SOLUTIONS TO HEALTH CARE PREMIUMS AND SMOKERS

On the last blog, we addressed the issue of smoking and health care insurance premiums. There are some simple solutions to this problem which are as follows:

 

1.         Private Health insurance companies should be allowed to increase their premiums for smokers. The amount of increase in premiums for these smokers should be based on the actual increase in health care costs. This number is probably over 20% but not as high as 50%. This recommendation will not apply for those on government programs such as Medicare and Medicaid (read further for explanation). The same type of proposal can be made for those that are overweight with high BMIs, except when caused by a pre-existing medical condition such as hypothyroidism or chronic steroid use, etc.

2.       For those on Medicare, higher premiums should not be applied to smokers but should be applied to increasing age. The last year of life is the most expensive year of Medicare cost for an individual. Most of these costs are due to unrealistic expectations by the patient and the family which can be corrected by further education on this matter. Also there are extensive costs due to highly technical services and intensive care services in a Hospital. Therefore, I propose that since the average person lives to about 82 years of age, that Medicare coverage is decreased from 80% down to 70% beginning at the age of 85. That is, at age 85, Medicare coverage would be 78% and at age 90 it would reduce to 70%. The remaining 20-30% would be picked up by either Medicaid or private insurer depending on the patient's financial status. More importantly, there needs to be health savings accounts especially in this Medicare population. Health savings accounts are utilized by those who are more informed about health insurance. The individual will have more control over his/her health care costs. If there is money left over in the health savings account when that person passes away, it can be inherited by surviving family members. This would definitely influence both the individual and family members in spending their money more wisely at the end of life. Unfortunately, Obamacare tries to eliminate health savings accounts through its policies and taxes. This needs to be changed if there is any meaningful attempt to reign in end-of-life health care costs.

3.       For those on Medicaid, that smoke or are obese, higher copayments will need to be paid. Right now, if people are paying $3 for the copayment, they should be paying $4.50 if they have a BMI over 35 or smoke. If the BMI is over 30 and less than 35 their copayment could be $3.75. Let me state that I believe that $3 is too low a copayment to pay for Medicaid and that needs to be readjusted so that even the indigent can make some  responsible healthcare choices or pay  because they have some “skin in the game”.

4.      For all types of insurance plans, there should be discounts for both employers and employees that utilize programs that encourage smoking cessation and weight loss. There should be incentives for individuals who make healthier choices and more economic choices with healthcare expenses.

Other behavioral choices that can be measured should be looked at such as diet and type 2 diabetes, etc. Healthcare premiums could be increased appropriately for these conditions depending on their increased cost to healthcare.

More comprehensive measures will be necessary to address the healthcare issues facing us in this country. The most important point is that we as citizens cannot allow the government to control us.  If one wishes to smoke or eat poorly, that is up to the individual. They may have to pay higher premiums but that should be their choice to make, not government's choice to control. They can try to influence behavior with higher premiums and through incentives. But, the individual should have the final say and control over their choices.

Also, health savings accounts should be encouraged and promoted since most people who utilize it are better informed and make better healthcare decisions , resulting in lower overall costs to the healthcare system. These health savings accounts should be available for all those with private insurance and with Medicare. We should also explore a way to utilize it within the Medicaid system. This one concept will decrease health care costs by a significant degree.

There are solutions to the rising healthcare costs. What is lacking is the political will to legislate it for the benefit of all Americans.