How data from fitness trackers, medical devices could affect health insurance.

Below is a link to completely clueless reportage about the use of wearables and fitness trackers by Big Brother, er, I mean, healthcare industry players that have only your interests at heart. If health plans wanted to finely tune their pricing models, as this writer doth protest, they could have done that anytime they wanted to. We have known for more than a decade that cardiorespiratory fitness is the single most powerful predictor of mortality and a highly accurate tool for assessing health statue. Put simply, the more fit you are, the longer you are likely to live and to live that time free of the burden of chronic illness, nearly all of which is driven by, you guessed it, a lack of fitness. Fitness also clearly indicates some kind of habitual exercise habit, and it may also betray a genetic tendency toward better health. But, as a recent release study of Finnish twins shows, even in people with the same genetic material, fitness is a powerful lever for health.

This writer completely ignores a fundamental issue with trackers: you can game the system. If I was an unfit person whose data was being collected for use by my health plan or employer, I would simply engage a friend (or any more fit person looking to make a few bucks) to be me digitally. Are health plans and employers going to verify data? How? Will they require that sensors be turned off at some times and on at others? Fitness is not the same as tracking someone’s physical activity (which no one in the health reporting media seems to grasp…how stupid are you people?).

With fitness testing to help establish pricing in insurance, as I write in Your Personal Affordable Care Act, all you need is a periodic test to establish how you are changing from your baseline test. And, the results can be stratified by gender, age, body mass, and health status. Fit people, regardless of starting point, should get beneficial pricing on health (and life) insurance coverage compared to people who are unfit. That’s a huge incentive, without persistent privacy invasion, for moving yourself from unfit to fit or from fit to more fit (nearly all the major health benefits come by simply going from unfit to fit). Finally, the author makes it seem like a terrible idea that prices should reflect actuarial reality. Does he feel the same way about auto insurance? I am pretty sure he won’t want to cross-subsidize a neighbor with a DUI conviction or a long sheet of moving violations. Likewise, would the writer want his homeowner’s insurance premium to go up because a neighbor insured by the same company refuses to put a fence around his pool? We price insurance based on actuarial risk all the time, why should we not do it on health, without privacy invasion, behavior tracking, or other degradations of individuals?

Pricing risk as accurately as possible is a worthwhile endeavor, but the jump into trackables and wearables is froth. We’ve avoided pricing risk in healthcare on the mistaken belief that healthcare is “special.” This is why the Affordable Care Act disallows pricing risk on anything except the most basic parameters (location, age, family size, and smoking status). No analysis from our enterprising journalist on how health plans will get around that statutory blockade by tracking physical activity or trips to the produce department and including those data points in the pricing stew. Doing periodic fitness-test-based pricing is all the insurance industry needs and has needed for some time. Unfortunately, it’s not all they want.

As tech innovators rush to unlock our physiological secrets, it’s unclear what will happen to all the data generated from sensor-based devices. How will the data be secured? Who owns the rights to it? Can the information be sold to third parties? What restrictions exist for using health data in unexpected and potentially harmful ways? Our lawmakers haven’t answered these questions—and neither have the companies they’re meant to oversee.

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