Sunday, March 22, 2009

Implementing Responsible Universal Health Insurance

As mentioned in my "is healthcare scalable" post, one of the only ways to provide everyone with healthcare in the United States in a feasible manner is to make a serious push towards preventative medicine.

Therefore, if the government implements a universal healthcare plan (which I think can be great in theory, with severe execution issues), one of the most important things is to ensure that people actually are forced to take responsibility for their own health. In my mind, that includes a number of policies:

1) Pigouvian taxes on unhealthful activities. This will significantly cut costs and provide funding at the same time. I'm thinking big trans-fat taxes, big smoking taxes, big alcohol taxes, taxes on sodas, etc. Similarly, pigouvian subsidies on good things - healthy weight loss products should be tax-free, gym memberships should be partially tax deductible, etc. The subsidies pay for themselves, and the taxes reduce incidence.

2) Healthcare premiums that actually reflect initial health status. Obese people should pay more for health insurance, smokers should pay more for health insurance, etc. Without this feature, you functionally have healthy people subsidizing the unhealthy behaviors of their peers.

These things should be remeasured every year at a checkup. If you miss your checkup by more than some number of months, your premium automatically starts going up on the assumption your condition has deteriorated until you go have a checkup. The months flexibility means that if people gain a little, they still have the opportunity to go back down - it's not totally heartless and left to chance, because you schedule your own checkup. But you can't be irresponsible forever and avoid the consequences.

3)This can be used to further other policies by creating a 1 (or if you're tolerant of stupidity, 2) strike policy. If you're caught using illegal drugs once/twice, you lose the right to government health insurance, or you have a MASSIVE premium hike for the rest of your life. If you're using ecstasy, cocaine, oxycontin, heroin, marijuana (which IS, by the way, SIGNIFICANTLY more harmful to your health than cigarettes and alcohol, contrary to popular belief), etc, it isn't fair for the rest of us to have to subsidize fixing you for your irresponsible and illegal behavior.

Same goes for driving under the influence, soliciting a prostitute, etc.

4) This relates to 2. Preventative healthcare steps should factor in significantly. If you don't get annual checkups, your premium should go up. If you're of the appropriate age (and gender, where appropriate) and don't get mammograms or pap smears or colonoscopies, your premium should go up. The cost of catching colon cancer or breast cancer is so much less if you catch it early, and is better for everyone involved. Laziness or lack of perception of risk is the major reason for these things not happening. When it hits your healthcare premiums, maybe that improves compliance.

No comments:

Post a Comment