Charging the Unhealthy More For Insurance 1106
Joe The Dragon sends us a BusinessWeek story, run on Yahoo, about Clarian Health and the new thing they are trying with health insurance coverage for their employees. They are charging unhealthy people more. The article goes into some depth about whether this is a good idea and whether the practice might spread. "In late June, the Indianapolis-based hospital system announced that starting in 2009, it will fine employees $10 per paycheck if their body mass index (BMI, a ratio of height to weight that measures body fat) is over 30. If their cholesterol, blood pressure, and glucose levels are too high, they'll be charged $5 for each standard they don't meet. Ditto if they smoke: Starting next year, they'll be charged another $5 in each check."
Re:What's the problem? (Score:5, Informative)
Employment Attourney meet your new clients (Score:2, Informative)
BMI is BS (Score:2, Informative)
Really a hospital should know enough to use an accurate measure of body fat, as opposed to this bogus rough appropriation.
from Wiki:
The medical establishment has generally acknowledged some shortcomings of BMI. Because the BMI is dependent only upon net weight and height, it makes simplistic assumptions about distribution of muscle and bone mass, and thus may overestimate adiposity on those with more lean body mass (e.g. athletes) while underestimating adiposity on those with less lean body mass (e.g. the elderly). However, some argue that the error in the BMI is significant and so pervasive that it is not generally useful in evaluation of health. Due to these limitations, body composition for athletes is often better calculated using measures of body fat, as determined by such techniques as skinfold measurements or underwater weighing.
An analysis of 40 studies involving 250,000 people, heart patients with normal BMIs were at higher risk of death from cardiovascular disease than people whose BMIs put them in the "overweight" range (BMI 25-29.9). Patients who were underweight or severely overweight had an increased risk of death from cardiovascular disease. The implications of this finding can be confounded by the fact that many chronic diseases, such as diabetes, cause weight loss before the eventual death. In light of this, higher death rates among thinner people would be the expected result.
Re:and if you have a slashdot account (Score:5, Informative)
Great, but the BMI is not accurate (Score:2, Informative)
Re:I hate BMI (Score:3, Informative)
The BMI values are a total load of crapola. I've been checked since, and to get down to my "ideal" BMI would require me to reach a -12% body fat. (That's negative 12% -- also known as dead.)
Re:Slow news day? (Score:4, Informative)
Have you read an insurance application lately? Non-commercial pilot, skydiving, rock climbing and other "dangerous" activities are asked about.
As for the rest, I'm sure they'll get to them eventually.
Re:How not to do this (Score:5, Informative)
Re:and if you have a slashdot account (Score:5, Informative)
You need to worry about triglycerides too. I'm predisposed to very high levels...as high as 1200+ in the past....down to 540 these days....started on meds again and working out to try to get them under 200.
The reason I state this? I can't GET freakin' insurance.....unless you are working for someone else in a group plan, you can't get anyone to insure you. I have no other problems, BP is good, etc. I can more than afford to pay for insurance, but, I cannot get anyone reputible to sell it to me.
I didn't realize it would be so tough to get it at any price.
Re:BMI?? (Score:3, Informative)
BMI is well known for being grossly off in predicting disease for tall or muscular people, and if you're both, that's the worst.
I used
http://www.nhlbisupport.com/bmi/bmicalc.htm [nhlbisupport.com]
which gives me the same BMI number as every other calculator I've seen.
Re:because averages are good. (Score:3, Informative)
you're making a joke but (Score:3, Informative)
Re:Good (Score:3, Informative)
Re:and if you have a slashdot account (Score:3, Informative)
Re:and if you have a slashdot account (Score:5, Informative)
I can't GET freakin' insurance...
You should check if your state has a state risk pool.
I am also self employed, and since I got sick once years ago I also
was not insurable through individual policies. A state risk pool gives people
like me coverage when nobody else will.
It's a little screwy because it is still a private insurer (at
least in the state of Texas) that is contracted by the state.
The premiums are set at double the average, so the private insurer
makes loads of cash (and the tax payers don't take a hit), but at least I have insurance.
The deductible is high, but I do get the negotiated rates
which are usually 1/3 to 1/2 of what the uninsured are charged.
Re:BMI subtly skewed (Score:2, Informative)
are you kidding? I could see this happening if this was, say, BMI 25, but at BMI 30 a 6'4" individual would need to be over 246lb to be hit by the penalties, and I don't know many people that are 250lb and I would classify at a 'healthy' weight even at 6'4". Heck, I am 6'0" and I'd need to be over 220lb to be hit by that, and once again, I don't think there's that many healthy six footers that weigh over 220lb, and for those there is the doctor's note route to be exempt.
Body fat % would be a much better indicator than BMI, but of course it's a bit harder to calculate so it's always BMI-this and BMI-that, I really don't see that changing in the near future (although the new impedence body fat % measuring scales that have you stand on two electrodes and hold another two in your hands are a step in the right direction, albeit still one susceptible to dehydration inaccuracies for example)
Re:Slope Slippery When Wet (Score:1, Informative)
Starting 2 years ago, I started being differed from donating blood because of my high blood pressure. My dad had extreme high blood pressure until he died, my older brother has high blood pressure. Both of them have/had been taking high blood pressure medication.
I went to the doctor spring of 2006 for a cold. My doctor took my blood pressure at 162/110. He wanted to start me on blood pressure medicine. I refused. I wasn't going to start taking medication every day.
I started trying to ride a bicycle for exercise. I started out riding to the end of my street and back, not more than 200 yards or so with a slight hill out so coming back was down hill. After 1 month or so of trying to do that every other day or so, I attempted to ride around the neighborhood. Probably half mile. At the end of the summer last year my blood pressure was down enough that I was able to donate blood again.
I stopped riding a bicycle for the winter. My blood pressure started to creep up but not high enough to where I was differed from giving blood.
I started riding again back in the end of February this year. I now put my bicycle in the back of my truck and drive to the nearest shopping mall to my job. I park my truck get the bicycle out of the back and ride the rest of the way to work, 6 miles. That is 12 miles a day.
My blood pressure is now normal and I have dropped 20 pounds since the end of February. I now weigh in the 175 to 180lbs range. I'm 6'1".
There is nothing like a bunch of exercise to do you a world of good.
Nathan
Re:and if you have a slashdot account (Score:5, Informative)
Re:Mostly OK (Score:2, Informative)
It seems like adding more rules and caveats to a medical system is a recipe for inefficiency, which results in more unhealthy people and higher premiums all around.
Of course, take my comments with a grain of salt: I come from a country where all medical needs are fully covered. In such a system, doctors and patients and employers (and maybe even insurance companies) all have their goals aligned: to keep everyone as healthy as possible.
Re:I hate BMI (Score:3, Informative)
As others have said... BMI is pretty useless. I don't consider myself overweight, and according to my body fat.. I'm between "athletic" and "fit" (which are both below "normal"). Yet, with such a plan, I would have to pay a premium??? Silly.
This is not a good idea for anybody (Score:5, Informative)
The whole point of insurance is to spread the costs around. Not risks, costs. Let's take an example. Suppose there's a group of 1000 people, and in any given year one of them's going to get hit with a $100,000 bill. None of them can afford that large hit, but all of them can afford to pay $100 per year. So they start a pool, each paying in their $100 with the understanding that the pool will cover the entire bill for whichever of them gets unlucky that year. Sure, the other 999 have to pay even if they don't get hit that year, but they also avoid the even higher expense of preparing to handle that big bill and the worrying over what'll happen if they get unlucky before they've saved up enough to handle it.
Now, suppose the guy running the pool for everybody decides there's an awful lot of money floating around in the pool. He could, he thinks, work out which person'll be the unlucky one that year. If he can, then he can charge that person the full $100,000 that year. That'll cover the pay-out and leave the other $99,900 in the pool for him to play with. Yes, this is the extreme case, but it's what the insurance companies here want to do taken to it's logical conclusion.
But wait a minute. If I'm a member of the pool, the whole reason I'm paying my $100 every year is so I won't get hit with the high bill if my number happens to come up that year. If I'm going to get hit with that huge bill anyway, why am I paying in? I'm not getting any protection from it, I'd be better off with that extra $100 every year to spend myself. The more it moves towards that extreme case, the less reason I have to pay into the pool. And even at the near end, the more people decide to pull out of the pool the more the guy running it has to charge those who're left, which makes it less attractive for them to remain in the pool, which means more people will pull out. And when there's nobody left, who will the guy running the pool get his money from? Oops.
Re:Bad idea (Score:2, Informative)
Re:and if you have a slashdot account (Score:3, Informative)
Re:and if you have a slashdot account (Score:3, Informative)
Essentially, those earning over $50k (IIRC) are taxed an additional 1% for healthcare. Medication on the PBS [health.gov.au] is subsidised by the government (A$3.50 for low-income individuals, $22 for everyone else), and covers most everyday prescription medication. As for general practitioners, "bulk billing" is the tagline that refers to doctors that bill directly to Medicare (read: $0 out of pocket), which is approx. $30 from the government for each consultation. Unfortunately, there's a trend lately towards not taking on any new bulk-billing patients with the current shortage of general practitioners.
On the whole though, it's a pretty fair system - I recently had a cholecystectomy, and had approx. $200 out of pocket charges.. $100 for the x-ray, and $100 for the specialist consultation. The surgery itself is free in public hospitals, and I only had to wait about 3 weeks.
The private health system operates their own hospitals; costs start at about $400-500/year for individuals... but I'll let someone else cover that. Or Google.
Re:and if you have a slashdot account (Score:3, Informative)
Waist to hip ratio has been shown to correlate much better than BMI with your risk of obesity related disease.
Re:and if you have a slashdot account (Score:3, Informative)
I live in Illinois and my states tax rate is 3% flat and most states are between 2 to 5%. There are only a few that are upwards of 8 or 9%. So using the example of a $8,000 a year income, you are being taxed 18% federally, 15% via SS, 5% state and 3% for Medicare. Now that is 41%. A difference of 7%. 7% of $80,000 is $5,600. Assume a $40 a month or $480 per year for a standard health care plan that you are paying 10% and your employer covers the other 90%. That is $480 annually or giving you a rough savings of over $5,000 a year. As you make more money this number gets even better. Which is why "People making more than $150,000 a year are eight times more likely than average to leave the country,'' said the Business Council on National Issues in a memo to Prime Minister Jean Chrétien.
diabetic? (Score:1, Informative)
I already pay more to stay alive because I require supplies (needles, lancets, insulin, test strips, etc.). While my blood glucose is more well managed than most morbidly obese people, I shouldn't have to pay my _insurance_ company more money because of a chronic, genetic illness outside of my control. While it may give some people some morbid satisfaction that sick people are being punished, all this does is make insurance companies rich.
Health care problems aren't caused by people that have health insurance (healthy or not). The problem is people that don't have health insurance that get treated anyway because emergency rooms can't turn patience away (and they shouldn't).
Unified health care where everyone is covered (and then pays a premium for better services) means that my insurance isn't paying $200 for a bag of electrolytes so the hospital can pay for the five people that got those same fluids for free.
Re:and if you have a slashdot account (Score:3, Informative)
In short, thanks for the strawman.
Re:and if you have a slashdot account (Score:3, Informative)
Nope.
What would happen if a fabulously rich American industrialist decided to fix up Somalia and run it as a free market? If he bought native $PRODUCT, the Western opinion movers would decry it as Blood $PRODUCT and embargo it. If he hired people and put them together on useful projects, he would be called an exploiter; the projects, sweatshops. If he put in a sensible government, it would be called a colonial puppet regime.
What Somalia has is a siege. Western intelligentsia has pretty much blockaded Africa. After the example of Rhodesia, renamed Zimbabwe when the light of civilization was doused and Mugabe's "fair" non-colonial government installed with the full support of Washington D.C., most of Africa is a business no-go zone.
DOL (Score:3, Informative)
I had the chance to ask a Department of Labor representitive about these "wellness" plans. By regulation, the cost can't be more then 20% different between a "good health" and a "bad health" person. So, the cost per paycheck to the employee for medical insurance has to be 125. The employer portion does not count. So, if a single person is paying at least $3,250 per year on medical insurance (ASSUMPTION: paycheck every two weeks), then this is legal. If not, then the company can have issues. I pay $2,080 for my wife and I. This also can apply to the out of pocket costs of the employees. If the company puts all the good health people on 90/10 and the bad health people on 70/30, the potential difference for a 70/30 can be greater then 20%, making the plan illegal.
What the nice lady told me though is that they are waiting for an age discrimination lawsuit. This is because peoples' health scores get worse as they age, so it can be discriminatory for such plans. The DOL is actually waiting for this to hit the courts. A good lawyer could make a nice chunk off of this.
Re:and if you have a slashdot account (Score:1, Informative)
http://www.cra-arc.gc.ca/tax/individuals/faq/taxr
http://www.taxtips.ca/tax_rates.htm [taxtips.ca]
Re:you're making a joke but (Score:3, Informative)