Quote of the Week: Do You Agree or Disagree?

From a review of The Truth About Health Care, by David Mechanic. The review is written by Rob Cunningham and appears in Health Affairs, September/October 2007.

“At some point we as a nation will have to decide whether we wish to design our health care system primarily to satisfy those who profit form it or to protect the health and welfare of all Americans.” Mechanic speculates that “anything is possible if the public begins to appreciate how little it gets for what it really pays.” But even as reform begins to rise again on the political agenda, the preponderance of the evidence in this book says that a majority of American prefer pluralism and individual liberty to the tedious business of working together . . .”

IF YOU’D LIKE TO COMMENT ON THIS POST, PLEASE CLICK HERE TO E-MAIL MAGGIE WITH YOUR THOUGHTS.

Thoughts on SCHIP

For a discussion of SCHIP,  and how easy it is for children to be dropped from the rolls, see my blog on The Guardian here.

Clinton and Edwards Open a Back Door

For a discussion of Clinton’s and Edwards’ health care plans, see my post on The Health Care Blog here.

Comment on Class and Health

(To see the original post on Class and health, click here.  To add your comment, scroll down and click on “Contact” on the left-hand side of the page.)

From Alan Abrams (a.k.a. Alan_A at the hpscleansing.com/group community forums)

I just read Maggie Mahar's health blog after linking to it from an agonist.org blog on universal health care. I then read Maggie Mahar's blog [post] on "Class and Health."  thus this quote:

"And yet, and yet . . . Schroeder sees reason for "cautious optimism." Although we trail behind other countries, we are healthier than we once were. We have reduced smoking ratse, homicide rates and motor-vehicle accidents. Vaccines and cardiovascular drugs have improved medical care. But progress in other areas will require "political action," Schroeder declares, "starting with relentless measurement of and focus on actual health status and the actions that could improve it. Inaction means acceptance of America's poor health status."

Healthier than we once were? Really?  Are…smoking, homicide rates, and motor-vehicle accidents adequate measures of the overall improving general health of Americans?

What about these:

• 58 Million Overweight; 40 Million Obese; 3 Million morbidly Obese
• Eight out of 10 over 25's Overweight
• 78% of American's not meeting basic activity level recommendations
• 25% completely Sedentary
• 76% increase in Type II diabetes in adults 30-40 yrs old since 1990

Comment on Class and Health

(To see the original post on Class and health, click here.  To add your comment, scroll down and click on “Contact” on the left-hand side of the page.)

Maggie,

A couple of thoughts on this.

First, Americans who work in physically demanding and/or dangerous jobs such as coal mining, steel manufacturing, auto manufacturing, etc. do not live as long, on average, as the population overall despite comparatively good wages and benefits.  I don't think countries like Iceland and Switzerland have nearly as many people relative to their populations working in these jobs as the U.S. does.  Japanese people in the U.S. also live longer than most people.  I suspect that it's due to a combination of diet and genetics. However, as they are here longer and adopt a more westernized lifestyle and diet, they probably don't live as long as Japanese people in Japan with comparable socioeconomic status do.

Second, regarding social inequality, I think our system, does, to a large extent, reflect our more entrepreneurial culture.  While reasonable people can differ about how much taxes should be raised on higher income people to both reduce inequality and raise money for worthwhile public priorities, I think it is important to remember that there could also be economic costs. In Western Europe and Canada, the total tax burden on middle and upper income people generally exceeds 50% of gross income.  It's expensive to sustain a welfare state with a generous social safety net.  I think, at the end of the day, those countries, which embraced socialism decades ago, are trading less inequality and more economic security for less economic growth and less opportunity, especially for its younger people. 

Class and Health

When compared to other developed countries, the U.S. ranks near the bottom on most standard measures of health. Many people assume that this is because the U.S. is more ethnically heterogeneous than the nations at the top of the rankings, such as Japan, Switzerland, and Iceland. But while it is true that within the U.S. there are enormous disparities by race and ethnic group, even when comparisons are limited to white Americans our performance is “dismal” observes Dr. Steven Schroeder in a lecture  published in the New England Journal of Medicine yesterday.

Why? It’s not the lack of universal access to healthcare" says Schroeder, though that’s important. And it’s not just that we don’t exercise enough and eat too much—though that is a major cause. But there is one factor undermining the nation’s health that we just don’t like to talk about in polite society: Class. When it comes to health, class matters.

Schroeder, who is the Distinguished Professor of Health and Health Care at the University of California San Francisco (UCSF) underlines how poorly even white Americans stack up when compared to the citizens of other countries by pointing to maternal mortality as one measure of health. When you look at “all races” you find that in the U.S. 9.9 out of 100,000 women die during childbirth.  Focus solely on white women, and the number is still high—7.2 deaths out of 100,000 –especially when compared to Switzerland where only 1.4 women out of 100,000 die while giving birth.

Statistics on infant mortality reveal the same pattern: among “all races” 6.8 American children who were born alive die during infancy; limit the analysis to “whites only” and 5.7 infants die—compared to just 2.7 out of 1,000 in Iceland. .) When researchers compare maternal mortality and infant mortality in white America to rates of death in the 29 other OECD countries, white America ranks close to the bottom third in both categories.

Turn to life expectancy, and you find that white women in the U.S. can expect to live 80.5 years, only slightly longer than American women of all races (who average 80.1 years). Both groups lag far behind Japanese women (who, on average, clock 85.3 years). The gap between “all American men” (who live an average of 74.8  years) and white men in the U.S. (75.3 years) is wider—but not as wide as the gap between white men in the U.S. and men in Iceland (who live an average of 79.7 years).

“How can this be?” asks Schroeder. After all, as everyone knows, the U.S. spends far more on health care than any other nation in the world.

The answer is a stunner: the path “to better health does not generally depend on better health care,” says Schroeder. “Health is influenced by factors in five domains — genetics, social circumstances, environmental exposures, behavioral patterns, and health care. When it comes to reducing early deaths, medical care has a relatively minor role. Even if the entire U.S. population had access to excellent medical care — which it does not — only a small fraction of premature  deaths could be prevented.” [my emphasis]

A Healthcare System That Works

Medscape offers a window on one U.S. healthcare system that is working. It’s worth clicking here: http://www.medscape.com/viewarticle/503922?src=mp (free registration/log-in required) to find out more.

I should add that I have had very similar experiences with the same system. Why does it work better than most U.S.healthcare?

If you would like to comment, scroll down and click on “contact” (right under “Google search”) on the left-hand side of the page.

My response to Barry Carol’s comment on “If We Mandate Insurance Should Twenty-Somethings Pay Less?”

(To read my original post on whether 20-somethings should pay less, scroll down to Archives on the left-hand side of the page and click on “September 2007.” You will find my post about three-quarters of the way down the page)

Barry—

First, let me say that if we mandate insurance I very much doubt that it will cost $12,000 for a family of four. That number includes a private insurer’s profits and administrative costs (which can eat up as much as 20 percent of premiums) as well as a lot of waste in the form of redundant and unnecessary tests, over-priced drugs and devices and unproven treatments.  Politicians who talk about requiring everyone to buy insurance almost always stress that we have to rein in health care spending by refusing to pay exorbitant prices for drugs and devices (manufacturers need to give us the discounts that they give patients in other countries), and by rewarding efficient care—while penalizing providers who are less efficient. (For example, if a hospital has a very high rate of infections, the insurer might refuse to pay the cost of the extra treatment needed to treat the infection, forcing the hospital to absorb the cost. If this happened to often, the hospital administration would have to step down.)

Secondly, if we do mandate insurance, large employers would be required to continue to contribute as they do now, either by providing insurance for their employees or by contributing to a large fund to finance subsidies. So they would be paying a large chunk of the premiums for a family of four. In addition, any plan that calls for mandates also calls for subsidies for those who cannot afford to pay the full premium. For example, a median-income family earning $50,000 a year, before taxes, cannot afford to pay $8,000 a year for health insurance. That family would need a subsidy.

My Response to Barbara Rodin’s comment

(To see my original post on cutting back on healthcare spending, scroll down and click on “September 2007”under “Archives” on the left-hand side of the page. You will find my September 12 post a little more than halfway down the page.)

Barbara—

In some cases, patients can and should actively share in decision as to what kind of care they need. For instance, in the case of elective surgery like a knee implant,  the surgeon and  the patients should discuss the risks and benefits. How long will it take to convalesce? How much pain will the patient experience after surgery?  What can he or she expect in terms of improved function?
Is physical therapy an alternative to sugery? I’ll be writing more about “shared decision-making” for elective surgery in the future.

On the other hand, when it comes to picking a particular knee implant, this is a decision that you want your surgeon to make. Research shows that you are most likely to be satisfied with the outcome if your surgeon uses a device that he has used many times  in the past. Practice makes perfect.

Moreover, too often consumers are influenced by misleading advertising. See my post on “Bespoke Knees” below.  Often drug-makers and device-makers advertise a product “directly to the consumer” because they know they would have a hard time persuading physicians of their claims. They just don’t have the medical evidence to back up what they’re saying.

Bespoke Knees

Bloomberg recently announced that the Food & Drug Administration has bestowed its blessing on a new “gender-specific” knee implant. Manufactured by Smith & Nephew, the new knee is designed to fit the “unique anatomy” of a female. This is not the first knee- for- women-only. Last year the FDA approved a similar knee made by Zimmer Holdings, the company that takes credit for what it describes as a “bespoke knee” for women.

Will the new devices allow women to function better? "In theory, yes, but the evidence isn't there," Kimberly Templeton, an associate professor of orthopedic surgery at the University of Kansas Medical Center and a spokesperson for the American Academy of Orthopaedic Surgeons told U.S. New & World Report. Sheryl Conley, Zimmer's chief marketing officer explained seven studies now underway will look at patient satisfaction and range of motion. Preliminary data will be available in a year or so.

In the meantime, these couture knees for women are fetching twice as much as the plain-vanilla knees that, until recently, were used for both men and women. But this is not the FDA’s concern.

HILLARY CLINTON'S NEW PLAN

   I have written two posts analyzing Hillary Clinton's healthcare plan. You will find them on www.tpmcafe.com (where I am a contributor). You can comment there.

   

    

Why Are Earnings at Health Care Companies Growing So Much Faster than the S&P 500?

Yesterday Bloomberg reported that, according to its data, "earnings at health care  companies will expand 15 percent this year, compared with estimated profit growth of 8.5 percent for the S&P 500."

If you own healthcare stocks, this is good news. But if you are a consumer paying for drugs, insurance and the hospital bills that insurance doesn’t cover, you have to wonder: why are their earnings so high? Is this what people are talking about when they say that healthcare is overpriced?

On Wall Street, healthcare and tobacco are both considered "defensive investments." Why? Because in a recession they’re less likely to plummet. If you’re addicted to tobacco, you are going to continue to buy cigarettes, even if it means giving up something else. As one Wall Street analyst puts it, “You just don’t have much choice.”

The same could be said of healthcare: you just don’t have much choice. When you are sick, you are not in a position to say “I’ll wait until prices come down" or "that’s too expensive; I’ll find something just as good that’s cheaper.” You are not in a position to comparison shop.

This is why market competition doesn’t work to control healthcare prices: the consumer just doesn’t have the same power that he has in most markets. 

Commenting on “Do We Really Have to Cut Back on Healthcare Spending?”

This is a great overview of the facts and clearly demonstrates the urgent need for evidence-based medicine.  No matter what form health care reform takes in the future, the issue of cost has to be addressed.  However, I believe that a significant key to solving the puzzle of spiraling cost is an active and educated consumer of health care. 

To begin the process of developing such a consumer, there must be financial “skin in the game.”  How often does a consumer of non-health care goods purchase a car, home or a computer without asking the price of the item?   All would demand a Rolls Royce if someone else paid the vast majority of the bill.  Admittedly, when it comes to health care, the information needed for efficient purchasing is not sufficiently available and is more complex than that necessary for purchasing simple consumer goods.  However, this is not an excuse for lack of consumer participation and decision-making in the economic process of health care.

Have you noticed that most discussions of health care reform are supply-side and payer driven?   This is yet another indication of the passive role that consumers take in our health care system……..like children with parents who know better who make the major decisions for us.

-Barbara E. Rodin, Ph.D

Commenting on “If We Mandate Insurance, Should Twenty-Somethings Pay Less?”

I can see the community rating argument (same rate for all vs. lower rate for young people) both ways.  The important thing to understand, I believe, is how much the premium would have to be in order to charge a uniform rate for the under 65 adult population.  Data that I've seen suggest that the premium for adults would have to be about $4,000-$4,500 per year while children (under 18) would have to pay $1,000-$1,500 based on what Medicaid current spends on the children covered by its program.  The current average premium for a family of four is about $12,000.  As an aside, we think community rating is a fair way to price health insurance, but we don't have any problem charging young people more for car insurance because they have more accidents than older drivers.  Go figure.

I prefer payroll tax financing for two reasons.  First, it's a flat rate (not regressive) scaled to income, so low income people pay less and higher income people pay more, but I think there should be a cap on the wages to which the payroll tax applies so you don't have very high income people paying 10 or 20 times what the insurance benefit is worth.  The more important reason, however, is transparency.  I think it is extremely important for people to fully understand just how much their health insurance costs whether the payroll tax is paid by the employee or by the employer.  If we are ever going to get to the point politically where we can start to make some of the tough tradeoffs needed to better control medical cost growth, transparency of health insurance costs at the individual level and the taxes required to finance them will be extremely helpful, in my opinion.

The Social Security payroll tax is also a flat rate tax with a wage cap. Since the infrastructure is already in place to withhold FICA taxes from wages, it would be easy to use the same infrastructure to withhold a healthcare payroll tax.  If we also had a flat rate income tax of 28% that applied to all income (including capital gains and dividends) above the federal poverty level but gave a dollar for dollar credit for all FICA and health insurance taxes paid by the employee but not the employer), we would have a more progressive income tax structure than we have now. 

Example: Assume one person earns $100,000, all of it from wages.  He or she pays about $7,500 in FICA taxes and a similar amount under my approach in health insurance taxes (assuming the same 50-50 employee / employer split that we have for FICA).  The standard deduction is $10,000 and taxable income is $90,000.  The gross income tax liability is $25,200 ($90,000 taxable income x 28%) less a credit for employee's share of FICA and health insurance taxes paid of $15,000.  Net income tax liability:  $10,200.  A second person earns the same $100,000, all from capital gains and dividends.  That person pays nothing in either FICA or health insurance taxes but pays $25,200 in income tax. 

So, two people earning the same income but from different sources pay bear the same federal tax burden.  State and local taxes probably add another 10% or so to the tax burden for both people.  For very high income people ($500,000 and above), my approach would, in effect, subject virtually all of their income to the Alternative Minimum Tax which, under current rules, does not apply (for the most part) to capital gains and dividends. To the extent that employers' health insurance costs go down from what they were previously paying, they could be required to raise salaries by a comparable amount per Senator Wyden's cash out concept.

I have no problem with high tobacco taxes because they drive demand for cigarettes down, not because it raises a lot of money.  I suspect we are already reaching the point of diminishing returns from that revenue source, at least in states like NY, NJ and CT with very high tobacco taxes already. With respect to one set of national rules for Medicaid, I agree with paying the higher Medicare rates even though it will raise costs in the short run. It would simplify life for providers, make them more willing to see Medicaid patients, and it's the right thing to do. Much longer term, serious cost control is likely to require either global budgets (especially for hospitals), explicit rationing or both.  If the public has clear transparency with respect to the actual cost of their health insurance and the associated taxes, it should advance the day when they will not only accept global budgets and/or rationing to better control medical cost growth, they might even demand it. 

-Barry Carol

Responding to Comment on “Should People Who Don’t Take Care of Themselves Pay More?”

Bradley—Thanks for your comment. I’m inclined to agree with you about smoking. Because so many people do quit, it’s clear that it is possible for most people who are addicted to tobacco to give it up. So a financial incentive (or penalty) might have some results. And there is no question but what smoking adds to our national health bill.

When it comes to weight loss, however, I’m convinced by the research that only a small percentage of the truly obese can take the weight off and keep it off. As for adults who are carrying an extra 10 to 20 pounds, this doesn’t seem to me a major health problem. Ideally everyone would be at their perfect weight, but if we begin charging people who are 10 pounds overweight an extra premium I’m afraid we would be feeding our culture’s obsession with being thin.

Responding to Comment on “The FDA Betrays Its Mandate”

Gregory—

Sorry I’ve been so slow in responding; I was traveling last week. I completely agree that doctors should not be making a profit on anemia injections or cancer drugs that they deliver in their offices. They should, of course, be paid for their time and the skill involved in administering the injection or drug. But they should not be making a profit on the product itself—inevitably that creates a potential conflict of interest (even if it is subconscious) when a doctor decides what drug to prescribe.

The real problem is that drugmakers are willing to give doctors discounts which then let doctors bill insurers at the full rate and pocket the “discount.”In the 19^th century we learned about the problems associated with letting doctors become pharmacists—it’s ironic that we have to learn the same lesson all over again.

Conference Blogging: “Employer Innovations in Health Care”

The moderator of this session, Helen Darling, President of the National Business Group on Health, began by suggesting that we can’t just put more people into the system without fixing it. If we try that “we’ll have twice the mess we have now. . . We need to provide universal access and fix the system simultaneously,” she stressed.

In addition, she pointed out “The largest employers in every jurisdiction in this country are public employers. We have to ask, where are they in this picture?” This is a question that is rarely asked.

Darling then introduced the panelists: Francois de Brantes, National Coordinator of Bridges to Excellence and Michael Widmer, President of the Massachusetts Taxpayers Foundation. De Brantes began by saying that when we think of health care reform, we tend to think first, about universal coverage. “Employers I have talked to agree that we need universal coverage. But once you have access, you have to ask: ‘Access to what?’”

If we don’t change the system, de Brantes said, we will be providing “access to mediocrity.”

Conference Blogging: The Business Case for National Health Care Reform

The Business Case for National Health Care Reform

In her opening remarks, moderator Cheryl Matheis, director of health strategies, Office of Social Impact, AARP, declared “It seems to us the business community is ready to engage in health care reform.” She also suggested that states can serve as laboratories, noting that two panelists in this session are from California and can tell us something about what is happening there.

 She then introduced Bruce Bodaken, CEO of Blue Shield of California, and John Arensmeyer, founder and CEO of the Small Business Majority.

Conference Blogging: Second half of first session

Carl Camden, CEO of Kelly Services, began his address by  observing that, ten years ago, too many in the business community were happy to  stay on the sidelines—and many were, in fact, in active opposition to health  care reform.

“It’s different now,” he said. “Health care reform will be  influenced by the 2008 election,” he added, “and I expect little will happen  until 2009. But we need to do the work now so that come 2009 we can put forward  legislation for aggressive reform.”

Conference on Business and National Health Care—September 14, 2007

The conference began with opening remarks by Greg Anrig, vice president, policy, at The Century Foundation, who welcomed the audience and speakers and Karen Davis, president of The Commonwealth Fund.

Karen Davis began by stressing the advantages of employer-based healthcare including:

•  a large company provides a natural risk pool, with a mix of older and  younger,healthier and less healthy people; and

• lack of underwriting—no one is excluded on the basis of age or health status.

Do We Really Have to Cut Back On How Much We Spend on Health Care?

After all, we’re the wealthiest nation in the world. And what is more important than the health of our citizens?

Nevertheless, even in the U.S. resources are finite. And in 2007, Congressional Budget Office director Petter Orzag warns, "The central fiscal challenge facing the nation involves rising health care costs." In a recent letter to the House Subcommittee on Health chairman Pete Stark, Orzag frames the problem in a way that no one can ignore by comparing how much faster healthcare spending is growing than income per capita. "The rate at which health care costs grow relative to income is the most important determinant of the nation's long-term fiscal balance," he explains. "It exerts a significantly larger influence on the budget over the long term than other commonly cited factors such as the aging of the population.”

Let’s cut to the bottom line: If health care inflation continues to outstrip income growth over the next forty years at the same rate that it has over the past 40 years, spending on Medicare and Medicaid alone will rise to 20 percent of GDP in 2050. (To give you a sense of how big a slice of the pie that is: today, the entire federal budget equals roughly 20 percent of GDP).

Replying to Comment on "Should 21-year olds pay less,"

Barry—

Thanks for your comment on “Should 21-Year Olds Pay Less . . .” While we’re in agreement on many points, I have to disagree with your first sentence—that “in theory the Massachusetts approach of charging older people up to twice as much as younger people for health insurance is more reasonable, in my opinion, than pure community rating because younger people, as a group, incur far lower healthcare costs.”

I believe that insurance, by definition, is supposed to get everyone into one pool so that those who need less care can help those who need more care.  You are, of course, right that younger people incur far lower costs—until they get older. At that point, another generation of young people will help pay for their care. That’s how insurance is supposed to work.

Quote of the Week

“If we stopped paying for everything that had no evidence of benefit, we would be a very unpopular organization," Dr. Steve Phurrough, director of Medicare's coverage and analysis group told the Boston Globe last week.

Responding to Bradley, Gregory and Barry's comments . . .

First, thank you for you comments. This is a fledgling blog, but your comments are far from fledgling.

I plan to  respond to all of them in the next couple of days--translating, where it might be needed, for people who are not health care industry professionals.

I want to spread a wide net with this blog; at the same time  I greatly appreciate the well-informed opinions that come form industry insiders. I take it as my responsbility to mediate (and translate) between most of us (potential patients) and the professionals.

Before I comment, I woud be delighted if more readers respond to your comments. Ulimately, I would like to see this blog become a dialogue among readers while I moderate . . .

Commenting on "Should 21-year-olds pay less . .."

Commenting on "Should 21-year-olds pay more "  Barry Carol writes:

Several points on this.

First, in theory, the Massachusetts approach of charging older people up to twice as much as younger people for health insurance is more reasonable, in my opinion, than pure community rating because younger people, as a group, incur far lower healthcare costs.  Even the modified community rating approach used in MA probably charges younger people considerably more than their actuarial risk would justify.  As for employer coverage, Bob also pointed out that if the employees do not sign up when insurance is first offered, they must show evidence of insurability if they want it later.

Affordability is an increasingly challenging issue for both employers
(especially small businesses) and those seeking coverage in the individual market.  I suspect that the eventual solution will likely be taxpayer financing.

If We Mandate Insurance, Should 20-Somethings Pay Less?

Should insurers be able to offer less expensive policies to the young and healthy? Or should they be required to offer the same benefits to everyone at the same price?

In states where insurance is mandated, should twenty-somethings get a break? In a post on Health Care Policy and Marketplace Blog Robert Laszewski addresses these questions. He begins by focusing on a report  just released by the health insurance trade association (AHIP). The study looks at state health insurance reforms of the 1990s that tried to eliminate discrimination by insisting that insurers must sell “individual” policies to people who are not covered by an employer or another group without discriminating on the basis of health, age or gender. According to the AHIP, these reforms have had some “unintended consequences.”

Commenting on "Should People Who Don't Take Care of Themselves Pay More?"

Commenting on "Should People Who Don't Take Care of Themselves Pay More?"

Maggie,

Great post re: higher premiums for lifestyle choices.  I am a physician interested in public health and policy and have grappled with the issue you write about.  Having thought about the same upsides and downsides you review, I have to say, my heart and brain remain conflicted.  My heart agrees with everything you are saying.  My brain tells me that with obesity though, especially in view of the rise in this epidemic over the last 20 years (our genes have not changed, ask Michael Pollan), some incentives need to be on the table. 

Commenting on "The FDA Betrays its Mandate"

Commenting on "The FDA Betrays its Mandate,"  Gregory D. Pawelski  responded:

Take Physicians Out of the Retail Pharmacy Business

Lee Newcomer, with United Health Group, had stated at the 12th annual conference of the National Comprehensive Cancer Network, 44% of patients having blood work-ups indicated they were not anemic. Len Lichtenfeld, deputy chief medical officer for the American Cancer Society, reiterated that Newcomer was right on the spot on this. Few drugs work the way we think and few physicians/scientists take the time to think through what it is they are using them for.

A New York Times article stated that anemia drugs, given by injection, have been heavily advertised, and there is evidence that they have been overused, in part because oncologists can make money by using more of the drug. Lichtenfeld told United Press International, "Probably more than a billion dollars is spent on erythropoietin each year, which makes it one of the most expensive cancer drugs."

The FDA Betrays Its Mandate

Why are so many drugs withdrawn from the marketplace after physicians realize that their patients are suffering serious, sometimes life-threatening side effects? Why aren’t these products  thoroughly tested before being sold to the public? The current issue of The New England Journal of Medicine (Sept. 6) places the blame right where it belongs—with the FDA. In “Sidelining Safety—The FDA’s Inadequate Response to the IOM”  Sheila Weiss Smith describes the Food & Drug Agency’s weak response to the  Institute of Medicine’s sharply critical report on the agency’s failure to “embrace a culture of safety.”

If you would like to comment on these posts . . .

     To comment on these posts, please scroll down and click on "contact" right below SEARCH on the left-hand side of the page. I'll be reading and posting the comments here. (If you want to reply to someone's comment, feel free to contact me again. Dialogue among readers is always good.)

Should People Who Don’t Take Good Care of Themselves Pay More for Health Insurance?

When healthcare reformers talk about making health insurance fair, some suggest that people who don’t take care of themselves really shouldn’t expect the rest of us to pay for their folly. They point to a study published in 2002 showing that, each year, the average smoker needs an extra $230 worth of inpatient and ambulatory care. “Problem drinkers” require an additional $150; obesity adds $395 to the annual bill, while simply being overweight costs an average of $125 a year. (According to researchers about one in three Americans are overweight while in one in five is obese).

Asking those who puruse less-than-healthy lifestyles to pay higher healthcare premiums seems, on the face of it, a simple matter of equity. But one needs to ask: what will be the effect? And where do we draw the  line?