This idea came to me the other day and I’ve “run it up the flag pole” for some of my friends but as of yet no ones saluting.
Maybe y’all can tell me why.
It’s a part private and part socialized system I call Loser Pays
It works this way:
If you get sick or injured and it’s not your fault society pays.
What I mean by “fault” is if you are engaging in a lifestyle choice or pastime that would ordinarily cause higher insurance rates. For example say: motor cycle racing, overeating, skydiving, running smack, smoking and so on and you suffer health consequences directly attributable to them, you pay. If you are a smoker and you get cancer, you pay but if you get gout, you don’t. So if you smoke you’d need to get some kind of supplementary private insurance to cover any possible related illness.
See what I mean?
The up sides are:
The health Nazis would have to shut up about the cost of lifestyle choices to society.
The morality police would have to shut up also.
Kids rarely have lifestyle related illness so pretty much every thing would be covered for them.
Nah, not a good idea.
First of all, you´d have to decide what´s acceptable risky behaviour and what not…
In the industrialized world, about 50% of all deaths are due to cardiovascular diseases - heavily life-style dependent (overweight, too little exercise, smoking.)
Followed by malignant neoplasms (nearly one in four deaths), and while not all cases of cancer are caused by smoking, it is an important factor.
These are the mortality rates, I can´t find the morbidity rates right now, but go and have a look at the US annual health report, or the WHO World Health Report.
Sure, accidents from risky sports behaviour result in expensive treatement, but that´s not the main group.
So, smoking and being overweight are definitely risky behaviour, as is too little exercise, and then you´d have to exclude a large majority of the population from health care coverage.
Which brings me to my next point - I don’t think this would work, because people would be constantly bickering over just what activities are high-risk. Automobile accidents, for example. Are they covered? Insurance companies pay gobs of money for automobile related injuries. Is driving “high-risk” or not? Arguments can be made either way.
Also, you get into some grey areas. Take canoeing or kayaking. If I take my one-person boat out in Lake Superior in 5’ waves, that’s high risk (for me, at least. Others are better at it.) However, I can take my sea kayak out in that lazy river south of town, the one that never gets more than 2’ deep and has practically no current, and I’d have to work at getting hurt. So is kayaking/canoeing high risk or not?
Main problem I see is that in matters of health, the linkage of cause and effect is generally done statistically, i.e. “smokers/morbidly obese people/etc. are X% more likely to die prematurely of __________”.
But on an individual level, things are a lot trickier. Smoking and being overweight both add to the likelihood of heart attacks. But thin, healthy nonsmokers have heart attacks too. So if a smoker or overweight person has a heart attack, how is it decided (to settle who pays) whether the bad habits caused the heart attack, or whether it would have happened anyway?
I’d prefer universal insurance, and a more active role of government in promoting exercise and healthy eating. Just to take one example, we have hundreds of billions of dollars of agricultural subsidies, and IIRC, not a dollar of those subsidies is for green vegetables.
I think this may be somewhat trickier to define than you think. You are going to have write it down, administer it and subject it to legal scrutiny.
What do you do with the losers? One of the problems of the health market is the role of the government as “insurer of last resort”. A brute fact of a rich democracy is that a government cannot credibly commit to letting those who have made bad choices go without any medical care. People know this and depend on it. I doubt that your scheme can overcome it.
Private insurance doesn’t have to cover birth control and pregnancies now. I had insurance a few years back which did not pay for birth control. Even worse, you had to purchase a seperate (and rather expensive) rider if you wanted it to cover pregnancy.
I think the idea in the OP is completely unworkable. We aren’t even sure what causes every disease now. How about STSs? Sure, some people get them from engaging in risky behavior but some people get them despite being careful (ie, cheating husband bring home disease to wife). In the OPs world people who have to provide proof on what caused their illness before they can even get medical care.
…and if you have a job that involves much sitting and don´t exercise enough, and if you exercise or move in an inappropriate way or have a bad posture (heck, arthritis can even be caused by crossing your legs when sitting or holding the phone receiver between head and shoulder!), and if you eat too much, and if you eat too little, and if you eat in an inappropriate way, and if you´re too poor to afford a healthy diet, and and and… because who is going to be able to determine what the actual cause of your illness is, you´d have to keep detailed records on everyone´s life style.
And it makes the situation even worse than it already is for the lower income segments and the poor - morbidity rates are significantly higher among them, and this is life style-related. It is linked to the housing situation, education, social situation, income, and a whole host of other factors.
Or would it be “reasonable and customary behaviour” if you were too poor to afford a healthy life style?
You´d have to improve the living conditions for everyone first, but in my opinion a good public health care system for all is one of the best measures to that end.
As you can see, I´m strongly in favour of the welfare state…
I’ve heard that smokers save Medicare a bunch of money because they die early and don’t stick around long enough to draw benefits (I’ve heard the same thing with regards to Social Security). I don’t know if it’s true, but if it was, does that mean that smokers should get a lower rate, since over the long run, they’re going to save the system money?
Two people can engage in the same behaviors and one will get sick while the other doesn’t. My husband had a heart attack at age 34. His father and all of his father’s family died before they reached 50.