One thing I keep coming back to is how broken the incentives are between health insurers, employers, and individuals. Because people change jobs, employers switch carriers, and plans reset every year, both insurers and employers are pushed to optimize for short-term results instead of long-term health value. If the relationship may only last 12 months, why invest heavily in prevention, chronic disease management, or better long-run outcomes? The person ends up carrying the downside through disrupted care, deductible resets, and more administrative friction.
That leads to a basic question I've never understood: why can't an individual buy a 3- or 5-year health plan? A longer-duration plan seems like it could align incentives better by giving the carrier more reason to think in LTV terms and giving the consumer more continuity. The obvious downside is pricing and regulation: locking in multi-year risk is hard in a market with annual rate resets, changing regulation, and adverse selection concerns.
Open Questions
- What mechanism would transfer enough “risk-lock” to the insurer without making coverage unaffordable?
- Could we re-introduce continuity incentives while still allowing annual adjustments?
- How would adverse selection be handled in a multi-year contract?
Status: Seedling - thinking about incentive design and contract structure for long-run care value.