Today's Managing Health Care Costs Number is NOT 75%
Here are two lines I hear over and over again.
"I pay so much more for health insurance than I get in benefits."
And
"I resent paying insurance premiums to subsidize people who aren't taking care of their own health."
I generally hear this from young, healthy people -and this represents a fundamental problem with the way we view health insurance. Our sense of fairness is built into the more primitive (and automatic) portion of our brain - and it's hard for us to get over this.
But we should!
Health insurance is wealth transfer from the healthy to the sick -so that the sick can transfer wealth to the health care system in exchange for medical care. If you're healthy - you will definitely pay more in health care premiums than you get in benefits. (For many, employer sponsorship of health insurance makes this less obvious). If you get leukemia - you will definitely get more benefits than you paid in premium. That's the nature of health insurance -and frankly we'd all rather "lose" in health insurance than be unlucky enough to "win" and have our health insurance pay for grueling chemotherapy or worse.
Many don't like the idea of any redistribution -but that's what insurance is. Most of us pay more for home insurance than we ever get back - but each year our house doesn't burn down, we're grateful. We should think about health insurance the same way.
The next issue is whether those who "win" in health insurance (get more benefit payout than their premium) are "deserving."
It's true that there are many behaviors that can increase health care costs. Some of those behaviors are socially acknowledged to be "bad," like smoking or excessive alcohol consumption. Smokers often pay an extra health insurance premium to defray excess costs. Some behaviors that increase medical costs are thought to be socially virtuous, like jogging or biking. But shin splints and broken collarbones increase health care costs even if the patient was training for a 10K run or riding a bike for exercise.
Many quote the Centers for Disease Control and Prevention which says that 75% of all medical costs are due to chronic disease - many of which are preventable through better health behaviors. But let's unpack this
- 75% is all costs associated with these patients. That includes costs due to the chronic disease, but also costs due to preventive care, accidents, and pretty much anything else.
- MANY of these with chronic diseases that are associated with lifestyle live a perfectly healthy lifestyle - and are just unlucky enough to have genes that predispose them to a chronic disease. There are plenty of non-obese diabetics, and many Americans with hypertension who exercise regularly and are not overweight.
- The 75% includes all cancers, many of which have little or no lifestyle etiology. We should not include these.
- The 75% includes mental illness, much (most) of which is not brought on by unhealthy lifestyle. We should not include these
- Some have considered breast cancer costs to be related to healthy behavior -reasoning that breast cancer is amenable to early detection. But recent evidence shows that the number of lives "saved" from breast cancer screening is modest - and mammography does not save total medical costs. So we should not consider breast cancer costs amenable to healthier behavior.
- Recent evidence suggests that obesity, the most visible result of "unhealthy lifestyle" is largely due to factors of the intrauterine environment and early childhood nutrition. Obese adults simply can't use a time machine to reverse these - although we should redouble our efforts to prevent obesity in the next generation.
My main concern is that this entire approach reeks of blaming the victim. Much of our health (and our health cost) is not related to our behavior. Our health care costs are related to our genes, our environment, and our luck.
I'd rather win the "health" lottery (and enjoy better health) than the "health insurance" lottery (and get extra payout from my health insurance premium).
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