> When I was fat, my insurance wouldn't cover any weight loss procedure (including just visiting my primary physician to discuss my options for weight loss-- a lovely $250 surprise) because I had no obesity-related health problems (heart disease, diabetes, joint issues, etc).

This is such a stupid, self-defeating policy for an insurer. Until your problem costs us a lot, don't you dare try to mitigate it on our dime!

>> self-defeating policy for an insurer.

Bariatric procedures can be included as a sort of "rider". This is typically written into self funded plans. Bariatric is not an essential coverage therefore ACA qualified plans do not typically include them - unless medically necessary.

In the US with healthcare tied to either employment or medicare, by the time these costs come around you're likely to either transfer out of this insurance or to the medicare option. Either way, it's someone else's problem (from the perspective of the current insurer).

I don’t know, looking at the percentages… I’m not sure preventative care for obese people is sustainable at this point.

Not that I shed tears for insurance companies, but I think this would be a lot of money. Now… the problem should have been addressed twenty years ago before it went critical.

After Obama Care, insurance companies profits are now capped at 8% (think that is the number) of revenue (ie premiums) in the US. So one way to grow revenue is to have higher costs per policy, pay out more, and charge higher premiums. If you are at 8% profit and you reduce your payouts as you are describing with preventative care, then you don't get to keep that money. You have to pay it back to the insurance buyers. Very perverse incentive.

The goal of the insurance companies is to make sure that all medical costs go up 10% every year so that their profits can increase and shareholders benefit. They are NOT negotiating lower pricing from medical providers, because why would they? Medical providers (and even individual care givers) have similar incentive structures to raise rates since they are paid only by insurance.

The last local obstetricians were pushed into hospitals and large groups by insurance companies paying them 20-40% of prevailing fees. They now make more per procedure and don't have to pay for facilities or do billing. Why would the insurance company pay so much less? Because once the cartel is created their profit (and pricing) will double.

That is for profit healthcare for you. Costs guaranteed to grow at DJI rates.

>>>>>That is for profit healthcare for you. Costs guaranteed to grow at DJI rates.

Not true. The Surgical Center of Oklahoma, a purely for profit clinic that does not take insurance, has not raised the rates for any of their services since 1995.

Yes, they have not raised rates...despite inflation

That's true profit healthcare.

What we have is a monster hybrid between government healthcare and subsidized, monopoly care

Unfortunately no one is lobbying for a truly free market in healthcare. For instance, at all the supply-side restrictions on new physicians and hospitals. Limited residency spots, certificates of need whatever.

Ideally the party in opposition to government-funded healthcare would do this.

>Not true. The Surgical Center of Oklahoma, a purely for profit clinic that does not take insurance, has not raised the rates for any of their services since 1995.

Source?

This portion of the linked article seems to contradict your claim of "has not raised the rates for any of their services since 1995"

>Had the pathology fees that apply to the examination of breast masses not increased, our price would be the same now as it was in 1997, but alas it is now $2,365. Only three other fees have increased since we began quoting them over the phone in 1997.

That said, I'll admit that the claim is broadly true.

Well, I'm not sure I buy it, and the actual date is 1997, but here is the story on Mises.org from 2021.

https://mises.org/wire/why-arent-there-more-free-market-surg...

That is not really how the modern medical insurance business works. Most group buyers such as employers are now self insured. The medical "insurance" companies no longer bear much risk, they merely administer claims and manage provider networks. This business is intensely competitive with low profit margins. Insurance companies have to negotiate lower costs in order to sell to their customers, which are primarily employers that buy plans on behalf of their employees.

Costs have continued to rise because provider organizations have been merging in order to gain more market negotiating power. Expensive patented drugs and medical devices also play a major role in driving up costs.

Ya insurers are price takers. They’re fine being the bad guy though—your employer picks them, not you.

It’s unpopular to point fingers at provider orgs.

> Until your problem costs us a lot, don't you dare try to mitigate it on our dime!

I assume gp meant bariatric surgeries by 'weight loss procedure'. These are not just cost considerations , they come with significant risks and long term side effects. They aren't get out jail free card to be handed out like candy and isn't a 'preventive care' for obesity related diseases.

No. I was literally charged full price just for consulting with my family doctor about my weight. The doctor at the time referred me to a nutritionist; the nutritionist coverage was further denied because I had no qualifying health conditions. There was another option for weight loss medication, not the kind that affects hormones but makes the stomach feel full. These were also denied because I was just fat, not diabetic, heart problem, etc.

yea you might be one of those 'overweight but metabolically healthy' people. Despite the common misconception, you can infact live a healthy life even you are overweight if you are metabolically healthy ( ie. no insulin resistance)

Perhaps they are, perhaps they aren't. But it seems to me that the way to figure out whether they are or are not is by taking the very reasonable step that they took: a visit to their GP (and including following the doctor's referral to a nutritionist).

Metabolic health is not the only type of issue overweight people face.

I suspect the real issue is that there are no universally proven ways to reduce weight that have high success rates of adherence - for example, this is why CPAP and insurance is really tricky... too many people wear them for a bit then stop using them, wasting thousands of dollars (between the sleep study and the equipment itself).

> This is such a stupid, self-defeating policy for an insurer.

Quick, rank speculation:

100% of obese people don't go on to suffer from 100% of the potential risks of obesity.

Given the actual percentages, it may be cheaper for the insurance company to pay for (and, at least in part, deny!) actual treatment for those potential risks than to cover the vast majority of preventative doctor visits and labs.

Additional rank speculation-- I wonder if that problem gets worse as obesity numbers rise. E.g., symptom A necessitates a test for condition X, but symptom A plus obesity necessitates tests for condition X, Y, and Z...

I'd be willing to bet that GP had a high deductible health plan. They leave you on the hook for 100% of your healthcare costs until you reach your deductible, unless your care is on a narrow list of things that they consider "preventable care." By insurer logic obesity is almost certainly an existing condition, even though treating it can prevent future healthcare complications. HDHP's are pretty perverse IMO.

How many pounds over a healthy weight were you? 20? 50? 150?

Just curious

Doesn't matter. I asked how significantly overweight I had to be to have access and the insurance company told me there's no weight-- it's purely obesity related health condition only. Theoretically also I could be 10 lbs overweight and diabetic and get a fast track to ozempic, lol.

At one point my family medicine guy suggested he could write down something arguable just to get me to a nutritionist (think making me do some wicked pose while measuring my blood pressure and then writing it down as "high blood pressure") and I told him just don't bother. We did however in future meetings ensure I always had something else to talk about besides my weight progress so I'd never get billed again.

They usually consider you for surgery if your bmi is over 40 and you've tried ( and failed) conservative approaches to weightloss.

No, that's not the case for many insurance companies. My insurance company only qualified surgery if you had a qualifying health condition. If you were just obese you didn't qualify.

The most serious health effects tend to come not from absolute weight per se, but from excessive body fat percentage. And particularly from visceral (intra-abdominal) fat, which is far more dangerous than subcutaneous fat in terms of risk for conditions like type-2 diabetes, arteriosclerosis, and COVID-19.

The excess adipose tissue causes subtle, progressive damage which won't necessarily be obvious in the regular preventative screening exams that most younger patients receive. But as some point after age 50 or so the systems decompensate and the patient's overall health deteriorates rapidly.

I received a lot of these services for free at the local health food store.

Offering nutrition advice at food stores is probably a better approach then doctors visits.

The number one problem is that a visit with a discussion costs $250 which is absolutely ridiculous, obscenely expensive.

Healthcare insists on the very best, most expensive in gauzes and then when they can’t afford them they let people die, instead of using cheaper gauzes which are just fine and have been used for years.