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The coming healthcare police state
Old 08-15-2007, 11:46 PM   #1
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The coming healthcare police state

Privacy is true price of healthy worker discounts - Breaking Bioethics - MSNBC.com

I realize it can turn into an emotional debate between the (now) "healthy" and the "unhealthy" people, but does anyone have opinions on this article about recent health care plans and their carrot/stick approach?

How long before our bodies have little black boxes implanted in them so the health insurance company will simply be sent all of our vitals via wireless connection and our bank accounts adjusted accordingly for whether we got our heart rate up that day or not?
(of course that will be under the guise that the little black box provides for quicker response time for treatment)
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Old 08-16-2007, 12:30 AM   #2
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I wonder how committed these managers and directors would be to employee health if their employees were likely to be healthier if the managers and directors tried to make their lives less stressful. If the bosses as well as the employees were expected to show personal responsibility for employee health, they might have second thoughts.
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Old 08-16-2007, 07:51 AM   #3
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There is a widespread push to use risk-adjusted rates - lower rates for those who are healthy and higher rates for those with higher cost conditions. The problem with this approach is that young people, even with poor lifestyles, are often "healthy" based on blood work, etc, because many conditions take years to materialize.

The rationale for insurance is that those who do not need services subsidize those who do. This is true of car, homeowner, and health. If we take the current trend to the outer most conclusion with full risk adjusted rates, those who are ill will pay their full share and those who are healthy will only cover their lower costs. We then have moved away from the concept of insurance and are essentially all self-pay, adding administrative overhead.

Yes, there is a true public health crisis due to poor lifestyles, the cost of which is exacerbated by an aging population. This must be addressed at a societal (public health) level. But, as we did not rely on the cigarette manufacturers to reduce the incidence of smoking, we can not rely on health insurance companies to provide the motivation to improve lifestyles.
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Old 08-16-2007, 08:03 AM   #4
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The rationale for insurance is that those who do not need services subsidize those who do. This is true of car, homeowner, and health. If we take the current trend to the outer most conclusion with full risk adjusted rates, those who are ill will pay their full share and those who are healthy will only cover their lower costs. We then have moved away from the concept of insurance and are essentially all self-pay, adding administrative overhead.

Yes, there is a true public health crisis due to poor lifestyles, the cost of which is exacerbated by an aging population. This must be addressed at a societal (public health) level. But, as we did not rely on the cigarette manufacturers to reduce the incidence of smoking, we can not rely on health insurance companies to provide the motivation to improve lifestyles.
Well stated, Sandy. While risk-adjusting premiums is intuitively appealing to the young and healthy, it seems to be justified only where the insured can voluntarily modify his or her risk by lifestyle adjustments. Otherwise, there's no behavior to modify by doing so.

To do it across the board implies penalizing a young, previously healthy individual who develops a costly disease through on action or neglect of their own. I doubt that many would want to place an undue burden on a well-behaved 23 year old parent who gets Hodgkins' Disease.

This is tricky stuff. Every time I hear it discussed I seem to come to the same conclusion: there really is no fair way to do this other than by broad community ratings, guaranteed availability of coverage (with individual costs), and lifestyle health enhancement education for those able to participate (e.g. complete the course and get a 10% premium reduction).
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Old 08-16-2007, 08:45 AM   #5
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Originally Posted by just_hatched View Post
I realize it can turn into an emotional debate between the (now) "healthy" and the "unhealthy" people, but does anyone have opinions on this article about recent health care plans and their carrot/stick approach?
(Taking a few deep breaths to avoid politics or rants)

I believe incentives such as these are the logical consequence of a health system that stratifies individuals not only by health condition, but by socio-economic status. If you click on the image accompanying the article you see a trend in number of uninsured between 2000 and 2005. 15.7% of Americans were uninsured in 2005, with the largest increases being in states with lower incomes and with larger immigrant populations. These individuals are more likely to score lower on health scores for reasons of diet, stressful lifestyles, and low income. So, even though it was not an intended consequence, our health care system is becoming increasingly de-facto racist and elitist.

(Taking additional deep breaths)
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Old 08-16-2007, 09:08 AM   #6
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Assuming that current health premiums and deductible levels have, in part, resulted from the overall unhealthy lifestyles of Americans, I don't see a problem with offering monetary incentives for people, who have the ability to do so, to improve their health with better eating habits, exercise, etc.

I have a difficult time understanding why some people think that these incentives are unfair, given that we are ALL currently paying the higher price in the absence of change. Granted, some people simply cannot help their current health situation, but, IMO, doesn't it makes sense to encourage people to live healthier lifestyles so that we can ultimately have a positive impact on healthcare inflation, overall, for EVERYONE? I am making the assumption that rates will generally flatten for everyone as the overall health of our society improves...

I have read statistics that obesity, smoking, drug and alcohol usage can be blamed for as much as 50% of health problems.
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Old 08-16-2007, 09:54 AM   #7
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Sorry. I think the author is a privacy freak and packed every single negative he could possibly find into the article.

"HMOs and insurance companies have proven completely unable to contain rising health care costs. This is mainly due to the fact that costs are fueled by an aging population using more services, an increased reliance on technologies and drugs whose prices are out of control, topped off by a massive dose of error, fraud and administrative waste."

Oops. Guess he just hasn't heard about a population simply becoming less healthy and convinced that there's a pill or procedure for everything.

Our community had to purchase a new ambulance. It is rated to handle people up to 1,700 freakin pounds. Has to have a winch on the back to get the gurney into it. Airlines are seriously trying to deal with people that need two seats.

Is your kid a handful? Here's some ADD pills.

Our sheriff's department's physical test includes running.... 900 feet.

No lead in the pencil? We got something for that too.

We got something for what ails ya'. And if you don't feel "ailed", we'll show you how wrong you are.

Prices are going up because technology is providing more treatments they want to sell and people want to buy them. Insurance is evolving to pay for them because of demand. And as was pointed out above, it's the healthy that pay for the rest.

I am perfectly fine with charging smokers an extra $500 a year. Or even refusing them coverage. Same with untreated cholesteral and hypertension. Same with alcoholics. If you want to enjoy your lifestyle, feel free. Just don't expect me to kick in a share for you.

Same if you don't want to wear a seat belt or a helmet on your bike. You're an adult. Just don't come crawling back expecting your auto insurance to cover your increased injuries.
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Old 08-16-2007, 11:01 AM   #8
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Oops. Guess he just hasn't heard about a population simply becoming less healthy and convinced that there's a pill or procedure for everything.
So we can solve the problem by just issuing treadmills to the poor and uninsured. Thank goodness, I thought we had a health care problem.
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Old 08-16-2007, 12:48 PM   #9
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Well excuse the heck out of me.

My breakfast is oatmeal and an egg. My lunch is raw broccoli, carrots, turnips and celery, an apple, a banana and a piece of lean meat about the size of a deck of cards. For supper it might be a salad or a sandwich.

You think maybe this is a gourmet delight?

I weigh about 175 and do karate three nights a week. My health costs, now, amount mostly to an annual checkup. Yet I pay the same premiums as co-workers that do utterly nothing.... except eat.

And, frankly, this is a non-issue to me until somebody wants to wring their hands and carry on about how unfair it all is. Unfair, that the employer, who foots the lion's share of the insurance premium where I work, might POSSIBLY wonder just what the heck they are paying for.

Privacy was the point of the article, not health care for the poor. I figure if privacy is all that important, pay your own way.
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Old 08-16-2007, 01:04 PM   #10
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Here are some interesting statistics to mull over regarding the association of poor lifestyle choices and healthcare costs:

WebPhyAct(Medical Costs)
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Old 08-16-2007, 01:14 PM   #11
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Given the statistics I mentioned earlier it's no wonder employers want to offer incentives for prevention. I don't see this as a privacy infringement. I see it more as employers protecting their bottom line, which, IMO, they have every right to do, as they are the ones generally footing the bill for the health insurance. If they can get their costs down, maybe they'll start offering better coverage options for employee's dependents, and maybe that will even have a positive impact on uninsured numbers.
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Old 08-16-2007, 08:33 PM   #12
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Oops. Guess he just hasn't heard about a population simply becoming less healthy and convinced that there's a pill or procedure for everything.
Interesting you say this, coz I actually saw a patient today (about 240 lbs) asking for advice on her "sweating" problem. She said that she would sweat profusely after brisk walking for a few minutes. I was at a loss for words upon hearing this. Aren't people supposed to sweat when they phsyically exert themselves? And this person actually thought this was abnormal.....
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Old 08-16-2007, 10:38 PM   #13
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HMOs and insurance companies have proven completely unable to contain rising health care costs. This is mainly due to the fact that costs are fueled by an aging population using more services, an increased reliance on technologies and drugs whose prices are out of control, topped off by a massive dose of error, fraud and administrative waste.
Seems pretty intuitive to me....the times that I go see the doctor, it is a bunch of old people and a few young kids always waiting....never see a bunch of "fat people", druggies, or drunks....I think their lifestyles actually end up saving society money since their lifespans are shorter....

The fact remains that older people use more health care...if it wasnt true, insurance costs would be the same for a 20 year old vs. a 50 year old.....
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Old 08-18-2007, 01:55 PM   #14
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Another article related to this topic --- only from a slightly different point of view (I just got this in my email inbox today):

Slim Down or Pay Up
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Old 08-18-2007, 06:07 PM   #15
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Let's just cap the amount of health care a plan will provide for anyone over, say, 40. I suggest $100,000 a year and then cut them loose. I know it sounds crazy, but the hospitals can just drop them off in a scary area of town when they hit the magic number.

This will not only decrease health care expenses, but it will also bring in more profit for health care companies and employers who pay the premiums. It's a win-win for everyone.

Except for those over 40, who shouldn't have let that happen to them in the first place.
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Old 08-18-2007, 07:13 PM   #16
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I am perfectly fine with charging smokers an extra $500 a year. Or even refusing them coverage. Same with untreated cholesteral and hypertension. Same with alcoholics. If you want to enjoy your lifestyle, feel free. Just don't expect me to kick in a share for you.
Of course this brings up some interesting scenarios, like -- We'll charge you extra if you don't treat your cholesterol. But, BTW, we won't cover the cholesterol drug you may need to treat the problem.... (I'm not making this last part up. My insurance won't cover Lipitor.)
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Old 08-18-2007, 08:09 PM   #17
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Of course this brings up some interesting scenarios, like -- We'll charge you extra if you don't treat your cholesterol. But, BTW, we won't cover the cholesterol drug you may need to treat the problem.... (I'm not making this last part up. My insurance won't cover Lipitor.)
Are you on a group plan or an individual plan? If it's a group, or employer sponsored plan, then your cholesterol medications should be covered. However, some carriers require what is called "step therapy" before they will cover certain drugs, due to the cost of the drug. In other words, they want you to try a formulary drug first that is less expensive, and if that still doesn't work, then they will allow your doctor to pre-authorize the Lipitor once it is shown that the alternative drug does not work.

If it is an individual plan, then they would only exclude all Rx's for cholesterol if it was a pre-existing condition. Individual carriers also require "step therapy" at times, too.
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Old 08-18-2007, 09:41 PM   #18
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At a certain level I can understand that because physicians can be 'sold' drugs that are more expensive but not more effective.

However, one must be VERY careful about drug reactions. I have had an allergic reaction to an anti-viral that is the standard for Shingles, but not the more expensive alternate. Once I told Group Health that if I took the Shingles anti-viral that I am allergic to I was told that I was a serious risk of death, that I would pay for the other med and file for the difference in cost. When I submitted the claim I told them that I saved them a VERY EXPENSIVE malpractice suit. I offered that the next time I was faced with this choice I would be willing to try the other med while camping in their emergency room. They paid the difference without comment.
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Old 08-18-2007, 10:58 PM   #19
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For anyone interested, Here is the $4 prescription drug list from Walmart. You can get all of these Rx's for only $4, even if you don't have insurance. Included in the list are several commonly prescribed HBP and Cholesterol lowering medications. You need to bring the list with you to Walmart when you fill the Rx and let them know that you want to take advantage of the $4 formulary.

http://i.walmart.com/i/if/hmp/fusion...icdruglist.pdf
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Old 08-19-2007, 04:28 AM   #20
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The article cites a common phenomenon that is occurring in company plans. Risk adjust ones premium (or add a penalty if you think about it that way). It is commonly done for smoking and weight. This is all about incentive to adjust behavior or cost adjust due to increased risk.

IMO - Insurance is about pooling money and reducing financial risk. Risky behavior and charging extra is part of the overall actuarial model and part of the underwriting process of any insurance plan/product. But it still makes me cringe when things change (more constraints and costs).

Heck the situation cannot get any worse than unaffordable health insurance... which is pretty much where we are today.

I can't help but feel that our overall system is working for 75% (unacceptable IMO)... and is woefully inadequate in terms of optimizing it (in a balanced way) for all of us.
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