By Julie Appleby
Kaiser Health News, April 2, 2012
Gone are the days of just signing up for health insurance and hoping you don’t have to use it. Now, more employees are being asked to roll up their sleeves for medical tests — and to exercise, participate in disease management programs and quit smoking to qualify for hundreds, even thousands of dollars’ worth of premium or deductible discounts.
Proponents say such plans offer people a financial incentive to make healthier choices and manage chronic conditions such as obesity, high blood pressure and diabetes, which are driving up healthcare costs in the USA. Even so, studies of the effect of such policies on lifestyle changes are inconclusive. And advocates for people with chronic health conditions, such as heart disease and diabetes, fear that tying premium costs directly to test results could lead to discrimination.
Nonetheless, such plans could be the wave of the future. Faced with crippling healthcare costs, the number of employers embracing such programs shot up from 49 percent in 2010 to 54 percent last year — and more say they expect to do so soon, according to a survey by consultants Aon Hewitt. Big-name participants include insurer UnitedHealthcare, car rental firm Hertz, postage meter maker Pitney Bowes and media owner Gannett, owner of USA TODAY.
And more employers are expected to adopt them starting in 2014, when the health law allows them to offer larger incentives or penalties than they can now.
Starting in 2014, federal law allows employers to raise the value of the perk or penalty from 20 percent of the cost of a worker’s health insurance plan, to 30 percent. Based on the average cost of employer-offered insurance today, that means firms will be able to offer annual discounts or penalties of more than $4,500 a family, or $1,600 for individuals.
Given the available data, it’s hard to parse how much of the reported savings from such programs come from improved health, and how much from the frequent pairing of such programs with high deductible policies, which shift more costs onto workers.
Comment:
By Don McCanne, MD
Because we continue to insist that private insurance remains a mainstay of financing health care, we perpetuate the confusion between the health insurance product itself and the actual health care that people need. A well functioning health care financing system should remove financial barriers to health care that people need.
Single payer supporters understand that a universal pool should be financed equitably through progressive taxes, and that full payment for necessary health care should come from this pool – pretty much as they do in Canada. When people need health care, they get it, and the bill goes to the public agency.
In the United States we have inserted these very expensive and wasteful insurer intermediaries that continue to manipulate the patients and the health care providers primarily to meet the requirements of their own insurer business model. To cater to these intermediaries, we are paying them far too much for their administrative excesses while we fail to improve the payment system with the goal of obtaining optimal value in our health care purchasing.
Today’s message demonstrates more of the innovative approaches designed to keep the insurers in business while pretending that these financing innovations improve health, when there is a paucity of evidence for that. Smoking cessation programs are an exception, but they should be separate programs unrelated to health insurance.
Blaming the patient for hypertension, hyperlipidemia, obesity, and diabetes is misdirected since most of these patients have little control over being inflicted with their chronic disorders. Yes, interventions should be instituted where effective, but that does not mean that these people should be financially penalized. Supposed rewards for not having these disorders are really penalties for those that do since the pooled funds are directed away from the patients in need and to the healthy.
This is just another example of attacking the social contract under which we should all receive the care that we need, and transferring the responsibility to individuals who have greater needs. These programs use not only cash penalties and penalties disguised as pseudo-rewards, but also they usually are combined with greater cost sharing, especially higher deductibles. That transfers more of the responsibility to the “consumers” who then have greater control over their own health care – or so the phony argument goes. In reality, these individuals have less control because of the financial barriers being erected between them and their health care – the exact opposite of policies which we should be adopting.
Today Kaiser Health News published a haiku which I wrote in response to Julie Appleby’s article above about penalties being assessed for failing certain health tests. In the haiku, my hyperbole is within the bounds of poetic license since it represents the continuing trends under private insurers:
PAY TO THE TEST
Bad health? Pay up here.
Social contract? That’s passe.
You are on your own.
-Don McCanne, MD