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Charging the Unhealthy More For Insurance
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."
Except for the fact that the BMI is an outdated and inaccurate POS.
Linux, you magnificent bastard, I read the fucking manual!
There will be a lawsuit about this. It's just a matter of when. It looked like it's the employer doing the fining not the insurance company, which I know in my state if an employer holds back any part of your paycheck, you can get back 3 times the amount.
Don't Vote for Norm Dicks! http://www.nodicks2008.com Another nutless dirtbag that voted for the FISA bill!
Regardless of whether you think this is a good idea or not, the BMI is Bullshit!
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.
Actually, I don't think it's at odds with the summary, it's just that the BMI is a pretty useless measure of someone's health.
Great plan, but defining 'healthy' isn't that simple. The BMI is a good case in point. Very healthy/athletic body types can be surprisingly heavy because muscle weighs more than fat. With serious weightlifting, people's weight goes up even as their pants size drops. With serious exercise, one can easily get their weight into the BMI's "unhealthy zone" while they are simultaneously in the best shape of their lives.
Exactly. When I was in college (many moons ago) and weightlifting, I was measured with an 11% body fat (on the low end for "highly athletic") and weighed 205 pounds with a height of 5' 8". According to BMI, that's morbidly obese and I'd have been paying extra. Explain how an athlete who can bench press 400# and leg press 1200# is in extra danger of keeling over dead?
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.)
Life, the Universe, and Everything... in my image.
What about sexually promiscuous employees, or employees that like skydiving or downhill skiing?
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.
Learning HOW to think is more important than learning WHAT to think.
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.
Light travels faster than sound. This is why some people appear bright until you hear them speak.........
Maybe you're using the wrong BMI formula. Mine is 26 and I'm in excellent shape.
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
which gives me the same BMI number as every other calculator I've seen.
"Who is the Journal of Quantum Physics going to believe?" --Stephen Hawking
I'm sorry about your mother. In case it wasn't clear my post was intended to be extremely sarcastic. I think insurance is the right way to go, and we shouldn't back away from it and allow crap like charging overweight people extra.
"Who is the Journal of Quantum Physics going to believe?" --Stephen Hawking
body builders and the like have skewed BMIs, for example.
You better watch out, there may be dogs about . .
Bad form to reply to myself, but in case it isn't clear, I'm fully intending the above to be highly sarcastic. I believe risk averaging is a good idea, and the ideas proposed in this article to be on a pretty steep slippery slope to being sufficiently obviously evil for anyone to recognize it as such.
"Who is the Journal of Quantum Physics going to believe?" --Stephen Hawking
Some state governments have programs available for folks who are otherwise unable to find coverage. It's not necessarily cheap, but it's something rather than nothing.
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.
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)
-- the cake is a lie
I'm staring at 42 years old in less than a month. I've donated blood all of my adult life, I'm working on my 6th gallon.
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
The previous poster wasn't arguing that NO health metrics should be used, rather they were arguing that BMI probably isn't the best one. Which is entirely true. BMI makes assumptions about the amount of muscle and bone in someone's body. Since the percentage of muscle can vary widely, that's obviously not the best assumption to make. There are better ways to measure only the amount of fat in someone's body that resolves that problem, though they require more specialized equipment.
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.
I'm not very active -- the standard desk jockey, but I have a high metabolism and I *used* to be very active, though it has been nearly a decade since I stopped being actively athletic. That said... I'm 5'11, 185lb but sometimes up to 195lb, that puts me around 25-27 BMI with a blistering 10-14% body fat. Surely, I could lose some weight, I've lost the "6-pack" I had a decade ago, but I'm not over-weight by any stretch of the imagination.
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.
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.
You've completely misunderstood insurance. It's about risk aggregation and mitigation. Good, cheap insurance is priced according to the risks associated with it. The stuff that gets called medical insurance and flood insurance(hint, you can't buy real flood insurance if you live in an area prone to floods!) is indeed socialism, but it sure isn't insurance.
Nerd rage is the funniest rage.
Which they do.
Fly me to the moon Let me sing among those stars Let me see what spring is like On jupiter and mars
I'm in Australia, and we've got a national healthcare system, (Medicare, which operates in parallel with the private health system.
Essentially, those earning over $50k (IIRC) are taxed an additional 1% for healthcare. Medication on the PBS 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.
Even that isn't such a great way. Superficial fat is much less dangerous than the kind that packs in around your organs. You really need a CT or MR scan to figure it out though.
Waist to hip ratio has been shown to correlate much better than BMI with your risk of obesity related disease.
Ok, well they make it sound like 48% is the effective tax rate not the marginal rate. First off you would have to be making $78,000 a year in 2007 to fall into the 28% marginal tax bracket but still do not see an effective tax rate that high. If you made $80,000, your effective tax rate is 20% even though your marginal tax rate is 28%. Don't forget that that is taxable income and doesn't include even standard deductions. If you take the standard that is $5,350 + $3,400 for yourself as a dependent. Now your taxable income is $71,250, bringing your tax burden down to $14,200 or 17.75%.
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.
I'm not not licking toads.
I'm type 1 diabetic with a bmi of 23.8. I'm active, healthy and eat a very controlled diet.
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.
If you're 5'11, and you weigh 133lbs, I'd suggest you eat some food. I'm only an inch taller, and my normal weight is 175-180 lbs. I can't imagine being 40 lbs lighter...I'd be a stick, and look much like christian bale in the machinist weights ~125, and he looks absolutely sick (like he will die at any moment.)
In short, thanks for the strawman.
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.
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.
In God we trust, all others require data.
That article doesn't says "The average Canadian family pays about 48 percent of its income in taxes each year", which is different matter entirely from the "almost 50% income tax" that you suggest. I can only assume that this estimate also includes property taxes and sales taxes, because it clearly isn't true for federal and provincial income tax:
a tes-e.html
http://www.cra-arc.gc.ca/tax/individuals/faq/taxr
http://www.taxtips.ca/tax_rates.htm