system
Given the following post, respond as if you're commenting on Reddit:
human
CMV: Optical insurance should be part of regular health insurance plans

In the US, vision insurance is usually sold separately from health insurance plans for the rest of your body. The reason for this, I understand, is historical. Eye doctors/optometrists aren't educated at the same facilities as ophthalmologists and the professions were historically considered separate. However, I don't think it makes sense that traditional health insurance plans in the USA don't cover vision care. Arguments I have heard for why this makes sense:

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* Most people don't use vision insurance, so adding it in would drive up premiums unnecessarily. I don't think this makes sense at all. Most people won't require \*most\* services that their health insurance plans cover. I have never needed a cardiologist, a radiologist, or a dermatologist, but if I did, my health insurance plan would cover it.
* Vision insurance isn't medically necessary; you won't die just because you can't see well. I think this argument is made primarily by people who don't have poor vision. I do have poor vision, and my glasses/contact lenses allow me to live a normal life. It's just as medically necessary for my health and happiness as a hearing aid or prosthetic. I could not function independently without my glasses.
* Vision care is relatively cheap, so most people can afford it on their own, so it isn't an injustice that it isn't covered. Perhaps, but it's still a huge hassle to have to shell out a couple hundred dollars every year for something I need to function.
* The only argument I've ever heard that even remotely makes sense to me is that eye care is usually a very predictable, fixed cost every year, so it wouldn't make economic sense to cover it. For example, insurance companies know that it will cost them about $100 per person with vision deficiencies per year, so they will try to get each of those people to pay in about $100 each for the benefits, which then defeats the purpose of the insurance policy for the customer, as they will be just as well off paying for the services directly themselves. The thing I don't understand is why this argument is applied to vision insurance and nothing else. For example, I could see it being quite predictable that women of child-bearing age will each cost an insurance company $500 every three years for pap smears--thus insurance companies would try to raise prices to recoup those costs--and then the insurance plan would no longer really be a viable option for the customer. But it only seems to happen for optometry and other services considered medically unnecessary.

I actually am generally extremely pleased with my health insurance, but this one baffles me. Other than for historical reasons, why can't I get vision care through my insurance? Why can I get so many services for free but when I need glasses, I'm left scouring weird websites hunting for deals? Why does this system make sense at all? Someone please CMV.
gpt
Ok, first... you need to understand why routine care is covered by medical insurance rather than being "pay as you go":

People who skimp on preventative care because of the cost are very expensive to the insurer in the long run because lack of preventative care means you have a higher chance of an expensive disease or missing cancer until it's too late (and much more  expensive to treat). Furthermore, there are public health benefits to things like vaccinations and infectious disease review. 

Vision, on the other hand... really doesn't have any of these problems. There's almost nothing you can do to "prevent" vision problems, so there's no reason for the health insurance company (or the people paying for it, like your work) to want to cover "routine care". And you basically automatically know when your own vision is getting blurry... you don't need a doctor to tell you that. 

The only exception might be glaucoma screening... but you can have that done by an opthamologist's office on your medical insurance already. 

Now we come to the economic reasons: Others have mentioned the predictability of vision costs... actually, it's the exact opposite: you spend as much on glasses and contacts *as you want to*. It's almost entirely under the control of the patient. 

For this reason, as you've pointed out, vision care always has a low-end "allowance" for the cheapest possible glasses. And the premiums for that are actually higher than the predicted payout, to allow for insurance company profit... so actually there's very little incentive for an *individual* to want to pay for vision insurance... it's a sucker's game... it's basically prepaid service, not insurance. 

Except for one thing: in the US, healthcare is generally paid for by employers, who will offer this "insurance" separately as a benefit to attract employees (and employees having good vision is in their interest too... and many companies actually care about their employees)... 

But... naturally... a company doesn't want to pay for vision coverage for every worker... only those who actually need it and are willing to cough up a small coinsurance payment to discourage *everyone* from just taking it. 

Hence... market forces have demanded that it be separate coverage in the US and other places with common workplace-based insurance.