to pay out more than you take in. All the best with that.

> Your example also has the problem of measuring the "lifestyle questions" being presented. How would you prove a person isn't exercising enough? If I know it will get me denied I'm not going to self report.

And then the insurance company can decide what level of fraud it will tolerate (something HN has discussed previously[0], and the linked article[1] is enlightening) and thus adjust its costs, and perhaps premiums.

> Your dismissal of my specific example is silly - I don't want to sue a doctor for misdiagnosing a relatively common issue.

If it's not a problem then don't sue. If it is, that is what the court system is for (or whatever system doctors and medical companies would put in place to avoid going to court).

[0] https://news.ycombinator.com/item?id=38905889

[1] https://www.bitsaboutmoney.com/archive/optimal-amount-of-fra...

[miki123211]

You don't, but you provide lower insurance prices to those who can demonstrate a healthy lifestyle.

You wouldn't even need too much surveillance to do this. Give people a yearly "fitness checkup" to encourage physical exercise, monitor weight to encourage healthy eating habits, do periodic drug tests to discourage drug use etc.

If you combined this with a (privacy preserving) fitness band that would monitor your vitals, and only send a list of premiums you're eligible for, you could do even better.

You'd have to account for preconditions that make it hard/impossible to exercise, but this would work for most people.

[int_19h]

Any actual, real-world implementation of such a thing would 1) not be privacy preserving (except in the "we pinky promise we're not going to use this data!" kind of deal), and 2) would inevitably expand the definition of "unhealthy lifestyle" over time as a way to exclude undesirables from the system and thereby leave more resources for those who remain.