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Senate Health Care Bill: Shape Up! Or Pay Extra!
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by Roy C | October 17, 2009 at 11:11 am
629 views | 56 Recommendations | 30 comments
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This writer, certified as a personal trainer, has to admit to being pleasantly surprised by an overlooked aspect of the Health Care bill that has recently come out of committee.
The aspect? That the US Senate bill has a wellness plan to charge high-risk individuals more for their coverage to help reduce costs. This has received next to nothing in terms of news coverage.
As I had pointed out in a story about the Safeway Health Plan, the only way that we can provide an aging population affordable medical care as technology gets more sophisticated and a lot more expensive is to use wellness plans and financial incentives to keep people healthier and reduce the need for medical intervention.
The Safeway Health plan has effectively contained costs for the last several years. The Whole Foods Health Plan has had similar success, and there are others.
This approach, having policies and premiums reflecting your weight, smoking and other health habits, will not stop you from being covered. However since the wellness/preventive medicine approach will raise your premiums in an effort to make you accountable for your health and reward you for efforts taken to reduce your risk, labor unions and others who want total inclusion see it as a version of exclusion for pre-existing condition.
Backers of this approach say that your premiums or your deductibles will reflect your commitment to a reducing your risks and that this approach is completely comparable to automobile insurance.
Some analysis of why this has gone essentially unreported: the so-called Mainstream Media root for the Obama administration and know that this type of wellness plan doesn't sit well with key Obama constituencies such as labor unions and others who oppose exclusions based on pre-existing conditions.
Meanhwile, the right seems to be opposed to anything with government involvement. In any case, I assume the right doesn't want to come out with any approval of anything in the ObamaCare package. The right also had ambivalence about having to admit to the need for such economic incentives while they lambaste rationing and seem to promise care without regard to limits for the elderly.
Get in shape or pay a price.
That's a message more Americans could hear if the health care reform bills passed by the Senate Finance and Health committees become law.
By more than doubling the maximum rewards and penalties that companies can apply to employees who flunk medical evaluations, the bills could put workers under intense financial pressure to lose weight, stop smoking or even lower their cholesterol.The initiative, largely eclipsed in the health care debate, builds on a trend that is already in play among some corporations and that more workers will see in the packages they bring home during this month's open enrollment.
The current legislative effort takes the trend a step further. It is backed by major employer groups, including the U.S. Chamber of Commerce and the National Association of Manufacturers. It is opposed by labor unions and groups devoted to combating serious illnesses, such as the American Heart Association, the American Cancer Society, and the American Diabetes Association.
National epidemic of obesity
The incentives could attack a national epidemic of obesity. They also cut to a philosophical core of the health care debate. Should health insurance be like auto insurance, in which good drivers earn discounts and reckless ones pay a price, thereby encouraging better habits? Or should it be a safety net in which the young and healthy support the old and sick with the understanding that youth and good health are transitory?Under current regulation, incentives based on health factors can be no larger than 20 percent of the premium paid by employer and employee combined. The legislation passed by the Health and Finance committees would increase the limit to 30 percent, and it would give government officials the power to raise it to 50 percent.
A single employee whose annual premiums cost him and his employer the national average of $4,824 could have as much as $2,412 on the line. At least under the Health Committee bill, the stakes could be higher for people with family coverage. Families with premiums of $13,375 — the combined average for employer-sponsored coverage, according to a recent survey — could have $6,687.50 at risk.
An amendment passed unanimously by the Health Committee would allow insurers to use the same rewards and penalties in the market for individual insurance, though legislative language subsequently drafted by the committee's Democratic staff does not reflect that vote, Sen. Mike Enzi (Wyo.), for the committee's ranking Republican, has said.
The bill drafted by the Senate Finance Committee
would set up a trial program allowing insurers in 10 states to use wellness-based incentives for individuals.
America's Health Insurance Plans, an industry lobby, has argued that insurers should be allowed to consider participation in wellness programs when setting individual premiums. Valeo, a supplier of auto parts, four years ago raised the deductible on an employee health plan to $2,200 from $200 for individual coverage and to $4,400 from $400 for family coverage. Then it gave employees the opportunity to reduce the deductible to its starting point by being nonsmokers and meeting goals for blood pressure, cholesterol, and body mass index, said Robert Wade, Valeo's director of human resources for North America.
"If they don't comply they end up being penalized, if you will, but we refer to it as a Healthy Rewards program," Wade said
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Most RecentMost Recommended Comments (30)
at 11:56 on October 17th, 2009
So, do I get on the "good list" by backing effective health care reform? :)
at 13:16 on October 17th, 2009
Good health care must include mental for not addressing the root of the cause for one to not take care of their body is in vain..
Have you seen the horrific show on tv about taking 3-400lb people and putting them thru a drill worse than the military...? It is insane...and unhealthy..not to mention totally unrealistic. They will not keep their weight off.
at 13:24 on October 17th, 2009
Does it state what the high risk conditions are?
Smoking and weight are the obvious ones. Where there any others?
I am asking this because there are some conditions more prevalent in urban areas, and I would not want to see anyone discrimminated against or this used in a non-egalilarian way.
at 14:36 on October 17th, 2009
From what I can gather, and I have frequent conversations with health care execs and wellness experts due to the nature of my work, it is all run on real risk as worked out from the databanks that they have on correlations between certain lipid profiles, for example, and how the group that has that lipid profile will do when it comes to heart attacks, strokes, high blood pressure medication, and cost.
Weight is number one. Weight helps produce heart disease, strokes, diabetes, and osteoarthritis. Smoking and other addictive activities such as heavy drinking and drug use are probably second on the list. Then comes bad nutrition.
at 15:48 on October 17th, 2009
The bad nutrition could run into problems, especially when it comes to ethnic foods.
Not that I am a proponent of poor eating habits, but some diets have more fat, hence, cholesterol could be an issue. Would someone with high cholesterol have to pay higher premiums, if for example, they are Hispanic and their foods are cooked in lard, rather than oils containing no trans fats. These are hypothetical questions, but I think worthy of discussion in terms of defining certain conditions that would prompt increased premiums. Also, some people have conditions like high cholesterol that is not diet related; therefore, they should not have to pay higher premiums because their condition is not lifestyle related.
I would be in favor of system that if a person has high cholesterol is quoted a premium price, and they successfully lower their choesterol, their premiums should lowered. The same with weight loss and smoking cessation. Money is a good motivator, so perhaps this system might encourage people.
In general, any parts of health care reform that give the insurance companies loop holes that arbitrarily give them the ability to raise someone premiums has to be specially spelled out with little to no intepretation left up to the insurance companies.
at 15:55 on October 17th, 2009
No, cholesterol is not going to be looked at that way.
Lard will not raise your cholesterol much more than corn oil will.
Yes, I said "corn oil will". Why? Because omega-6 oils raise inflammation in the body and the body responds to this increase in free radical activity by raising the cholesterol level. Cholesterol is a low-level anti-oxidant of last resort.
Hispanics get fatter in America the longer they are here and the farther they are from the border.. Same for Asians. They should go back to eating traditional foods, as far as I can see.
But, if not true, why do I have to subsidize the cost of your ancestors' bad habits to be "fair"?
We are all responsible for ourselves.
at 16:18 on October 17th, 2009
Wow all the premiums are very high even $2,412. I can never understand why you have not got a national heath system such as UK. Your being sold short.
at 16:57 on October 17th, 2009
200 dollars a month is not high. I paid less in Italy but I paid a lot more in taxes. Same as UK.
Hey, give up cable TV and your cell phones and you have 200 bucks a month. No excuse.
at 16:29 on October 17th, 2009
Well then I can see the bureacracy growing bigger and bigger...paperwork! I think and feel that anything like this controlled by the Government is going to be a big "expletive" mess.
Doctors should treat anyone uncondtionally . When someone goes in Obese then if they do not get the mental h elp they will not make it. If they can't after that then what. We put them on welfare and watch them roll around in mobile shopping carts hanging over and buying junk food. We support that don't we. I see it everywhere. Will they develop a system where if you have a college education and have made contributions to society then you will get some benefits? The hospitals now have what is called shit wings. Only people there are treated who are on medicaid. There is no system that can be set up that will judge fairly for people going thru different transitions in their lives go in and out of some bad habits. We have so many mental problems that must be treated. I hear no one discussing this for it must still be a shameful act to need counseling. Anyone who overeats, overdrinks etc. must have both...the physical and the mental
I am not informed actually to discuss this but thought I would give ya my bit.
Obama does not value the fact that a human alive is precious ...even if they breathe for they may be affecting the auric atmosphere. They could very well be sending loving molecules into the air. I do not want this elitist snob who will not do anything he asks americans to do concerning taxes to be making moral decisions for he is really not a mature or wise man.
We will continue to disintegrate as a country until the leaders really are connected to soul development. The inner world must be recognized..discovered.. it is the jewel...not a collossal Government Bad Health Care Center.
at 17:05 on October 17th, 2009
No one stops acting out if no opposition to the acting out occurs.
I don't quite agree that everyone overweight is acting out, anyway. "Jarod" of SubWay stopped eating crap food and got thin.
Sometimes taste preferences and habit override good sense. Later on, good sense takes over.
at 16:29 on October 17th, 2009
My plan is to have nothing to so with this plan.
All these ideas will add bureaucrats to those we already have.
We have to remember the government is not giving us health care.
They are taking our money to set it up- and trying to force us to spend more on their plan.
at 16:44 on October 17th, 2009
Who is going to maintain the list of bad habits and enforce it? My God , universal health care is universal health care. Why does it have to be so complicated? People aren't cars and shouldn't be insured that way.
Recommendation to Congress: Get a copy of the Canada Health Act and Americanize it. Decentralize the Administration to the States. Believe me it works.
at 16:58 on October 17th, 2009
Not in this aspect. This will all be done by private insurance anyway. What private insurance needed was permission to do such plans better and more completely.
at 17:31 on October 17th, 2009
Disagree, ACP.
I am not paying for someone's bad habits. Pay for your own bad habits. Getting lipid profiles better is not a form of torture, but rather easily accomplished with some good nutrients such as niacin, policosinol, pomegranate extract, and cod liver oil.
Losing weight is not that hard either.
And, you will get a reward for it. More cash or a lower deductible.
Insurance is completely set up to do this, just as it is for cars and drivers.
at 17:32 on October 17th, 2009
Revelation Roy, you pay for people;s bad habits now when you buy automobile insurance. I am not for punishing the disadvantaged in society because all they can afford is pasta and other stables. It takes money, in this society to live healthy. If you go with the recommendations of the Canada food guide, it almost impossible for those living on or below the poverty line.
It doesn.t matter how you turn it, you will pay for all those insured. That is how the system works. To punish the poor is counterproductive to a Health Care System.
Sometimes I think the whole thing is about every dog for himself.
Roy there are thousands of articles on good nutrients, which one right? You can.t treat people like an automobile.
I am pleased that our Health Care System shows some compassion for the less fortunate. Why would I want to punish them even more.
In this case we will just have to agree to disagree.
at 18:22 on October 17th, 2009
ACPl, if you weigh 50 lbs more than you should, that is not the fault of pasta. Italians only got fat as they stopped eating pasta.
We don't treat them like cars, but like drivers. :)
Poor people need to stop eating at fast food places or the fast food places need to change the percentage of fat in their food.
I will pay for help for an alcoholic, but I will not pay for a man who does nothing to help himself. I suppose we should give him a new liver just as fast as someone who lost their liver to hepatitis?
ACP, these programs work. They work well. There is nothing Draconian about them.
at 02:13 on October 18th, 2009
Roy I believe in taking care of your body and eating healthy, however I don.t want the government or anybody else setting a standard of what is and what isn't healthy eating or lifestyle. This would become a bureaucratic nightmare.
With constant conflicting studies of what and what may not be good for you, who will make that decision? What standard is used to determine if you.re overweight?
I.ll give you an example of a ridiculous overweight program. When I was with the Canadian Airborne School, a program was in place that measured BMI. Seven or eight of our instructors exceeded the BMI indicator. Under the program it was required to send them to a medical officer for assessment. Well the reason their BMI was over the limit was due to muscle and not fat.
Needless to say this program took up unnecessary time of Medical Officers, the Chain of Command and the accompanying paperwork.
These programs may work for you, but they may not work for everyone.
at 06:45 on October 18th, 2009
ACP, this is about what private insurance can do.
I am well aware that the BMI is a bad measure of body weight being too much or too little. Private insurance companies look at a whole panoply of indicators, especially lipid profiles, along with body weight and other habits.
Any program will have flaws that need improvement.
Not having wellness programs means that limited resources are used up and can't be used elsewhere.
at 18:49 on October 17th, 2009
An overeater deserves as much help as an alcoholic..it is just a slower death and more repulsive to the public..They are sad , unhappy people. Maybe we have so many fat people cause the country sucks with no good places to work anymore and even if you do you can barely make ends meet.....AND THE WOMEN usually have to work so there is no real nourishment coming from the home. One has to plan, shop often and have money to eat healthy. We are spirit too. Is a disease more honorable if it is not self inflicted?
The fast food places popped up because no one is home cooking anymore. People are hungry because they are in pain..it is the solar plexus...third chakra that gets blocked when feelings are anaesthetized from food..a type of pain killer for the soul of the body...the alcohol shuts the brain down....smoke represses rage...
at 19:13 on October 17th, 2009
Agreed.
Also, fast food is addictive, literally. Did you see the documentary on the guy who lived on McDonald's for thirty days? What it did to his blood chemistry? His weight?
He had no problems.
Some people just don't eat right because they don't know. The rest need help, and they might start looking for it when their premiums go up.
at 19:49 on October 17th, 2009
Make health care universal, take competition out of the picture by putting the gummit in charge, and you will literally be giving your life over to gummit control.
Think the mavens of mercy will allow you to eat things that are bad for you? Won't happen overnight, but give it time, they will be scheduling time at the gym for you, or some other form of nonsense.
Is healthy food bad for you? Is an enforced workout unconstitutional?
Try it when they force it on you. Won't be able to find a different job to get better health care. What they got is what you get.
Four pounds of paperwork every time you want to see a doctor. Counseling about your lifestyle.
Think it can't happen? Talk to someone on Medicare, or the folks behind the scene that do the paperwork or the counseling.
O, it will be swell. Big Bro will take care of us, cuz we ain't smart enuff, thass fo sure.
at 20:31 on October 17th, 2009
With this program, private insurance will have the chance to develop what the gov't could never do: find a way out of spiraling costs to fiscal "do-ability".
- reply
Kal Alex (not verified)at 23:18 on October 17th, 2009
There are other factors that must be considered when trying to force a population to 'live right'. Some of those factors have been brought up; ie- Who decides what 'living right' system will actually work for the majority of the population, Who decides when not 'living right' isn't the fault of the individual, and Who pays for this 'living right' lifestyle? Other factors? How about loss of employment, leading to the increase of those required to have coverage not having coverage? If fast food becomes a villain (and Americans love to have villains), the loss of business could not only increase unemployment, but put some companies out of business. Another factor would be the loss of taxes on 'evil' products. In my state, I believe we have around $3.30 in taxes on every pack of cigarettes sold. (I recently watched a person pay $9.00 for one pack. If that doesn't drive one to quit, I don't know what would.) These taxes pay for many programs we would not want to lose. With quitting smoking being a necessity, these programs would need to find funds elsewhere, probably in other forms of taxation. How about recreational activities? Should a skydiver have to pay more? Statistically, you are more likely to be hurt or killed driving to work everyday. Should those who drive to work pay more? Should carpools also pay more, since a car with carpoolers increases the number of people potentially hurt or killed in one accident? Think very hard before giving the government the ability to financially control how you live, what you eat, where you go for recreation. That is a level of control you will ultimately be unable to control.
at 07:47 on October 18th, 2009
Kal I couldn't agree more. Besides the private insurers have had decades to get it right. I don.t want anyone to tell me what to do. I have undertaken many risk related activities, including skydiving, riding, cycling in a city, four wheeling, etc, etc.
A program like this, in my mind, would be a nightmare, let alone to think of some bureaucrat or the health care industry is setting the standard.
at 07:54 on October 18th, 2009
Not true about the "decades".
Private insurance was not even allowed to do this for the most part, ACP. That is precisely why the law had to change.
The law!
Now, Safeway Health plan makes it where people take home more pay because they have to pay out less in insurance premiums.
The union likes it. The workers like it. Management likes it.
If you go sky diving, you should pay more for life insurance. If you climb Mt Hood nearby and want to be rescued, then before you climb you should pay an insurance fee to provide the service.
One last point. BMI is for collecting data on groups. No one should be using it to evaluate an individual.
All well-informed physicians and personal trainers know this. Apparently your military didn't. Aren't they the government?
at 07:57 on October 18th, 2009
Source: my.nowpublic.com
Notice it says "allow". That means that permission was not there to do this previously.
at 08:30 on October 18th, 2009
So, what you all don't seem to get is that you are asking the non-smokers, and the light drinkers/abstainers, the ones who eat well, to subsidize the medical costs of people who won't rein themselves in!
You don't want to be told how to live by the government, a sentiment I share, but you would willingly use the government to tell me to pay money to them to pay the medical bills of people I don't know, and that I will be arrested and put in jail for not paying these taxes.
That aspect of "government bureaucrats telling me what to do" is OK?
Does not make sense to me. :)
at 08:59 on October 18th, 2009
We offer help, and we subsidize it, but when it comes time to do a liver transplant, who gets it first? The nurse who got it working in a hospital or an alcoholic?
When we replace knees, do we do the surgery first for the policeman or construction worker injured on the job, a crime victim, or the guy who weighs 350 lbs.?
There is no way to give everyone everything without a demand at their end to at least pay more for services that will be provided to them more often.
at 09:46 on October 18th, 2009
Some really interesting debates here and some really good points made. I get impatient watching someone smoke outside a hospital and dragging their intravenous stand with them, but it is part of our social contract to treat everyone to the best of our ability. Sure it costs a lot in taxes and our system in BC is far from perfect, but you know you won't have to mortgage your house to get cancer treatment. On the other hand waiting lists are growing for so called elective surgeries. We do have the option of going private on some of those.
at 10:20 on October 18th, 2009
No one envisions going draconian, but I will make a point about Alberta, Canada.
Recently, they cut back on surgery for transsexuals.
I would bet that if all the good (adult) people of Alberta ate 200 calories less in an entire day, the oil in two tablespoons, with the resultant decrease in weight, improvement in lipid profile, reduction in need for pharmacological agents for blood pressure, the wages not lost for heart attacks, strokes and the cost of therapy, that surgery could be restored. There would be funds for it.