<p>Expanding on TatinG’s post, instead of messing up the coverage for so-called healthy people, I would prefer to pay a tax along with everyone else to subsidize coverage for low income people who are sick for genetic reasons or just plain bad luck. Not so for voluntary undesirable behavioral actions.</p>
<p>I don’t disagree but now it gets tricky. Is dropping out of 10th grade to have a baby and virtually lock yourself into a life of poverty voluntary?</p>
<p>It would be interesting to hear from the doctor’s on this forum. My friend can tell the tales, anonymously of course. The guy who never changed his wound dressing until he came to her office with a ghastly infected pus-filled smelling mess. Simple things like that. You’d think it would be more trouble going to the doctor’s office than taking care of a wound himself. </p>
<p>My own mother is told by her doctors to keep her feet up as much as possible to stop her feet from swelling. But does she do it? No. She’s also told to drink more water and go to the bathroom more to stop UTIs. Not really doing that either, despite the fact that UTIs have put her in the hospital several times.</p>
<p>Texaspg, interesting link. I think the story is an optimistic one. The problems are not insurmountable.</p>
<p>Do we apply this sick-people-blaming to our own families? A look at the Parents Taking Care of Parents thread shows a lot of us with parents who have serious health care needs. Do our parents follow all the dreary, joyless recommendations of their doctors? Are they losing weight, eating low-salt, unspiced food like they are supposed to? Are they doing all the exercises they are supposed to do? I know my mother is not perfect in doing what she is supposed to do.</p>
<p>If we aren’t willing to remove our own parents from Medicare because they aren’t following all the recommendations of their doctors, then why are we willing to withdraw health care support to others, who may have more unpleasant lives and worse health conditions to deal with?</p>
<p>[on edit] Xpost with TatinG, who says her mom doesn’t follow all the recommendations either.</p>
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<p>It not <em>me</em> skimming off healthy people - its them acting rationally. </p>
<p>If you have actually sick people people in the pool, like they know they will incur >$50K in services in a year, then I think the expense is going to be roughly the same. They max out the out of pocket early and then is lower premiums vs deductible. </p>
<p>We are are really talking about is not the “sick” so much but they regular person who might use health care a few times a year vs the health guy who is never in the doctors office at all. </p>
<p>By having forcing them into a comprehensive plan you force them to use services they otherwise wouldnt. If you are paying $3500 a year in premiums dont you have an incentive to use health care. </p>
<p>Comprehensive plans drive incremental spending that wouldnt otherwise exist.</p>
<p>Well, we have singled out smokers. That seems to be the only bad behavior we are allowed to punish. I should think drug addicts and alcoholics could be quite costly. It’s a little odd.</p>
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<p>I don’t dispute that they are acting rationally. I merely point out that the result is adverse selection.</p>
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<p>The copay is supposed to discourage you.</p>
<p>Hey I am in the doctors office with a cold and he tells me its a virus. I’m not going home empty handed for $3500 bucks- give me a zpack. And while you are at it run some cultures.</p>
<p>Hey argbargy, Do you have the actual premiums for catastrophic, bronze, silver and gold for some particular age group for some area? I want to play around with a spreadsheet and look at who would choose which plan.</p>
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<p>California and other supposedly caring states have decided not to charge smokers more. Go figure.</p>
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<p><a href=“http://www.webmd.com/health-insurance/20130716/how-affordable-care-act-affects-smokers[/url]”>WebMD's Guide to Quit Smoking;
<p>No only should smokers pay more, fat people should pay more. We have an epidemic of obesity and charging fat people more would help end that.</p>
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<p>It’d be nice to have doctors with skin in the game:</p>
<p>Doctor: Your strep test is negative. You just have an ordinary sore throat. </p>
<p>Silly patient: Could you give me a prescription for antibiotics?</p>
<p>Doctor: No. You don’t need antibiotics. All you would be doing is wasting money and creating antibiotic resistance. No.</p>
<p>Argbargy, do you buy insurance in the individual marketplace?</p>
<p>“Doctor: No. You don’t need antibiotics. All you would be doing is wasting money and creating antibiotic resistance. No.”</p>
<p>Lawyer: See you in court.</p>
<p>Nah… It is hard to sue…</p>
<p>Yeah- I’d say use this Federal spreadsheet and apply filters to the county you want
<a href=“https://data.healthcare.gov/dataset/QHP-Individual-Medical-Landscape/ba45-xusy[/url]”>https://data.healthcare.gov/dataset/QHP-Individual-Medical-Landscape/ba45-xusy</a></p>
<p>To put together the plan details you can use ehealthinsurance. For instance
[Anthem</a> Catastrophic Direct Access - California Health Insurance - Anthem Blue Cross](<a href=“http://www.ehealthinsurance.com/health-insurance-companies/anthem-blue-cross-california/benefit-detail/?health-plan=200026]Anthem”>http://www.ehealthinsurance.com/health-insurance-companies/anthem-blue-cross-california/benefit-detail/?health-plan=200026)</p>
<p>“No only should smokers pay more, fat people should pay more. We have an epidemic of obesity and charging fat people more would help end that.”</p>
<p>Sounds good to me.</p>
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<p>It would be nice to have patients with skin in the game. </p>
<p>Doctor: And so I’ll scheduled you in at Cedars for the laser treatment…</p>
<p>Patient: Whoa- what is this going to cost?</p>
<p>Doctor: Cost? I dont understand. Most people like Cedars. They have an espresso girl. </p>
<p>Patient: Yeah I am paying for this- can I see a cost break down. Why does Cedars have a facility charge of $5K?</p>
<p>Doctors: Well they have a high patient sat. Did I mention the espresso girl? And they have a new laser.</p>
<p>Patient: Do I need the laser?</p>
<p>Doctor: No, I could use a regular scalpel at the outpatient surgery center down the street, thats only $500. But there is a chance it could leave a white scar. And they only have Sanka. </p>
<p>Patient: Its the back of my knee, I’ll take a chance on a scar for $4,500. </p>
<p>And scene…</p>
<p>Yeah, and when we get rid of all the fat people lets go after all those with high blood pressure. Lets get the diabetics too. Lets charge certain races more since they have specific health issues but keep having children. How about women over 40 who get pregnant and have a child with Down’s syndrome. Yeah, who else? Oh, how about anyone who is not a vegetarian? Those beef eaters…lets get them. And oh yeah, how about anyone who s not eating organic only.</p>
<p>Slippery, slippery slope folks.</p>
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<p>You cant equate the new morality with risk. </p>
<p>Smokers actually costs the system less money than non-smokers. </p>
<p>And meta studies show that the pleasantly plump have a lower mortality rate than regular BMI and low BMI types have a higher mortality than both. </p>
<p>For the sake of my premiums I demand all women look like Nigella Lawson or face surcharges.</p>