Without argument, the U.S. is intended to be a free country, yet arguments abound as
to how free we really are, as well as
how free we really should be. To illustrate the argument, the City of New York recently attempted to regulate our health by eliminating large sugar-filled drinks – a move that caused uproar from the conservative right, declaring that our government was trying to control our every move and deny us our freedom. In that vein, should we be free to smoke cigarettes,
drink excessive alcohol and sugar, over eat, and not exercise while still being guaranteed
access to affordable healthcare? In
recent years, the answer to that question has become “yes”. As America casts their vote to the left,
we make the statement that we have the freedom to be cavalier with our
health while expecting a safety net when our health fails. So where do we find the
balance between affordable health care and the freedom to be ill?
The answer to this question has already been
determined. The consequences will be
coming soon, and it will come in a surprising way. Because we have asked our government to force
insurance companies to cover everyone regardless of the risks, insurance
companies will respond by raising the rates that corporations pay to cover
their employees. Most corporations will
not immediately force all employees to pay a greater share of healthcare costs
right away because they want to preserve employee retention and morale. Instead, corporations will find ways to
control their risks. They cannot fire unhealthy employees,
and they cannot deny their healthcare.
The only thing they can do is to incentivize employees to get healthier. Employees are now being asked by their
employers to take voluntary health screenings.
We are free to decline the health screen, but we will pay a higher share of
our insurance out of our paycheck if we make this choice. If we take the health screen and are found to
be healthy, our insurance costs remain the same or may even be reduced. If we take the health screen and are found to be ill or at risk, we then have the option to modify our behavior or take a cut
out of our paycheck to cover insurance.
As we continue to rely on our employers to provide our
health insurance, eventually we will be screened, prodded, sampled, questioned,
and then asked to modify our behavior to make us healthier. This may mean quitting smoking, or taking
alcohol abuse classes, or losing a specified amount of weight, or hitting a
certain target of cholesterol reduction, or even keeping a workout log. We will be asked to do this for two reasons; one, because our employer cares about our health, and two, because our employer
cares about the cost of our healthcare. Our
health will not be defined by how we feel or what a doctor thinks. Health is more likely become a matter of hitting
certain standards determined by insurance companies. Either way, our health will be regulated, or
at least incentivized by the people who are in control of our prosperity.
So, what is the difference if we are regulated by our government
or if we are regulated by our employer?
Not much, except that we can hold a corporation liable or change employers if we believe we are treated unfairly. It is reasonable to say this is the less frightening scenario. Either way, the state of our
health and the things we do to our health will be someone else’s
business. We will no longer be in the
position to eat as we want, drink as we want, and relax as we want. We will be charged by our employers to live a
healthier life or pay the consequences. For better or worse, we are no longer free to
be ill.
Tony F. 2013
Tony, I've been turning this one over for a while now, because it's something I have strong feelings about (which isn't the same thing as having clear answers, of course). I have an illness that makes me too ill to work full time. That illness--which I ended up with through no fault of my own--is a pre-existing condition that insurance providers do not cover, so I cannot simply purchase an individual plan. Most employers do not insure their part-time employees. I have been very, very lucky to find one that does, and I have turned out to be very low-risk to them. I see my doctor once a year for a check-up; the one medication that helps me costs less than the co-pay, so it costs my insurer nothing. None of the (expensive) complementary care type things that help me function are covered by insurance. My cholesterol, blood pressure, and blood sugar are all "perfect" in my dr's words, as are all other markers for major illness, because I take phenomenally good care of myself. I eat healthfully, get regular, light exercise, sleep lots, minimize stress, drink wine in moderation if at all, and take my vitamin C. And outside of a group plan, even though I am doing all the right things and none of the wrong ones, I am uninsurable. Since I can't work full time, my choices are either to go without even catastrophic coverage or to stay forever in this dead-end, extremely dull job. That doesn't look a heck of a lot like freedom to me.
ReplyDeleteMeanwhile, my neighbor, who smokes like a chimney and is obese, and on disability because of illnesses caused by both, has no worries about medical care, because exhausted, hard-working taxpayers like me are paying the bills. I certainly don't want his illness not to be covered! But the inequity drives me nuts. He has the freedom to self-destruct if he likes by making small, bad choices on a regular basis. Meanwhile I don't have the freedom to determine my own path in life--unless I choose to run the mammoth risk of being uninsured.
We sacrifice small freedoms to corporations all the time. My car insurance co. incentivizes me to wear seat belts and charges me more if I engage in risky behavior. My home insurance co. insists that I have working smoke alarms and would charge me more--or not insure me at all--if I had a house full of pit bulls.
If no individual behavior ever affected anyone else, we would have no barriers to freedom. The reality is that my behavior often affects you, and yours affects me. The tricky thing is to find the balance that allows each of us the most freedom while having the fewest consequences for everyone else. Once you opt into an insurance plan, you are part of a group. Your actions affect the group, and so consequences to the rest of the group have to be weighed and minimized. To me this is just part of the reality of life in community.
Insurance companies already restrict our freedom--they've certainly restricted mine, even though I am very little risk to them. They don't consider what my doctor thinks or what choices I make or how little I've cost them over the years. They just look at the fact that I don't hit one standard and mark me off their list. The coming changes are another set of "restrictions"--but at least they strike me as more fair and equitable than the ones we have now.
Sorry about the diatribe, Tony...
Thank you for your thoughtful input Stacy. I can't find the words to tell you how much I empathize with your plight, and how much I respect your ability to find peace and comfort in your situation. This post was not intended to be an answer, but more of a conundrum to toss around. I had hoped the title would clearly state the paradox. Free to be Ill? Not sure I ever wanted that. As we grapple with the idea of socialized medicine vs. comm-unitized insurance I agree with your bottom line - we all affect one another.
ReplyDeleteTony
Tony, I hope I didn't sound like I was haranguing you--that certainly wasn't my intention! I definitely see the paradox you're exploring and am just throwing in my 2 cents worth (with perhaps more passion than is helpful). The whole question reminds me in an odd way of Annie Proulx's The Shipping News (the book, not the movie), which takes place in Newfoundland just as a business boom starts, bringing people in from all over the world. The locals complain about crime--drugs, burglary--like they've never had crime before, even though domestic violence, incest, and the like have been huge problems for years. The point being, it's not that the devil you know is better than the one you don't, but that the devil you know stops looking like a devil at all. We already have plenty of restrictions on our freedom! We just don't see them as restrictions because we're used to them.
ReplyDeleteI follow some British news blogs, and even though the UK has had the NHS for decades and decades they still debate this conundrum. (For whatever it's worth, I'm not a fan of NHS type systems.)
Again, I'm sorry if this came across as an attack, Tony! In my head it was more just a venting session among friends.
No apology needed Stacy. I am glad that this post generated some thoughtful input, as that was my sole intention. Thank you for reading and commenting!
ReplyDelete