Margot Sanger-Katz of the New York Times was watching and live tweeting the CNN health care townhall and this stood out to me:
Oh this just got weird: The questioner just clarified she might want a plan that doesn't cover chemo or vaccines.
— Margot Sanger-Katz (@sangerkatz) March 16, 2017
Two things came to mind immediately.
First was a pragmatic consideration. An insurer will only sell a benefit design if there are sufficient numbers of people to cover the cost of the actuaries pricing it, the analytics team looking for non-obvious and subtle interactions, and then the plumbers putting the tweaked design into the system. My rough guess is at least a 1,000 members is the minimal break even point if those members are paying commercial premiums.
When I worked as a plumber, the common waivers (which are what the exceptions are called) would be a state mandated autism coverage waiver that was introduced after the core of the claim system was designed, two flavors of birth control restriction waivers, infertility treatment waivers where we would pay some proportion of infertility treatment if the waiver was activated and then a variety of dental/vision plans that could attach to any plan. Those were the big waivers that were commonly selected.
Insurers have to believe that there will be a significantly large number of buyers at a high enough premium before they’ll custom a benefit package.
My second thought is far more cynical. Insurers have a well defined social role. They are the evil bastards of the system that say no. There are few situations where an insurer’s PR firm is happy when they have a front page story about the insurer.
Essential Health Benefits level set the playing field. We had to offer cancer treatment. We had to offer rehab. All our competitors had to offer the same basic set of benefits. If a patient needed a treatment, their complaints are either cost sharing or network related. With a defined set of EHBs, the patient can’t complain that they are not receiving cancer treatment. The Evil Bastard nature of being an insurer is decreased with common EHB.
If EHB’s are removed, the incentive is for insurers to not offer benefits or to precisely segment benefit categories. So when someone buys a policy that does not have a cancer rider and they come down with cancer, they’ll complain to the press and the insurer becomes the Evil Bastard again. Yes, the contract says that the insurer has no liability nor obligation for cancer treatment but someone’s daughter is dying, someone’s father has three months to live because the insurer won’t pay for their needed treatment.
ThresherK
You were a plumber?
B-b-b-but you’re an intellectual. If I’ve learned anything from the news it’s that you can’t have been both.
David Anderson
@ThresherK: health insurance plumber. I unclogged the pipes to make sure the money flowed
ThresherK
@David Anderson: Eh, still better than a White House Plumber.
I’m enough of a coastal elite that I have to refer to that summer in college I worked at a warehouse for my blue-collar creds. Or show people the pics of the lawnmower carburetor I rebuilt.
Hunter Gathers
That woman is so fucking stupid that I’m amazed she hasen’t been killed by licking a wall outlet.
rikyrah
What kind of stupid muthaphucka doesn’t want a plan that includes cancer treatments?
I.Just.cant.
With these selfish muthaphuckas ???
trnc
@Hunter Gathers: Either that, or she’s a plant to try to lend credence to the “choices” bullshit.
I was thinking more yesterday about the republicans’ cynical argument about health care choices. I have 2 plans available through my work. They’re pretty similar, but one has somewhat better benefits for a slightly higher premium. If the one I usually choose goes away, I’ll still have a pretty good plan.
I think most people really just want coverage. I don’t think they care about having dozens of choices or a la carte health insurance menus, so the freedom of choice argument is bullshit.
JPL
@rikyrah: Rep. Shimkus will might want coverage that doesn’t cover breast cancer, because he’s a guy. Yes I know that men can get breast cancer, but does he?
JPL
I just saw this
Baud
@JPL: I think it’s currently up to the states.
OzarkHillbilly
“SIr, I want a healthcare plan that doesn’t cover chemo or vaccines but does cover bullets.”
maurinsky
Well, the plus side of all this is that we’ll find out how completely atrocious a poorly regulated market based health care can be.
Just One More Canuck
@Hunter Gathers: yet she will be exactly the person that Richard aka David mentions in his last paragraph. “Why didn’t they protect me from my stupid decision?”
Chyron HR
Wait, so now we call the insurance guy “David Anderson”? I’m getting real tired of these “Wilbur” code names, I tell you what.
trnc
@maurinsky: Didn’t we already know the answer to that 8 years ago?
JPL
@Baud: Thanks. As of now, all states require vaccinations. I thought it was tied to federal funding, but that doesn’t appear to be the case.
Ohio Mom
@JPL: IIRC, each state makes its own laws about vaccination and school attendance but no one requires adults to get vaccines.
For adults, there’s the annual flu vaccine, tetnus boosters every ten years (and anytime you have the sort of injury that might might you susceptible to tetnus), and pneumonia and shingles for the older set. At least those are the ones I’ve gotten and remember getting.
Then there are the vaccines for those about to travel to exotic places abroad. I don’t know anything about those.
sherparick
@Baud: Yes, all that the employer group and and Individual exchange insurance policies do is provide reimbursement for vaccinations, they do not require it. States can make vaccinations mandatory for children attending schools. How strict the requirement is varies from state to state with some states offering waivers that one can drive a truck through.
Again, the modern conservative ideology is about making normal, intelligent people stupid. You put so many stupid ideas in people’s heads, stir in a ton of anti-intellectualism and contempt for expertise (e.g. the concept that “any right thinking, God-fearing American knows more through his “common sense” then some doctor with 30 years of experience in medicine at John Hopkins, or infectious disease expert at CDC, or climatologist at NOAA about chemotherapy, vaccine risks and benefits, or the effect of doubling CO2 content in the atmosphere in 50 years), and you get idiots saying what this woman said. She wants to buy health insurance that won’t pay for chemo or vaccines because she does not want to share the cost of those thing when used by people who do get therapy and get their vaccinations. She believes fairy tales that chemo and vaccinations are all conspiracies to make drug companies rich while putting her family and her in danger! Ironically, I expect a policy with a no vaccination rider would be more expensive then one that that paid for vaccinations since the insurance company would see this person and her family as at greater risk of getting sick with infectious diseases. Also, ironic, while seeing the drug companies and her doctors as part of an evil conspiracy in this particular case, she believes in all other facets of the economy in the “free market,” no regulation, and that the EPA is not necessary to protect her from oil, power, and chemical companies dumping stuff in the Air and Water. And she knows all this because she and her friends watch Fox and listen to Limbaugh, Levine, Hannity, and Ingraham. The answer is always “stupid and evil,” plus anything for a buck.
sherparick
@JPL: More evidence that Tom Price is also an idiot as well as evil. Screwtape is really going to enjoy eating this guy’s soul when he ends up in Hell.
gvg
Employers can require certain vaccinations. My sister the doctor has in various jobs had elaborate requirements. In fact, that started in med school. She currently works for the VA. Hospitals also have rules. I would imagine other jobs have them too, like for instance the military. I would bet insurance for a practice has vaccination requirements too.
I think the suggestion she is a plant is correct. It’s too stupid to be believed.
Ian
Why for my comment in trash?
Esc
@Hunter Gathers: My mother-in-law would look you right in the eye and tell you she cured her thyroid cancer with herbal supplements. That was flatly untrue of course. These people are the homeopathic version of abortion protesters; of course they would never need chemo or radiation, how dare you suggest such a thing, they are as pure as the fresh fallen snow! And they’ll go right back to it after availing themselves of modern medicine, assuming they didn’t put it off too long. Steve Jobs basically killed himself by trying to cure a treatable cancer with a fruit diet.
Barbara
@Esc: Jobs made choices that lowered his odds of survival, that is clearly true. But a lot of people react to illness with a form of denial. My aunt and my husband’s uncle both ignored clear signs of cancer until it was too late to cure. She died within one year, and he spent the better part of a decade being treated for something that would have been nearly 100% curable had he been willing to get treatment reasonably early. Jobs was a bit more rogue, in that he didn’t follow the advice of doctors even after being diagnosed (whereas my relatives just avoided getting a diagnosis but dutifully followed advice once they did receive the bad news). The point of all this being, fear and denial of illness are endemic to human beings. The thing is, some of these people are so loopy, when they make comments most other people look at each other and think, “okay, I think this is why we don’t have self-designed insurance plans.” Price doesn’t seem to be doing too well in his efforts to put a pretty face on AHCA.
Ruckus
@gvg:
Unless it’s changed, entirely possible, vaccinations in the military were optional. No one ever explained that before giving them to you (telling you to stand in line and get your shots) but it falls under the fact that as long as you are awake you have control over any medical procedure and can not be forced into something you don’t want. Same for the VA. Employees of the VA may have to be vaccinated to keep their job but no patient does.
rikyrah
@Chyron HR:
Wait, so now we call the insurance guy “David Anderson”?
I still call him Mayhew
Feathers
I wondered at the chemo bit, but then remembered a doctor saying that one of the unfortunate side effects of over diagnosing fairly begnign breast tumors as deadly cancers was the cohort of women who came to believe that they beat big pharma and cured their cancer with herbs and meditation (ignoring the surgery and radiation they inevitably turn out to have had).
Sigh.
Barbara
@Feathers: The bigger problem are the number of women subjected to aggressive treatment with potentially long-term side effects, especially if that treatment involves radiation. I had a friend who survived breast cancer only to die from a kind of leukemia that was highly correlated for her demographic with prior exposure to radiation. I don’t know enough about her breast cancer diagnosis to have any opinion on the need for radiation, but she is probably not the first person to suffer this consequence.
Petorado
I really wonder how actuaries respond to people who ask for plans that eschew the inexpensive preventive care options and only want coverage for the really expensive protocols that will ensue without common-sense health maintenance? It must be assumed that people who don’t believe in nipping problems in the bud, or preventing them from occurring in the first place, will probably be massive liabilities when something inevitably goes wrong.
WereBear
@Barbara: It is a sick fact that many current treatments for cancer also cause cancer.
Ruckus
@Barbara:
Dead thread but yes radiation has it’s limitations and issues. Like almost all other medical treatments. I’ll describe it to you if you really need to know. It’s not a lot of fun but then dying from cancer isn’t either.
@WereBear:
A lot depends on what stage a cancer is at as to what can be done. Sometimes it’s an all out assault on what is known and what the risks are. Problem as I see it is two fold. First, some people can not actually understand what is happening, both in the concept of cancer and in the consequences of various treatments (if more that one treatment is viable) and make realistic decisions. Second, some doctors advocate for specific treatments, because of their own biases or possibly because they may have monetary interests in those treatments.
Also I’d bet that some of the diagnostic tools that might tell if someone is genetically not a candidate for a specific treatment can be pretty expensive and might not be covered by insurance.