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:Form of Discrimination? (Score:2, Interesting)
Mostly OK (Score:5, Interesting)
1. I would want it to lower my (a "healthy" person) premiums, deductibles, out-of-pocket expenses. I'm not trying to sound selfish, but the reason mine were so high to begin with is because of all the unhealthy people. If they're just going to use this to help their own bottom line without helping those that make the health insurance system work (the healthy people, again), then they can shove that plan where the sun don't shine.
2. Don't use BMI. It's a crappy measure. Anyone who lifts weights regularly can easily be considered obese by BMI (even if they're not a "body builder"). I've been over that line my whole life and I'm not fat.
One of the things that I really like about it is that it provides extra incentive for someone to be healthy. Want to save $50 / month? Get in shape, and that will help lower the expenses & burdens of the insurance system for everyone else. It's like taxing a congested road to help clear it up, or taxing emissions to clean up the environment. Sometimes money talks louder than anything.
Re:What's the problem? (Score:3, Interesting)
This is crap (Score:5, Interesting)
They can go screw.
I have a BMI over 30. I used to play baseball. Heartrate? 63. BP? 122/63. Glucose, white cell count, red cell count? Normal. My doctors say I'm perfectly healthy, except for the rare form of cancer.
I truly fear the future where we treat insurance as a personal thing. We invented insurance as a way to spread risk. If we charge you directly for your risk, we are creating no economic benefit. It just means that in the future, I'll have to bear the entire cost of my cancer treatments.
And the healthy? You'll get the privilege to pay a private company to absorb zero risk.
Re:and if you have a slashdot account (Score:3, Interesting)
Lame idea.
I much prefer the idea my insurance company has. They give you this monopoly money for doing healthy stuff, getting checkups, and generally keeping in good condition. You can later redeem the fake money for real stuff like merchandise and vacations. If only their website didn't suck so badly, I'd have a huge pile of their funny money.
Bad idea.... BMI is flawed (Score:3, Interesting)
For example I'm 6'2" and 280 lbs. I've got some fat on me, I won't argue that. I also work out daily, deadlift 350+lbs, and can run a 6 minute mile (although I wish I hadn't after I do). I'm going to be generous and say 30% bodyfat, which I think is a good bit above reality. That's 84 lbs of fat. Losing 20% (56 lbs) to put me at 10% bodyfat, which is fairly low for anyone other than professional bodybuilders (and those guys who go way lower are being arguably just as unhealthy) leaves me at 224 lbs. According to this BMI calculator [nhlbisupport.com] I'm still way overweight and nearly obese and am currently ridiculously obese in my 40" waist jeans. According to that I should weigh 145 to 195 lbs. 145 lbs? Talk about unhealthy for someone who's 6'2". My Junior year in high school I weight 190-195. I was skinny. Not muscled, not ripped, skinny. Not unhealthy thin, but I would say more than 5-10lbs less than that would have been unhealthy.
How about a better idea? If you go to the doctor all the fucking time you pay more.
Re:BMI?? (Score:1, Interesting)
Gattaca here we come! (Score:2, Interesting)
"Save on post-natal care, genetically screen your unborn child for conditions that may affect your post-natal coverage".
Offer not valid in ND, AK, and HI etc. etc.
Punitive measures will backfire (Score:3, Interesting)
Punitive measures will backfire due to human nature. If you're paying the extra $10 for being 5 pounds overweight you are likely to think: Oh well, I'm paying to be fat so I may as well get 20 pounds overweight.
Re:and if you have a slashdot account (Score:3, Interesting)
Re:BMI?? (Score:4, Interesting)
I'm 5ft 8in tall and 200 lbs. According to this site [nhlbisupport.com], that gives me a BMI of 30.4
On the other hand, my chest is 44 inches, my waist is 37 inches (for the pervs that are salivating: I'm a guy. For the remaining pervs still salivating: I'm hetero. For the woman salivating: I'm single). I regularly bike (50 to 100 miles per week @ 15+ mph in preparation for a 60 mile charity ride this fall), run (I can run 2 miles in just over 17 minutes) and weight lift. Last time I got my cholesterol checked, my doctor mentioned that it might be too low (!).
Am I "grossly obese"?
Re:Charge vegetarians less? (Score:1, Interesting)
I'm a vegetarian, and I disagree with such a simplistic proposal.
Imagine somebody ate nothing but french fries, mayonaise, and Jolt. Vegetarian, but not exactly healthy.
You can be a very healthy omnivore. You can be a very unhealthy vegetarian. Whether you eat meat or not is just a small piece of the puzzle. There is no one "do this and you'll be healthy" action.
If you try to optimize for one attribute, people will game the system. It always happens. If insurance companies offered econimic benefits for vegetarianism, who knows? Maybe people will make up their meat cravings by eating a lot more fried food. It's not at all clear to me that it would result in healthier people. Higher premiums for smokers work because smoking is entirely unhealthy; eating meat isn't.
Come to think of it, have you been to a grocery store? Buying vegetarian food is already cheaper than buying meat. People already have economic incentive to stop eating meat, and yet most (in America, anyway) still eat the stuff.
Re:Form of Discrimination? (Score:3, Interesting)
depends on definitions (Score:5, Interesting)
If you're talking about regulars at T-Nation, or other natural body builders, I'd say you're wrong. There are people who manipulate their intakes, know everything (EVERYTHING!) about their diets, and keep meticulous workout and diet logs. They tend to be pretty damn healthy. If a bit obsessive compulsive. ;)
I'm not one of them but I play one on TV.
Re:Un-American (Score:3, Interesting)
That's the American way.
Many years ago military officers had trouble getting various types of car and home insurance because they were deemed more "at risk" than other occupations. They formed USAA, which to this day has some of the lowest insurance rates going.
It's NOT health care (Score:5, Interesting)
Someone asked me about Michael Moore's Sicko today, and I said that while he had some good points, he missed the problem entirely. If the medical industry was like the auto industry, it'd be like ignoring your car until the brakes failed and you ran into a brick wall, or never changing the oil until the engine needed replacing. Auto bodywork == expensive, brakes == cheap; replacing the engine == expensive, regular oil changes == cheap.
Americans would be a whole lot healthier (and health care expenses a whole lot lower) if health care was about prevention. (Mammograms & prostate exams, et al, are NOT prevention - they're screening for conventional treatments). The basics of human health haven't changed in thousands of years. The body requires certain levels of essential nutrients (some bodies need more of a nutrient than others due to genetic variation - some sailors were resistant to scurvy, for example). These nutrients need to be effectively assimilated through the digestive system, and the waste products of the body's metabolic processes need to be efficiently disposed of. The body requires clear air, clean water, sunlight (to synthesize Vitamin D), essential fatty acids [nutru.com], etc. If any of these are missing, or are not available in the required amounts, illness will invariably result.
Dr. Harold Reilly's Handbook for Health Through Drugless Therapy [amazon.com] covers the basics pretty well.
(it's not 'health care' because the system waits until a person gets sick, then it performs highly profitable 'disease-care'.)
Re:Charge vegetarians less? (Score:2, Interesting)
What most fail to realize is that the way they are killed in slaughterhouses/by humans is FAR more 'humane' than what they would suffer in the wild from a predator. Most predators will eat the kill while it's still fucking alive as long as it's immobilized. Most slaughterhouses kill the animal instantly, such as at many beef ranches where they use a nailgun with a nail welded to the piston to the forehead of the cow to kill it instantly.
As a licensed insurance agent (Score:5, Interesting)
I can most credibly say that insurance companies would LOVE to not pay out. They try to avoid paying out all the time. This is part of why people absolutely hate insurance and why state regulators are coming down so hard on them all the time.
All corporations would like to not make good on their obligations if they can get away with it. It's the inherent nature of capitalism.
If we only had real Physical Education in schools (Score:2, Interesting)
Re:and if you have a slashdot account (Score:4, Interesting)
Here's examples without going into bodybuilders.
A 5'11" guy is "normal" if he weighs 133lbs. If you add 40lbs of pure fat, he's still "normal". If the 5'11" guy is athletic and has a lean body mass of 155lbs and has 15% bodyfat, he's overweight.
In case you haven't noticed, women tend to be built differently than guys too.
The place I work has started things like this. Besides smoking ($25 a paycheck), they've gone the opposite route and "reward" employees who have a "healthier" lifestyle. Same difference, but it makes a little better PR.
Re:Driving optional, living less so (Score:3, Interesting)
Re:It's NOT health care (Score:3, Interesting)
A ball player's life expectancy in the nineteenth century was about sixty years. For Love, for Money, for Real Money: Life Expectancy Among 19th Century Baseball Players [wwu.edu]
There is scarcely need to screen the general population for prostate cancer if your fittest males are dead at age sixty of other causes.
Diet matters in diseases like diabetes. Quit smoking and you reduce your risk of cancer. But talk of prevention forty or sixty years after a disease has taken root isn't terribly helpful. Asbestos was in every home for decades - as a fire retardant, thermal insulation and so on. You could argue quite plausibly that it saved - or extended - more lives than it harmed.
You rarely get an unambiguous answer to the questions "What should I do?" or "What should have been done?" You can't speak of a strategy for "preventing Alzheimer's Disease" or other diseases of aging with any degree of confidence. Particularly if your goal is to do it on the cheap.
What the elderly most need is outside contact, a secure and yet stimulating environment. Not the warehousing of the nursing home but something more intimate and humane. That costs money - rather a lot of money = and it doesn't eliminate the need for conventional medical care.
Re:and if you have a slashdot account (Score:3, Interesting)
You're probably comparing 48% to the 28% that "income tax" tops out around in the US. Unfortunately, that overlooks the separately-listed Social Security and Medicare taxes: add in 15% for SSI and 3% for Medicare, and you're already just about at the total Canadian level cited here.
And given that the article says the rate varies from one province to another, it sounds as if they're including the equivalent of US state income tax. So add in another 5%-10% for most states, and the Canadians are already looking like winners.
But most importantly, this elides the cost of your insurance premiums. Whether "you" pay them or "your employer" pays them, it comes to the same thing: they're part of the cost of employing you, and money that your employer would otherwise probably be paying to you.
So no, even aside from the advantages of being more fairly distributed, every comparison indicates that nationalized healthcare is in fact far less expensive.
Re:and if you have a slashdot account (Score:4, Interesting)
Anecdote #1: January of 2001, I developed appendicitis. I got an urgent appointment to see a GP (General Practitioner, "regular family doctor") at my local GP clinic. They took a bit of a history, quick manual exam of my abdomen, found the telltale "rebound pain" and immediately referred me to hospital. As my mum had taken me to the docs in the first place, she drove me to the hospital and generally did all the thinking for me.
Arrived at hospital, went to the MAU ward (Medical Assessment Unit - for GP referrals, as opposed to Accident&Emergency which = "the ER"). I threw up I think 15 times in total (I kept count purely by the number of little press-board "kidney dishes" I got through!) before they managed to hit me with a strong enough anti-emetic to stop that. I had been scheduled to be the last surgery of the evening but I got "bumped" because a major emergency case came in - so they stuck me with some sweet sweet morphine to enable me to sleep. (Oh, and they put me on IV fluids as soon as they'd managed to stop the puking. Pissing like a racehorse when you know you've not been drinking that much is one of the weirdest body-things ever!)
Come the morning, I got my surgery spot and swapped my appendix for a nifty well-stitched abdominal wound. I believe I had another day or two in hospital to keep an eye on me (check the wound was starting to heal and that the main symptoms were clearing, I guess). I did that recovery time in a single-sex part of the ward (but not a private room - they're not the norm in the NHS).
*Up-front* cost of all of the above: Nothing. No itemised bill, listing every dish I puked in and every injection I received. At the point I needed it, the care was there, it was entirely adequate, and the only concerns I had were boredom and recovery. Of course we know this isn't free, it gets paid for by the comparatively high levels of taxes on things. Also, the local Health Authorities in different areas sometimes differ in terms of what sort of treatments they will pay for (not offering certain very-expensive drugs on a purely cost-benefit basis, causing the so-called "postcode lottery" effect).
The thing a great deal of Americans seem not to know about the UK setup: There IS private, pay-for healthcare over here *as well* as the NHS. For less-urgent stuff, waiting lists on the NHS can be significantly bothersome - it can potentially take many weeks to get something done. There are some private hospitals around, and some consultants only do NHS work part-time and also see private patients. To pay for this, you can take out private health insurance which will hopefully pay for that sort of thing.
Anecdote #2: When I was 16, there were some concerns about potential blood-sugar weirdness - so my GP suggested I have an Extended Glucose Tolerance Test done (eat nothing for 12 hours, go to hospital and drink a glass of sugar-syrup and then give blood/urine samples over the course of a few hours - checking for sugar spike/crash stuff). It would've taken quite a few weeks to get that sorted under the NHS, but my dad had extra private cover at the time (it's not uncommon for it to be offered by employers) which covered family too - so my NHS GP referred me to a local BUPA private hospital, where the test was booked and done much more quickly (and I had a really nice private room, hotel-quality). Upfront cost: Whatever the "excess" was on my dad's medical insurance - in the region of 50GBP I think.
Anecdote #3: Turned out, one of my good friends I made at university has a peanut allergy. His first ever proper reaction (not "choke and collapse", but certainly "go very blotchy and itchy") won him a nice ride in an ambulance and spending the evening in Accident & Emergency. I went along for the ride and to keep him company. Direct cost of ambulance: Nothing. Number of times ambulance crew mentioned money: Zer
Re:and if you have a slashdot account (Score:4, Interesting)
We may have problems with our 30yr old system but bankruptcy/death from health-care and medicine costs are not amoung them.
Disclaimer: Even though I would "save money" I refuse to take out the extra private cover (it DOES NOT give you better medical care but it will pay for a private room or silicone tits). I willingly pay the extra 1% since I know it goes to health care for someone less fortunate and not some fat-cat's profit margin. The system saved my son's life in the 80's, at the time I was classified as "working poor" and it certainly saved my family from bankruptcy.
Re:and if you have a slashdot account (Score:4, Interesting)
Or you could look at the US Medicare system, which is almost an order of magnitude more efficient than any private health insurer in the entire country.
Anyone who thinks that having a single system could possibly generate MORE bureaucracy than our existing private health care system has obviously never worked in health care.
There are approximately 18 billion different private insurance programs in the US, each of which has arbitrary rules that serve no purpose other than to deny coverage to the most patients possible (what, your doctors didn't read all 14,372 pages of our plan's guidelines before performing the emergency surgery? sorry, not our fault you used a 6mm staple instead of a 5mm when closing the incision -- we're not paying for the procedure! Plus we're canceling the patient's coverage.)
Re:and if you have a slashdot account (Score:4, Interesting)
U.S. Medicare efficient? It rations mercilessly, pays so little that many people cannot get care even though it is "free", and spends money in isolation from personal economic consequences. The doctor contracts also have a Mob provision that makes it very hard to leave the Medicare "family" once you do a job for them.
And anyone who thinks they know bureaucratic red tape has never worked with government agencies that have a statutory monopoly. Single payer would be like getting health care from the Immigration and Naturalization Service.
Incidentally, one of the big problems with the existing system is that the GOVERNMENT only pays for a third of your insurance if it comes from an employer. Competition is drastically curtailed because important business relationships cannot be quickly changed. For many people, changing spouses is easier and cheaper than changing health insurance underwriters. Yet another reason to abolish that antique law.
Re:you're making a joke but (Score:3, Interesting)
More mass basically means more strain on the heart, and also other organs. That is a valuable statistic.
Body fat has different effects, and just like the BMI, a higher number correlates with higher risk.