Health Insurance and Personal Responsibility
Little attention is being paid to personal responsibility in setting health insurance premiums. While health status and pre-existing conditions have been determinant factors in the past for obtaining individual health insurance and the premium rates for coverage, these differentials will be eliminated as part of the Affordable Care Act. And in obtaining group health insurance, an individual’s health status is usually not a consideration.
Personal responsibility in terms of health status has always been an important factor in deciding the premiums for life insurance. Thus, individuals with high blood pressure, elevated cholesterol, elevated blood sugar levels, smokers, drug and alcohol abusers, have to pay more in order for them to obtain life insurance, or may not be able to get insurance at all.
Some companies attempting to lower their costs for employee health insurance are offering incentives to workers for life style changes that lower blood pressure, body mass index, or other parameters, or who partake in wellness programs. (http://goo.gl/dVtMo) Both rewards for the employees such as lower premiums or deductibles may be offered, or penalties may be imposed such as higher premiums or an insurance surcharge.
It may seem odd that companies have to provide financial incentives to employees to prod them to lifestyle changes that will improve their health and longevity. But many individuals refuse to take personal responsibility for their health, with the rates of obesity skyrocketing in the United States over the last few decades, resulting in an increased incidence of diabetes, hypertension, coronary artery disease, strokes, and other disease entities, that will only increase in the future.
This leads us to a moral dilemma. Since health care costs are spread over the population that is insured, or partially paid for by taxpayers in Medicare and Medicaid, should those who are responsible and lead a healthy lifestyle pay more for those who disregard their health and eat and drink with abandon, or smoke, or use drugs, or drive recklessly, and so forth. Many of these people, who will be most in need of care, are poor, or with low educational levels, or with psychiatric problems. But some are quite intelligent, educated, and middle class. How do we get these individuals who are unwilling to assume responsibility for their own health to change their behavior and start acting in a way that will enhance their own health? It would seem to be unethical to refuse them care, even for those conditions that are self-induced. And if their health insurance deductibles for treatment are increased to penalize them, they will be less likely to seek care. In that case, their conditions will worsen and require more intensive treatment in the future.
Perhaps positive incentives can be tried such as lowering their health insurance premiums and/or deductibles for healthy conduct and any improvement that can be measured in the harmful conditions they exhibit. But what if they don’t respond to these inducements and persist in behavior that damages their minds or bodies and will ultimately cost responsible citizens money to care for them? This is unfair to those Americans who are attentive to their health and who will not become a burden to society because of self-destructive conduct.
I don’t know the answer to this quandary. My heart says society must pay for the care of those unfortunate individuals whose actions have resulted in serious illnesses. My brain says it is unfair to expect people who act responsibly in regard to their health to be saddled with the cost of care for individuals who give no thought to how their behavior will subsequently affect their minds and bodies. There appears to be no way to reconcile my heart and my brain over this issue. I am my brother’s keeper, or am I?