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Comment by criddell | Hacker News Reader

At some point I wonder if health insurers will start denying claims related to the treatment of COVID infections if the person is eligible for the vaccine but has refused to get one?

On TV today I saw that Kroger employees don't get sick day pay if they are off because of COVID unless they have been vaccinated (and I would assume there's a medical exemption).

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> if health insurers will start denying claims related to the treatment of COVID infections

Will health insurers deny claims related to cancer if you have been drinking alcohol? Good luck living in that world.

Health insurers want to increase, or at least maintain, their profits. They won't deny claims because they want a better society, they want to minimize their financial risk.

So yes, one would expect to be in their commercial interest to deny cancer claims to people who willingly put themselves at excessive risk of cancer at some point in the future. It's the infinite wisdom of the free market!

Quitting alcohol is nowhere as easy as getting covid vaccines. If there was a cheap/free safe vaccine that reduced the chances of getting hospitalized or dying of cancer by >60%, your point would be more valid.

They are clearly not the same, but you first have to make the claim that insurance coverage should be tied to ease of prevention at all, before arguing where the line should be.

I'm not aware of any other risky behaviors that exclude coverage, so this would be a precedent.

I've since come around and now think they wouldn't exclude coverage, but they might charge a different premium. That seems fair.

So are they going to charge premiums for gay people because they have a higher risk of STDs? Seems fair to you?

You wouldn't charge gay people more because that isn't a choice.

Do you think it's unfair that smokers pay more for life insurance?

Pretty much every smoker has higher medical bills. Labelling all gay people as STD risks is a much bigger reach?

If you don't have 3-4 comordibities your risk of hospitalization + dying of COVID is so low it's close to zero. Not sure what you point is, unless you consider everyone has loads of comorbidities out there.

> Quitting alcohol is nowhere as easy as getting covid vaccines

you have a choice to buy the next bottle or not, as far as I know. It's not like addiction is unavoidable. And cancer risk for alcohol consumption is not even related to addiction, you increase your risk of cancer significantly even with a small, non-zero consumption of alcohol. Look at the data.

The difference is that it's a choice to get addicted to alcohol.

By that logic insurers could deny claims related to obesity, or risky sexual behavior. Would you approve of that?

This is a grossly disingenuous analogy. A vaccine is trivial to get, takes no willpower, isn’t a result of addiction, isn’t negatively influenced by such factors as advertising, restaurants, food deserts, requires no trust in individuals, etc.

I have never seen a person trying hard to get vaccinated with available vaccines all around them unable to do so. I have seen people attempt to lose weight. The fact that it’s big business is a testament to this.

Sexual behavior, well yea there is careless behavior but also deceit. How would you tell the difference?

With vaccines, the end goal is to get people to get the vaccine so they can live their normal lives. There is no one time simple action someone can take to prevent obesity. There is no vaccine for all stds I’m aware of.

I would not be in favor of denying health insurance claims but I would be less averse to allowing health insurance companies to factor in certain chronically risky behaviors when calculating health insurance premiums.

For example, a smoker who is not actively engaged in a smoking cessation program or someone who is morbidly obese by choice and not actively engaged in a medical weight loss program should be paying higher health-insurance premiums to offset their increased costs. (The former is not uncommon and while the latter may be controversial it is not necessarily a niche perspective. [1])

So yes, I think the same logic should apply to individuals who choose not to receive vaccines.

[1] https://pubmed.ncbi.nlm.nih.gov/19548556/

Try getting a liver transplant without sobriety.

Sure, but everything up to that point gets paid for happily.

It is not possible to spread obesity or risky sexual behavior to others.

Not true. It's trivial to spread immorality and normalize it which would lead to risky sexual behavior. We're literally living through it now. Just look at how things slid in the past 100 years on that front.

People who engage in risky sexual behavior increase the spread of STDs in the population as a whole, causing increased risk even for those who don't engage in risky sexual behavior. The parallels to COVID seem pretty clear, no?

Irrelevant? Personal choice = costs to others.

Isn’t that the argument?

Not denial, but businesses classified as for profit are certainly within moral rights to claim risk appropriate premium.

Insurance companies have to toe the thin line between a business and a social good. With prediction models to become more and more accurate I would be happier if we have non-profit insurance that amortizes/socializes the draw of the lottery. For voluntary choices of risky behavior, drug addiction, unsafe sex, etc etc., I think insurance companies are within their rights to charge more.

I would agree in principle, but notice that health "insurance" has migrated from a risk-management product to a health care financing/service provision mechanism.

Some of us gladly would.

Accusations of Racism. Only 28% of young black people in New York are vaccinated as of October, for example.

https://www.nytimes.com/2021/08/12/nyregion/covid-vaccine-bl...

Edit: Added "young" adjective that was missing, point remains.

Please don't overuse the word racism. Yes, a smaller percentage of black people in both the US and Canada are vaccinated. Yes they have very good reasons to be distrustful of government and institutions in general. It doesn't mean the vaccine distribution or enforcement is racist.

I am very much against the forced vaccinations of people, and I very much abhor what is happening in Canada (where I live) with the vaccine passports and the making of the unvaccinated second class citizens. But don't make the term racism a worthless term by using it for everything. It's counterproductive.

I say all this as a black Trinidadian immigrant that lives in Canada. I am vaccinated myself, but many black people I know are not.

I am not going to state here whether I think it would or would not be racist.

I am saying though, that if you unilaterally denied COVID care to non-vaccinated patients, that would be the equivalent of denying service to ~70% of "young black people," which would be easy bait for people calling that racist. Which is why the health system probably won't do it.

I understand what you're saying actually. I mean, if that hinders the enforcement of vaccination to exist in society, then I'm on board I guess. Even if I would prefer if people got vaccinated.

> Only 28% of black people in New York are vaccinated […]

This is not what the article you’ve cited says.

Whoops - It said young (whatever that means) as an adjective. I'll edit that in.

It means 18 to 44, according to the article.

AKA working age people that will have to choose eventually between getting the vaccine and losing their job. A pretty rough choice for those hesitant.

(I am vaccinated please don't post hot takes about how I am a anti-vaxer.)

Ah yeah, anti-vaxxers (I'm not calling you one) grasping at straws including calling the vax mandates racist because of the low vax uptake from Black people.

If it was a policy that's based on something that the Black people can't change about them (e.g. refusal to entry to a club based on your address, with majority black areas of town being in that list), and it disadvantages them, yes that'd be racist. But in this case, the Black people (or whoever) can easily change it by getting vaxed...

Racism by intent and racism by outcome are both racism.

Regarding the latter, it's not difficult to create a policy that's non-racist in construction, but has reliably racist results. Correlated parameters, etc. Whether anything can or should be done about it is a thornier question.

It's important to keep in mind that black people have very many reasons to distrust government.

But isn't that the point of insurance? You pay in some money to offset the risk of an unlikely yet massive expense? What's special about covid versus other risky activities that individuals can take action to offset? Even something as horribly negligent as drunk-driving is handled by insurance. So are drug overdoses.

IMO this sentiment is just another manifestation of the overwhelming desire to punish the unvaccinated, rather than being based on clear thinking.

If you have a drunk driving conviction, your insurance rates are going to go way up. If you are a drug addict, your life insurance premiums will be very high. I suppose the appropriate response to people who choose to not get vaccinated would be to pay a higher premium to account for the extra risk.

BUPA (UK private health insurer) isn't covering treatment for conditions caused by the vaccine:

https://twitter.com/bupauk/status/1368841967086473216

https://pbs.twimg.com/media/ExeyKpEW8AEDAdg?format=jpg&name=...

In my country (EU) COVID incidents get handled by public health system only. Which was not in great shape to begin with. Health insurers had bailed out since day zero on COVID.

There's lately though talk about unvaccinated COVID patients bearing the cost nonetheless. Note that public health system is for free.

> Note that public health system is for free.

In my country (also EU) the public health system is most definitely not "free". It is paid for by a universal tax called (insidiously and inaccurately) "health insurance".

> There's lately though talk about unvaccinated COVID patients bearing the cost nonetheless.

Calls for true insurance (individualized, based on actual health and habits) are completely infeasible for political reasons.

What I can see happening is the existing mandatory health tax PLUS extra payments for non-grata groups. Some constitutional changes may be needed, but since all the right people would profit (extra $$$), that's just a technical detail in this day and age.

I'm not sure I follow you but a few things are apparent to me at 45 yrs of age:

1. public health system will take care of you to its abilities (which to a large extent are defined by the taxation yes)

2. no private insurer is paying or covering anything COVID-related and they never did

3. been trying to get private insurance on top of the public one and I'm told time and again that a few systems of mine will be excluded (i.e. they won't insure me for anything bearing the remotest possibility of actually needing them for). Also that I am too old to start now...

if anything is clear from the COVID story in my mind is that we need a better and more capable public health system. Private healthcare is not about health or care.

Usually, insurance companies do this carrot-style, not stick-style (i.e. they will give you a premiums discount of some kind if you get a COVID vaccine, or possibly even a one-off gift like a gift card or toaster or something).

... but yes, they definitely already do similar things to influence customer behavior (such as discounts on weight loss programs).

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