… As Mickey Kaus puts it. This kind of thing is enough to remind me why, despite the fact that I consider it a beginning point rather than necessarily always the end point, I am fundamentally a libertarian.
We have ways of making you stress-free: Someone should write the fictionalized dystopian nightmare of mandatory “wellness” programs foreshadowed in Sen. Ensign’s business backed plan to let insurers penalize even those who seek non-employer-based health coverage if they don’t participate in healthy life regimens.” Like THX 1138, but with brownies. … Nineteen-Eighty-Fat! … Ensign says his plan “would guarantee that the incentive is strong enough for Americans to want to participate.” … Next: Marital fidelity incentives!
Blar says:
Why is this a reason to be a libertarian? The Ensign amendment gives businesses more freedom to set the terms of their contracts. If you don’t like it, you can buy your insurance from an insurer that doesn’t base its rates on participation in wellness programs.
October 19, 2009, 11:47 pmDoug says:
Because it is cohesive in a way that the govt or business ought not be.
October 20, 2009, 12:16 amMark N. says:
This actually sounds like you’re arguing against libertarianism, and in favor of the government regulating what health insurance companies can demand as a condition of acquiring insurance.
October 20, 2009, 12:21 amMahan Atma says:
Kaus… Such poor writing… Hurts brain to read…
October 20, 2009, 12:22 amEnhanceYourCalm says:
“Smoking is not good for you. Anything not good for you is bad. Hence, illegal. Alcohol, caffeine, chocolate, gasoline, uneducational toys and spicy food. Abortion is illegal, so is pregnancy if you don’t have a license.”
October 20, 2009, 12:28 amGo Horns! says:
I think the problem is that the “plan” will require me to buy insurance even if I don’t want it.
I think all references that legislation is like sausage because you don’t want watch either get made should stop. Sausage tastes good, this “plan” just makes me want to puke. I sure am going to miss sausage.
October 20, 2009, 1:08 amOff Kilter says:
Because it is
cohesivecoercive in a way that the govt or business ought not be.Fixed it for you…
October 20, 2009, 1:29 amredc1c4 says:
i’m not sure what the road to hell is paved with, but i’m fairly certain one of the main entrances onto it is clearly marked “For Your Own Good”
“America wasn’t founded so that we could all be better. America was founded so we could all be anything we damned well pleased.”
October 20, 2009, 1:45 amP. J. O’Rourke
theobromophile says:
Um… isn’t the argument here that there are basically two options: allow for these pricing schemes or force people who make healthy choices to subsidise those who do not?
Given that, what is so wrong with allowing pricing based on risk? No one gets their panties in a twist when insurance companies charge people with five speeding tickets more than those with clean records; how is this different?
October 20, 2009, 1:59 amMark N. says:
I think there are levels of intrusiveness, and there’s some threshold where the unfairness of some safe people subsidizing the unsafe is less bad than the intrusiveness of some company monitoring every minute if your life. Charging smokers/nonsmokers differently seems fine, and maybe people who participate in particularly dangerous sports. But some corporate bureaucrat deciding if my daily routine is a “healthy life regimen”? Will I have to report for mandatory workouts, and have someone vet whether I’m allowed to eat my lunch?
October 20, 2009, 2:10 amLarryA says:
Get real. The insurance companies will be “encouraged” to establish voluntary wellness-based rates the same way you are “encouraged” to pay your voluntary income tax.
Lipidleggin by F. Paul Wilson, 1978.
October 20, 2009, 2:10 amtheobromophile says:
That would probably cost more than a company would save via the differential pricing and incentives towards healthy behaviour.
Sadly, BMI, cholesterol, blood pressure, and the like are often poor indicators of a person’s lifestyle; there are plenty of people who simply have bad genes or conditions like PCOS and cannot, hard as they may try, keep their weight down. Presumably, this would enable insurance companies to factor things like gym membership into the equation.
October 20, 2009, 2:16 amJay says:
“Because it is cohesive coercive in a way that the govt or business ought not be.
Fixed it for you…”
Or, if you didn’t want to sound like a complete dick, you could have said “I think you meant ‘coercive,’ rather than ‘cohesive.’” Sorry, but the whole “fixed it” shtick is the single most obnoxious thing in blog commenting.
October 20, 2009, 2:34 ampmorem says:
I think gym membership would be off the list. It’s expensive to know if someone is actually utilizing that. It’s much easier to use this as a way of raising rates based on BMI. That’s just the first one that came to mind. In other words, it’s a stealth form of “pre-existing conditions”.
I’m amused.
If a 1500 page bill passes, it will be years before we figure out who buried what where in it. People who support this may find themselves regretting it over subtleties like this.
I’ll be laughing at you, even if I’m crying with you.
October 20, 2009, 5:37 ammikeyes says:
If I remember correctly, there was a NEJM article on the economics of “wellness” which came to the conclusion that in the long run unhealthy life styles cost less because the persons attending such life styles die earlier and die quicker of heart disease while the healthy life style persons linger on forever in nursing homes eating up all the services and costing a lot more money.
Of course, the insurance companies don’t have to deal with older people dying or getting sick, that is what Medicare is for.
Nonetheless, we all pay into Medicare and we all (will) pay into other insurance. If you do the math, isn’t the insistence that we all lead a “healthy life style” false savings?
In addition, exactly what is a “healthy life style”? Just yesterday a report came out stating that drinking in moderate amounts, hertofore thought to be healthy, is no longer good for you. If you gather all the dire warnings about food, exercise, stress, and geopgraphic location it turns out that you can’t live because everything is bad (or good) for you. You may as well give up and die.
Of course that would save a lot of money.
October 20, 2009, 7:50 amegd says:
Fixed it for you.
Off Kilter was doing it wrong.
October 20, 2009, 9:25 amJohn R. Mayne says:
1. I agree with other commenters that opposing this is anti-Libertarian. The proposal restricts businesses’ freedom. If it passes, it may give other people more options, but that’s not the point, is it?
2. If it worked, it would shift costs to government. The studies I’ve seen – which strike me as fairly robust – seem to show that smokers and fat people die politely without using up all those Medicare dollars that the fit and healthy use.
–JRM
October 20, 2009, 10:22 amSebastian says:
Reminds me of a Dead Kennedys tune.
October 20, 2009, 10:23 amd-berg says:
One of my previous employer’s plans had something about going to a health club at least 100 times a year. Takers were supposed to submit validation. It was a totally different beast, in that insurance company offered a token rebate of dues if you did that, but it is such an easy thing, it is likely to become a model. Just look to increasing digitization and automation of everything! Tracking will be automated and painless.
And here’s one problem: what with joggers who do not buy expensive club memberships and just run on the streets instead? I tell you what – they will get a shaft. Whole thing will become a giant health club subsidy program in a blink, because this is how government works. If they can discover a possibility of this interpretation, untold millions will be poured into legalized bribes for politicians (that they call lobbying and fund-raising), to ensure this is enacted. This way government will coerce private citizens to buy an expensive product from private industry.
October 20, 2009, 10:45 amTeh Anonymous says:
Mainly in response to d-berg: in consumer complaint fora I see a ton of complaints about gyms. Apparently the entire industry is notorious for having a lot of trouble getting the auto-debit of your bank account or credit card stopped. (i.e., many facilities continue to charge you after you terminate your membership.)
If what you described came to pass I’d expect to see an explosion of such complaints.
October 20, 2009, 11:07 amcubanbob says:
Whats next? Your sexual activities? A penalty for ‘high risk’ sex? A druggie tax? A penalty for not enough sleeping?
October 20, 2009, 11:56 amtheobromophile says:
Mikeyes: true, but consider that people themselves cost money. Not to be sarcastic, just to make a point: we could easily eliminate all costs if we eliminated most or all of the human population. No housing, health care, food, or entertainment needed.
Given that we generally think that people are a good thing (and those who don’t are more than free to take matters into their own hands), we’re going to have to accept that reducing costs isn’t always the first goal; it’s a means to an end.
Moreover, I’m always perplexed by the idea that healthy people are more expensive. Yes, if you compare the medical costs of hanging around a nursing home with dying of a heart attack at age 40, the former may be more costly. Nevertheless, the latter person also spent more time paying into the system and did so as a high earner in his 50s and 60s. Anyone know how much that offsets the increased costs?
October 20, 2009, 12:46 pmmikeyes says:
What you say is true, assuming you are talking to normal human beings, but the issue is not with the general population, it is with insurance companies whose main goal is to make money.
In general, insurance is a bet that nothing bad will happen and most people and insurance companies will readily get together to make that bet. But in the case of health insurance the prospect of some illness at some time in life is 100% so all bets are off unless you make that bet for a limited time. The house (insurance companies) wins when all risk is eliminated by lemon dropping, cherry picking, and Medicare. So insurance companies are not interested in preventive care except as a way to eliminate risks. And they don’t do this by causing incentive, they just make the conditions so difficult that the unwanted customers go elsewhere or deny themselves coverage. Hence the common complaint of being dropped because they are sick.
On the other hand, paying for medical care via a bet like that is not a smart idea if there is a profit motive. Medicare is not insurance per se, it is a mutual benefit society with a lot of risk. There are no profit motives involved and Medicare has a very low administrative cost because it doesn’t have to find ways to make money or pay huge salaries. There is no political incentive to force people to live “healthy lifestyles” and at age 85 there probably is no such thing anyway as your life expectancy is not very long no matter what you do. By that time it is all up to your genetic strength.
I suspect that Senator Ensign is simply trying to keep the spotlight off of his weaknesses in the next election and making sure that someone gives him money. I do like the idea of his proposing incentives for marital fidelity, however :grin:
October 20, 2009, 1:07 pmAnatid says:
What’s special about smokers? Why are they different from overeaters or the like?
We could always measure your glucocorticoid levels. Better indicator of future cardiovascular disease than BMI, cholesterol levels, or anything similar.
You forget that on VC each man is responsible for his own genetics. If you have a diminished prefrontal cortex and have poorer impulse control, any trouble you get into is still 100% your fault. If you carry the predisposition towards depression under stress, then when you fall into a hard place and can’t help yourself, it’s still on you to pull yourself up by your bootstraps. And I shouldn’t even mention some of the latest studies that may have found genetic correlates to cortical grey matter thickness – if you’re not intelligent, that’s your fault, too. If you have a mental illness, and are unable to procure treatment for yourself and have no family, tough cookies. The state won’t look out for you.
Of course, I would also suspect that the majority of VC are folks who have high resilience, so why should they have any pity?
IIRC, a meta-analysis recently estimated that ~$20 billion of productivity are lost every year in America due to stress-induced mental and physical illness, most notably depression, anxiety, and cardiovascular disease.
A single night of short-sleep (4 hrs or less) can cut immune system response to pathogens by half; can cut concentration, memory consolidation and learning by half; can impair automobile driving as much as being over the legal BAC limit. Results in thousands of deaths from car accidents every year, and contributed to notable catastrophes like the crash of the Exxon Valdez or the meltdown of Chernobyl.
I doubt sleep deprivation could be affecting the economy, though.
Please do not mistake my sarcasm for agreement that it would be a good idea to fine people for short-sleeping. But sleep IS a behavioral choice, and sleep dep also results in metabolic changes that contribute to overeating (leptin falls and ghrelin rises), obesity (insulin resistance rises), and heart disease (cortisol levels elevated). For that matter, though, choosing to pursue a high-stress lifestyle is also a behavioral choice, and if your genetics happen to be low-resilient and condemn you for it, then what?
… And we’re still okay going after smokers, right?
October 20, 2009, 4:49 pmBarbara Skolaut says:
Don’t get out much, do you, Jay?
October 20, 2009, 6:07 pmGabriel McCall says:
In a true free market, insurance companies would be allowed to offer whatever contracts they wished, and companies which offered contract terms which nobody wanted to comply with would simply not be able to sell any of those contracts.
The question of what is the “libertarian” way to regulate the existing fascist/mercantilist government-industrial complex has very little to do with the abstractions of laissez-faire theory.
With that said, though, I have to reply to Anatid and ask: if it’s not his fault, whose is it? The only alternative to holding each individual responsible for his own actions is holding the innocent bystanders around him responsible instead. No moral or political system can change the unfortunate fact that people are born with different capacities; the only question is who has to clean up the messes. And remember that you always get more of what you subsidize.
October 20, 2009, 8:49 pmAnatid says:
Does it have to be anyone’s fault? Someone’s responsibility, yes, but maybe we can leave fault out of it.
From an individualistic standpoint, each person must take responsibility for his own wellbeing, and those who have a limited capacity to do so must carry the full weight of the consequences. It’s unfair to those at a natural disadvantage. From a collectivistic standpoint, a culture can agree that the more advantaged (and you may be advantaged in some ways, and disadvantaged in others) should extend some level of compassion and aid to the disadvantaged. This ranges from using taxpayer dollars to install handicap ramps to states offering student loans at public universities to companies offering free stress counseling to their employees to a man helping his elderly neighbor move some furniture. Any such system imposed by the state will tax its people whether they individually agree or not, and is unfair to the individual.
Either way, you’ve got a system that is unfair. Any given person’s view of which direction the unfairness should go usually aligns with which system would advantage them more.
This is true in economics. In biology, there’s usually a balance of “use it or lose it” with “any trait, until it is maladaptive, will linger” that results in all kinds of weird vestigial organs and genetic introns. There are plenty of lifestyle-related illnesses, such as metabolic syndrome, that increase healthcare costs dramatically but aren’t immediately maladaptive.
So in some cases, yes, what you say is true. If you offer healthcare unconditionally, with the same rates whether or not a person attempts to maintain their health, then there is little economic incentive (although still plenty of personal incentive not to have one’s lifespan shortened by 10-20 years) to do so. But offering treatment for dysfunctional schizophrenics will not increase the number of schizophrenics.
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