{"items": [{"author": "Sarah", "source_link": "https://www.facebook.com/jefftk/posts/240533616042537?comment_id=240544889374743", "anchor": "fb-240544889374743", "service": "fb", "text": "Correction: higher for 25 y.o. women in capital cities.", "timestamp": "1332597178"}, {"author": "Elizabeth", "source_link": "https://www.facebook.com/jefftk/posts/240533616042537?comment_id=240550039374228", "anchor": "fb-240550039374228", "service": "fb", "text": "I think you could also take into account the fact that certain health services are indeed risk-based, but many are actually relatively fixed (i.e. yearly physicals, routine check-ups). I think that some part of what is covered by health insurance isn't really risk-based at all, which has never made much sense to me.", "timestamp": "1332597916"}, {"author": "Peter", "source_link": "https://www.facebook.com/jefftk/posts/240533616042537?comment_id=240556146040284", "anchor": "fb-240556146040284", "service": "fb", "text": "I'm pretty sure there are other cases where insurance companies may not charge more for members of \"protected\" classes even if they have solid actuarial data backing up their rates. I believe there are jurisdictions which prevent insurance companies from charging older drivers more.", "timestamp": "1332598747"}, {"author": "Peter", "source_link": "https://www.facebook.com/jefftk/posts/240533616042537?comment_id=240556962706869", "anchor": "fb-240556962706869", "service": "fb", "text": "I think a fair way to address the issue would be to pass a law requiring insurance companies to have the same loss ratio for every category of person they insure.", "timestamp": "1332598856"}, {"author": "Paul", "source_link": "https://www.facebook.com/jefftk/posts/240533616042537?comment_id=240560182706547", "anchor": "fb-240560182706547", "service": "fb", "text": "Pension plans used to routinely pay retired women less because they lived longer after retirement, but that was eventually ruled to be illegal descrimination.", "timestamp": "1332599318"}, {"author": "Daniel", "source_link": "https://www.facebook.com/jefftk/posts/240533616042537?comment_id=240576442704921", "anchor": "fb-240576442704921", "service": "fb", "text": "Given that pension plans are also based on income, which seems to be skewed against women, I'd say if they live longer that might no more than balance out what they get out of their pensions in total.
My personal view on health care costs and what we should/shouldn't use to determine prices for different people: I think insurance companies should be able to make use of risk factors that people had a choice in (behaviors, drugs/smoking, etc.) but not ones that are just the result of their birth (gender, age, genetic risk factors, etc.) To me, this means we'd be dealing everyone an equal hand (at least in the one aspect of health insurance), and any inequality here would be something you could choose or not.", "timestamp": "1332601472"}, {"author": "Peter", "source_link": "https://www.facebook.com/jefftk/posts/240533616042537?comment_id=240580179371214", "anchor": "fb-240580179371214", "service": "fb", "text": "DR: The system you describe might appear more equitable, but it doesn't address adverse selection. Someone who is healthier for _whatever_ reason, gets less from buying insurance and will want to buy less given the option, unless the price compensates. You wouldn't expect someone born small to pay the same for food as someone born large.", "timestamp": "1332601957"}, {"author": "Jeff Kaufman", "source_link": "https://www.facebook.com/jefftk/posts/240533616042537?comment_id=240601626035736", "anchor": "fb-240601626035736", "service": "fb", "text": "@Peter: \"same loss ratio for every category of person they insure\"
That prevents capricious insurance company discrimination, but it doesn't change that some people will be paying more than others for health insurance because of risk factors that they have no control over.", "timestamp": "1332604604"}, {"author": "Paul", "source_link": "https://www.facebook.com/jefftk/posts/240533616042537?comment_id=240602989368933", "anchor": "fb-240602989368933", "service": "fb", "text": "Where do you draw the line between risk factors and preexisting conditions?", "timestamp": "1332604783"}, {"author": "Jeff Kaufman", "source_link": "https://www.facebook.com/jefftk/posts/240533616042537?comment_id=240605746035324", "anchor": "fb-240605746035324", "service": "fb", "text": "@Daniel: \"should be able to make use of risk factors that people had a choice in but not ones that are just the result of their birth\"
Imagine that some insurance company decided to charge more for people who visit nail salons because of the fumes. They say it's a risky behavior like smoking, and their data backs their claim up in that people who visit nail salons really are costing them more than people that don't. Perhaps even an automated system found it from looking only at statistics they are allowed to collect. If you look closely at their data, however, perhaps you find that the main increase in cost for people who visit nail salons is because they are more likely to have children and the insurance company pays for pregnancy related care. They're really just using one risk factor, nail-salon-visiting, as a proxy for the real risk factor, gender, because they're not allowed to use that factor.", "timestamp": "1332605122"}, {"author": "Adrian", "source_link": "https://www.facebook.com/jefftk/posts/240533616042537?comment_id=240614649367767", "anchor": "fb-240614649367767", "service": "fb", "text": "Jeff, the comparison you made with men being charged more for auto insurance elides the fact that healthcare directly impacts a woman's quality of life and, sometimes, ability to live, period. Yes, car insurance is an essential for many people--but many people do not own or cannot afford to own cars. Those same people, disproportionately women, also are more likely to have limited or no access to needed healthcare services. Also, within this current system, women are punished for their increased statistical likelihood to get checkups, among other things--not their increased statistical likelihood to endanger others through irresponsibility, as with men's auto insurance. Making this comparison without noting the disparity of this impact further adds to the impression that you're referring to a fictional world in which men and women are adversely affected by sexism with an equal impact. Finally, the priority in terms of healthcare is access, hands-down. There isn't a moral contest between single-payer healthcare and healthcare with premiums proportional to risk.", "timestamp": "1332606291"}, {"author": "BDan", "source_link": "https://www.facebook.com/jefftk/posts/240533616042537?comment_id=240627309366501", "anchor": "fb-240627309366501", "service": "fb", "text": "Part of the problem is the word \"insurance\" -- most health care shouldn't really be thought of on the insurance paradigm, which is designed for low frequency, high cost risks. That covers things like major injuries and serious illnesses, but not routine or preventative care, or chronic illnesses. I think that's actually the root of a lot of the problems with the American health care system.", "timestamp": "1332607836"}, {"author": "Jeff Kaufman", "source_link": "https://www.facebook.com/jefftk/posts/240533616042537?comment_id=240635712698994", "anchor": "fb-240635712698994", "service": "fb", "text": "@Marianna: \"the comparison with men being charged more for auto insurance elides the fact that healthcare directly impacts a woman's quality of life and, sometimes, ability to live\"
Right. Health care is more important than driving. The auto insurance example is to show that we don't have a general problem with people at risk for a large expense to be paying insurance in proportion to the expected value of the expense.
\"within this current system, women are punished for their increased statistical likelihood to get checkups\"
Is this true? I thought preventative care decreased healthcare expenses, and so in as much as women are getting more of their necessary checkups they should be decreasing costs for the insurance companies.
\"statistical likelihood to endanger others through irresponsibility\"
If you want we could use life insurance costs instead of car insurance to separate irresponsible endangerment from others from the general category of \"things that increase the expected payouts of insurance companies\".
\"adds to the impression that you're referring to a fictional world in which men and women are adversely affected by sexism with an equal impact\"
I'm not trying to claim this. Sexism clearly impacts women more.
\"There isn't a moral contest between single-payer healthcare and healthcare with premiums proportional to risk.\"
I'm not sure what you're saying here.", "timestamp": "1332608838"}, {"author": "Peter", "source_link": "https://www.facebook.com/jefftk/posts/240533616042537?comment_id=240638589365373", "anchor": "fb-240638589365373", "service": "fb", "text": "Upon thinking about this, the fact that health insurance isn't exactly insurance (because it covers so many things that are predictable, avoidable, or elective) makes me think we might establish single payer for all the non-insurance stuff, but still have private insurance for everything else.", "timestamp": "1332609221"}, {"author": "Peter", "source_link": "https://www.facebook.com/jefftk/posts/240533616042537?comment_id=240639242698641", "anchor": "fb-240639242698641", "service": "fb", "text": "So what I'm saying is that the gov't should cover preventative medicine, obstetrics, contraceptives, etc. and private insurance or patients' own responsibility should cover the rest.", "timestamp": "1332609318"}, {"author": "Mac", "source_link": "https://www.facebook.com/jefftk/posts/240533616042537?comment_id=240676772694888", "anchor": "fb-240676772694888", "service": "fb", "text": "Universal health care. Per capita, the US spends about double what other first world countries spend and delivers health outcomes way back in the pack. Personally, I tend to dislike government programs. But as an engineer, I like what works.", "timestamp": "1332613962"}, {"author": "Adrian", "source_link": "https://www.facebook.com/jefftk/posts/240533616042537?comment_id=240704086025490", "anchor": "fb-240704086025490", "service": "fb", "text": "Jeff--I misunderstood what you were trying to do with the auto insurance example. Perhaps I've been reading too much about masculism and it's infecting how I react to everything. In terms of the last quote, can you explain further what you meant by the two options you had in your last paragraph? I might have misunderstood this too.", "timestamp": "1332617457"}, {"author": "BDan", "source_link": "https://www.facebook.com/jefftk/posts/240533616042537?comment_id=240776026018296", "anchor": "fb-240776026018296", "service": "fb", "text": "Peter - just having private insurance for the major, unexpected things might work, but it would still need to be required (like it is in Massachusetts). Otherwise you wind up with the situation we have now where uninsured people get injured, the hospital treats them, and the hospital has no way to collect while the people are in deep debt.", "timestamp": "1332626208"}, {"author": "Todd", "source_link": "https://www.facebook.com/jefftk/posts/240533616042537?comment_id=240815472681018", "anchor": "fb-240815472681018", "service": "fb", "text": "Jeff Kaufman \"I thought preventative care decreased healthcare expenses...\" I'm pretty sure it does the opposite. It's probably more effective in terms of health, but from what I've read, it's generally less expensive to treat things as they come up then to try to prevent them (probably since you end up addressing a lot more potential problems then what would have actually happened).", "timestamp": "1332631967"}, {"author": "BDan", "source_link": "https://www.facebook.com/jefftk/posts/240533616042537?comment_id=240821322680433", "anchor": "fb-240821322680433", "service": "fb", "text": "Todd - if preventative care increased costs, I'm pretty sure my insurance company would not spend nearly so much effort trying to get me to get it. There are some exceptions (some kinds of cancer screenings, for example), but there are a lot of major, very expensive things that are easy to prevent with low cost preventative care.", "timestamp": "1332632924"}, {"author": "Todd", "source_link": "https://www.facebook.com/jefftk/posts/240533616042537?comment_id=240999805995918", "anchor": "fb-240999805995918", "service": "fb", "text": "Are you sure it's your insurance company that's spending that effort? Most cases I've heard of that kind of thing are efforts on the part of employers, not the insurance company. And as I understand it, the employer has to pay for the preventative care anyway, so they want the employees to take advantage of it because it does reduce costs if it's already paid for.", "timestamp": "1332666648"}, {"author": "BDan", "source_link": "https://www.facebook.com/jefftk/posts/240533616042537?comment_id=241004125995486", "anchor": "fb-241004125995486", "service": "fb", "text": "Quite sure -- I'm self-employed, and I'm pretty sure I would know if I were going to all that effort to convince myself to get care. :-) (It also happened before I was self-employed, but then I was working for such a small company that I really doubt they had the time/organization to initiate anything like that, unless it was just a matter of checking a box on the insurance company's paperwork... at which point it still seems like the insurance company doing it.) It's my impression, though, that employers generally just pay premiums, the same as I do, so it doesn't matter to them that the preventative care is \"paid for\" -- that's true of all care, and it's not going to change the premiums whether the employees get it or not.", "timestamp": "1332667612"}, {"author": "Todd", "source_link": "https://www.facebook.com/jefftk/posts/240533616042537?comment_id=241084085987490", "anchor": "fb-241084085987490", "service": "fb", "text": "In the case of large employers, I would imagine that having their employees utilize preventative care does affect their premiums, both directly if such things are reported, and indirectly by lowering future care costs. That having been said, it may be that what I've read about preventative care costs apply only to certain exceptional cases, as you suggested. I seem to recall reading that it was more then just a few isolated cases, but perhaps not.", "timestamp": "1332681537"}, {"author": "Jeff Kaufman", "source_link": "https://www.facebook.com/jefftk/posts/240533616042537?comment_id=241109022651663", "anchor": "fb-241109022651663", "service": "fb", "text": "@Marianna: \"can you explain further what you meant by the two options you had in your last paragraph?\"
It comes down to whether people with lower/higher expected future medical expenses should be paying less/more for medical care. If we think they should we should let insurance companies take into account any information they have about patients in determining prices and let patients choose between options. If we think they shouldn't we need mandatory single-price insurance.
We're currently in between, where people who expect to have low (near) future expenses can choose options like a high deductible plan with a health savings account or going uninsured while insurance companies can use some risk factors but not others in determining prices. I think either end of the spectrum makes sense, but I do lean towards universal health care.", "timestamp": "1332684906"}, {"author": "Adrian", "source_link": "https://www.facebook.com/jefftk/posts/240533616042537?comment_id=241341695961729", "anchor": "fb-241341695961729", "service": "fb", "text": "That's what I thought you were saying... If we're talking about access, and healthcare as a basic need everyone should be entitled to, single-payer is the only moral option.", "timestamp": "1332711519"}, {"author": "Jeff Kaufman", "source_link": "https://www.facebook.com/jefftk/posts/240533616042537?comment_id=241424279286804", "anchor": "fb-241424279286804", "service": "fb", "text": "@Marianna: Food is also a basic need, so why isn't single-payer the only moral option for food?
You can deal with the access aspect with a safety net, and to some extent we currently do this: medicaid for health care, EBT for food. Say MA switched to pay-in-proportion-to-risk while keeping the requirement that you purchase health care and also keeping subsidized plans for people who couldn't afford them. I don't see why that isn't a moral option.
(The reason I think single-payer makes sense is that it works well in practice in other countries. If it did not work well for others I wouldn't support it. To me it's not a moral question but a practical one.)", "timestamp": "1332724198"}, {"author": "Pat", "source_link": "https://www.facebook.com/jefftk/posts/240533616042537?comment_id=242906449138587", "anchor": "fb-242906449138587", "service": "fb", "text": "Health care should be able to be shopped around for by the consumer with either a benefit amount from the employer or a higher rate of pay. It should not be risk-based unless the risk is a result of the person's behavior. Insurance for those uninsured should be as is welfare benefis and people who chose not to buy it should just assume the risk that if they need it, it will cost them. IN ADDITION, the costs are out of control due to the health ins cos allowing dr's - for example - charging someone over $900 for a PA to give them a piece of felt to put between their fingers on a follow-up for a finger fracture (experienced this!)", "timestamp": "1332953305"}, {"author": "Jeff Kaufman", "source_link": "https://www.facebook.com/jefftk/posts/240533616042537?comment_id=242907792471786", "anchor": "fb-242907792471786", "service": "fb", "text": "@Pat: if you let people shop around but don't want people's costs to reflect risks, how do you keep people who are lower risk (healthy, young, etc) from buying less insurance?", "timestamp": "1332953440"}, {"author": "Pat", "source_link": "https://www.facebook.com/jefftk/posts/240533616042537?comment_id=242911349138097", "anchor": "fb-242911349138097", "service": "fb", "text": "They should be able to buy less if they chose to do so. It all evens out in the end, if it costs more later. Why should one be obligated to be the bearer of someone else? Costs should be brought down not only by disallowing overcharging, but also by reforming frivolous lawsuits. It is unfortunate, as we age , that we may have more issues; however, that is not necessariy always true. Many young people, sadly, have mre needs as well. The insurance companies can compete if the individual can shop aroud. It will never be perfect, bu, again, the younger \"healthier\" generation is a lready paying fr SS which they will never get back - why should they bear the burden for others health ins costs as well? (And the countries deficit as weel , I might add)", "timestamp": "1332953843"}, {"author": "Jeff Kaufman", "source_link": "https://www.facebook.com/jefftk/posts/240533616042537?comment_id=242913519137880", "anchor": "fb-242913519137880", "service": "fb", "text": "@Pat: I don't understand how you can think both \"Why should one be obligated to be the bearer of someone else?\" and \"It should not be risk-based unless the risk is a result of the person's behavior.\"", "timestamp": "1332954096"}, {"author": "Pat", "source_link": "https://www.facebook.com/jefftk/posts/240533616042537?comment_id=242914045804494", "anchor": "fb-242914045804494", "service": "fb", "text": "Don't see the confusion here.", "timestamp": "1332954158"}, {"author": "Jeff Kaufman", "source_link": "https://www.facebook.com/jefftk/posts/240533616042537?comment_id=242928702469695", "anchor": "fb-242928702469695", "service": "fb", "text": "@Pat: Let's say I have a family history of kidney failure in your thirties. My insurance would like to charge me more because my risk is higher, even though the risk is not \"a result of my behavior\". If we prohibit them from doing so, and prohibit them from denying me coverage, they will expect to take a loss on me. To make this up, they have to charge everyone else more, obligating them \"to be the bearer of someone else\".
The problem is that it doesn't \"all even out in the end\". Some people are higher risk because of their birth or other factors outside of their control (gender, genetics, childhood chemical exposures, ...).", "timestamp": "1332955796"}, {"author": "Pat", "source_link": "https://www.facebook.com/jefftk/posts/240533616042537?comment_id=242934675802431", "anchor": "fb-242934675802431", "service": "fb", "text": "That is what insurance is all about. One never knows when it will be needed or if it won't be needed at all. The insurance companies would have to take all of this into account when determining premiums for different coverages i.e. catastrophic, basic, etc. Someone who is completely healthy could become chronically ill ( : ( )and, of course, that is why they pay for one plan or another. Just because someone is already ill doesn't make someone healthy at the time of purchase \"less of a risk\" The difference I make is the Amount of coverage purchased. Not the price of the premium of the plan they chose. Unless someone outrightly abuses their body (drugs, alcohol, cigarettes), they should not be penalized for something out of their control = or due to occupational hazard (after all, we all benefit from all occupations).", "timestamp": "1332956558"}, {"author": "opted out", "source_link": "#", "anchor": "unknown", "service": "unknown", "text": "this user has requested that their comments not be shown here", "timestamp": "1332956994"}, {"author": "Jeff Kaufman", "source_link": "https://www.facebook.com/jefftk/posts/240533616042537?comment_id=242942592468306", "anchor": "fb-242942592468306", "service": "fb", "text": "@Pat: \"Just because someone is already ill doesn't make someone healthy at the time of purchase 'less of a risk'\"
It very much does. Your risk to an insurer is the expected value of the amount they'll have to pay out. Someone who already has a failed kidney and needs dialysis is much more likely to cost the insurance company much more money than someone chosen at random from the population. Similarly, someone who is not currently sick but who has a family history of a genetic disorder may also have much higher risk.", "timestamp": "1332957540"}, {"author": "Pat", "source_link": "https://www.facebook.com/jefftk/posts/240533616042537?comment_id=242944132468152", "anchor": "fb-242944132468152", "service": "fb", "text": "That's just the way I feel about it. People should not be penalized if they are sick - at the same time , people should not be forsed to buy insurance or More insurance if they choose not to. Like it or ont, that is my opinion. And, beside, I don't get to make the decisions.", "timestamp": "1332957727"}, {"author": "Jeff Kaufman", "source_link": "https://www.facebook.com/jefftk/posts/240533616042537?comment_id=242956549133577", "anchor": "fb-242956549133577", "service": "fb", "text": "@Pat: the problem is that your opinions conflict with each other. I don't think you've fully thought through their consequences.", "timestamp": "1332959296"}, {"author": "Pat", "source_link": "https://www.facebook.com/jefftk/posts/240533616042537?comment_id=242960142466551", "anchor": "fb-242960142466551", "service": "fb", "text": "No consequence here. You want insurance, you pay what the company determines is an appropriate premiumto be feasible for their costs. If it exceeds what you think you will use, then don't buy it. Or - better yet - it woud be nice to have a more competitive market place and more reasonable medical costs with, again, torte reform for frivolous lawsuits.", "timestamp": "1332959748"}, {"author": "Jeff Kaufman", "source_link": "https://www.facebook.com/jefftk/posts/240533616042537?comment_id=280113148751250", "anchor": "fb-280113148751250", "service": "fb", "text": "@Marianna, @Todd, @BDan: I looked into whether annual physicals and preventative care save money: http://www.jefftk.com/news/2012-05-25.html", "timestamp": "1337989009"}]}