Reigning in Health Care Costs in the USA

Congress is considering a proposal designed to reward healthy behavior and flatten skyrocketing health care costs. The idea is to allow employers and health insurers to give larger discounts to employees who lose weight or lower their cholesterol. Employers would be able to increase the level of discounts in premiums, co-pays and deductibles they can give to workers who participate in wellness programs.

Under current law, employers and insurers are permitted to give discounts of up to 20 percent on premiums, co-payments or deductibles to workers who take part in wellness programs, which include anti-smoking and weight-loss programs. Some wellness programs simply require participation in order to get the discount but other programs require employees to reduce their weight, blood pressure or cholesterol by specific levels. A House proposal would allow employers to charge workers who participate in wellness programs 50 percent less than workers who don’t.

Proponents say the measure would improve health and lower costs, and that workers who can’t hit specific targets could seek a medical exemption. They cite significant savings and significant positive aspects to encouraging people to live healthy lifestyles and reward people monetarily for doing it. They claim that creating a healthier workforce by giving incentives for healthy lifestyles would reduce the overall cost of health care for everyone.

But critics say the efforts raise big questions about privacy and fairness. They note that corporate wellness programs often administer surveys that ask employees personal questions. They claim that lower-income workers, in particular might not be able to afford gym memberships, even with employers’ subsidies. They fear that premiums will become unaffordable for people who can’t change their behavior.

I understand the need to bring health care costs under control, but this proposal seems like an onerous infringement on peoples’ privacy and may have harsh discriminatory consequences. What do you think? Are there better alternatives to reigning in health care costs?


I’m changing the title of this thread to hopefully broaden the discussion on bringing down health care costs in the USA.

Let’s see.

Smokers pay more for life insurance than nonsmokers do.

People who drive cars with antitheft devices pay less than those who don’t.

Homeowners with circuit breakers pay less than those with fuses for their homeowner’s insurance.

Well, I assume this is about the program started by Safeway (grocery chain)
Well, I work at Safeway less than 20 miles from the coroprate HQ. It is a small program designed
for the suits at coroprate and doesn’t get down to the store level. store Managers aren’t involved
probably district managers who already make 250,000 plus a year anyway. So, that is the real target area,
suits who make over 150,000 and workers not involved at all. Typical corporate bullshit meant to sound good but is really
a smoke screen for what really happens.

Kropotkin

MORE IS NOT NECESSARILY BETTER:

Excerpt from: “The Telltale Wombs Of Lewiston, Maine”
by ALIX SPIEGEL/NPR/ALL THINGS CONSIDERED/10/08/2009

In fact, felix, more can be worse.

The whole system is overused. You don’t need a study to show that. People go to the doctor when they have a cold, the flu, a broken toe, a simple rash, pulled muscles - loads of stuff you don’t need to go to the doctor for.

We need the public option because we need rationing.

I’m inclined to agree. Here’s a story from the same article that supports the “more can be worse” thesis:

[Natasha Saint ]Amand has spent her whole life in the Lewiston area, but like most people who live there, had no idea that the area had an unusually high rate of back surgery. The rate has varied over the years, but between 2003 and 2007, the rate of lower-back fusions in Lewiston was around 107 percent higher than in the rest of Maine.

Five years ago, Saint Amand was in a car accident and after that had serious pain in her back several times a week. Her doctor strongly recommended a fusion, and so she got one. And then another. And then another. And then neck surgery.

Now Saint Amand is in pain every hour of every day. She can’t bend at the waist or at her knees. Not for the original sickness, she says, but from the cure. She is disabled, and she says really understanding the reality of that took a long time.

“I think it really hit me after after my third back surgery and after I had my neck surgery,” Saint Amand says. “It really hit me that, wow, there’s really not much I can do. My leg is all nerve-damaged. My lower back is nerve-damaged. I have nerve damage in my left arm. There’s really not much left that doesn’t hurt.”

But anecdotal evidence isn’t enough when it comes to large scale public policy decisions. And the research shows some interesting counterintuitive things as well.

Yeah, don’t get me wrong - do the studies. But the real problem is the attitude and ignorance of the US populace. We treat health care like a trip to the beauty parlor. And we go to the beauty parlor too much.

My mother had severe chronic back pain for years and years. Many surgeries were proposed. She didn’t have any of them. One day, her heart stopped. She was brought to the hospital. She had Alzheimer’s - she wound up in a home. From the time she was in the hospital until her death two or three years later, she never had a moment of back pain.

I don’t know what caused the pain, or why it went away - I do have a theory. But clearly, the surgeries (which included at least one fusion) that were proposed were not required.

Right. I tentatively agree with you. {Hey whatever happened to Tentative?} But your mother was experiencing pain so it’s undertstandible that she would seek relief. Rational rationing has to come from someplace other than the sufferer. European countries have various kinds of rationing and the people seem to be accepting it. Do US citizens have a higher sense of entitlement?

YES! About everything!

This is a country where people get into fights over parking spaces. If they didn’t, and just walked a little, we save a couple of billion on health care right there!

Right. That’s largely a function of mass advertising. People have bought all these labor saving devices. The automobile has reigned supreme. Where I live there are no sidewalks or bike trails in a lot of places. You have to drive a car to safely cross the street in many places. If you’re out walking on the side of the street people think your homeless. They are the only people you regularly see on foot.

Another big factor is the hours people spend doing mind numbing work in this country. Last time I checked people work many more hours here than they do in other industrialized nations. It doesn’t leave much time for leisure activities that include enough exercise. Barely enough time to chug down a few alcoholic beverages, mow the lawn and fall into a stupor in preparation for Monday morning.

I don’t buy it, felix. None of this has anything to do with circling the parking lot a dozen times to get twenty feet closer to the front door of the store. Where I work, in a brew pub, people complain bitterly that they have to park in the back. And actually go up a flight of stairs. Maybe two or three hundred feet, from car to door.

I know plenty of people, as do you, who run off the doctor or the emergency room when in the slightest pain. And if, on that rare occasion, they don’t get pain relieving pills, they’re upset.

Americans are coddled, entitled, spoiled, soft - unable to endure the slightest hardship.

And entirely unprepared for it, as well.

The jack in my car has been used twice - neither time by me, on my car.

People giggle at me for always having a flashlight on me - until they need one.

And people complain about the first hundred dollars they spend to see the doctor, but not about the first thousand they spend on taxes to fight a ridiculous and useless war.

They have AAA instead of a car jack. And seem happy with a shitty health insurance plan that they don’t have to think about - until they need it. Until it lets them down and makes them broke.

The problem is that most health insurance in this country sucks. And it’s expensive. But people spend more time thinking about their next trip to the mall than about their health insurance. It’s too much trouble. Like walking a block to the store.

It’s a myth that we have good health care in this country. We just don;t.

Well I’m not disagreeing about the general state of America vis a vis health and health care. I merely supplied a couple of possible causes for it. What do you think caused Americans to become “coddled, entitled, spoiled, soft, and unable to endure the slightest hardship”?

World War II. It’s when we began to rule the world. My parents’ generation. We began to believe that everyone should have indoor plumbing, two cars and all the gadgets and gizmos that technology could afford us. We ruled the world. We were entitled.

Life was quite easy in the wake of WWII. Our economy was guaranteed to be the strongest, for the others were in shambles. Unions were tolerated, for there was plenty to go around. Unionism is the epitome of entitlement. You have longer tenure and you make more, and have automatic seniority (job security).

And there was a veritable explosion of cheap consumer goods. Transportation and communication were at last good enough to make the importation of even cheap goods viable. Oil was cheap, in part because of the hegemony we had in the Middle East, and because our own refinery capacity was so great - again, because of the war.

So everyone got a washing machine, a vacuum cleaner, a car, a boat - and we lived in suburbs - so we not only had plenty of room for stuff, but a convenient way to display it. We all had lawns and garages. And we could motor through our suburban subdivisions and see what our neighbors had. And they could do the same.

And if we were already here, with our union jobs or GI Bill financed professional careers and our suburban homes, the next waves of immigrants would not work along side us in factories, but as servants. Mowing our nice lawns and building our nice suburban houses.

We are kings and queens now, all of us. And we act it.

Very good. Understandable that people would want to hold on to or get back to that situation. It would be nice if we could just roll back the clock to a time when health care was affordable for most Americans. Conservative demagogues prey on people’s nostalgia for that period, but offer no viable means of getting there.

That’s exactly what they do.

Meanwhile this from today’s New York Times:

It all comes down to this: Should healthy, young people be forced to pay insurance premiums to make sure old people get their medications? You want to talk about a Ponzi scheme? How about me paying close to 20% on the off-chance that this entitlement program might still be around ten years around from now? Are you fucking kidding me?

Right, because healthy young people don’t get injured in car accidents. They don’t get pregnant or have children who require health care. They don’t get cancer or STDs, or the flu or require sports medicine care. Healthy young people are surrounded by a bubble of invincibility.

I have hospitalization and emergency room visits covered on myself and 80% prescription coverage. My wife and son have the full package, but I have everything that I think I need for myself.

I think that Herbal Liquor brings up a good point about values.

Ought I value my own bottom line more than my elders? What about society’s elders? Do we have some obligation to them?