Discussion: What the health? Should sicker people pay higher premiums? 

Around 12 years ago, when we lived in Houston, we were out to dinner with some friends.

Over the course of dinner, we had a lively and interesting discussion about healthcare. Talk of health insurance was all over the national media, and as many of our friends are health professionals, there were a lot of opinions.

I can’t remember exactly how the conversation went, but at some point, our one friend Mike (not his real name) said that he was firmly and adamantly against universal healthcare.

Mike went on to say that healthcare premiums should be based on the person’s health status… that healthy people should pay less than “unhealthy” people.

His perspective was that healthy people aren’t a huge burden to the system, and therefore shouldn’t have to pay as much as their sicker counterparts.

Mike also felt that incentivizing healthcare by offering lower premiums to those who are healthy would encourage everyone to do things like exercise, avoid excessive drinking, smoking, etc.

Our other friend James (not his real name either) was in complete disagreement with Mike.

James argued that it would be unfair to expect the sickest people to pay the highest insurance premiums. After all, these individuals are also most likely to be too sick to work or generate income.

Listening to Mike and James go back and forth was interesting and thought-provoking. I realized then that there were good points to be made for both.

I would love for you all to share your perspectives on this topic. There are no right or wrong answers! :)

Are you Team Mike or Team James? 


60 thoughts on “Discussion: What the health? Should sicker people pay higher premiums? 

  1. I’m still new to the whole “adulting” world since I graduate college back in May and haven’t needed to look at healthcare since I’ve been lucky enough to stay on my parents thus far. I never thought about whether healthy people should pay more than unhealthy people. I feel like it’s out of some people’s control if they are “unhealthy” i.e. if you have Type I diabetes, it’s usually not something you did to get it where as if you have Type II that is influenced more by your habits. It would be an interesting debate for sure!

    1. Hi Maureen! It’s true, many people have chronic, degenerative, or genetic disorders. Thanks for sharing your thoughts! 😊

  2. Hi. At one point in life I agreed that healthy-habit people should not pay for those who abused their health. I ate right and was never overweight, gave up smoking and alcohol 35 years ago, exercised daily, slept well and I thought my bases were covered. Guess what? At 70 I suffer from high BP, out of balance lipids, and now a new diagnosis of emphysema. But even that argument is a moot point. We live in a land of unfathomable wealth……and we can’t afford health care for everybody? C’mon, this issue falls under the category of moral or immoral.

    1. Larry, I totally understand what you mean. Should those who genuinely strive to maintain healthy behaviors (balanced diet, exercise, etc) have to pay the same cost as someone who willingly abuses their health (substance abuse, etc)? Where do we draw the line? It seems that we need to carefully re-think the way we “care” for and insure health as a nation. Thanks for sharing your thoughts, I really appreciate it!

  3. Very interesting topic. I’m from Ireland so healthcare is waaaaay less expensive than you guys but then I also lived in the U.K. With free healthcare. The free healthcare was miles better than what we pay for!

    1. I can imagine! Free healthcare would be somethin! There are so many here who cannot get treatment or must acquire crippling debt due to the high cost of healthcare.

  4. I live in UK and the National Health Service here is paid for through general taxation. Healthcare is seen as a basic human right. The system isn’t perfect, but it works most of the time. I can’t imagine having to take out expensive insurance to cover my healthcare, but I do make sure I have great travel insurance for when I visit the USA! Just in case.

    1. Hi Steve, thanks so much for weighing in. It certainly does seem like it should be a basic human right. It would be comforting to have that peace of mind. Good thinking on the travel insurance — important to be covered when you are abroad!

  5. I donated a kidney to my husband who had a rare genetic disorder that ruined his kidney. Since being children e both have always eaten healthy, are into regular exercise and fitness, never smoked, etc… I don’t want to be treated unfairly with higher premiums because of something that we did not create through bad choices.

    1. Oh Jenny that is quite a gift to your husband, he’s a lucky guy. I agree with your sentiment, particularly where it’s not their fault that someone needs treatment. As we get older, even the healthiest among us will eventually need some kind of treatment anyway.

  6. The sick (I know because I am one who can’t afford health insurance) can usually barely afford to live already. That could cripple some people or cause people to go untreated.. Not fair. I didn’t ask for illness.

    1. I understand what you mean, you didn’t ask for it. Thanks for giving your thoughts. We (collective “we”) have got to rethink this healthcare thing.

  7. I live in Australia and we have universal health care. If you earn over a certain amount per year you are required to take out a private health insurance plan and if you don’t you are taxed more. The system works. No one is dying because they can’t afford health care. If you need emergency care, you can get it. If you need to see a doctor, you don’t have to fear the cost. And those who earn more and take out private health insurance are taking stress off the public system, which can have longer waiting periods for elective surgeries etc. I actually can’t understand how anyone could stand by and think it’s ok that people suffer because they can’t afford basic healthcare.

    1. Hi Cassie, it sounds as though the Australians have things figured out in the healthcare department. We can learn a thing or two from our Aussie friends! :) Thanks for your comment, i appreciate learning something new about how things work on your side of the world!

  8. I think we need to think about what kind of culture we want to foster in our country. Sick people, such as someone with terminal cancer can’t afford to pay higher premiums. It’s likely that they are on disability. The same could be said for the elderly, who are the most likely to be a “burden” on the health care system and have the least ability to pay. The result is those people will have to go without health care. They drew the short straw, so it’s their problem. In my mind, that’s not the kind of mindset I want in our country. We should be willing to help people who can’t help themselves. I’ve been to countries where people are left to die in the streets. I don’t want my kids growing up in that kind of world. As a Christian, I feel compelled to speak up for those who have no voice. That includes the sick and the impoverished. Thanks for having the guts to take on such a tough subject. Bless you!

    1. Oh Heather, your words are compassionate and wise. I 100% agree with everything you said. A little compassion goes a looong way.

  9. I will start off by saying that i have always believed that free, or very low cost universal healthcare is a right of every person living in the United States.

    I am 65 years old, have never been hospitalized (except for alcoholism some 30 years ago). I don’t smoke or drink, ride my bike 50 miles per week, at least, etc. etc. In other words, I am a “healthy” person. I am so healthy that the only meds I have ever been prescribed were for high blood pressure, the annual cost of which was significantly less than the cost of Medicare Part D.

    So when I retired one year ago I procrastinated and only got Medicare Parts A, B, and the supplement, leaving Medicare Part D out at the time.

    I have now been diagnosed with cancer, with treatments tbd in the coming week or so. I am concerned that the notoriously expensive cancer drugs which I cannot get Medicare Part D coverage for until January 1 of this coming year could completely eat up the limited savings of my wife and I. Further, I have no idea at this point what treatment coverage my insurance will even pay for.

    So, I am probably a model for a healthy lifestyle, yet in just the next year, I could well run up a medical tab greater than the unhealthy lifestyle person.

    I am not particularly angry about the cancer. Here is my story on that (https://processnotevent.wordpress.com/2017/09/07/cancer-and-recovery/) However, I will be quite angry if it comes down to choosing between my receiving adequate treatment or my wife having a roof over her head if/when I die in the next year or so.

    Sorry, I simply have absolutely no patience for these repeal/replace ACA folks. It is mean spirited and cruel. Plus, these are by and large the same folks in the pockets of the NRA and Mega-Food Corps whose very policies promote poor life-style choices.

    1. Oh Robert, I’m sorry to hear of your diagnosis. Thank you for sharing your story and perspective. I too believe that free/inexpensive healthcare should be available to everyone. No one should have to choose between having a roof over their head and receiving treatment. Sending you hugs and all the positive thoughts and prayers.

  10. I’m not team Mike. I hope he and his family never find themselves in a situation where they unexpectedly need expensive treatment for an illness or condition that was unforeseeable. Insurance should be incentivized for making healthy life choices, but those needing it most should not be penalized. We should be sympathetic to those in need. I feel we, as citizens, would give more generously if we knew our money was going to those in need and not to those abusing the system or administrative fees that are a mess! I also cannot say I’m team James, but I appreciate his compassion.

    1. Yes, yes, yes! I love the idea of incentivizing healthy behaviours (and not penalizing those in need of treatment)! Thanks for weighing in, i appreciate hearing your perspective!

  11. Yes this is indeed a debatable topic and both James and mike are correct when looked upon from their angle. I would be more biased for team James. We need more of health awareness and support for people prone to be sick.

    1. True, both Mike and James have their own points and perspectives. Yes, it would be wonderful to have more in the way of support for those prone to sickness.

  12. Good topic, interesting views. Healthcare should be affordable period. The reality is some people would require a little more than others but they should not be punished or penalized for it. We need to find a way to reward those who need less and help those who need it. Thanks for sharing.

  13. I see both sides to this argument. While lower premiums may encourage others to live a healthier lifestyle, when others get ill or injured and it has nothing to do with their lifestyle choices, they will have a hard time paying for those higher premiums. My husband was injured on the job and of course his work was protected by workers comp so his medical care is left up to us. And I struggle as the only income to provide his needed medical care and care for our 3 children. I am not sure of the answer to this dilemma but there has to be an in between some where.

    1. That is a difficult situation, I’m sorry to hear of your husband’s injury. I agree, there needs to be a solution. Even the healthiest among us will need treatment as we age (getting old will do that!) so we need to rethink this whole healthcare thing as a nation.

  14. I can’t imagine what it would have been like having this discussion while sitting down to dinner. Given that I am Canadian and you prettymuch pay premiums based on your income or family size, I haven’t really given much thought about it. I should probably rethink that!

    1. It seems reasonable to factor income and family size into premiums, similar to how we do with taxes. Thanks for leaving your thoughts! :)

  15. As a health care provider and now a person with a chronic illness, I have a lot of thoughts on this topic. I do not think sicker people should pay more for coverage. That is discrimination. We are a society and as such, we are all in this together. Everyone should get the same coverage for the same dollar. Unfortunately, that is not the case. I am lucky that we have good coverage to pay for my very expensive medications. I fight every day for my patients who aren’t so lucky.

    1. Yes, we are all in this together! And you know what, every patient needs healthcare providers like you! Thanks for sharing your thoughts, it’s great to hear the perspective of healthcare professionals.

  16. Aside from the well thought out points by both James and Mike and those who responded, I believe our current ‘for-profit’ health care system doesn’t enough health at all or cure disease, they want to manage your care to profit as much from illness as possible. I believe this is a moral failing of the system we have in the US.

    1. This is a sobering truth. The fact that people/companies profit from this system really does seem “off,” doesn’t it. It makes it all the more disturbing as there are many who have lost the very roof over their heads due to crippling medical debt. Thanks, Linda, for sharing your perspective!

  17. Well, I think that healthcare should not be made affordable to the people who need it. I understand wanting to add incentive to good personal care, but there are other discounts that are typically offered for things like gym memberships, low BP, etc. Think of the kid with cancer and how much their parents are already having to pay. There’s no way to rationalize raising it for them imo.

    1. I see your point! Healthcare is expensive, and it shouldn’t be. No one should have to choose between food and their child’s chemo. Thanks for adding your thoughts! :)

  18. I disagree that people who are more sick should pay more…I think it needs to be standard across the board. But the healthcare system has gotten outta control. I currently have the worst insurance for our family plan and because both our daughters had medical issues from birth it is putting us in huge financial debt with a $3,000 deductible per person. But we can’t afford better insurance. And they are just tiny babes it’s not their fault they are sick nor anything they could do differently like exercise, eat healthy etc (like your friend says) to avoid their conditions.

    1. Oh Julia, I’m sorry to hear about your daughters’ medical issues. I wholeheartedly agree, the way the system is built puts an unfair burden on patients and their parents. Sending you and your family lots of hugs and positive thoughts.

  19. I am with Team James!
    Like he says, many people have chronic illness or are disabled and can’t work meanly due to physical impediments. Also, premiums are extremely high these days and what used to be a simple procedure is now billed as a surgery.

    Great article by the way!

    1. Thanks Astrid! Yes, many people with illnesses cannot work, and therefore lose their coverage. It’s an unfortunate catch 22. Thanks for giving your perspective! :)

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