Personal Responsibility for Healthcare?

[imoldernu]

This recent Op-Ed from the New York Times... poses some interesting questions about some proposed plans to require individuals to make personal, written commitments to take charge of their own healthcare in order to participate in government plans. Possible requirements are to require personal savings for healthcare, maintaining a healthy lifestyle, keeping doctor check up appointments, maintaining a healthy weight etc, etc.
While this seems far off in the future, and there are no details on how it could be accomplished, there are also questions on the practicality and legality of the concept, as well as the effect on the economy.
Posted just as food for thought.

https://www.nytimes.com/2018/01/10/upshot/youre-sick-whose-fault-is-that.html?em_pos=small&emc=edit_up_20180110&nl=upshot&nl_art=1&nlid=54661265&ref=headline&te=1

 

[USGrant1962]

To me this seems like a "good idea" but totally impractical to enforce.

 

[easysurfer]

To me this seems like a "good idea" but totally impractical to enforce.

+100

Enforcing someone's lifestyle is impractical.

Also, will there be a health panel assigning priority what's more healthy. Smoking vs overweight or lack of sleep? Will be required to wear fitbits to prove we are getting at least 8 hours a sleep a night?

 

[FIREmenow]

The only real way to do that is to have people pay for their own healthcare. The only way lifestyle changes will happen is if people have to pay for their own care. As my dad used to say, "...people won't change unless it hurts too much NOT to change."

There would be additional pressure on healthcare COSTS in this case as well, IMHO. Maybe not enough, but some.

Health insurance should be just that - insurance (not care).

Getting to that model from where we are today seems mostly impossible, however.

 

[gayl]

Unable to open link so just responding to post

I think keeping dr check ups should NOT cost the patient as they spot issues earlier when they are less expensive for the ultimate payer (insurance) to treat. How about a mandatory $penalty for not showing up?

 

[easysurfer]

Seems to me like an indirect way to bring back underwriting for healthcare qualification.

 

[athena53]

This isn't too different from corporate wellness programs and my first thought would be "where do I sign up?" My last employer was largely self-insured for medical costs, with some insurance purchased to cover catastrophic losses. DH and I got brownie points under the Wellness program that reduced Employee contribution to the premiums by 50%. Some of the things that can be recorded/documented include:

1. Regular exercise, as measured by FitBit, heart rate monitor or other device. OK, I've heard of people putting the FitBit on a ceiling fan or on the dog, so not perfect.
2. "Biometric screening", which included cholesterol and glucose levels as well as test for the presence of a chemical that would indicate nicotine use.
3. A "Step Test"- you step on and off a step in time with a metronome for a few minutes and your pulse is measured right after and then a few minutes later.
4. People who were overweight or smokers were offered large amounts of brownie points (redeemable for Amazon gift cards, among others) to change. I was offered a similar incentive to reduce my cholesterol but since statins had once given me awful tendinitis I passed up that one.
5. Brownie points for getting a flu shot.

My employer concluded that employees and family members who were "engaged" (defined by accumulating a certain level of points) had lower average costs, but to me that was a chicken-or-egg question. The people who weren't engaged would include those who had given up on losing weight, lowering BP, etc. so I would expect them to have higher costs than those of us for whom it was "preaching to the choir".

Still, I'd gladly sign up for a plan that would give me lower premiums in return for the healthy stuff I do already.

 

[joeea]

Still, I'd gladly sign up for a plan that would give me lower premiums in return for the healthy stuff I do already.

Isn't that true of everyone?
Can you think of anyone who wouldn't like to get rewarded for things they already do?

 

[easysurfer]

I agree with the closing paragraph of the article:

Personal responsibility is an attractive goal with deep roots in American culture. But if it’s too aggressively pursued, it may conflict with another worthy ideal: In a nation as wealthy as the United States, sick humans deserve health care — even if they can’t pay, and even if they've made some bad choices.

 

[EastWest Gal]

Does the op-ed count those over 65 on Medicare? So if you get sick or injured and cannot exercise for awhile, do you get penalized? And what about children? Many of the people that are on government health insurance are: People over 65 (Medicare), disabled people, pregnant women, and children. 43% of children are on public insurance. The webpage below does not include Medicare.

https://www.cdc.gov/nchs/fastats/health-insurance.htm

It seems awfully intrusive, and makes biased presumptions about who actually gets "government" health insurance. People on Medicaid don't have Fit Bits. So if you don't qualify for a plan based on these behavior parameters, and you get kicked off of Medicaid, then what? You show up in the emergency room once/month when you go into diabetic ketoacidosis, get a prescription for insulin when you are discharged from the hospital two days later, including a one day stay in the ICU, scrounge some money to buy your insulin at what is now an exhorbitant price, run out, then go back to the ER when your diabetes gets out of control, and repeat the process.

https://www.cbsnews.com/news/insulin-price-hike-lawsuit-accuses-drug-makers-of-conspiring/


The hospital doesn't get reimbursed for the charity care it provided you because you can't get insurance and can't pay. Everyone else's premiums go up. No matter what, the costs are shared by all.

Some of the most expensive health care is not lifestyle dependent--many cancers occur despite "lifestyle". Congenital heart disease, metabolic diseases one is born with, etc. Children with major health problems become adults with major health problems. Adults with chronic myelogenous leukemia and mesothelioma due to asbestos exposure in the the Navy and in other work places. First responders exposed to toxic smoke and fumes from work. Coal miners with lung disease. And so on.

 

[GravitySucks]

This is a great idea.... If I get to be the one to decide what behaviors are healthy.
Should we all be on statins? Are the new numbers for diabetes more valid than the earlier? Remember when margarine was a healthy alternative? How many drinks are enough? How many are too much?

 

[2HOTinPHX]

Meanwhile Dunkin' Donuts wants to open 9,000 new stores....
We will never win this battle of the bulge too much delicious junk food every where you look...

 

[Luck_Club]

The only real way to do that is to have people pay for their own healthcare. The only way lifestyle changes will happen is if people have to pay for their own care. As my dad used to say, "...people won't change unless it hurts too much NOT to change."

There would be additional pressure on healthcare COSTS in this case as well, IMHO. Maybe not enough, but some.

Health insurance should be just that - insurance (not care).

Getting to that model from where we are today seems mostly impossible, however.

+1000

Even on this board with so many "well to do" members, there are many discussions about managing income to avoid going over ACA limits. Imagine if the entire country had to "pay" for their care or insurance. All of a sudden lifestyle choices would have a cost associated with them, and in general people would try and figure out a way to lower those costs.

 

[jollystomper]

Coming soon... a chip implanted under your skin that analyzes your makeup and DNA, and monitors your vital signs, to determine, specifically for you, the parameters you need to maintain to be considered "healthy" and therefore eligible for insurance. If you exceed any parameter for a certain time, you get fined or your rates go up. If you get them better than expected, you get better insurance rates.

Of course, the next step... if the chip can monitor, why can it not also control?

Brave new world coming...

 

[Chuckanut]

How would this be enforced?

For example, I ate eggs for years even though we were told to limit them to just 3 or 4 a week, certainly no more than one a day. So... imagine I was denied care for a heart problem or charged more because I ate to many eggs. Today, we find that eggs are not the problem they were thought to be. How do we handle that? Do I get a refund for the extra money I paid? What if I was refused care and died? Should my family sue?

No good can come from this. Unless one is a tort lawyer.

 

[kgtest]

Hunger games v2.0 Only the strong thoroughbred will survive. The genetically insignificant will parish with the rest of the peasants.

 

[Chuckanut]

Coming soon... a chip implanted under your skin that analyzes your makeup and DNA, and monitors your vital signs, to determine, specifically for you, the parameters you need to maintain to be considered "healthy" and therefore eligible for insurance. If you exceed any parameter for a certain time, you get fined or your rates go up. If you get them better than expected, you get better insurance rates.

Worse, who sets the parameters you need to maintain? The same people who told us that highly processed sugary cereals and high trans-fat margarine were better for us than eggs and butter?

 

[athena53]

I'm advocate of preventing the preventable. No amount of healthy habits would have kept my mother from dying of breast cancer at age 85 or DH from being diagnosed with acute myeloid leukemia at age 77. My 5-year old great-niece survived miraculous surgery within a week after her birth and her heart has only 2 chambers. We all know stories like that. We also see stories here about people who lost weight and got their BP and blood sugar levels down through lifestyle changes and, with the agreement of their doctors, were able to get off of medication.

Life insurance companies can put you in a higher rating tier if you smoke or are overweight. Auto insurers can charge you more if you have a record of moving violations or at-fault accidents. Why is this different?

 

[easysurfer]

.....

Life insurance companies can put you in a higher rating tier if you smoke or are overweight. Auto insurers can charge you more if you have a record of moving violations or at-fault accidents. Why is this different?

Different because is the US that turns away people for treatment or not?

As devil's advocate, how about his case? John and Jane Doe did everything right, diet, exercise when for annual health screenings. But one day they go on vacation and get into an accident from bungee jumping. Who is to say their lifestyle is more or less healthy than someone who sits around all day posting on a retirement board? . In this example, the Doe's didn't eat bad or not exercise but got hurt thrill seeking.

 

[kgtest]

Worse, who sets the parameters you need to maintain? The same people who told us that highly processed sugary cereals and high trans-fat margarine were better for us than eggs and butter?

The person with the biggest button? Zing.

 

[Midpack]

The only real way to do that is to have people pay for their own healthcare. The only way lifestyle changes will happen is if people have to pay for their own care. As my dad used to say, "...people won't change unless it hurts too much NOT to change."

There would be additional pressure on healthcare COSTS in this case as well, IMHO. Maybe not enough, but some.

Health insurance should be just that - insurance (not care).

Getting to that model from where we are today seems mostly impossible, however.

Well said.

If there aren’t monetary incentives for individuals, the healthcare “system” will never be fair. We have to quit letting exceptions prevent all progress.

And if there aren’t pressures on the cost side, it’ll never be affordable in the USA compared to every other country in the world. But until we have campaign finance reform, that seems hopeless.

 

[athena53]

As devil's advocate, how about his case? John and Jane Doe did everything right, diet, exercise when for annual health screenings. But one day they go on vacation and get into an accident from bungee jumping. Who is to say their lifestyle is more or less healthy than someone who sits around all day posting on a retirement board? . In this example, the Does didn't eat bad or not exercise but got hurt thrill seeking.

Well, life insurers will rate you higher if you regularly engage in certain risky activities such as skydiving, but I think I'd exclude actual hazardous activities from higher rating- too hard to define them all and too hard to police.

I'm thinking of SMART-type goals (sorry for lapsing into corporate jargon):

Specific
Measurable
Attainable
Relevant
Time=bound

Examples: Lose 20 lbs. in 6 months. Walk at least 10,000 steps/day at least 5 days a week during the policy period. Stop smoking. Improve cardiac function from "Poor" to "Good" as measured by step test.

 

[easysurfer]

Well, life insurers will rate you higher if you regularly engage in certain risky activities such as skydiving, but I think I'd exclude actual hazardous activities from higher rating- too hard to define them all and too hard to police.

I'm thinking of SMART-type goals (sorry for lapsing into corporate jargon):

Specific
Measurable
Attainable
Relevant
Time=bound

Examples: Lose 20 lbs. in 6 months. Walk at least 10,000 steps/day at least 5 days a week during the policy period. Stop smoking. Improve cardiac function from "Poor" to "Good" as measured by step test.

I think reward and incentive for healthy behavior are good things. But cringe a bit at punishment for non-healthy.

Reading the article, I think about first class vs coach flying. Those who are fortunate enough to fly first class without a problem vs everyone else.

 

[Mr._Graybeard]

Part of the health problem this country has is the economy's tendency to promote unhealthy, nutritionally unbalanced products. When was the last time you saw a television commercial for kale or broccoli? McDonalds and Burger King, conversely, have a huge ad budget.

Then there's the tendency for makers of processed food to add high levels of sugar or salt to make their product more appealing. Check the sodium content in a can of soup.

People who want or need cheap, convenient dietary options may have little choice but to consume foods that, in the long run, are bad for them. And producers of those products spend big bucks to stimulate that market. It's easy to blame the consumer in this case, but some blame has to rely on the producers of unhealthy products as well.

 

[MRG]

Part of the health problem this country has is the economy's tendency to promote unhealthy, nutritionally unbalanced products. When was the last time you saw a television commercial for kale or broccoli? McDonalds and Burger King, conversely, have a huge ad budget.

Then there's the tendency for makers of processed food to add high levels of sugar or salt to make their product more appealing. Check the sodium content in a can of soup.

People who want or need cheap, convenient dietary options may have little choice but to consume foods that, in the long run, are bad for them. And producers of those products spend big bucks to stimulate that market. It's easy to blame the consumer in this case, but some blame has to rely on the producers of unhealthy products as well.

Wow. You said a mouth full!

When I started to understand nutrition and diet the grocery store became scary!
Walking through wally world was like walking naked through hell!

Seriously where else can you go to buy so many cheap carbs for a dollar? Maybe a large feedstore?