Healthcare Extrapolation Exercise

As a bit of fun, I tend to fall back on a simplistic and absurd example to illustrate The Nanny state and its need to regulate behavior in order to minimize and manage risks or costs to society. 

NOW!

 The biggest danger in modern society is lack of sleep. Lack of sleep (eg. exhaustion) has proven to be a leading cause of household accidents, car crashes, and work related mistakes or injuries. Lack of sleep causes immeasurable economic and personal losses - therefor the most logical solution is to regulate sleep.

Federal and state laws and regulations need to be put into place. The beds of chronic Wake  Abusers need to be monitored with cheap and easy sensors. Random check stops need to be implemented during major sleepy-driving hours such as Monday mornings. Sleep incentives need to be put into place by employers and federal and state governments. Sleep-Easy Zones need to be created and noise pollution regulated stringently. Random 'Wakefulness-Tests' need to be implemented on all employees and students. "Just say Yes!' campaigns should be embraced, teaching our younger generation the benefits of sleep and the dangers of Wake Abuse. Those not meeting their sleep quotas need to be put into voluntary treatment at sleep clinics or face harsh punishment. Those refusing every effort at treatment should be put on a controlled sedation regiment. Because lack of sleep is so measurably dangerous not doing any of the above suggestions would be a crime against our society and children. Do you want sleep deprived school bus drivers driving your children or groggy doctors treating your cancer? Do you wish to see exhausted delivery truck drivers roaming our roads, or flummoxed fork lift operators ferrying flammable or explosive items around?

Ok. I hope no policy makers will take me seriously. That would suck. But frankly, we're already allowing many of these things to happen with other  identified "dangers to society". While that topic could fill a number of posts this one is about healthcare. 

Sinner

So what does behavior regulation have to do with healthcare? 

To save costs and to streamline function; private, public, or mixed health-care systems will inevitably move down the road of punishing risky and irresponsible behavior. This is behavior that they will decide on. And these decisions will not be based on personal freedoms but will be based on bottom lines. The fact is, we the public are already calling for such behavior regulation and modification. We want to save costs. We clamor to see others punished so that we can save a few dollars.

The question then becomes:

"What is risky and irresponsible behavior?"

You can bet the farm that these are going to be at along the moral and lifestyle lines of sexual activity (multiple partners, experimentation), gluttony (fats, sugars etc), reward and consumption behavior (smoking, drinking, eating), physical activities (bungee jumping, sitting, driving) etc.

The examples given by the advocates of behavior regulation are too easy, too simple minded to argue agains. Proponents say they are in fact 'obvious.' Behaviors like drinking and driving, driving without a seat belt, sex without condoms, riding a motorcycle without a helmet, eating fries and milkshakes for every meal every day. These examples play on the obvious - and the subtle message is that anyone engaging in these behaviors is stupid so they should be punished somehow. For the betterment of society. Why would anyone defend stupid choices? Our intentions are to help people lead better, healthier lives!

What's that they say about good intentions?

Good Intentions

 Of course, it's not the intentions we should really be worried about. It's the deeds that can truly mess shit up.

A few years ago I chose to help out at a student run art gallery. While setting up some temporary walls a dropped 2x4 fell about 8 feet and landed on my shoulder. Today I still have occasional flares of pain. Can you tell me, was I engaged in risky behavior? I'm not a trained carpenter. Could my health-care refuse to cover the pain treatment because of my  choice? Can they penalize me with higher premiums? Can the government? Should they? I had a hard hat on, gloves and even eye protection but like hell was I going to done football padding . There's realistic risk mitigation and then there is paranoia and utter impracticality. Sometimes shit just happens. And lots of shit happens if you choose to be involved in life on a daily basis.

On average we humans are quite good at weighing short term risk - in contrast to what the Darwin Awards reveal. It's just that we do not use the same criteria of a piece of insurance software that calculates the bottom line. Our priorities are vastly different from those in charge of figuring out what our health is worth.

What's my point? With the way things are going, it doesn't matter what kind of system we have. Completely free market  or completely government run. The people who will be paying the lowest premiums and receiving the cheapest/easiest to access care will be the ones that do nothing, have never done anything and never plan on doing anything because every activity has risk. Government, corporate, or a mix will definitely be grading to that risk. They already do. Call me Paranoid McParanoia but I can't help wonder - at some point will we be permitted to do certain activities only if we can cover the premiums for the risk? There's plenty futurecasting speculation and theories written about the shape and structure of that type of society. It's an ultimate melding of capitalistic personal responsibility and freedom of choice. Whatever system this nation and most other nations will gravitate towards will rely heavily on risk assessment. It’s unstoppable and is already here. 

Scales

 Who really wants to spend most of their life weighing every action against a potential hike in their health premiums? If I agree to help at my kid’s summer camp will my insurance go up because I’ve exposed myself to the risk of West Nile or Lime Disease? 

I'm a journalist, do I cover this tense political protest? What if my health insurance sees me here and hikes my rate up because I exposed myself to a potentially violent situation and chemical irritants? 

If I purchase Sushi on my credit card, will i be penalized due to the risk of parasites or heavy metals? Yes these examples are silly but do they not seem likely to happen in the near future?

The health care debate is not just about who foots the bill for what. In fact, it can not only be about who pays and how much. It needs to be about how we as human beings allow ourselves to be monitored, classified, and graded. It’s about how we wish to live our lives and you can bet every second will be counted by someone out there...

NSFW