I finally got around to reading the book "Being Mortal" and highly recommend it. It's a long overdue discussion of aging and healthcare and quality of life as we grow older, by the surgeon Atul Gawande. Among other things, he talks about the way older Americans are treated like children unable to make decisions for themselves by the healthcare and elder care system, especially when we reach the stage of needing assistance with daily living.
Between that, and the annual health insurance open enrollment period (I've really come to dread these lately), I found this article interesting:
Maryland doesn't trust state employees to manage their health
http://www.baltimoresun.com/news/opinio ... ss-program
State employees have all been given a mandate to conform to this new initiative, which purports to cut costs by requiring participants to "better manage" their health, or pay extra for our health benefits. . .
We inquired about the data behind using these coercive Wellness Plans and data related to either disease reduction or dollars saved (by any person or organization). In response to our request, we were sent only a table of the insurance costs for people with selected chronic conditions. Notice that this is a different set of data...
If you are part of the program, you must work with a doctor who is part of the program. Note that this may not be your chosen primary physician. Based on personal experience, the "Disease Management" involves calls and monitoring from an anonymous medical person who may not understand your chronic conditions, but is still ready to "manage" them for you without apparent regard to what you and your doctor have already decided to do over years of managing the condition.
If you decide not to accede to the allegedly well-intended program by 2016, with its Orwellian labels such as "Healthy Activities" and "Disease Management Program," the disincentives are severe: You will be penalized with annual surcharges, as summarized below:
•2016: $50 per person, per year, for failure to complete Health Activities;
•2017 forward: $75 per person, per year, for failing to complete Healthy Activities and $250 per person, per year, for failure to participate actively in a "Disease Management Program."
The authors of this op ed piece are 2 professors, one an expert on adult developlment and aging.
One reason the insurance companies probably couldn't give them evidence the program will save money is that there's a good chance it won't (except by charging people for "noncompliance"). Out of curiosity, I've skimmed a few studies on healthcare costs, and so far, it seems like what they find is that most universal screening programs don't save money (as opposed to true prevention activities like getting a polio vaccine). That's not to say that they don't provide benefits for an individual who chooses to be screened, but in terms of costs to society, it can be a lot of testing to catch few cases, which isn't necessarily cost-effective, especially when the test itself is expensive.
Must admit, this leaves me scratching my head as far as why a for-profit system insists on them - except that these companies are managed by bureaucrats rather than physicians and scientists, and I've heard a lot of hype about how screening is supposed to be the panacea for increasing healthcare costs.
And the insurance companies have now released details about the Maryland disease management programs the authors discussed in this article: they are required for anyone with lower back pain, asthma, high cholesterol, diabetes, heart disease in any form, and high blood pressure.
Why this particular list? The insurance companies found these diseases accounted for most of their costs. People with any of these conditions will be contacted by the insurance company's "disease management nurse" and must agree to "engage with that nurse in a treatment plan that will help you manage your illness better." Also, you are no longer allowed to make decisions with your own doctor about the frequency of mammography between the ages of 40-49 (as recommended by some recent physician's expert panels) - it's "have an annual mammogram or pay up." Likewise, pay up if you miss your required physical (annually if ages 18 to 30, or 50-64, and 1-3 years between 30 and 50) or any of their other required tests.
If things continue like this, I suspect we're not just going to be talking about how to balance what's personally important vs what's "good for us" (in terms of optimal safety and "health") as we get old and frail. Not that I'm surprised, given that we handed control of universal healthcare to some for-profit companies, added more bureaucracies, made a few tweaks, and somehow expected an ailing and overpriced system to suddenly start working better and get cheaper.