medical big brother

[tempo]

60 minutes did a report tonight on employers who regulate their employees' lifestyles as a way to control health care costs:

http://www.cbsnews.com/stories/2005/10/28/60minutes/main990617.shtml

This is a fascinating story to me because it crystalizes so many of the issues we face in public health care policy.

Nobody wants a Big Brother telling us how many Cheetos we're allowed to eat, whether it's big gummit (by power of of law) or big business (by power of the purse). A government monopoly on health care would give us the former, and a laissez-faire free market would give us the latter.

Do we agree as a society that the healthy should subsidize the sick? Most people would probably say yes, but try telling that to someone who has diabetes in today's insurance market.

[jneale]

missed the show - but having to deal with insurance renewals for the past 7 yrs now it does frustrate me when I see employees with unhealthy habits responsible for the bulk of our experience (costs @ the end of the year used to base the next year's premium.)

Like it or not - people who are several hundred pounds over a "normal" weight use more insurance dollars OVER TIME. People who smoke are at increased risk for monumental health issues. I've watched the medical system try to keep someone alive, knowing that they have a terminal diagnosis. I had a spouse in ICU for two months following a radical surgery for lung cancer - he was a heavy smoker.

When an employee comes to visit me - and they can't fit it my chair OR I've got to spray the room with air freshener because they leave a cigarette pigpen cloud hanging in the air .....then I do wish I had a say in what their "habits" are are costing me.

You want insurance - fine, get your weight down so you can fit in a chair & quit smoking. The only way it is going to change is when we are forced to pay the bulk of our insurance.

So do I believe the health should pay for the sick - yes. Do I believe I should pay for blobs who can't walk to their car without eating a snack or for someone who can't get through an hour without a smoke - no.

And yes I could loose 20 lbs myself - so I'm sympathetic to others in the same boat. I know smoking is an addiction - stronger than I think most people realize. I'm not saying off with their heads, but I am saying that it is time to admit that there are costs involved & it is time to pay the piper.

[markalot]

Do we agree as a society that the healthy should subsidize the sick? Most people would probably say yes, but try telling that to someone who has diabetes in today's insurance market.

No.

Maybe?


I do think we need to add personal responsability into the equation, and make sure genetics stays out of it. If you're a heavy smoker and get a smoking related disease, tough shit. If you're a heavy eater, like me, and get a fat related disease then tough shit. Much as I hate to admit it, I take affordable health care for granted, and that's exactly the problem with the health care system today.

Now who decides what is responsible? I would go with business. Different businesses would have different rules, so you'de still have a choice. That choice would be reduced to almost zero as health care providers colluded to keep costs down, but that's another issue.

If big government (I love the word gummit) decided then you'de have zero choice from the get go, and the decisions the gummit makes would most likely be bizaar. I'm thinking along the lines of the food pyramid and a certain lobbying group.

[Megs79]

missed the show - but having to deal with insurance renewals for the past 7 yrs now it does frustrate me when I see employees with unhealthy habits responsible for the bulk of our experience (costs @ the end of the year used to base the next year's premium.)

Like it or not - people who are several hundred pounds over a "normal" weight use more insurance dollars OVER TIME. People who smoke are at increased risk for monumental health issues. I've watched the medical system try to keep someone alive, knowing that they have a terminal diagnosis. I had a spouse in ICU for two months following a radical surgery for lung cancer - he was a heavy smoker.

...

So do I believe the health should pay for the sick - yes. Do I believe I should pay for blobs who can't walk to their car without eating a snack or for someone who can't get through an hour without a smoke - no.


Amen to that. I work in a small office, and we got screwed this year when our insurance came to be renewed because of the medical costs of a few people. Now my prescriptions (I have 2, one that I fill monthly and one for migraines, and occasionally allergy meds and antibiotics for sinus infections) cost me more and our deductible doubled (from $250 to $500) because the same plan we had before was too expensive. It frustrates me that some people spend 20% of their day outside smoking, while the rest of us who have healthier lifestyles work during their smoke breaks and have to pay for their bad habits. And since I'm in Kentucky, smokers are practically a protected class.

[tempo]

I do think we need to add personal responsability into the equation, and make sure genetics stays out of it.
Yes, we are of one mind here. There has to be a monetary incentive for people to adopt healthy habits. But implementing a policy that is blind to genetics will be damned tricky.

It's easy to correlate overeating and smoking with expensive health problems, but what about diseases that have both genetic and behavioral risk factors (like diabetes)? Once an insurance company knows your genetic factors, there would be a strong incentive for them to selectively enforce their behavioral criteria.

I'm thinking along the lines of the food pyramid and a certain lobbying group.
Yup. Even with a set of sincere policy makers, this would be a difficult problem to solve. In our current system of campaign finance (i.e. legalized bribery), I don't hold out much hope for the sick folks.

[the happy prole]

Yes, the healthy should absolutely subsidize the sick. Anytime you're in a very weak physiological state in a non-sterile environment, you're a huge risk for communicable diseases. That's true if you have lung cancer, or even if you're dying on the road with your brains leaking out of your skull after a motorcycle accident.

The trade-off here is right to privacy. I have seen people get government disability for Type II diabetes and asthma while smoking and weighing 300 lbs. I don't know if their problems are solely due to their health habits, but they'd certainly be lessened. They get away with it because the government doesn't look to close at their records so long as you have a legitimate doctor's notice.

If you want to stop this, you've got to be okay with business and/or government looking at all your medical results. And if it's business they will want you to see one of their pre-approved doctors. And then you're going to have to wonder if those doctors are biased. If I played pro sports, there's no way I'd take a team doctor's decision on anything.

One of the bigger myths is that health care costs are driven by the poor and sick. That's partly true and partly not. The rich/healthy pay their bills and the poor do not, so in that sense yes, the rich are paying for the poor guy who goes into the emergency room and can't pay for it.

On the other hand, the rich and healthy spend tons on health care, and that demand drives costs up the most. If you're smart, you probably get a medical every year for your whole family, flu shots, you'll come in for a cold or a back ache, etc. That costs a lot of money.

In poor areas, that doesn't happen. They don't go to the hospital until they're about ready to drop dead. A lot of times that means extra emergency costs because someone got pneumonia instead of taking care of a cold earlier. But more of the time it means great cost-savings because they basically show up when they're about to drop dead, thus alleviating the costs of second opinions and cat scans and chemo and long hospital stays and all the rest of that stuff.

[BigSugar]

in August '04, our HI premiums rose 48%. August '05, they went up another 15%. paying $100K a year in health insurance for attorneys and staff is an absolute bitch.....and it kills me when the staff bitches about a small raise, or small bonus. umm.....yeah, but you got $3K in total health coverage and it goes up 25% a year on avg. we'll happily give you a raise and tax you on it, versus paying for your entire health coverage. we're only obligated to pay 50% after all. take your pick.

played poker last week in a doctor friends brand new 8000 sq. foot mansion. malpractice coverage and reduced insurance payments must be killing them. LOL!

two sectors with record profits, despite hurricanes and disasters......insurance and energy. buy them both. hold them. they will go up. period. (*this is personal opinion and i cannot be held resposible for your losses:)

[icehouse]

in August '04, our HI premiums rose 48%. August '05, they went up another 15%. paying $100K a year in health insurance for attorneys and staff is an absolute bitch.....and it kills me when the staff bitches about a small raise, or small bonus. umm.....yeah, but you got $3K in total health coverage and it goes up 25% a year on avg. we'll happily give you a raise and tax you on it, versus paying for your entire health coverage. we're only obligated to pay 50% after all. take your pick.

played poker last week in a doctor friends brand new 8000 sq. foot mansion. malpractice coverage and reduced insurance payments must be killing them. LOL!

two sectors with record profits, despite hurricanes and disasters......insurance and energy. buy them both. hold them. they will go up. period. (*this is personal opinion and i cannot be held resposible for your losses:)
true. true. That is why many of the smaller local governments across my state have increased co-pays and decreased benefits; they cannot afford the raises in premiums. This has led to a major recruitment problem; "hey come work for us, our benefits keep decreasing." I think the insurance industry as a whole is messed up. Chris Rock once said that they shouldn't call it insurance but instead "incase sh#t cause you are paying for it "incase sh#t happens." He continued by saying if "sh*t doesn't happen, shouldn't I get my money back?"

One of the most creative solutions I have seen is a self-insurance liability fund. Basically, you pool money from employees and pay out based on claims. No insurance middleman and a HUGE reduction in cost. The only problem is the health and viablity of the employees must be sound while the pool builds AND does your organization want to underwrite/undertake the liability caused by multiple person encountering huge medical bills.

Oh, and currently my provider will grant awards if you have documented proof of trying to increase you healthy activity. (like documents from a trainer or doctor).

[akip]

it's gonna be very interesting to see how this all shakes out. 'cause things are gonna be different.

the wal-mart memo story is another manifestation of this trend. americans, generally, are becoming less healthy because of poor diet and no exercise. wal-mart is the biggest employer in the country, esp. of the underskilled (and often overweight) and they are talking about changing their hiring practices because their health insurance costs are skyrocketing.

an aside---there was a piece on cnn, i believe, about american kids growing up fat in record numbers. it's a strong possibility that they will not live as long as their parents' generation. i noticed while picking up my kid at private school how few of the kids i saw there were overweight. it's becoming a big class difference and something that will widen the opportunity gap.

i have no doubt that, in a nation in a mounting health care crisis, the healthy will rule.

[tobedawg]

i have no doubt that, in a nation in a mounting health care crisis, the healthy will rule.

So, those among us in the nation that can afford to keep healthy will rule..

I believe in a healthy diet and exercise as well, but I don't think that body fascism is the way to go..

IF you look at many of the people in low income neighborhoods, you'll see that many of the ones (that aren't tweakers or junkies) are overweight.. Why? Many folks with low incomes can't really afford to eat fresh fruits or vegetables, but they CAN afford a pack of those "Little Debbie" snack cakes for 89 Cents..

To tell poor people to shape up or lose their health insurance costs is like saying that only the rich should be allowed to have health care.. "Shape up or ship out!".. Nice attitude!

What Next? Only "Beautiful" people should be allowed to have Health Insurance because Ugly people are a strain on the rest of us..

[akip]

So, those among us in the nation that can afford to keep healthy will rule..

I believe in a healthy diet and exercise as well, but I don't think that body fascism is the way to go..

IF you look at many of the people in low income neighborhoods, you'll see that many of the ones (that aren't tweakers or junkies) are overweight.. Why? Many folks with low incomes can't really afford to eat fresh fruits or vegetables, but they CAN afford a pack of those "Little Debbie" snack cakes for 89 Cents..

To tell poor people to shape up or lose their health insurance costs is like saying that only the rich should be allowed to have health care.. "Shape up or ship out!".. Nice attitude!

What Next? Only "Beautiful" people should be allowed to have Health Insurance because Ugly people are a strain on the rest of us..

i agree, it's not fair. but i work in the system and i can see the writing on the wall.

[jneale]

.... self-insurance liability fund. Basically, you pool money from employees and pay out based on claims. No insurance middleman and a HUGE reduction in cost. The only problem is the health and viablity of the employees must be sound while the pool builds AND does your organization want to underwrite/undertake the liability caused by multiple person encountering huge medical bills.

People grow old, As long as you send them off to carousel at regular intervals - then it might work

[ICONOCLAST420]

I saw the story and found one statistic interesting is that in a typical company 5% of employees incur 50% of health care costs. I would almost be willing to bet my right arm that it is also the laziest and least productive 5% as well. Too bad it's so hard to fire anyone anymore.

[markalot]

So, those among us in the nation that can afford to keep healthy will rule..

I believe in a healthy diet and exercise as well, but I don't think that body fascism is the way to go..

IF you look at many of the people in low income neighborhoods, you'll see that many of the ones (that aren't tweakers or junkies) are overweight.. Why? Many folks with low incomes can't really afford to eat fresh fruits or vegetables, but they CAN afford a pack of those "Little Debbie" snack cakes for 89 Cents..

To tell poor people to shape up or lose their health insurance costs is like saying that only the rich should be allowed to have health care.. "Shape up or ship out!".. Nice attitude!

What Next? Only "Beautiful" people should be allowed to have Health Insurance because Ugly people are a strain on the rest of us..


Wait a sec tobedawg.

So what is your solution then? Why is forcing people to be healthy or lose subsidized healthcare a bad thing. Why do you immediatly connect that to the evil rich (which by your thinking seems to be anyone that owns a house).

Your post pretty much sums up the lack of ideas coming from those who want to help the disadvantaged. Why not propose a healthy food education program to go along with restrictions in subsidized healthcare? How about food stamps for healthy food or a recipe cards with food stamps?

How about an IDEA?

Healthy food does not cost more.

What Next? Only "Beautiful" people should be allowed to have Health Insurance because Ugly people are a strain on the rest of us..

What the hell does this mean and how does it apply to this conversation? Ugly people are not a burden on the system, why would they be. Are you trying to do anything but hate?

[tobedawg]

So what is your solution then? Why is forcing people to be healthy or lose subsidized healthcare a bad thing. Why do you immediatly connect that to the evil rich (which by your thinking seems to be anyone that owns a house).

Because it is another indication that our country has gone to CORPORATE FASCISM and the consensus here seems to like the idea of Corporations controlling EVERYTHING..

My solution would be to adopt a Single-Payer Government run health care system similar to that of Canada, everybody contributes, everybody gets health care.. It's just that simple!

Healthy food does not cost more.

Which Grocery Store DO YOU Shop at? If you look at the Natural/Healthy Foods sections anbd compare them to the aisle with the Cookies and Snack Cakes you will see that Healthy Foods DO in fact, Cost up to 50% MORE Than Junk Foods.. You should probably go grocery shopping more often!

How about food stamps for healthy food or a recipe cards with food stamps?

I can agree with that.. OR maybe there should BE a special discount for those who choose to buy healthy foods with their food stamps.. Unfortunately because we live in a Corporate Fascist society, Nabisco and Hostess would be outraged and get their way..

[markalot]

Which Grocery Store DO YOU Shop at? If you look at the Natural/Healthy Foods sections anbd compare them to the aisle with the Cookies and Snack Cakes you will see that Healthy Foods DO in fact, Cost up to 50% MORE Than Junk Foods.. You should probably go grocery shopping more often!

You're in the designer food isle. Stick with the staples that can be used to make healthy food. A bag of beans for bean soup, flour, rice, fresh veggies. Sure, little debbies look cheap but that ain't eating just one.

[icehouse]

i saw the recommendation that stamps only allow the purchase of healthy foods...I know WIC (with Infant Children) requires only certain items can be purchased and are prior approved.

[akip]

unfortunately, our whole culture has to change to impact this problem. you have to swim against the entire marketing-to-the-lowest-common-denominator-to-make-the-biggest-profit-for-the-stockholders tide.

let's face it. we've become a junk society. as individuals, we can choose to eat right and exercise (and read/watch better news/entertainment/art), but it's evolved into a class distinction. people who are in the game, aspiring to the top, are breaking through the junk noise. but those who are drifting toward the bottom, for whatever reasons---poor education, poor access, poor social environment, poor family habits, whatever---are having a harder time doing that.

[BigSugar]

i can just see the new job app form now.....

"42. Have you ever engaged in unprotected anal sex? Y___ N___ Explain(in detail...with pictures if any):______________________________________"