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walkitouthttp://www.kaisernetwork.org/daily_reports/rep_index.cfm?DR_ID=54156
This is not the most detailed, but it looks like the best coverage I've seen so far.
Short form: Alabama has decided to do something about the high cost of providing health care at no cost (in terms of premium) to its single employees (people with a family enrolled do pay a bit more for spouse and/or kids). They're go to have everyone either pony up $25/month, or go get screened. If the screening (glucose, cholesterol, BP, BMI) looks bad, employee gets a year to improve it. If they fail to make "progress" (unclear what that means), they get to pony up $25/month.
Given what everyone _else_ is having to pay for health insurance? SO seems like a good idea. However, people have really focused in on that obesity number, despite the fact that Alabama opted for a pretty durn conservative BMI break point of 35.
(Check for yourself what that would mean: http://www.consumer.gov/weightloss/bmi.htm)
Whatever. I'd have more issues with the cholesterol number, honestly. Making someone pony up extra for a genetic condition they've already moved heaven and earth to mitigate seems a little mean, but I'm guessing there's some wiggle room in this system somewhere.
This is not the most detailed, but it looks like the best coverage I've seen so far.
Short form: Alabama has decided to do something about the high cost of providing health care at no cost (in terms of premium) to its single employees (people with a family enrolled do pay a bit more for spouse and/or kids). They're go to have everyone either pony up $25/month, or go get screened. If the screening (glucose, cholesterol, BP, BMI) looks bad, employee gets a year to improve it. If they fail to make "progress" (unclear what that means), they get to pony up $25/month.
Given what everyone _else_ is having to pay for health insurance? SO seems like a good idea. However, people have really focused in on that obesity number, despite the fact that Alabama opted for a pretty durn conservative BMI break point of 35.
(Check for yourself what that would mean: http://www.consumer.gov/weightloss/bmi.htm)
Whatever. I'd have more issues with the cholesterol number, honestly. Making someone pony up extra for a genetic condition they've already moved heaven and earth to mitigate seems a little mean, but I'm guessing there's some wiggle room in this system somewhere.
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Date: 2008-08-29 02:01 pm (UTC)I have problems with the BMI and BP requirements. I'm certain you've perused the arguments against BMI to death (me, obese? Ummm... no. Overweight, yes. For me to get a 'healthy' BMI with my frame... I'll be looking fairly skeletal), so I shan't rehash those.
My BP however, is something that I have little control over. Indeed, I have frustrated more than one doctor who've discovered that as I lose weight, my BP stays put (or even goes up). This, on top of the beloved food diary showing that I do eat low-salt, and do take sufficient vitamin supplements, and am not pre-diabetic. Plus I'm a classic hypertensive (the more stress I'm under, the more my BP climbs), so short of removing myself to a low stress situation (i.e. away from a job), I can't budge that number any lower.
I suppose different grudges for different folks.
different grudges. . .
Date: 2008-08-29 03:22 pm (UTC)At least according to the Kaiser summary (and, as I noted, the secondary coverage in general Sucks), it looks like they aren't requiring people with problematic metrics to get into a "healthy" range -- they want to see progress. Of course, with progress undefined, there's still a serious problem.
I would _never_ want to see a health system that punishes people for being "overweight" or even the lower end of "obese", given the all-causes mortality and morbidity numbers for these groups. Yup -- I've seen the BMI numbers. But BMIs over 35 (which is _well_ into the "obese" range) are getting into a pretty interesting set of problems, so asking them to make "progress" is not unreasonable. Ideally, progress should be defined initially as not-gaining-further, then as small, sustainable reductions (I'm thinking on the order of 1-2% of body weight per year or, alternatively, metrics that look at body composition). Given that most people with BMI 35+ are going to also show up on negative metrics, the focus could also be put on those metrics instead.
BP is a tricky thing as well, and suffers from a lot of the same escalating expectations. I wish we lived in a world that took more seriously things like I'm-stressed-and-my-BP-is-therefore-high and worked _hard_ to find a way to create satisfying work/life/etc. situations for everyone so we had a whole lot less of that going around. That's the only right solution, to my mind; popping pills is just lame.
Either way, asking for cost sharing on the order of $300/year does not seem unreasonable, even with lame ass metrics. R. and I want to know why they aren't going after the smokers; my theory is there's no good way to test for that, without also picking up people who are on, say, the patch or whatever as part of a cessation program.