Liz discusses some of her work on the history of insurance and how early industrial life insurance worked through door-to-door collection of small amounts of money which she explored in her book Devising Consumption: Cultural Economies of Insurance, Credit and Spending. She also argues that insurance, and specifically life insurance, has always been a big data practice due to the amount of number crunching which had to be done either by hand or more usually (in the early days) through early mechanical, punch card computers.
We talk about the interest which Liz developed in the developments in healthcare insurance in the USA with with the introduction of the Affordable Care Act (ACA) and the opportunities this opened up for health insurers like Oscar who also offered a free wearable device with their policies and using social media for promotion. This established a new market in a similar way to the emergence of industrial life insurance.
Liz talked about broccoli, and the idea that the state should not be able to tell us to eat it, became an important issue in the debate about the “individual mandate” or forcing people to buy a premium. I (rather unfairly) asked Liz to speculate about what m
We discuss the structural problems which are caused by “adverse selection”. This is the well-accepted principle that those who are most likely to perceive themselves at risk are least likely to buy health insurance. While, those who consider themselves least at risk (eg. the “young invincibles“) are least likely to get insured. This is a major problem as insurance works on the principle of spreading risk widely across a population.
Liz told me about the fascinating, and concerning, ways in which self-tracking devices and other online data (eg. from social media posts) is being used to inform legal challenges to insurance claims. She offers some thoughts on whether these same kinds of data will be used to price individual insurance premiums.
One of the major problems Liz identifies with the use of data from wearable devices to inform health insurance pricing is a fundamental principle of insurance (also highlighted by the epidemiologist George Davey Smith). This is that insurance is a population level enterprise so it is possible that individual, personalised pricing would not work.
As part of the discussion we mention a particular health and life insurer, Vitality, who allow people to “pay” for an Apple Watch through exercise (a case I have also written about). We discuss whether these types of initiatives are really about improving health (as the insurers claim), collecting data on us (as some critics) claim or merely a marketing gimmick.
At the end of the interview we talk about the way in which health insurance has been aligned with notions of the privatized, entrepreneurial self and whether there is potential for it to be used differently to promote solidarity. As insurance is an inherently collective system (based on the spreading of risk across a population) couldn’t it be used to bring us together rather than blame and penalise individuals?