Should you have to pay more for an unhealthy lifestyle?

[simple girl]

This employer thinks so:
Memo to staff: Shape up or pay up - Health - MSNBC.com

The employer tried a reward system first, reducing premiums for healthy lifestyle choices. However, they stated healthcare costs continued upward and employees were not taking advantage of the program.

An excerpt from the article:

"To combat the problem, beginning in 2009 Clarian employees will be charged up to $30 every two weeks for failing to meet standards set by the company in a number of areas. That breaks down to $10 for a body mass index that’s too high, and $5 each for smoking, high cholesterol, high blood sugar and high blood pressure."

I have mixed feelings on this. I can see the point of trying to reward those who make healthy lifestyle choices. However, it just seems like there could be such a slippery slope here...

 

[Rich_by_the_Bay]

One problem is that cholesterol, hypertension and blood sugar are not always lifestyle problems - they can have genetic components ranging from minimal to predominant. True, lifestyle changes can be an important part of the treatment, but they are on thin ice here. To me it's different from choosing to be a smoker, for example.

 

[simple girl]

One problem is that cholesterol, hypertension and blood sugar are not always lifestyle problems - they can have genetic components ranging from minimal to predominant. True, lifestyle changes can be an important part of the treatment, but they are on thin ice here. To me it's different from choosing to be a smoker, for example.

My thoughts exactly.

 

[RetireeRobert]

I think the relevant question is not "Should you have to pay more for an unhealthy lifestyle". I think the reality in fact is "one does pay more for an unhealthy lifestyle". On average, unhealthy lifestyle means shorter life expectancy, more expense for needed medical treatments, more time being sick, more restrictions on daily living activities, etc etc etc.

So, irregardless of rewards or penalties in an employer benefits scheme, the unhealthy lifestylers do "pay more" in other ways.

 

[clifp]

I read somewhere that smoker are actually net contributors to the Medicare/Social Security system, because what they cost in health care expenses they make up for in lower life expectancy.

Anyboyd know Is this an urban myth or true. If so I wonder if the same thing is true for the handful of companies with traditional pensions for employees?

 

[RetireeRobert]

I read somewhere that smoker are actually net contributors to the Medicare/Social Security system, because what they cost in health care expenses they make up for in lower life expectancy.

Anyboyd know Is this an urban myth or true. If so I wonder if the same thing is true for the handful of companies with traditional pensions for employees?

I think that one ranks higher than "urban myth". I don't know where to find stats on it, but I think there is a lot of truth to it. And it would be the same for private pension plans as for SS/Medicare.

 

[donheff]

This is a natural outgrowth of our lame brained medical insurance system. Insurance companies can refuse to cover people who inherit bad health so why shouldn't employers join the game. The next thing we will see is employers refusing to hire people who are not buff enough to help in the battle against costs. Why not just shoot the obese kids before the charges start piling up?

 

[Sandy]

A quick search, shows there is some evidence that smokers save health care $$ in the long term, but this may not be true for obesity. I am not saying that this is what should drive policy and practice, but for what it's worth....

NEJM -- The Health Care Costs of Smoking

Conclusions If people stopped smoking, there would be a savings in health care costs, but only in the short term. Eventually, smoking cessation would lead to increased health care costs.

Arch Intern Med -- Abstract: Lifetime Health and Economic Consequences of Obesity, October 11, 1999, Thompson et al. 159 (18): 2177

Conclusions The lifetime health and economic consequences of obesity are substantial and suggest that efforts to prevent or reduce this problem might yield significant benefits.

 

[Zathras]

irregardless

My wife absolutely hates that made up word

And I agree with your post 100%

 

[kcowan]

I guess the key question is the following:
"Is this discimination better than having the employer drop health insurance entirely?"

 

[Coach]

I wonder how they'll implement this. Bi-weekly blood draws, BPs, weighings for all covered employees?

Coach

 

[youbet]

it just seems like there could be such a slippery slope here...

There sure could be!

"Lifestyle" takes in a lot more than smoking, drinking or over eating. Dangerous hobbies, living in a high crime neighborhood, feeling inappropriately stressed (type A personality), driving a car without wearing a seatbelt or a motorcycle without a helmet, multiple sexual partners, etc. Hey, measure 'em all and charge those folks more than those who don't have these things as part of their "lifestyle."

 

[almostperfect]

It would seem to me that since most employees spend at least 1/3 of their waking time at the company, that the company might have better success in getting the employees to make lifestyle changes by making different changes in their own way of doing business. For instance, perhaps make one half hour of walking daily allowed with pay on company time, or serving free healthy balanced lunches to the employees. If these type of changes were incorporated, yes they would still be optional, I suspect that the employer would get a lot better participation and in the long run gain some of those benefits they hoped for in reduced health care costs. All they seem to be setting themselves up for now is a ton of lawsuits and unhappy employees. I mean if someone told me I had to lose weight or pay up on a weekly basis, the first thing I'd do is be beating the bushes for a new place to work. Because as others have already stated, it is a way too slippery slope to start down. There are so many tangents that branch off into personal/private life that could easily be also considered dangerous to your health.

 

[Joss]

I think if I'm paying for the health costs of my choices - I ought to be able to do anything I please.

I also think it's ludicrous to expect someone else to pay my health costs - and that I should still be able to do anything I please.

Looks like everyone wants freedom, but someone else should pay for it.

 

[RetireeRobert]

My wife absolutely hates that made up word

"Irregardless" bugs your wife?

Yes, the word "regardless" might suit her better. But perhaps she should take up her displeasure about "irregardless" with American Heritage Dictionary or any of several others.

If a word is in the dictionary (and not as slang), is it really "made up"? What constitutes "made up"? If people use it regularly, they use it. They communicate with it.

What is language? What would S. I. Hayakawa have to say about this?

What would...........

Sorry, got off on a tangent.

 

[RetireeRobert]

There sure could be!

"Lifestyle" takes in a lot more than smoking, drinking or over eating. Dangerous hobbies, living in a high crime neighborhood, feeling inappropriately stressed (type A personality), driving a car without wearing a seatbelt or a motorcycle without a helmet, multiple sexual partners, etc. Hey, measure 'em all and charge those folks more than those who don't have these things as part of their "lifestyle."

In fact, life insurers already routinely ask about some "dangerous" hobbies such as mountain climbing, flying planes, hanggliding, etc on their applications.

Would not be much of a step for medical insurers to ask the same.

 

[Zathras]

If a word is in the dictionary (and not as slang), is it really "made up"? What constitutes "made up"? If people use it regularly, they use it. They communicate with it.

Perhaps innacurate would have been a better word. As gramatically speaking, irregardless means the opposite of what most people use it for. Regardless would be the correct term, as you said.

 

[RetireeRobert]

As gramatically speaking, irregardless means the opposite of what most people use it for. Regardless would be the correct term, as you said.

Actually, I don't think that is correct. The dictionary says "regardless" and "irregardless" mean the same thing. The dictionary (American Heritage) considers both to be valid words. They both mean "notwithstanding", or "not considering", or "disregarding", or "ignoring" some thing. This is the sense in which I used "irregardless".

And I think most people think "irregardless" means what the dictionary says. In other words, most people, when they say "irregardless", do *not* mean to say "considering", or "regarding", or "not ignoring" some thing. Rather, they mean to "ignore" or "disregard" or "not consider" that thing.

So, "regardless" or "irregardless" are BOTH correct terms meaning the same thing, according to the dictionary, and according to how most people use either term.

Isn't English a funny language?

 

[Martha]

I guess the key question is the following:
"Is this discimination better than having the employer drop health insurance entirely?"

I don't think that is the question. The questions are who is going to bear increased costs of health care, and are there things that employers can do to help their employees be more healthy so costs go down.

Some things are pretty easy. My old office holds a flu shot clinic once a year. Free shots for you and your family. Cuts down absences. You don't have to have the shot but just about everyone gets one.

My office also pays for a gym membership.

Even though our insurance does not cover smoking cessation programs or things like the patch, my old office will pay for those things. It will also pay for weight loss programs.

These carrots have had some success.

Maybe there is some sense to having negative consequences if certain behaviors don't change, but as Rich mentioned, the high BP, Cholesterol or blood sugar may not be a lifestyle issue, so the whole thing makes me squeamish.

A separate issue is whether we are going to charge the less healthy more for insurance. We don't tend to do that on the group market, but it certainly occurs on the private market. I believe this is bad policy.

 

[kcowan]

A separate issue is whether we are going to charge the less healthy more for insurance. We don't tend to do that on the group market, but it certainly occurs on the private market. I believe this is bad policy.

Insurance is rooted in categorizing people for the purpose of slotting them into separate rate categories. That is a slope that we have always been on. The unique thing about this thread is an employer sharing those rate categories with their emploees. Whether those categories are fair is an issue with the insurance company, not the employer.

So the employer is saying that if an employee happens to earn a cheaper category, he is willing to share the savings with them. This seems to be pretty democratic to me.

Any other argument seems to lean towards socialism.

 

[Rich_by_the_Bay]

Health insurance underwriting serves the financial interests of the carrier and will virtually always lead to discrepancies in availability of insurance, exaggerated premiums for some, and system gaming. I am not aware of any evidence that underwriting lowers costs overall, though it may do so for a specific carrier in specific markets.

Largely the result is cost shifting toward the insured, affluent population in the form of entitlement programs, taxes, grotesque pricing schemes (the $70 tylenol pill in the hosptial), and disruption of career and personal life planning due to exaggerated dependence on sources of health insurance outside the workplace.

If the playing field is leveled to the point of defining basic levels of coverage, and if underwriting were eliminated, carriers could compete on the basis of price, efficiency, marketing skills, customer satisfaction, prevention add-ons, and all the other free market issues, albeit with oversight. Those without means would still need subsidization but not necessarily a separate entity like Medicaid.

It's not a "socialized medicine" or political thing - just reflects the unique characteristics and imperatives of health insurance as compared to other types of insurance.

 

[Martha]

So the employer is saying that if an employee happens to earn a cheaper category, he is willing to share the savings with them. This seems to be pretty democratic to me.

Any other argument seems to lean towards socialism.

Earn a cheaper category? Classification by health may have nothing to do with what you do and your lifestyle. Type 1 diabetes is an example.

The problem with the US private insurance market is that the unhealthy are too expensive, no one wants to cover them and pay for their care and they can't afford to pay for their own care. But if we all share the cost it works out ok. We need people who are healthy to contribute to the system. However, if you are healthy today, you may not be tomorrow so it is in your interest to participate.

Not undemocratic to me, given that democratic implies social equality and fairness.

 

[Eyerishgold]

The problem with the US private insurance market is that the unhealthy are too expensive, no one wants to cover them and pay for their care and they can't afford to pay for their own care. But if we all share the cost it works out ok. We need people who are healthy to contribute to the system. However, if you are healthy today, you may not be tomorrow so it is in your interest to participate.

I told myself I wouldn't post in any more healthcare discussions.....

Those who pose more risk to the insurance company should pay more. It's common practice in the banking and mortgage industries. The amount of risk we pose to a mortgage company dictates the interest rate we end up paying on the loan.

Should we argue, if we have bad credit, that because somebody else with good credit has applied for the same type of loan we should be given the same rate of interest that they qualify for? That logic doesn't make sense to me.

 

[Rich_by_the_Bay]

Those who pose more risk to the insurance company should pay more. It's common practice in the banking and mortgage industries. The amount of risk we pose to a mortgage company dictates the interest rate we end up paying on the loan.

Should we argue, if we have bad credit, that because somebody else with good credit has applied for the same type of loan we should be given the same rate of interest that they qualify for? That logic doesn't make sense to me.

Eyerishgold, I realize your position is not meant to be absolute or insensitive, and I get the gist of what you're saying. But it's a slippery slope.

Should an individual who has type 1 (childhood onset) diabetes and thus faces greater challenges in all ways, should be asked to pay a high premium for the rest of their life, or else face poverty after their first major complication? Or someone with cerebral palsy requiring everything from bladder care to a wheel chair should be faced with higher premiums? Or an upstanding adult who suffered a heart attack or stroke (many have no lifestyle risk factors) should be sentenced to crushing premiums forever?

Peoples' impairments and risks, especially when they happen through no fault or decision of the victim, are not cars or mortgages or houses. I don't think a prosperous country should treat them as such. Want to rate my auto policy because I bought a motorcycle? Fine. Want to rate my health insurance premiums because I developed cancer and survived? I don't support that, and careful what you wish for.

I also think it's bad business to do so. Their needs go on well after they are medically bankrupt, and who ends up paying?

Trust me, horrible things happen every day to people like you and me who did nothing "wrong." Things most people can't even pronounce, let alone imagine. Any one of them would make you instantly uninsurable the day they occur. To say, "too bad, I'm healthy, I win, you lose" may not be the best solution.

 

[starter82]

I told myself I wouldn't post in any more healthcare discussions.....

Those who pose more risk to the insurance company should pay more. It's common practice in the banking and mortgage industries. The amount of risk we pose to a mortgage company dictates the interest rate we end up paying on the loan.

Should we argue, if we have bad credit, that because somebody else with good credit has applied for the same type of loan we should be given the same rate of interest that they qualify for? That logic doesn't make sense to me.

Same thing with auto insurance.

Earn a cheaper category? Classification by health may have nothing to do with what you do and your lifestyle. Type 1 diabetes is an example.

I'd say that you can't look at it as just any one health issue. I do think that a person with Type 1 diabetes who eats healthful food, exercises, doesn't smoke, etc. should have a lower premium than a person who has it but doesn't do those things.