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Comment by jckt | Hacker News Reader

Does it make sense to buy insurance if you take a hypothetically accurate genetic test? The business of insurance companies only makes sense (at least to me) if we are talking about preparing for uncertain loss. But with a genetic test kit (and for argument's sake let's assume it's very accurate) the concept of "uncertain loss" flies out the window, if not at least vastly different from its current conception.

Doesn't this just mean the eventual death of health insurance completely?

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At the extreme, imagine a future world where long term health is so predictable that there's no uncertainty. You definitely can't offer an optional insurance policy here (at least, the insurer either isn't going to make any money, or the policy costs will make buying it pointless). In a similar way, you won't do very well selling retrospective fire insurance, as only those people with burnt-down houses will buy it.

Insurance needs 1) a large pool of coverage, where the combined average costs will cover the peak extremes. It also needs 2) variability: you have to have people with lower-than-average costs to balance out the higher-than-average costs. If everyone has average costs then once again, you've lost the uncertainty and any benefit of insurance.

To get 1), you could enforce insurance on people. To get 2), you have to ensure insurance products aren't ultra-specific. Neither of these are popular!

If you're in a world where long-term health is so predictable there's no uncertainty, there's no need for insurance on your long-term health. What you want is some structure to pay for your long-term health care.

You are certainly free to advocate for your government to initiate a wealth transfer. Perhaps you will also consider a variety of ways of conducting this wealth transfer. (On that note, our current approach of "make young people buy more expensive insurance or get fined to pay for it" is a dubious one, and quite regressive.)

I don't think this is true. Let's say that a child from a poor family is discovered to have a rare heart condition that would require very expensive treatment. Should they be expected to pay for it? Should we just let them die if they can't? Isn't this the kind of situation that healthcare insurance is designed to fix?

The situation you propose and the situation the grandparent poster proposed are different. He proposed total foreknowledge of future health outcomes. Unrealistic? Yes. Different from what you just proposed? Also yes.

Insurance is designed to restructure uncertainty: it replaces a tiny risk of needing HUGE AMOUNTS OF MONEY with a 100% risk of paying a small amount of money. If the long-term health outcomes are known, as he proposed, then there is NO UNCERTAINTY about it. You either need the huge amounts of money to pay for care, or you need no money. All else being equal, the same amount of money is needed, and less money is spent on the overhead of running an insurance company and paying off the capitalists in charge of it.

Now, if you'd like to argue that society has a duty to assist someone who needs this care by transferring wealth to them to cover cost of the healthcare procedures they need, that's a perfectly legitimate thing to argue. It's also another matter.

Fair point. I was confusing/merging health insurance and some generalised form of 'health coverage' in my last post.

Even in a situation with no uncertainty, you can still have forms of personal health insurance, e.g. you have a system where everyone is enroled, everyone pays and everyone gets the same cover. The collective benefits of insurance still apply, even if one individual's outcomes and costs are known. Whether this system counts as 'healthcare insurance' or it is now a 'national health service' just depends on how you want to name it...

It doesn't mean the death of health insurance if people still require medical care for infection or injury. And while there are certain genes that make certain cancers much more or less likely, the average person still has an average chance of being the victim of some sort of cancer.

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