You Veel Follow Zee Orders
This is Robert Brook (RAND), describing his vision for the next phase of health reform [gated], in JAMA:
- What if to obtain and keep health insurance, individuals had to pass something like a driver’s license test?…What skills should be demonstrated?
- Should insurance be more costly, or even withdrawn, not because individuals become sick but because they do not use preventive services or evidence-based care in a manner that both protects their health and reduces health care costs for others?
- Consider a health system in which individuals who have health insurance and are competent to care for themselves would be required to take medications and have procedures known to be necessary and would do so; and a severe penalty would be imposed if they do not.
What if individuals were required to receive vaccines for which they were eligible, as soon as the vaccines became available — and were penalized if they contracted an illness the vaccination could have prevented?
- What if individuals with hypertension or hyperlipidemia who did not take their medications became responsible for some of the costs of future cardiac care?
- Should parents be expected to maintain their young children’s weight-to-height index at the 50th percentile or less? Should sedentary workers be expected to participate in an exercise program provided at the workplace?
The guy is a real facist.
Interesting concept. Insurers use speeding tickets as a proxy for risky driving behavior, and raise premiums accordingly. Young drivers are charged more than adults because history shows young people are more prone to take risks and have accidents. Unlike mutual funds, auto insurers assume past performance (i.e. numerous fender benders) is indicative of future performance.
Certain conditions are genetic and the risk (if unknown) should be pooled. However, I’m not convinced the high cost of bad behavior should be pooled with (i.e. shifted to) younger, healthier enrollees.
Agree with Bruce. This is disgusting.
One thing to remember is the unstated premise behind all this. Brook believes in socialized medicine, by which I mean that we all pay for each other’s health care regardless of the cause of ill health. In such a world every decision you make affecting your health affects my pocketbook. So just about everything you do creates positive and negative externalities for me and everyone else.
If you don’t like Brook’s proposals then you have to reject the underlying premise that gives rise to them.
When you think about it, Ken’s point has applications that go way beyond health care. Under a general socialist system, in which we all are responsible for taking care of each other’s needs, anything I do creates positive and negative externalities for you and vice versa.
So beginning with feel good socialism, it’s only a short hop, skip and jump to a draconian fascist world.
Brook’s view of the world is the opposite of what you find in Gooodman and Musgrave’s book, Patient Power. Brook doesn’t want to liberate patients. He wants to control them.
Whoa, whoa, whoa, chaps!
Prof. Brook may well be a “fascist” and believe that it is the government’s role to tell you how much you should weigh and how to behave in order to maximize your chances of being healthy.
But the prescriptions described here would come about if health insurance was a voluntary choice. An insurer won’t insure your home against flood or fire unless your house is built to a certain standard. Similarly, a health insurer would have the right to impose certain conditions as a term of the contract. My (limited) knowledge of the actuarial tables suggests that they’d be less draconian than proposed by Prof. Brook.
In a voluntary market for health insurance, such terms would be “tuned” more finely than in a government-dictated environment. For example, health costs incurred as a result of an accident would not be limited because of failure to take your lipid-lowering medicines, but they might have a higher deductible if you incurred them as a result of doing something dangerous.
Smoking and over (or under) weight would almost certainly be factors in any health-insurance policy.
If I have to keep my kid’s weight at the 50th percentile or less and the policy succeeds, then the 50th percentile falls. If it keeps falling, at some point we are starving kids to meet the diktats of those who would dictate. The good news: growth is stunted and everyone fits into airline seats again. And no more complaining about the undue influence of sports in high school and college because extremely well muscled athletes typically have high BMIs.
Twin studies suggest that there is a strong genetic contribution to BMI. Correlation may exceed 0.5 in Caucasians. Makes one wonder why some health policy analysts seem to like proposing metrics to control other people’s lives but don’t seem to spend much time exercising their imaginations in thinking about possible unintended consequences.
Paul sez: “Under a general socialist system, in which we all are responsible for taking care of each other’s needs”
You know that wolfs travel in packs and monkeys travel in troops because they know they are all responsible to each other. Apparently the uber Austrians are less evolved then that.
Artk, don’t you think we can rise above the wolf pack and the monkey packs? Wolves don’t have inalienable rights. Nor do monkeys.
Humans have the capacity to be humane and feel compassion, without enslaving each other.
I thought the commentary was tongue-in-cheek or satire but from the published comments I guess most people think he was serious.
James, we are ecumenical here. You may be serious or satirical or both.