Saturday, September 10, 2016

Mills Healthcare Plan

Mills Healthcare Plan

"If you want to look at the success of a program over time, you need to look at a bunch of things that are not discussed by Mills. What is the health status of people coming into the plan, which relates to a number of facts - their average age, the gender breakdown, their health history and their lifestyles? What the outcomes of the program in terms health improvement, the break out of costs between the company and whether people continue to work their in good health?
If you employ younger employees to begin with, and make an effort to eliminate older employees who have more health issues and hold down your corporate costs, you keep your costs down and your employee's can more easily handle the occasional health issue. Whether intentional, if you punish those who get sick financially to save corporate funds and financially reward those who through no effort of their own are healthier, you fail to understand the purpose of health insurance, to make sure employees with real persistent problems get the care they need.
Encouraging healthy lifestyles is of course a good idea, but you need to be careful how you do it. Some of us get a bad draw genetically. I person knew for 25 years before I got it, that a genetic condition would some day mean I would need a kidney transplant. Nothing I could do would alter that fact - and that treatment was 1) extremely expensive and 2) somewhat toxic, as after effects are the norm. Early death was the only way to avoid the need. Only the very rich could fund this treatment out of their personal funds and all of us face the cost of a chronic illness that will be tremendously expensive, if not soon rather than later.
People don't think of these things, but benefit managers do. When I had the surgery, obviously any smart employer knew my continuing costs would be high. For self funded companies, there is a big temptation to get rid of those with these problems. In fact, it was necessary for Congress to ban genetic discrimination in hiring and firing. This didn't pass without strong Republican opposition. I suspect that if Mills had he been in a position to vote of this law, he would have opposed it, as genetic discrimnation would allow him to cut corporate spending.
So ultimately, for a program like company health insurance, one needs to look at what motivates a company to offer things like wellness programs. If they call on employees doing things that they have some control over, produce better health status and don't discriminate against older, sicker employees, OK. However, if they are designed mostly to lower corporate benefit costs, increasing employee risk of neglecting their care need or experiencing medical bankruptcies, it is not OK. It is never right to weed out those who are less health due to their genetics and the aging process.
It is not clear where this company comes out. However, if worker interests are not served well, then any person who designed such a program should not be rewarded by being allowed to impose their wrong-headed notions on the country. If Mills has designed program that is more beneficial than not, then he should back up his claims with supporting data." Joel S.

"My company just implemented one of these plans and did a terrible job of explaining it.  However after studying how it worked I think they are a step in the correct direction. (maybe)

You are correct that as long as the company is paying a large part of the employee's healthcare cost, there is an incentive to employ young healthy people. I was talking with a friend and found that their company's premiums are much lower because their workforce has many young single men in it, whereas my company's employee pool is very diverse.

So exactly how much more should the young single men with excellent lifestyle habits at my firm have to pay each month to subsidize the premium of older peers who make poor lifestyle choices?

How do you think we can encourage the older person to change their life long habits to become healthier?

With obesity and overweight sky rocketing in the USA, we need to do something about it if we truly want to reduce healthcare costs. I think programs like that set up by Mill's is a good start.

By the way, the program I am part of allows employees to get their Doctor to sign a medical waiver if the employee truly has a condition that prevents them from attaining the normal and is under the direct care of a doctor for that issue." G2A


Sean said...

Once again, you're complaining about what others think health care policy should be without providing any ideas of your own.

John said...

Oh I think I came out pretty clearly in support of wellness programs with all their carrots and sticks, even though it may cost me more next year.

And personally I don't think saying that we need Universal Healthcare / Single Payer and everything will be better is not much of a policy proposal.

I think the supporters of Universal Healthcare should be able to answer questions regarding the details, and how this will promote good choices. Since that is the most effective way to reduce healthcare costs for all.

Their proposal will clearly separate the benefit recipient from the premium payer. Kind of like what welfare does...

Now we know that increasing welfare has at least a strong correlation relationship to an increase in single Parent households / poverty, and likely it is causal.

So if we make healthcare like welfare on steroids. (ie few pay the bill and many reap the benefits) What behaviors could result? I think that is a good and fair question.

Sean said...

It's a good and fair question, but it has to be evaluated against the alternatives. Every health care policy choice has advantages and disadvantages and you can pick any of them apart in a vacuum. If you're not thrilled with the ACA and you don't like Medicare For All, then what's your path and why is it better?

John said...

In my perfect healthcare policy world, health insurance would be like auto insurance. Our employers would have nothing to do with it, and we would be legal bound to carry certain minimums. And the plans would charge high premiums to those who choose to live an unhealthy lifestyle.

Now what to do with the unfortunate and/or lazy? (ie poor) That is the question... I would probably get rid of Medicare and similar programs, and replace them with insurance vouchers of a fixed value that can be used to purchase "healthy living" insurance. And they would need to make up the difference if they chose to live an unhealthy lifestyle.

And what to do with those who let their insurance lapse??? Jail, Fines?, Other?, Take away right to vote?,

Sean said...

But that doesn't even answer most of the questions. Would insurers be able to charge more to people who were sick? Old? Women? Could they kick off people who were sick? Would they be force to issue to people who were sick, and if not, how would those people be covered? Who would get a voucher -- everyone or just poor people? How would you treat health insurance for tax purposes, since moving people off employer-paid health care would cause those people to lose a huge tax advantage? And that's just for starters...

John said...

In the case of our wellness plan, your Doctor in essence gets to decide if you are sick or making bad choices... The truly old would still be covered under Medicare.

Like ACA, I assume there would be rules regarding classes and allowable premium variations between them. So the old / sick may pay a bit more, but the risk would be somewhat shared. Mostly it would be the "living unhealthy" folks who would be penalized.

Only the poor would get the voucher. I am fine making premiums tax free like a home mortgage.

Now your turn... How will universal healthcare / single payer encourage people to make healthier lifestyle choices?

John said...

Please remember that the biggest heartburn I have with ACA is that it is a substantial wealth transfer program.

It drives up the cost of heath insurance for the 60% to reduces the cost for the 40%... And it really jacks up the cost for the top ~5%.

Sean said...

There's no reason you can't combine elements of a wellness plan with single payer. It's just a matter of how you construct it.

Sean said...

"It drives up the cost of heath insurance for the 60% to reduces the cost for the 40%... And it really jacks up the cost for the top ~5%."

Your plan doesn't fundamentally change that. You're still giving vouchers to poor people, limiting how much the old and sick pay, and you're actually expanding the number of people who get a tax break for health insurance.

That's the point most people who oppose the ACA don't seem to get. Any realistic reform plan that doesn't cut back on the number of people being covered is going to look an awful lot like the ACA, just tweaked in some ways.

Anonymous said...

oooh, I have an idea!

Tie Doctor pay to patient outcomes. If the patient gets healthier, the Doctor gets paid more.

It apparently works for education.


jerrye92002 said...

Joel, I had a plan exactly as you describe, and I liked it, but when Obamacare came along I couldn't keep it.

jerrye92002 said...

John, it seems there is a simple solution to the problem you posit: simply detach health insurance from employment. Let employers offer a fixed stipend if you want, but then let every employee choose a personal plan that suits them and is portable between jobs, greatly reducing the "pre-existing condition" problem.

John said...

I agree with you since I see cash, bonuses, benefits, etc as just different forms of compensation. I know a number of married folks who love working contract jobs because they get paid more and are on their spouses family insurance.