The most important issue is how do we get control of skyrocketing healthcare costs and at the same time respect individual liberties. When talking about individual liberties and healthcare, the issue is that if individuals practice poor health habits, we all pay for it. We all know that the highest risk patients utilize the most healthcare dollars driving up costs for everyone. I'd like to throw out a proposal (I'm sure controversial) for discussion. Suppose any organization or insurance company offered the following type of program for it's employees and subscribers: There would be three sets of premiums A) Persons with no risk factors would have their premiums capped for 3 years as long as their annual risk assessment didn't change. 2) Patients with certain Risk Factors ,let's take for exampls an obese , type 2 diabetic with hypertension. They would be given let's say three penalty points worth $500 each. That would mean that their premium would be $1500 above (1). However,if they entered a weight loss program, diabetes program (endocrinologist,regular hemoglobin A1C's, etc.) and took all of their meds as prescribed and met the set goals,then they could wipe out the penalty points and receive the same premium plan as a healthy person. 3) The third group would be those high risk patients who decide not to participate. In that case they would have a significant deductible. This allows, in a fair way, that everyone has "skin in the game' and shares in the responsibilty of keeping healthcare costs down. Everything else has been tried with few successes. Unless we think out of the box and have real bold incentives,in my opinion the trajectory of healthcare costs won't change.While I understand the health and wellness aspect of this, I am afraid it opens up a door to escalating discrimination. We are essentially talking about behavior that increases insurance claims, so what about those who play sports and are repeatedly injured? What about potential employees who have kids? An employee who has his or her family covered by insurance surely will mean more claims--why don't we stop hiring people who have reproduced? Can we come up with a test that can tell the last time someone had a glass of wine? That must mean that they can't be hired by a hospital either. What about those who are overweight? I believe that if we continue along these lines, weight discrimination will be the next thing on the horizon: we won't hire you because you exceed the weight statistics for your age and height and are therefore more likely to use more health benefits. Let's remember that healthcare organizations are to PROMOTE health, not MANDATE it.
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