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The Economist on Healthcare

CHDeac said:
The path to lower medical trend? This idea has a lot of merit so long as its managed with a high risk pool product. You need good pool management and this is a good place to start.

I also dont buy the other comment about the inability of the employer to control trend. The employer system does have well known shortcomings....However, don't discount the role the employer can play in managing expenses. There are some very savvy employers who are starting to really put contribution $ at risk based on behavior. And its working.
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Maybe we should start basing premiums on genetic testing for newborns?
 
ONW said:
Maybe we should start basing premiums on genetic testing for newborns?
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As someone close to these issues, your examples aren't realistic.

There are plenty of ways to manage age based risk. This is a non issue.

There are also very solid programs to reward employers with a condition to participate in programs to manage that disease. A very simple example: You'll often see cases where diabetic supplies are covered at no expense if the employees does x, y and Z related to their diabetes. Same for weight management, exercise as well as a slew of more complicated programs, I see no issue with this. Insurers too are tackling this through value based benefit designs.

One of the larger drivers of trend is consumer behavior and I have no issue with payors to help manage this demand through various carrot and stick approaches. Better outcomes, lower costs.
 
CHDeac said:
As someone close to these issues, your examples aren't realistic.

There are plenty of ways to manage age based risk. This is a non issue.
There are also very solid programs to reward employers with a condition to participate in programs to manage that disease. A very simple example: You'll often see cases where diabetic supplies are covered at no expense if the employees does x, y and Z related to their diabetes. Same for weight management, exercise as well as a slew of more complicated programs, I see no issue with this. Insurers too are tackling this through value based benefit designs.

One of the larger drivers of trend is consumer behavior and I have no issue with payors to help manage this demand through various carrot and stick approaches. Better outcomes, lower costs.
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Honestly I'm interested in what you've experienced.
 
ONW said:
Honestly I'm interested in what you've experienced.
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Age/sex factor slope changes. Modified underwriting rules by age band. Active life reserve assumptions. Benefit design. Insurers largely aren't concerned about the age band changes being mandated in 2014 though community rating is a different story.
 
CHDeac said:
Age/sex factor slope changes. Modified underwriting rules by age band. Active life reserve assumptions. Benefit design. Insurers largely aren't concerned about the age band changes being mandated in 2014 though community rating is a different story.
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What happens in 2014?
 
ONW said:
Will you explain that for me?
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In the individual market, the adults rates can only vary from a factor of 3. Males/females pay the same rate. Generally speaking, younger males will pay a whole lot more which will test the strength of the mandate for the healthy. In year 1, a male making 50k will pay a $500 penalty and insurance is expected to be $5000 a year+.
 
CHDeac said:
In the individual market, the adults rates can only vary from a factor of 3. Males/females pay the same rate. Generally speaking, younger males will pay a whole lot more which will test the strength of the mandate for the healthy. In year 1, a male making 50k will pay a $500 penalty and insurance is expected to be $5000 a year+.
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Thanks. Who mandates the 3:1 ratio?
 
CHDeac said:
Its actually spelled out in the law (PPACA).....HHS has issues most of the guidance to date.
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Do they mandate any other requirements, age, lifestyle, gender, etc.?
 
ONW said:
I understand the higher risk concept, but do you really want your employer looking over your shoulder to makr sure you're jogging daily and not eating fast food?
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If someone else is footing the bill, IMO they have very right to do this if your poor health choices are costing them money. Some companies build gyms and do establish reward systems for good health.

Your money, your choice. If you rely on someone else, they get a say. It's too bad this didn't happen years ago, maybe the country wouldn't be full of fatasses.
 
KanhojiAngre said:
If someone else is footing the bill, IMO they have very right to do this if your poor health choices are costing them money. Some companies build gyms and do establish reward systems for good health.

Your money, your choice. If you rely on someone else, they get a say. It's too bad this didn't happen years ago, maybe the country wouldn't be full of fatasses.
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The last time I checked, the average employer is shelling out over 10k per year on health care. in many cases (and for virtually every employer over 250 EEs) this literally means paying the claims directly as they are incurred.
 
Kanhoji, what about when the government is footing the bill.
 
KanhojiAngre said:
If someone else is footing the bill, IMO they have very right to do this if your poor health choices are costing them money. Some companies build gyms and do establish reward systems for good health.

Your money, your choice. If you rely on someone else, they get a say. It's too bad this didn't happen years ago, maybe the country wouldn't be full of fatasses.
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Is bad health a fireable offense?
 
My company is self-insured with a third party administrator. So this year, we basically made the most attractive health insurance option a HDHP. In the first 5 months that had made a dramatic difference (lowering) in health care expenditures among our employees.

So, there's one answer. (of many needed answers)
 
PhDeac said:
Kanhoji, what about when the government is footing the bill.
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Same. Government = you and me, among others. Why should we pay for someone to smoke, eat consistently unhealthily, not exercise, drink excessively, etc...
 
ONW said:
Is bad health a fireable offense?
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Depends. Was that bad health a result of poor fitness/wellness habits? Is there company policy or does the company provide a path to fitness/wellness? Is that bad health impairing the company's ability to conduct business?

I think people need to start taking responsibility for their own bad decisions, or have someone else take responsibility for them. The people whose skin is in the game based on those decisions seems like the right people.

I work for the government and the government damn sure tells me what I have to do to stay employed by them from a fitness standpoint.
 
KanhojiAngre said:
Depends. Was that bad health a result of poor fitness/wellness habits? Is there company policy or does the company provide a path to fitness/wellness? Is that bad health impairing the company's ability to conduct business?

I think people need to start taking responsibility for their own bad decisions, or have someone else take responsibility for them. The people whose skin is in the game based on those decisions seems like the right people.

I work for the government and the government damn sure tells me what I have to do to stay employed by them from a fitness standpoint.
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What happens if it's genetic?

If this is allowed to happen, then when interviewing for a job your family's health history could keep you from being hired.

It's one thing to say your "cholice" to drink too much can inhibit your ability to be a truck driver.

It's quite another to say you're too fat to be an accountant.
 
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