Obamacare and obesity

h7463 · May 2014

Of course, everybody likes to save a few bucks, but the incentives do not serve a purpose for this kind of insurance. To make an insurance like this work, there have to be as many participants as possible signed up, so that the premiums will be at a reasonable rate for everybody. There is a pot to be filled, and if you start giving out a bonus for various things, there will be again not enough money left for the claims.....and the premiums will again go up....
I don't know why they've been trying to reinvent the wheel here. It's been working well in other countries for decades. I can tell, because I have enjoyed several European healthcare plans for a good 30 years. The premiums were a percentage of my salary every month, not a fixed amount. No point in paying $300 for insurance, if the paycheck is only $500, right...?
Employers only payed their share, as required by law, but they had no involvement in deciding which provider or plan I wanted. I was free to sign up with any insurance that I liked. There were, however, insurance companies that specialized for certain trades, which sometimes resulted in lower percentages for the premiums. E.G. the construction industry traditionally employs less women in the field, therefore, the costs for anything related to women's health care and child birth are lower. Access to this insurance is restricted to employees of qualifying companies, and this way, the savings can be passed on to the customers, men and women alike.
Also, I rarely ever had a co-pay. It was all inclusive. No fights with doctors about a remaining balance. Once the doctors sign up with the insurance companies, they have to be content with their rates. No dozen bills from as many doctors after a hospital visit, either. The insurance company took care of it all. I'd like to see that here in the US....

To sum up my rant, health care and insurance in this country has been and still is a joke, IMHO....

harvo · May 2014

While i agree with a lot of your post,and i appreciate you explaining it well, i disagree with one part and as to not stray off topic i will move on. Thank you again.

bregalad5 · May 2014

I was working part-time, and also in a state that didn't expand Medicaid, so if I were still living there I'd also continue to be without insurance because the costs would have been outrageous for me.

On topic, I like where you're going, but the chances of something like that working are slim to none, unfortunately

krawhitham · May 2014

It's because Obamacare isn't affordable care for everyone. Many people saw their health insurance premiums rise. These same people may not have gotten a raise in the last 10 years. Unfortunately, the new American system is absolutely nothing like the Canadian system.

The only reason I can "afford" it is because my state expanded Medicaid, so I get "free" insurance since I don't have an income. That's no way to live. Once I get a job... I get kicked off - NO health insurance again. :^\

Tigg_er · May 2014

^^ This so much so !

stealthq · May 2014

You're welcome. Forums aren't the best place for this kind of discussion anyway, in my opinion. Too much TL, DR; :laugh:

And ... back to the OP!

Quasita · May 2014

A lot of plans do indeed have discounts for healthy living. Most of the ACA coverages have wellness plans built into them so that you can get free counseling for various wellness topics, discounts towards certain programs, etc. While the rate on the coverage is potentially the same, you can get a decent amount of benefit out of the built in programs if you're willing to get into it.

However, ACA coverage is mandated by the Medicare/Medicaid office, and with it covering as many people as it does, it would be downright impossible to manage any monetary incentives on the rates themselves. You can, however, deduct a lot of wellness costs on your taxes, which would essentially be the same.

One could argue that you get a discount for not smoking... HA! Because smokers get charged a chunk more simply for that choice. LOL

Anyway, many healthcare plans DO give discounts for enrolling in their monitored health plans and habit changing programs. Smoking cessation is a big one, for example. A lot of them also offer reimbursement for gym memberships, associated discounts to merchants and things of that nature. Heck, the fact that insurance will cover your visit to a nutritionist or weight checks with your regular physician is a discount, because it certainly wasn't standard just a few years ago. That being said though, just attesting to a healthy lifestyle shouldn't earn you credit. Even those plans that do offer it require some sort of monitoring... Whether it is a questionnaire once a year, or regular physicals, or whatever. I certainly don't agree that someone using say, MFP, should be able to say, look I use MFP, so I should get cheaper medical coverage.

Health premiums are based on the overall projection of claims risk of the covered group. One of the reasons the ACA premiums ended up being so high for some of us is because without income contingent disqualification, we got hit with the most if not all of the premium cost. You have to remember it is the first year, and they were basing the numbers on projected claims increases and payouts. I suspect that after a year or two, we'll see some major changes to the costs, because they'll have a better idea as to how the US citizens use their coverage.
That's one of the damaging things about the fact that states didn't expand Medicaid, and didn't build state exchanges. Those choices not only included a larger selection of people in the premium pool, but also made it so those of us that had to go through the federal exchange were unable to get premium discounts that were associated with states who did take the time to make an exchange for their residents.

Frankly, I'm super overweight, and I wholeheartedly would support higher premium costs for obese individuals. Regardless of the lifestyle changes being made, obesity brings a lot of potential risk, more so than a lot of other conditions. Obese patients are also likely to be chronic long-term patients for conditions, as opposed to someone who is average weight. It's probably going to irritate people that I said that, but I'd rather pay higher premiums and have better access to weight management care on the plans...

healthyscratch1978 · May 2014

Sure, people differ on how to get there, but one method is actually in effect in the real world--problems and all--and other methods have been floating around in think-tanks and stump speeches and chats between partisans for 50+ years, where none of their shortcomings are evident.

Health insurance premiums and health insurance costs have been rising sharply, Obamacare, ACA, whatever you want to call it, certainly did not cause that.
.

Deipneus · May 2014

I'm no expert but it's my understanding that the Affordable Care Act only allows insurers to ask age and if you smoke.

harvo · May 2014

I would love to hear what is driving the cost up and are you during that the ACA has no hand in the continued higher cost of premiums.

seltzermint555 · May 2014

Yep, that's what is going on in my state and the reason I mentioned men's premiums being much lower - at least right now in my state.

Annie_01 · May 2014

I don't know...should we have to be given incentives to be healthy...we should want this for ourselves...not because someone is going to give us something...IMO.

mlanders22 · May 2014

I agree it's not the best way to categorize "healthy". It's hard to come up with metrics that work for this though.
I don't have a healthy BMI at the moment, but I qualified because I made an improvement over my BMI from last year.

strawberrypopsicles · May 2014

I think there definitely needs to be an overhaul in the health care system because insurance is a total scam. Once we needed this medication and it was over $200 but since our health insurance didn't cover it they only charged us $80, because that's how much it cost -- the rest of the money would have gone to men in suits.

And to the Canadian, Obamacare doesn't give health care to everyone. It requires everyone to have health insurance, whether or not they can afford it. The people who can't have to pay a fine to the government. So people who can't afford health insurance have to pay more than they used to, without getting any more medical help.

09_Harley · May 2014

***This***

weird_me2 · May 2014

We have so many problems with a lot of the health care systems here in the US, it's not even funny. A lot of our problems stem from people overtaxing the medical community and services that are available. A $5000 ambulance ride or $200 medication charged to people who have insurance is to help cover the people who don't have insurance and help them break even. Being in medicine nowadays is not a guaranteed way to "get rich" and most doctors aren't making the kind of money people think they do. Sure, some people and industries are making money, but that money is also used to create more and better treatments to benefit the people (and of course the "men in suits").

While I don't necessarily agree with the ACA, I don't disagree that everyone needs to be insured. I also don't disagree with penalizing those who aren't insured. Many of the people who "can't" afford insurance choose to not purchase their employer sponsored insurance or private insurance because it's "too expensive" yet still get thousands of dollars back every year on their tax returns. If they are getting money back from their tax returns, then the money is there to pay for the insurance, they just choose not to pay for something that's not fun and take what they can because they know that if something does happen to them, they can just go to the ER and they will get treated anyway. Yes, I know this isn't true for all of the uninsured people, but there are a lot of people out there who are like this. There are also those people out there who feel the need to run to the ER or urgent care with every little sniffle and there are those who will call for an ambulance so they don't have to pay for a ride to the hospital. These uninsured (and insured) people who mis-use the services that are available tie up these services, increases the workload of those providing the services and overall just makes the system worse. Until people stop doing crap like this, health care in the US is probably not going to be in a good place. If everyone was insured and had to help pay for their medical bills, then I think we would see a reduction in the over use of services and the costs for these services could reduce which would make health care more affordable for everyone. That's not happening any time in the near future because so many people in the US don't like to make the right choice instead of the easy one.

(I am putting a disclaimer out there that I know that not all uninsured people in the US are like those I described above and that I do understand that there are unexpected situations that happen that cause people to run in to hardships which may cause them to be uninsured temporarily, but I believe these are the exceptions and not the rule. The United States really seems to be becoming the land of the free - as in, I want it, I deserve it, I shouldn't have to earn it so give it to me. Too many people are unwilling to sacrifice what they want for what they need.)

No_Finish_Line · May 2014

nothings going to bring down healthcare cost until there is a 'single payor system' in place.

I don't mean to say that all health insurance should be run by the government, just that there be one and only one protocol for claims processing. HIPAA has gone a long way to standardize billing, but there quirks between how different insurance companies pay claims that necessitates more staff and expenses then would be neccesary in a more symplified system. this would also improve fraud control.

theres another change to the system that needs to be made which is far more radical. the entire industry needs to move to an outcome based payment system. A doctor might order tests X, Y, and Z when Z might have told him everything he needed to know. but by doing three tests the event is more profitable, and the increased cost is shared amoungst all the policy holders. This is controversal for a number of reasons, but not subjecting a patient to tests/procedures that aren't really necessary is also an improvement in patient care, when on the service it might seem the opposite.

Outcome based meaning that a healthcare provider is reimbursed at a much higher rate if the patients status improves then they do if it does not, with the actual treatments the hospital/dr performs effecting the payment less.

Obamacare and obesity

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