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http://www.kaisernetwork.org/daily_reports/rep_index.cfm?DR_ID=54156

This is not the most detailed, but it looks like the best coverage I've seen so far.

Short form: Alabama has decided to do something about the high cost of providing health care at no cost (in terms of premium) to its single employees (people with a family enrolled do pay a bit more for spouse and/or kids). They're go to have everyone either pony up $25/month, or go get screened. If the screening (glucose, cholesterol, BP, BMI) looks bad, employee gets a year to improve it. If they fail to make "progress" (unclear what that means), they get to pony up $25/month.

Given what everyone _else_ is having to pay for health insurance? SO seems like a good idea. However, people have really focused in on that obesity number, despite the fact that Alabama opted for a pretty durn conservative BMI break point of 35.

(Check for yourself what that would mean: http://www.consumer.gov/weightloss/bmi.htm)

Whatever. I'd have more issues with the cholesterol number, honestly. Making someone pony up extra for a genetic condition they've already moved heaven and earth to mitigate seems a little mean, but I'm guessing there's some wiggle room in this system somewhere.

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(Deleted comment)
walkitout
Aug. 29th, 2008 03:22 pm (UTC)
different grudges. . .
Hopefully, they'll leave a little slack for the genetic hypercholesterolemias; that would basically address that issue from my perspective.

At least according to the Kaiser summary (and, as I noted, the secondary coverage in general Sucks), it looks like they aren't requiring people with problematic metrics to get into a "healthy" range -- they want to see progress. Of course, with progress undefined, there's still a serious problem.

I would _never_ want to see a health system that punishes people for being "overweight" or even the lower end of "obese", given the all-causes mortality and morbidity numbers for these groups. Yup -- I've seen the BMI numbers. But BMIs over 35 (which is _well_ into the "obese" range) are getting into a pretty interesting set of problems, so asking them to make "progress" is not unreasonable. Ideally, progress should be defined initially as not-gaining-further, then as small, sustainable reductions (I'm thinking on the order of 1-2% of body weight per year or, alternatively, metrics that look at body composition). Given that most people with BMI 35+ are going to also show up on negative metrics, the focus could also be put on those metrics instead.

BP is a tricky thing as well, and suffers from a lot of the same escalating expectations. I wish we lived in a world that took more seriously things like I'm-stressed-and-my-BP-is-therefore-high and worked _hard_ to find a way to create satisfying work/life/etc. situations for everyone so we had a whole lot less of that going around. That's the only right solution, to my mind; popping pills is just lame.

Either way, asking for cost sharing on the order of $300/year does not seem unreasonable, even with lame ass metrics. R. and I want to know why they aren't going after the smokers; my theory is there's no good way to test for that, without also picking up people who are on, say, the patch or whatever as part of a cessation program.

Edited at 2008-08-29 03:25 pm (UTC)
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