
Health Insurers Are Vacuuming Up Details About Customers - marchenko
https://www.propublica.org/article/health-insurers-are-vacuuming-up-details-about-you-and-it-could-raise-your-rates
======
a_d
Whenever someone says that AI and IoT would automate insurance underwriting, I
start to fret — because it very quickly starts to imply more and more data
collection. This is like pre-crime but for your health. Meaning, you start
paying high premiums right away because later in life you might be at a high
risk for a specific condition. (I know this already happens for smoking, but
that is declared on a form — not by a company sending a drone to spy on you)

Since this is a startup forum — I believe health insurance to be so dark and
morbid (with things like companies haggling with living relatives about
ventilator care) — there is got to be a better way! (I realize this is more of
a lament than a constructive suggestion)

~~~
rsync
"there is(sic) got to be a better way!"

There are _two_ better ways - each at a different end of the spectrum.

You can give up entirely on government intervention in health insurance and
social "goods" being pursued - everyone is on their own and "healthcare" is a
private, personal matter. You can play these agency/incentive games with
insurers for better or for worse and you're on your own.

OR

We declare "healthcare" to be a public, common good and completely socialize
it. Like roads and fire departments.

What these two different strategies have in common is that _both of them_ are
intelligible, reasonable and give people a framework for planning and making
long term decisions.

Anything between these two points on the spectrum is unintelligible and
unsustainable. You would probably be better off with (the option above that
you like the least) than any option between them.

~~~
Gibbon1
> You can give up entirely on government intervention in health insurance and
> social "goods" being pursued - everyone is on their own and "healthcare" is
> a private, personal matter.

Except Kenneth Arrow showed market based health care doesn't work. That was in
1963. Since then the US has pursued market based heath insurance for
ideological reasons and... that doesn't work without vast government
subsidies. The government pays enough subsidies to cover a socialized system.

[http://www.who.int/bulletin/volumes/82/2/PHCBP.pdf](http://www.who.int/bulletin/volumes/82/2/PHCBP.pdf)

~~~
chimeracoder
> Except Kenneth Arrow showed market based health care doesn't work.

That is a really disingenuous reading of Arrow's work. Even if you ignore the
myriad of ways in which the global heathcare market has changed in the last 55
years and how those affect the US (which is the largest player in the global
system), that's still an unjustifiably broad interpretation of his research.

~~~
Gibbon1
> That is a really disingenuous reading of Arrow's work

You say so, but provide no examples. So your argument is an unsupported
conclusory one.

------
samfisher83
While its called its called Health Insurance, it should be called health care
costs.

The US is the only 1st world country without universal healthcare. The thing
is most of us already subsidize the healthcare industry. The hospital has to
treat someone in an emergency if they take medicare or medicaid. A lot of
times people are using the emergency room as their primary care since they
can't afford primary care. The hospital increases the rates it charges
everyone else to cover this.

You can use data to predict who is going to be more sick and charge them more.
However do you want them to die or suffer. I wouldn't. So why not try to fix
the big problem instead of all these little ones about data misuse and just
cover everyone since you are paying for them anyway.

~~~
chimeracoder
> The thing is most of us already subsidize the healthcare industry. The
> hospital has to treat someone in an emergency if they take medicare or
> medicaid.

The "subsidies" run the other way. Medicare reimbursements do not cover COGS,
which means that providers cannot sustain themselves solely on Medicare
reimbursement rates; they need to take privately-insured patients (whom they
charge dramatically more) in order to stay afloat[0].

These costs get passed on to privately-insured patients in the form of higher
premiums.

[0] Medicare acknowledges this, and in fact, Medicare even runs multiple
stipend programs to essentially pay extra to hospitals who don't see enough
privately-insured patients that they can make up the difference. If they
didn't, those hospitals would close, because you can't lose money on a per-
patient basis and still run a practice, even if you managed to recruit
doctors, nurses, and staff who agreed to work for free as volunteers.

------
FireBeyond
> Insurers contend they use the information to spot health issues in their
> clients — and flag them so they get services they need.

Horse shit. And I say that as someone who writes claims management software
for the healthcare industry.

I challenge ANY health insurer to provide examples of this. Of course, they
won't, because they'll cite "patient confidentiality", but that just doesn't
happen.

They've wanted to do this for years, though, and try to. Requests to be able
mine claim data for familial predispositions to diseases was one that we
fended off multiple times.

~~~
sidlls
You may have fended it off but I assure you there is a whole industry devoted
to using claims and other health data to manage care and costs. Insurers are
primary partners of these companies and act as both providers and consumers of
the data.

Not just insurers, but big hospitals and provider networks, too.

~~~
pishpash
We're going down some kind of bizarre path. Insurance is ultimately about risk
sharing. If every risk is modeled then there is no insurance, just expensive
prepayment.

~~~
lftl
This is the core problem of health insurance as currently structured in the US
-- everyone will make a claim eventually so it's effectively a whole life
insurance policy except the payout is sporadic and involves tons of
bureaucratic crap. I personally would be fine with either universal healthcare
or regulating the marketing to outlaw non-catastrophic health "insurance"
thereby forcing routine care to be a direct payment relationship with your
doctor.

~~~
ryandrake
The major problem with that is there is no price transparency. If I go see a
doctor, I have no idea if I will end up with a $40, $400, $4000, or $40,000
bill until the bill comes months later and I have to pay it.

I’m relying on insurance because going to the doctor is such a financially
risky gamble.

~~~
micaksica
> If I go see a doctor, I have no idea if I will end up with a $40, $400,
> $4000, or $40,000 bill until the bill comes months later and I have to pay
> it. NO IDEA.

This is what's really strange about the American healthcare system. For
everything else in America you can either get a price up front or an estimate
of total costs up front. Why should going to the doctor be any different than
going to a mechanic? Pay advertised flat rates for issue diagnosis, and get
estimates for the problem.

Yes, in cases of emergency you can't really shop around too much, but the
majority of the time you're going to a doctor, you could at least call and get
estimates of how much things will cost. It's not even possible to do this with
most healthcare organizations. If you call your doctor's reception and ask
"how much will it cost for this visit?" they'll tell you they don't do billing
and they won't know until it's processed by insurance.

Price transparency in the healthcare market - or at least some decent estimate
of it - would be a great thing to see. American healthcare is ridiculously
inefficient because it appears wholly designed to be byzantine.

~~~
knuththetruth
Or we could just have universal healthcare with government-set price controls,
just like Japan does. The ultimate in price transparency. Everyone is
healthier, lives longer, and it’s far cheaper.

~~~
lftl
I'd be fine with that, but I'm acutely aware living in the deep south that
_MANY_ people would not be happy with that. If we're talking about what's
politically feasible within the US, "universal" healthcare is only really an
option at the state level, or maybe with some federal maneuvering, as a multi-
state regional coordination. It's simply not going to be accepted anywhere in
the near-future on a national level.

For the parts of the country that are rabidly anti-universal healthcare, a
more free market solution would be a nice consolation prize.

~~~
knuththetruth
There’s already tons of people on Medicare and Medicaid in red states and
there hasn’t been an armed insurrection.

I think that working class people in these regions wouldn’t be adverse to
Medicare being expanded to include them. I’m sure the Republican Party base of
upper middle income and wealthy whites would be, but again, not so much
everyone else there. It’s a matter of how and what constituencies you recruit
and activate.

~~~
ryandrake
> I think that working class people in these regions wouldn’t be adverse to
> the program being expanded to include them

It’s so strange, the people who would most benefit from universal healthcare
(and those that currently do, like Medicare beneficiaries) tend to be the
strongest objectors to it, citing hard-to-understand ideological reasons.

~~~
chimeracoder
> It’s so strange, the people who would most benefit from universal healthcare
> (and those that currently do, like Medicare beneficiaries) tend to be the
> strongest objectors to it, citing hard-to-understand ideological reasons.

It's not so strange if you allow yourself to question the assumption that
they'd benefit from it in the first place.

Medicare is a great example. Patients can opt to receive their Medicare
inpatient and outpatient coverage through a private plan instead of through
the government-managed plan. Since this program was introduced, it's gained
popularity rapidly, over a third of Medicare beneficiaries receive their
benefits from private plans. Many private plans are the same price as Medicare
or cheaper.

From the data, the private plans beat government-managed plans on the three
major metrics: medical outcomes, cost, and patient satisfaction. On the last
one, the difference isn't even close: the _worst_ of the major private plans
(by patient satisfaction scores) still manages higher scores than Original
Medicare does.

People who haven't ever dealt with Medicare themselves directly (which
includes most HN commenters) find this hard to understand, but it really
isn't: dealing with Medicare is _awful_. I could give you my personal
anecdotes, but they'd overfill the comment length on HN, and again, at the end
of the day, the numbers speak for themselves. Medicare beneficiaries
themselves are turning to private plans to replace their government-managed
plans, so it's really not surprising if they're not the biggest advocates of
expanding government-managed plans.

~~~
sidlls
The private plans you refer to are mainly either simply administrators (the
government pays them to administer the benefits) or supplemental providers or
both. And their existence and popularity has more to do with their sponsorship
by insurance funded politicians than anything else. Dealing with these
administrators isn't generally better or worse than dealing with the
government directly. Exceptions exist, but that goes without saying.

~~~
chimeracoder
> The private plans you refer to are mainly either simply administrators (the
> government pays them to administer the benefits) or supplemental providers
> or both

No, they're much more than that.

> And their existence and popularity has more to do with their sponsorship by
> insurance funded politicians than anything else.

The programs are cheaper, provide better medical outcomes, and patients prefer
them.

That doesn't mean they're perfect, but you have to bend over pretty far
backwards to say that they're inferior and only popular because of "insurance-
funded politicians".

> Dealing with these administrators isn't generally better or worse than
> dealing with the government directly. Exceptions exist, but that goes
> without saying.

It is monumentally easier to deal with private insurers than to deal with an
Original Medicare plan.

------
turc1656
_" The companies are tracking your race, education level, TV habits, marital
status, net worth. They’re collecting what you post on social media, whether
you’re behind on your bills, what you order online."_

The only way they can do this _and_ link it to you as an individual is if we
have all been lied to about how everything is "anonymized" data being sent
between the data brokers and sold to corporations. I've always assumed that
the whole narrative about all this data being anonymized was complete and
utter bullshit.

Now we know with certainty.

~~~
staticautomatic
The companies that sell your data non-anonymously to brokers have always
(unless they're shady af) said somewhere in their T&C that they will or may do
so, and the brokers themselves have never said the data are anonymous (unless
you're talking about the ad targeting space).

------
1996
> The company, owned by the massive UnitedHealth Group, has collected the
> medical diagnoses, tests, prescriptions, costs and socioeconomic data of 150
> million Americans going back to 1993

I think they just use their point of sales (primary care, etc) to collect data
from the client and use it against the client. I know because I used to be in
a very similar line of business.

It is easy because clients give you a permanent unique id for payment purposes
(ssn), or other unique id (phone numbers) that varies with time (now less with
people porting their number). Of course, the point of sale has a list of
previous items, even from competitors (medical history) but that has become
harder to use, due to laws. Still, most places ask for "emergency contact",
which you can use to build a social network. Sick people cluster together. I
don't know why, it just happens, and it is a good workaround.

Of course, you need enough data, but it is then a matter of scale (if you have
75% of the market, you have seen everyone in a county at least once) and trade
(buy the same data from your competitors).

Personally, due to experience, I prefer to forego insurance and get my
healthcare abroad. Better prices than paying deductibles, better services. But
I can not recommend that for everyone.

Still this is a dirty business, and I strongly recommend to adopt basic opsec
precautions if you get healthcare in the US: never give your ssn, give a phone
number that is not used for anything else even better if it is prepaid so not
linked to a ssn, never ever give an emergency contact, only list medical
conditions that will not cause you legal issues.

~~~
394549
> Personally, due to experienck, I prefer to forego insurance and get my
> healthcare abroad. Better prices than paying deductibles, better services.
> But I can not recommend that for everyone.

If you're in the US, that choice could _bankrupt you_ if you ever need major
emergency medical care, because of an accident or some condition requiring
emergency surgery, like a brain hemorrhage.

[https://www.nytimes.com/2017/03/29/magazine/those-
indecipher...](https://www.nytimes.com/2017/03/29/magazine/those-
indecipherable-medical-bills-theyre-one-reason-health-care-costs-so-much.html)

~~~
rhombocombus
My father went from having a comfortable nest egg to living on social security
alone because he was unable to get insurance before the ACA. All it took was a
trip to the emergency room and a heart catheterization, followed by another
procedure a couple days later and he was penniless.

~~~
1996
I wonder: did he go to court at any moment? Or did he just caved in and
accepted to cough up the money?

Based on my experience, in the US, people rarely fight their debts. I have had
debt go to collection before, I disagreed with it so I sent the collector a
friendly letter saying the debt came from a breach of contract by the other
party, so I will not pay it, and will be happy to go to court if they want.

It is very rarely worth the time for collectors. The debt will just eventually
be resold, penny on the dollar.

In the very unlikely case it ends up in court, based on some friends
experience, it can take a long long time for the problem to be resolved - if
ever, because our lifetimes are finite.

------
dhimes
Exactly why I won't do those genetic-sample tests for "ancestry" or anything
else. Eventually, those data will be sold, even if the entire company is sold
with it. Eventually, we will be much better at decoding the DNA for
predispositions to medical problems like heart disease, diabetes, alzheimers,
and so on.

That information will also be used against our kids and maybe our other
relatives even if they don't undergo the testing.

~~~
supertrope
Data is forever. The Genetic Information Non-Discrimination Act could be
repealed in the future. Even governments can change.

------
jesseryoung
Heard about this article on NPR this morning. Thought the concern was valid
but a little on the alarmist end of things.

Most of the data they need to know if you are going to be an expensive
subscriber or a cheap one you're required to give them directly: Your age,
your gender, your home address and the list of services you received at your
doctor's visits that they were billed for.

Both healthcare providers and insurance providers know that the most efficient
way to lower your healthcare costs is to get the patient to go to preventive
care visits and keep them out of the ER. It doesn't matter how much money you
give them each month, if they can prevent you from going to the doctor all
together it's 100% (roughly) profit.

~~~
lvspiff
I work alongside healthcare informatics and I got to say this is entirely the
case from what I have experienced - the less you go to the ER the more the
insurance profits. All of our research and data collection revolves around
people getting tests and treatment PRIOR to something major happening. Regular
bloods tests, proactive bp and a1c monitoring, etc lead to better heart
disease and diabetes treatments so you don't go into a crisis. The collection
of data allows treatment to be better for the population not to charge a
higher rate to specific people. Keeping you out of the hospital is
monumentally cheaper than a couple doc visits a year for a couple lab tests.

------
hirundo
> But patient advocates are skeptical health insurers have altruistic designs
> on people’s personal information.

It's funny that the article felt this needed to be said. Just how would an
altruistic insurance company have survived in such a competitive market?

I think I learned the insurance business model early in life. I lived near a
horse race track, and used to collect the programs and assemble giant (paper)
spreadsheets with various data on horses and their win/loss records. Does the
jockey make a big difference? Does the wetness of the track? I would have used
any measure that gave me an edge in betting, with zero "altruistic" regard for
the horse, its owners, or anyone else but me. You know, like an insurance
company.

It turned out that there was a datum that significantly improved my odds, and
converted me from a regular loser to an irregular net winner. And it didn't
come from a program. I figured out that I could just watch the horses as they
paraded to the starting gate, pick the one that I thought looked like it
wanted to win, and could, and ran to place a bet on it before the race
started. Far from perfect obviously, and I didn't win big, but I started
winning more than losing.

I'd bet that insurance companies wish they could do something similar: Have
experienced medical underwriters examine and interview potential customers and
then make gut level decisions, then judge more by underwriter stats than
patient stats.

But that approach seems to be increasingly prohibited, so they make do with
what data they can get. It's hard to find that surprising, unless somehow
you've confused "insurance" and "altruism" to be related terms.

------
stakhanov
I think there's something to be said IN FAVOR of the notion that person A's
health risks don't trade off against person B's health risks at a 1:1 rate.

The crucial thing however, in a data protection sense, is that there are too
many people who don't realize the implications of giving away data about
themselves. A shopper signing up for a loyalty card scheme in a grocery store
might sign a blanket waiver allowing the scheme operator to pass the data on
to whoever they please to be used in whatever way they want, without thinking
about the possibility that it may end up in places where it won't serve their
best interests.

So there should be something similar here to health warning on cigarettes.
Kind of like "Warning: Signing up for this loyalty card may make you
uninsurable."

Also, I think there should be legal infrastructure in place to ensure that
there are certain rights that you can't sign away as part of a contract that,
in practice, you don't have the option not to sign (like Google's general
terms & conditions).

~~~
koolba
Which is also why you should use a fake phone number, name, etc for those
loyalty cards.

Also a neat trick is to just (XYZ)-867-5309 as someone already signed up with
the number from that song and it’s not a real number.

~~~
jasonjayr
It's a real number in the 401 area code.

[https://www.askgem.com/](https://www.askgem.com/)

See the contact info in the lower left of the page.

------
clumsysmurf
A recent-ish book that talks a little about this (surprised the article did
not mention QuintilesIMS):

"Our Bodies, Our Data: How Companies Make Billions Selling Our Medical
Records"

[https://www.amazon.com/Our-Bodies-Data-Companies-
Billions/dp...](https://www.amazon.com/Our-Bodies-Data-Companies-
Billions/dp/0807059021)

------
ohazi
Isn't this super illegal? Who are the lawyers at these companies who are
signing off on these projects?

~~~
throwaway5752
No. Using that data might be. In any case, it's only illegal if the Supreme
Court interprets it to be illegal. If you have been following the recent years
of Supreme Court decisions/dissents it will not be comforting.

~~~
icebraining
Can you point to the cases that concern you? I haven't been following it
closely enough.

~~~
throwaway5752
I'm sorry, I can't right now in detail. The general trend started with
Citizens United and followed through Masterpiece is a increased set of
precedents for corporate personhood, with some harsh dissents from the
Alito/Thomas/Gorsuch contingent in cases where that was at issue (but corp.
personhood side lost). When Kennedy retires and of Kavanaugh is his
replacement, that will give put an awful lot on Robert's judgement as the
swing decision. If I'm really getting picky, the lack of consistency in Trump
v Hawaii and the Masterpiece case shows a certain amount of prioritizing
partisan concerns over logical consistency (imo, ianal).

edit: taking corporate personhood to logical extremes reverses a lot prior
precedent and I would have doubted it would have happened until recently.

------
mnm1
I wouldn't be surprised if people are denied care and left to die due to
exorbitant prices based on random, undoubtedly wrong algorithms. Here's where
the cost of personal data really becomes huge, at in life or death. Insurers
have played god like this since their inception and nothing is going stop them
from making more money by shutting out anyone who is a threat to their bottom
line. We've only had a law that prevents discrimination on pre-existing
conditions for a few years. I'm sure the insurance companies will lobby hard
to get rid of it so they can let the very sick suffer and die rather than be
forced to pay for their healthcare. This is an end run to that goal in case
lobbying to murder people legally fails.

------
staticautomatic
I buy data from LexisNexis. AMA.

~~~
mindslight
What is the pricing model? (eg per request?) Roughly what is that cost?

Is there an "all-you-can-eat" access level that other organizations have?

How granular are the data fields per record (/person) ?

Do requesters generally cache the retrieved data on their own stores,
continually re-retrieve it, do analysis in large batches, or what? Would we
expect to see big caches of this data sitting around outside of Lexis's
vaults?

~~~
staticautomatic
> What is the pricing model? (eg per request?) Roughly what is that cost?

Across all the products I've used (web, batch, API), the price is per-request
(where a batch is multiple requests). The actual price can vary by several
orders of magnitude depending on what you're requesting. If we're talking
about list pricing, it ranges from about 10 cents to tens of dollars per
request. There are significant volume discounts available, of course.

>Is there an "all-you-can-eat" access level that other organizations have?

I have not seen one myself and I doubt they offer one even to their largest
enterprise customers. However, I am fairly certain that they offer it to
certain government agencies. For example, I have seen federal government RFP's
that require it.

>How granular are the data fields per record (/person) ?

It depends on the kind of response/report you're looking at, but as a general
matter they are highly granular. For example, provided the data are available,
I could itemize a list of every car you've ever owned by make/model/year,
infer whether you're in a same-sex relationship, or see what the grounds were
for granting your divorce.

>Do requesters generally cache the retrieved data on their own stores,
continually re-retrieve it, do analysis in large batches, or what?

Aggressive caching is an absolute requirement for API users. That is
proximately because Lexis's server does not "remember" your requests. They are
logged and have unique transaction ID's but if you run the same search twice
they will not check the request against a log cache to see if it's the same as
one you ran recently. Instead they'll just charge you a second time (a very
easy way to accidentally run up a big bill when running tests against a
production endpoint). In combination with the high price per request, you'd be
stupid not to cache the whole response.

>Would we expect to see big caches of this data sitting around outside of
their vaults?

Yeah certainly. You can't arbitrarily run requests and store the data (e.g. in
order to resell it), but you can store the results of requests you've made.

------
kyrieeschaton
This is complete nonsense and entirely speculative. They admit as much when
they inform you they can find no evidence of any individual underwriting
decision being made based on this data, which the companies strongly deny, and
would be illegal. Insurance is highly regulated, both on a state and federal
level. Pricing algorithms and variables are public in most states (albeit
obfuscated).

What does seem to be happening is the companies are using third party data
providers for marketing and market analysis, as literally every other company
from your local HVAC guy to McDonald's does.

------
stakhanov
There are certain dimensions that it makes a lot of sense to discriminate
around: For example, if you're a roofing contractor, I really think you SHOULD
be paying higher health insurance rates than I do, as an office worker. You'll
just price it into whatever you charge to make roofs, which means the price of
a house will start getting closer to what it actually costs the economy. Since
I rent, I would otherwise end up subsidizing other people to build or buy
houses for themselves, and I don't think that's how an economy should work.

~~~
ceejayoz
> For example, if you're a roofing contractor, I really think you SHOULD be
> paying higher health insurance rates than I do, as an office worker.

Why? Your sitting eight hours a day is remarkably unhealthy, and roofers (at
least where I'm located) are typically separately insured for on-the-job
injuries.

~~~
stakhanov
Don't get unduly bogged down with the example: It works equally well with
"horse trainer" or whatever. Clearly some professions have a bearing on your
risk profile with regard to certain types of insurance, and there is not
always a clear distinction between risks you incur as a private person and
risks that your business needs to indemnify you against. -- Like, if you're in
a job that involves a lot of travelling and being away from your family for
extended periods of time puts you at greater risk of developing mental health
conditions etc.

~~~
phil21
I think the numbers may not come out the way you think they will. Sedentary
lifestyles are by far the largest medical expense in the country as a whole,
so office jobs I would expect to have much higher premiums.

Sure you're not gonna get your sternum crushed by a falling 2000lb pallet -
but those situations are already typical covered by workmans comp and other
company insurance.

------
jschwartzi
Considering how inaccurate some of Fitbit's measurements are( resting heart
rate, for example ), I would sue my insurer if I found out they were using
that data. My doctor shouldn't be using it either.

RHR is normally measured within the first 30 minutes of waking while lying in
bed, which is something Fitbit can determine. What I've noticed is that on
days when my RHR that I've measured using their monitor after waking is 54
BPM, they report up to 61 BPM. There's a very long chain on their forum about
how inaccurate the measurement is.

~~~
brlewis
I work for Fitbit but am speaking only for myself.

I'm guessing that this is the chain you're referring to since it echoes the
"30 minutes after waking while lying in bed" claim:
[https://community.fitbit.com/t5/Charge-HR/Resting-Heart-
Rate...](https://community.fitbit.com/t5/Charge-HR/Resting-Heart-Rate-
Inaccuracies/td-p/901287)

Other sources I checked did not echo that claim. As one commenter in the chain
pointed out, RHR is not minimum HR.

[http://www.heart.org/HEARTORG/Conditions/HighBloodPressure/G...](http://www.heart.org/HEARTORG/Conditions/HighBloodPressure/GettheFactsAboutHighBloodPressure/All-
About-Heart-Rate-Pulse_UCM_438850_Article.jsp#.W04ycdhKhE4)

[https://www.mayoclinic.org/healthy-
lifestyle/fitness/expert-...](https://www.mayoclinic.org/healthy-
lifestyle/fitness/expert-answers/heart-rate/faq-20057979)

[https://www.health.harvard.edu/blog/resting-heart-rate-
can-r...](https://www.health.harvard.edu/blog/resting-heart-rate-can-reflect-
current-future-health-201606179806)

Also, one of the critics in the chain thinks Fitbit must be inaccurate after
his RHR rose from 68 to 71 after "hiking at altitudes up to 14,200 feet" then
fell back to 68. I think this criticism stems from a misunderstanding about
how altitude affects oxygen levels and how oxygen levels affect heart rate.

All that being said, even if the devices are generally accurate, there are
defects and they aren't designed as medical devices. To the extent you
voluntarily share your data with a doctor or insurer (which is the only way
they'd get your data), your doctor or insurer should treat it the same way
they treat other useful but potentially inaccurate information.

~~~
jschwartzi
Thanks! This is way more informative than any of the responses I've seen from
your support team in that chain.

------
dawhizkid
Most people who work for medium or large sized companies in the US are working
for companies that are self-insured, meaning your company is taking on all the
risk, so if anything your own employer is incentivized to do this and not the
insurance company itself.

When I first heard of the Amazon/JP Morgan/BH heathcare initiative my thought
on what that company would actually do is surveillance on their collective
millions of employees to better predict if they are prone to disease and use
predictive analytics to lower their own claims cost.

~~~
mtberatwork
> meaning your company is taking on all the risk

While I wouldn't say there aren't any companies out there that are absorbing
the entire cost of insurance premiums, most are splitting this in some
proportion with the employee.

~~~
dawhizkid
by risk I mean that the company is liable for all claims cost, but right
premiums can come from the employee, employer, or both.

------
shiburizu
As a college student I work taking phone calls for a biz that attends entirely
US customer base, my colleague asked why our clients were often leery about
sharing things like their photo ID with us, despite being customers with us
for many years.

As one of the few who lived in the US amongst us I'd have to say it might have
to do with how much companies involved in risk assessment really know about
you and how much of it goes to the government -- they have no interest in
having us show up in their credit or what have you.

------
exabrial
That's ok with me? I wish it were like life insurance where they can ask you
anything and then you get that rate locked down for the term.

I also actually liked the proposal in Congress that got rejected: allow people
to make their own groups. So if you are a person who likes to work out and get
your fat levels tested once a year, you could join a group of like minded
individuals and insurance companies would bid to insure your group.

~~~
ceejayoz
> That's ok with me? I wish it were like life insurance where they can ask you
> anything and then you get that rate locked down for the term.

That's an understandable attitude for a healthy person.

What is the person born with a disability or a gene making cancer, Alzheimers,
heart disease, etc. likely supposed to do?

"Your insurance premium is $25k/month. We take checks!"

~~~
sDlEzAtyoNAz
If they can't afford to pay anyone enough to insure them, they should ask for
charity, because that's what they need.

~~~
ceejayoz
Shockingly, it turns out that most charities don't have the financial
resources to dedicate a hundred thousand dollars for a single heat transplant.

~~~
sDlEzAtyoNAz
Also shockingly, if you already know you need a heart transplant, you're well
beyond the point where any market-based risk pool is going to offer to pay for
your transplant in exchange for a premium that's below the cost of your
transplant.

You need charity, not a market.

~~~
ceejayoz
> Also shockingly, if you already know you need a heart transplant, you're
> well beyond the point where any market-based risk pool is going to offer to
> pay for your transplant in exchange for a premium that's below the cost of
> your transplant.

 _Everyone_ is at potential risk for needing something like a transplant
eventually. Making the pool large enough allows reasonable premiums, just as I
can pay a couple hundred bucks a year to replace my entire house if it burns
down.

The rest of the developed world defines the risk pool as "everyone", and the
end result is healthcare costs half of ours (including the tax component) and
similar outcomes.

> You need charity, not a market.

You need government, not a charity.

~~~
sDlEzAtyoNAz
>Everyone is at potential risk for needing something like a transplant
eventually.

Not everyone is at equal risk, and many choices people make can have an impact
on that risk. That's the point of this thread.

>Making the pool large enough allows reasonable premiums, just as I can pay a
couple hundred bucks a year to replace my entire house if it burns down.

What is 'large enough'? The populations of many entire European countries are
dwarfed by the number of subscribers to several health insurance companies in
the US. Of course we don't know how large health insurance companies would get
in a market without heavy government interference, but do you have some reason
to believe the size of pools in a market with less interference would result
in unreasonable premiums?

>The rest of the developed world defines the risk pool as "everyone", and the
end result is healthcare costs half of ours (including the tax component) and
similar outcomes.

And our health care system requires subscribers to insurance companies to pay
those insurance companies to A) provide charity to people who wouldn't be able
to afford to buy insurance in real market and B) pay for routine care (i.e.
care where there is no risk to insure against - you know you're going to need
it). And of course the health insurance company is going to collect its cut of
the money that the government has forced subscribers to funnel through those
companies. Is it really any surprise that system gets expensive?

>You need government, not a charity.

You need charity, whether it's administered by a public organization or a
private organization or funded by private individuals or taxpayers.

~~~
ceejayoz
> do you have some reason to believe the size of pools in a market with less
> interference would result in unreasonable premiums?

Demonstrably so. Just look at pre-Obamacare "high risk pools" for concrete
examples. [https://www.kff.org/health-reform/issue-brief/high-risk-
pool...](https://www.kff.org/health-reform/issue-brief/high-risk-pools-for-
uninsurable-individuals/)

You'll also see it in other insurance markets, like life, house, car,
malpractice, etc. - many people are largely uninsurable in these markets.

> What is 'large enough'? The populations of many entire European countries
> are dwarfed by the number of subscribers to several health insurance
> companies in the US.

It's not so much raw population as how much you're allowed to slice it up. A
decent sized city is big enough - many corporations of a few thousand people
self-insure as it's cheaper.

The problem is when you allow insurance to pick their customers. They just
pick the healthy ones, if allowed.

> And our health care system requires subscribers to insurance companies to
> pay those insurance companies to A) provide charity to people who wouldn't
> be able to afford to buy insurance in real market...

You are using some _very_ weird definitions of "charity".

Obamacare's subsidized premiums aren't shouldered by the insurance companies,
they're provided by the government. Those insurance companies are making bank,
not providing charity.

Single-payer or income-based subsidized healthcare isn't "charity". Insurance
paying out more than premiums taken in for a particular subscriber isn't
"charity", it's how insurance works.

> Is it really any surprise that system gets expensive?

Oh, not at all, but that's because we've picked the _least_ cost-effective
bits of both private and public healthcare systems to combine into a
monstrosity.

~~~
sDlEzAtyoNAz
>Demonstrably so. Just look at pre-Obamacare "high risk pools" for concrete
examples.

I'm obviously not talking about individuals who are so expensive to profitably
insure that they can't afford the premiums. I've already stated that the
market isn't going to work for them. It's not the size of the pool that's
causing problems here; the contents of the pool are the problem.

>They just pick the healthy ones, if allowed.

They also pick the less healthy ones that are able to afford to pay the higher
premiums it takes to make it worth it for the insurance company to cover them,
assuming the insurance company is allowed to charge such premiums. There is
plenty of money to be made there. Where there isn't any money to be made is in
people who know they have high expenses and can't afford to pay them.

>You are using some very weird definitions of "charity".

Are you taking issue with my characterization of government welfare as
charity? Why should it be excluded from such a broad category?

>Obamacare's subsidized premiums aren't shouldered by the insurance companies,
they're provided by the government.

That's not what I'm talking about. I'm talking about people who have pre-
existing conditions, who are definitely going to cost the insurance company
more than they're going to be paying in, regardless of subsidies, who the
health insurance company can't charge more money to and can't deny coverage
to.

>Insurance paying out more than premiums taken in for a particular subscriber
isn't "charity", it's how insurance works.

Actually that hinges on whether it's known before the agreement is made that
the particular subscriber is going to have more paid out on his behalf than he
is going to pay in. If it is known, then that's not insurance. It's charity.

------
u801e
My employer used to provide additional funding in employees' HSAs (Health
Savings Accounts) if they participated in a health screening. The health
screening involved measuring height, weight, blood sugar, cholesterol and
other lipids. There was also a questionnaire about lifestyle choices related
to health in terms of how physically active you were, smoking, drinking, etc.

------
madengr
I've been saying this for years. That discount card you use at the grocery
store tells your insurance company how much bacon you eat.

------
bawana
LexisNexis said there is no web page to submit a request for info. I tried
their chat option and that person said I had to call. 888.497.0011 After 30
min on hold I spoke to someone. They wanted my personal info including SS# and
Drivers license# They saifd they would mail out the info in 10 days.

I guess this 'personal touch' is a security measure.

------
DenisM
In WA state to price out insurance all you need to provide is your age,
gender, and smoking status. I don't see how insurance companies can use any
other information in setting the price?

------
394549
Has anyone done any research to map out the relationships between the
different data brokers? E.g. who has what data to sell, and who's selling what
data to who?

~~~
staticautomatic
I could tell you who is selling what, and a little bit of who is selling what
to who, but I don't think any one person has a complete picture.

~~~
394549
Would it be too much trouble to share what you know? Even just a list of the
players would be helpful.

I'd really like to understand more about this industry, but from a consumer
perspective, it's very opaque. It's easy to find people search websites (and
articles about them), but much harder to understand how they got your data or
what else about you may be getting sold.

~~~
staticautomatic
I'll do my best to explain. I need to start by noting that, as far as I'm
aware, there's no generally accepted nomenclature for this stuff. Accordingly,
I've invented my own terms (some of them as I write this).

At a high level there are two different kinds of brokers, which I'll call
"primary brokers" and "secondary brokers." Primary brokers are companies that
primarily aggregate their own data and sell it to other businesses. Secondary
brokers are companies that primarily buy data from primary brokers and resell
them to other companies or to consumers.

Each broker can further be defined by the kind(s) of data they sell. Generally
speaking, there are 5 categories of data:

1\. FCRA records. These are mainly credit records and credit-related data that
are permitted to be used in making credit determinations.

2\. Non-FCRA public records. This is stuff like birth, death, marriage,
property records, DMV records, criminal records, etc. These are explicitly not
to be used for credit and hiring determinations (not sure about renting, off-
hand).

3\. Hiring data. Frankly I'm not entirely sure what these are beyond criminal
background stuff, but they are allowed to be used for making hiring decisions,
where permitted.

4\. Marketing/Lifestyle data. This is stuff like purchase history, magazine
subscriptions, hobbies and interests, data sold by companies whose products
you sign up for for free, etc.

5\. Insurance underwriting data. These tend not to be explicitly tied to a
non-anonymous person. However, given someone's street address, you'd be able
to pull some info on their property or something.

Most brokers sell data belonging to multiple of the above categories.

The big primary brokers for FCRA data are, as you might expect, credit
agencies (Experian, Equifax, and TransUnion).

The big brokers who deal in mixes of data are LexisNexis (a Reed Elsevier
company), Thomson Reuters/WestLaw, and TLO (a TransUnion subsidiary). They are
primary brokers of Non-FCRA and hiring data but secondary brokers of FCRA data
(I believe they mainly purchase it from the credit agencies). There are a
couple small companies that are primary brokers of things like hiring data
(e.g. Checkr).

The big primary brokers of marketing/lifestyle data are companies like Acxiom,
BlueKai, Epsilon, US Data, and a number of others. I have heard that credit
card companies sell certain kinds of data but I am not sure what exactly and
have not used their products myself.

The big primary broker of insurance underwriting data (along with a couple
other categories) is CoreLogic.

The big secondary brokers of Non-FCRA data are Intelius and Instant Checkmate.
I do not think they are primary brokers under my definition because most of
what they sell is basically an identical copy of what the primary brokers
sell, but for a lot more money. It's hard for me to imagine them taking on the
expense of aggregating the bulk of their own primary data when they can run a
search against a primary broker DB for a few bucks and resell a pretty version
of the response to a consumer for $50. They probably aggregate _some_ of their
own data but I'd guess it's low-hanging fruit.

There are also some purely social media-driven secondary brokers, like Pipl.

------
deegles
To play devil's advocate, I think data should be used to manage rates for
things that a consumer can reasonably change, like diet/exercise. Smokers are
already penalized.

e.g. "Our data indicates your average sugar consumption is over Xg per day
over the last 6 months. If you commit to reducing this to Yg per day over the
next 6 months, your insurance rate will drop by 10%. Otherwise rates will
increase by 20% to cover your increased risk for diabetes, heart disease, and
stroke."

~~~
jschwartzi
On that note, my insurer helpfully put a note in my file that the doctor
should tell me about being more physically active based on my BMI. When I
listed everything I do, he turned to his intern and said "this is an example
of how BMI doesn't tell the whole story." Then he deleted the note. So it has
to be the right data and the doctor needs to be the final arbiter of whether
it's meaningful or not.

------
smileysteve
> And it could raise your rates

And it could lower your rates.

~~~
yourapostasy
> And it could lower your rates.

Lack of a national competitive market for healthcare insurance in the US
ensures an oligopoly within each state, and thus argues against your reply.
Also, keep your eye upon demographic rate _trends_ , not individual rates.

In other words, for the same demographic over time, have rates been going up
or down as the insurance market consolidates players over the past few
decades? The trend is inarguable [1]; it is a monotonic function. What data do
you have that convincingly advocates including data brokering of lifestyle
data into insurance actuarial calculations makes a material change in this
function or the marketplace?

[1] [https://www.thebalance.com/causes-of-rising-healthcare-
costs...](https://www.thebalance.com/causes-of-rising-healthcare-
costs-4064878)

------
cutler
Aren't there obvious GDPR issues with this unless you're limiting the analysis
to US insurers?

------
Cieplak
Just clicked for me why “healthcare” companies spend so much money on hard
discs and data storage.

------
mixmastamyk
We desperately need some privacy legislation in the US, years ago.

------
adrianhel
Free'ish healthcare is the only way...

------
jadedhacker
Whelp, just one more reason why we need Medicare for All. There's no need to
enable these people whose business is to find ways to deny people healthcare,
just eliminate their industry completely and save money in the process too.

------
mtgx
This will ensure the death of the private healthcare system. It won't happen
overnight, but eventually the private/hybrid healthcare system will have _no_
redeeming qualities other than to extract as much profit as possible out of
anyone's health issues. That's when no one will support it anymore (except the
politicians taking bribes to support it).

~~~
Analemma_
Why the downvotes? He's right. The thing about insurance is that the only
reason it works is because of imperfect information about the future. The more
accurately people can be priced, the more pointless private health insurance
becomes: the expensive patients (pre-existing conditions, or just people with
bad luck) will get accurately priced and have impossible premiums and won't
bother, and the cheap patients will realize they probably don't need it, take
a gamble and also not bother. Microtargeted health insurance will be its own
undoing.

~~~
mindcrime
It sounds like you're doing something that most people do, despite it being
incorrect. That is, conflating "health care" and "health insurance". Everybody
has gotten so conditioned to the idea that "health insurance" pays for
everything health related, that we all seem to take this for granted. But it
doesn't have to be so.

I believe that our goal should be to reduce the cost of health care so that
most of it can be afforded _without_ insurance - with insurance then returned
to its role as a hedge against the more extreme/unlikely events.

~~~
poulsbohemian
>Everybody has gotten so conditioned to the idea that "health insurance" pays
for everything health related, that we all seem to take this for granted. But
it doesn't have to be so.

Try this experiment. Walk into your doctor's office and ask what a procedure
would cost. Ask the doctor, the receptionist, the billing clerk - ask
everyone. No one will be able to give you an answer. That's why they are
conflated. Fix that (very ripe for disruption) problem and you'll fix health
care.

PS: I agree with you, it should generally be affordable without insurance.

~~~
jsoc815
> _Try this experiment. ...ask everyone. No one will be able to give you an
> answer._

Funny you say this. A friend just went through this. Not even the insurance
company could say. The calls to everyone got so ridiculous that I had to
construct _lawyerly_ questions so that people couldn't default to weaselly
answers. The provider billing staff seemed to feel put upon that they were
being asked to _coordinate w /the insurer_ to figure out patient out of pocket
cost would be. And in the end they still couldn't figure it out.

~~~
poulsbohemian
Here's what gets to me as well... providers love to talk about how little they
get reimbursed from medicare and from many insurers. But, for example, I'm not
going to have a surgery that I would really like to have (and that a doctor
agreed I should have) because nobody can tell me what the cost would be. The
15 minute appointment with the doctor who recommended it to me was $700 out of
pocket - so I'm unlikely to return if that's the kind of bill I get hit with
for having a cup of coffee with them. So, I'd like to believe that at some
point, given the current environment in which people are paying for insurance
but can't afford to go to the doctor, that we'll see providers realize they
are losing out on revenue opportunities by not actually serving their
customers.

~~~
dragonwriter
> of bill I get hit with for having a cup of coffee with them. So, I'd like to
> believe that at some point, given the current environment in which people
> are paying for insurance but can't afford to go to the doctor, that we'll
> see providers realize they are losing out on revenue opportunities by not
> actually serving their customers.

The customers from which the providers drive revenue are the ones who _can_
afford to go to the doctor. The ones who can't (even if they pay for
insurance) are ones providers wouldn't be getting revenue by serving.

~~~
poulsbohemian
But you are missing my point and that of joc815 below you - if I knew the
cost, then I could determine whether or not to become a customer. In the
absence of a clear cost structure, I can't answer the question of whether I
can afford the care or not.

~~~
dragonwriter
> But you are missing my point and that of joc815 below you - if I knew the
> cost, then I could determine whether or not to become a customer.

“If you have to ask, you can't afford it.”

Or, more to the point, medical procedures often have an unbounded upper limit
on potential billed costs, without the opportunity to stop work and inform the
customer and get new instructions when it is realized that the original
estimate will be exceeded, and even getting a reasonable idea of the
statistical distribution of charges for a particular procedure under costly
comparable conditions by the same provider wouldn't be easy.

Now, providers could adopt a flat fee structure and eat the risk of long-tail
costs, but that creates a lot of risk (and some perverse incentives) for
providers.

~~~
jsoc815
> _“If you have to ask, you can 't afford it.”_

Unless we're discussing medical care as a _luxury good_ \-- and if that's the
way that we really want to approach this, okay, let's just _be honest about
that_ \-- this is incorrect. In my experience, med professionals have made
assumptions about what I could and couldn't afford based on their mental
databases of flawed correlations. _Things they thought I probably couldn 't
pay for, not only could I have if necessary, but didn't need to_ because my
insurance was willing to cover it any way.

I'm not going to address the rest of what you've written because, quite
frankly, I have a difficult time believing that you are being serious, for a
number of reasons. If I'm mistaken, then I thank you for sharing an
interesting thought pattern and apologize in advance.

------
gascan
There are surely privacy concerns, but it seems like the evolution of all
insurance markets trend towards better risk profiling.

This is a good thing IMO. The point of insurance is to _pool_ risk, not get
your high risk subsidized by some sap with low risk. The better insurance
companies can profile risk, the more fair the pools.

Then if we want subsidies for high risk individuals, we can work on that
separately.

