Blowing Smoke

Thursday, June 09, 2005

A glimmer of hope!

Accountability: Did 2.2 miles in just over 20 minutes today. Then found arm curl and leg press machines that proved just how weak I am (relative to body size at least).

What I've Learned: 1) Monkeys are the only animal crackers that wear clothes. 2) We're all heathens to someone. 3) TBD is not a universally recognized acronym (To Be Determined, for the curious).

I've been thinking about insurance. It's supposed to be in case of an emergency loss. As I've discovered, insurers' opinions of what constitutes an emergency loss is far greater than mine (when my ceiling starts falling, it's fairly urgent for me). So why is health insurance supposed to pay for everything? Why is it supposed to pay for on-going prescriptions? For cosmetic treatments? I think this is one reason why people are against a national health insurance - we'd all like to help people who are badly injured, but acne medication for all and all for acne medication? Not so much.

What if a national health-care system only paid for actual injuries that require treatment above a certain amount (perhaps a % of income)? Probably more coverage/treatment for pregnant women and kids would be included so adults could start their independent lives healthy. Maybe there would be some kind of incentive for regular checkups, not smoking, losing weight, and other healthy behaviors, but not paying for it, just an incentive for it. Seems like that could be done much more cheaply and without all the excess bureaucracy (I can't remember the exact figure, but I think something like 19% of health-care costs are due to filing/tracking/correcting paperwork). And if employers or individuals want other services, I'm sure private providers would offer them.

So that's just some rumination. Please let me know what you think as it's nothing like a finished proposal yet.

posted by Unknown 10:41 AM | 4 comments

Comments:

I'm sure this is just personal beef of mine, but I already feel that we suffer from a lack of emphasis on preventative health care in our system. I can't say that I believe paying for a person to have an annual checkup is more fiscally draining than paying for extensive treatment, medication, and chemotherapy when something could have been caught much earlier. By not covering preventative medicine at all, I would venture a guess that the number of more "major" complaints that insurance would have to cover stands a good chance of rising. What kind of incentive do you propose? I think it is a great idea for behavioral and lifestyle changes (like smoking and weight loss), but knowing an annual is covered is pretty big incentive for me to go, personally. It means there's nothing that I can claim as an excuse, at least. :) This is pure conjecture on my part, obviously.

# posted by

Kat : 2:49 PM

Incentives could be at what level the insurance kicks in. So if you don't smoke, are a reasonable weight (or have a medical reason to be at your weight), and got regular checkups, it cuts in once you've spent 2% of your annual income on an emergency instead of 10%. If it's a federal program, maybe it affects your tax rate or credits (it'd be closer to the public good than most tax credits).

We have car insurance but that doesn't cover oil changes. But if you don't change the oil for a year and your engine breaks, the insurance won't cover any of it. I don't want to go that far, since a life is (hopefully) worth more than a car, but why is the government responsible for our health? We don't expect them to pay for healthier food or nicotine patches or gym memberships, so why checkups? I think it's mostly a cultural thing that's developed in the last 50 years. Preventative care should definitely be an important consideration, but we need to look at the basis for what society can/will pay for.

I guess part of my problem is that most people don't get checkups even when they're covered. So we're already paying the back-end costs. Incentives would encourage more checkups (I could see paying for regular checkups being part of the incentive), and hopefully removing the "who-pays?" game would reduce costs for all parties. That might be somewhat idealistic, but most doctors do seem to want to help, so I think they would agree to a plan requiring certain lower rates for certain services as their costs drop.

That might have been rambling - if so, I apologize.

# posted by

Unknown : 3:11 PM

Cap'n,

I agree completely on the height/weight charts - I know I'm not near an ideal weight but I'd like to not have to have limbs amputated to meet the goals.

Kat and I chatted on the preventative stuff yesterday, and came up with a couple of thoughts. 1) The incentives could be based on analysis of data from checkups, so no checkups, no reduced contribution in an emergency. Given most Americans' inability to look past this paycheck, it probably doesn't help much. 2) An incentive could be free/reduced-cost checkups as long as you are getting them regularly. Preventative care does lower costs, so could be covered as long as it's actually being used in a way that will lower costs.

Why do we expect not to have to pay medical costs? And that it's a luxury we'd forgo if we have to pay for it? Most people wouldn't consider a car that kind of luxury (at least not in Texas). That question's going to be important, because as health-care costs go up (no end in sight yet) and shareholders get more impatient, employer insurance is going to become steadily less available and more expensive.

# posted by

Unknown : 10:37 AM

What strikes me as I'm reading this proposal and related comments is this:

We're assuming that the end-user's cost for health insurance premiums decreases as a result of a lower quantity of payouts (totaling an arguably significant number).

Arguments above about the logistics and fairness of asking people to pay more health care costs out-of-pocket aside, I really don't see that premiums would go down significantly--seeing as the cost of insurance premiums in general seems only to be marginally related to actual insurance company payouts. This seems to be an insurance industry-wide issue. Health care costs and insurance premiums have been spiraling upward, bouncing off each others' price increases for the longest time.

In short, the key to this whole argument is the nationalization of the health care system (as you said in your original post--not sure if that's implied in the comments as well)....forcing the insurance companies and health care providers to re-align their prices with actual costs.

And once you've done that--insurance premiums come spiraling down anyway.

P.S. There's a great illustration of this issue (premiums vs. actual costs), relating to medical malpractice insurance I just read about somewhere (CNN Infographic, i believe?).

# posted by

Sameer : 5:54 PM