Wednesday, July 11, 2007

Reforming Health Care: Part 2 - Preventative Measures and Insurance

I previously established that we should require every legal US resident to have insurance. This would be coupled with requiring health insurance companies to cover without penalty those with pre-existing conditions that are not caused by their lifestyle. This would ensure that the un-insurable could get insurance when this is implemented. When your house burns down, you can't go out and buy fire insurance, likewise, its unreasonable to expect insurance companies to insure people after they're sick. By requiring everyone to have health insurance, when they do get sick they would not be stuck without insurance and become un-insurable, and would contribute their fair share. And this would be paid for by giving individuals the tax rebate that corporations already get for insuring their employees but that individuals do not qualify for. But this alone is not enough. Other steps must be taken to prevent diseases, or at least catch them early, which would reduce overall costs. Today we will deal with what measures insurance companies could take to help accomplish this.

In addition to these measures, I'd give insurance companies the power to require certain preventive measures. If they wanted to, they could require an annual physical, not for the purpose of charging you more but with the purpose of catching problems earlier when they're easier to deal with (meaning better quality care) and cheaper to deal with. And for example, women could be required to have a mammogram or men to be screened for prostate cancer. Obviously this would have to be carefully regulated, to prevent abuse. If you preferred not to be forced to do all these preventative measures you could elect for a more expensive plan (since its covering more losses that occur from lack of prevention) or a plan that doesn't require them but offers a discount for each preventative measures voluntarily taken. That might be the better route since if you were fine with most measures but objected to one, e.g. the controversial HP vaccine for cervical cancer, you would still be overall more healthy.

Insurance only works when a few people are obtaining losses while they're are others to cover those losses. If most people are suffering losses, then the underwriter won't be able to cover them. Take Hurricane Katrina, insurance companies can't afford to cover everyone hit since the damage was so widespread. Likewise, health insurance becomes ineffective if everyone is sick. And what we have in America is an epidemic of obesity. Health insurance is getting so expensive because so much money is having to be paid out to cover health problems caused by obesity. Thus, we really need preventative measures to address this problem in particular.

Insurance companies can turn down or charge higher premiums to sick people right now, but they can't make such decisions on lifestyle issues like obesity. The exception is smoking, which is as much a choice as overeating and not exercising. This is completely backwards. You should not be charged more for being sick which you may not be your fault, you should be charged more for living unhealthy which increases your chance of being sick that is your fault. (not society's) If someone should object and say that being fat is a disorder and it would be unfair to discriminate against them, I'd reply that smoking is addictive and yet no one seems to have a problem doing the same to them. This plan would just restrict it to differentiating based on factors within your control, which would be fair and more effective at encouraging healthy living which will lower the cost and raise the quality of health care for everyone. Which is easier, telling a man to lose weight or telling a man not to have a hard attack? We could provide a grace period, perhaps a year, to get healthy by exercising and eating right before this part would be implemented. (Undoubtedly it would take more than a year to get it through Congress, so that could be the grace period.) And of course, it there was a proven medical reason why it was not possibly to lose weight, that would be exempt. (Then everyone will say they have some phony medical condition in this age of ADHD and IED. I kid you not, Intermittent Explosive Disorder, or road rage.) If it helps, instead of charging unhealthy people more we're giving healthy people a discount. Effectively the same thing, but more politically correct.

People are probably more likely to take advantage of preventative measures like vaccines and screenings if their insurance covers them. On the other hand, catastrophic insurance (high deductible after which your completely covered) is attractive since it has lower premiums, especially so to the young and healthy who are less likely to get sick. When you couple that with health savings accounts (which allow you to save tax free like with an IRA for out of pocket health expenses) you can save up your deductible for if and when you do get sick. So which route people take is up for them to decide when buying their coverage. If some combination could be created, high deductible but certain required or optional preventative measures are covered, that would lead to healthier people and thus lower costs without the significantly higher premiums incurred when every little cost is covered. But again, that is outside of government control and up to the individual, although it should be studied in order to make recommendations.

These measures would first and foremost put an end to discrimination by insurance companies against the sick. Conversely, it would give them the ability to fairly place more burden on those who are by choice living unhealthy lifestyles. It would allow them to cut long-term costs by requiring preventative measures or at least offering discounts to those who take advantage of them. This is a win-win situation since it leads not only to lower costs for insurance companies and those paying premiums, but to higher quality health care. Indeed, it would truly bring us into an age of health care out of the darkness of sick care that for so long has reigned.


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