There are both hidden and obvious costs to being healthy. And they drive how we feel about a host of economic issues that surround traditional health care, from how we’re treated when we get sick, to how much we pay into a reimbursement system versus how much we get out. In fact, if we’re in that no-man’s land of “not really healthy but not quite chronically ill,” it may make better economic sense to roll over and give up on our kidneys/joints/arteries rather than fight our way back to health.
And as we move into year three of Obamacare’s version of health care reform and potentially to whatever this new administration has in mind for a replacement, the one sure bet is that we need to address health care differently. The fact is, reforms in the health care system have created significant financial penalties for the healthy insured. It’s an unintended consequence of overall healthcare reform, but one that stings.
How are the healthy being penalized now?
In traditional health care models, healthy people are ignored.
No one in traditional health care, from our primary care doctors to the insurance company underwriting the costs, thinks about us when we’re healthy. The Centers for Disease Control notes that the average person interacts with health care only 4 times each year (physician, hospital ER or hospital outpatient visits). I am more than the sum of the notes in my patient file, which don’t account for my actions in the other 361 days a year I am invisible to the system.
The price advantage for being healthy is disappearing.
We’ve begun to absorb the costs of unhealthy behaviors across the entire pool of insured in order to accept all comers, so while I’m helping the actuarial curve of the less healthy by never smoking or drinking, the smokers and drinkers have cost me more overall. The slim financial advantage of being healthy has disappeared.
Actuarial tables are logical, but they are cold and oddly unmoved by the workouts I regularly log. Nor do they care that I lowered my cholesterol by 34 points in one year—without drugs—by actually listening to what my doctor told me and then doing all the stuff she said I should do. Interestingly, it cost me more to follow the doctor’s orders than it would have to go on a cholesterol-lowering drug, which would have been covered by insurance.
Healthy people likely pay more when they get sick…
Faced with absorbing a skyrocketing insurance premium, I opted for maintaining our current premium level by increasing the individual and family deductibles in 2016. It was a gamble. So not only would I have to shoulder the premiums, I would have had to take a $12,000 hit for the deductible if someone got really sick. The tradeoff is getting harder and harder for healthier folks to stomach: Pay 15% or more annually for coverage you rarely need, or suck up another 30-50% in out of pocket costs to keep the premiums in the affordable range.
…and definitely pay more for staying healthy.
There’s no finish line in getting healthy. It takes constant work on both diet and fitness to stay there. So those who are or have become healthy likely have picked some activities and habits to maintain that health. Those activities and habits cost money. From gym or fitness studio memberships to the gear required to participate in a particular sport or hobby to the additional food and nutritional requirements for the hard-core, there are plenty of dollars being spent in pursuit of better health.
Let’s take a look at my cholesterol lowering efforts I mentioned above. A good pair of running shoes, seasonal running clothes, five race entry fees that year (approx. $35 each), an iPod Classic and a Polar Heart Rate monitor for inspiration and motivation (did I mention this was 2004?) cost me around $900. Compare this to the average out of pocket cost of a generic statin drug: $120 ($10/month).
Money spent on staying healthy drive close to half (over $2 Trillion) the spending in what we’re calling the New Health Economy.
I believe some of the answers to solving the larger public health crisis will come from paying attention to what the healthy are doing and why they do it. Healthy people have a solid grip on the long-term benefits of healthy decisions they make on a daily basis. Like dollars in a retirement account, investments in a healthy future are small, measurable and repeatable actions done consistently. Without a concerted effort to reframe the health argument from short term costs to long term benefits, we will continue to waste time and money in failed efforts to reverse declines in population health.