Vice, originally uploaded by ::oscar::
Here’s an unpopular notion: individuals should foot the bill for the harmful external impact of vices. I’ve recently been thinking a lot about this topic as it relates to healthcare, and recognize that there are going to be some easy, and generally acceptable, inroads and some much more tricky ones. For example, some employers are asking employees that smoke to pay a higher health insurance premium. Especially as cities across the country move on smoking bans and smoking prevalence continues to decline, I don’t foresee an uproar happening here.
On the other hand, consider the following vignette from my Friday trip back to Louisville from LA. Sitting on the tarmac in Chicago (a layover), the flight attendant informed us that the plane was “overweight.” Heads started turning - you could literally see passengers “sizing each other up.” I had, in fact, noted on my way down the aisle a somewhat atypical distribution. Well, United (and therefore, its customers) footed the bill. They asked for a volunteer to take a later flight and, I’m sure, compensated him for the concession.
As we took off, my mind wandered to luggage and personal poundage. Most airlines charge for luggage over a certain weight - say, 40 lbs. for carry-on and 50 for checked baggage. Should similar restrictions, and resulting price points pertain to passengers? In 2002, Southwest Airlines began enforcing a program that required folks whose bodies extended beyond the bounds of a single seat belt to purchase two seats. That raised some eyebrows. In fact, I’m not sure we’ll see real “variable” pricing for airline tickets anytime soon (and our “overweight” status I’m sure could have been a function of luggage).
On the healthcare front, though, I bet we’ll see the payers incentivize more via cost savings than penalties. Consider Humana’s health rewards program. In theory, the same ends should be met but rewarding the “good” is simply more palatable than penalizing the “bad.”
Matt, great post.
I agree that rewarding good behaviour will be easier that punishing the bad. As you can imagine, the debate is even more intense here with our socialized healthcare.
Hey did you get my e-mail about my pf company NIH going to Michigan in Feb. (and maybe meeting HealthMedia) ? I might have had the wrong address…
David
David:
Thanks for the kind words. And no, I definitely didn’t receive that email from you. I’ll shoot you a line directly and see if we can work out a meeting.
Best,
Matt
Matt,
Very interesting post. I couldn’t agree more with the idea of incentiving people towards health. And very interesting re: the Humana health rewards program! I hadn’t heard of it and am thankful to you for mentioning it.
st
Great Post. We have HSA in our company. The money we save in premium is the incentive.