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PaperclipPerfector  9d ago (text post)   26392 thread views

Culture War Roundup for the week of December 30, 2024

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I've expressed before that veterinary care has a lot of medicine, especially the business side, figured out better than humans.

Insurance, for the most part, really is for the big stuff that can't be anticipated, and is priced as such. It's $60 a month to insure my 14 year old beagle with 50% coinsurance. It doesn't cover the cost of exams or checkups. It does cover things like surgeries and cancer treatment.

I once used it for a spine surgery. The total cost was about $7,000, quoted upfront. I paid about $3,500 and the insurance covered the other half. This would have been well into hundreds of thousands of dollars if performed on a human.

I was able to have conversations via email, not through some dumb HIPAA compliant portal.

That most dogs are uninsured probably keeps costs down, as does that typically pet insurance has a higher coinsurance figure than human insurance. There's an unavoidable principal-agent problem that we exacerbate with regulations that practically remove all incentive for people to price shop.

Why did you get insurance with a co-pay of 50%?

Insurance is good if it prevents improbable but huge payments. It has a negative expectation value on your net worth, but should have a positive expectation value on the logarithm of your net worth (presumably defined inclusive enough that the case of going negative does not appear), which is closer to actual utility. LW recently had an article on this, here.

A fixed co-pay seems reasonable enough, the case you want to avoid with insurance is paying hundreds of thousands of dollars, and if you co-pay is a few thousand, then that limits your risk exposure.

But an insurance with a proportional co-pay feels different. I mean, if it is 1% co-pay, one could still argue that it scales the treatment options one can afford by orders of magnitudes. By contrast, a 99% co-pay would not be worth it for anyone, because if you can afford 99%, you can also pay 100%.

I would argue that 50% co-pay is more like 99% co-pay than 1%. If X is the maximum loss you could absorb, it will only be helpful for losses between X and 2X. For example, say you could absorb losses of 5k$ without insurance. Then for any treatment which ends up costing up to 5k$, you would have been better off to just absorb the losses in case they appear without paying a middle man. And for everything which costs more than 10k$, you could not afford your co-pay and thus would not benefit from insurance. Now, if it happens that most vet bills are in that range, then it could still make sense to buy it, but from my priors, they are likely much wider in distribution.

Insurance, for the most part, really is for the big stuff that can't be anticipated

Which is certainly what it should be for healthy people. A high deductible catastrophic plan. But the ACA outlawed that and instead young healthy people have to buy expensive insurance that they largely don't use.

It's called a health sharing plan. They exist mostly as religious exemptions to ACA requirements to cover the morning after pill, but nobody actually checks whether you go to church or not.

Your rate sounds not to far off from what a cash pay health sharing or a ultra high deductible plan would be- and that’s basically what you have.

How much has your pet insurance paid out? Seems that unless you're having major procedures regularly, self insurance is the way to go.

Roughly $5,000, dog had another surgery later on to remove a bunch of tumors.

Got the dog in 2018, at about $60 per month since then, I'm still ahead, but that's very luck of the draw. I'd prefer not to have some other incident that would make the insurance pay out and deliver more value for my premiums, I'd rather he just die in his sleep when the time comes.

These products are regulated and competetive, I expect the rates to be actuarily fair and the median customer to have been better of self insured.

I expect the rates to be actuarily fair and the median customer to have been better of self insured.

That doesn't make any sense. For an insurance to exist as a business, they have to take more then they're giving to the average customer. They have to pay for offices, ads and personnel. Maybe you got lucky and are temporarily ahead financially, but long-term insurance will always result in a net negative for the customer.

I think we agree.

I’m curious if survival rates are similar? That is, if the margin for error is much smaller when operating on humans it makes sense to me the cost may be orders of magnitude higher

Even if survival rates are similar, a dog's life is worth less than a human's in court.

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