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Peas, you stated that: "There are lots of studies about the effects of preventative care and I could cite any one of them to show that it reduces costs." Would you please provide a link to one of those studies? Eating better and exercising more should improve health and reduce medical costs, but I would appreciate seeing research that shows that preventive care provided by a physician or other health care professional saves money.

Also, are you really asking who funded the Congressional Budget Office study? In addition to the CBO study and the one published in the New England Journal of Medicine, the Politifact link mentioned another study:

"Meanwhile, a separate study conducted by researchers from the American Diabetes Association, American Heart Association and the American Cancer Society concluded that, while interventions to prevent cardiovascular disease would prevent many strokes and deaths, "'as they are currently delivered, most of the prevention activities will substantially increase costs.'"

Since CHIPS (medicaid for low income children) is mostly funded by cigarette taxes, I wonder what will happen to it when there are no more smokers because all of the smokers were taxed into quitting.

point 1 I already addressed, by saying its not an important point to make
point 2 is false
with respect to point 3, the answer is: because a law was passed. You might recall me asking you early on if your dispute is that the law is unconstitutional or a preference. You said both. Your reason for believing it is unconstitutional was incomprehensible to me and I think probably invalid. To the extent your dispute with the law is based on personal preference, I would again urge you to contact your federal legislators/president and ask them to change the law.
Many people want absolute freedom for everyone, freedom to beat the crap out of their kids, freedom to commit suicide, freedom to drink and drive like the old days.
Other people want a very regulated society, with the state playing a significant role in all decisions you make.
We are somewhere in between those two extremes. But assuming you enjoy living in our representative democracy, you should be willing to take the laws you like and the laws you don't like. I don't laws that limit my choices but favor your rights, such as my inability to "borrow" your car without your permission. But we all abide.

BrodyInsurance said:   My basic argument is that health insurance should be "insurance" and not "pre-paid health care".
This is so basic and fundamental; yet often not understood or even appreciated by most folks.
IMO, having it act as "pre-paid health care" is one of the forces driving overall cost.

Squeezer99 said:   Since CHIPS (medicaid for low income children) is mostly funded by cigarette taxes, I wonder what will happen to it when there are no more smokers because all of the smokers were taxed into quitting.

It is an interesting dilemma in many states even if the taxes don't go to a specific cause. They act like they don't want people to smoke while at the same time they are dependent upon the tax receipts.

BEEFjerKAY said:   caterpillar123 said:    Insurers have always charged more based on risk

Yup.

Of course, one alternative would be to not charge smokers for the costs of treating the proven consequences of their intentional self-destructive behavior.

Or, in other words, tax non-smokers.



And another (Better, IMO) alternative would be to give non-smokers a discount, rather than penalize smokers. It effectively does the same thing, but sounds a lot better.

Rokuk said:   BEEFjerKAY said:   caterpillar123 said:    Insurers have always charged more based on risk

Yup.

Of course, one alternative would be to not charge smokers for the costs of treating the proven consequences of their intentional self-destructive behavior.

Or, in other words, tax non-smokers.



And another (Better, IMO) alternative would be to give non-smokers a discount, rather than penalize smokers. It effectively does the same thing, but sounds a lot better.


They do this same sort of thing in my state. One can't be charged more for health care based upon how they are paying. So, they just jack up the costs and give discounts from there.

Ex. They can't charge $100 for XYZ procedure, but charge you $300 if you don't have insurance.
Instead, they charge $300 for XYZ procedure, but will discount it $200 if you have insurance.

The result is the same...$100 with insurance, $300 without insurance, but one is legal and one isn't.

uutxs said:   BrodyInsurance said:   My basic argument is that health insurance should be "insurance" and not "pre-paid health care".
This is so basic and fundamental; yet often not understood or even appreciated by most folks.
IMO, having it act as "pre-paid health care" is one of the forces driving overall cost.

Interesting statement. So what are you proposing? Make health insurance function as a catastrophic type of insurance, only have major medical coverage, impose a certain out-of-pocket amount before health insurance kicks in? Should the quality of health care correspond to one's ability to pay for it? Should families be possibly penalized because their health care costs are likely higher than, say, singles? What about the unfortunate folks with pre-existing, chronic conditions who need lifetime medication and/or monitoring? I haven't even mentioned the role age plays in health care costs.

In fact, one could argue the insurance model isn't the appropriate vehicle for delivery of health care. Yet that is what we have to work with. To be sure, I don't see Obamacare as a panacea to controlling health care costs, but, for reasons already mentioned, private health insurance with no Obamacare isn't a real solution to making health care affordable, either. It's important to separate administrative costs of healthcare from the cost of the care itself. Theoretically, Obamacare seeks to address the first type of cost, but not necessarily the second. "True" healthcare costs are thus an issue with or without Obamacare.

There are many factors in play here, and I suspect Obamacare will see much revision. To get back to the thread topic, I'd rather see other ways to incentivize people from smoking than raising smokers' insurance costs.

BrodyInsurance said:   Addressing preventative care - ....(s)he is to the economy.
Sorry, I can't comment. I'm just hearing too much blah, blah, blah. I don't mean to be offensive with that comment. I'm sure that you are probably making a good point.
Well at least you can start to understand what your analogies sound like to others


ryeny3 said:   Peas, you stated that: "There are lots of studies about the effects of preventative care and I could cite any one of them to show that it reduces costs." Would you please provide a link to one of those studies? Eating better and exercising more should improve health and reduce medical costs, but I would appreciate seeing research that shows that preventive care provided by a physician or other health care professional saves money.

Also, are you really asking who funded the Congressional Budget Office study? In addition to the CBO study and the one published in the New England Journal of Medicine, the Politifact link mentioned another study
A tempting quote would be "Do I look like your mother?". There's loads of information on the big ol' world wide web but I'll humor you since you seem fond of self-censoring your sources of information.
http://www.huffingtonpost.com/chris-fey/rebutting-the-cbos-preve...

http://www.prevent.org/data/files/initiatives/economicargumentfo...

http://www.bizjournals.com/denver/print-edition/2010/11/05/compa...


How this all pans out depends on what exactly gets implemented. While the studies showing cost increases bring up valid points, they also use the worst case scenario in their conclusions. For instance a popular assumption is that preventive care means that 100% of the population would get screened for everything, a patently false presumption. My family has no history of hypertension, therefore no doctor worth his salt would put me through a regiment of those tests. If he did, I wouldn't go forward without getting a second opinion or unless I started to exhibit classical hypertensic symptoms. Maybe the argument would be that "hey it's free", but it also takes time out of people's workday so that's a factor that pushes back on willy nilly procedures. An annual physical has always been recommended for adults past a certain age. It's inexpensive and helps catch diseases early. It's puzzling how some people rabidly argue against that.

Well at least you can start to understand what your analogies sound like to others

I have no doubt that you are probably correct.

peas said:   A tempting quote would be "Do I look like your mother?". There's loads of information on the big ol' world wide web but I'll humor you since you seem fond of self-censoring your sources of information.
http://www.huffingtonpost.com/chris-fey/rebutting-the-cbos-preve...

http://www.prevent.org/data/files/initiatives/economicargumentfo...

http://www.bizjournals.com/denver/print-edition/2010/11/05/compa...


How this all pans out depends on what exactly gets implemented. While the studies showing cost increases bring up valid points, they also use the worst case scenario in their conclusions. For instance a popular assumption is that preventive care means that 100% of the population would get screened for everything, a patently false presumption. My family has no history of hypertension, therefore no doctor worth his salt would put me through a regiment of those tests. If he did, I wouldn't go forward without getting a second opinion or unless I started to exhibit classical hypertensic symptoms. Maybe the argument would be that "hey it's free", but it also takes time out of people's workday so that's a factor that pushes back on willy nilly procedures. An annual physical has always been recommended for adults past a certain age. It's inexpensive and helps catch diseases early. It's puzzling how some people rabidly argue against that.


Sorry, I don't have time to look closely at link #2 so I'll withhold comment but #1 and #3 are pretty unimpressive for the purpose of argument. Ryeny asked for studies supporting your point, but #1 is an critique of the CBO report written by a not-disinterested party, and #3 makes a reference to unspecified "studies" talking about workplace interventions as opposed to the healthcare system on a national scale.

Any chance you can offer a synopsis of #2? Not asking you to play a maternal role, just want to know if I should waste my time reading it.

BrodyInsurance said:   Well at least you can start to understand what your analogies sound like to others

I have no doubt that you are probably correct.


I have every doubt that you are probably incorrect about that.

DrDubious said:   peas said:   A tempting quote would be "Do I look like your mother?". There's loads of information on the big ol' world wide web but I'll humor you since you seem fond of self-censoring your sources of information.
http://www.huffingtonpost.com/chris-fey/rebutting-the-cbos-preve...

http://www.prevent.org/data/files/initiatives/economicargumentfo...

http://www.bizjournals.com/denver/print-edition/2010/11/05/compa...


How this all pans out depends on what exactly gets implemented. While the studies showing cost increases bring up valid points, they also use the worst case scenario in their conclusions. For instance a popular assumption is that preventive care means that 100% of the population would get screened for everything, a patently false presumption. My family has no history of hypertension, therefore no doctor worth his salt would put me through a regiment of those tests. If he did, I wouldn't go forward without getting a second opinion or unless I started to exhibit classical hypertensic symptoms. Maybe the argument would be that "hey it's free", but it also takes time out of people's workday so that's a factor that pushes back on willy nilly procedures. An annual physical has always been recommended for adults past a certain age. It's inexpensive and helps catch diseases early. It's puzzling how some people rabidly argue against that.


Sorry, I don't have time to look closely at link #2 so I'll withhold comment but #1 and #3 are pretty unimpressive for the purpose of argument. Ryeny asked for studies supporting your point, but #1 is an critique of the CBO report written by a not-disinterested party, and #3 makes a reference to unspecified "studies" talking about workplace interventions as opposed to the healthcare system on a national scale.

Any chance you can offer a synopsis of #2? Not asking you to play a maternal role, just want to know if I should waste my time reading it.


From #2: "The Trust for America’s Health reported that prevention programs could save the country more than $16 billion annually within five years, a return of $5.60 per dollar invested.10 The Commonwealth Fund estimated that reduced tobacco use and a decline in obesity would lower national health expenditures by $474 billion over 10 years.11"

The Trust for America's Health appears to be looking at preventive measures that don't involve medical treatment.

"...The researchers evaluated 84 studies that met their criteria to develop the assumptions for the drops in disease rates and the costs of the programs. To be included in the review, the studies had to focus on:
1) Prevention programs that do not require medical treatment;
2) Programs that target communities rather than individuals; and
3) Evidence-based programs that have been shown to reduce disease through improv- ing physical activity and nutrition and preventing smoking and other tobacco use in communities.
Examples of the types of studies include programs that:
 Keep schools open after hours where chil- dren can play with adult supervision;
 Provide access to fresh produce through farmers markets;
 Make nutritious foods more affordable and accessible in low-income areas;
 Require clear calorie and nutrition label- ing of foods;
 Provide young mothers with information about how to make good choices about nutrition;
 Offer information and support for peo- ple trying to quit smoking and other tobacco use; and
 Raise cigarette and other tobacco tax rates...."

http://healthyamericans.org/reports/prevention08/Prevention08.pd...

Peas, someone who uses The Huffington Post as a source probably shouldn't accuse someone who linked Politifact as a reference of self-censorship. Whether or not you agree with the methodology of the CBO, the study published in the New England Journal of Medicine, or the study conducted by researchers from the American Diabetes Association, American Heart Association and the American Cancer Society, they are each credible sources.

Most of the saving suggested by the Commonwealth Fund study appear to be the result of new taxes on cigarettes and sweetened soft drinks and not from increased access to preventive medical care.


"..Promoting Health and Disease Prevention These options focus on the substantial costs to the health system of the care and complications of chronic diseases, such as diabetes or heart disease. They seek to lower the incidence of disease through public health initiatives and improved care.
• Public Health: Reducing Tobacco Use. Increase federal taxes on tobacco products by $2 per pack for cigarettes, with revenues going toward support of national and state tobacco control programs. If revenues were invested in effective programs, this option could yield $191 billion in health system savings over 10 years, shared by all payers. State savings would be largely offset by reduced state tobacco tax revenue, as consumption of tobacco products fell.

xii
• Public Health: Reducing Obesity. Establish a new nominal tax on sugar- sweetened soft drinks of 1 cent per 12-ounce drink to finance national and state obesity prevention programs. If successful in reducing rates of increases in obesity and associated costs, the option could yield an estimated $283 billion in savings over 10 years, shared by all payers. • Positive Incentives for Health. This option would use federal funds and incentives to encourage the federal government, state governments, and private employers to create positive incentives for individuals to engage in wellness programs and healthy behavior, and to cover preventive services. Such a focus on high value benefit designs could save an estimated $19 billion over 10 years, with a net investment by the federal government of $2 billion..."


http://www.commonwealthfund.org/usr_doc/Schoen_bendingthecurve_1...

DrDubious said:   Any chance you can offer a synopsis of #2? Not asking you to play a maternal role, just want to know if I should waste my time reading it.

Apparently not. Thanks rye for doing the heavy lifting.

I don't know if these sources are credible, but there is at least some research showing that annual physicals do not save money. Since flu shots at my doctor's office require $0 copay and my insurer won't reimburse the @ $17 if I get my shot at Costco, my insurer ends up paying many times the amount that I would have paid for the same service.

"We have gradually come to realize that the routine physical did little or nothing to improve health outcomes and was largely a waste of time and money. Today the emphasis is on identifying factors that can be altered to improve outcomes. We are even seeing articles in the popular press telling the public that no medical group advises annual checkups for healthy adults. If patients see their doctor only when they have symptoms, the doctor can take advantage of those visits to update vaccinations and any indicated screening tests."


Results showed patients who received routine health checks were just as likely to die over a nine-year period compared with those who did not receive health checks. Routine health checks also had no effect on hospital admission rates, patient worry, referrals to specialists or time off work.

The findings suggest "general health checks are unlikely to be beneficial," the researchers write in the October issue of the journal the Cochrane Library.

The study's overall conclusions agree with those of previous research, which has found little evidence that annual physicals have any value, said Dr. Doug Campos-Outcalt, chairman of Family, Community and Preventive Medicine at the University of Arizona College of Medicine, who was not involved in the study.



http://news.yahoo.com/yearly-physicals-deemed-meaningless-health...

http://www.sciencebasedmedicine.org/index.php/re-thinking-the-an...

DrDubious said:   DrDubious said:   Any chance you can offer a synopsis of #2? Not asking you to play a maternal role, just want to know if I should waste my time reading it.

Apparently not. Thanks rye for doing the heavy lifting.



Glad to try. Since most of the research focused on cost-effectiveness and not cost savings, I only looked at the two sources that mentioned saving money. I might have missed something, but it appears that most of the suggested savings come from better diet and exercise and not increased preventive medical care. While I believe that preventive medical care can be beneficial even when the monetary costs exceed the benefits, even the authors don't suggest that in most case such care actually saves money.

"...In economic terms, value is the ratio between the cost of a service and its benefits. The metric that is used widely in health care is the cost-effectiveness (CE), or cost-utility ratio.* Some goods offer very high value by producing net savings, in which the cost of providing the service is exceeded by the savings it produces, but such services are rare..."

BrodyInsurance said:   1)I am arguing against the notion that preventive care saves money. I am not arguing against preventive care.If the doctor says, "get a breast exam", it is probably beneficial to get a breast exam.

....


Since you mentioned breast exams here's a study that concludes that mammography screening saves money.

You think theres scenarios where doctors think mammography is not a good idea? Should we pay for a doctor to tell women that getting a mammography is a good idea or just pay for the mammography?

I'm pretty sure flu and polio vaccines save money. I'm pretty sure that colorectal cancer screening saves money.

Thats the kind of preventative care stuff that is required now.


What actual preventative care treatments do you think is more costly??

jerosen said:   BrodyInsurance said:   1)I am arguing against the notion that preventive care saves money. I am not arguing against preventive care.If the doctor says, "get a breast exam", it is probably beneficial to get a breast exam.

....


Since you mentioned breast exams here's a study that concludes that mammography screening saves money.

You think theres scenarios where doctors think mammography is not a good idea? Should we pay for a doctor to tell women that getting a mammography is a good idea or just pay for the mammography?

I'm pretty sure flu and polio vaccines save money. I'm pretty sure that colorectal cancer screening saves money.

Thats the kind of preventative care stuff that is required now.


What actual preventative care treatments do you think is more costly??

Keep in mind that a reason preventive care might raise costs is that if diagnostic tests are part of that preventive care, it's likely that the number of people tested is directly proportional to the number of people found that need treatment. Unless one tries to integrate costs from those using health care insurance and with the costs of treatment for those outside the system, we don't have a complete picture of healthcare costs.

In addition to the costs of testing, there are the risks of false positives with almost any medical test. I am in no way arguing against preventive care, since it can save lives; but it is worth noting that there are risks of overdiagnosis which offset some, but not all, of the net benefits of testing.


"..Suppose your doctor also explained that “PSA-based screening leads to a substantial overdiagnosis of prostate tumors” and that treatment usually requires surgery. The effects of treatment are serious: 20-30% of men treated with surgery and radiation suffer from long-term incontinence and erectile dysfunction..."

http://www.forbes.com/sites/stevensalzberg/2012/06/24/psa-tests-...

"Mammograms for women over the age of 50 save lives, an independent British panel has concluded, confirming findings in U.S. and other studies. But the screening may come at a cost.

The panel's review of breast cancer screening studies found that for every life saved, about three other women were overdiagnosed, meaning they were subjected to unnecessary treatments for a cancer that would never have threatened their lives...."


http://www.cbsnews.com/8301-204_162-57542398/mammograms-may-save...

Interesting statement. So what are you proposing? Make health insurance function as a catastrophic type of insurance, only have major medical coverage, impose a certain out-of-pocket amount before health insurance kicks in? Should the quality of health care correspond to one's ability to pay for it? Should families be possibly penalized because their health care costs are likely higher than, say, singles? What about the unfortunate folks with pre-existing, chronic conditions who need lifetime medication and/or monitoring? I haven't even mentioned the role age plays in health care costs.

The quote above is in response to a statement that I made that health insurance to a large extent has morphed into pre-paid health care and I'm arguing that it needs to be health insurance.

Let me do my best to explain, but first is my standard caveat that I am not a health insurance expert. My expertise is with life, DI, and LTCi. I make money selling health insurance, but I let others do the work. My knowledge level is truly just that of a lay person.

First of all, although I believe that my arguments are valid, they miss the most important part. The majority of our health care spending is on end of life care. As a country, we have a refusal to deal with that issue.

Health Insurance acting as Health Insurance vs. Health Insurance acting as Pre-Paid Health Care (and Insurance):

What's the difference? There's different ways to structure things, but let's keep it simple. "Health Insurance" would have nothing that is specifically covered in the plan. It would kick in after the insured pays $10,000 out of pocket. All medical expenses up to this point would come out of the insured's pocket.

Pre-paid health care has a relatively small deductible and many things are mandated to be covered (well visits, birth control pills (even for 58 year old men), etc)

The premium for health insurance is $2,000/year. The premium for pre-paid health care is $8,000/year. These are made up numbers and let's just assume that they make sense.

Here is why I think health insurance is the better option for the country as a whole.
1)It makes people care about the cost of care. If Jim's doctor tells him to get an MRI. He is going to question the doctor to make sure that it is necessary instead of just defensive medicine. He isn't just going to go to the MRI center attached to the doctor's office. He will look into the price.

2)Health insurance gives people a much bigger financial stake in their own health. "Jim" is starting to get heavy and his cholesterol is getting higher. He knows that if he doesn't knock off some weight and get his cholesterol down, he is going to have to go on meds. With health insurance, there is a financial benefit to staying healthy because being unhealthy will increase his costs. This is not true with pre-paid health care.

3)Health insurance has less cost sharing. With Pre-Paid Health Care, we all pay for the drugs, extra doctor appts, etc of people who don't take care of themselves. There is still cost sharing for those who are very sick and have very large medical bills. But, at least to some extent, those who take care of themselves aren't subsidizing those who don't. This is true even if everything is guaranteed issue.

4) Health insurance puts some personal responsibility back into the equation. It's your choice about how often you are going to get medical care. Want to get a physical every 9 months? Fine. Want one every 3 years? Fine. If going less often saves some money, but adds risk, that is up to the individual. If it means an increase in getting sick and having increased expenses, to a large extent that will fall back on the individual.


Let me try to specifically answer your questions:

Make health insurance function as a catastrophic type of insurance, only have major medical coverage, impose a certain out-of-pocket amount before health insurance kicks in?

Basically, I am simply talking about lower premiums in exchange for a high deductible with nothing covered before the deductible is met.


Should the quality of health care correspond to one's ability to pay for it?

What I'm proposing doesn't change this at all. (However, at some point, ability to pay is going to have to come into the equation when we talk about end of life care. It's one thing for one's family to pay to keep a 93 year old on life support. It's another thing to make everybody else pay.)


Should families be possibly penalized because their health care costs are likely higher than, say, singles?


They are "penalized" now and they will continue to be penalized. Insuring more people should cost more money.

What about the unfortunate folks with pre-existing, chronic conditions who need lifetime medication and/or monitoring?


They would pick up more of their own costs. There would be less cost shifting except when care is ultra expensive.

I haven't even mentioned the role age plays in health care costs.

Yep, this is the big issue and what I'm suggesting plays into this only a tiny bit.

The main things that are being accomplished are people caring more about costs, less cost shifting, and more personal responsibility.

What happens to people who can't afford large deductibles? The same thing that happens now with people who can't afford large premiums. There will need to be subsidies of some sort.

jerosen said:   
I'm pretty sure flu and polio vaccines save money.
I'm pretty sure you are stating a brainwashed belief and not a fact. The flu shot doesn't prevent flu and the polio shot causes more polio than it prevents in a developed society.

My health insurance bill is already $18k+ per year. I tell you what: I'm dropping health insurance because of recent changes. I'll simply pay the non-insured tax and buy insurance after I have a need.

b0mbrman said:   depalma13 said:   DrDubious said:   Correct me if I am wrong here, but I was under the impression the law allowed insurers to increase rates on smokers but did not mandate them to do so. So if the insurers believe status as a smoker affects risk, they are free to price it accordingly, at least up to 150%. If anyone can figure out the costs associated with smoking, it's the actuaries at the insurance companies. What's wrong with letting them do what they do? Sure, they'd like to price other risks if they could, but if the law throws them 1 variable to use, isn't that better than none?

You would have to be really naive if you think that insurance companies are not going to charge the maximum. Why would they pass up the opportunity to either get as much money as they can or keep a class of individuals that they don't want off of their coverage plans.


Did prior law disallow them from charging different rates to smokers than non-smokers?


Prior law allows different rates to smokers and in fact many other life choice situations. The top two such surcharges for private medical insurance in the recent past have averaged:

1. For obesity : +19%
2. For smoking : +14%

I suspect that the only reason the smoking surcharge is not higher is that most of the cost increase occur after age 65 when Medicare picks up the costs.

In short there is no rational reason to expect insurance companies to suddently charge 50% surcharges for smokers.

ananthar said:   b0mbrman said:   depalma13 said:   DrDubious said:   Correct me if I am wrong here, but I was under the impression the law allowed insurers to increase rates on smokers but did not mandate them to do so. So if the insurers believe status as a smoker affects risk, they are free to price it accordingly, at least up to 150%. If anyone can figure out the costs associated with smoking, it's the actuaries at the insurance companies. What's wrong with letting them do what they do? Sure, they'd like to price other risks if they could, but if the law throws them 1 variable to use, isn't that better than none?

You would have to be really naive if you think that insurance companies are not going to charge the maximum. Why would they pass up the opportunity to either get as much money as they can or keep a class of individuals that they don't want off of their coverage plans.


Did prior law disallow them from charging different rates to smokers than non-smokers?


Prior law allows different rates to smokers and in fact many other life choice situations. The top two such surcharges for private medical insurance in the recent past have averaged:

1. For obesity : +19%
2. For smoking : +14%

I suspect that the only reason the smoking surcharge is not higher is that most of the cost increase occur after age 65 when Medicare picks up the costs.

In short there is no rational reason to expect insurance companies to suddently charge 50% surcharges for smokers.


They may or may not do it, but there is certainly a rational reason why they may do so. Let's look at both ends of the competition spectrum. Either the health insurance market is competitive or it is not-competitive. Let's also make the crazy assumption that companies like to make money.

Not-competitive market: If they charge more, people who need insurance still have to pay this extra cost because they don't have any choice. From a business perspective, it does not make sense to charge less than the market will bear.

Competitive market: Competition brings the price down in most situations. This may not be one of them. Smokers may get charged a 14% surcharge now (no clue as to the accuracy of that stat), but unhealthy smokers get charged much more or don't get insurance at all. Smokers are more likely to to be unhealthy, but these other fact patterns can't be factored into the equation with Obamacare. Competition will drive the price up instead of down because whichever company charges the least will get the business of the smokers (and their health issues). The "winner" of a smoker price war gets to "win" all of the smokers and whatever health problems that they have. This is a competition that all companies want to lose.

Ex. Company A charges $200 for non-smokers.
Company B charges $200 for non-smokers.

Company A charges a 10% surcharge for smokers.
Company B charges a 25% surcharge.


Company A gets all of the smokers and their health problems. They raise their surcharge to 40%. Company B starts to get all of the smokers, so they raise their surcharge to 50%. Company A starts to get all of the smokers so they also raise their surcharge to 50%.

The reason that they might not do is because they can price the additional risk into all policies. As it is now, it isn't unreasonable to expect healthy people to see increases of 50-100%. However, this can lead to the exact same issue as not charging the maximum surcharge.

Ex. Company A charges $200. They charge smokers a 30% surcharge for a total of $260.
Company B doesn't charge a smoker surcharge. It is built into the price. They charge everyone $220.

Result:
Company A will get the non-smokers.
Company B will get the smokers.

The concern is that charging anything different than the competition will result in a business model that is skewed towards smokers. If the price is going to be the same as the others, the higher the price, the more profit.

How does this differ from pre-Obamacare. Before Obamacare, this was about healthy smokers. Post Obamacare, this is about healthy AND non-healthy smokers combined. It makes a world of difference.

ryeny3 said:   Peas, someone who uses The Huffington Post as a source probably shouldn't accuse someone who linked Politifact as a reference of self-censorship. Whether or not you agree with the methodology of the CBO, the study published in the New England Journal of Medicine, or the study conducted by researchers from the American Diabetes Association, American Heart Association and the American Cancer Society, they are each credible sources.Fair enough and point taken. The second article that cites thousands of studies is at least comprehensive, yes? The articles were meant to highlight a counterpoint against the assertion that preventive care necessarily increases costs. I think the answer is a less-than-satisfying "it depends" which is an eye-opener to me.
Thanks for pulling some of the relevant quotes from the articles. I know it seems like I troll the forums alot but I'm strapped for time like everyone else.


BrodyInsurance said:   The main things that are being accomplished are people caring more about costs, less cost shifting, and more personal responsibility.It strikes me as inconsistent that you argue personal responsibility in a thread about smokers. Smokers knowingly do harm to themselves and others purely for pleasure. Isn't that the epitome of irresponsibility? Argue one or the other, but arguing for smokers' rights and for personal responsibility is a bit like having your cake and eating it too.
Edit: Oh no, more Brody analogies in this thread

Personal responsibility doesn't mean that one doesn't do bad things to themselves. It means that the consequences of their actions belong to themselves.

peas said:   ryeny3 said:   Peas, someone who uses The Huffington Post as a source probably shouldn't accuse someone who linked Politifact as a reference of self-censorship. Whether or not you agree with the methodology of the CBO, the study published in the New England Journal of Medicine, or the study conducted by researchers from the American Diabetes Association, American Heart Association and the American Cancer Society, they are each credible sources.Fair enough and point taken. The second article that cites thousands of studies is at least comprehensive, yes? The articles were meant to highlight a counterpoint against the assertion that preventive care necessarily increases costs. I think the answer is a less-than-satisfying "it depends" which is an eye-opener to me.
Thanks for pulling some of the relevant quotes from the articles. I know it seems like I troll the forums alot but I'm strapped for time like everyone else.
The reason I joined the discussion was to point out that there is s fair amount of research that shows that preventive medical care doesn't necessarily save money. It doesn't mean that something that improves and saves lives is a bad idea; it merely suggests that the benefits to society of preventive care aren't necessarily economic. Although the second article deals primarily with preventive programs not administered by the medical community, I found it informative and I appreciate you that took the time to find and post it.

According to the second article, "Some goods offer very high value by producing net savings, in which the cost of providing the service is exceeded by the savings it produces, but such services are rare." On the other hand, the second article pointed out that The Trust for America's Health found significant savings from "Prevention programs that do not require medical treatment." In addition, the Commonwealth Fund suggested that new taxes on cigarettes and soft drinks would substantially reduce medical costs. Perhaps the most interesting part of this research is the analysis of the cost-effectiveness of different preventive measures.

BrodyInsurance said:   Personal responsibility doesn't mean that one doesn't do bad things to themselves. It means that the consequences of their actions belong to themselves. Although I believe that we should provide for the helpless and the luckless, I object to subsidizing those who are financially able to bear the costs of bad lifestyle decisions. IMO, wealthy overweight people like Rush Limbaugh and Michael Moore shouldn't be charged the same for health insurance as those individuals who live healthier lives.

BrodyInsurance said:   Personal responsibility doesn't mean that one doesn't do bad things to themselves. It means that the consequences of their actions belong to themselves.As it should be. What's your objection with smokers bearing higher insurance premiums, aka the consequences of their actions? Don't forget that smokers negatively impact the health of others so how should that be factored in?

You had mentioned that health insurance shouldn't be pre-paid health care, and that's one of the ills of our health care system. Isn't insurance for anything essentially pre-paid coverage for that thing? At a macro level, insurers must take in enough premiums (plus some) to pay out claims. Even at an individual level it averages out to what-you-put-in is what-you-get out-from insurers (minus their profits and overhead of course). For example, they're betting (overwhelmingly correctly) that an individual who puts in $10k ($1k/yr over 10 yrs) will have claims of $10k - administrative overhead - profits over that period. How is your proposal different?

As it should be. What's your objection with smokers bearing higher insurance premiums, aka the consequences of their actions? Don't forget that smokers negatively impact the health of others so how should that be factored in?

Pre-Obamacare, I would have no objection. I also have no problem when this is done with life and disability income insurance.

I have several objections with this as it pertains to Obamacare.
1)Smokers are being singled out.
2)Smokers can get charged 50% more for the action of smoking while the impact of their smoking will have no impact on cost.
3)Because of the small amount of competition, smokers may very likely have a surcharge that is not in relation to the risk.
4)The end result may be the exact opposite of the goal. The goal is to charge smokers more because they result in more future risk. However, the impact of this is that it will make it much more likely that healthy smokers choose to go without health insurance.



You had mentioned that health insurance shouldn't be pre-paid health care, and that's one of the ills of our health care system. Isn't insurance for anything essentially pre-paid coverage for that thing? At a macro level, insurers must take in enough premiums (plus some) to pay out claims. Even at an individual level it averages out to what-you-put-in is what-you-get out-from insurers (minus their profits and overhead of course). For example, they're betting (overwhelmingly correctly) that an individual who puts in $10k ($1k/yr over 10 yrs) will have claims of $10k - administrative overhead - profits over that period. How is your proposal different?

Insurance is not pre-paid coverage for that thing. Insurance is for risks that we can't financially handle. It is for things that we can't pre-pay. It if for the $25,000 operation or the $5,000/month income that we need for the next 20 years or the $1,000,000 that is needed to replace to allow our family to live comfortably. It is not needed for a $100 doctor appointment or a $175 car repair.

My proposal is different because it forces people to care about costs and puts more personal responsibility into the equation. Use obesity as an example. If obesity causes health issues. An obese person will need more medical care than someone who is not obese. The costs of the care, in my proposal, will come more out of the pocket of the person needing the care.

mainomega said:   soxfan2004 said:   Honestly, I may catch hell for this, but when did we start accepting government to get involved with EVERYTHING? I quit smoking over 5 years ago (not for bragging rights) so this will not affect me at all (at least...I hope, yes we can, yes we can...control your lives)

Well, crazy tea party people want less government... except when it comes to abortion, then they want more government.


Please label me further. I believe everyone should be free to make their own choices (as long as you are not hurting anyone...well, sometimes people want to be hurt - so as long as you're not hurting anyone against his/her will). Unalienable rights apply to everyone. There is debate to when does that fetus receive those unalienable rights, but as far as I see it, to each his own. I might not agree with abortion, but what you do is your business...not mine...and especially not the government's.

Long time lurker, first time poster.

This idiotic and hastily written law is fraught with loopholes, pitfalls, nonsense, and moral hazard.

The smoking issue is a great example. Don't believe me?

The mandate is based on "affordability" - income tied to various thresholds, the most important one of which is a mandate exemption if the cost of care exceeds 8% of income.

If you're on the cusp of being subject to the mandate, smoke one cigarette a year, report yourself as a smoker, watch your premiums go up 50% - and thus become unaffordable, and, VOILA, you're exempt!

The smoking loophole in effect allows for any enterprising individual to raise his own thresholds for unaffordability by 50%.

Depending on the subsidies, many people who choose to buy the insurance will save money by starting smoking according to the same principle. In certain situations, being charged 50% more puts one into a higher subsidy tier, which depending on income and family size, could more than pay for the 50% bump by being a smoker.

Sorry, this is why we need to read bills before we pass them.

There are too many people already gaming the system, and this broken law allows for even more gaming, such as what I just described.

what's the problem? --- just switch to brownies

avalon6 said:   God forbid we starting charging people responsible for driving up healthcare costs.

How dare you. We should provide everyone the same benefits regardless of their life decisions.

I want to pay for health insurance for life altering catastrophic events (cancer, bad injury, etc).

I do not want to pay for insurance that covers me going to the doctor for a common cold, yearly physical, etc.

Let's have "a la carte" insurance where you buy for what you want covered (like auto insurance). I want to be covered for cancer, but I don't want to pay insurance for pregnancy, etc.

I do understand that some people need to pay for pre existing "health care"... not insurance. You don't pay for car insurance after an accident, and if you do you pay more.

Some people's health care is going to cost more than others, that is just a fact of life, and unfortunately those people should pay more than the healthy.

biglittle, what you are saying is that you want health insurance. Unfortunately, what we have, and what Obamacare is mandating is pre-paid health care.

BamBam0099 said:   BEEFjerKAY said:   caterpillar123 said:    Insurers have always charged more based on risk

Yup.

Of course, one alternative would be to not charge smokers for the costs of treating the proven consequences of their intentional self-destructive behaviorText.

Or, in other words, tax non-smokers.


So what is the definition of "self-destructive behavior"? Unsafe sex? Alcohol? Over eating? Sky diving? Driving over the speed limit? Driving a motorcycle? Skiing? Hand gliding? etc. etc. What about driving over X miles per week? Don't you increase your chance of getting in an accident? In fact, why not punish those that choose to drive and are a higher risk versus those that take mass transit? Once these types of laws start, it only gets worse.


Many of those things you just mentioned do result in high insurance premiums for their respective products.

So, in short, yes, those are all definitions of self-destructive behavior that warrant additional cost.

Insurance schemes are designed to spread risk-costs among large groups of people so that an individual doesn't run into a single low-probability high-payout event that ruins them. Given that this is the fundamental principal of all insurance schemes, two design parameters should always rule an insurance scheme: the difference between the maximum and minimum premium to be paid, and how to measure the risk-costs of individuals. If you could measure the risk-cost of every single individual, exactly, with 100% certainty, and you could charge them the exactly correlated risk-cost, then insurance schemes would be pointless. Everyone would be practically self-insuring ... through an insurance company. But, if you could measure the risk-cost exactly, you could still create a risk-cost-spread benefit by limiting the ratio of maximum to minimum premium paid. And that is the direction we should be heading. Determine what a "fair" spread should be. Should the most risky individual pay 2x, 3x, 4x the least risky individual? Then determine where in the spread every individual should be located.

stomie said:   nsdp said:   stomie said:   Aren't smokers charged $9 a pack? Where is that money going? How about basing insurance on education or IQ?

Ask your state AG. She/he is in charge of wasting that money.


I know where all of our State's taxes go. NYC!


Assuming you live in NY State, then "NYC" is the answer to the question "where do all our state's taxes come FROM," while "upstate" is the correct answer to "where do all our State's taxes go."

http://www.rockinst.org/observations/wardr/2011-12-giving_gettin...

FYI - DC just ruled that smoking is a pre-existing condition. With horrible, horrible logic to go with it:

http://www.washingtontimes.com/news/2013/apr/9/insurers-cant-cha...

Good to see the head of DC's insurance exchange has no idea how the law is implemented nor how health care is priced. This will not change how much low-income families pay for insurance, but will decrease the number of middle-income families who have access under the health-care law, thereby decreasing how many people are enrolled in the program.



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