<p>The Wikipedia article that was quoted is misleading at best. “A recent study concluded that 15% of people shopping online for health insurance are considered “uninsurable” because of a preexisting condition, or for being overweight. This label does not necessarily mean they can never get health insurance, but that they will not qualify for standard individual coverage. People with similar health status can be covered via employer-provided health insurance, Medicare, or Medicaid.”</p>
<p>This blends together people of all different ages. The percentage of the population 55 and over who were declined coverage on individual policies is much, much higher than 15%. My state’s state-run plan for those who were turned down and who were uninsured for many months quickly closed because it hit the enrollment cap. It’s so nice of the article to suggest that they can simply get employer provided coverage, since everyone knows that getting a new corporate job when you’re 55 or older is so very easy. (And non-corporate jobs are still pretty unlikely to provide health insurance.)</p>
<p>Like Goldenpooch, I’d prefer to have health insurance options that let me pay the first dollar cost of preventative services in return for a lower premium, but I understand why they didn’t go in that direction. I don’t need health insurance to help me pay for the equivalent of oil changes or tune-ups; I need insurance to help pay for the transmission rebuild.</p>
<p>Mnmomof2’s comment that she’d rather pay for someone’s asthma inhaler than their trip to the ER makes sense to me. Some innovative corporate-determined (vs. standard insurer) policies started putting in place prescription co-pays that were very, very cheap ($5?) for blood pressure medications, asthma medications, diabetes drugs, and some of the cardiac drugs – but I never saw anything that reviewed whether that had in fact reduced overall health costs. I’d suppose it would, but maybe not. We do have a really hard time with expenditures that don’t yield an immediate savings.</p>
<p>You can buy the policy that meets your needs as you define them.* It’s just that no one is selling it because it would cost too much and you’d be in a risk pool of one.</p>
<ul>
<li>OK, a policy that meets your needs except that it has mandated benefits. But seriously, your insurance company is not paying out money for birth control pills for people in our age group! And free flu shots for our age group almost certainly save the insurance company money rather than costing.</li>
</ul>
<p>No no, you can’t buy a policy with all the expensive doctors and hospitals you want, because that policy only works when the insurance company knows that the people it’s selling the policy to aren’t going to need those expensive operations at Cedars Sinai (or if the insurance company can bargain Cedars Sinai down, a negotiation I suspect is happening right now). If anyone could buy that policy, then only sick people and rich people would buy it, and the sick people would be using the expensive doctors and hospitals, and the health costs would go through the roof. So the insurance companies aren’t selling it.</p>
<p>In my opinion that isnt the function of insurance. It doesnt work when 90% of the group needs a fixed cost benefit with a fixed frequency. </p>
<p>It would be like ‘insuring’ that everyone can have a new Ford Focus every year. Whats the premium for that insurance- well what the cost of a Ford Focus. Except add 40% because now I have the cost of money for premiums to you and the dealer has to wait for reimbursements from me. And I have to hire an army of people to process paperwork and make sure no one is getting two Ford Foci a year.</p>
<p>If you chance of needing a heart transplant is 1/500,000 and the cost of a heart transplant is $1M then we can have a pool where everyone pays $2. Thats the function of insurance. </p>
<p>If enough people want to get the transplant from Cedars and they charge $1.25M I can make a insurance product for $2.50.</p>
<p>As argybargy says, these are fixed cost benefits at a fixed frequency. But argybargy’s analogy is somewhat flawed. Rather than insuring that everyone can have a new Ford Focus every year, it’s more like insuring checking everybody’s cars’ brakes every two years. </p>
<p>Your insurance was already paying for those things. Now you don’t have a copay, but I doubt that you were paying the entire cost of your colonoscopy or your mammogram; your insurance covered those things. At least, mine does, and I suspect most people’s insurance already covered mammograms and colonoscopies.</p>
<p>How much does it cost for your insurance company to offer you a mammogram with no copay, instead of a mammogram with a copay? Not that much.</p>
<p>It will not; despite conventional wisdom, preventive care increases (collective) costs (and there is plenty of research on this). OTOH, preventive care can save individuals lives and money.</p>
<p>What can reduce costs, is healthier living: less smoking, drinking, sedentary lifestyles… :)</p>
<p>Isnt the point of differentiation really whether I write a check to the guy who owns a mammogram machine directly verses I write a check to the insurance company and they remit payment to the guy after a lot of paperwork and 6 months delay? I am betting the first case is much cheaper (and it is). </p>
<p>Someone like Goldenpooch hit with a huge increase in premiums is going to respond by doing what? - making damn sure he gets his money worth. No Sniffle Left Behind. </p>
<p>I wonder if we are going to have enough data after a year to tell if the current California approach is effective. Will there be enough data to make an apples/apples comparison against Michigan, Texas and North Carolina?</p>
<p>That’s not the point of differentiation between Goldenpooch’s old insurance policy and Goldenpooch’s new insurance policy. In both cases, the insurance company pays for the mammogram and the colonoscopy. The issue is whether Goldenpooch has a $50 copay (or whatever the copay used to be).</p>
<p>What can reduce costs, is healthier living: less smoking, drinking, sedentary lifestyles… </p>
<p>But since only smokers are charged more in insurance premiums under ACA, there is less incentive for people to lose weight, stop excess drinking, etc. </p>
<p>Instead doctor’s payments will be based on patient outcome. It’s like blaming the teachers when the students who never do homework or study do poorly on the tests.</p>
<p>I completely agree that we need to provide incentives and nudges for people to adopt healthier habits. But, y’know, “If you get fat you’ll have to pay higher insurance premiums” has not proven to be an effective incentive for people to lose weight. It hasn’t worked. Pre-ACA, if you asked people why they wanted to lose weight, they’d say they wanted to be more attractive, they wanted to be healthier, they wanted to be more appealing to potential employers, they wanted doctors to treat their non-weight-related health concerns more seriously, blah blah blah, but they wouldn’t say “I want to lose weight so my insurance premiums are lower.”</p>
<p>We need to figure out different ways to keep people from gaining weight, ways that, unlike raising insurance premiums, actually work at keeping people from gaining weight.</p>
<p>I assume they charge smokers more (in states where they do; California is not one of them) for political reasons. Smoking is unpopular. And of course, smokers really do cost more to insure.</p>
<p>But those higher premiums aren’t going to do much to make smokers quit. They’re not charging higher premiums as an incentive to make people quit.</p>
<p>I seem to recall a couple of studies that show smokers actually have a lower total health cost. They tend to die quickly instead of lingering for years with high maintenance cost diseases. </p>
<p>It brings up the question of if we want to nudge people to “good” behavior that actually has no, or negative payback. For instance, I believe there was a large meta study in the last year that indicated that people with an unsightly BMI (I think 25-35) actually at a longer lifespan than those who were at weight or underweight. </p>
<p>So should there be a surcharge on size 0 jeans in that case, or do we ignore the correlation since its not a PC as anti-smoking?</p>
<p>They have a lower lifetime cost, but a higher yearly cost. Insurance is sold by the year, not by the lifetime. A smoker costs more per year than an otherwise similar non-smoker, so an insurance company would want to charge more if they could.</p>
<p>Smokers cost nothing compared to obese people and their chronic illnesses. Nothing is more expensive than obesity. Nothing comes close.</p>
<p>But, to be honest, I’m not really sure about all of this alleged cost reduction. I think it’s been shown that most of the care expense is end of life care. It then follows if there is no capping allowed on payouts that there is simply no incentive to lower the end of life care costs.</p>
<p>I also think the mandate that insurers have to pay out 85% is good, except with no caps on end of life expense? The pay out possibilities are endless.</p>
<p>As for covering the uncovered, doing it through these insurance exchanges and with subsidies is a lot like financial aid for colleges. It will just cause costs to go up for coverage for those of us who pay.</p>
<p>Interesting to see the word “full pay” starting to crop up on this thread in regard to those who pay their own way.</p>
<p>Also, those who are saying that those who get coverage through employers will not be effected are not taking into account the taxation they will face on those plans.</p>
<p>I really think that the insurance companies, as always, turn out to be the winners, not the middle class, whose premiums or taxes will be going up, depending on how they contract their mandatory health insurance. Nothing better than a captive clientelle.</p>
<p>Chronic illness you can live with costs a lot. </p>
<p>Just in terms of the cold hard facts about health insurance costs.</p>
<p>I couldn’t care less if people want to overeat and be obese or if they want to smoke, either. I’m not much for regulations, which we have too many of already, in this increasingly unfree country.</p>
<p>But the care and feeding of the obese is more expensive, any way you look at it than the death of smokers.</p>
<p>I am not so much interested in which factoid or other is true. There are confounding factors in every study. (I will note parenthetically that I find it very unlikely that high BMI living longer and and low BMI having a higher mortality than average could both argue the lower the weight the less cost). </p>
<p>What I find interesting is the intersection of the new morality vs shared societal costs. <em>Something</em> is going to come up that is going to challenge the GOOP morality- whether its smoking being less costly to society or an unattractive BMI being more healthy than rail thin. Maybe yoga will need a surcharge. </p>
<p>Do you surcharge a population genetically predisposed to diabetes? Or the people whose lifestyle predisposed to diabetes?</p>
<p>So, we have about 25% of Medicare payments going to people in their last year of life. And most people die at age 65 or older. So it can’t be the case that most of the care expense is at the end of life, at least if you call the last year of life the end of life.</p>
<p>What is true, and is obviously true, is that older people have higher health care costs. But most of those costs go to people who are not dying.</p>
<p>To add to my previous message, end-of-life health care costs are not the largest health care costs. But in my opinion, we have low-hanging fruit there. A lot of end-of-life care makes people’s remaining lives worse, not better. We could save money, and make people better off, if we stopped doing futile aggressive expensive care on dying people, and instead resorted to aggressive palliative care to make their dying less painful.</p>