Get healthy or get out
June 24, 2009 by Bill MeltzerPosted in: Health care, Pay and benefits, Special Report - Benefits, policies
By now, most companies know how important it is for employees to undergo health risk assessments as part of a wellness program. But what if people are reluctant to do it?
An ever-growing number of employers are wrestling with the question of whether it’s legal to condition employees’ eligibility to enroll in the health plan on whether they get a health risk assessment and/or undergo preventive care.
As of now, there’s no clear answer to the question.
HIPAA non-discrimination rules may or may not prohibit it, based on different interpretations of the law. HIPAA prohibits employers from conditioning coverage based “upon receipt of health care.”
Technically, this prohibition was designed to prevent employers from denying a person health coverage because he or she received a certain types of health care, not because the person declined to receive care.
Even so, it’s not a big stretch for the feds or the courts to put the kibosh on requiring health risk assessments or preventive care in order to enroll. Additionally, even if HIPAA doesn’t prohibit it, you risk opening a can of worms with the Americans with Disabilities Act (ADA).
It may be tough to argue that getting the assessment or being denied coverage is a “voluntary” choice. The Equal Employment Opportunity Commission has suggested that it frowns on these programs for ADA reasons.
Bottom line: There hasn’t been a major test case yet to determine the legality of these types of policies. The question you have to ask yourself is whether your organization is willing to risk sailing into stormy waters.
Plenty of employers are doing it, but that doesn’t necessarily make it a smart or safe long-term strategy.
Tags: compliance, wellness programs
June 25th, 2009 at 1:28 pm
I am an employee and an HR manager. I have some health issues as everyone, wheather they be hayfever or cancer. We all have certain health risk because we are human. However, I try to eat right, I’m not a smoker, and I do not drink alcahol. But I admit, I don’t get enough exercise.
I believe it is the employees responsibility to maintain a healthy lifestyle. If they do not take that responsibility, then they should not drive up the cost of insurance for those who do.
I’m sick of laws that protect the guilty and make others have to pay the price. I believe strongly that if an employee wants health coverage, then they must do whatever is necessary to insure they prevent major health issues.
For instance, it is against the law to descriminate against grossly overweight individuals. I have worked with a few and in most cases they have major health issues. Yet in many cases they refuse to give up the breads, sweets and the pasta’s that make them overweight.
In addition, I have worked with smokers who come to work hacking from the caugh, don’t you think they create an extreme health risk for cancer.
I believe the employer has the right to require potential employees and current employees who want the insurance benefit the responsibilty to maintain a healthy life style and to prove they are.
Insurance benefit cost these days are outrageous and to keep them under control employers cannot afford to hire or even keep employees that don’t take responsibiltiy for their poor choices in not eating right, smoking, not getting enough exercise, etc. If an employee creates a greater than necessary risk for insurance, then that employee needs to burden the cost for that risk, if it is due to a health poor lifestyle.
Why should everyone have to pay for those who don’t care.
June 25th, 2009 at 1:47 pm
Apparently, Sandra is a thin, non-smoker who believes that quitting smoking and losing weight is easy. Let’s hope she never gets ill with something other people may believe is her fault.
June 25th, 2009 at 2:19 pm
I believe it should be ok for employers to require that employees complete HRA’s in order to participate in wellness program. as long as the information of individuals is kept confidential. the employer can then use the group results and interests to help develeop wellness programs they can promote. From there though it is then the employee and their dependents to take individual responsibility for what is rececommended from their inidvidual assessments and or offered by their employer
The employer/health insurance should then be able to provide credits or premium reductions for those that participate in wellness programs. Those that don’t, well, they just don’t get any extra wellness benefits.
Any more requirements from employers is crossing the line on individual privacy rights.
Thanks.
June 25th, 2009 at 2:23 pm
I pay 100% of the health insurance premiums for my company and we do not have a health group. Smokers, heart conditions, overweight, etc. Would I be able to tell the employees they have to have health risk assessments or preventive care if I am going to continue to pay 100%? If not then it would be set at 50/50!!!!!
June 25th, 2009 at 2:29 pm
It is no ones business regarding my health…with the exception of my doctor. If you looked at me you would think I was very health, but I am a breast cancer survivor. The cancer was not my fault and there were no factors that played into my having this terrible illness.
June 25th, 2009 at 2:29 pm
I agree with Rebecca. Employees should get discounts for completing HRA’s and wellness programs that will promote a healthy lifestyle. Afterall, the employee and employer will all benefit from having a healthy lifestyle. However, those employees that chose not to participate should not be denied coverage.
Employers should not get the results of the HRA for individuals, only for the group. Otherwise you could be violating HIPPA, not to mention the risk of not being in compliance with ADA.
By the way – good for you Susan!! Sandra sounds like an uncompassionate snob!
June 25th, 2009 at 2:30 pm
Also apparent is the fact that Sandra doesn’t know that a number of health conditions are more genetic than lifestyle, such as high cholesterol which is a major factor for heart disease. By eating healthy and taking care of ourselves we can only control approximately 10% of our cholesterol level – the rest is genetic. I am not saying all conditions are not manageable but let’s be reasonable and realize some people are just at a disadvantage because of their genetic makeup. Something they have no control over. I agree with Rebecca about some of these requirements crossing the line.
June 25th, 2009 at 2:32 pm
I have taken part in wellness screenings in the past and we (the Employer) found that it did help some employees get a hold of their health issues. Of course, there was an incentive to participate which was a &50 check for both EE and spouse and their rates did not increase for the year. For non-participants, the premium went up $50 per month. I
was surprised to see employees the following year receive even more money for improvements on their overall scores. We did keep the info confidentail and I would gladly recommend the screenings.
BTW, I agee with Sandra. We should not have to pay for the poor health of others.
June 25th, 2009 at 2:42 pm
It does not sound to me that Sandra is saying that it is easy to do these things. But I have to agree with her that everyone should do their part in trying to live a healthy lifestyle so we can keep health costs down. Healty living affects so much in a persons life. Depression and many other diseases are caused from people who do not take care of themselves.
I do not think it is that difficult to take care of yourself. If an employeer asks everyone to join a gym and go to it 12 days a month in order to stay on the insurance plan I don’t think there should be anything wrong with this.
My company only offers a High Deductable Health insurance plan. For my family I need to pay $2,900 /year out of my pocket before health insurance pays anything!! That is on top of the premium of $650/month. Do you think I ever go to the doctor? NO WAY. I keep my family and me healthy by staying active and eating healthy. I know there are unexpected things that people can not avoid, like family health problems that are passed on to you, or like my son who got warts on his feet (HOW?). But things that you can control should be a priority and it is being selfish to think “oh well insurance will cover it”. Money has to come from somewhere and I don’t want it to be me.
June 25th, 2009 at 2:58 pm
Assigning fault to a health issue is a fool’s game – unless there is an outstanding negative issue, the known factors that contribute to poor health can vary from person to person and change due to technology and knowledge – remember the egg scare with cholesterol. Any savings derived from health status differentiatlon will be eaten up other ways. DNA testing and full body MRI’s next?
June 25th, 2009 at 2:59 pm
There are so many factors that drive up the cost of health insurance. It would be interesting to see what percentage is actually attributed to what we perceive as an unhealthy lifestyle. The itemized hospital bill for my firstborn, 25 years ago, included charges (to the insurance company) for regular strength Tylenol: $10/pill, pads: $3/pad, bottled sterilized water (baby): $6 each, etc. Can you say “ka-ching!!” I had a GREAT insurance plan back then and the hospital thought so too. Who is really abusing the healthcare system? How can we avoid certain terminal/genetic diseases, i.e., diabetes, cancer, Parkinson’s, Crohn’s etc., when the specific cause has not been identified and/or there is no cure? Just my two cents…
June 25th, 2009 at 3:02 pm
Not everyone who is overweight (and I’m not talking 15 pounds here) has health issues related to that weight. I am considered morbidly obese by medical definition. I have NO health issues related to my weight. No high cholesteral, no diabetes, and in fact, my doctor says I’m extremely healthy. I don’t exercise regularly, but I do try. The biggest issue I have is stress….from my job, society’s image of “wellness” and John Q Public trying to say I’m unhealthy and something must be wrong with me just because I’m overweight. I have a real problem with this junk attitude. Y’all should try walking in someone else’s shoes for a while. And, if/when asked to participate in and HRA, the information should NOT BE IN THE EMPLOYER’S POSSESSION. It should be jobbed out to a company that specializes in that type of work. No one where I work should ever see my health history.
June 25th, 2009 at 3:05 pm
People, when presented options and choices, will choose based on the magnitude of the payoff and the proability of success. This goes for healthcare or any other myriad of choices. Doctors do not have definitive answers to life’s most perplexing questions. How can a nonsmoker get cancer of the lungs? How can a smoker and heavy drinker live to 90 with very little health problems? Companies and politicians rely on numbers and statistics, which can be manipulated and spun.
I think that given the information and the opportunities for a better and healthier lifestyle (as we understand it today) people will make their choices based on the benefits they see and the probability they see for success. Companies can benefit by presenting this information and encouraging employees to make such choices. When a company requires certain choices, and then blames the employee for failure to comply, negates the concept of free will. Our politicians and courts have given the nod to business to set the cultural norms of what is acceptable, who succeeds and who fails, who is rich and who is poor, who gets healthcare and who doesn’t. And business sets its norms on financial goals and usually for short term results.
Hence it is easy to see why healthcare is so expensive in the US and that we don’t get a good return on our investment. Our healthcare is based on the short term instead of looking at what someone will need over their entire life. We allow the healthy to opt out or pay the least and exclude those who need services now or turn them over to the government to care for. Here’s the catch, over the course of a person’s life, you will need healthcare and it will cost you regardless if you exercise regularly, eat right, don’t smoke or drink or do drugs, etc. If someone has a bunch of poor habits, they will have to pay the price sooner and will probably die sooner, but I would be willing to bet, the final tally will show that the overall cost of healthcare over an entire life is pretty much constant from person to person. The insurance companies want to insure you if you are young and healthy and leave you for the government if you are old or unhealthy. So we are okay with a free market for the one group (young and healthy) and for socialized medicine for the other group (sick and elderly). And companies who have had to provide healthcare, also wants to promote the young and healthy and exclude the old and infirmed.
June 25th, 2009 at 3:07 pm
I disagree with Sara’s comment that to be on insurance plan one has to go to gym 12 times a month. So then we have more people uninsured, that’s crazy! Again, give credits and premium reductions to those that participate in wellness activities. The result is, those that aren’t will be paying more. Have one of those people die on you, then perhaps others will start to participate.
June 25th, 2009 at 3:08 pm
It’s odd that insurance companies that insure your house or your car can consider a variety of factors in setting your rates, but for health insurance… its discriminatory. Never heard a good reason why. Can someone tell me?
If I want insurance and my health (for whatever reason) generates claims, I should be rated and pay appropriately – shouldn’t I? I know it sounds unfair to some, but life’s not fair.
June 25th, 2009 at 3:18 pm
Ditto to Susan! Next thing you’ll hear is “Well, we hired that person because (s)he was young, thin, and attractive – who ever thought THEY would get cancer (ALS, HIV, etc.). Are we actually going to have to cover them now??? I mean, gosh, we weeded out all the fatties and smokers – I thought we were all done!”
People who think this way might want to consider screening out those who are overly physically active as well – a fractured hip or a ruptured disk from roller blading or biking can be pretty costly to treat as well. Better check out those irresponsible people who drive cars, too. The health bill an auto accident can wrack up might be something you want to avoid. And you know those walkers might step off the curb at the wrong time . . . whatever.
June 25th, 2009 at 3:27 pm
As I listened to the President speak last night on health care and his thoughts on reform, the thought about requiring employees to participate in preventive health care to be eligible for programs popped into my head. I did not know that some employers were already doing that or were thinking about doing that.
Under current laws, maybe you cannot do such a thing, but if the President and his allies are serious about changing things, perhaps this is an area that needs to be addressed. “Get healthy” may not be the requirement because people might not have full control of some things, but certainly “particpate in preventive health care activities” can be the requirement so that the medical professionals can more appropriate manage the issues at their earlier stages in the hopes of having better, more cost efficient outcomes.
June 25th, 2009 at 3:39 pm
Lets get somehting straight, it is not your right to be provided insurance by your employer – it is a privilege. If your employer wants, or requests, that you complete a non invasive assesment to determine the companies overall health risks, that is their right. If you refuse to take the assesment it is also their right to either have you pay more for your insurance or determine that you are not eligible. The only reason an employer would be asking employees to take an HRA is to ensure they structure plans and programs that are available to everyone that would make the most impact on keeping ALL employess healthy. They are asking for this participation with the best intentions. As employees you have the choice to refuse, and then either not have coverage, pay more for coverage or find another job.
As to Sandra’s comments – GOOD FOR HER!!!! She did not say it was easy to lose weight or stop smoking, but she did elude to the fact that they were lifestyle decisions people made. If you CHOOSE to live an unhealthy lifestyle you should have to pay more for your insurance. I am not in perfect shape so don’t make assumptions as to my comments, just know that making the choice to live an unhealthy life should result in your paying more for coverage. We have this program in other walks of life, like auto insurance. If you get a couple speeding tickets or cause a couple accidents, your rates go up. If you are a jelly donut eating, soda pop drinking, extra butter popcorn scarfing, lazy, smoker you should take responsiblity if paying more for your healthcare as your risks for serious care are multiple times greater.
No one is saying that if you have cancer you should pay more. I have two family members that are current survivors, I get it. No one has ever said claims should drive ones cost up or down. Major claims can happen to anyone, and the claims alone are not enough to warrant different prices. People have only said lifestle choices should alter premiums. Keep in mind, 60% of cancer claims are preventable based upon lifestyle decisions. I am sure many of you won’t believe that, but since I am in the medical field I trust my knowledge over yours.
June 25th, 2009 at 3:41 pm
I agree with Cat. I too am considered morbidly obese. I have no health conditions to speak of and do not contribute to the high costs of my plan. In fact, I am the lowest dollar claimant at my location, yet outwardly am the one that appears to be the most unhealthy. I think some of the attitudes of those above, including Hmmm… and Sandra are failing to consider that not everyone who is overweight is unhealthy. I agree that we all need to try and live the healthiest lifestyles, but no one is doing everything 100% correctly. We all have vices that we can improve. Should we deny coverage to those that drink alot of coffee or caffeine because it’s a drug and can raise blood pressure and cause acid reflux? Where does it end? I am in the same situation as Cat, very stressful job, travel often to various locations, not to mention the responsibilities at home with a young child and husband. While this is not an excuse, it is no reason to have the attitudes these people appear to. I do not agree that anyone gets penalized for the dolalrs incurred by the sick. But I am bigger sighted than these people appear to be, as I realize, that the point of a large group health plan is that the healthy balance out the sick. Remember, you at some point in your lifetime, will have an injury or illness that requires care and you will no longer be in the majority who have low dollar claims, you will now be one of those that you so vehemently despise. What is next, saying that we don’t want to provide care to the middle aged because they tend to have more health problems and require more medication that those that are younger, yet we all know this is not always the case. Risks will never be fully eliminated on a group health plan until we eliminate injuries, disease, sickness, etc. My highest dollar claimants are those with cancer, those that have injuries, not those that suffer high blood pressure or other obesity related diseases. I do not feel these people should ever be discriminated against in their time of need. These people could’ve been the healthiest people prior to their illness or injury, yet they still ended up costing the plan alot of money. For someone to say that they don’t want to pay the costs of those that are fat is discriminatory and ridiculous. A group health plan is shared risk.
June 25th, 2009 at 3:43 pm
If the employer is going to require participation, wouldn’t they have to pay for the time the employee spends at the gym, or working out?
June 25th, 2009 at 3:43 pm
Sorry, I disagree on HRAs. Employers discriminate now against those with obvious disabilities, pregnancy and obese individuals though very few admit that is why they were not given the job or promoted etc. I’ve been in HR at a SR level for 18 years. It’s gone on in every company I’ve worked at. Personally I have some health conditions that my employer is not aware of and I would like to keep it that way. I’ve seen too many examples of “confidential” information being told on the sly because after all, who pays that 3rd party and wants to keep the contract? I like the incentives better. Assist in smoking cessation costs and gym memberships etc. Our medical issues are our personal business nobody elses. By the way, I am 52, non-smoker, non-drinker and weigh 101 on a 5′1″ frame.
June 25th, 2009 at 3:45 pm
Sandy needs to get a better command of the english language. I couldn’t even digest what she said because all I wanted to do was correct her grammar.
June 25th, 2009 at 3:50 pm
I do somewhat agree to the testing to target wellness programs. As a single woman who has never had children, is it unfair that I pay higher premiums because other employees have children? And what if one of those babies is a high-risk pregnancy and a preemie to boot? Are my rates going to go up? Absolutely; prescreening will not help determine these issues. What about someone who did not recover from surgery and in fact had another high-cost surgery that was not foreseen by the doctors?
Will my insurance go up? Absolutely. I do not begrudge anyone access to health care for any reason. My rates my go way up, but when all else fails remember the golden rule. For those who can’t remember or don’t know it, Do unto others as you would have them do unto you. To me that means biting the bullet when it comes to health insurance hikes and not making judgments about others. My mom was a smoker for over 60 years, but had almost perfect lungs when she died. Should she have paid higher premiums all those years, especially in her fixed-income years? You make the call.
June 25th, 2009 at 3:52 pm
We’ve beat this one to death at another post – we need to take health insurance out of the governments hands and out of the employers realm. Covering your health with insurance should be no different than covering anything else with insurance. Unless, of course, you think you are entitled to tax me to pay for your insurance.
June 25th, 2009 at 4:01 pm
Wow, that’s harsh! I’ve been paying premiums since I started working 30 years ago, with just normal flu or sinus infection stuff. A few years ago I up and decided to get MS and Cancer, how inconsiderate of me! Now because I do not want my employer to be aware of these issues, I’m irresponsible and am expecting everyone to pay my coverage? I’m still working every day because that’s the way I was raised! My premeiums are paid every pay check. Am I going to get any kind of a discount based on all the money I paid in and wasn’t used for me? NOT! All that will happen is my job will gbe in jepordy and then tguess who will be paying my unemployment, Social Security, Medicade etc. get real. Employers still discriminate, they hide it better and many, many of them are making a concentrated effort to change practices but not all. But this is my fault so what, selective termination because of a drain on resources? Is that what’s ext?
June 25th, 2009 at 4:05 pm
Ok so now my employer states I have to partcipate in a wellness program, like joining a gym as Sara stated, is my employer responsible for me if I get injured while excersing? Would I have to exercise during work hours or on my on time? And who pays for the cost of the gym? So who decides? And living a healthy life style, that does not guarantee you will not develope diseases rather they are passed down from generation to genertion or you just get sick; should these folks be penalized for some disease they have NO control over getting? I agree the health cost is over the top, but who allowed this to get so out of control? There is no easy answer, no easy fix. Discrimination is still out there why give employers a loop hole to continue to discrminate…..
June 25th, 2009 at 4:08 pm
Julie, you nailed it!
June 25th, 2009 at 4:14 pm
I am absolutely disgusted by some of the narrow-minded rhetoric in this forum. You’re right, an employer does not have to offer insurance, but once they do, it needs to be across the board and equal for all.
To the ones that think all ails come down to poor lifestyle choices…
I have a stepmother that is morbidly obese. She has been to the doctor ONE TIME in the last 10 years, for a slip and fall. I, on the other hand, have a gastrointestinal disorder (born with it, sue me!!) that has caused ailments since the day I was born. I am rail thin, and am lucky if I can stomach so much as 1200 calories a day without becoming ill. Yes, I meter those calories wisely and ensure just about everything I eat is healthy and nutritious. Bottom line, I look fabulous on the outside (I hear it often enough to believe others think so too), and I’m a mess on the inside. I’m 35, and my condition has caused ulcers, peptic ulcers, gall stones, osteoporosis and the list goes on and on and on.
Yet I still go to work everyday and give it all I’ve got and I get ZERO problems or requests to try wellness programs. Why? Because I look good! That’s the only reason!! My stepmother on the other hand (who by the way works within my organizations), is harrassed constantly because she is the perceived healthcare-relacted financial drain. Drivel, I tell you.
Get your head out of your rears and have a little sensitivity why don’t you?
And Bill, get your statistics straight – 60% of cancer DEATHS are preventable. This is not just an issue of wellness, it is about early detection and proper treatment. Lifestyle choices are one facet of that, not the whole picture.
And to that woman who wants to see all people go to the gym 12 times a month… If I ever see you on the elliptical, I’m so knocking you off it. Ha ha ha.
To the rest of you siding on the position of sensitivity and respect, G-D bless you, Human Relations/Resources need more of you!
June 25th, 2009 at 4:16 pm
There is a falsehood and a presumption that is accpeted by most as fact: unhealthy lifestyles are the main reason for the skyrocketing cost of healthcare. This does not make sense when you consider that our population eats healthier, smokes and drinks less, exercises more than previous generations. The sad truth is that those who live healthier live longer and cost more for healthcare. The sickly tend to die off quicker. I know many people who have smoked, drinked, were overweight and lived “unhealthy lifestyles” who rarely saw a doctor and when they died, had one short hospital stay. On the otherhand I know many who live “healthy” lifestyles and they regularly utilize the healthcare system, have extended stays in the hospital followed by convalescence.
Of course we don’t want to have people live unhealthy to lower costs, but without looking at what the cost of healthcare over an ENTIRE life, prorating the cost to every person, and requiring EVERYONE to pay their fair share whether healthy or infirmed, then all we are left with is blaming, accusations, and rhetoric. Until the insurance industry and the government look at the problem honestly, the insurance company will want to continue to insure the healthy and make a profit. The government will want to avoid spending all that money on the unhealthy that the insurance companies will not cover. Both will focus on lifestyles rather than on the real problem.
Of course, living a stressful life is an unhealthy lifestyle that is seldom mentioned. I guess it is good that our healthcare system is geared for the elderly to force them into bankrupcy and sell off all their assets. And the younger members of the family also get stressed and try to help out financially which can lead to their own health problems. Those living unhealthy lifestyles tend to die sooner and at a reduced overall cost to the healthcare system. With all the stress the system is placing on people to figure out how to deal with healthcare with dignity, many will die before their time and perhaps there will be some savings in that.
June 25th, 2009 at 4:29 pm
Our premiums are based on a couple of things; one is the claims history of the group over the past year. The other part is based on a larger group’s claim history. We cannot control either in most cases. The increases each year are getting higher and obviously it makes employees unhappy (including me) but the alternative is that the person would either die or develop serious complications with no care. To me, it’s more important to see the employee make a complete recovery or manage serious health concerns than the cost of future increases. Will I say that if we have a huge increase? Yes, I will even though the rate increase hits me harder and especially because I’m the one who informs employees of the rate increases at our annual benefits meeting.
We are in the best group possible for our plan; we started an HRA a few years ago to help keep costs down through cost sharing, but we cannot foresee serious illnesses or medical conditions that require extensive hospitalization and certainly cannot forbid employees to have more children!
June 25th, 2009 at 4:32 pm
I personally don’t believe that employers should be responsible for providing heathcare. It sends the wrong message to employees – stay with this employer, even if you despise the work, because they offer healthcare. I think that it is wrong for my ability to have access to healthcare to depend on whether I’m employed – what if I want to operate my own business? We do have a platform in place that covers everyone, but only when they reach the age of a senior, 62. Everyone should have access to the same system and no, it should not be free.
In today’s environment, you can do all the right things as far as staying or becoming more healthy, but the large insurers can simply deny you if you admit that you’ve ever been treated for a chronic illness. This is true even if you can afford the premiums. What kind of health system allows people who want to do the right things by managing their illness to be denied healthcare? If those with chronic illnesses are allowed access to healthcare, they are far more likely to have an episode that will land them in the hospital – guess who pays for it then? People who already have healthcare through higher premiums, that’s who. A national system such as the medicare platform would allow people to receive coverage even if they were traveling to a different state. This type of platform would allow employers to bring more money to the bottom line, stay out of the business of monitoring an employees health, and perhaps allow for the creation of more jobs. Discrimination due to chronic illnesses would end because everyone would be covered. We would also spend a lot less time trying to deny coverage and more time actually helping people get and stay healthly.
People need to think outside of the box about what would benefit everyone. If there were an affordable premium and a national sales tax, an individual or family would not need to be US Citizens to apply. When people insist that having everyone on the medicare platform is the same as socialized medicine, I ask them what they believe they have today. There is already denial of care, substandard care, and rising costs, all because the insurance companies only want to insure those who are healthy. Since the healthy insured are already subsidizing the uninsured, this is the very definition of socialized medicine. Think about it!
June 25th, 2009 at 4:35 pm
Beside the fact that employees are going to be forced to disclose private information about themselves to bureaucrats whose only interest is their bottom-line, and besides the breach of civil liberty, the focus on rising health costs as the problems of individuals (rather than on our increasingly greedy culture), is the ultimate issue here!
Rather than labeling smokers and overweight people as the cause for rising health premiums, let’s put the focus back where it belongs: in the workplace. The multi-billion dollar mental-health industry likely presents some of the highest costs for insurance providers. Employers are likely shelling out far more money on their overworked employees who are seeking help for their stress-rattled brains, high blood pressure, and anxiety. Women (who are forced to work twice as hard as men) to maintain a career may find themselves approaching forty and wanting children – and here come the high costs for fertility treatments. Think about all of the individuals who put off taking a sick day, or making an appointment for a specialist, because of the fear that they will “look bad” in their workplace for taking time off – and think of what that costs them over the course of a few years. I believe that work-related issues would likely represent a good deal of health insurance costs, if examined in an unbiased survey.
The statement “We should not have to pay for the poor health of others” is contradictory with what insurance actually stands for. You are contributing money to a pool, on the belief that if YOU need medical care, you – like all others who contribute to the pool – will receive it, no matter the circumstances. And look out – many people have their hands in that pool! But, the ones who are robbing the pool of all of its money are not a select group of unhealthy individuals. Its not a bunch of smokers taking all the health-insurance money from everyone else.
Believe that the majority of the money is going somewhere corporate, and not back into the pockets of “healthy people.” Don’t let companies dictate which aspects of your employers lives they should be forced to divulge in the sake of keeping premiums down – its another attempt across the boards to keep money in the “right” pockets. To believe that by targeting one group of “unhealthy” individuals for all of the health-care industry’s woes, you’re saving yourself some money? I mean, what rationally-minded individual would swallow such nonsense? Call it what it is: attempts to raise premiums without “upsetting” the general populace (”in the name of good health!”), a.k.a. attempts to line the pockets of greedy insurance big-wigs.
June 25th, 2009 at 4:43 pm
Wow. I’ve got no problem with wellness activities – for everyone! Then you aren’t targeting certain people who because of a combination of factors may or may not have a healthy lifestyle. And everyone benefits. I think you should take health care coverage out of the hands of the employers and the insurers and have a single payer system (call me a socialist, but I think health care is a right in a civilized country). Imagine the alternative – Apparently Jim wouldn’t mind it if his neighbors just laid down and died on the street because they couldn’t afford coverage. By the way, as you get older the cost for coverage goes up anyway, whether or not you have medical issues.
June 25th, 2009 at 4:54 pm
Are you kidding me? How is it my company’s business at all what I do outside of work? Perhaps it’s not “fair” that the healthy need to spend the same as the unhealthy, but what is fair anyway? I think it’s funny that a skinny person may think fat people are fat because they are lazy and eat too much. I know several overweight people who have thyroid issues, disability issues (not caused by their weight, but leading to the gain). Is it fair to discriminate against these employees?
I find it completely out of the question for employers to require employees to give up their private health information. Information regarding my health is between me, my doctor, family and close friends (or whomever I so choose to share that information with, not whomever I am forced to share that information with). If someone wants to dish out the information voluntarily, by all means, go for it.
Let’s think big picture here for the time being.
My thoughts immediately turn to the higher rate of asthma in children living in urban areas. Typically, these children live in less fortunate areas that are downwind of manufacturing facilities (or highly polluted areas). Is it truly the responsibility of the parent (who would pay the health insurance premiums) to pay higher premiums given that they chose to live in an area more prone to asthma in children? Given that they most likely had little choice in where they could afford to live, how does it make sense for them to pay more for insurance?
On a side note, states collect taxes on cigarettes; I find it sickening that smokers are constantly being blamed for many problems (lung cancer, emphysema), but they contribute millions and millions of dollars in taxes annually. I think there is little argument that smokers do, indeed, give back to their community just by paying these taxes. Smokers made the choice to smoke, but they also make the choice to purchase the cigarettes at a highly taxed rate. Then, smokers are accused of being unhealthy and gross, but are never thanked for their giant tax contribution.
I think we need to take a step back and ask “Why are these problems arising in the first place?” Not all fat people are lazy, not all smokers are unhealthy (or careless regarding their health). Is there something else that might be causing people to eat more or smoke at all? I think so; stress, which originates in the workplace a lot of the time.
Also, the line for preventative health activity doesn’t start or stop with smokers and the obese. What about groups that are considered a higher risk for STDs like HIV/AIDS, or even someone from a genetic line of cancer? Basically, this sounds like a good way to get your company into a huge discrimination debacle.
June 25th, 2009 at 4:56 pm
Blah, Blah, Blah. Bottom line is there are those that want to be responsible, and those who want others to be responsible for them.
Here is a plan I would have loved to have had available to me when I was young with my work life ahead of me. It is provided to our employees (not to me because the Government thinks I am too old for it!!) by United Health Care. We are a very small company with only 13 employees — how is that for a group? It costs $237 a month for each employee, which our company pays (except for $10 a pay check). The Employee pays the first $2500 of their health care costs (United Health gets reduced prices on quite a number of the procedures with this plan) and the Plan pays 100% beyond that. It is an HSA. Our company pays $50 a month into each individuals plan, which is theirs to keep if they don’t have to use it for Health Care. If they are healthy and don’t need care, at the end of the 1st year, they are $600 richer. (Because of our Sec 125 status, it is also tax free). If they can remain healthy and do not need any care for 10 years, they would be $6000 richer ( plus interest if they invested it). If something does befall them in their later years, remember the first $2500 is all they have to pay each year.
I am only telling you this to show you there are good plans out there for those who want to take responsibility for themselves. An indivual could fund their own HSA plan. Get a group together — how about your neighborhood, or your Church group, or a Health Club you put together. For less than $250 a month you guard against catastrophic “happenings” and if you want to put more in, it is like a savings account you could use to invest or do whatever with, as it is YOUR money.
June 25th, 2009 at 5:01 pm
Sara says an employee should have no problem going to the gym 12 times a month; that’s 3 times a week. Sounds good except for the single parent rushing to pick up a child before day care closes and have time to cook dinner, monitor home work and maybe read a bed time story. Before work is difficult for the same reasons, what time does day care open? I am not saying people should not exercise, but it might be walking the dog, using a video or treadmill at home. I don’t think an employer can control time off the clock, we all have commitments in life be it small children or ailing family members or something else. Living a healthy lifestyle is an admirable goal, but reducing benefits based upon arbitrary conclusions doesn’t seem ethical.
June 25th, 2009 at 5:15 pm
Just because you join a gym and go doesn’t mean you exercise and are healthy and likewise, just because you don’t belong to a gym doesn’t mean you don’t exercise or aren’t healthy.
Assessments would have the possibility of inaccuracies also. People knowing they would be denied insurance or have to pay a higher price may not always answer accurately.
If someone doesn’t sleep 8 hours a day, should they pay more for insurance? Where will the line be drawn?
Just my 2 cents.
June 25th, 2009 at 5:52 pm
Julie & Cindy-
No one is saying you need to join a gym or even work out hard to have medical insurance or pay less. A wellness program simply incentivises you to do somehting. It could be walking 3 days a week for 20 minutes, just anything to get people on their feet and active. An employer that does care about the health of employees will offer to cover a gym membership, or at least part of it. It could also be anything else that an employee wants to do that might be outside of a gym, but that is an activity they would partake in a few times a week to get them out of a seditary lifestyle.
Helathy lifestyles do not guarantee no medical claims, nothing can go that far. They do however have proven impacts on a reduction in risk. Did you know you can also be too skinny. Underweight individuals are a major risk group that is overlooked by many due to lack of understanding.
No one should be, are currently, or are even being considered to pay more (or be penalized) for any illnesses big or small, or any family history. The goal is not to weed anyone out. The penilization only applies to lifestyle decisions people make that leads to a higher risk for major medical claims.
All info gathered in and HRA is confidential. The 3rd party gathering the information does not even record the employee’s personal information (name, employee ID, nothing). If there is a discovery of cnacer or anything of the sort that stays private between the employee and the 3rd party.
There was a comment about paying for someones elses pregnancy. That is a non issue, it is already build into pricing for plans that cover maternity. There are also individual plans available that don’t cover maternity if you don’t want to pay for that type of coverage.
Tabacco usage and weight are the primary two categories screened for in terms of having an employee pay more for coverage with blood pressure and cholesterol being the other two that are less often but occasionally included.
last point, why would you not want to do all you can to take care of yourself. A wellness program includes provided receipe’s that are easy and healthy to prepare. Simple lifestyle changes that you can incorporate with your family to try and help your spouse and children also live longer healthier lives. Everyone can find 20 minutes 3 days a week to do some sort of physical activity to help stay active. It can be weekends or weekdays. I would argue that everyone can find 20 minutes every day. How hurt will you get walking, or doing jumping jax, or a few sit ups or push ups. I realize you can get hurt doing anything, but doing nothing is not an answer. You get hurt a lot worse doing nothing, you just don’t see or feel it the same. I challenge you to look at your last few nights this week. When you got him did you spend any time wathcing TV, or reading a book, or playing on the computer? If so, could you have carved out 20 minutes to do somehting different with the family? If not you must be the most active person on the planet, because even the president can find time to jog. I have 3 jobs and can find the time.
June 25th, 2009 at 6:16 pm
I thought being healthy was an individual choice not a requirement. EEs are free to decline coverage, decline wellness programs and decline the job if they wish. We don’t and wouldn’t require a new employee to make such a choice (drug screens are required though). We are considering a wellness plan but I doubt that we will see much interest from our line workers and more from office staff. Physical work is hard enough without gently suggesting our employees give up their comforts. Regarding clearly disabled EEs, what do they have to lose in having the RA? We couldn’t discriminate against them if we wanted to so they have nothing to lose. They may learn something they didn’t know. I do agree any results should be only available to the ER in the aggregate. Let’s hope the govt does less harm than it sounds like they intend.
June 25th, 2009 at 6:17 pm
to Bill,
Actually, some people have commented here that if you don’t join a gym or do wellness or complete HRA, you would be denied insurance. Again, I think that’s wrong, that’s crazy! But, again, being able to pay less premium or earn benefits if you do wellness activites is the way to go.
Even those who have serious illness and diseases that do wellness activities – to help improve their quality of life – regardless of eventual prognosis – I think should be eligible for wellness benefits and premium reduction.
I believe what’s costing us the most is the uninsured and the elderly. We have a plan for the elderly, though it does need improvements and that’s another discussion. Now we need a plan for the uninsured. Not a plan for more uninsured.
June 26th, 2009 at 6:28 am
I am an employer. I pay 100% of my employee’s health insurance, by choice. It is a fact eating right, exercising, don’t smoke, don’t do drugs, drink alcohol in moderation will lower you risk of major illness, improve your overall health and reduce insurance claims. Bottom line here is money. One side is tired of paying for the others bad choices. One side says “we can afford it”. But what make you think the other side can? Entitlement has become common place in America.
June 26th, 2009 at 7:00 am
Wow, where do you start on this one. Misunderstanding of insurance companies, entitlement attitudes, statistics from nowhere. Have any of you worked for insurance companies? Have any of you gone through an annual calculation of how your premiums are calculated – the taxes, reserves, governemt mandates an insurance comapny must comply with. Have you looked at the premium to claims ratio for not only your company the the insurance company as well? Have you studied where your claims are coming from, what meds are being prescribed for what illnesses. Judging by the comments, I’d say many of you don’t have a clue. But that is often the case in issues like this. In HR, we see this stuff everyday (or you should be looking at it) to see where are trends are and how we can take preventative steps to minimize. If you think your insurance company is ripping you off, sit with your underwriter (not your agent) and go through the numbers with them – you’ll learn something.
Medical insurance is a benefit – not a right or a privilege. If an employer wants to pay for your health care then it seems reasonable to allow them to set the rates and use whatever tools they need to get the best for their money. If that inconveniences you, remember who is paying and remember you can opt out if you don’t like the plan or the conditions. Perhaps someone can explain what “right” they have to an employers money – where is that written? Only people with an entitlement mentality would argue from that position.
Mel – you make good sense.
June 26th, 2009 at 8:14 am
To Rebecca and those against HRA requirements for healthcare coverage or lower premiums:
I am head of our Wellness Team in our TPA environment. As a company, we promote prevention and wellness to our clients and try to prevent not only the 2nd heart attack, but also the first. We suggest to our clients to conduct HRAs..voluntary or not. So, we are practicing what we preach and having all of our health plan members take the HRA and suggesting that the rest of the employees do it as well so they can be aware of their glucose, cholesterol, blood pressure and BMI levels. We had an overwhelming response…only 10 people out of 55 did NOT get the HRA done. Also, some of them were shocked to find that they were either borderline or just in the high range. Some even went on meds and started eating better….BY THEMSELVES, not by us telling them that they had to. As a wellness team and a company, we only see group results and can plan activities and events around the categories that effect our company.
Health Care is already moving to consumer awareness through HDHPs, Health Savings Accounts and even Flexible Spending Accounts. We all want employees to be aware of what they are spending on healthcare, so why wouldn’t we want them to know their own state of health as well? This lets them know where to start.
June 26th, 2009 at 9:54 am
Agree with Jim that health care stay out of government hands absolutely – but those in power sure want that to happen – and post haste!
They know that more info and influence means vastly more power and control over anyone who might disagree with their agenda….which is sadly for us – one leader rule and one form of representation (none). Thinking otherwise might be wishful thinking at this point.
Just look at how the 28 page census questions read – like “if you have had experienced a mental illness”….are you kidding? Have you seen the questions and not answering can bring a $5K fine? Are you going to give that info to the (Acorn) government? Recall that the Japanese were rounded up in the 1940’s and detained after Pearl Harbor because the government used the census data to locate them. Who is going to stop the government now……ACLU? Hardly.
So, how safe do you think your medical records are or will be going forward……just remember how easy it was for Joe the Plumber’s personal data to be broadcast on tv last year and what little punishment was metted out or concern there was about the Obama supporter who intentionally leaked it. Freedom of speech? This issue ties in with the overall destruction of our society as we have known it…nothing is perfect but some in power think their way is the only way!
Having this data all around and controlled by one entity is indeed Big Brother and bad for us. Hope my grammar and spelling lives up to the standards here……
June 26th, 2009 at 10:36 am
To Kelly,
I am 100% for HRA’s. We are with BCBS and they have been helping us do them and our wellness activities for about a year and a half now. They are voluntary, though we promote and encourage as best we can. We have near 100% participation amongst our employees, 73% amoungst family members – so far only 3 employees did not participate – one is not on our plan and the other two just don’t participate in anything. I am fortunate that our group is consumer aware, we have HMO and HDHP/HSA plans, and that they saw the great benefit of doing them – the benefit for the employer to help develop our wellness activities (from the group results, not individual – that’s kept confidential); and the benefit to the individual employees and their family members to be more informed and improve their health.
Again, I’m for them, let’s promote and reward for them, but just don’t require them in order to have insurance.
June 26th, 2009 at 10:49 am
To Sandra,
I believe we should all strive to lead a healthy life; all the efforts of exercise, low fat and sugar + high fiber diet, no smoking, and no to small amounts of alcohol will make the golden years more tolerable.
However with that being said, sometimes it’s not enough. Genetics and the environment around itself can somehow prevail. I do all the right things but yet I still have a list of ailments….one from actually working out too much. So we can all try to lead a healthy life but sometimes you can still come in second, so to speak.
So Sandra, it’s not always about not caring about one’s health. Sometimes it’s just the cards we are dealt.
June 26th, 2009 at 11:14 am
Honestly, some of these comments on this chain makes me cringe because they are sincere statements made by Human Resource Professionals. We are supposed to be the gate keepers. This information WILL get out, employees WILL be discriminated on based on statistics and perceptions. If the Pentegon can’t keep secure laptops from being misplaced, and MaterCard can’t keep their data systems safe from hackers, THEN you might have a slim chance of convincing somebody that the third party the employer is paying will not reveal any information on employees, but I doubt it. Also, we have not addressed pre-hire selection. What do you propose? A medical questionaire to “weed out” older, overweight smokers and drinkers? Don’t you recognize that this takes us backwards not forwards? Probably not as many may not have been in HR as long (18 yrs) as me but I’m sure some of you have.
June 26th, 2009 at 12:17 pm
What info are you afraid is going to get out. It’s out there already. Consumers for individual coverage and employees that work for small companies with less than 50 employees are already required by insurance companies to provide their medical history to get insurance in the first place. HIPAA is now supposed to help protect that information better, employers aren’t supposed to see that info, but they probably still do in many cases – especially with paper enrollments that go through employer vs. electronic enrollments. So again the insurance companies already have the info and employers get quarterly utilization reports with the group’s claims history – so they get some info – but it’s after a claim is already filed, after someone has the heart attack.
The HRA’s help consumers and groups be more informed, be more proactive vs reactive. But again, keep them voluntary, do not require them. Employers should not require HRA’s or participation in wellness activities, or for people to get care to have insurance or a get job, keep the decision to participate or not an individual/consumer choice. Of course continue to do what’s necessary to keep individual info confidential, but allow group reporting so employers can help promote the benefits of HRA’s and wellness activities, the keyword is promote not demote!
June 26th, 2009 at 1:21 pm
Cindy is right! Several years ago, it was suggested that two of our employees should be “run-off” because their spouses were extremely ill. The spouses were covered on our health insurance. It never occured to the company that my spouse was also covered on my plan, and that she too, could become ill. I asked for this request in writing and it was quickly dropped.
We hire people on their ability and experience to do a job. They are required to pass a physical and drug screen. We do a complete criminal background check. We should not do a “lifestyle” screen to qualify prospective employees for employment, nor for health insurance to cover them and their families.
June 26th, 2009 at 1:40 pm
What about the poeple like me who ran, rode dirt bikes, played hard and now have many medical issues due to this “healthy” behavior. Come on people quit being so judgemental, I guarentee I can find many things you do that can cause health costs to rise, many of these are thought to be healthy things to do. I for one will have chronic pain for the rest of my life and may undergo more surgeries due to my “exercising”. Is exercise good? Yes. Is eating healthy good? Yes. But let’s not start this slippery slope of judgement or you will get caught up in it someday.
June 26th, 2009 at 1:46 pm
This is one of the biggest problems with these discussions – everyone somehow ends up debating on the extreme end of the issue at hand.
The article is not talking about businesses charging an employee higher rates because they have cancer, are obese, smoke or anything else. The topic is about giving employees the opportunity to participate in an HRA and make a concerted effort to diagnose, eliminate or treat those things that CAN be controlled.
I have conducted HRA’s in the past and have had employees thank me for the opportunity to have some of the baseline tests (cholesterol, blood sugar, blood pressure, etc.) performed. Two of them found out that they were diabetic, another had high blood pressure. Because we offered this opportunity and they took advantage of it, all three of them were able to begin treatment and avoid large doctor bills, missing work, suffering the more severe effects of their illnesses.
The current coverage offered at my company offers FREE preventative/wellness care – pap tests, mammograms, colonoscopies, physicals and vaccinations (to name a few) are covered at 100% with no co-pay. The point of offering this is to encourage our employees to get their annual exams and to promote wellness in order to curb the occurence of major illnesses and high dollar amount claims.
Next year, I hope to have the budget to do HRA’s and focus a wellness program based on the group results. Maybe even offer an incentive to employees who successfully quit smoking, start and maintain an exercise program or lower their cholesterol. If that makes me a horrible shallow person – so be it.
June 26th, 2009 at 2:03 pm
Stacey, I don’t think you’re shallow. I just don’t agree that we are looking down the same long term path. I’ve seen very innocent programs become much more invasive than ever intended. If the information is out there it can be used in a negative way.
If we are saying “Hey, we are going to have a voluntary evaluation clinic and if you want a free BP check or whatever then come on in” fine. That’s not what is being proposed. I want to choose what health information I want to give as long as I can do my job. I should not be forced, fined or otherwise punished because I want to keep my private life private!
This has some very scary implications down the road if it becomes mandatory that an employee or potential employee is required to give this type of non work related information. At what point does the line get drawn? Who draws it and what are the consequences of it?
June 26th, 2009 at 2:09 pm
Stacey, PHR- from a practicle standpoint I agree with you. From a philisophical and problemsolving standpoint, I see the elephant in the room is how healthcare is handled in two pools; Employer sponsered healthcare insurance and government sponsered healthcare insurance. IMHO, Employers should not be in the healthcare insurance business. Employers should be able to focus on the job and the ability of their workers to do the job.
From a productivity standpoint, getting rid of “unhealthy” lifestyle behaviors will lead to immediate returns on investments for employers only to drive up the end of life costs for the government. Most research is focused on the effect of “unhealthy’ lifestyles on employers while the effect on overall costs are ignored. (One such study can be found here http://gateway.nlm.nih.gov/MeetingAbstracts/ma?f=102233459.html ) Businesses armed with information from studies like this, take license to intrude into people’s lives and discriminate with impunity. Another study looks at lifetime costs ( http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=1361028). A study done in Holland (probably won’t be done in the US) shows that for lifetime healthcare costs, that the obese cost 10% less than the healthy. The study also found that smokers cost the least.
We need to look at the total cost of healthcare over a lifetime and stop blaming and discriminating against those we feel don’t have “appropriate” lifestyles. We need to get a system that addresses these cost over the lifetime. It’s the costs now deferred to the government that every person and business must cover with taxes.
June 26th, 2009 at 2:34 pm
It all boils down to the same thing.
Individual responsiblily.
Individual buys health care insurance from whom ever they want, deals for the best price, finds the provider that rewards for healthy lifestyle.
The problem comes in when it is not important enough to some, so they don’t buy (don’t say “can’t afford it” you find a way to afford car insurance.) If you had to have some form of health insurance (or prove viability of payment) before you could get treated, you would find a way, just like you find a way to buy car insurance because you can’t drive without it.
Cindy, I hear the same fear of Government in your comments that so many feel. We just don’t trust the Government anymore because Obama tells us one thing, then slides around the issue, and brings us along to believing his lies until it hits us in the face — too late — damage already done.
We need the government to fear us, not the other way around. Peoples fear of Government brings Tyranny, Governments fear of the people brings Freedom.
June 26th, 2009 at 5:06 pm
Careful TH – under the ADA amendments passed this year, bad spelling could be viewed as a disability.
June 29th, 2009 at 7:10 am
I’ve been in HR for 30+ years and have seen health care coverage change over the years; even at one point the employee’s contribution was based on salary. Several years ago employees could participate in an HRA and receive monetary compensation. That changed to a “requirement” with a session with a “heath coach” to set up a “plan” to be entitled to equal coverage offered the previous year. I’m anticipating this next year the HRA and health coach options will be “required” to be entitled to equal coverage offered this past year and in addition I have a suspicion the “plan” will have to be completed or you will be subject to a reduction in coverage. I’m not opposed to the HRAs, but I can honestly say I’d rather have a discussion regarding my health with my only family physician versus a stranger on the phone. What will be next? A Health Care Nazi? Maybe we need to do a root cause analysis on the rising cost of health care. I agree that it is not all attributable to “unhealthy” lifestyles. A good friend of mine had a grandfather that used to eat bacon grease on bread and smoked cigars and he lived to be 100 and had relatively few sick days! I hope all of you who are judgmental of people’s lifestyles and think you “know” why they have issues never have a medical setback in your lifetime because Uncle Bob or Grandma Sally had a bad medical gene.
June 29th, 2009 at 9:03 am
I think everyone tends to forget that this is about risk and not about actual healthcare costs incurred, just likelihood and risks. If you are overweight, smoke, drink and do other unhealthy things, it is not guaranteed you will actually have all the health issues associated with them, but there is more risk that you will. That being said, I think premiums and discounts should be based off of the risk. Granted, you can’t help things like age which is a factor though. Sandra, I do actually agree with you. But also, part of HI is being part of the pool, and your health and risk will always be factored in with others.
June 29th, 2009 at 4:39 pm
I think RWA has summed up what many feel is the answer, charge according to risk rather than expected cost. The problem is that we can easily jump on “unhealthy” behaviors as risky behavior resulting in higher healthcare costs. This may be true concerning costs during the “productive” years of employment. However, the older you get, the higher the RISK that you will cost the healthcare system a bundle. So using this model, all those with healthy lifestyles will live longer and cost more for healthcare when older.
This is the problem with employers providing healthcare. They focus only on the short term risks/ costs while a person is in their “working” years. The cost for care at the end of life is ignored. Either the person must sell all their assets and go into bankruptcy, have family members pick up the cost, or go on government assistance (or a combination). For those who have unhealthy lifestyles and have been maligned for the cost of healthcare, they tend to die before receiving the expensive end of life treatments and care. Studies have shown that for the cost of healthcare over an entire life, those that are overweight cost on average 10% less than those who live healthy lifestyles. The studies show that those who smoke can cost on average 26% less than the healthy.
If we continue to promote health insurance through employers and do not pay attention to the cost when the healthy age and leave the work force, then we ignore the cost individuals, their families, and our government medicare/ medicaid system.
June 29th, 2009 at 5:57 pm
The Employer is going to Have to be left out of the mix in order to have a plan like Mike and RWA are suggesting. That is Good. The Employer should not have anything to do with people’s health care. That was started in the war years, as an incentive……..and just became the norm. However, the Government likes the Employer’s to do all the work for them. Collect the taxes, provide the health care, provide Cobra, report the taxes, …………oh well, someone’s got to do it.
GET THE EMPLOYER OUT OF PEOPLE’S HEALTH CARE.
June 29th, 2009 at 6:32 pm
Sandra needs to learn how to spell. On another note, not every sick person can help being sick and some people have to take medication for an illness and the medication makes them have other health problems. And since when did this become a political forum????
June 30th, 2009 at 12:42 pm
I cannot believe that in this day and age there are so many people who don’t get it!!! Those contributors who believe it is appropriate to dictate people’s personal lifestyles ignorantly assuming that that will keep health care costs down need a reality check. I have a perfect example – my father, who was thin, non smoker, non drinker, athletic was diagnosed with multiple sclerosis at the age of 31 – according to some of the ill logic presented here he would have been a prime candidate for health benefits at the lowest cost possible PRIOR TO BECOMING ILL. What does the employer do in a situation like this – once someone becomes ill through no fault of their own then they’re dropped or premiums raised – RIDICULOUS – and so is everyone who thinks this is a viable option – especially in light of new ADA legislation. I have one other point – I have no children, therefore, costing the insurance company no money in regard to childbirth and then the additional healthcare costs of numerous family members – why don’t I get a cheaper premium than people who have 3, 4 or more kids and are costing the insurance company at best 10’s of thousands of dollars just to deliver those kids. As you can see just from the few examples I used, this whole idea of charging or qualifying for health insurance according to PERCEIVED lifestyle is archaic and would take human rights back at least 100 years.
June 30th, 2009 at 2:07 pm
Yeah!!!!! Susan A gets exactly what I have been trying to get across too! Trying to “predict” health care costs ranks right up there with playing the lottery!!!!
June 30th, 2009 at 3:03 pm
Jagger –
Isn’t comparing auto insurance to health insurance a bit like comparing a trip to the local beach with a tropical vacation????
I pay $253 every six months for full coverage auto insurance. My employer pays $450 a month for my group health plan. If I had to pay $450 a month just to insure my vehicle, I wouldn’t be able to afford it, would effectively lose the ability to drive legally, and boy… wouldn’t that be the start of a nice downward spiral? Sort of like the same spiral a person would tumble down if they had no health care and had an emergency happen.
Come on!
June 30th, 2009 at 4:40 pm
First let me say, you are getting pretty cheap car insurance! Good for you. Of course we would expect to pay more for Health Insurance, because it costs more to get something “fixed” if something goes wrong. Let me ask you this: If your Employer stopped providing your Health Insurance, but
paid you $450 a month extra, would you use it for Health Insurance?
July 1st, 2009 at 7:32 am
I’d agree – cheap car insurance.
I would say that comparing auto and health insurance is valid – insurance is insurance. The basic process and assumptions used are the same. The reason car insurance is less is that the frequency of use is far lower than that of health insurance. Also, using your car insurance could result in a premium increase while using your health insurance may cause your employer’s premiums to rise which are spread out over a larger population, so less noticeable. And a s Jagger notes, the cost to fix a car generally are less than that of a body. Of course the cost to insure a super-tanker from sinking or causing an oil spill are staggering as well – it’s all proportional to the risk the person chooses to insure against.
Hopefully Grace would take the money and buy the health insurance. There is plenty of evidence that others who could afford the $450 would not/ do not, even if it is in hand. They’d spend it on that new boat, the 4th car, the house that’s beyond their means, etc… Too much is spent by people keeping up with the Jones and not enough is being saved or spent on the real necessities. Among other things, I’ve managed a 401k plan for many years and over those years I’ve watched people borrow against their retirement to get that new car, that boat, that vacation house, etc… Then they tell me they are working night and day just to make ends meet. I just shake my head….
July 1st, 2009 at 1:25 pm
There is much to be learned by comparing car insurance and health inurance. I agree that insurance is insurance and it varies due to the cost of coverage and the risk pool.
Not long ago, car insurance was like our health insurance (optional). Those who could afford it bought it (along with insurance for uninsured motorist), those who didn’t took their chances. When the law changed to where it was required in order to drive, the costs skyrocketed and there was no provision to cover high risk individuals. They were excluded from the pool, but they didn’t need to drive anyway (but they did).
Now we have various plans from full coverage to liability and a bunch of bargain basement minimum coverage providers like SAFE AUTO. Today, the vast majority of people with full coverage are older adults. The vast majority of those with minimum coverage are the young. These minimum coverage plans do more to protect the other person and meet legal responsiblities than replace anything that you may lose in an accident. And still, the risky are excluded. Of course they still drive, just without insurance.
Now it is proposed to have “universal coverage” which will be the same as ALL people employed must have health insurance. (This will be similar to workers compensation insurance, I would expect only the employee will have to pay the premium). If you don’t agree to pay the premium or don’t qualify for the health insurance, you don’t work. So don’t be surprised if the cost of this insurance skyrockets as welll. There will be plans from full health coverage to a minimum coverage plan that will meet the bare legal responsibilities. And then there will be those who will still be excluded because they are unemployed or due to their risk (age, pre-existing conditions) and will have to be picked up by a government plan. And there will be a push to terminate those who exhibit unhealthy lifestyles (smoking, over weight, drug and alcohol use, etc.) to move them into the government risk pool. And there will be those who work “under the table” who will also be in the government risk pool if their health suffers.
Health insurance DOES differ from car insurance. Employers don’t provide car insurance and you have a moral imperative to live. It is a “right” with a moral responsibility. And the government exists to deal with issues like these. The country was founded to “establish justice, insure domestic tranquility, provide for the common defence, promote the general Welfare, and secure the blessings of liberty to ourselves and our posterity.”
July 1st, 2009 at 1:54 pm
Mike – I’d disagree respectfully – insurance is the same regardless of what you are insuring, ie, it functions in the same manner. As I have written elsewhere, and remind people often, when my grandfather was alive and working, he did not have health insurance. Nor did any one else. It was not a crisis. People paid for the cost themselves. Charity was abundant for those who were in need. Employers only got into the business of health insurance recently and only as a recruiting and retention tool to distinguish themselves from others. Now it seems they are being mandated to do so – or expected to provide when for most of this country’s history, they did not – nor did the government. I’m not sure I understand your moral imperative but I understand the President used the same statement recently. Perhaps someone can explain how it is now a moral imperative when it never was before. Not being insensitive here – just trying to understand at what point did health insurance sneak into the Bill of Rights or the Constitution. The Constitution provides for equal opportunity but not equal achievement.
July 1st, 2009 at 3:07 pm
Jim, I apologize. Insurance is the same. The problem is people confuse insurance with healthcare. Employers should not be in the business of healthcare. Government should not be in the business of insurance. My intent was to distinguish the moral imperative for maintaining your health over driving a car.
“Health” is not a personal choice, but a moral imperative. “Healthcare” has no business in the free market, because a moral person will pay any price to live and the market will then take everything making them dependent (in servitude) on the system. That is why you cannot sell your organs or compromise your health for financial gain in medical studies.
That being said, the government from its inception (see our preamble to the constitution) is not about equal opportunity, but “justice, insuring demostic tranquility (maybe that is where they got into the healthcare insurance business), provide for the common defence, and promoting the general welfare.” So the government MUST ensure justice (fairness) when determining who lives or dies (has access to healthcare). When a person becomes ill or disabled, it affects everyone around them, as well, so government has a role to insure domestic tranquility and providing for the general welfare.
July 1st, 2009 at 3:21 pm
Mike, I get hung up on the moral imperative part – recall George Bush told us it was a moral imperative to be in Iran for example. I also get hung up on the right to live and how long and who decides. Does the government force healthcare in all cases and at who’s expense? Justice cannot be equated with fairness for who can define “fair”. And fairness varies over time as does justice. It was once fair and just to have slaves or burn witches. The preamble is a great statement within the Constitution yet it grants no authority to any one to take those actions. Its like a mission statement yet it does not require nor empower the government to act in any special way. Not any easy one Mike – and one I’m afraid will lead to rationing if the government remains involved.
July 1st, 2009 at 5:02 pm
Jim, I agree. The preamble provides the substance for why the union of states, the government was formed. The constitution and laws dictate the how the government will conduct business. When an organization fails to consider its mission in its operations, it will either fail or have to revise its mission statement to reflect its reason for being.
The challenge for democracy is to establish justice and fairness. Our country is founded on the concept that the government is “We the people.” This requires everyone to approach these problems in good faith with an attempt to see the problems from all sides and agree to a fair resolution. I don’t know if there are enough people in the country that are able to put aside their biases and self interests to accomplish this. Everyone seems to be afraid of what they might lose or what it may cost them. The days of “don’t ask what your country can do for you, but what you can do for your country” has been replaced by a sense of entitlement, fear, and greed. If that is the case, then our republic will collapse. It seems that the failings of the economic markets, banks, and businesses is just the beginning.
July 1st, 2009 at 5:03 pm
Thanks, Jim, for answering Mike so elequently. I disagreed with what he wrote, but didn’t quite know how to answer it. Again, you cleared it all up nicely.
I also, identified that statement “moral imperative” as a talking point sometime in the past. And how can health not be considered a personal choice? And as far as the “free market” taking everything, making them dependent????? And what is our government trying to do?
July 1st, 2009 at 5:40 pm
FEAR is the operative word. When the People fear the Government, there is tyranny. When the Government fears the people, there is freedom. The question is for today: Who is doing the fearing?
There is a difference between justice and fairness. Justice is not always fair, and “Fair” is not always Just. Justice is formulated from Law, Fairness is formulated from feelings. THe law remains constant until it is changed, feelings are not a constant, ever. They can change in a whim.
I do believe the problems in America, right now, did not start Yesterday (meaning during the last few administrations) They started a long time ago. They are just coming to pass right now.
http://video.google.com/videoplay?docid=-515319560256183936&q=the+money+masters+video&total=364&start
July 2nd, 2009 at 7:21 am
Agree Mike – so many have not saved for a rainy day, have over-extended themselves, over consumed, over-reached beyond their means – short-term gratification, so they now are relying on their employer to foot the bill – they are relying on their government (you and me) to foot the bill. Should we foot the bill for people who have to by that John Deere tractor instead of walking behind their mower or that new boat or sports car and deplete their 401k (with a reliance on Social Security as their “retirement”)?
I did a post on rugged individualism vs rugged entitlement a while ago – I believe there are too many people who are are passengers – just riding, and not enough people contributing.
Yes Jagger, you have brought up the issue of moral imperatives before. I believe in freedom, which I have stated before is not having your hand in my pocket. I should be free to insure myself or not and be willing to pay for it – it should not be mandated by the government either to me or to my employer. If I choose to contribute to the plight of others (which I have done generously over the years), it should be my choice, not my governments in terms of forced taxes. Unfortunately in this country we have “We the people” and “We the government” – they are mutually exclusive and they don’t trust each other.
July 6th, 2009 at 3:45 pm
As a society, we expect that a certain level of care is provided to all that respects human dignity and provides for basic needs. For the most part, we live under the belief that we have systems in place that provide for those basic needs. When I speak of a moral imperative, I liken healthcare to someone who has a gun to your head. The healthcare system can demand anything and you will agree because we have an imperative to live. It’s not like fancy cars or large screen tv’s where there is a viable choice to do without.
It is not until we, ourselves are afflicted that we come to realize how woefully inadequate and inefficient the current system is. That affliction may be due to our own healthcare concerns or for those of a family member. And we will all have to face healthcare concerns at one time or another and the longer we live, the sooner that will likely be. When you see grandparents lose their homes they have worked for all their lives and file bankrupcy due to a medical issue. When you see families pooling resources and drowning financially to help cover healthcare costs for an ailing family member, it becomes clear that what we got costs too much and is not working.
As a disabled american veteran, I know how the system fails to work. As a professional working in social services, I see people choosing incarceration over freedom because they have a higher standard of living while in custody (shelter, nutritious meals, healthcare, access to mental health and educational services, etc.)
Those in authority will point to costs and change the discussion to “insurance” and “medicare/medicaid,” but they ignore systems in other countries that provide better overall care at a cheaper cost. Businesses are not burdened with providing healthcare and the costs are spread out from cradle to grave. And people are less stressed because they know their basic needs will be met.
Unfortunately, so long as the insurance companies can limit their pool to the young and healthy and leave the elderly and infirmed to the government, the system will remain inefficient and costly.
July 6th, 2009 at 3:58 pm
Mike – Wow…your insights are spot on.
Thank you for your past sacrifices and for your current wisdom in seeing the issue as a whole.
July 7th, 2009 at 7:49 am
Thanks for serving Mike. Those of us who have served have a special appreciation of America, what it stands for and the cost to keep it free.
I’m not sure the Europeans have the handle on the solution either. They have not been able to control the riding cost of health care any better than we. They do ration meds, doctors and services (much like Medicare) to try to control costs and their outcomes on many diseases is not as favorable as the US or significantly better. A lot of the data from other countries is flawed in the sense that some do not report the full cost of the providers salaries, capital improvements, etc… In the US, we rely on the latest technologies and they are expensive but not always the most effective.
Perhaps a simple law that does not permit exclusions and ratings based on large pools of people rather than individuals would offer a solution without the obvious problems of a large, Medicare like system.
August 27th, 2009 at 8:24 am
Our company pays 65% of health insurance and offers incentives for participating in an HRA. Despite of what some people believe, we get no personal results, only composite results. Our goal this year is to raise our HDL. Some people will never work to achieve results. We don’t penalize them. Requiring a gym membership isn’t the answer. I don’t belong to a gym, but I walk 3 miles during lunch every day. I also do strength training in the compay gym, which we set up for less thatn $1000. We offer people options and hope they take advantage of them.