Nathan Strang

To Save On Health Insurance, You Want My blood?

Filed By Nathan Strang | August 14, 2009 12:00 PM | comments

Filed in: Living
Tags: health care reform, health insurance reform

I just had to attend a staff meeting at the blood.jpgagency I work for. I run a computer lab in a sheltered workshop teaching technology to people with developmental disabilities. Its a great job... awful pay, but wonderful benefits, like comprehensive health care from Univera. Anyways, the meeting went on, anniversaries, new hires, contracts we didn't get, we're doing ok, blah, blah, blah...

Staff meetings are always Thursday, but this is Wednesday, apparently because the person who came to talk to us would only make it Wednesday. This better be important, I thought.

It was, the man was from Interactive Health Solutions, hired by my small non-profit agency, to tell us he wanted to take our blood.

He said they were going to take our blood, ask our medical history and then give us the full gamut of tests. Then, we'd get results on cholesterol, blood sugar, cancer risks, weight... actually everything but a drug test they'd have results for. We'd be given a health risk assessment and told how we should change our lifestyle to get healthy or stay healthy. Then after a year (I think) we'd go back for tests and find out if we passed our goals. If we did, we'd get a bit off of our monthly premium. If we didn't pass, however, we'd end up paying a little more. And if we DIDN'T take the test, we would end up paying more anyways.

"I don't want the agency to know my medical history."

"What if I take the test but want to hold back a part of my medical history?"

"What if we don't need to get healthy?"

"What if its not our fault we can't make our goal? Do we still get penalized?"

Those questions and more were immediately lobbed at the representative. God, the woman behind me kept going off on how she wasn't about let the agency know anything about her. I don't like her; she doesn't shut up. The representative took each question and answered it plainly. He even re answered every time someone expressed their extreme aversion to letting the agency know their medical history. He reassured us the agency would only get aggregate data back, and whether we passed our goal or not. He said they were full HIPPA compliant, which everyone in the agency operates under HIPPA compliancy due to the nature of our work. And still, people were not satisfied, and not happy about having to pay extra if they opted out.

I dunno, I don't mind it. Everything's free, I get to save a doctor visit, I'll know if i need to go find a kidney specialist or not. I hate going to see a doctor, if this will save some time, count me in. Of course, I'll actually have to go see a doctor if something Is wrong, but maybe I should stop being such a procrastinator. I only have a few more years as a P.Y.T., I should start thinking long term. Um, anyways...

We'd also get free health coaching and access to online healthy living courses. The overall goal, was to make us smarter healthier people, because smarter, healthier people don't use that much insurance, therefore lowering the premium in a group. The group is our agency, since last year Univera switched from a region wide pool to being just within the company purchasing the group policy. If our agency used less insurance, then we'd all benefit. The representative said that healthcare is moving in this direction; eventually we'd pay for health insurance like we do for car insurance, based on the individual. He said that participating with Interactive Health Solutions was like taking defensive driving for our health insurance.

I suppose I have a question. And it's for you, Projectors:

Am I too ok with this? I'm mean, I'm young and fit, and I don't smoke, this isn't a big deal for me. I know I'll get a discount on my insurance no sweat, but what if I wasn't so fit? Let em loose in the comments.

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I personally think that you are being too naive about what the insurance company wants all of this for. That could also be a factor of your age. The older you get and the more you get screwed over by insurance companies, the more you understand that insurance companies NEVER have your best interest at heart.

If I was there, I would be louder than the woman you didn't like. And as far as complying with HIPPA, that is probably bullshit, to the nth degree. All I ask is to remove the rose-colored glasses and see this through the eyes of those of us with the life experience of having to deal with insurance companies for decades. We don't want you to suffer like many of us have.

Fine print! Read the fine print!

The board voted on this, but there was enough positive reaction that they went through with it. I get 18 bucks taken out bi-weekly for health insurance now as it is. We have it pretty good here to begin with, I just don't know how bad or better it could get.

I'm not naive, maybe ambivalent. And I have to believe in HIPPA, it's the foundation of my job: protecting the individual, I have to trust it works for me, too.

And Warren, I do think that if an agency is responsible for health insurance then the employees should be responsible for their own health as well. Health insurance is grossly overoworked, overused, and undereducated. You absolutely have the right to smoke, eat horrible, and have a stroke, but you should have to be responsible for the consequences.

I'm healthy, yes. Even I know I could get better in shape, but I think its completely unfair that I have to pay a higher premium because Cathy down the hall chain smokes and eats Doritos every day.

No one should be forced to take a test, required to get "healthier" or get an increased premium. This is one of the most absurd things I have ever heard. It's one thing for it to be offered as an option but required or your penalized.

I am very sure that this is a way for your employer to either save money or reduce a potential increase. Remember the employer is the customer and insurance companies negotiated all aspects of the plan with human resources.

And people are afraid of a government sponsored plan when private plans can pull this stuff, amazing!

I'm with Monica on this one. Insurance companies are slaves, ultimately, to profitability, and while it sounds like they're going to use all this information to your benefit now, what about later? Will the base premium for everyone increase depending on their findings, even in the aggregate? It certainly won't decrease, ever.

The more places my medical records are stored, the greater the chances they will be leaked, stolen, or used inappropriately. That probably wouldn't have bothered me in my early 20s, when all my records reflected was seasonal allergies, but I've been through the gamut of issues since then, and have chronic health issues now, and I'm not so keen on the idea of anyone perusing that, even for altruistic reasons. It's simply no one else's business.

And, let's face it, insurance companies lie and cheat, all the time. It's not matter of whether they'll try to screw you, it's when and how.

I agree with Monica and Warren. You don't know what other tests they'll be running with your blood...DNA, for instance. Some insurers are trying to link insurability to ensuring that an employee has no inherited susceptibilities to developing this or that disease or disorder later in life, which is a spin on the "pre-existing condition" stipulation.

In my opinion, medical files are private and intimately personal information and should stay private.

And pressuring employees in this way, even if it's only with the lure of a lower premium, amounts to extortion.

What especially troubles me is this from the rep:

The representative said that healthcare is moving in this direction; eventually we'd pay for health insurance like we do for car insurance, based on the individual.

The big problem with this is that health care costs are infinitely higher than car repair costs. Even more, the chance of being hit with a significant health problem is so arbitrary, based on your genes, your environmental exposures, other situations far beyond just adopting a healthier lifestyle. Once you have any of those "black marks" against your record -- where a "black mark" is a pre-existing condition -- than your cost, as an individual paying for insurance, goes up and up and up.

This is why most employers offer group health insurance, if they have health insurance. Spreading the cost and the risk around among a group -- especially if you can make the group as large as possible -- reduces the exposure for any one individual. Treatment for just one major illness can into hundreds of thousands of dollars of expenses. When the premium is based on individuals' experience (as it is with car insurance) then it skyrockets, and it isn't because the individual "did something wrong." It's almost like being punished for getting sick.

If your employer, and your insurance company, is moving toward basing your premiums on the experience of individuals, then they may not have your best interests at heart.

I'm just thinking about all the things they could do with this set up. They could run DNA tests for every susceptibility, and if I've got a gene that predisposes me to this kind of cancer or another, then they could call it a pre-existing condition. Or if they check for chromosomes they could know trans status and start denying things left or right. After I've had an allergy test denied because of a trans exclusion clause I've gotten a bit paranoid.

And personally, I don't understand HIPPA enough to know how it works within the same agency. In order to evaluate if I would meet my goals, someone in the insurance agency is going to have to know my history. And that's one too many people for me.

Now, if it was all done by a local health organization not affiliated with the insurance company, then I would probably trust the outside organization not to share details with the insurance company. But it sounds as if it's run by folks who work directly for the insurance company, and that's what would worry me.

Tobi, IHS are health coaches and health evaluators. their job is to work with who hired them to educate the staff on how to stay healthy and how to make better use of preventative maintenance health-care... like PSA test, mammograms, paps, physicals. the idea is that if we get more aware then it will cost less to take care of ourselves in the long run.

HIPPA states that IHS can gather and collect data but MAY NOT share specific data with anyone else. They only disperse aggregate data (how many smoke, how many are pre-diabetic, and such) to our employer, who makes the premium/discount decision. they do not publish individual medical data to Univera, nor our employers.

Wait, are you saying that you're employer hired them? That's a bit different. I'd still want to check out all the fine print, but that's a lot less worrisome.

The part I'd still be a bit concerned about wouldn't be my own self interest but the way that "healthy" overlaps with privileged. If you can afford organic food do you get a discount over those who can only afford fast food? If you are thin and don't exercise at all do you get a discount over those who are fat, fit, and exercise regularly? If someone is young but doesn't do anything in particular to take care of their health, with they get a discount over someone who is old and has a lot of healthy habits? And so on.

I like the idea of getting a free checkup and health care. I like the idea of getting a discount. I don't like the idea of other people paying more because of my discount. Especially if they are paying more because they are dealing with a form of oppression that I don't have to deal with.

Do women pay more because they may get pregnant?

Do gay men have to pay more because they could contract HIV?

Do people that drink alcohol have to pay more?

Are drug tests part of the screening process?

How about allergies? Birth defects?

Let's look at it this way: should white people be discriminated against in an effort to provide equal opportunity to people of color?

Universal health care is the only answer.

This is the worst kind of fraud. Pit everyone against each other to ensure profit for insurance companies.

I'd tell the employer to find another carrier.

Not the point Nathan. My point is this: if they want to give you an incentive to reduce your personal insurance cost by say losing 10 lbs, great! Go for it. But if Cathy down the hall doesn't want to lose 10 lbs because she is fine with the way she looks and feels regardless of the medical industry telling her she may cost them less in ten years from now or live 5 more years its her choice. You or I or certainly not the medical industry should not be treating her differently just because she "smokes" and you don't. Give a benefit for "good behavior" sure, penalize absolutely not.

Bottom line: this is a stick proposal, not a carrot and that is what I greatly disagree with... let's see it's not death panels we should be afraid of... it's insurance cost panels!

One positive thing about this is giving people 'free' health coaching and online ways to track health. PREVENTATIVE MEDICINE IS THE BEST MEDICINE. America's healthcare is the most expensive in the world because we have a bad habbit of waiting until everything is AS BAD AS IT COULD POSSIBLY BE before doing anything about it. I'm guilty of this, I have to wear a knee brace right now because I didn't go see a doctor when the pain started--and its a really minor injury... just think if I had broken and fractured something.

We hate the doctor. We're scared of the doctor. The doctor is inconvenient. So we put off everything as long as we can stand, and then our bill is huge because instead of just quickly and cheaply treating something minor, we've now got all of these OTHER problems that have popped up and need attention, caused by the initial problem.

I would NOT subject myself to tests like this, but I would welcome the preventative advice and interaction, as well as help setting PERSONAL health goals. Wouldn't it be great to have an expert to talk to for free when a problem appears initially? Rather than wait until I can't walk anymore from the pain? I'd love that kind of care--would save me time and money! We all need a little of that, ehh?

I can accept the professionalism of folks committed to following HIPPA guidelines. I'm not convinced, though, that reporting of aggregate data back to the employer will protect employee privacy.

For a smaller employer, it's often possible to surmise who's who; same goes if the aggregated data is reported by age, gender, or department.

In a best-case scenario, I think of an employee with long-standing chronic health issues (diabetes, asthma, bipolar, for example) who is well-informed, getting good care, and following the provider's instructions carefully. I don't understand why the employee should be required to choose between inviting the employer, if indirectly, into her/his health management and paying more.

Which highlights the fact, doesn't it, that the employer will know which employees have opted out of the program.

If blood was drawn on the person with diabetes at a less than optimal time of day, does the aggregated data include that one employee's sugar was 200+? Is that employee obligated to participate in counseling in order to keep the lower rate, or can she/he opt out? Would opting out require a note from the employee's Dr. saying that all necessary medical care is being received?

Regardless whether the blood is tested for illicit drugs, could it be tested for prescription drugs? Could the person with asthma be identified as taking steroids? Might the aggregate data include the number of employees apparently taking various classes of mental health drugs? How about chemotherapy? Will pregnancy tests be included? Reported?

Might an employer of 100 find out that 3 employees are HIV+, and the average of their T-cell counts? What about other STDs?

Bottom line, for me it comes down to these two points:
* Employees are being asked to seek health care from a provider chosen by the employer, or pay a penalty.
* Aggregate reporting of results is not the same as privacy. Opting out is reported to the employer, and small numbers among the aggregates can be revealing.

The biggest thing you need to fear are the words "pre-existing conditions." You do not have any idea what can be deduced from your blood. Years later, you get sick with something that you carried with you, and is in their data base. WHAM! Coverage denied! You're screwed, and all because you gave them access to your blood years before. You not only handed the insurance company a gun, you gave them the bullets and cocked the hammer for them. It'll be up to them when to pull the trigger.

No one, I mean absolutely no one should have access to your medical information EXCEPT your doctor(s), and they are required by oath to keep it secret, one they live by. The insurance company does not follow that oath, HIPPA be damned. HIPPA only helps once the information has leaked out, then you can sue. But, it doesn't put the information back into the closet.

Having an insurance company say, "Trust us" falls in the same vain as "The check's in the mail," and "I won't cum in your mouth." You don't get anything for free. Save money today, lose it tomorrow. Remember, they're in the business of making money, lots of it.

"There's a sucker born every minute." - P.T. Barnum -

Bill Perdue Bill Perdue | August 15, 2009 5:39 AM

First, ask yourself why HIPPA created in the first place?

It became law because of the scandal caused by insurance companies, predatory lenders and employers who were hacking medical data bases to eliminate employees, clients and consumers who might cost them money immediately or down the line.

Then ask yourself if federal regulatory laws actually work. Is hamburger safe or is it riddled with bone shards and the occasional salmonella infestation? Is corporate pollution a thing of the past? Is Obama a fierce defender of GLBT rights? Would you willingly live within five miles of a nuclear power plant? 10 Miles? Twenty? Do you feel safe because the FBI and Homeland Security are on the job? Will HIPPA end the abuses? Is your care safe and built to last? And what about Santa?

The solution to honest vs. predatory screening is the same for virtually all the problems associated with medical care in the US: socialized medicine with a single payer based on the expropriation without compensation of the assets of HMOs, Big Pharma and insurance companies to create a comprehensive health care system.

Obama's plan, backed 100% by those same HMOs, Big Pharma and insurance companies because it benefits them instead of working people is as open to abuse as these screenings. Some nevertheless will refuse to make the connections between Obama’s health care fiasco, written by HMOs, Big Pharma and insurance conglomerates like AIG and the fact that those same companies contributed $18.5 million dollars to his campaign. As Donna Smith of the California Nurses Association, National Nurses Organizing Committee, AFL-CIO said to Obama and the Democrats “Shame!”

“…Barack Obama has hosted at least 27 meetings with some of the most influential private health-industry executives in the country in an effort to placate or at least quiet potential opponents of reform in what remains a tenuous legislative process.” He met with PhRMA President and CEO Billy Tauzin 4 times, with Karen Ignagni, president and chief executive officer of America's Health Insurance Plans 4 times, with Richard Umbdenstock, President and CEO of the American Hospital Association 7 times and with the AMAs President Dr. James Rohack 3 times. Obama, mimicking Cheney and Bush, refuses to comment on what he gave away and what he got paid for it.

The fix is on. Obama is selling out so fast it's making heads swim. His health care fiasco will end up being worse than those proposed by Clinton and McCain. So much for the lesser evil of health plans.

Bill Perdue Bill Perdue | August 16, 2009 10:36 AM

Oh pshaw. You just say that because according to the O-bus drivers we're both stealth Republicans?

I’ve noticed that as reality sets in and Obama begins to resemble Clinton and Bush more and more that they’ve calmed down a bit.

rapid butterfly | August 15, 2009 9:27 AM

it seems as though the other posters have said it very well (tobi in particular). I'll just add - Mr. Strang - I think you're "too okay with this" if it does not concern you in the slightest not only whether you, while you're young and fit, get a discount, but what happens to others who may not be so young, or fit, or who may be trans, etc. etc. My guess is that it DOES concern you or you wouldn't have asked for comments, and that is a good thing.

And as for HIPPA, IMO it is a bandaid on a severed artery.