[trollbridge]

This sounds like excellent evidentiary material for a future insurer or government health provider to decide you're uninsurable, not eligible for a job, and so on.

And the great thing about it is that you already signed all your rights away for them to do this exact thing, when we could have had an open world with open models run locally instead where you got to keep your private health information private.

[simianwords]

Can you explain the exact way in which this is possible? It’s not legal to be denied jobs based on health. Not to deny insurance

[Flatterer3544]

And how would you know what they base their hiring upon? You would just get a generic automated response..

You would not be privy to their internal processes, and thusfar not be able to prove wrong doing. You would just have to hope for a new Snowden and that the found wrongdoings would actually be punished this time.

[bko]

I don't get it, if you're medically unfit for a job, why would you want the job?

For instance, if your job is to be on your feet all day and you can barely stand, then that job is not for you. I have never met employers that are so flush in opportunities of candidates that they just randomly choose to exclude certain people.

And if it's insurance, there's a group rate. The difference only variable is what the employee chooses out of your selected plans (why make a plan available if you don't want people to pick that one?) and family size. It's illegal to discriminate of family size and that does add up to 10k extra on the employer side. But there are downsides to hiring young single people, so things may balance out.

[zopa]

Usually there's one or two job responsibilities among many, that you can do, but not the way everyone else does them. The ADA requires employers to make reasonable accommodations, and some employers don't want to.

So less, the job requires you to stand all day, and more, once a week or so they ask you make a binder of materials, and the hole puncher they want you to use dislocates your hands (true story). Or, it's a desk job, but you can't get from your desk to the bathroom in your wheelchair unless they widen the aisles between desks (hypothetical).

[jjmarr]

Very large employers don't have a group rate. The insurance company administers the plan on behalf of the company according to pre-agreed rules, then the company covers all costs according to the employee health situation.

Read your policy!

[rafterydj]

I believe existing laws carve out exceptions for medical fitness for certain positions for this very reason. If I may, stepping back for a second: the reason privacy laws exist, is to protect people from bad behavior from employers, health insurance, etc.

If we circumvent those privacy laws, through user licenses, or new technology - we are removing the protections of normal citizens. Therefore, the bad behavior which we already decided as a society to ban can now be perpetrated again, with perhaps a fresh new word for it to dodge said old laws.

If I understand your comment, you are essentially wondering why those old laws existed in the first place. I would suggest racism or other systemic issues, and differences in insurance premiums, are more than enough to justify the existence of privacy laws. Take a normal office job as an example over a manual labor intensive job. No reason at all that health conditions should impact that. The idea of not being hired because I have a young child, or a health condition, that would raise the group rate from the insurer passing the cost to my employer (which would be in their best interest to do) is a terrible thought. And it happened before, and we banned that practice (or did our best to do so).

All this to say, I believe HIPAA helps people, and if ChatGPT is being used to partially or fully facilitate medical decision making, they should be bound under strict laws preventing the release of that data regardless of their existing user agreements.

[throwup238]

> I believe existing laws carve out exceptions for medical fitness for certain positions for this very reason.

It’s not just medical but a broad carve out called “bona fide occupational qualifications”. If there’s a good reason for it, hiring antidiscrimination laws allow exceptions.

[pseudalopex]

> And if it's insurance, there's a group rate.

Insurers derive rates for each employer from each employer's costs where laws allow this. And many employers self fund medical insurance.

[simianwords]

Do corporations use my google searches as data to hire me?

[well_ackshually]

Do you have any proof they don't? Do you have any proof the "AI System" that they use to filter out candidates doesn't "accidentally" access data ? Are you willing to bet that Google, OpenAI, Anthropic, Meta, won't sell access to that information?

Also, in some cases: they absolutely do. Try to get hired in Palantir and see how much they know about your browsing history. Anything related to national security or requiring clearances has you investigated.

[linkregister]

The last time I went through the Palantir hiring process, the effort on their end was almost exclusively on technical and cultural fit interviews. My references told me they had not been contacted.

Calibrating your threat model against this attack is unlikely to give you any alpha in 2026. Hiring at tech companies and government is much less deliberate than your mental model supposes.

The current extent of background checks is an API call to Checkr. This is simply to control hiring costs.

As a heuristic, speculated information to build a threat model is unlikely to yield a helpful framework.

[bossyTeacher]

>the effort on their end was almost exclusively on technical and cultural fit interviews

How could you possibly know if they use other undisclosed methods as part of the recruitment? You are assuming Palatir would behave ethically. Palantir, the company that will never win awards based on ethics

[raw_anon_1111]

As if any company that did that is a company I would want to work for.

For instance back when I was interviewing at startups and other companies where I was going to be a strategic hire, I would casually mention how much I enjoyed spending time on my hobbies and with my family on the weekend so companies wouldn’t even extend an offer if they wanted someone “passionate” who would work 60 hours a week and be on call.

[two_tasty]

I certainly understand this perspective.

But is it really so hard to imagine a world where your individual choice to "opt-out" or work for companies that don't use that info is a massive detriment to your individual life? It doesn't have to be every single company doing it for you to have no _practical_ choice about it (if you want to make market rate for your services.)

[moi2388]

“ Do you have any proof they don't?”

Do you have any proof they don’t have a goose randomly deciding to hire you?

The lack of proof gives no credence to it actually happening

[smsm42]

Probably not directly, that would be too vulnerable. But they could hire a background check company, that could pay a data aggregator to check if you searched for some forbidden words, and then feed the results into a threat model...

[Aurornis]

No they do not.

Anyone who has worked in hiring for any big company knows how much goes into ensuring hiring processes don't accidentally touch anything that could be construed as illegal discrimination. Employees are trained, policies and procedures are documented, and anyone who even accidentally says or does anything that comes too close to possibly running afoul of hiring laws will find themselves involved with HR.

The idea that these same companies also have a group of people buying private search information or ChatGPT conversations for individual applicants from somewhere (which nobody can link to) and then secretly making hiring decisions based on what they find is silly.

The arguments come with the usual array of conspiracy theory defenses, like the "How can you prove it's not happening" or the claims that it's well documented that it's happening but nobody can link to that documentation.

[anal_reactor]

Not yet. But Google itself would ask you for your resume if you happened to search for a lot of things related to programming.

[LPisGood]

Yes, I remember a friend that interned there a couple times showed me that. One of them was “list comprehensive python” and the Google website would split in 2 and give you some really fun coding challenges. I did a few, and you get 4(?) right you get a guaranteed interview I think. I intended to come back and spend a lot of time on an additional one, but I never did. Oops

[anal_reactor]

I think I only did three or something and I didn't hear back from them. Honestly my view of Google is that they aren't as cool as they think they are. My current position allows me to slack off as much as I want and it's hard to beat that, even if they offer more money (they won't in the current market).

[Aurornis]

"Ask you for your resume" is a funny way of saying "Show an advertisement to invite people to apply for a job"

[Aurornis]

I'm kind of amazed that so many people in this comment section believe their Google searches and ChatGPT conversations are being sold and used.

Under this conspiracy theory they'd have to be available for sale somewhere, right? Yet no journalist has ever picked up the story? Nobody has ever come out and whistleblown that their company was buying Google searches and denying applicants for searching for naughty words?

[nyrikki]

Google "doesn't sell your data" but RTB leaks that info, and the reason no one is called out for "buying Google searches and denying applicants for searching for naughty words" is because it is trivial to make legal.

It is well documented in many many places, people just don't care.

Google can claim that it doesn’t sell your data, but if you think that the data about your searches isn't being sold, here is just a small selection of real sources.

https://www.iccl.ie/wp-content/uploads/2022/05/Mass-data-bre...

And it isn't paranoia, consumer surveillance is a very real problem, and one of the few paths to profitability for OpenAI.

https://techpolicy.sanford.duke.edu/data-brokers-and-the-sal...

https://stratcomcoe.org/cuploads/pfiles/data_brokers_and_sec...

https://www.ftc.gov/system/files/ftc_gov/pdf/26AmendedCompla...

https://epic.org/a-health-privacy-check-up-how-unfair-modern...

[Aurornis]

> and the reason no one is called out for "buying Google searches and denying applicants for searching for naughty words" is because it is trivial to make legal.

Citation needed for a claim of this magnitude.

> It is well documented in many many places, people just don't care.

Yes, please share documentation of companies buying search data and rejecting candidates for it.

Like most conspiracy theories, there are a lot of statements about this happening and being documented but the documentation never arrives.

[Aurornis]

This fails the classic conspiracy theory test: Any company practicing this would have to be large enough to be able to afford to orchestrate a chain of illegal transactions to get the data, develop a process for using it in hiring, and routinely act upon it.

The continued secrecy of the conspiracy would then depend on every person involved in orchestrating this privacy violation and illegal hiring scheme keeping it secret forever. Nobody ever leaking it to the press, no disgruntled employees e-mailing their congress people, no concerned citizens slipping a screenshot to journalists. Both during and after their employment with the company.

To even make this profitable at all, the data would have to be secretly sold to a lot of companies for this use, and also continuously updated to be relevant. Giant databases of your secret ChatGPT queries being sold continuously in volume, with all employees at both the sellers, the buyers, and the users of this information all keeping it perfectly quiet, never leaking anything.

[drawnwren]

It doesn't though. As an aside, I have been using a competitor to chatgpt health (nori) for a while now, and I have been getting an extreme amount of targeted ads about HRV and other metrics that the app consumes. I have been collecting health metrics through wearables for years, so there has been no change in my own search patterns or beliefs about my health. I just thought ai + health data was cool.

[purrcat259]

> And how would you know what they base their hiring upon?

GDPR Request. Ah wait, regulation bad.

[DetectDefect]

> It’s not legal to be denied jobs based on health.

There is a vast gap between what is not legal and what is actually actionable in a court of law, which is well known to a large power nexus.

[neilv]

> It’s not legal to be denied jobs based on health. Not to deny insurance

The US has been pretty much a free-for-all for surveillance and abusing all sorts of information, even when illegal to do so. On the rare occasions that they get caught, the penalty is almost always a handslap, and they know it.

[trollbridge]

How are you ever going to prove this?

You just get an automated denial from the ATS that's based on the output from AI inference engine.

[joe_the_user]

The ADA made it illegal to discriminate against job seekers for health conditions and ObamaCare made it illegal to base cover and rates on pre-existing conditions.

What are the chances those bills last long in the current administration and supreme court?

[darth_avocado]

And yet, if you want life insurance you can’t get it with a bunch of pre existing conditions. And you can be discriminated against as a job seeker as long as they don’t make it obvious.

[matt3D]

These strawman arguments lack nuance.

If the person can use AI to lead a noticeably better life, something that may have been impossible previously due to economic circumstance, then the first order benefits outweigh the second order drawbacks.

I’m not disputing what you’re saying, I just think that treating it like a zero sum game every time the conversation comes up is showing an immense amount of privilege.

You, me, the parent commenter; we’re all dying, we don’t have time to optimise for the best outcome.

[xigoi]

If the tool that allows you to have a “noticeably better life” is heavily subsidized by venture capital, you have turned yourself into a ticking bomb.

[newyankee]

there is also no easy way to build a perfect health AI without giving up some privacy. Now there will always be risks, but this is why I think China might overtake everyone else in Healthcare AI at the least

[carlosjobim]

What do you consider the purpose of life to be? To me being in good health is immensely more important than health insurance, a government health plan, or a job.

I know that neither health insurers nor any government agency nor anybody else have even 0,0000000000000001% as much interest in my health, well being and survival as I do.

When it is the matter of my health and my life, I care as much about what an insurer or employer thinks as I would care about what the Ayatollah of Iran thinks. Or what you think. Ie: Those opinions are without any value at all.

[paulryanrogers]

Most of us cannot afford to pay the full cost of healthcare for an emergency or major intervention. Medical bankruptcy is an increasingly common phenomenon.

So if insurers can cut you off based on your ChatGPT queries or test results then you may find yourself in serious debt, homeless, without medical care, etc

[carlosjobim]

Money is imaginary. Health is health. Sacrificing your health and your life in order to hedge against a completely hypothetical situation is not a dignified existence.

Bankruptcy is of course much preferable to not having your health. Even having to argue this is bizarre. We are not human batteries in the Matrix. Our purpose is not to please institutions or destroy our own lives for fear of hypothetical situations.

Don't you understand that you only have one life and one body. That's it. You have 70 or 80 years with one body and one mind. That is the only thing which matters.

[nrb]

Health is imaginary, life is imaginary, this is all imaginary. There’s no point in drawing an arbitrary line in the sand for what our purpose is or lecturing us on what we should be focusing on.

We have seen, again and again, business encroach on our quality of life and it does warrant skepticism and alertness about their motivations.

[carlosjobim]

What are you even saying? You are outright denying reality it seems. Health and life are not imaginary. They are as real as it gets.

[kouteiheika]

> when we could have had an open world with open models run locally instead where you got to keep your private health information private

But we can have that? If you have powerful enough hardware you can do it, right now. At very least until the anti-AI people get their way and either make the models' creators liable for what the models say or get rid of the "training is fair use" thing everyone depends on, in which case, sure, you'll have to kiss legal open-weight models goodbye.

[beepbopboopp]

This is an argument against the general data collection internet NOT chatGPT.

[mrcincinnatus]

Precisely right. Related. https://www.socialcooling.com/

[SecretDreams]

System working as intended!

[lotsofpulp]

If an insurer is able to reduce (or recoup) costs from likelier risks, then the remaining insureds benefit from lower premiums.

If the goal is providing subsidies (i.e. wealth transfers), then insurance is not the way to do it. That is the government’s role.

[alpinisme]

Insurance that is maximally responsive to patient health changes in terms of cost (ie making healthier people pay less) ends up being an inefficient way of just having people pay for their healthcare directly.

And it naturally means the people with highest premiums are the least likely to be able to afford it (the elderly, the disabled, those with chronic conditions that make them less likely to maintain high earning jobs steadily, etc)

[Workaccount2]

The obvious retort to this is:

"If I focused on my health, ate clean and exercised daily, why should I also be subsidizing Billy "video-games-are-my-exercise" fatass's chronic health conditions?"

This is why there is a hyperfixation on shifting blame away from (failing) individuals. The logic breaks when Billy has to admit he just hates exercising.

And yes, before you comment, I know "maybe Billy has (condition outside all control) so it's not on him". Please, see what I just said in the previous statement.

[ImPostingOnHN]

The entire purpose of health insurance is spreading risk across a wide and diverse risk pool.

> why should I also be subsidizing Billy "video-games-are-my-exercise" fatass's chronic health conditions?"

Nobody is asking you to: enrolling in insurance is a choice in the USA.

Also, replace "chronic health conditions" with "unavoidable inherited genetic risk factors". We don't want Billy to be screwed for life just because he was born to a suboptimal combination of parents.

[Workaccount2]

The most cataclysmic thing that could happen to healthcare would be chronically healthy individuals creating their own health insurance.

[ImPostingOnHN]

Not really (in fact that doesn't even make sense), but in any case, I think you replied to the wrong post. Your reply doesn't seem to have anything to do with the post it replied to

[alpinisme]

In some respects, the ideal world is one in which everyone’s premiums are tied to a free and easy Apple Watch-like device that silently tracks exercise, blood sugar at a frequency that can tell when you ate a big dessert, air quality (and the presence of smoke or pollution), blood alcohol content, whether you are in speeding cars, whether you are participating in dangerous sports, etc. Such a system would directly confront individuals with the cost of their behaviors in an economic way, probably leading many or even most people to improve their habits in the aggregate.

But such a system comes at other costs that most people intuitively feel infringes on core values they have.

Edit to add: this system would actually have some great advantages over an “existing conditions” tax in that now you pay low rates until you have diabetes, all during the time you are leading the unhealthy lifestyle. But once you have it you are not rewarded for starting to exercise and eat healthy and get it under control. In the hypothetical scenario above, you’d be punished economically during the period you were building bad habits and you would be able to restore sane costs after course correction

[Terr_]

There's a similar phenomenon when people grouse about paying taxes for "roads I don't even use." Even if we assume zero indirect benefits, the billing infrastructure necessary to truly achieve that goal would create a creepy panopticon of constant surveillance.

This is difficult to convey to certain brands of self-styled libertarians.

[tonyedgecombe]

> creepy panopticon of constant surveillance

Which we have anyway. We might as well get some benefits from it.

[xigoi]

The government already knows whether you have a car. What more information would they need?

[duskdozer]

It also fails to take into account the fact that eating clean and exercising daily doesn't eliminate your risk of getting cancer at age 40 or having your car's brakes fail randomly.

[Workaccount2]

Its dumb to create an insurance program using anecdotes.

The system can accommodate (and frankly is the ideal many people strive for) some health nut getting long drawn out cancer battle at 41. Its rare enough to be noise in the giant money payout pool.

Obesity and it's litany of health effects are not rare, and next to age, are a dominating signal drawing money from the pool.

[OverTheTetons]

Is the obvious retort to this:

I don't think we should play arbiter for who has and hasn't lived a healthy enough life to still believe they should get healthcare?

[Analemma_]

Yeah, I think what Workaccount2 is not realizing is that there's no bottom to "you have higher risk factors, why should I pay for you?", and so once you start down that way you may not like where it ends up. Some hobbies have higher injury rates, why should I pay for your health care if you choose to play those? Some parts of the country have lower life expectancies, why should I pay for your health care if you choose to live there?

[Workaccount2]

The actual realization, which usually comes years after the realization that there is no bottom, is that there is no top either.

The battle along the spectrum of privatizing gains (lower healthcare premiums for a healthy lifestyle - high premiums for unhealthy lifestyle) vs socializing losses (paying $20/mo to get $1200/mo of care - paying $1200/mo for $0/mo of care) is constant and boundless in either direction.

[FireBeyond]

> "If I focused on my health, ate clean and exercised daily, why should I also be subsidizing Billy "video-games-are-my-exercise" fatass's chronic health conditions?"

Then why are you not asking your insurer why they cover a lot less preventative health or other options. For example, Kaiser flat out refuses to prescribe GLP-1s for weight loss, others insurers are the same with gym subsidies or not covering nutritionists.

But they'll happily pay for your gastric bypass.

[IanCal]

> Insurance that is maximally responsive to patient health changes in terms of cost (ie making healthier people pay less) ends up being an inefficient way of just having people pay for their healthcare directly.

That's true for predictable costs, but not true for unpredictable ones - which is the point of most insurance (housing, car, etc). The point and use of insurance is to move risk to entities that can bear it.

Utility is non-linear with money, and so you easily have situations where spending X times more on something "costs" you more than X times if measured in how useful the money is to you.

Typically, as you have more money, each further dollar doesn't provide as much benefit as the last (sometimes things are lumpy, the difference between "not quite enough to pay rent" and "just enough to pay rent" is huge, but broadly this is true). Going from $1000 to $10000 is more impactful than $1001000 to $1010000.

That means that moving the other way, each additional dollar spent has a greater personal cost to you.

Therefore, sharing unlikely but high expenses can mean that your expected cost is the same (if there's no profit/middleman) or a bit higher, but your expected personal cost is lower.

[monooso]

Not a US citizen, so a genuine question: do US health insurance companies have a track record of passing on such savings to consumers?

That has not been my impression as an outside observer.

[vjvjvjvjghv]

"passing on such savings to consumers"

Absolutely not. They inflate prices by 200% and then give you 20% "savings" back. The whole idea of a health insurance company as publicly traded corporation is totally insane. They are designed to extract maximum profit from wherever they can get. The is no incentive to save money for patients. Any savings go to shareholders.

[lotsofpulp]

There are plenty of health insurers that are not publicly traded, and in fact are non profit, and yet they have the same premiums as the publicly traded ones. See Kaiser, Providence, Cambia, Regence, and the dozens of other BCBS affiliated plans.

If your claims were true, then the publicly traded businesses would have no customers.

[Buttons840]

> There are plenty of health insurers

Yeah. And they all ultimately have to be paid by my health premiums.

When I visit my parents, and they have the TV on, and I see 3 90-second advertisments for prescription drugs every single commercial break, I remind myself that, no matter what, we have to keep funding these commercials. Whatever the US decides to do for healthcare, I guarantee these commercials will continue to be paid for.

I also guarantee that pharmacy company executives, and insurance company executives will continue to make millions of dollars a year. We have to keep paying them as well.

The huge bureaucracy of insurance workers who decide what is and isn't approved, that all will have to be paid for as well.

I used to work for a company that did background checks on doctors, we had different customers in every state, every state had their own companies and their own system for maintaining and verifying doctors licenses. These different companies in each state have to be paid. I made good money as a programmer doing background checks for these various companies and my paycheck also ultimately came from your medical premiums.

I think we need to stop and appreciate the patriotic duty we all have to pay high premiums and medical costs, because every time we do we're propping up a huge portion of US workers. -- Just kidding. The truth is a lot of companies need to go out of business before things get cheaper.

[vjvjvjvjghv]

I would argue the non profit insurers are as profit oriented as the publicly traded ones.

[zdragnar]

Ostensibly, the Affordable Care Act was supposed to reduce the average family's premiums by $2,500 a year.

When that didn't happen, the story changed to that number being how much more premiums would have risen.

Insurance premiums have only gone up as far as I can remember, though there's a ton of variables at play here. Inflation is an obvious one, plus continual introduction of more and more costly treatments- biologic injections, cancer therapies and so forth. The unfortunate increase in obesity rates in my lifetime (along with all the health complications) has been a significant contributor as well.

It all adds up.

[tzs]

> Insurance premiums have only gone up as far as I can remember, though there's a ton of variables at play here.

An interesting thing about rising health costs is that it has happened at roughly similar rates in most first world countries for the last 50+ years.

For example in 1990 the UK, FR, and US were paying 2.0, 2.2, and 2.6 times their 1980 costs per capita. By 2000 that was 4.1, 4.1, and 4.2. By 2018 (the last year I had data for when I calculated this a few years ago) it was 10.6, 7.5, and 10.2.

Here's the 2000 to 2018 increase for those and some others: DE, FR, CA, IT, JP, UK, US were 2.1, 1.8, 2.0, 1.7, 2.6, 2.6, 2.3.

When politicians in the US talk about rising health care costs they usually put the blame on recent policies from opposing politicians. That so many first world countries with so many different health care systems all have seen similar increases for the last 50+ years suggests that it is due to something they all have in common and that government policy doesn't affect it much.

[alright2565]

The individual mandate part of the ACA was the part designed to reduce premiums. You need healthy participants in any health insurance scheme to subsidize unhealthy people.

That was eliminated by a Republican bill, the Tax Cuts and Jobs Act of 2017.

[zdragnar]

Yes, and that was years after the ACA took full effect and the rates did not decrease.

Most people get insurance through their employer, and most employer plans (at medium to large companies) are self funded by the company and merely administered by insurance companies.

That means the healthy participants had no effect on those plans whatsoever. Even at peak, the individual mandate had only cut the number of uninsured by half, and the effect on rates was negligible.

[kjkjadksj]

FWIW the state of california has its own individual mandate.

[lotsofpulp]

In 2010, it was already known the proportion of old to young was increasing, and the proportion of doctors was decreasing.

Prices were always going to increase.

[butvacuum]

you're correct. UHC is so hated because they're a "pharmacy benefits manager." - an organization that exists soley to make your life so miserable you give up on getting your medication.

[FireBeyond]

Aetna has their own scumminess. Want the convenience of 90 day refills? Have to use their mail order service. They'll refuse to authorize >30 day supplies of medication through any other pharmacy.

[DANmode]

These comments (on UHC, Aetna) always strike me the same way as complaining about the lack of inflight meal,

baggage fees,

or lack of WiFi,

on, say, Spirit Airlines.

You looked at the list of insurers/jobs offering health insurance carriers,

selected the cheapest, or second-cheapest option,

and you’re surprised they’re harder to work with?

How?

[FireBeyond]

Oh yes, because the vast majority of employers in the US say "pick whatever healthcare plan you want from whatever carrier you want, we'll make it work" and not "You'll get what you're given and be glad for it".

Even in tech spaces with money to throw around, that just means that maybe your partner and dependent's premiums will be covered/negligible, or that your deductible will be low.

You're still going to be fucked by their policies, though.

[butvacuum]

aetna uses UHC for this.

[lotsofpulp]

Health insurance companies in the US are not allowed to deny coverage, and can only price premiums based on age (highest premium capped at 3x lowest premium, location, and tobacco use.

https://www.healthcare.gov/coverage/pre-existing-conditions/

https://www.healthcare.gov/how-plans-set-your-premiums/

Health insurance premiums in the US are more tax than insurance. They also have low single digit profit margins with less than desirable shareholder returns (many are non profit in the first place), so they don’t have much room to lower premiums without also reducing healthcare expenses.

The insurance business in general is very competitive and not very profitable, so an insurer that tries to collect outsized premiums will usually suffer a loss of business.

[monooso]

> The insurance business in general is very competitive and not very profitable...

Knowing several Americans, and how much they pay for health insurance (and are still required to pay for some things "out of pocket"), this is incredible to me. And that's before you even get to the process of making a claim.

Such a broken system.

[SpicyLemonZest]

We agree that insurance is not the right way to handle health as a product, since some people predictably need much more medical treatment than others. But it’s how the US has chosen to do it, so we have to do it in a way that works. Correctly identifying a systemic issue won’t pay your medical bills.

[lotsofpulp]

That is not how the US has chosen to do it. The ACA prohibits using anything other than age, location, and tobacco use for premium pricing, and the ACA prohibits denying coverage (resulting in a wealth transfer from healthy to sick).

Even the age rating factor is capped at 3, so there are also massive wealth transfers from young to old.

Mathematically, health insurance premiums in the US are more tax than insurance premium.

[trollbridge]

The ACA doesn't prevent some magical fairy-dust AI from pricing premiums, though, which is currently all the rage amongst insurers. (Not because AI will be accurate or anything, but because it offers a completely opaque pricing process.)

[avalys]

Why not? If the only factors allowed to be used in settings premiums are age, location and smoking status, then those are the only parameters that could be input to an AI model, no?

[kyboren]

Warning: I am not in this industry and the below is speculation:

AIUI the idea is to predict the "correct" price for an individual premium, Y, which is restricted to being the result of some insurance model function, f(), that is itself restricted to the domain of age (A), location (L), and smoking status (S):

  Y = f(A, L, S)

My impression was that the idea was that this would handicap insurers' natural desire to price premiums individually and have a smoothing effect on prices over the population.

But why is location useful for insurers to price premiums? I assume because healthcare has different costs in different locations, and different utilization rates: People living in coal mining towns or near oil refineries may be expected to use more healthcare and thus cost more to insure.

Thus, you can imagine insurers building a price map (like a heat map) overlay for the state/country, plotting each applicant on it, and checking the "color" there as part of their model function. So they are effectively embedding out-of-band information (prices and utilization rates for locations) into the model function f() itself.

What "AI", or large-parameter Deep Neural Networks, fundamentally change here is:

   - They can approximate any effectively computable function, the same class of functions that a programmer can write and execute on a computer[0].

   - They can be scaled up to an arbitrarily large number of parameters, i.e. an arbitrarily precise approximation limited only by the number of parameters and the amount and quality of model training data.

   - Absolutely critically: They are programmed implicitly, through brute-force training on input-output pairs, rather than explicitly, with some programmer writing an explicit series of instructions to compute the function.

This last point is probably the most important.

Large insurers previously had sophisticated models for f() hand-built by math whizzes, but they were limited in the amount of out-of-band information they could encode into that function by the limited cognitive and programmatic capacity of a human team.

But now with DNNs you can scalably encode unlimited out-of-band information into the function f(), while also totally obscuring how you're computing that location-based price adjustment.

The result, in extremis, is that f() is not some fancy algorithm cooked up by a few dozen math whizzes. Instead f() becomes a fancy database, allowing the tuple (A, L, S) to act merely as an index to an individualized premium Y, which defeats the entire purpose of restricting the domain of their model function.

[0]: https://en.wikipedia.org/wiki/Universal_approximation_theore...