don's report archive

by Donald B. Ardell, Ph. D.

Wellness in the Headlines
(Don's Report to the World)

Many employees of large companies face health insurance rate increases as high as 15 percent, the biggest jump in a decade. An expert in this area suggests such increases can be expected annually for at least the next three years. (See "The High Cost of Being Well: Benefits at a Premium" by Milt Freudenheim, NY Times, 10/16/01, page one.) Many analysts lament the burdens and the risks associated with these cost trends, particularly in light of the fact that when costs reach certain levels, usually $700 a month, the "well" or at least those who do not think they will need medical care anytime soon drop their policies.

For some, doing so could be a good move. For others, it could be catastrophic. If your health insurance costs are subsidized by your employer, at what point might you consider dropping out of the system, and on what basis will you make such a critical decision?

In this country, health insurance is mostly paid by companies, which in turn pass the costs along to the consumers of their products and services. Employees usually pay only for family members, not for their own health insurance or, more accurately, sickness care payment plans. (I prefer the latter term because, in fact, the only person who can "insure" your health is you, via a self-managing lifestyle.) Thus, employees with no families or with a working spouse and no children get a free ride. This payment system is one of the key factors in the continued inflation of health care or medical insurance. So, too, is higher demand. Higher demand in the past decade is in part caused by an aging population. Another factor is the high number of employees who lack well-developed lifestyle artistry skills (stress management, emotional intelligence, mental health, for examples) needed to deal with depression and other problems and to reduce their exposure to chronic illnesses.

Starting in the mid-80's, HMOs were able to muscle doctors and hospitals to mitigate cost increases while protecting quality of care, in return for guaranteed customers. However, employees kept insisting on more freedom to pick their providers and those providers, especially hospitals, grew stronger via mergers. All the while, the median age of the population kept rising, and with it more sickness and greater medical demand. Something had to give -- and that is the costs of offering these services. Somebody had to pay the middle-man insurance companies, who in turn pay the doctors, hospitals, pharmaceutical companies and other health care personnel more money, and that somebody was usually the employer of the patients. Now the employers are saying, "Enough already!" They are passing on the costs to those who are incurring them. Personally, I think this is a good thing, in the long run, for it will stimulate reforms in a system that is inefficient, inequitable and injurious to the patients. Among other problems, it provides no or too little incentives for staying well via adequate supports for healthy lifestyles.

Besides paying more for health insurance, employees will have to pay more for prescription drugs, deductibles will be increased and co-payments not previously assessed will be required for doctor visits and hospital stays. These factors, along with the advent of a weakening economy, are bringing changes to the employer-subsidized medical care system. These changes will force more and more employees to make hard choices.

At present, people make lots of hard choices in the areas of insurance. One example is whether to purchase varied forms of insurance, including life, disability, long-term care, earthquake, flood, homeowners and, of course, health insurance and, if so, how much. In an odd way, much of this represents betting against yourself! To "win" the life insurance bet big time, for instance, you would want to pay a big premium for a short time and then die, leaving a bundle for someone else. In a way, health insurance has the same morbid quality. To get the "most" from it, you want to spend a lot on premiums for a minimal period and get a dread disease requiring expensive treatments and long-term hospitalization, all of which will, of course, then be "free" more or less. It's a weird system.

Not surprisingly, one of the near-term consequences of the health insurance cost increases is that employees who use the system less are most likely to drop out of it. A savings of $700 per month can look mighty appealing to someone who does not think he/she is likely to become ill in the near-term. When these people leave the system, there is less money available to subsidize the less well citizens who need expensive treatments and care. Worse for the system and those still in it, the costs of such services will have to rise to make up for all the healthy employees who have elected to opt out.

Life is not fair, which I imagine you knew by this time. Yet, choices still have to be made.

What is the solution? IS there a solution? Is the solution NOT to buy health insurance if you find the costs oppressive and think you have a good chance to stay well?

There are many good questions including, I believe, those just posed, but alas, there are fewer equally good answers. What is a solution for some adds to the gravity of the problem for others. While most look to their employer for the solution (pay my bills!), or the state, the current Administration or the Congress (pass legislation that benefits me!), the best solution for you is the one that saves you money AND helps you stay well, for many years to come. Who can say what the best solution might be? It's your choice. Life is filled with choices, and this is one of the tough ones.

If you choose to drop out of the system because you are well and plan to stay, you can always look for ways to pay as little as possible for catastrophic health insurance. As the name implies, this is a relatively low cost program that pays medical costs only after a certain level of expenditure is incurred, say $200,000. The higher the deductible, naturally, the lower the premium. This option requires your willingness to gamble that you can stay out of harm's way for many years. Lots of things can happen to people over which they have little or no control, given the way the fickle hand of fate seems to work. A necessary part of the "drop out if you are well and want to stay that way" solution, of course, is to live a wellness lifestyle! If you are not going to pay into the full medical protection scheme, you'd better exercise daily, think pure thoughts and refrain from self-destructive stupidity (smoking or other substance abuse), recklessness and other negativities while fashioning as serene, fit, enjoyable and fulfilling an existence as possible.

OK, I exaggerated a little -- forget about the pure thoughts.

As I always say, look on the bright side of life. Cheers.

(Note: This essay will be filed in the archives in the PHYSICAL DOMAIN under the skill area of adaptations and challenges. Additional articles related to this theme may be found there.)

(Ed. Note: Views expressed in this and other columns are those of the author and not necessarily those of the SeekWellness Editorial Board.)

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