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Being in charge of a health insurance company is like being a world leader: you are going to be making decisions that result in some people living and other people dying. There's no way around it. Your whole job is allocating scarce healthcare resources.
The scarcity is the real problem. But we'd rather murder a scapegoat, in cold blood, than face reality.
And scarcity is not going away. Not when it's possible to pour a near-infinite amount of money into eking out another year or two at end of life. Stop and think about what that means. I honestly question whether health is "insurable" even in principle.
Healthcare in America has problems but we cannot even begin as a society to discuss those problems with anything resembling sanity until we as a society learn to memento mori.
So if you're gonna murder a guy you might wanna have a better reason than some people get their claims denied.
This becomes perfectly obvious when we consider the different products that are wrapped up in Health Insurance in America.
If I wanted similar coverage for my car, I would need all of Car Insurance, a Warranty, and a prepaid Service plan. All are available on the market for most cars, all can be priced out, but they are different products completely. Comp Car Insurance makes sure that if I get into an accident, I won't be left without a car, but does not cover mechanical failures or ordinary wear and tear. A warranty makes sure that if my car breaks down, it will be fixed, but doesn't cover ordinary wear items. A Service plan allows me to bring my car into the dealer for regular service for wear items, fluids, etc, but doesn't cover those other things. Health insurance, by comparison, covers all three situations at the same time. It is true insurance, in that if I have an accident, it will cover my medical costs. It is a warranty, in that if I suffer from a genetic condition it will cover me. And it is a service plan, in that it covers my regular expected doctor's visits. But I expect to make the same payment for all three, and it is not clear how to distinguish among them.
This is what's attractive about those health ministry things that (ironically) aren't allowed to be called "health insurance". Some of them are more like "really big surprise medical bill from casualty events" insurance, and those are way more affordable. They have a high deductible for that and cover nothing else.
Does it mean you have to pay out of pocket for checkups and other routine stuff? Yes. Do you shop around sometime for competitively priced MRIs? Yes. Do you find yourself traveling a bit for providers? Yes. Are you looking for coupons on goodrx.com for prescription meds? Yes. Are your (family) premiums $5,000/year instead of $24,000/year? Absolutely.
If you have a warranty condition, that's on you to cover. Which, you know, is expensive. But so is covering everyone else's when you don't.
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It sounds weirdly blasphemous when you put it like that. “We take responsibility for this product not being delivered in useable condition.” I wonder if your warranty should be issued by the Church…
I guess the warrant is for your body, with your mind/soul is the intended owner, but that raises all sorts of philosophical questions.
Except that it covers your mind, assuming coverage would also include psych/mental health stuff, which it reasonably should inasmuch as we're not going full Szasz-pilled. The blasphemy disappears inasmuch as you stop thinking of a warranty as coming from the manufacturer, and moreso assuring the consumer a roughly median experience.
The more concerning part to me is that warranties always restrict uses. Your factory warranty on your car won't pay out for damage that results from racing. Your consumer warranty on your washer-dryer set won't pay out if you open a laundromat.
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Interestingly, the Knights of Columbus looked into offering health insurance for its members but couldn't find a good enough loophole on paying for abortifacients. This has been told to me personally by high ranking members and I'm really not sure what the relevant law(well, I guess section of the ACA) was, but that is how the Church would offer a warranty on genetic conditions, at least in the US.
I've always been curious: would refusal to pay for birth control or plan B etc actually make the plan cheaper, or more expensive?
For a single man, almost certainly cheaper. For a family, the major confound is that the knights of Columbus would expel a member who admitted to using birth control. Even if there's probably some cheating, a KofC healthplan would be covering lots of childbirths anyways.
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As long as something can in principle be fabricated by cells fed Gatorade in your basement, I question the necessity of its scarcity.
Even if this made any sense at all, neither Gatorade nor my basement is free nor available in unlimited quantities.
The demand for off brand cell medium (gatorade) is so outstripped by the supply that its almost too cheap to meter unless you're doing industrial bulk. I suppose I can't speak for your basement. But surely someone you know has room for a petri dish.
There are drugs that cost hundreds of dollars even though we can engineer cells to just bioprint them. These cell cultures can be shared by moving them from one petri dish to another. We should mandate the open sourcing of such cultures. To do otherwise is ethically obscene.
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Do you think it's always a tradeoff between who gets treatment, never a tradeoff between profit and treatment?
That trade-off certainly exists sometimes, but is overdetermined. Under Obamacare they're heavily regulated and their profits are bounded.
It's not totally grim of course, they can earn a return on the parked capital and the float on premiums but it does complicate the picture. And they are incentivized to scale.
In the limit they actually prefer "the standard of medical care" to go up[1], because it means premiums go up, because the pie is bigger and the 15% of the bigger pie is more absolute profit.
Nevertheless, these corporations may be big, and profit-seeking, but you would not get rich quick by investing in them.
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That is a destructive question. The tradeoff between profit and treatment is discussed ad nauseam. The gradual accumulation of treatments that extend life, without restoring its quality, and are expensive, is painful to think about. So we don't. But we need to, and the profit question helps us procrastinate and never get round to the uncomfortable issue :-(
I frame it with an equation life-span = health-span + grim-span. Modern medicine is extending the health-span. But for every extra year of health-span, we get three or four years more grim-span. (3? 4? I'll admit that I'm guessing wildly. I just don't want to follow my grand-mother and my parents down the care-home, dementia-unit, nursing-home, route.) Expensive grim-span.
We are well down the road of nibbling away at the quality of the health-span with taxes (or insurance premiums) to pay for expensive medical treatments. When do we say: there is a cash limit. That is a scary thing to say. Perhaps I will fall ill, find out that there is a treatment to save my life, find out the cost is over the cash limit, and get told "sorry, you'll have to die". Maybe the cash limit will be low because I decide to opt out of insurance for expensive treatments, enjoy spending the money I save, and die when my luck runs out.
There are two battles. One is around opting out. If I opt out of paying for the more expensive treatments for others, and therefore (by fairness) for myself, can I change my mind when I fall ill? Obviously not. Can I still whine about it, or must I die quietly? The other battle is about the future. More expensive treatments are coming. When is the breaking point when the money runs out?
Returning to the profit question, the British National Health Service (the NHS) is funded out of general taxation and free at the point of use. Do we Britbongs escape the profit issue? We should, because the NHS is a non-profit. But it doesn't work out like that. At constant funding there is a tradeoff between the wages of doctors and nurses and treatment. At constant funding, higher pay means fewer doctors means less treatment. Alternatively there is a tradeoff between funding and taxes. The politicians in charge need to keep in touch with fluctuating public sentiment. What will get them re-elected? More taxes and more health care? Lower taxes and scandals about people dying waiting for treatment? Perhaps the warning sign of the impending breaking point is no-one can get re-elected. The low tax politicians cannot get re-elected because of the deaths. The health care spenders cannot get re-elected because of the taxes.
We need to learn to memento mori least we build a world in which we spend our lives working long hours in health care, before eventually falling ill and taking a very long time dying, kept alive by the strenuous efforts of many younger people.
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I don't have enough insight into their inner workings to be able to answer this. But my guess is they are targeting some positive profit margin (since they would have to) and creating actuarial rules to target this number. Then claims etc are mostly following an algorithm. But then again given as I have alleged the "non-insurable" nature of health, they are probably having to constantly tweak this.
I doubt they're frequently making individual case-by-case decisions to deny somebody for the sake of let's-get-rich-and-do-coke, but maybe I inappropriately assume people aren't monsters.
In any case I'd want to see evidence of such backroom decisions because it's quite an allegation. But that would be hard because I'd also want to see that it's not just "this guy is trying to spend infinite money to eke out another month and unfortunately we don't have that" sort of thing. Like my point is it's actually really hard to prove actual malice here.
I think directionally, yes. It’s just good resource allocation to look at the actuarial data and say “this drug might marginally improve your life for a few months, but you’re old or in bad shape physically and thus your treatment makes no sense.”
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