Value Oriented Health Care

Using the increasingly popular keyword lifestyle, a spirited member of the conservative side of the morals war brought his version of compassionate conservatism into the healthcare debate yesterday.  “Lifestyle reflects values,” he raged.  “Slime bag smokers are a drag on the system.  They have no values.”

 The veins in his red face pulsed.  He wheezed and shook.  “I pay too much for my health insurance as it is.  I don’t want another cent of my hard earned money used to cover their immoral lifestyles and disgusting habits,” he added, puffing out his barrel chest before he scratched his beer belly and shuffled his flat feet.

I butted my cigarette and sat back to consider his position.  I felt his frustration and realized his proposal sounded like a simple solution, on the surface.  Applying his logic from my own point of view, I had to admit that I would prefer my risk in the premium pot remain separate from the cost of treating his obesity and stress related conditions.  Tit for tat, we could shave a huge segment of the population out of the insurance game at this rate, or at least force them pay up.

In the spirit of a value driven society, we would have to allow everyone their personal prejudices.  Wouldn’t we?  We could develop risk rated criteria, to use in determining a sliding scale rate for insurance coverage, based on a culmination of all our individual morals.  I think gluttony is immoral, and want obesity weighted at least as high as smoking, since it causes as many, if not more, drains on the health care pot.  Alcohol consumption is a given.  Enough people disapprove and the high cost of treating the disease and its secondary conditions warrant either disallowing or overcharging drinkers.

The gray areas would be more difficult to iron out.  A sedentary lifestyle lends itself to a whole host of medical conditions.  Yet, on the other hand, there are increased risks for those who jog on polluted streets, swim in contaminated lakes, fall off of bicycles, and twist an ankle dancing.  And what about the drivers who choose vehicles with high roll-over risks, or who don’t replace their brakes or tires when needed, or talk on phones and watch movies while they are driving?  Accident related hospitalizations not only drain the system at the time of the accident, they often continue to drain more through post-hospitalization rehabilitation.  Would the increased risk apply only to the driver, or to the passengers as well?

Lifestyle includes more choices than I had originally considered.  Do we reward those who choose reclusive lifestyles?  Their exposure to contagions is much lower than that of the person who chooses to attend a church with a large congregation or a basketball arena. 

Finally, we have the things that are often beyond choice, like family history.  Is it fair to risk rate the diabetic child, or should the parents carry the burden of choosing to pro-create a high risk to the collective healthcare burden?  Who pays when one person wears cologne in public and another has an allergic reaction?  Is it fair to assign increased risk everyone who has an enemy?  How about gun owners, or people who live in their neighborhoods?  People who choose to own swimming pools and trampolines?  Dogs?

I’ve posed the questions.  I think I’ll leave the job of finding the answers or writing the criteria up to someone who already has a high stress rating.  I can’t afford it.