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I'm not sure I agree with this: there are lots of tests like BRCA1 that reveal something like 40% of women with the gene will develop breast cancer. Large employers often self-insure for employee health insurance (often with a known insurer providing the infrastructure and managing benefits), so health care costs actually come directly out of their bottom line. I can imagine that the math works out pretty easily that if, say, Starbucks knew of a positive test for the gene or a family history of certain diseases, it would actually be an actuarial loss to hire certain candidates and provide health insurance.
The US prohibits discrimination in employment on the basis of genetic information, and I'm not sure I disagree with the idea that we should do so.
That's not a vanishingly small likelihood is it? It makes perfect sense for insurers to cover it.
As for me, I'm fine with it, I consider attempts to shield important information away with a sceptical eye, leaving aside issues of poor incentives like the police breaking the law to acquire evidence which ought to be inadmissible and such. Sunlight is the best disinfectant, and rare is the time when more information is bad for you.
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Is this how it works?
I thought the whole point of health insurance was that it cost the company the same amount no matter how much of it you use.
I guess if they told the health insurance company they were genetically screening employees they could ask for a lower rate, but I sort of wouldn't expect the health insurance companies to go along with it, when they can refer to it being bad optics in order to not give a discount.
Unless I'm misunderstanding something.
If you doubt it, you could literally just hit your favorite search engine up for an explanation of self-insuring companies.
No, the whole point of health insurance is to pool risk. Companies offer it as a perk, now, but the typical American association between employment and insurance is exceedingly contingent. Insurance companies collect premiums to finance the pool, as well as to finance the administration of the pool and also to distribute profits to shareholders and do all the other things companies do. Large insurance companies have larger pools, distributing risk more widely and collecting more money to the pool. If you're a large enough corporation, however, collecting the premiums yourself (and perhaps paying a small administrative fee to an insurance company) may save you and/or your employees a lot of money, for example if your employees tend to be some combination of young, healthy, unmarried, and/or childless.
Strictly speaking, you can self-insure as an individual, too. If you forgo insurance and simply put your "premiums" into a high yield savings account every month, then over the course of your lifetime you should on average actually come out ahead of people who buy insurance, since the whole point of insurance companies employing armies of actuaries is to be sure that they don't go bankrupt--that is, to insure that more money is coming into the pool, than going out of it. So if you believe the mathematicians, you should self-insure! Of course in reality it doesn't work out this way, even if you're relatively lucky; since insurance companies also have enormous negotiating power, even when self-insuring accurately duplicates the risk pool it doesn't duplicate stuff like "in network" discounts, negotiated rates, "maximum out-of-pocket," and other such perks. To say nothing of most peoples' inability to truly weather a large financial shock on the theory that they should, by the time they are ready to die, still technically come out financially ahead.
You have an inverse of Pascal's Wager going on as an individual. If MegaCorp runs its health insurance in house it at least in theory turns a profit from 99 mostly healthy employees paying for the 1 unlucky guy that gets into a terrible car accident or gets cancer. If it's Joe Schmoe trying to do that then he comes out ahead 99 percent of the time and gets fucking cleaned out 1 percent of the time. This isn't the same.
Right, that's why I said:
For that matter, self-insurance sometimes goes very badly even for whole corporations--though, as with insurance companies, the larger they get the less this is likely to be a problem. Small and mid-size firms do self-insure sometimes, and sometimes this goes badly for them. Two or three million-dollar medical events in a single year would be terribly bad luck for a company of, say, 500 employees, but it's well within the realm of the possible. This is why a company that self-insures should typically also have some kind of stop-loss policy backing up its self-insurance pool (and indeed many insurance companies themselves have stop-loss coverage). This is a fascinating area of the law that unfortunately falls outside my expertise, but I find it fascinating even so. Insurance and, essentially, meta-insurance form the basis of all sorts of interesting economic gambits. But some of the greatest profits of all have been won by persuading whole nations that participation in such gambits is wise, or even obligatory.
Which is to say: while I acknowledge that the equilibrium I live in requires that I bet, pragmatically, against the actuaries who think they'll take more of my money than they'll have to give back, I remain suspicious that insurance is in fact a deeply parasitic economic entity, of a kind that should probably be much more regulated than it is (even though I am, in almost all cases, reflexively anti-regulation).
Maybe I'm just being autistic here, but I was thinking that most of these self-insuring fools actually make it out OK or even come out ahead, a few break even, and some get hauled to the cleaners and back.
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