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Comment by AnarchismIsCool | Hacker News Reader

Interesting that the insurance companies aren't interested in supporting weight loss, the complications from being overweight are gonna be a whole lot worse than getting the drug. Did someone run the tables and find that obese people are dying too quickly to end up with medical bills?

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I imagine there is too much churn for insurance companies to be able to be confident that they will be the ones to benefit from lower long-term health costs and not Medicare or some other insurance provider.

This is right. I worked in health insurance for a while. If you aren't in Medicare Advantage (which has relatively lower plan churn) it is very unclear that preventative spend on an employer based plan will benefit the payor that paid for it.

Not for any specific payor, but when people shop around insurances and every insurance pays Ozempic, then everyone will profit from it in the end.

But they'd also benefit as recipients of these "churning" patients. To abuse a saying, "A slimmer population lowers all insurance costs."

There an are a few reasons. First, the cost of being overweight may take a long time to appear, going decades without any problems is realistic. By the time that happens there may be a different insurer on the hook(Medicare?). The second reason as you alluded to is that end of life care is extremely expensive for everyone in this country, and a shorter life span may actually save the insurer money even if there’s a massive bill for heart surgery.

And that's why health care should be universal and not subject patients to the worst outcomes of capitalistic tendencies.

It's mostly not the insurance companies. What a lot of people fail to realize is that most medical "insurance" companies no longer provide much insurance, in the sense of bearing financial risk for medical expenses. Their main business now is administering health plans for self-insured employers. If Ozempic isn't covered by your health plan then the decision was most likely made by your employer's HR department. An insurer will be happy to include Ozempic in their formulary with liberal claim approval rules if the customer wants it; they design custom plans for large customers all the time. This actually means higher profits for insurers (including their captive PBMs and mail-order pharmacies).

Health insurance has cost+ pricing in the form of capped margins. One could say it is a case of misaligned incentives. But how would incentives get aligned absent a single payer system?

Healthcare economics on of the most interesting subfields imo. Extremely tough to get markets to work here

Obesity leads to diabetes, fatty liver disease, various cancers and other problems. It's shortsighted to not cover drugs that can actually reduce it, but if the actuarial tables are silent on the matter or actually support obesity leading to lower payouts from increased mortality, then that's exactly what the insurance companies are gonna do.

>Did someone run the tables and find that obese people are dying too quickly to end up with medical bills?

Genuinely would not be surprised if this does increase medical costs for society as a whole. Obesity related deaths seem like they're more likely to be sudden compared to what might get you if you live longer.

I doubt it's anywhere near that clearcut. "Weight" by itself is neither a disease nor a symptom. I have read numerous reports saying that weight loss often does not improve outcomes for various specific problems. Or that weight loss can help, but the way that it is lost matters more than the amount lost, and losing it the wrong way can be worse than maintaining the original weight. Not to mention that there are plenty of healthy overweight people and unhealthy skinny people. So I wouldn't be surprised if insurance companies are sitting back to see what the empirical effects of semaglutide-induced weight loss are on health outcomes. Perhaps there are data available on that now; I haven't looked.

Besides, it's hard to know what the health effects really are of being overweight, because it's such a convenient rug for doctors to sweep any and all problems under. "Let's see if you still have this problem after you've dropped 20 pounds, ok?" Because clearly your weight is due to a moral failing, and it suggests you're probably screwing up all kinds of other things. Why bother to work on helping you when you're unwilling to even try to do your part? Fat => lazy and weak-willed => won't stick to medication schedule or exercise or diet or anything => unworthy of help. There's not a lot of questioning whether being overweight is an effect or has a common cause; it's assumed to be the relevant cause, or at least has a high enough probability of being the only relevant cause worth looking at because it's common knowledge.

(Neither I nor anyone in my immediate family are overweight, by the way, so don't ignore my rant by assuming I'm being bitter about personal experience.)

> there are plenty of healthy overweight people

No, there aren't. Being significantly overweight is unhealthy, full stop.

> (Neither I nor anyone in my immediate family are overweight, by the way, so don't ignore my rant by assuming I'm being bitter about personal experience.)

If you haven't been living with extra weight for a decade, you wouldn't have the first-hand experience of why being overweight is definitely a symptom of and contributor to health issues as well as quality of life degredation.

> I have read numerous reports... > Besides, it's hard to know what the health effects really are of being overweight...

I can agree that being overweight is often what a doctor sees, but honestly any doctor that makes assumptions like that is not interested in root causes. They're trying to see as many patients as possible, e.g. as a GP, and offer fixes for what they can fix, and referrals to specialists for that which they can't fix with the usual prescription or advice.

All this to say that I really disagree with the first paragraph, and this entire post feels like just opinion despite conjecture on what numerous reports you've read.

> Not to mention that there are plenty of healthy overweight people

This is only true in the most disingenuous of interpretations and look purely at BMI. The "health overweight" people are nearly exclusively those with significant lean body mass from the hypertrophy induced by resistance training. If it's fat pushing you into the overweight category, you're almost certainly unhealthy in a variety of manners. Insulin resistance, lipid profiles, blood sugar, arterial calcification, visceral fat pressing on organs, etc. etc. etc. all the way to less obvious ones like high estrogen levels in men causing issues with mood, etc.

Being overweight is one of the worst things you can do to your health.

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