[aqme28]

You’re thinking too highly about the incentives of the US healthcare system. Since insurance is tied to your employer (and therefore changing every few years), and most people die on Medicare, there’s not much incentive for insurance companies to pay for preventative care that won’t actually help you for several decades.

[ethbr1]

That’s one reason the ACA shifted it to a mandatory (in most cases) category: https://www.healthcare.gov/preventive-care-adults/

Minimal, but minimal progress in the US was/is still progress.

[eru]

It's a shame the contracts you'd need to set the right incentives are probably illegal.

[darkwizard42]

Actually from what I have heard, GLP-1 are maybe the first category of drugs which have impact within the median tenure of people on a medical plan (~2 years). It is so significant that you can see ROI within that window which justifies in subsidizing/encouraging patients to use it.

Doesn't disagree with your original claim that there is low incentive for any private insurance to care regarding longevity, but figured I could add some color

[helicalmix]

hmm...doesn't this possibly incentivize ozempic subsidies even more?

If you know a "customer" of yours (an individual employee) is only going to be with you until they either change jobs or go on Medicare, then it seems the name of the game then is to make sure that nothing catastrophic happens to them until you can hand them off to someone else.

In which case, they should definitely go on ozempic. Even if the effects of ozempic immediately come off after usage, it's a short-term enough solution that benefits the insurance company, no?

[vrc]

Yes. For very high risk patients, payers do want this. I’ve even heard of some paying pharmacies $100/fill if done on time for select people.

The problem is, prediabetic and folks who may have crossed 7.0 A1C once, and just overweight folks with docs who are willing to play fast and loose are demanding it. Skipping metformin and other first line treatment options that are way cheaper. For those folks, complications might be the next guys problem.

[altcognito]

If you were guaranteed 5% over the total cost of the medical services provided as profit, would you want people to have expensive or cheap medical. Are?

[helicalmix]

can you explain this statement to me more? I think i'm missing something

[gangstead]

The health insurance companies are paid as a percentage of the amount of care that flows through them. So healthier customers means their profit is 5% of SMALLER_NUMBER.

[helicalmix]

> So healthier customers means their profit is 5% of SMALLER_NUMBER.

I don't think this is completely true right? Rather, it's more accurate to say that customers that are seen as healthier get to pay less premiums, but customers that are seen as unhealthy have to pay more.

In both scenarios, you, as the insurance company, still want to be minimizing the amount of care you actually pay for.

In other words, to maximize profits, it seems like the best customer is one that's high risk (high premiums), but less likely to require a catastrophic payout. In which case, it feels like an obese high risk patient on ozempic seems like a pretty solid deal.

[gangstead]

My understanding is that under ACA their profit is capped and if they don't pay out they have to issue rebates:

> In the simplest terms, the 80/20 rule requires that insurance companies spend at least 80 percent of the premiums they collect on medical claims, effectively capping their profit margins. If insurers fall under this threshold, they must rebate the difference to policyholders.

Source: https://www.aeaweb.org/research/regulating-health-insurers-a....

So that would mean that the only way to increase the profit is to reduce over head and keep more of the 20% or increase the amount of claims. Paying out less in claims would mean they have to give rebates back to the customers.

As with everything health care related I'm sure it's more complicated than that and I'm missing something. For instance my health care plan is through my employer so everyone pays the same premium and the provider doesn't get to set it based on how healthy each employee is (although certainly the whole group is negotiated when the contract comes up for renewal).

[Aurornis]

> You’re thinking too highly about the incentives of the US healthcare system. Since insurance is tied to your employer (and therefore changing every few years)

Most people don’t change jobs or insurance companies every few years. When they do, it’s often within similar regions and industries so the chances of ending up right back under the same insurance company are significant.

Regardless, the issue is more complicated than your line of thinking. Insurance companies have very small profit margins. Current GLP-1 drugs are expensive, around $1,000 per month.

So each patient on GLP-1 drugs costs an extra $12K per year (roughly) or $120K per decade. That would have to offset a lot of other expenditures to break even from a pure cost perspective, which isn’t supported by the math. So the only alternative would be to raise everyone’s rates.

I know the insurance industry is the favorite target for explaining everything people dislike about healthcare right now, but at the end of the day they can’t conjure money out of nothing to cover everything at any cost demanded by drug makers. These drugs are super expensive and honestly it’s kind of amazing that so many people are getting them covered at all.

[DrillShopper]

I haven't changed jobs and I've had three different health insurance companies in as many years, all of which needed new prior auths for Trulicity/Mounjaro.

[alphabettsy]

A night in the hospital is easily $12k almost anywhere in the U.S.

People with chronic health conditions spend an inordinate amount of time at the doctor and in hospitals. That could save a significant amount of money if that’s reduced or eliminated. Not to mention the time savings.

I could be wrong, but all things being equal doesn’t it make sense to spend $12k/year on medication than $12/year on doctor and specialist visits in addition to medication?

[rstuart4133]

A one off anecdote here - I ended up in hospital for a TIA. I'm in Australia, and this is a public hospital. Free in other words. I have never seen so many seriously obese people in my life. They were all occupying hospital beds. I swear at least half the beds were use occupied by them. Meanwhile, we have ambulance lining the ramps of hospitals, with patients in them, waiting for bed to become free.

To put the this in perspective, where I live spends about $10,000/yr/person on health. That's all kinds of health. I'm not sure $5,000/yr (which is about the price here) of GLP-1 would be a generate proportionate decline, but I would not write it off. The $10K is paid by everybody, the $5k would only be for the obese.

[coredog64]

This misunderstands how employer-provided insurance works for most people. Large employers sign up with a company like Cigna to provide a network and administrative process. But the actual healthcare is covered by the employer. So really, Cigna or BCBS don't really give a rip if you're taking a bunch of money out of the pool.

[fn-mote]

USA: That’s the case if your company is “self-insured”. Some are, some aren’t. I imagine there are financial requirements to self-insure but I’ve never looked.

[reverendsteveii]

So what you're saying is when I file a claim and it's paid (precious miracle that that is) it comes from my employer and not the insurance company?

[sgerenser]

Most likely, if you’re in a medium to large company (not sure the cutoff, probably somewhere around 500-1000 employees). Smaller companies will generally actually need the insurance company to be the payer as well since otherwise one or two huge payouts could bankrupt them.

[raldi]

Then wouldn’t the government want to subsidize it?

[dfxm12]

A government for and by the people would, yes. This doesn't describe the US government though.

[TimedToasts]

We do not want tens of millions of people excreting GLP via waste products into our environment. Hormones and others are already effing things up.

[gscott]

Elon Musk suggested it. The fast food Industry has ppl addicted along with the lack of health education in schools.

[NoMoreNicksLeft]

The effectiveness of "health education" is somewhere between extraordinarily modest and nonexistent. It's not that people don't know what's healthy, it's that when it comes time to resist compulsion that is difficult, uncomfortable, and undesirable.

[eru]

> [...] along with the lack of health education in schools.

I don't think that's too much of a factor?

I mean, check how much (or rather how little) people learn of the stuff that _is_ covered in school. Tweaking the curriculum would just mean that instead of not paying attention in algebra, students would not pay attention in 'health education class'.

[Jalad]

In my school there was a strong emphasis on what a healthy diet is baked into the curriculum. Along with my family's relatively healthy cooking, that set me up for cooking and eating well on my own through college and life after that. I would edge away from takes related to "it just wouldn't work"

I mean the education system is its own mess for other reasons, but it's not a complete failure

[eru]

Maybe, though in your case, your family's cooking (and other background) probably already determined your fate.