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Model for Healthcare Reform is Non Existent – Wellness Incentives Move Cost to Sick Employees With “Scoring” A

Posted Jan 10 2010 10:29am

This is pretty much what we having happening today with what’s sitting on the table, a form of judgment to where those who are sick and need care will pay more and this is the exact crowd that can’t afford healthcare right now.  With health insurance relying on stock market profits and paying dividends, there’s not much imagethat is going to work and we end up with a huge amount of political rhetoric that nobody’s formulas are going to fix.  If we were truly trying to get everyone to be healthy, we would stop judging people and work with what we have, sick people who need care and educate those who can improve their health with changing lifestyles.

We have all read enough with all the news today to know how crooked Wall Street is and yet we continue to foster the belief that health insurance should survive on the market.  This is not like car insurance where one can make a decision to have or not have a car, it’s health that we all have in one shape or another.  Again, rewarding those who are in a position to be healthier than others really is prohibitive to better healthcare and as the article states we are doing nothing but shifting cost.  I don’t see perfect body masses sitting in those seats in Congress either for that matter, and yet they are given care no matter what and I see little effort of any role models there either. 

Wellness should be removed in it’s current format with employers remodeled.  If you really want to provide care and education, what is happening today is not doing the trick.  Add in the new GINA rules where a healthcare assessment can’t include family history now and what are we accomplishing, not much, but the algorithmic formulas to cut cost simply remove those who need care.  Furthermore if a small company is too costly, they get dropped. 

I’m not saying wellness is out of the picture by any means, as there have been companies who have seen both healthier employees and cost reductions, but again when it revolves around the distribution of costs and algorithmic formulas that simply denounce the folks that are not healthy and create an even further negative human judgment factor of one against another versus helping and educating, it won’t get there.  An individual begins to look like they are not any type of employee asset, but rather only a “body” that is to be judged.  With healthcare on the stock market and dividends paid off against cost lowering it won’t get there.  Big companies are already getting breaks on health insurance due to their size, while the individual wanting a policy has to pay more. 

What is interesting here is to also see a health insurance executive substantiate this with his comments below, they will drive right through it, so here we even have insurance companies telling us this is what will happen, but we don’t listen when we should, they run the algorithms and know their business models.  We have read lately in the news about the 600,000 people that Aetna has “scored” and is ready to dump, what more do we need to see here?  image

This will NEVER work with insurers who are on the market to make dollars and we would be better served with a non profit model that entertains an alternative role of action.  Why do you think we have such a battle going today?  Can we not see the forest for the trees?  Algorithmic formulas that are created for profit don’t ride in the same lane on the highway as healthcare reform, they are telling us, but do lawmakers listen?  BD 

WASHINGTON -- Incentives within the U.S. Senate health care bill designed to encourage healthy lifestyles unfairly target the poor, elderly, overweight and disabled, and could be exploited by insurance companies for financial gain, advocacy groups claim.

"This is a loophole that [insurance companies] will drive right through on day one," added Andrew Kurz, former chief financial officer of Wisconsin Blue Cross-Blue Shield. "This can lead to huge differences in premiums."

However, it's not so cut-and-dry, advocacy groups contend. Employers could first raise premiums for workers across-the-board, and then lower premiums for employees that meet certain goals, such as having low cholesterol or reaching a certain body mass index.

Those who are unable to meet such goals would be forced to pay a high premium that could well be unaffordable.  "This is not workplace wellness, this is cost-shifting," added AHA's Nelson, arguing that costs would likely move from healthy employees to sick employees, and from employers to employees.

Advocacy Groups Protest Wellness Provision in Senate Health Care Bill - ABC News

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