The coming healthcare police state

just_hatched

just_hatched

Recycles dryer sheets
Joined
Sep 12, 2005
Messages
97
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)
 
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.
 
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.
 
Sandy said:
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.
Click to expand...

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).
 
just_hatched said:
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?
Click to expand...

(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)
 
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.
 
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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Joss said:
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.
Click to expand...

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.
 
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? :p

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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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.
 
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.
Click to expand...

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.....
 
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.
Click to expand...
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.....
 
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.
 
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.
Click to expand...

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.)
 
VoyT said:
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.)
Click to expand...

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.
 
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.
 
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/genericdruglist.pdf
 
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.
 
chinaco said:
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.
Click to expand...

From a statistical standpoint, approx 13% of the entire USA population is uninsured.

About 7 1/2% of the USA population is uninsured because they can't qualify for state programs AND can't afford insurance. The rest of the uninsured can either qualify for state programs but either don't know how to sign up or aren't interested in signing up, OR they can afford some kind of coverage but choose not to buy it.

Only about 1.4 million of the uninsured population considers themselves "unhealthy" (.004% of the American population) see page 11 of the kff.org document below - IMO this is the worst case scenario to be both unhealthy AND uninsured. Notice how small the percentage is.

Here are the most recent actual stats taken by the Kaiser Foundation if you want to see them: http://www.kff.org/uninsured/upload/2005DataUpdate.pdf

Here's a video that goes over who the uninsured are:

Free Market Cure - Uninsured in America
 
The whole system is broken. Medicare is making a change in how it pays doctors and hospitals. It will no longer pay for mistakes. Health Insurance companies should do the same. Why should a doctor or hospital get paid to fix a mistake made during your treatment. Here is a link to the article. Object left after surgery? Medicare won't pay - Health Care - MSNBC.com

How much does such poor treatment play play into the cost of medical care?

There are so many health issues out side of your control setting risked based system would be unfair to everyone. For example the air pollution is so bad in many parts of the US people who breath the air lungs are damaged something like the equivalent of smoking a pack of cigarettes a day. What about the person who smokes all of their life and never gets lung cancer does he/she get a refund on all of the extra premiums they paid? Remember the majority of the people who smoke do not get lung cancer! I do not smoke so I have no bone to pick here but many people seem to be trying to lay the blame on a broken system on one group of people.
 
mykidslovedogs said:
Only about 1.4 million of the uninsured population considers themselves "unhealthy" (.004% of the American population) see page 11 of the kff.org document below - IMO this is the worst case scenario to be both unhealthy AND uninsured. Notice how small the percentage is.
Click to expand...

Are we back to billions of people in the U.S.? 1.4M is .46%, say, half a percent, of the US population, not .004%. Unless you think there are 30 Billion Americans, in which case it really is .004%

Oh, and I'm sure the Kaiser people polled all of those who are uninsured to figure out how many are "unhealthy." Why, all those folks are really doing great, except for the .004% of them.

But it's much worse than that. If I look at page 11, as you suggested, I find 21.5M nonelderly in poor or fair health, of which 4.3M, or 20.1%, are uninsured. That means 1 out of 5 Americans in fair or poor health are uninsured. Sounds pretty lousy to me. And these are numbers from the insurance people!
 
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While we're kicking around unhealthy lifestyles why not include drivers that run stop signs and red lights and cruise at 80 mph in the left lane on the freeway while talking on the cell phone and sipping a Starbucks? That should be worth a few demerits from the health insurance people.

Then there are those people that stop at Mickey D's and get a Double Big Mac and Giant fries.........

And the joggers that dash across an intersection without even looking.......
 
mykidslovedogs said:
From a statistical standpoint, approx 13% of the entire USA population is uninsured.

About 7 1/2% of the USA population is uninsured because they can't qualify for state programs AND can't afford insurance. The rest of the uninsured can either qualify for state programs but either don't know how to sign up or aren't interested in signing up, OR they can afford some kind of coverage but choose not to buy it.

Only about 1.4 million of the uninsured population considers themselves "unhealthy" (.004% of the American population) see page 11 of the kff.org document below - IMO this is the worst case scenario to be both unhealthy AND uninsured. Notice how small the percentage is.

Here are the most recent actual stats taken by the Kaiser Foundation if you want to see them: http://www.kff.org/uninsured/upload/2005DataUpdate.pdf

Here's a video that goes over who the uninsured are:

Free Market Cure - Uninsured in America
Click to expand...

You are correct. 25% was a bit high... I winged the number.

I think the actual numbers vary a bit from study to study. A Dept of Health and Human Services (2005) shows 16% uninsured Plus 13% on Medicaid (welfare). That total approaches 29%.

If those same welfare recipients earned just a little more... they would not qualify for welfare and be part of the working poor that can't afford health insurance.

The net result is close to the same... If one cannot work and achieve what one can get on welfare... why work.
 
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