Health Insurance 44

[tbonebanjo]

I was just wondering how many companies still have good insurance and how many have gone the way of Obamacare. I am in a small MEP firm in Maryland. Our health insurance just changed, our premiums went up and our coverage went way down. I have maximum out of pocket expenses of $12,500 per year, $4000 deductable per person, tnen start the copay schedules. Should I start looking for other employment or are all companies being affected this way?

 

[cranky108]

Why not rate car drivers ability to drive and tax them accordingly for the same medical reasons. It taxes people who drive fast, and a factor for miles driven.

Make sin taxes inclusive. Motorcycle drivers pay more in taxes, and even more if they don't wear helments.

It's the same a sin taxes on food.

 

[KENAT]

Well, if you look at automotive insurance as a kind of tax since govt requires you to have it then this already happens, mostly based on statistical norms but at least one Insurance company will loan you a device that plugs into you cars on board computer to gather certain driving behavior data and supposedly adjust your rate accordingly.

Of course, one of the outcomes of the statistical side of car insurance rate setting is that women tend to get charged less than men, other factors being nominally equal. Statistically total costs of accidents by male drivers is apparently higher.

In health care, the cost of care for women tends to be higher than for men. However, the idea of charging women more for healthcare is highly contentious and often legislated against. Mostly because much of the difference in cost is probably related to the role women pay in reproduction of our species and it is arguably a bit unfair to charge them more for doing the heavy lifting when it comes to maintaining our genetic line.

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[glass99]

davefitz: $15k/day for neo natal intensive care adds up pretty quick. I would be interested to see how the hospital thinks that $15k/day is broken down.

cranky + Kenat: driving is an inherently risky business, and offloading your risk to other drivers is kind of sketchy. If you commute 100 miles a day at 90mph, you should not expect to be paying the same flat rate as someone who only drives on weekends. If we all had a straightforward metric we could track and control which is tied to our insurance premiums (like distance driven or speed), it lets us work to reduce cost. When we have no levers to pull, we finish up with the US healthcare system.

-> Could our health premiums be tied to our BMI's?

 

[IRstuff]

"I just saw a report of a Canadian woman who had her child while vacationing in Hawaii (US), and the US hospital sent her a bill for $600 K USD. Talk about post-partum depression."

http://www.today.com/parents/canadian-mom-who-gives-birth-hawaii-gets-near-1-million-1D80302220

note that the supposed charge was actually around $900k US

So, the baby was 10 wks premature at birth, hence neo-natal for 2 months. The roughly $15k/day is not that unusual, given that my kid's stay in the non-ICU hospital for pneumonia clocked in at $5k/day

Interesting that this is suddenly coming up now, even though the baby in question is almost a year old.

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[beej67]

davefitz: $15k/day for neo natal intensive care adds up pretty quick.

Unless I'm crazy, it takes somewhere around 40 days for it to add up to $600,000.



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[beej67]

My response appears to have been sniped.

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[KENAT]

"-> Could our health premiums be tied to our BMI's?"

I pray not, BMI is an extremely crude measurement. People with a lot of muscle mass and/or naturally high bone density (i.e. those of us who sink in the swimming pool) may have very poor BMI scores despite being relatively healthy. Many serious athletes have poor BMI due to all the muscle despite getting lots of exercise and being relatively fit by most measures. (Obviously participation in sports increases certain health risks though.)

Don't get me wrong, I know I'm a bit overweight but my BMI gives a truly misleading impression of just how badly - at my last annual exam my doctor even came out and said so.

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[glass99]

Kenat: acknowledged that BMI is crude, but its not that crude. An athlete with six pack abs is going to have lower BMI than couch potato with a different kind of six pack. BMI is tied to all kinds of expensive health risks ranging from heart disease to cancer. BMI is also something comprehensible and controllable by individuals.

 

[cranky108]

My comment was in reference that people who have more auto accedents use more medical care. Medical care usage is not just limited to a persons health, but people who maybe more accident prone also use more medical care. So why would a cost allocation be solely based on a persons health.

 

[KENAT]

glass, I've seen amateur sportsmen, gym enthusiasts etc. whose BMI was no just in the overweight category but into obese etc. such that they had trouble getting life insurance.

So to me, it's too crude.

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[beej67]

Depends on the athlete. A football player with 3% body fat is still going to have an overweight / borderline obese BMI. A tennis player won't. It all depends on what you're training for.

BMI is too crude, but timing a one mile jog wouldn't be a bad idea at all.

Good luck getting that past the voters.





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[SPDL310]

In health care, the cost of care for women tends to be higher than for men. However, the idea of charging women more for healthcare is highly contentious and often legislated against. Mostly because much of the difference in cost is probably related to the role women pay in reproduction of our species and it is arguably a bit unfair to charge them more for doing the heavy lifting when it comes to maintaining our genetic line.

While obstetrical is certainly a factor adding to the discrepancy in male and female health care costs, women still consume more across the board healthcare than men.

If you are in favor of a high sin tax to pay for the future care of alcohol and tobacco consumers, what is the difference between a government taxing those consumers in order to offset the perceived future costs they will cause a public service, and a tax on say parents to compensate the government for the perceived cost of educating their child.

 

[IRstuff]

The baby was supposedly in neonatal for 2 months given that the article states that the overall bill was over $900k, not $600k. Possibly, that's factoring in the cost of the delivery, but that's usually less than $50k. The hospital and state apparently chipped in enough to just get the bill down to $900k.

"An athlete with six pack abs is going to have lower BMI than couch potato with a different kind of six pack"

In many cases, the BMIs for athletes, particularly those that require strength muscular as opposed to fast twitch, will be considerably higher than BMI guidelines for obese. BMI is so blunt that a weighlifter or bodybuilder can have substantially higher than 30 BMI. Of course, one might possibly argue that neither of those are particularly healthy...

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[moltenmetal]

Apparently neither the province nor their travel insurance company want to pay this bill...if they'd not left the country, it wouldn't have cost them a cent.

 

[IRstuff]

One thing they attempted to do, but failed, was to acquire travel insurance, which was rejected due to the pregnancy being an "pre-existing condition." From a business perspective, that insurance company made the correct decision, given that the premium would have been insignificant compared to the eventual hospital bill.

This is one of the horns of the dilemma of insurance, "pre-existing conditions" generate definitive, nearly certain, cost exposure, which is not really the model of classical insurance.

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[glass99]

One thing which is cruder than using BMI to determine health insurance rates is not using BMI. By not having any incentive or cost in place tied to people being responsible for their weight, people rationally become irresponsible. You the responsible whole grain eating person are paying for the dude driving down the street with a 48oz Big Gulp in one hand and a insulin needle in the other. This guy is stealing from you if you pay the same insurance rate.

 

[IRstuff]

But, a blunt instrument is not necessarily any better, particularly if it winds up getting pushback from those that will be erroneously penalized. BMI does not measure health; it measures weight relative to some arbitrary reference. To force everyone into the BMI metric may have the same unintended consequences as the "war of fat." One would hope that given all that's transpires over the last century with missteps medical and health advice, we should now know that what is seemingly and intuitively "right" can turn out to be drastically wrong.

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[beej67]

I'll say again, time everyone in a 1 mile jog. I bet you get a very tight correlation between that and overall healthcare costs. Most healthy people I know, regardless of BMI, would knock that out no problem. Most unhealthy people I know, regardless of BMI, would really struggle with it.

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[glass99]

IRStuff: We can't ignore the obesity problem - it drives health costs as much as practically any other factor. If not BMI linked premiums, then what? While I agree that medical science has been wrong about a bunch of things, I think they are correct when they say it is unhealthy to be 300lbs if you are 5ft tall.

 

[IRstuff]

I would see a plausible approach as one using a personally-keyed FitBit, which I think is a better approach than a BMI approach, since the latter is a rather passive measure, and more difficult to convert into meaningful progress. There are already literature that says a substantial uptick in activity will still drastically improve your health, even if there is no significant change in BMI.

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