[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.