Greater personal accountability for health care costs:
 

Some were disappointed that the conversation was limited to hospitals, smoking and being overweight. It was limited because I was referencing an article I read in the newspaper. And I happened to add "being overweight."

But this thread is open to EVERYTHING that might raise health care costs. That means smoking, being overweight, being anorexic, driving too fast, being an alcoholic, or a drug user, etc..

My position: I stand for greater accountability in all areas where lifestyle plays a role. If people don't take personal responsibility to live a healthy lifestyle, they should be the ones to pay higher health insurance premiums. Higher costs should not be shifted to those who play by the rules.

Note: Getting older is not a lifestyle choice. Everyone gets older whether they like it or not.

What if the insurance folks would decide that being a vegan was unhealthy? And raise your premiums?

Who is going to make these decisions? I just read that my insurance says it is "wise" to get mammogram screening until 69. Hmmm I feel that screenings may well stop being reimbursed for older women. It is also "suggested" you get pap tests until you are 65. Who is in charge of these guidelines?

We will soon know.

Sigh. How I miss the good old days when we all paid a modest monthly fee for great coverage that paid for everything. One didn't even have to think about it. No options, checking fine print for exclusions, etc. Can't we go back there?

I wouldn't want to go back to the days of the dr. having nothing to offer except aspirin, penicillin shots and cobalt treatments for dreaded diseases. The incredible technology and knowledge we now have comes with a high price of research and development over decades for a single treatment, and medical workers' pay......all of which have to be heavily insured. When a major drug fails once approved and in use, like Vioxx...the lawsuits go on in perpetuity.

I do think however that people would be more accountable for their medical spending if THEY got the insurance payment to then pay the drs, hospitals and providers. Most people have NO idea how much they are spending and do not shop around for less costly treatment for things that can wait a bit.....or for things that have simple, over-the-counter remedies. Many people run to the ER for things responsible people would put a band-aid on.

I absolutely agree. If I learned that, without any question, that ANY refined sugar was the cause of dementia (as an example), I would give it up in a NY minute. Those who couldn't give it up, should pay more for their medical insurance. Its the same for other "choices" that we make. As Americans we are fortunate to have the freedoms to do many things. But with those freedoms comes extra self responsibility. In Michigan you can drive a motorcycle with or without a helmet. If you choose to ride without, you must prove that you have extra (catastropic) insurance. Seems fair doesn't it? How about jobs. Should people who choose not to have a job be afforded the same priviledges that people who have jobs? I really like to have a nice big, fat lobster once a month. But I worked hard all my life to put money away so that I could afford that treat. Should someone who spent every penny they ever had in their pocket be afforded the same treat? No, of course not. We all make choices, good or bad, and we all have to be responsible for those choices. I had 2 children because I could only afford 2. And this was before BCP's. I love children, I love my grandkids (and everyone elses too) but I was a responsible person and knew my limit. So, is it fair that I restrict myself but other people have as many as they choose?

Yes, I believe that self responsibility is one of our greatest faults in America.

BUT... how is it fair I give up things I enjoy so I can have a lower insurance premium, but someone else is doing whatever they please and don't have to worry about the cost of the premium 'cause the government is covering the cost???

I am not talking about the fact I may live longer and healthier, but just the cost of my insurance premium affected by what I do while someone on the government's role does not have the same responsibility or suffer the consequence as a result of this choice.

Excellent question Gracie, many already note there are many risks to being vegan.

Age will soon be a primary determining factor, if not the only factor, for very expensive health treatments and procedures though no one will dare admit it right now.

Too bad, but it makes absolutely no difference where we stand as it won't change a thing. Are you saying you are playing by the rules? If so by whose rules are you playing?

Would have to disagree, age would have to included in the list of things that raise health care costs. Many are already arguing that that older people should be paying a lot more for health insurance since it's the older people that are a heavy burden on the health care system...Age is the main driver of the costs.

Do you think younger healthier people that seldom need health care should pay more to cover older people and those with pre-existing conditions while you pay less?

To apply your thinking would you argue that health insurance premiums should not go up as we get older and if so why?

What if all health premiums started going up say 5-10% each year after we reach say 60 since we are more likely to need health care each day we live.

Since you say we are all ageing like it or not it sounds fair if applied to everyone. View the numbers below and estimate the daily costs.....We all know a great number of these residents bills are being paid by only Medicaid after Medicare pays for the first 100 days or so.

http://www.nolo.com/legal-encycloped...ed-living.html

Nursing homes are getting even more expensive -- with the average price tag now standing at more than $80,000 per year.
NEW YORK (CNNMoney)
The cost of living at a nursing home has soared to a new high of more than $80,000 per year.
Over the past five years, the median annual cost of private nursing home care has jumped 24% from $67,527 to $83,950, according to Genworth's 2013 Cost of Care Survey, based on data from nearly 15,000 long-term care providers. From 2012 to 2013 alone, the price climbed 4%.




Facts about Nursing Homes

There are 17,000 nursing homes in the United States.

1.6 million people live in nursing homes.

The average number of beds per home is 107, with an occupancy rate of 88 percent.

More than 90 percent of current residents are 65 years of age and over. Almost half are 85 years or over.

The average age upon admission to a nursing home is 79.

Women are almost three times as likely to live in nursing homes than men.

In 2000, 4.5 percent of Americans 65 years and older lived in nursing homes, a decline from 5.1 percent in 1990.

In 1999-2000, the average nursing facility patient required assistance with 3.75 activities of daily living. Five common activities are used to measure the functionality of a patient - bathing, dressing, transferring, toileting and eating.

42 percent of nursing home patients suffer from some level of dementia.

33 percent of nursing home patients have documented symptoms of depression.

67 percent of nursing home facilities were for-profit in 1999-2000, 26 percent were nonprofit and 7 percent were government owned and operated.


Sources: American Health Care Association, American Association of Homes and Services for the Aging.



view-source:http://kff.org/other/state-indicator...ity-residents/

Total Number of Residents in Certified Nursing Facilities
View Table in New Window

Location
Number of Nursing Facility Residents

Alabama 22,759
Alaska 621
Arizona 11,507
Arkansas 18,033
California 100,065
Colorado 13,724
Connecticut 25,493
Delaware 4,266
District of Columbia 2,588
Florida 72,373
Georgia 27,564
Hawaii 3,012
Idaho 4,276
Illinois 74,564
Indiana 39,045
Iowa 25,165
Kansas 18,497
Kentucky 22,680
Louisiana 25,522
Maine 6,345
Maryland 24,432
Massachusetts 42,160
Michigan 39,683
Minnesota 28,150
Mississippi 16,342
Missouri 37,329
Montana 4,729
Nebraska 12,227
Nevada 4,732
New Hampshire 6,892
New Jersey 45,443
New Mexico 5,447
New York 107,480
North Carolina 37,399
North Dakota 5,737
Ohio 77,702
Oklahoma 19,694
Oregon 6,982
Pennsylvania 80,310
Rhode Island 8,076
South Carolina 17,143
South Dakota 6,448
Tennessee 29,910
Texas 92,359
Utah 3,855
Vermont 2,848
Virginia 28,168
Washington 17,597
West Virginia 7,155
Wisconsin 29,467
Wyoming 2,395

Who would make the decision on defining a "healthy lifestyle, and what criteria should be used? For instance ... I haven't eaten red meat in seven years! During a recent surgery, I lost a lot of blood and was prescribed iron pills which aren't doing the trick. The doctors are suggesting that I should include red meat as a daily part of my regular diet to buildup my blood iron and become healthier.

Insurance companies usually have statistics to go by. For example, I believe if you buy a convertible car you will be charged a higher insurance premium. Partly it's because people riding in convertables do less well in rollover crashes etc.. We assume the cost of the insurance policy will be fair because many companies will be competing for your business.

First wait to see if they stop paying for older women. They might not. They have also said that PSA tests for men are of little or no value, but HMOs are still offering them at no cost to the patient. If they stop paying, we always have the option of going to a doctor and paying for it ourselves. Who's in charge of these guidelines? The free market will decide based on statistics. We have competition between HMOs and insurance companies.

I think you might be referring to those who are on medicaid. Those who are on medicaid usually receive food "stamps" too. Perhaps there should be stricter rules on what they can buy with their food-stamp-card. How about "no processed foods" like chips 'n' dips, cookies, donuts, ice cream, frozen pizza etc.? Just natural whole foods.

That's true because there may be some vegans who are not primarily interested in optimizing their health. Their main interest may have to do with the humane treatment of animals. They might like to drink lots of soda and eat BIG pancake breakfasts with lots of syrup etc.. The same could be said of carnivores who eat poor diets. This means testing of some sort is needed, just like they are doing at some hospitals to make sure their employees are not smoking. They could also test for weight, cholesterol, blood pressure etc.. A poor diet usually shows up in those numbers.

It's already happening to a certain extent. Some hospitals have been known to turn people away because of their age. Big operations get riskier as one gets older and some hospitals don't want to take the risk.

Rules, or generally accepted guidlines, can be found in many places. For example, the American Lung Association, the American Heart Association, the American Cancer Society and the American Diabetes Association, to name a few. Then there's the Center for Disease Control and Prevention.

Most people agree that smoking is an unhealthy habit and raises one's risk for lung disease, cardiovascular disease etc.. Most people agree that being overweight puts one at greater risk for heart disease, cancer, diabetes, etc.. So there are many (common sense) rules based on multiple long term studies.

Do I play by the rules? Absolutely! And I saw my doctor yesterday. The nurse said, "I would pay to have your numbers", keep doing whatever you're doing." My blood pressure was 95/55 (And I don't take any medication). All of my numbers are consistently good. Once, a few years ago, my blood glucose was at 100. I worked on it and on my next blood test it was 86. Anyone can do it. It's just a matter of taking one's health seriously and taking action. I don't take my health for granted. BTW, at the end of my office visit, my doctor said, "okay, we have to get you out of here, healthy people in my office is bad for business." ;-)

We always like to hear of a fellow member getting good test results. If you are also happy and living a joyous lifestyle, then congratulations to you.

Ditto to the happy and joyous lifestyle!

In my humble opinion, it's not how long you live, but whether you live your life with joy and generosity.

Moderation is the key to a long, happy, healthy life.
Restrictions are no guarantee for anything.
In the end, no matter what you do or how you live, life will throw you a curve ball and you are going to be out.

You are right about life throwing you a curve ball even if you do everything right. Back in December, I took my wife to the emergency room with the symptoms of a heart attack. The doctors did the standard tests expecting to find coronary artery disease. To their surprise, her arteries were clear with no sign of disease, yet she was in severe heart failure. After further testing, they found a congenital heart valve defect which went undetected for 56 years. After heart valve replacement surgery, and surviving several severe complications, I am happy to report that she is well on the road to recovery. Thank God we had good insurance - otherwise we would have been financially ruined.

I would just like to point out that the panel that recommended that did not have a single urologist or oncologist on it and was chaired by a female pediatrician.

Our health care system is seriously screwed up. I am a RN and I see it daily from the inside as well as being a patient and seeing it from the outside.

Last year I was out of work for 6 mo to have both thumbs reconstructed due to arthritis damage. Not fun.

But we have dual coverage. We both work and have great coverage. Now 15 months later the insurance companies are still fighting about who pays what. i spend hrs on the phone with the ins companies and with the facility where my surgery was done.
I seriously spend enough time on the phone to keep 1-2 employees busy 40 hrs a week. And our premiums are not cheap! They are just trying to pass the buck to each other and it end up back to me to pay the outstanding balance which should have been covered. Shameful!

Our system is totally screwed up!

I am hoping that the Affordable Care Act will clear some of this crap up. We already have done away with denial due to pre existing conditions, and with life time max. coverage.

Last year we went to Australia and talked with many couples our age. They have nationalized health care and LOVE it. In their 50's many will also take out personal coverage, but non of them felt that they did not get treatment when needed or were denied the best of care.

They were all perplexed as to why our system is so screwed up and why nationalized health care is so controversial. They compared it to tax dollars paying for schools, police and fire protection. It was really eye opening.

I personally would much prefer a single payer system. I blame much of our problems on the insurance companies and The Afforadable Care Act puts too much control in the Insurance industry's hands as far as I am concerned.

Hopefully we can learn form all the other industrialized nations who have single payer systems and much better health outcomes. If you look at our outcomes it is very embarrassing. We could do so much better. But American pride does not allow us to learn from others, we have to design it ourselves and spend years figuring out why it isn't working right before we evolve to a system that will work. Most of us will be dead and gone by then I am afraid.

Had a house guest from Austria and they are very proud of their system. I was appalled at their lack of choices and the wait they had to endure for things like mastectomy.

Have a person I exchange emails with in The Netherlands. They too are proud, but it isn't what we are used to here.

I very much fear that a good idea will end up being misused and abused just like all of the other things that the government monitors now.

I wish we could have it the old way.

Many years ago I saw a special report on TV about universal health care in France. It focused on a married couple who were both professionals with good incomes. They liked universal health care but admitted that their taxes were so high that they had little money left over. They didn't own their own home and lived in a small appartment. This was a long time ago, and, if I remember correctly, they paid something like a 60% tax rate.

About 10 years ago I did some online research to find out about health care in Canada. I found out what the population was at that time and then I found out what their national health care bill was. It came to something like $8,000. per person but not everyone pays for health care. Anyway, it's very difficult to figure out exactly what's going on. Some people pay a lot and some pay nothing. If you happen to ask those who get it for free, of course they will say they LOVE it. But if you ask those who are paying a large chunk of their income, it's likely you will get a different answer. So it all depends on who you ask.

Perhaps you will be "generous" enough to inform us how "joy and generosity" relates to the topic of this thread. And I will be "overjoyed" to be so informed.

I have no idea why, if you both have dual coverage insurance and both are "great", you would submit claims to both companies. If your own insurance doesn't pay for it, why would the spouse's company be expected to pay it?

And about the other countries with nationalized healthcare, which I like in concept but not the realities......a neighbor here is from Canada. She said they were moving to a new community and would have to use the primary doctor assigned to that community. When I asked "What if you don't like the new doctor?", the reply was, "I'd probably have no recourse, because to request a different doctor translates to having NO doctor, because there aren't enough of them."

As problematic as our system is, we can choose to go to a different doctor if the one we have is lazy, nasty, or a quack. This ability to choose, and pay for better care ourselves if need be, should not be underestimated.

I've never heard of a doctor being assigned to a community, but perhaps it happens. Canadian doctors are very busy, and some are not accepting new patients. I can only speak about my own experience. A few years ago I moved to a small retirement community and chose a new local male doctor. I recently decided that I would prefer a female doctor, and I had a choice of two female doctors.

What rules, whose rules??? And what about those people who never smoke and get lung cancer--the rates are rising.... you cannot, I repeat, cannot punish people who get sick or get old by making them pay more. Think about what you are saying. You are hoping because you "play by the rules" you won't get sick? You live in a fantasy world. Illness, injuries strike haphazardly. I don't care what anyone says. And for those who do also have a "family" predisposition you are punishing them... People think about what you are proposing and thinking...

Disregard -- this -- somehow I got pushed onto another post. I was answering a post about people who don't follow rules being charged more for insurance.......

You are hoping because you "play by the rules" you won't get sick? You live in a fantasy world.


:BigApplause::BigApplause:

Direct Question for Village PL
 

[QUOTE=Easyrider;738994]Would have to disagree, age would have to included in the list of things that raise health care costs. Many are already arguing that that older people should be paying a lot more for health insurance since it's the older people that are a heavy burden on the health care system...Age is the main driver of the costs.

1. Do you think younger healthier people that seldom need health care should pay more to cover older people and those with pre-existing conditions while you pay less?

2. To apply your thinking would you argue that health insurance premiums should not go up as we get older and if so why?

What if all health premiums started going up say 5-10% each year after we reach say 60 since we are more likely to need health care each day we live.


Direct Question for Village PL Questions ask in post #9...

VillagePL please answer the questions 1 and 2 above. This was ask previously and no answer was given. Please explain why or why not. Use all the space you need and give us a complete answer.

You might want to have that BP checked again and consider treatment as anything under 60 Diastolic is considered low which is actually sometimes harder to treat than high BP. Also with a reading already low at 55 it could drop more at any time and cause you to pass out or go into shock.


From Everyday Health

At the other end of the spectrum is low blood pressure. Ogedegbe says that blood pressure is generally considered to be low when either systolic blood pressure is less than 90 mmHg or diastolic blood pressure is less than 60 mmHg.

If the blood pressure reading is under 90/60 mm Hg, it is called hypotension. Hypotension can result in a decreased supply of oxygen and nutrients to your brain, which can eventually lead to life-threatening shock.

Anyone can develop hypotension, but certain groups of people are more likely to experience it. For instance, up to 30 percent of older adults will get sudden drops in blood pressure while sitting or standing.

Low blood pressure (hypotension) is pressure so low it causes symptoms or signs due to the low flow of blood through the arteries and veins. When the flow of blood is too low to deliver enough oxygen and nutrients to vital organs such as the brain, heart, and kidney, the organs do not function normally and may be temporarily or permanently damaged.
Symptoms of Hypotension

Signs and symptoms, may include:

Dizziness
Fainting
Fatigue
Problems concentrating
Blurry vision
Nausea
Clammy, pale skin
Shortness of breath

The insurance companies have made sure that there is no going back. When we raised our families, health care costs were under control, the more insurance got involved the more complicated it became for health care providers and for patients, the costs and red tape have just spiraled out of control.

When I tell our kids that it cost us $1000 for each delivery, including prenatal and postpartum care for each of them. They drop their jaws. Now a normal delivery is $10,000-$15,000. Heaven help you if there are any complications.

There's no going back, Gracie! We burned our bridges by letting insurance companies make all the rules. It's very sad.

My patients in the NICU end up with million dollar bills, many families file bankruptcy as a result. Our system is way out of control, unfortunately.

IMHO it is very dangerous to have people whose only objective is reducing costs to be the only ones controlling.

Ask yourself why do we have a medical profession? why did it begin and why has so much effort and resources been employed to raise the standards of care? Why because society rightfully understands that alleviating suffering is a noble goal......

Now ask yourself why did we create insurance? the answer is simply to ensure risks that we could not handle. Insurance is the pooling of resources to help people cope with financial events that they otherwise could never afford.

Ask why do we have this controversy and the answer lies in greedy people patients, doctors insurers. doctors in an effort to protect themselves over-prescribe ie over treat. Insurance companies pushed in the early 1980's for more control of their insurance dollars to control what they believed to be higher cost resulting from over treating and plain mismanagement on the part of the medical community.

The Affordability Act is not a health act it is only a method of how health care will be distributed. it does nothing to improve the health care system and by an account of the majority will only make it worse and more costly.

So given this madness we have people who are charged with reducing costs as their only goal. since the higher medical cost are incurred in th last two years of a person lives what d you think is going to happen when the tires hit the road?

As to the experts on health care styles I wished they make up their minds as to what is good for us once and for all, Because their flip flopping only confuses the issue.

for me I am going to continue my life style of moderation and enjoy my across the board menu and the heck with the experts because I thin of those folks who pushed away the dessert cart just before the Titanic went down as one great columnist once said

About lung cancer: A woman on my block died of lung cancer a few years ago. She had never smoked but lived in a large Texas city that had a lot of air polution (smog). Different people get lung cancer for different reasons that may or may not be avoidable. But smoking is totally avoidable.

I was just reading about the "Affordable Care Act" in the Daily Sun a few days ago, and it calls for charging older people more. Roughly, a 21 year old, non-smoker, would pay a little over $200 per month. And they comparred it to a 60 year old, non-smoker, who would pay several hundred dollars more. I don't remember exactly but I believe it was over $700 per month.

You made a wrong assumption which I suppose is common for anyone who's not used to talking about health risks. Playing by the "rules" basically means: Living a healthy lifestyle that's generally known to lower one's risk for disease. (No one is handing out guarantees.)

We all have predispositions for one thing or another; all the more reason to practice a healthy lifestyle.

I didn't think I needed to state the obvious. Following the rules means living a healthy lifestyle in order to lower one's risk. Nothing is guaranteed.

In my opening post I talked about "accountability" and taking responsibility. Getting older is not a lifestyle choice. Everyone gets older. So, for example, an older person who smokes should pay more than an older person who doesn't smoke. An older person who is overweight should pay more than an older person who's not overweight.

No, I don't think a younger healthier person should pay more to take care of older people, assuming that he/she is living a healthy lifestyle. Only those with unhealthy lifestyles should be charged more. About "pre-existing conditions": It's getting too hypothetical, it might depend on what caused the pre-existing condition. Should I pay less? I'm in medicare so I do pay less. But I keep myself healthy and I don't use anything close to what I pay in. Many in Medicare, who live unhealthy lifestyles, use much more than they pay in. And that's why medicare is having difficulty. Those in medicare who take health risks, like smoking, should pay more. That would help keep medicare solvent.


People should not be charged more simply because they get older. Of course there will be increases because of inflation in medical care etc..

I'm 72 and totally healthy. Not too long ago there was a man who lived to 114 and was totally healthy up until one month before he died. A Mexican woman just died at 115 and was never sick. A man who lived in Leesburg died at 109 and was never sick. And there were many many more, too many to mention all of them. They all lived healthy lifestyles. Why charge people a "penalty" simply because they get older?

My mother is 94 and in almost perfect health - takes an iron pill and Aricept. She rarely has a medicare claim and is paying her own way in memory care, so there are old folks not requiring medical attention.

As far as medicare having difficulty it can be attributed to fraud and waste much more than care that is provided. They will pay for anything as long as it is coded correctly. It makes my hair stand on end when someone says "why wouldn't I have that treatment I may not have really needed - I don't have to pay for it". Yes you do with you tax dollars. People we all need to wake up and smell the coffee.

How do you know what lifestyle they lived and how healthy they were, any facts to support the comment? Seems there is always an experience or story to fit every situation.
People that think they are perfectly healthy find out different everyday. I would guess every member of your entire family is also just as healthy as you.

Basically you are saying everyone that is not perfect like you think you are, should be paying more and you should be paying less as you say you do..

I don't think we need to picking on any particular group and pointing fingers at others including the elderly is where I stand. Ha! ha! :boom:

Your questions indicate that you don't really believe that lifestyle has very much to do with anything. But I know differently because I have been studying this subject for many years. I know from experience.

No, again you're reading things into my statements that I never said. I never said that I think I'm perfect. Do you have a grudge against people who live healthy lifestyles and are healthy? I don't eat processed foods and I'm at my ideal weight. Should I pay the same as people who overindulge in processed foods and are overweight? If you think it's fun to take that risk, you should also have the fun of paying for that risk.

It's not "picking" and it's not "pointing fingers". It's called facing reality and taking responsibility. And I believe there are health insurance companies that already do this. Even the Affordable Care Act, which I'm not a fan of, distinguishes between smokers and non-smokers.

In a discussion about health care costs, you were proudly giving the detailed results of your medical tests, and rightly so. Your results are great. I was making a point that emotional health is also important, as with a life lived with joy and generosity. I think there are two components to healthy living, body and mind. For instance, some people with healthy bodies could be depressed or have emotional issues that also cost money to treat. I'm sorry if you found my comments superfluous.

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