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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."
thats another 20
Charging drivers with more accidents higher rates for auto insurance?
That sounds like it could be considered a form of discrimination. I doubt that obese people would take this move lightly.
Except for the fact that the BMI is an outdated and inaccurate POS.
Linux, you magnificent bastard, I read the fucking manual!
I'm sorry, but this sounds dead on to me (and my BMI is over 30). If I'm too lazy, or too sick, to keep my BMI down, or if I have preexisting medical conditions that make me much more likely to cost the insurance provider more, I have no problem with being charged more. This is a great incentive to take preventative action, when possible (BMI, smoking, a better diet, etc), and it is a reasonable provision when not possible.
This will lower the insurance for the fit and healthy who never see a doctor (but want the insurance "just in case", and raise the cost for insurance for those who are ill or lazy and go often (I'm speaking in the long run, of course).
Sounds fine to me.
Encouraging Americans to be healthy is great. I don't really have a problem with charging those who smoke more, for instance. But high blood pressure? Come on, that's hereditary. Once you start discriminating against people for their genetic makeup, you're on a slope that is not just slippery, but frictionless.
This is a horrible idea. The entire point of insurance is that everyone pays a more-or-less baseline amount and some people don't realize any of that value and some people realize more than they put in. Of course, now that Americans expect to realize 100% of any tax or insurance payments, and if even one penny goes to someone else, well, that's socialism! Insurance is inherently socialist. That's why it's called INSURANCE. If you're expected to pay an equal amount to what you receive, you don't really have insurance, you're paying as you go.
The problem here is that it only assesses one kind of risk. What about sexually promiscuous employees, or employees that like skydiving or downhill skiing? What about employees that pop too many aspirin, or employees with physically abusive spouses? What about those employees with genetic predispositions to any number of chronic (read: EXPENSIVE) diseases, who have thus far been lucky enough not to come down with them (so far)?
The world's burning. Moped Jesus spotted on I50. Details at 11.
I would have expected this to be spun 180 degrees. i.e. Jack the rates up for all and then announce you get a $10 discount for meeting the BMI standard rather than a $10 penalty for failing to meet it. Same outcome, but less likely to piss people off.
None of them can see the clouds; The polished wings don't care.
Maybe we should do away with insurance (averaging) altogether, and just have everyone pay for whatever happens to them.
After all, if you don't have cancer, why should you pay extra for the people who do?
"Who is the Journal of Quantum Physics going to believe?" --Stephen Hawking
I would support a proposal like this with a couple of stipulations:
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.
Agreed, & I have a solution.
We should gather every employee in a room & stand them on a table one-by-one, if the majority of the room thinks that person is a fat bastard, that person gets charged more.
Wanna fight ? Bend over, stick your head up your ass, and fight for air.
No, it isn't. The point of insurance is that a certain percentage of a population will get hit. By spreading the financial risk over a large pool of people, each person pays an amount they can afford in case its them.
This is why private insurance is a bad thing- their job isn't to maximize protection, but to maximize profit. Ideally, they would want to insure only the people who don't get sick and none of those that do, to make 100% of that money in profit. In other words, they want to make it a giant scam, taking your money but providing no services. This doesn't stop the others from getting sick, it just forces them to pay through the nose for non-insured rates, or get no health services at all. And since we live in a humane society where we don't let them die on the street, society as a whole pays a higher rate as we pay for them to take up emergency services when things go completely wrong, rather than cheaper, more effective, and less risky preventitve care they'd recieve with insurance.
So no, this is *not* a good thing. This is a perversion that will inflate the pockets of wealthy insurance companies while bankrupting the lower and middle classes. This is why we need to get rid of insurance companies and get government healcare *now*.
I still have more fans than freaks. WTF is wrong with you people?
What about sexually promiscuous employees, or employees that like skydiving or downhill skiing? What about employees that pop too many aspirin, or employees with physically abusive spouses? What about those employees with genetic predispositions to any number of chronic (read: EXPENSIVE) diseases, who have thus far been lucky enough not to come down with them (so far)?
World wasn't invented in a day, boy. Simmer down. They'll get to it.
I always thought of medical insurance as a socialist concept. Everyone pays into a bucket, and the sick people take out of it when needed. So long as there are more healthy people than sick people, it should work. Even in capitalist implementations of medical insurance schemes.
So if sick people need to pay more than healthy people, what's the point of having insurance? Healthy people then shouldn't need to pay anything, as they aren't costing anyoen anything. And sick people should pay everything, as only they need it. Which completely voids any reason to send any money to the insurance guy. OK, that's going further than this article summary sounded, but if this idea gains any momentum that may be where we end up at.
How about this, as a related idea... Old people should pay more into social security because they use it more. young people should get discounts because they're a long way away from taking it. I bet todays elderly would get all riled up if we tried to make that change, eh?
If this is meant to be motivation to fix things, some things cannot be fixed. I've got high cholesterol. Very high. And very bad ratio of HDL to LDL. I'm relatively young, 31. I've gotten into running, have done a couple relay marathons (split the maraton distance between four runners) and am currently training for a 1/2 marathon. While still bad, my cholesterol measurements were better BEFORE I started running. Now after doing it for a few years, my cholesterol is 20 total points higher and it's time for the pills to fight it. Weird but true. Not sure what my genetics have in mind, but the doctor told me of other patients more athletic than I am trying to become are not able to lower their cholesterol without pills either. No amount of financial motivation can change that, and no amount of financial punishment for testing poorly will help either.
We could just put all the unhealthy people in gas chambers and kill them.
Oh yea, that was tried in the 1940's and for some reason people didn't like that. (don't flame me, I am being sarcastic.)
For someone who is sick or with a family member who is sick, just keeping a job and earning money is difficult, then add to that charging more health insurance costs, even if they could afford insurance would just push more people over the edge.
Increasing insurance costs would just be a slower, less obvious and more politically correct way to kill them off.
But it would be just as immoral, maybe even more so!
Anyhow Sick-o the movie already points out how screwed the system is.
I am always doing that which I can not do, in order that I may learn how to do it. - Pablo Picasso
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.
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.
Women have higher health costs, what with their frequent specialized doctors care, occasional pregnancies, and longer life span. They should be billed at a higher rate as well.
Any sufficiently advanced technology is indistinguishable from a rigged demo.
At the BMI's he is suggesting, you would be considered underweight. Normal BMI is 18.5-24.9. If he really had a BMI of 11, I'm surprised that he is still alive.
Here's a page giving some BMI weight ranges and a calculator.
http://www.nhlbisupport.com/bmi/
Josh
Open Your Mind. Open Your Source.
Okay, giving discounts, bonuses, etc. to say, folks that don't smoke, or something of value for regular exercise, great! But charging for many conditions that are hereditary, and/or difficult to control is stupid, as it just pisses off perfectly good employees, who then may quit because you are nickel and diming them.
This is one reason so many companies pound diversity and non-discrimination into their employee's heads over and over. Why? Because it results in the hiring and retention of quality employees. If a quality employee is fired, paid less, harassed, or whatever because of some trivial or irrelevant factor, such as gender, hereditary high blood pressure, race, religion etc., some other, more intelligent employer can pick them up, and they will be making money for somebody them instead of Morons, Inc. It is a colossally stupid business mistake to drive away (or not hire employees) for factors not relevant to your business.
Yes, unhealthy employees drive up health insurance costs for a business. But driving away otherwise perfectly good employees costs a business a heck of a lot more. It is an obvious fact that employees who voluntarily quit are generally those good enough to get paid the same or better elsewhere; otherwise, they would be far less likely to leave to begin with.
SirWired
Instead, employer sponsored group health plans are a form of socialized medicine, but implemented under a private feudal system. This system helps keep employees dependent on and loyal to their healthcare lords, the employers.
Since it's not insurance, there's really not much point in trying to charge differential rates within the group plans. If they go too far with it, they'll end up with the same premiums and individual filtering for preexisting conditions associated with individual health insurance. If that happens, the employers would no longer be able to use health plans as a tool to keep their employees pacified, employers no longer find it in their interest to offer group health plans, and the political pressure would quickly build to switch this country over to government-backed health plans like every other developed country on this planet.
I follow you, just making a joke. I believe that when filling in insurance forms, there are changes if your family has a history, or if you lead an unhealthy or dangerous lifestyle. One thing you might see to curtail generic rising charges, is selective policies:
I want to be insured for:
1) Accidental injuries incurred by non-dangerous activities (driving, swimming, non-extreme sports)
2) Cancer not directly related to my own activities (colon, prostate, lymph node)
I don't want to be insured for:
1) Extreme sports such as race car driving, motocross, ski jumping.
2) Cancer due to smoking
3) Liver failure due to alcoholic consumption
You start with a flat rate and go up from there.
BTW the BMI is subtly skewed against tall people. Ditto the "waist under 40 inches" rule.
The reason is simple -- the square-cube law. Your weight goes up by the cube of your height (so someone 10% taller is probably 30% heavier), while your cross-section only goes up by the square of your height. Waist size goes up linearly. This rule doesn't apply on large changes (you'll need changes in bone structures and musculature, etc.), but it's good enough for the variability you see in adult humans.
If you work out the numbers, you come up with the BMI being 'off' by about the person's height. That means that a 30 BMI for a guy at 5'8" (average height for calculations?) should correspond to approx 33 BMI for somebody who's 6'3" (one in twenty guys under 40?). Likewise for him to get under 30 BMI will be like his shorter peer getting under 27 BMI. Same thing applies on the 40" waist 'rule' -- a 40" waist on somebody 5'8" will be about 44" on somebody 6'3".
So flat fees are going to hit tall guys unreasonably hard... but our short peers still have a far worse deal. They get a false sense of security since their numbers appear to be good.
(The other benefit is that waist isn't the only thing that scales up!)
For every complex problem there is an answer that is clear, simple, and wrong. -- H L Mencken
i don't agree with this at all. the point of insurance is to *distribute risk* across a large pool of people. once you start penalizing on risk factors, you have people with pre-existing conditions, certain genetic markers, etc. becoming "uninsurable", which for many of them means "you go die now".
"uninsurable" is a ridiculous term, IMHO - everyone is "insurable" - you simply give them coverage from the pool. yes, that means your rates go up somewhat - too bad. the important thing is that people are getting covered.
the stunning intrusion into people's personal lives is another issue altogether.
free software, open standards, open file formats, no software patents.
I'm 5ft 8in tall and 200 lbs. According to this site, 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"?
I dunno, body builders with their crazy diets and protein concoctions don't impress me as having the healthiest lifestyle.
http://zero-to-enterprise.blogspot.com/
No, insurance is not about socialism. I'm healthy and in my 20s. I don't pay into insurance because I good-heartedly want to subsidize the healthcare of the unhealthy. I do it because I'm not that well off, so paying $200/month with 100% certainty is actually _much_ better for me than not having insurance, but running a half a percent risk per month of getting a $20,000 bill (even though .005*20,000 is only half of $200). Insurance allows me to spread the risk among other, equally healthy people, so that I can plan my life around it rather than risking bankruptcy.
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.
You better watch out, there may be dogs about . .
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, 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 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'.)
Learn the rules so you know how to break them properly.
www.teslabox.com
You're a higher risk so you pay more, seems like an insurance company at work to me.
Part of the obesity epidemic is the 60 hour work weeks that have become the norm, while real earning power has declined for most people. It's not like the company is going to give you the time to be healthy, so the pay cut is simply that and nothing more.
Friends don't help friends install M$ junk.
I'm not a body builder, but I work out regularly. I started last year. My BMI has remained the same (over 30), because neither my height nor weight have changed, but my body fat has dropped from 33% to 16%. I am still classified as obese by the BMI, but am now extremely healthy and well below the average (22%) for my age. BMI tells nothing. Body fat percentage is a better measurement, but you can't get that number from the information on the insurance application form.
Put identity in the browser.
"By that logic, no insurers would ever pay out. Thus, they would eventually have no customers so they would go out of business."
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.
--- Grow a pair, liberals... stop letting the Republicans bully you!
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.
We should gather every employee in a room & stand them on a table one-by-one...
Yeah! We could hire people the same way. Let different departments bid on them. Make them take their shirts off and show their teeth so you know they're nice and healthy. And, just for their safety and protection, we might want to chain them together, so they don't get scared and fall off the table. And maybe a small but tasteful whip, strictly to make sure things move along and people don't waste all day bidding on new employees. And make them sing worker songs, because people really like that. Swiiiing low, sweet cub-i-cle wor-ker...headed for the break room at niiiiiine. That's my favorite.
Dang, it seems so obvious. Why hasn't anyone thought of that before?
That's our life, the big wheel of shit. - The Fat Man, Blue Tango Salvage
You never thought that experience from Obfuscated C contests would be a good thing, did you?
Have you been touched by his noodly appendage?
But what you don't see is your lack of buoyancy increases your risk of drowning - why should a healthy tub-o like me have to pay for that? ;)
"If you have nothing to hide, you have nothing to fear." - Every fascist, ever