The Health Care Crisis: You call the shots

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The Health Care Crisis: You call the shots

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by Jim Catano

You may have no impact on the healthcare coverage crisis, but in the closely related arena of health, you’re the boss.
healthcareWhen President Obama delivered his message to Congress on healthcare reform, progressives breathed a qualified sigh of relief. The guy we’d worked so hard to elect didn’t throw in the towel on the public option for insurance coverage—at least not yet. Many of us had originally hoped for a single payer system like they have in Canada. Expecting the death of the insurance industry in America is a bit unrealistic…or at least premature. But we’re okay with just a public insurance option that would compete with the private money shufflers. Really, we are. And many of us are insisting on it, especially since we already compromised away a single payer system. Perhaps health insurers should take a page out of the auto insurance book: reward responsibility and healthy lifestyle with discounts—and charge more for those who choose an unhealthy lifestyle.

When President Obama delivered his message to Congress on healthcare reform, progressives breathed a qualified sigh of relief. The guy we’d worked so hard to elect didn’t throw in the towel on the public option for insurance coverage—at least not yet.

Many of us had originally hoped for a single payer system like they have in Canada. Expecting the death of the insurance industry in America is a bit unrealistic…or at least premature. But we’re okay with just a public insurance option that would compete with the private money shufflers. Really, we are. And many of us are insisting on it, especially since we already compromised away a single payer system.

Details are yet to be hammered out for a proposed bill; there’s time to incorporate a little “kick butt” radical into the public option to make it more sellable and more effective in delivering, well, health.

Yes, America has a healthcare coverage crisis. Yes, the healthcare system itself has massive problems and treatment is too expensive. But the biggest (and the least discussed) factor in the equation is our nation’s health crisis. It will take something radical to address that.

The “radical” concept I’ll suggest here is not really all that radical. It may be new to healthcare, but it’s not alien to other forms of insurance. In fact, anyone who drives a car legally pays for a policy that works in exactly the same way, and nobody complains about the basic structure of car insurance. Everyone ultimately considers it fair.

For example: I’ve been driving for 43 years. I’ve been in a couple of accidents but have never caused one. My fingers are crossed while I write this, but I’ve never had a moving violation except for one five-miles-per-hour-over ticket from a private university security officer. In other words, my record is spotless.

I’m also in an age bracket that most auto insurance companies consider “prime.” To be sure, certain people my age are terrible drivers but most are anything but, so I get the benefit of my group’s average added to my own perfect driving record and pay a really low rate for car insurance.

What would happen, however, if I started collecting moving violations, causing accidents and got a DUI? Well, my rates would gradually rise, and in the end I’d be paying several times what I did as my former perfect-behind-the-wheel self. That’s just the way auto insurance works, and few complain about it. It rewards responsibility and good performance with discounts, and punishes accidents and violations with rate hikes. That’s as American as apple pie, right?

So what does all that have to do with health insurance? Nothing, right now. But it should. The president’s proposed new legislation would prevent pre-existing health conditions from negatively impacting our ability to get or keep health insurance. Fantastic and long overdue! There’s nothing anyone can do to change the past once they’ve had a disease or injury.

But there’s a long list of health conditions we often can do something about: Certain lifestyle choices can lead to excess weight, high blood pressure, high cholesterol levels, high pulse rate, elevated blood sugar and fat levels and more. Those conditions are within the power of most people to change.

If the feds want to design an innovative program that effectively promotes better health, the public option coverage should be priced according to how well each of us “drives” the old body down the highway of life.

Some private insurance companies do offer wellness support and information to encourage healthy lifestyles, especially in corporate group programs. These tend to offer token awards when participants achieve goals and may even provide small cash incentives. What I’m suggesting is a graded and significant price break to the best body “drivers,” while charging full rate for those who are willing to risk “crashing and burning” as a result of their lifestyle choices.

I’m a good example of what I’m talking about. About 17 years ago, I got tired of being sick and tired. I radically altered my diet and reduced or eliminated things that did more harm than good once they slid past my taste buds. I eat very little meat and a lot of whole, unprocessed, raw or lightly cooked organic vegetables, fruits, nuts, seeds, beans and grains. I limit bread and pasta consumption to social situations, opting instead for brown rice, millet or quinoa (a nutrient-laden South American seed) with healthy sauces or stir-fries. I don’t smoke, drink or use recreational drugs, and never need the legal ones.

I now weigh what I did in high school. My immune system is so good that I don’t get sick any more. My medical stats (blood pressure, cholesterol, etc.) are those of someone much younger.

I know others who eat more raw food, pay stricter attention to seasonal eating, eat only organic, take a lot of supplements, exercise more. There are many ways to be good. The point is to do what we can to “maintain the engine.”

I’d love to find a health insurance program that would reward me for my good efforts instead of just looking at my birth date. Based on how often I’ve needed to see a physician for illness (not once in the past 16 years), I might never even use it. Still, as with all forms of insurance, it’s good to have, right?

Here’s a basic plan for a public health insurance option that would really interest someone like me. People of all political stripes could embrace it—it embodies both the fairness and affordability that liberals and populists love while honoring and requiring individual effort and personal responsibility conservatives and libertarians find lacking in government social programs.

Each covered person has a basic physical exam every year. Obama’s plan may include one anyway, as regular physicals are part of any good preventive health program and save money in the long run by spotting disease symptoms early. The exams could be done either in doctors’ offices or at large centers set up to conduct them efficiently and quickly. They would, of course, assess basic statistics. The standard blood analysis, the heart of the program, would measure more than 20 health markers such as cholesterol and blood fats, and cost about $20 per person. Some information would be self-reported (like smoking) but could be backed up by random verification testing.

The test result would be graded according to current medical understanding of how those levels relate to long-term health and the incidence of conditions such as diabetes, heart disease and cancer. Again, whether or not a person has or had any of those conditions would not be a factor. The tests are to find out how well we’re doing in trying to make sure problems don’t happen again.

From the test results, one is assigned to a fitness level and charged the corresponding rate. Five or so levels might be workable. The better your controllable wellness results, the bigger your discount.

As time passes, the result could be fine-tuned as each pool of insureds gains “experience” (that’s insurance speak for examining the amount and nature of claims), so the rates could be made to correlate precisely with how much medical treatment is needed by each group. Again, this is exactly how auto insurance works, and everybody accepts that what they pay corresponds directly to how well they drive.

You might ask why insurance companies haven’t come up with something like this already as it might be an interesting marketing angle. I learned the sad truth almost 20 years ago when I was the marketing director for the manufacturer of a new medical device. Since it enhanced the results of an established medical procedure, I thought it would easily win approval for insurance reimbursement. After a seminar session on reimbursement I attended, I was discussing with the speaker the cost-saving aspects of our device and how I expected the insurance industry to embrace it.

“You really don’t understand how things work, do you?” he responded. My confused look prompted his explanation: “Insurance companies work on a percentage, so they want the gross number for medical treatment to be as big as possible. Their slice of a big number is their bottom line. What they do is control their own internal costs while paying for the same expensive services all their competitors are covering, too. They pinch pennies in house or do things like try to deny certain claims or drop sick people from coverage, but they really don’t want overall medical expenses to be lower. The bigger the costs, the more they make.”

I’ll never forget that sobering lesson. And as much as I normally agree with food expert and writer Michael Pollan, I have to take issue with his position in a recent Sunday New York Times editorial. The fact that the insurance companies will have to take all comers regardless of pre-existing conditions under President Obama’s proposal will not by itself reduce costs. If anything, rates will go up, but the insurers really don’t care since their competitors will have to confront the same increases for added liabilities, too.

In the absence of other reforms, insurance companies will always want the overall cost for medical treatment to be high since they get paid a percentage of the bill.

But a public insurance option doesn’t have to work in the self-serving way that commercial insurance industry does. Because there will be no profit margin to return to investors (and upon which to base lucrative executive compensation packages), a public plan based on the ideas proposed here could be cost-effective even for participants in the worst level of fitness and also significantly reward those who go the extra mile to be healthy. Those who don’t qualify for the better ratings would have a significant financial incentive to take charge of their health to lower their rate in the future.

I realize, of course, the complexity of fully designing a plan like this. Providing public education about what causes lifestyle-related health problems and how to remedy them would be essential. Of all the various theories and contradictory claims floating around about how to achieve wellness, which health highways would become the recommended ones?

Ultimately, it might boil down to supplying the best thinking and research available and then allowing individuals to select their route. Putting all the conventional and alternative treatment modalities on a sliding scale of benefit might help, but it wouldn’t be an easy or uncontroversial tool to create.

There would also need to be ways to grade the results people get according to the methods they use. For example, controlling cholesterol through diet and natural means would need to “score more points” than artificially controlling it with statin drugs which have side effects that can cause other health problems. Yes, the pharmaceutical and food industries would likely spend a bundle of money to oppose changes that would certainly result in fewer sales of fattening, unhealthy foods and the drugs America currently uses to treat the resulting problems.

Finally, the time is right for another First Lady to get involved with promoting a healthcare proposal. I’d love to see Michele Obama take up this cause. She understands health and is a concerned mother trying to raise healthy children. She even tore up some of the White House lawn to put in an organic vegetable garden. Maybe she’s the right person to take the banner in promoting an innovative public option that could bless us all by kicking our butts to better health.

Jim Catano is a freelance copy editor and writer who finds every excuse to be hiking or running the Wasatch Front trails.

 
 
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