Choosing among insurance plans reveals what people value, which is a signal to innovators and investors as well. But it can be hard to change insurance plans, and a person’s choice of plan isn’t always so obvious or even available to them. After all, someone might be limited by the options their employer offers. So is it really a “market” that can inform us what people truly want? Not entirely.
Still, even though advocating for yourself and the insurance you need can be difficult, it remains an important market signal to the insurers and healthcare providers about what patients actually value. For example, if you’re weighing various job opportunities, you may factor in each employer’s insurance coverage into your decision. If you are already employed, and your employer-provided insurance isn’t paying for the care you need, you can go to your head of HR and complain.
Say insurance companies decided they weren’t going to cover Trikafta, the cystic fibrosis treatment, at the price Vertex was willing to accept. If people weren’t up in arms about that, it sends a signal that Trikafta isn’t valuable. This happens all the time with drugs or services that people aren’t clamoring for.
Now think about the new GLP-1 obesity medicines. Those drugs aren’t yet well covered, and people are beginning to demand their insurance cover them as evidence piles up showing that the drugs are safe and effective treatments that have benefits beyond weight loss. (And evidence is also piling up that covering these drugs will save insurers money — an absolute ton of it — which suggests the drugs are “worth it” to insurers in more ways than one.) When insurance plans lose customers, it signals to them and their competitors how much people value the service or drug they weren’t paying for.
Every time an insurer builds a formulary, a provider decides what insurance they accept, or a drug maker provides rebates through PBMs, choices are being made about what types of healthcare our society values. Consumers do have an impact on the insurance system by demanding better insurance plan offerings from their employers.