Flame-o-rama ;) fixing the insurance industry

  1. Here's a fun topic....dedicated JUST to you, rebel lol.

    As the health care system becomes more and more irretrievably broken, my husband and I were discussing how we put less emphasis on high risk behavior for medical insurance than, say, car insurance. Your risk is re-evaluated yearly (or more) for your car insurance. If you have accidents or get speeding tickets or otherwise show high-risk behavior, your rates go up.

    Except for an initial medical exam (and that doesn't always even happen) peoples' health risk is not really re-evaluated regularly. Why is that? We spread out the rising cost of insurance among all users, and with the exception of smoking not holding accountable those whose lifestyle choices increase their risk of chronic illness.

    Proposal - mandatory yearly basic medical workup for insurance purposes. Cholesterol/triglycerides, BMI, BP, whatever factors you want to throw in that are largely within our control to change based on diet, activity level, etc. For those whose risks go up disproportionately, increase rates. Reward improvements with lower rates.

    I was actually just joking about the flame thing, but I would love to see a good healthy debate on this topic.
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  2. 18 Comments

  3. by   Allison P
    What about people who have genetic predispositions to certain conditions like HTN or CAD? Even with diet and exercise, some people are still at higher risk than others. How can we ensure that they wouldn't be discriminated against by having higher premiums because of factors that are beyond their control?

    Allison P
  4. by   Sleepyeyes
    A-hem.....did you know that auto insurance companies decide policy rates based, not on driving record, but on CREDIT history??
  5. by   Sleepyeyes
    Anyhow...more to the topic point---

    Maybe if preventative health choices were offered, such as exercise classes, smoking cessation, etc, maybe then I could agree with the increased rates.

    A lot of people would like to change their behaviors, but can't without help. For instance, Weight Watchers, or exercise club discounts, etc.
  6. by   Stargazer
    Ratched, I understand what you're saying, but the potential for abuse is almost unlimited. Allison makes a great point. I can easily foresee a future where individuals with a family history of, or genetic markers for, everything from MS to Huntington's to Tay-Sachs would become virtually uninsureable.

    And the annual physical thing is something I deal with tangentially in my current position. Annual physicals for everyone, particularly ones that were in-depth enough to be of any real use, by which I mean, at minimum, a CXR, EKG, a chem panel and CBC---are expensive. Initially at least, I think we would have to see a significant spike in insurance COSTS--to the point where small business owners, for instance, would not be able to provide it.

    It's a great ideal--I just don't see it as being do-able in the real world. If anyone's got reasons why that wouldn't be so, I'm all ears.

    I think Sleepyeyes has a great idea--why not offer incentives for preventative-health behaviors, much like the non-smoker or good-student car insurance rates? Offer "points" for wellness-type classes--WW, gym memberships, smoking cessation programs, etc.--which can be "redeemed" for lower co-pays on doc visits and presriptions, for example.

    Interesting topic!
  7. by   rebelwaclause
    Nurse R...Ya got my attention with the "flame" part! Thanks for thinking about me! :kiss

    You know, this is a good topic here. If we have a car accident, our insurance goes up. If we "utilize" our medical benefits too much, we are denied additional treatment, and put in the "black sheep" file. I think for chronic illnesses like COPD and CHF there are case managed programs most insurance companies offer. I worked for one who's goal was to decrease hospitalizations by helping members make healthy "choices" while considering their illness. What I found was most elderly people weren't willing to be telephone weekly and reminded about medication compliance, weighing daily, and the constant undertone of just how sick they really where. You think forced or mandatory membership would be justified for the 45 year old smoker and drinker who has a hx of 6 hospitalizations in the past year with a dx of CHF? Ejection fraction 15?

    I think we already are bull-dozing seniors as it is with their medical insurance. Its cheaper for a chemo patient to let themselves just get sick than to pay a $100.00 chemo deductible per visit (Here is California for Medi-cal). And supplemental insurance is a JOKE!

    Reward for improvements actually sounds good. Please let it be something other than a refrigerator magnet to hold my pages of medications I take on a daily basis...! (Hahahahahaha)
    Last edit by rebelwaclause on Oct 13, '02
  8. by   bagladyrn
    Okay - just for the sake of debate: What happens to those(irresponsible, degenerate, smoking, drinking, junk food eating) types whose insurance rates skyrocket and are unable to afford the premiums? Do they go on medicaid (thus billing us for their care) or do we just leave 'em out on the street to pay the price of their unhealthy lifestyle?
    Just doing my part to stir up some healthy debate here - liven things up.
  9. by   Nurse Ratched
    Thanks for the responses - I knew I could count on you guys . Points all taken.

    How about we do away with Medicaid after the age of 18? Preventative measures available to all in the vein of universal health care but actually is universal wellness promotion; genetic markers would not be permitted to be used to discriminate against people in the case of non-preventable diseases. People who otherwise have no risk factors but experience certain conditions that become labeled as genetic predisposition by default don't get "dinged" for it.

    And (just to digress) anyone who thinks that we can afford to pay for the medications of senior citizens is off their rocker (but I'll reserve drug prices and those dang pizza-ribing drug reps for another thread...)

    (stirring the pot, stirring the pot...)

  10. by   Stargazer
    Originally posted by Nurse Ratched
    How about we do away with Medicaid after the age of 18?
    Because that would leave an enormous segment of the population between the ages of 18 - 65 uninsured. Hospitals would go broke, 7-figure CEO salaries notwithstanding. And I think it would be a pretty sorry commentary on our values as a society if a country this well-off couldn't manage to take a little better care of its poor and unemployed.

    What I would like to see is a way of reducing ABUSE of systems like Medicaid. Best example? Those folks who use the ER as their primary care provider.
  11. by   Nurse Ratched
    Originally posted by Stargazer
    What I would like to see is a way of reducing ABUSE of systems like Medicaid. Best example? Those folks who use the ER as their primary care provider.
    Excellent point.

    Know what the #1 reason for ED visits in my hospital is? Sore throats. (I have no idea what the breakdown is by payer source.)
  12. by   dianacs
    I think Sleepyeyes has a great idea--why not offer incentives for preventative-health behaviors, much like the non-smoker or good-student car insurance rates? Offer "points" for wellness-type classes--WW, gym memberships, smoking cessation programs, etc.--which can be "redeemed" for lower co-pays on doc visits and presriptions, for example.
    How would you quantify those behaviors/actions which do not involve some kind of formal membership? For instance, I eat a lot of fruits, vegetables, and whole grains on a daily basis. For exercise, I run in my neighborhood or lift weights at home. Aside from quantifying how much these are worth incentivewise, how would I even prove to the insurance co. that I eat healthy foods and exercise? A healthy diet and exercise are the two biggies as far as health is concerned, so these actions would have to factored in somehow. This is an interesting debate--I'm looking forward to hearing some more ideas.
  13. by   Stargazer
    Originally posted by Nurse Ratched
    Excellent point.

    Know what the #1 reason for ED visits in my hospital is? Sore throats. (I have no idea what the breakdown is by payer source.)
    Oh, that is just so very, very wrong. And maddening, by the way.
    Originally posted by dianacs
    I eat a lot of fruits, vegetables, and whole grains on a daily basis. For exercise, I run in my neighborhood or lift weights at home. Aside from quantifying how much these are worth incentivewise, how would I even prove to the insurance co. that I eat healthy foods and exercise?
    Well, lessee, we could make you strap on a pedometer to track how far you run, and you'd hafta submit all your grocery bills...Dude, I don't know! I'm just throwin' out ideas here!

    It's a fair question. I exercise at home, too, and I definitely want points for all the carrots I eat and all the Big Macs I don't.
  14. by   MollyMo
    It doesn't matter what your eating habits are, how high your cholesterol is, whether you smoke, drink or do drugs. It doesn't matter if you're sick more than you're well; in the hospital more than you are out. What matters to the insurance company is your weight. How do I know? Because I've had plenty of them tell me that I will never be insured because of my weight. My whole lipid profile is normal, my BP is normal, I'm not diabetic. I don't smoke, drink or do drugs. I've been in the hospital as a patient three times in my 41 years of living. I was born in 1961; I had an umbilical hernia repair in 1968 and I had my tonsils out in 1972. But I can't get insurance because of my weight. One rep even told me that they would insure some one who had pre-existing conditions but who was "normal" weight before they would insure me. What kind of torro excretio is that?!!

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