As a firm believer in the Law of Unintended Consequences (LoUC), it immediately came to mind when I read a post by Dan Diamond over at the Health Care Blog, About Time? Smokers Face Tough New Rules Under Obamacare which details a little known provision of the PPACA (Patient Protection and Affordable Care Act aka Obamacare). Go give it a read because this a place where the LoUC could wreak all sorts of havoc… especially to those of us who are diabetic.
Basically, the provision says that smokers can automatically be assessed a 50% surcharge on their health insurance premiums starting in 2014. ** believe me, I have some very strong opinions about tobacco and taxes in this country but that would that would be a huge aside, maybe another day
You’re probably saying “Uh… ok they chose to smoke but I didn’t choose to get diabetes so why should I worry about this?”
And that is a correct analysis… up to a point. Diabetes is one of the few conditions on the planet, besides STDs, where the patient is often blamed for having it. Often the patient themselves believe it is their fault. So, if perceived as our own fault, why shouldn’t we expect a surcharge as well?
Oh and let’s take it further to the dreaded word “non-compliant”. What if we don’t get the expected benefits from our treatment? The assumption usually is that we’re not doing something we’re supposed to, will there be a surcharge for that?
Exercise is good for us, if we don’t exercise will there be one for that as well? What is enough exercise?
How about obesity? Lord knows I could stand to lose two or three dozen pounds…
Diabetes and obesity? Even though most of the research is showing that obesity is often the first visual symptom of the most common types of diabetes, most still see obesity as the cause. ** quick reminder that correlation does not equal causation. In addition to that, there are conditions that make it difficult, if not impossible, to lose weight.
I chose to go skiing and broke my leg, I chose to drive my car and became injured in wreck. OK, those last two are pretty ludicrous but when you look at a system designed around making money those earlier examples start to look pretty reasonable.
Could the LoUC as applied here result in direct “intervention” into our treatment regimens? Who would do the “intervening”?
How about mental heath, again another stigmatized condition where often people don’t get help because of that stigma and sometimes can’t get help because of a lack of services and/or money. Unless you go to jail that is. Will I be penalized because I have clinical depression of the major recurrent kind? Mental health issues are again often viewed as being the patient’s fault some how.
I’m not debating if there should be a surcharge to smokers or not. I am asking if this will set a precedent?
© 2013 Scott Strange, Strangely Diabetic and http://StrangelyDiabetic.com