Are we finally to a point economically where healthy people will get tired of bearing the cost burden of supporting their sicker coworkers? As costs continue to skyrocket, most people probably don’t realize that those are from a minority of their coworkers who have chronic conditions. (Or in the case of Medicare, are from the costs incurred in the final year of life.)
If you’re like me, I generally don’t mind the risk pool concept (since I don’t know where I might end up any year). And, I certainly don”t mind paying for people who are genetically pre-disposed to some condition (we all may be in that bucket someday), but I could take issue with paying for people who don’t comply with their physician’s recommendations (most of us), don’t act preventatively (most of us), abuse their body with things like smoking, and I could go on.
It got me thinking this morning about a model where we were able to push costs to people based on them taking responsibility for their care (i.e., “responsibility-based care”). While we certainly won’t be at a place in the near future where genomics dominates and we can pull out people who can’t control their health, we can track things like compliance and adherence once we get an integrated HIT (healthcare information technology) system in place.
Additionally, we might get someday to a place where we can offer incentives based on active management and results which are self-reported by remote devices that track blood pressure, weight, cholesterol, etc. But, many of these have issues around confidentiality and would challenge the risk pool process that we use today to underwrite medical costs.
I am not sure what the right answer is, but I think it’s about time for this debate to rear its head again with more energy.