Is vaping bad for you? There is a huge debate on that but the science is murky.
What about smoking tobacco? We think we know the answer but it was very late in coming thanks to lobbying by the industry.
What about weed? Smoking that stuff replaced tobacco and most everyone says that’s great. But is it really? What about the impact on other life choices? The debate is weirdly unmoored from facts.
And what about alcohol? America has a massive addiction problem but what are the real health consequences? People often intuit that too much is too much but people lie to others and themselves all the time about their own liquor consumption. And why? Because the consequences are low stakes. People are generally unaware of the dangers.
Or what about various diet programs: Keto, Vegan, Pescatarian, Blue Zone, Gluten free, or whatever? Mostly we are in the dark on this stuff, forced to follow our favorite guru rather than look at population-wide hard data on these issues.
For that matter, precisely how dangerous are the mRNA shots that people were forced to inject into their bodies? There are opinions on all sides, with evidence running in many different directions from: these are nearly harmless to these are devastating and causing unprecedented death and disease.
A major reason that we don’t have evidence-based and clear answers to any of these areas is that actuaries have been largely removed from the industry that claims to be guarding our health. This is because our health insurance is forbidden by law from being adjusted for real-world risk factors. As a result, we are largely wandering around in the dark, chasing fads and deferring to the latest experts.
This is not how insurance is supposed to work. Consider home insurance, car insurance, or life insurance. The premiums in each of these industries is minutely adjusted for risk factors. The science that investigates these factors is called actuarial science.
It’s actuaries who tell us that locks on doors reduce theft, that smoke alarms are a good thing, that safe driving is, well, safer, and that this car is better than that car when it comes to crashes and in its repair record. Have you ever declined to buy a certain model of car because the insurance premiums are too high? This is the price system telling you a set of facts that you might otherwise not have known.
There are some 50,000 credentialed actuaries in the United States. They apply their amazing craft in several industries that are operating very well today. They have been kicked out of the health industry nearly completely.
This is why we don’t really have settled answers to the above questions. By eliminating “discrimination based on pre-existing conditions” we have eliminated the actuarial aspect of determining health risks. This is what Obamacare did.
In doing this, Obamacare contributed massively to the ill-health of the American people. We eliminated all the signs and financial incentives for getting and staying well. There is a reason for the massive substance abuse, the gorging of the public with liquor and pharmaceuticals, and the tremendous problem with obesity and chronic disease.
In short, people don’t know they are killing themselves with bad lifestyle choices. They have no roadmap to change and no financial incentive either. This is the fault of Obamacare and the whole industry that is detached from any real-world experience or evidence.
We need desperately to bring hard numbers and reality back to this industry, and do it today!
This is a promise. Any proposed reform to healthcare provision that does not address this will fail. It is the fundamental problem. True reformers have to take this up. Health insurance needs to be more like auto insurance else we are headed straight to the hell of single payer and massive ill-health.
The trouble is that Republicans are scared to take this on. It seems somehow cruel to allow for the adjustment of premiums based on health. The truth is the opposite. It is cruel to do the opposite. It allows people to persist in habits that are killing them. And it provides no reward at all for adopting more life-affirming practices.
We could massively diminish the problem with American drug abuse, alcohol abuse, obesity, and lack of exercise very quickly simply by changing this system. If a hard drinker had to pay an extra $300 a month in health insurance to continue the habit, he would shift. Same with smoking and being a couch potato. We would see millions suddenly hitting the gym and the tennis court. It would change everything.
And this would happen without one word of hectoring from the top much less interventions in people’s freedoms. You would still be free to smoke and drink yourself into a daily stupor. The only difference is that you will have to pay for the privilege, not by force but simply as a matter of the price system. No one needs to manage such a system through force. It happens solely due to the actuarial tables.
As I say, there are 50,000 actuaries in this country ready to get to work to tell us about the risks of various diet plans, drugs, vaping, exercise habits, vaccines, or anything else. We have endless debates about all of this stuff but no real hard data that can help us. An industry entirely devoted to discovery and pricing risk could solve the whole problem. Crucially, actuaries are constantly adjusting their risk models based on new information so the science gets updated constantly—without randomized controlled trials, founding funding, or peer review. It is simply a matter of good economics. Period.
Those 50,000 actuaries would then double and triple in number as people leave finance and other applied areas to take up the cause. Again, this would not require bureaucracies but rather simple freedom to make it happen. It could happen today with the right legislation. It could be handled entirely by the states, same as auto insurance, provided that the friggin’ federal government would get out of the way.
This absolutely must become the core of any serious legislation dealing with healthcare in America. Anything that bypasses this issue is not serious. Republicans should not be allowed to get away with claiming that they will reform the system while preserving its most damaging part.
The American system has produced illness, and now we see how a wicked industry itself is profiting from that sickness. Let’s disable the whole corrupt machine by putting actuaries and the price system back in charge. If we are worried about preexisting conditions, that’s a job for philanthropy and means-tested government welfare programs. You want those preserved, fine. But don’t weaken and destroy the will to health in the process.
If we do this right—and vast other reforms are need too such as untying insurance from employment—we’ll find out quickly about the health risks of vaping, drinking, drugging, overeating, and various diet plans, not to mention vaccines and other forms of meds. We need the truth. Only the trained actuaries and the truth-telling market for risk is going to give it to us.
