Republicans will continue to try and make "market forces" work to solve all problems. They will continue to fail. Its like a religion with them. All faith and no evidence. Really kind of sad but the wealthy like them because Republicans also want to make them richer. Something about the wealthy being "blessed". Kind of a merging of two religions.
2
First rule for first responders like parents is to look after your own long term health and safety first. If that means taking 45 min / day to your self for exercise to maintain your long term capacity to serve - then do that first. Children or partners may see this as selfish, but that is why us grown ups are in charge.
1
And while they're at, can't they remove the roulette wheel in the payroll tax deduction for health care expenses? Why should I have to guess what my health care costs are going to be and if I'm wrong (likely, because who knows) I either leave money on the table or lose money or have to spend it on glasses I may not really need at the time. Who the heck invented that and thought it was good for us?
It's too complicated. Just give us a $2500 deduction (the max) and let us use it, or not, without guesswork or penalty.
2
Here's my modest proposal: We should just give every citizen the 'choice' to wear a motion-registering ankle bracelet made in the USA. The device should be connected to a GPS system to avoid cheating. The control could be transferred to the Facebook organization (or Amazon),which could finance the expense by selling our data to the highest bidder (which they, of course, would not do otherwise :-)). Tax deductions should be based on the annual motion score for each individual, multiplied by an age-based multiplier with deductions allowed for hospitalization or doctor-ordered bed rest. The resulting tax motion allowance must be averaged for couples filing jointly and may also be used to calculate our health insurance rate.
3
When I had my taxes done last year the question of deductibility for gym fees came up. I had enough medical bills to take a medical deduction on 2017 taxes. I inquired as to whether my $ 600 annual gym fees also qualified. The answer was : only if the doctor has recently written an order that you start using a gym for the first time and for a specific exercise. If you have been using a gym for years on your own ( I have done so ) you cannot turn it into a medical expense.
As other commenters have pointed out a lot of exercise is free. Work in minutes of walking. Do some crunches in your car while waiting at red lights. Make sure you do something every day if it is only 15 or 20 minutes.
One thing that I have found that helps me: if I am running late for the gym I go anyway. If I can only exercise 25 minutes before they close instead of 45 it is better than 0 minutes. Once you skip a few days altogether it is easy to stop. Increments, however small, shore up your priorities.
6
The public university I work for and I have my health insurance from offers rewards for a gym membership - but only for a particular commercial chain. No rewards if you work out at the university gym (where membership is not free for employees), or at the YMCA... They care so much about the health of their employees...
1
Typical Republican move - health care via tax deductions. A sad joke. Pathetic. The American people need to wake up and DEMAND single payer like all intelligent countries already do.
6
When I lived and worked in France, I never had to be concerned about which insurance covered what or whom. The only paperwork I had to fill out were those for office visits - primarily a signature on a single page. Here, the major upside I have in my current coverage is that I can see almost any specialist without referral, because I've found my Primary Care Providers to be generally unhelpful for specific issues, and I can't switch to a different one more than once per year.
My mother, who is on Medicare, gets frustrated every time she has to deal with another piece of mail from her provider, or a different potential provider. Sometimes the insurers change name, or merge, or change their coverage policies.
3
I can see this in my own personal situation. I'm well educated and well compensated. For a variety of reasons, I ended up on 4 different health insurance programs last year and my wife was on 5. I spent many hours working through the details of these insurance programs to ensure that we were both covered and got a reasonably good deal. I can easily imagine someone with a little less time, a little less market savvy and a little less income abandoning the process and ending up with no insurance. It would have been a whole lot easier if we both could have just gone on Medicare . . .
4
Besides exercise, focusing on eating habits can go a long way in improving people's health. Since everyone must eat, they will make the time to do so, so, try promoting less or no meat consumption while increasing plant-based diet choices. Teaching people that a piece of meat does not need to be the center of any meal, by showing them how to cook without meat, could go a long way to change health outcomes. Habits and traditions are always the stumbling blocks to invoking real change in people's lives, but they can be overcome.
2
It's so easy for this Congress to propose silly legislation like this when they have their "no strings attached" gold standard of healthcare. Fat, slouchy old men playing armchair jocky to the rest of the country - holding wages, benefits, and opportunities hostage with their backward, pie-in-the-sky thinking.
6
You want to make people change their behaviors? Stop rewarding poor choices. If you smoke tobacco, no health care.
@Hb If you drink pop, no health care. If you're fat, no health care. If you are sedentary, no health care. What works for the insurance company's profit doesn't work for the workers in this country.
11
@Nell
And no knee replacements for runners.
2
All of the countries problems flow from the psychopathic greed of the few, greed is the biggest enemy of the human race. We will not survive this cancer.
8
If this country would simply STOP EATING PROCESSED GARBAGE, things would dramatically improve, regardless of 'exercise'
16
In my younger days, I made an Everest Trek - couldn't make base camp but did make it to 18,350 and when I got back to SF CA, went on a mountain run with a tri-athlete and ran away from him. Also used to heli ski in BC CA - we used to say heli skiing was the most fun U could have wearing a lot of clothes. Bought a commercial exercise bike 50 YAG for $2K plus - health clubs were full of yuk people.
I was fortunate to get a great separation package when I departed a Dow 30 and was able to travel around the world on an open ticket for over a year. After breakfast on Ko Samui, Thailand, saw some oatmeal cookies in the display case and bought and ate a couple. U could buy a great little hammock for less than a dollar from the kids on the beach. I had a couple of palm trees on the beach I would climb into my hammock and read. Soon I thought - WOW this is great - what is going on? Well Thai sticks were also available for around 20 cents each. I am not a mary jane fan - it destroys ambition but then a coupld of Canadian guys who were in their MD Internship saw me and immediately said - "Where did U get it". I told them where to go - to the next restaurant down the beach and they asked me if I had tried any magic mushroom omlets. The ladies running the restaurants offered single and doubles for 20 and 30 cents each. Wow
Am now 77 YO and in perfect health - was told by my physician at first physical - you are the type of guy who is a poor business prospect.
6
Too many words to make an obvious point. Healthcare should be free.
4
The solution is providing affordable health care. Period.
14
Amen
Everything has become so complicated and some of that is intentional
Who benefits from health care programs that benefits of which are so opaque that many people just join one that seems good.
And people need to be educated about these lacks of transparencies while still in school.
We also need to believe that we can figure things out with assistance.
But that can also be complicated to find.
4
Passive, active? What about rezoning and redesigning our communities so it makes more sense to get outside and walk: Densifying residential and retail, restricting automobile flow, and encouraging cycling and mass transit, building more parks with trees and walking paths, encouraging parents to walk their kids to school. One hundred years ago people walked a lot more than they do now, and they weighed a lot less. You can get just as much exercise from walking as you can by going to the gym, but walking is free, and being outside is better for you, unless you live next door to a freeway.
18
Frakt and Benavidez,
Where's the beef? That's a lot of talking about what doesn't work and why, while light on remedy. Details and proposals, please.
2
Imagine ! Taking responsibility for your own actions instead of blaming others and calling for government programs to subsidize---what exactly ?
2
A Health Savings Plan? Take a look at these prices: $70,000 to $200,000 for bypass surgery or heart valve replacement. $800,000 for heart transplant surgery. Good luck saving up for that. https://health.costhelper.com/heart-surgery.html
12
"scarcity of money ... is correlated with ... misinformed financial decisions like using costly payday ... loans." If your principle (or only) job barely provides a subsistence income, you have no money in the bank, and your child needs medication (or any of a thousand other scenarios), obtaining a high-interest payday loan is not a "misinformed financial decision." It may be the ONLY financial decision.
13
@Bob Gray
This. Exactly. People who have not been poor don’t realize how complicated and expensive it is to be poor. Things like payday loans and check cashing services are a bunch cheaper than overdraft fees, for example.
10
This health care plan is ridiculous simply because you have to have money in order to save money.
It would be great if the majority of Americans could afford a health care savings account. But they can't. Many can barely afford health insurance and when they can, their polices often have deductibles that run into the thousands of dollars.
Have you read the accounts of the federal workers under this government shut down? These are middle class folks who are living paycheck to paycheck.
The idea that they can take advantage of healthy living tax breaks is nonsense. There are at least 40 million Americans who officially by the very low government standards live in poverty. But there are another 150 million working class folk who are trying to support a family off of 50k a year.
There is no extra money for a healthy living account!
This is once more a reminder that America is the only Western developed country without single payer, national health care system.
Other nations see health care as an essential function of government. Our politicians only see it as one more profit center for those who can afford it. For those who can't, they get what they can pay for.
16
@Drspock Correct. And to take your point further, we are the only country in the world that sees medicine as a profit making venture. Docs should be paid, no doubt. And they bring with them enormous student loans. Everybody makes a buck along the way but the patients lose in the end. It's a greedy system.
If you want people to be healthier: 1. give them medicare for all; 2. Mandate 32-hour work week as full-time; and 3. Raise the minimum wage to $20 per hour. The rest will take care of itself, no need for complicated tax deduction schemes.
22
" Making time to exercise, like many good things in life, can be hard to accomplish unless it's on autopilot. "
" Autopilot " was the operative word for me. At 62 I was prediabetic, hypertensive and had a cholesterol level of 240mg/dl. I knew medication would help control the level of severity of all three conditions . However, I also was aware that a daily routine of cardiovascular stress exercise would augment this control. The key was to find an inexpensive way to do it in the shortest time possible.
I found a fitness center that charged me $150/yr. So I started an exercise routine. Since I work 50 hours per week, I wanted to get in and out fast. I started using a treadmill on an incline at 4 miles/hr for 30 min. 6 days a week. I've been at this for almost 2 years and my latest tests revealed my A1C dropping form 5.9 down to 5.5, my cholesterol is 125mg/dl and I only take half of my blood pressure meds now.
I know everyone is different. However I do believe if you are adamant about exercise and can put yourself on "autopilot "
when doing it, you can only benefit from it. Today at 65 I only see my primary once a year for refills. So for what it's worth, that's how I did it.
15
More fantasyland. 40% of Americans don’t have $400 saved for an emergency. 70% don’t itemize deductions including medical expenses.
25
Subsidizing gym memberships is really subsidizing gyms. Given how many people take out those memberships in January and stop using them by February, it doesn't seem to be much of a benefit to anyone but the gym industry.
22
Great incentive for those who don't need it, people in high tax bracket with enough other expenses to itemize.
Why not make this a tax deduction, not an income deduction. That would be democratic. Why should people in lower income be prejudiced against? Poor health delivery is a national problem in the US. We are BEHIND the Islamic Republic of Iran on such incentives.
Give everyone the incentive to take care of themselves. Tax big pharma and subsidies those who are below a certain income level. It will help free money for more nutritious food.
But obviously, why would the sick care system want people to be healthy? We have no health prevention for exactly that reason. Learn from Iran. Three health professionals for every 100 people, even in remote village as deprived as our worst, where there is no one within 50 miles to be proactive about people's health.
15
5 minute brisk walk 3 times or more a week. Include a few fast paced intervals. Cost $0.00. Sit ups and push ups and squats each day for 15 minutes. Cost. $0.00.
Change diet to grains, nuts, vegs, fruit and minimum meats. Savings ?Many $$. Get 8 hours sleep. No smoking and minimum alcoho;. Easy, cheap and no congress involved.
21
@RichardHead Your point is well taken. What's sadly lacking in this article is an appreciation for discipline.
1
The problem is that a large number of Republicans see value in keeping Americans desperate-- if people are scrambling to get by in their daily lives, they are less able to notice or resist the wholesale looting of the United States by corporate interests. "Active" approaches like this give them a fig leaf to scold people who don't "take advantage" of them, and thus "deserve" to be poor and desperate.
33
When people cant afford their insulin, a tax deduction for a gym membership is just another slap in the face. Should people exercise more, sure but people, average working people, are working harder and longer for less and less. It’s ludicrous.
Nothing about this bill was really focusing on helping peole with health care expenses.
35
The 40 million are not "living" in poverty...most would be if not for welfare,subsidized housing, free healthcare, medicaid, food stamps, earned income credit, free college,free public education,etc.
In India millions "live" in poverty. Better said about America, 40 million qualify for benefits due to their low or absent income.
5
Physical / mental fitness and exercise are in direct time competition with entertainment, social media, and digital life.
One is less expensive, makes you feel and look better; the other is more expensive and sells your information to any and all bidders.
7
When people increase the amount of exercise they do it typically comes in the form of walking (NYT article on this subject I think). Some ways to increase walking:
Sidewalks, public transportation, parks, schools
Basically we need to create/improve some safe, enjoyable, and convenient spaces for this to occur preferably without the need to drive anywhere. Also these spaces should be available to the community at minimal or no cost.
The problem - there's no profit in it.
22
Great perspective. No patient wants to be sick. Most are strongly motivated to be healthy so they can support their families and enjoy life. Prevention is the most cost effective solution --controlling blood pressure, weight, and lipids while maintaining vaccinations and some form of exercise like walking. Those are low tech solutions that have worked on my own patients, whether rich or poor. If we want to invest, let's make prevention easy and available to everyone. It is the best life-saver we will ever have.
7
I am a strong believer in Universal single payer healthcare for all , with prescription drug prices affordable and with uniformity of prices nationwide .
If a citizen doesn’t have to worry about having healthcare and affordable education automatically the quality of life will improve as well as the general well being .
A citizen will be free to search for better opportunities in the job market , not having to worry about losing health coverage .
Most low income Americans , and the number is staggering, have to work multiple part time jobs , have no opportunity to have some free time to take a walk , cook a decent and nutritious low calories meal , embrace some school program etc.
Most Americans are overwhelmed by heavy working hours , lack of sleep , lack of recreational time and debt .
They gulp down calories rich , nutrition poor food , that will bring on obesity , diabetes, hypertension, high cholesterol, arthritis etc the sad part is such changes are affecting also many children.
It is time to look to our Canadian neighbors and copy their benevolent socialism that it is granting them a better and healthier society.
25
I'm a big fan of encouraging self care and believe that it is necessarily the foundation for good health. The trouble is, our health care system is so far out to sea that the drivers of possible solutions are not really health care issues anymore, they're economic.
As well as I could determine from the Bureau of Labor and Statistics there were about 880,000 people working in the health insurance industry in 2005. This ballast pulling down the delivery of health care is not just massive, it's also aggressive in ways that make self care very difficult without opting in or living like a squirrel - which is probably what we should all be doing. If I went to see my cardiologist without my insurance, the echocardiograms I periodically get would be ruinous - not because the doctor is greedy, but because the doctor has been forced to charge a fake price, of which a tiny portion is actually paid to the doctor by the insurance company. The insurance companies have created a rigged system where doctors can only charge reasonable prices to patients with insurance.
So here we are out at sea, with the insurance CEO captains telling us we have the best system in the world, paying fortunes to advertising agencies to create campaigns to make it look like we do, and with legislators on the take.
What are we going to do with this predacious ballast? We need a program of economic rehab, but cartels, pushers and addicts are sailing the ship and they've sabotaged the lifeboats.
15
Good column. There are many better ways to help improve health. Let’s ditch this bill and focus on real solutions.
7
One of my favorite things is that feeling of a just-finished workout. My least favorite thing is to find an 2-hour window in the day to get that workout.
I consider the workout to like a real job: it supports my life. So it's not dispensable. Which makes that least favorite thing inescapable on a constant basis.
All of those things in the legislation are fine. I'd love to write off the $600 a year for my gym membership. But cost isn't a problem. Nor is will power. It's a matter of time.
4
@Wallyman6
It's a matter of time AND money. If people didn't have to work two or three jobs just to survive, they might have time to take better care of their health. They would not only be less stressed, they'd have money to buy wholesome rather than fast food, and time to prepare healthy meals.
They might even have time to do the kind of exercise that doesn't require a gym.
But of course, raising wages is out of the question.
12
Thanks for some common sense. This needs to be applied to many other topics!! I feel less stressed already!
4
As a Canadian, I feel incredibly fortunate we have a universal health care system. Yes, we have wait times to see specialists, but in spite of that I know my loved ones and I will receive the care we need. The cost, less than $100.00/month per person if single, slightly more for an entire family. If emergent, Canadians receive care expediently (specialists included).
My husband is American and he has lived in Canada for several years. One thing comes to mind, which he is very cognizant of, Canadians have more time off than Americans. Most months have at least one long weekend. What do we do on these long weekends you might ask, for the most part, we spend them with our families. Full time jobs have a bare minimum of 2 weeks vacation per year, but I would venture to say 3-6 weeks or more per year is more likely the average. One may ask, how do employers afford such benefits? The Society for Human Resource Management notes "Employees are increasingly aware that if they take time off, they will perform better at work. In his book The Happiness Advantage: The Seven Principles of Positive Psychology That Fuel Success and Performance at Work (Crown Business, 2010), Shawn Achor cites research from the American Psychological Association that found when "the brain can think positively, productivity improves by 31 percent, sales increase by 37 percent, and creativity and revenues can triple." (article written by Lisa Frye is a freelance writer based in Alexandria, Va. ).
22
When America decides it is ready to join the ranks of the civilized world, it will eject Trump and move to universal health care. Medicare for all. Healthcare has already been determined to be a necessity that is why we don't turn people away in the ER. Government pays an enormous amount in inefficient ways for the uninsured in America. We pay more for healthcare than all the other developed nations. By changing our healthcare system we invest in preventative care. The diabetic is seen in outpatient clinics designed to teach his self care rather than relying on emergency care when his leg is red and edematous with infection. The GOP would rather pay for his care in the ICU and his amputation of his leg and then the aftermath rather than invest in a system which provides regular check ups and prevention so that he prevents the complications and is able to live well and to keep working. It really is not that hard to appreciate the benefits of such a system. It hasn't happened in America because there is a billion dollar insurance industry which lobbies Washington. The same reason Climate Change has not been embraced. It's not because it's so difficult to prove or to comprehend. It's because of the money in the oil industry and the lobbying groups which fund Congress. NRA, follow the money. Remember: Health insurance providers do not deliver healthcare. They are only middle men making huge profits.
31
I am on my way to a doctor's appointment. Yet I have no clue at which level my insurance will cover it. No amount of research gave me a clear answer, the insurance itself does not know. For a minor surgery I recently had it took me days of phone calls to figure out which clinic is fully covered, and a lot of cross checking to know which information from clinic and insurance is correct, and which one false. And then there is the nearly monthly phone call to get some medical bills corrected. Sounds familiar? If a person with a PhD and plenty of time struggles and sometimes simply has to use savings to pay medical bills that should not have happened in the first place, how should somebody with less education get good health care without paying too much and going broke? The only solution is not to go to the doctor at all. But it does not have to be that way. Even in countries with private health care (e.g. Switzerland) people do not have to worry about any of this as coverage is clearly defined by law, in a very simple and straightforward way. Everybody has good coverage, there are no outrageous out-of-pocket costs, and whoever does not earn enough to pay the premium gets financial help. And because it is all regulated one does not regularly fall through the cracks or get caught up in loopholes.
28
@Dorothea Agreed. Germany is similar where I live part of the year. What subsidizes these health care systems is taxes. Here in America we want our cake and eat it too--we want a highly functioning and available health care system without paying the costs. Yet we are quite unwilling to reprioritize our values: we'd rather subsidize nuclear weapons, wars in far flung places, and the financiers. Until we have a shift in cultural values, we'll not have a shift in how our money is spent.
I think that tax destructibility of gym fees would increase gym membership. I think that would represent a public health success.
3
@Gerold Ashburry, the personal deduction is so high that few people would actually save. And if a membership cost $600 a year, you’d only save tax on that (if it’s worthwhile to itemize), which means you’re still dishing out probably $500. If I can’t afford that, there is no incentive for me.
2
@Gerold Ashburry
I'm against making gym fees tax destructible.
@Wine Country Dude
I dont know Dude. I did not know that gym fees were taxed. But if they are taxed, I think these taxes should be destroyed.Why would you want to tax gym fees?
Maybe in their place we could tax something really bad like watching porn or Netflix.
This is just another program to punish the poor and middle class who are already busy. Preventive care is best, which this law would try to encourage, but millions of people are already working really hard. The reality is that accidents and unforeseen illnesses happen. The GOP needs to realize that hereditary poverty and institutional racism often stand in the way of healthy lifestyles.
I wish we had a decent health system that could help lower and middle-income people. Oh yeah, we do, the ACA. Instead of killing it through a lack of funding, maybe the president, who is supposed to uphold the laws of the US (that is the main function of the job) could work with Congress to improve it. But, wait, I forgot, we don't have a president that cares about public service or a Republican Party that cares about people. They only care about helping their wealthy donors and themselves.
18
"This explains why people with an abundance of opportunity — those with higher incomes and more education among them — are likelier to make sound financial decisions, like investing in health savings accounts."
This isn't about making "sound financial decisions," but many people cannot afford to put enough money into an HSA to make it worth it. When your deductible as a single person is aorund $1500-1700, you're not going to be able to contribute enough into your HSA to pay for everything before you hit that deductible. As someone who is young and makes decent money, I have other bills to pay (car, insurance, student loans, etc.) and have medical conditions that require regular checkups and tests (depression, anxiety, cancer years ago, etc.) that make it so that an HSA is worthless. Luckily, I am now on a low deductible plan, but an HSA was never worth it to me because I could never put enough into it.
Additionally, you don't get your money upfront with an HSA, so if you have big bills to pay at the beginning of the year, that's coming out of your own pocket. I find it problematic that this article implies that the reason people don't put more money into an HSA is because they are uneducated. Maybe this article should focus on the fact that HSA's are not there to benefit the employee, but rather the employer and insurance company because they don't have to pay as much.
11
If you expect any of these ideas to work, start by reducing the work week to give people more time. How about a 32 hour work week at the same salary? I suspect productivity would be similar. Fund this somehow by diverting the corporate savings from outsourcing and replacing labor with robots.
14
@PSS It's been proven that shorter work days and weeks increases productivity. Other countries do this, but then again, they also have universal healthcare, paid parental leave, mandatory vacation days, etc. that the U.S. is unwilling to implement.
13
@Stacy
True! As long as the Almighty Dollar and Higher Social Status are the major foci, people will be working long hours and not paying enough attention to their health.
A look at some European countries' and Canada's systems will provide ideas which would be useful. "MAGA" ideally would include sober thought and action about national health .
1
We already hear that fewer people will be needed in many areas of the labor market; instead of fewer jobs, we need to keep people fully employed but for fewer hours at a sustainable salary. We also need to keep an immigrant pool adequate to support the aging baby boomers’ activities of daily living. This is one area where we need more workers, not fewer, but immigration policy runs counter to the need for support services.
3
I lived in the UK for a few years and their health care system, while not perfect, was heads and tails better than our's. Once I got my NHS card I really didn't have to think about health insurance or expenses at all. All medical records were computerized so no filling out silly forms every time you see a new doctor. No copays for anything! All of my specialists could see all of my records unlike here. I even had to go gluten free for a short bit of time and the NHS provided essential gluten free foods for free.
And it all cost me less in taxes than what I pay here for private insurance.
The only reason our current system remains in place is become some people are getting rich off of it and ignorance on the part of some members of the voting public.
Sigh.
18
@Kathy
I understand that NHS is under considerable financial strain. There's no guarantee, particularly given the political turmoil in Britain, that it will remain unchanged.
This doesn't sound like an incentive "to nudge Americans".
It sounds like a tax giveaway to the upper middle class (of which I'm a member), who:
- already pay for gym memberships
- have full-time white-collar jobs that offer HSA's and FSA's, and
- can afford to take a chance on high-deductible plans and have enough saved to pay a $2,700 deductible.
19
A study illustrating that law-makers and the well-off don't understand how people in real poverty actually need to behave to get by seems ridiculous at first. But it is not. It is necessary to factually and rationally counter the delusional 'bootstraps' fantasy the financial elite carry about their own capabilities and use to disparage and discredit everyone else.
99% of policy makers don't have any lived experience with bottom 25% grinding poverty. Those who claim modest roots were not in desperate multi-generational poverty. Education was still seen as a possible goal and understood as desirable. Not true everywhere.
Rational policy based on fact is a good thing. Politicians need to know the realities of their constituents, even without having to live it themselves. In the putative wealthiest country in the world we should not have any poverty at all. All our citizens should be secure in their residence, sustenance, heath, and education, with NO exceptions. Or we have no moral claim to the greatest nation on earth. Our only real claim is the wealthiest, most shortsighted, mentally ill, and morally bereft financial elite.
22
@Trebor We are demonstrably not the greatest nation on earth as evidenced by current objective research. We are the greatest at continuing the fable.
The revised statement should be "we are the greatest nation on earth [for 1% of our populace]". How can people not see from all the reported hardships we saw during the shutdown that we are all living too close to the bone? We have to get our expenses (health, education, etc) in sync with our salaries. We need a modern day moon shot program to get us out of national decline. A sharing economy with We The People as the beneficiaries of nationhood is going to get us there- the current carving it up in a backroom for a few is going to break us apart.
3
@Bill Bloggins Well said. Myth busting needed. We need to get real about our self image in the USA.
I just had an experience with excessive choices. The DOD dental plan closed down the end of the year and I had to sign up for the federal employee plan which had 37 choices. It was overwhelming and since I don’t have dental issues I chose not to sign up for any of them. How do you predict what health problems you will have the next year. My sister got lucky, she got cancer during the Medicare sign up period. So she went from a nothing plan to a full coverage plan and didn’t waste money. But the waste from HSA is enormous, how many pairs of glasses or elective procedures do you need so you use all the funds each year.
7
Walk, don't run, to your nearest Progressive Dem Candidate.
Walk, take the stairs.
Smile.
13
So, who is going to regulate these fitness clubs? When does a fitness club with a juice bar become a restaurant with a half dozen tread mills? What understaffed IRS is going to enforce whatever rules are established? Will a religiously financed fitness center be allowed to deny membership to LGBT people, while still benefitting it’s straight members’ tax deduction? Come on, folks. This isn’t even a reasonably well disguised honeypot for the fitness real estate industry, which will use the tax deduction as a way to justify raising “membership rates”. So, I have a suggestion for our esteemed, but totally out-of-shape Members of Congress and Senators, why don’t you put away foolish things and fix Obamacare. Oh, and lose weight and get in shape. Just saying.
56
@CABchi
This is a very accurate description of the real world consequences of creating a new deduction: unless carefully policed (and the IRS doesn't have the resources to scrutinize these relatively small ticket items), you just create a new boondoggle.
1
A public swimming pool for every 10,000 to 15,000 people would do more good than all the medical care put together (not kidding do the math).
However make all the swimming pools safe from bacteria using sea salts that release small amounts of chlorine slowly or even better ozone with no chlorine, doing infinitely less harm to lungs and less damage to skin and hair.
Why all Australian pools are made safe from bacteria with salts or even better with ozone? Why do we use in the US mostly use raw chlorine?
Annual maintenance costs quickly pay back the extra cost of installation for salts or ozone! Is someone using public pools as profit opportunities at the expense of public health? Or is just ignorance?
11
@Eli-excellent! thanks for the Australian method of water safety!
For the millions of people who have difficulty walking, swimming is great, what with the low impact on the body's joints. The cardiovascular benefits of swimming can not be over estimated. And the terrific feeling and exhilaration after a good swim in a properly regulated (temperature and low bacteria-count) public community pool is priceless.
2
And they needed studies to figure this out?
10
Simplify, simplify, simplify.
It's our culture ... it's running us like a cowboy herding cattle.
1. Simplify how healthcare is delivered and paid for. Universal.
2. Simplify after-school activities--your kid may say he/she LOVES such and such an activity, but put some limits on the number of activities. Oh, and a fifth grader doesn't need to go across town or to another state to compete. Or go on a trip overseas.
3. Simplify what you really need--you may find that having friends over while watching kids play outside is much less expensive and much more relaxing than running to the next competition, sitting on backless benches. You may find you don't need 3 TV sets, a new phone with each new edition or whatever.
4. Simplify your exercise. Participate in community provided activities, such as softball, pickle ball, tennis, walking clubs, pick-up games at the local schoolyard.
We create our own days/lives. We don't have to follow the herd. We can choose to live in a slower lane without depriving ourselves or our children.
Have someone over for tea or coffee and while you're doing that, let the kids figure out what they want to do--don't let them interrupt you. Let them figure it out.
It's so much more relaxing. It's so much easier to eat nutritionally when you're not always rushing. It's so much healthier for everyone. It's your life. I hope you enjoy every last minute of it.
24
@Nancy
That sounds nice, but I have to call out #2. I played rec sports growing up, and didn't get serious about athletics - or even good at them - until my last couple years of high school, after which I went on to play in college. I'm only 37, but the entire landscape of youth sports has changed in the last 20 years since I was a kid. I don't like the changes. I don't like the expense. I don't like the schedule. But, opting out means that your child will never even make it onto his or her middle school team, let alone the high school team. Where I live (a very affluent city), in order to continue playing (many) sports past elementary school, you have to have a significantly higher level of athleticism and skill than you did when we were kids. Travel teams and private lessons are de rigeuer.
Participation in sports are some of my happiest childhood memories, and I give it 100% credit for the habits of exercise I continue as an adult. I want my kids to have that, too. In 2019, in Boca Raton, for the sports that my kids play, that means joining the Crazy. It's a collective action problem, but it won't be solved by my kids, and I won't ask that of them as long as I can make it happen.
Bottom line
A very ill person and stressed out family caregivers with low education will be unable to manage their health needs and outcomes.
Healthcare plans should be patient friendly and easy to. Use.
There are elderly that eschew computers.
11
The simplest 'passive' healthcare plan is medicare-for-All with premiums deducted with taxes & social security. Incentives for healthy living could reside with primary care clinicians (MD, NP, PA) with whom 'motivational interviewing' is available.
Tax deductible expenses for certain verified activities might be part of a tax return...rather active but highly incentivized by refund.
The government can impose 'cap&trade' style disincentives on corn syrup, processed sugar & carb products, cigarettes, red meat and toxic additives.
13
Our country needs universal service for all young people (age 18 or 21). This service would facilitate “rubbing shoulders “ with others outside your own socio/economic group, and would would diminish the polarizing forces in society. We’d like develop more empathetic citizens who would be willing to fund healthcare and quality education.
9
@rach55 Nah, this country needs universal healthcare.
2
@rach55, But the stress of the experience would probably kill half of them.
2
@rach55. Bone spurs and the equivalent would keep out the Uber rich so it would be a false leveling device.
"...deposit more money in tax-shielded health savings accounts"
And more, and more, and more.
What happens with the money sitting in these pools of accounts? Is it used to make profits? If so, did lobbyists supporting those industries help write this legislation? Am I too cynical?
11
Saying that "most" people won't benefit from a proposal doesn't mean it's a bad proposal, even if you think there's a better one. Encouraging people to take an active role in their health seems worthwhile.
4
I think we would do well to start talking about public health as infrastructure, the way we talk about roads and bridges and water and electricity and internet and basic education.
24
The solution is not to treat people like livestock and make their decisions for them, it is to declutter both the healthcare and healthcare insurance markets to simplify the decisions that must be made.
That starts with reducing complexity by repealing regilations that create it and instead creating regulations that curb the chaos of an otherwise unregulated sector where free market economics often provides perverse results.
For example the necessity to spend FSA $ by the end of the year vs allowing HSA $ to accumulate and the necessity that the accounts be coupled with specific prescribed insurance plans provide unnecessary complications and barriers. One simple HSA account law that lets anyone and everyone take advantage with a single $ limitation would simplify that matter considerably.
The healthcare sector is in dire need of price regulation for out of network emergency services. This can be done at the state level by simply mandating that providers charge no more than, say 150% of Medicaid payment, for emergency service preventing rapacious piratical billing. It isn’t perfect but it would be enforceable since the states set Medicaid fees.
4
@KBronson You state the root of the problem but your solutions suggest continuing in a fundamentally problematic way. "chaos of an otherwise unregulated sector where free market economics often provides perverse results." This is a far more substantial observation than your solution suggests. In health care, at a fundamental level, drug research as a for profit enterprise is beyond perverse. It precludes even the possibility of research into drugs that might be effective, cheap, and readily available. When you consider we are talking about our health, our physical being, and constraining our efforts in health care to those that will be profitable to someone? WTF is that?
Limiting out of network billing rates would certainly be consumer friendlier. But networks themselves are the problem. They are absolutely useless wasteful artificial barriers to access. An example...I was in a plan of an insurance company that offered the same plan at the same price in another city about 30 miles away. The "networks" were different though. If you were in one you could not access another. I had to enroll in the network away from my town in order to have access to an oncologist running a trial I was interested in. So ALL of my other medical interactions had to be in the out of town "network". Same plan, Same price, BS network.
The actual answer to the dysfunction is a single payer, medicare for all system and vastly expanded public research with NO transfer to private patents. Nonprofit
3
Trying to predict health care needs for the next year (so you can pick the best plan) is a ridiculous exercise. Especially if your are making the selection for family members as well. The article hit the nail on the head - our overly complicated healthcare delivery and payment system is unlikely to improve enough to deliver the kind of results seen in other first world countries. Where people live longer and are healthier than in the US. And medical bankruptcy is unheard of.
21
If and until we have universal health care, the US will remain a country where the rich continue to get richer and the poor continue to get poorer, but hey who cares about them?
“I’ve got mine, so to hell with you” is the American way, and we have a president to prove it.
35
Yeah, we’re all too stupid to do this ourselves so let’s get government to do it for us. I’m sure that’ll be super efficient and will work great.
4
@Thor
You missed the point of this article. We're not too stupid, we are too busy if we have full time jobs plus housework, not to mention childcare and/or elder care.
11
Ridiculous proposal. Waste of money.
The proposal benefits few. Many who are employed with HSAs already get an employee contribution to funding the HSA...plus many employers offer gym memberships and have wellness programs. People who want to do wellness, already are. Those who aren’t doing it now, won’t do it in the future.
Need we remind the Repubs that HSAs are coupled to insurance. Where I live, the silver ACA plans have 5k deductibles per person and do not have an HSA option. And no FSA. You can’t elect an HSA on your own even with high deductible insurance unless it’s part of your plan. So, the benefits of this silly proposal go to those who really don’t need them, like most Repub health proposals.
Medicare for all. Please.
10
The answer is universal health care with a cradle to grave education on preventive care through healthy living .The end result is a strong productive population, and the medical establishment would end up with less of your money.
24
@Joe Gilkey
great idea, but there's nothing in it for Big Pharma, which is the main driving force in our country, and certainly in Congress.
6
@Joe Gilkey
I love this approach but I don't even think it requires "cradle-to-grave education". It requires following 4 simple edicts: (1) eat only natural, diverse, and minimally processed foods, (2) maintain a healthy weight (BMI 19ish-24ish, depending on your build), (3) stay physically active through a variety of exercise modalities, and (4) avoid exposure to known carcinogens. Voila!
7
@GBR Great suggestions for those who have the time and inclination to read up on things like: natural, diverse, minimally processed foods, BMI, avoid exposure to known carcinogens. What you are describing way outside most peoples' orbits. Many places are struggling to get clean drinking water to people. Been to Detroit lately?
For a family, you can talk all you want, but with the long commutes and the use of the parent as the unpaid homework helper, there isn't much time. How about start with ditching the homework helper role. Stop sending homework for preK-8 that the child can't do by himself within the 10 min x grade level recommendation so both the child and the parent can have the time to participate in making healthy meals and physical activity if he doesn't walk a mile or more to the bus / train stop.
11
As suggested in several points in the article, this Republican plan addresses motivations for those with means. Yes, people living even at 200% or the federal poverty limit and much higher often live hand to mouth, completely focused on the present. They might love to join a gym but have to focus every minute/calorie on the time and energy it takes to get through the day, one day at a time.
And where are the affordable gyms in low-income communities? And how would this address the needs for non-white cultures adversely impacted by language challenges and access challenges, to boot? And with whom did the Republicans consult? Anyone that wasn't just like them?
This is just another sliver of an effort to address just one part of the larger and inter-connected issues of wealth distribution, poverty, education, health care and culture. Start with making the education system work well for everyone, so everyone has an equal opportunity to compete for available current and future jobs. Start with comprehensive and personalized primary health care for everyone. Start with a living wage for everyone. Those three legs could build a powerful system of sustainable growth and achievement for the majority of Americans.
18
My spouse and I have been using our employer’s FSA option the past two years. The first year, we had several extraordinary health expenses and exhausted the funds before the year was out. So, we increased the amount that was taken in 2018. We had extraordinarily low expenses, and found ourselves on New Year’s Eve with nearly $1,200 of OUR money that was still in the account, had to be spent by midnight (no spending grace period), and by IRS code could not be given back to us. We ended up shopping in one of those online FSA stores for stuff like deluxe first aid kits and cases of contact lens cleaning solutions. I couldn’t stomach the thought of purchasing things I hope we never need, like special vibrating bed mats. But, this drive to buy semi-useful things convinced me that the FSA is one of those illusory choices that soaked up our energy and free time. It also persuaded me that single-payer health care is something our country must do, before we drown in our choices.
46
FSA allows each person to carry over $500 to next year. Since I expect your $1200 is combined, you should cover $1000. Could you have gotten a teeth cleaning in December to eat up the $200?
It used to be that UpShot articles were the gems of the paper.
With this one though, is unlimited access (or quantity requirements?) causing declining returns to publishing?
1
I've been saying these things for decades. All you get from well-to-do, well-educated conservatives who make government policy is complaints about the "nanny state" and noises about the great benefits of the "competitive market" and "individual choice".
For life and death things like health care, retirement income, public safety, and financial protection, we need less choice and more well-designed systems that benefit us all. Little people being tripped up by the fine print that rich people have "advisors" to steer them through is not a way to run a just society. Rich people blaming the poor for not prospering in this screwed-up system make my blood boil. As the article says, your average person is too stressed and overwhelmed to do a decent job making so many complicated decisions about so many areas of life. It only leaves him vulnerable to abuse by those who hold all the cards. It all comes down to who gets to rip you off when you are too fed up to keep dithering over what "plan" to sign up for-- whether it's your insurance, banking, cell phone, cable TV, retirement, loans, education, travel, or what-have-you.
38
@Lisa M. Thank you-- my sentiments exactly.
8
More rearranging deck chairs on the Titanic mistake that is our privatized health coverage system. Enough. MedicAID for all. No copays, no premiums, no deductibles. And control the drug and specialist prices. I'd pay more taxes for that.
30
Yeah, Ill pay more taxes. But I want to get a rebate from my employer who will save a bundle if they no longer provide health care.
2
@JohnYou are free to negotiate higher wages.
1
"Work by the University of Southern California economics professor Leandro Carvalho and colleagues showed that low-income people were more “present-biased” after payday, worrying about the immediate more than the long-term effects of their decisions."
You think?!
Another "solution" for the demographic that already has more than enough time, capital, and gym memberships - and whose income can benefit from another deduction.
Brilliant!
9
My wife and I just met with a financial planner after inheriting a moderate sum of money. We have two young children, and both work in white collar outside the home jobs.
The planner regaled us with all the nooks and crannies of the tax code around retirement, education, and health savings. We were overwhelmed with the options and basically agreed between the two of us we should just do the simplest thing so we don't have another thing we have to manage (backdoor Roth? who's going to manage the four days of shuffling it between tradition IRA and Roth? Who has time?)
It struck me there is a large population of the US public who is not used to the idea of either paying someone or even making time to manage their finances. To people who did not grow up with means, witnessing their parents allowing themselves time to make these decisions, likely find it difficult to think it is worth the time.
Another element is the marginal benefit a Health Savings Plan may provide us. If we made a lot of money, that benefit would be more obvious. In order to empower people without a lot of money to invest in health savings, the benefit will need to be easy, obvious, and overwhelming.
Wealth isn't just a number; it is a way of perceiving the world around you. It will take a real shift in our mindset from the head-down, just pay the bills, to thinking we deserve the time to spend managing wealth. We know this is a crisis of success, but it still feels foreign and weird.
12
The head down approach was an anomaly of the post war decades. Historically every asset owner always actively managed her assets from early colonial days. The idea that some institution would take care of you was a byproduct of certain corporate and government structures that never had a future. FYI, go back and look at the back door Roth. In a time of sudden decrease in stock value, now, it offers a great way to move your assets at much lower tax impact to a tax free investment account with great flexibility. Your future self could be kicking your current self for not exploiting it.
3
The owners of gyms would love this but unfortunately most people who join gyms opt out after a couple of months. I've never seen Lindsey Graham break a sweat.
4
"It encourages exercise by treating gym memberships as tax-deductible medical expenses." This completely ignores that fact that many people pay little or no federal tax. In other words (surprise, surprise!) this would only have any effect for the wealthier folks. But who needs poor people, anyway?
10
@Marc Wanner Thank you. My sentiments exactly
3
Gym memberships as tax deductible medical expenses? Whaaa? Who lobbied for this thing? World, Planet and/or Gold Gym per chance? Somebody sure thinks they'll make out, haven't they? I wonder if gyms will be required to provide a 1099 at the end of every year? ;-)
John~
American Net'Zen
9
The US medical system does not work well for anyone. I am tired of politicians who value our having choices instead of our having a stress free guaranteed coverage aka single payer system. I had to stay in a job that literally made me sick for 10 years because I feared I wouldn't get insurance anywhere else. I had no choice there. Now I am on Medicare. Talk about stress. I don't know anyone who can understand it. Elderly sick people do not need the stressful burden of having to shop for complicated insurance! Wouldn't it be wonderful to know that you are covered from cradle to grave no matter what? So what if I have to wait a little longer for non emergency care? Even Medicare doesn't cover everything as I found out in my first months of coverage. Even my docs staff and the Medicare customer svc reps don't understand the coverage. How am I supposed to? If everyone in US had same coverage, it would be clear to all what the coverage is! Just standardize it and simplify it already. We are being victimized by Republicans who chant "we must have choices" when all they are is a burden. Single payer=healthier individuals=healthier country. Now please.
46
@cjs Yes, single payer! Certainly not a revision of the Affordable Care Act. I, too, am on Medicare. It is the beginning of a new year -- out of the donut hole into trying to understand this year's deductible rules! Stress 101.
11
This is another tax scam for the wealthy dressed up as a social good. You give the rich increased ability to consume using tax free resources since they are the only ones with disposable money who can risk high deductible plans for the benefit of putting money in HSA savings pools, who have funds to give their kids tax free in the form of education 529s, and who would now get to pay some of their gym and other lifestyle consumption with tax advantaged funds as well. This is but another way of taking resources out of the commons to the fetriment of those who have little or no disposible money.
16
The standard deduction for a married couple is $24K. The median household income is $59K. That means, to itemize deductions, the median family needs to spend over 40% of their income on deductible items. If they are doing that, they have no money left for gym membership.
In short, no one who can't easily afford gym membership without a deduction will take the deduction.
14
The US has the world's most inefficient and expensive health care system. Naturally, the Republican solution to this is another tax deduction -- for health club memberships. Always thinking of themselves, the wealthy white men of the GOP.
26
The authors would have been better informed if they'd actually talked to lower income people who choose to forgo flexible spending accounts. When every penny counts, they are a poor choice in the bigger picture. When there is no health care stability, sliding between Medicaid and Obamacare Market coverage, as anyone would who works, the accounts don't cover the bigger expenses, insurance premiums, co-pays and uncovered unanticipated expenses. The cost of prescriptions shift so much it's difficult to calculate. Bandwidth is the key factor that keeps the poor from taking advantage. Literally, going from crisis to crisis all while dealing with inhumane working conditions, it is simply asking too much of even an informed, educated but still poor person. How can anyone go to a gym when they only get one day off at a time, that day determined by an algorythm that cares nothing for the well being of the employee, and a schedule that is never the same week in week out, making some one work til 9 at night and 7 or 8 the next day and at risk of getting a tardy for being even 1 second late.
This educated, informed but poor person blames, Kronos software allowing employers to torture employees with a time clock as the single greatest health risk in the country. Not only adding stress but making driving lethal with so many under the gun literally scared they will loose their job because of traffic when all resources, time, money, mental bandwidth are stretched beyond all human reckoning.
29
To this I would add many other passive steps governments can make to improve physical (and, by extension, mental) health:
Walkable communities
Protected bike paths
European-level vacation benefits made universal
Clean, safe parks
Subsidized sports clubs for youth and adults through well-funded parks & recreation departments.
34
@IanC My employer already offers to pay $25/month for a gym membership, but I don't use it because I can't be bothered with the paperwork even if I did want to spend the time before or after work on the drive to the gym plus an extra shower and change of clothes. A tax break won't make me join a gym either. What did help my fitness was buying a bike and getting into the habit of riding to work and errands, because the streets where I live give me room to do that. Another built-in form of fitness is taking the bus to work and walking to the bus stop on either end. Either one gives me a total of about 45-60 minutes of exercise per day, built into my routine. No tax break needed.
11
@IanC
Running tracks that are open to the public are necessary too. Running on paved sidewalks or isolated paths is not for everyone. Some high schools have tracks but they tend to be restricted to students.
3
Do not understand understand the appeal of a gym membership and a tax deduction for the same. Regardless of the time i spend at the gym, I would need to add at least 40 minutes (getting to the gym and returning home or work or whatever), not to mention the travel costs in gasoline or bus charge or whatever. It would be more economical and sustainable to improve infrastructure, adding sidewalks, improve local parks adding walking trails, improve grocery store options closer to residential areas etc. Exercise has to be integrated in our daily living not a separate item/thing to add to to our "To do" list and eat less than we do now.
40
@jana "the appeal of a gym membership and a tax deduction for the same". Almost every bill is initiated by the lobbyist. Tax deduction for commercial gym membership certainly falls in this category.
11
@jana. Yes, I agree with you completely. I think part of the problem has been this outsourcing of exercise and physical activity to a gym, as a separate thing that you may or may not have time for. I went to the doctor a couple of years ago and they asked about my exercise, and I was embarrassed to say that I didn't make much time for it. The doctor asked some follow-up questions about my physical activity, and I said, well, yes, I walk about 3 miles a day to/from work, more if I'm running errands, I live up multiple flights of steps, I actively play at the park with my kid, I do housework, and I garden in the warm months. I was informed that I was getting the recommended amount of activity.
2
I cannot find out which surgeon or specialist has good results indicating superior skill versus bad results. I cannot find out which doctor will see me in a hospital or interpret my test results to find out if they are in network. I find out at the pharmacy that a drug that was covered last year is not covered anymore. I cannot find out how much a procedure will cost ahead of time. Without basic information being routinely available such an active plan is doomed to fail. It is just another Republican con game that will give more tax cuts and shift more money to the rich.
75
Looks like you got results of the Carvalheo et al study backwards. You say "Work by the University of Southern California economics professor Leandro Carvalho and colleagues showed that low-income people were more “present-biased” after payday, worrying about the immediate more than the long-term effects of their decisions."
Carvalho et al's paper says: " Before-payday participants behave as if they are more present-biased when making intertemporal choices about monetary rewards ..."
The larger point is that the lack of liquidity immediately before payday leads people to focus more on short-term outcomes. This may also support your point, but it's nice to get the science right when making an argument
12
@R Clark Thanks, I didn't catch that myself. It isn't intuitive as presented in the article but makes more sense as it is in the science paper.
3
This whole plan is just ridiculous. It doesn't provide care, doesn't keep you well, doesn't give the average American realistic options, and most don't itemize. This is just a plan that makes rich people and bad politicians feel better about themselves.
25
Totally agree that wellness programs represent the vilest, most cynical intrusion into employees health yet devised, and amount to nothing more than extortion of overworked employees who cannot take the time for yet another administrative burden.
The thing to understand about your time vis-a-vis the medical system is: it is worthless. Anyone who has had an elder relative in need of a great deal of care understands that: appointments to get appointments to get appointments, etc. Every visit piling on more and more paperwork, it gets to be a full-time job for somebody.
It's not true that the US health system has absolutely no advantages (although heavily weighted in favor of for-profit healthcare providers), but every time I get yet another piece of administrative work related to healthcare I am ready to just give up: single-payer, socialized medicine for all; we do what the UK does and set an upper limit on what we as a society are willing to pay and sneak in under that budget by rationing (in the form of waiting lists).
22
While reading, I was waiting to hear the author expound on which new passive health policies would work to help our current state of affairs. I was disappointed by the end of the article.
Anyone who has thought at all about these issues knows that the current policies only help the more well-off people. What we really need is systematic change that helps all of us, especially those who are struggling. Let's hear more of that, please!
19
It would be nice to use the card for my HSA account when I buy new running shoes.
9
@Joe Mc also yoga /meditation classes. Massage?
2
Tax shielding helps the rich the most. This is just doubling down on a broken system. How many more hospitals need to close before the Republicans, and rural America, come to their senses? We're the richest nation in the world, yet we have the worst health Care system. Enough is enough!
23
It is illogical to think that exercise & gym usage will stop all health problems. My sister & her husband both go to the gym several times weekly for decades. At 75 they have recently had surgery for broken hip, gall bladder, prostate cancer in addition to multiple hospital stays for pancreatic issues and a months long stay for MRSA. I work in health care and it is sad to see the people struggling to pay their bills for meds, chemo etc. That “free” gym membership from you insurance company is costly if you do get sick and is no guarantee you will stay well. We all age ( or die)
38
Currently living in Washington DC, we are taxed for having a gym membership. That's right, if you want to be healthy, you are taxed for it in the nation's capital.
3
I have to agree with some others here.... who itemizes? Every time I drop something off at Good Will and they ask if I want a receipt I think, did you see this Honda? What makes you think I could use a receipt here?
I do bust out the big bucks (from my teacher salary) for a gym membership and fresh produce. But there's no way that I'd ever be able to itemize more value than the standard deduction. And I'm middle class (only because I'm married). I agree with others here. This is more welfare for the wealthy.
74
@ LB
"who itemizes? Every time I drop something off at Good Will and they ask if I want a receipt I think, did you see this Honda? What makes you think I could use a receipt here?"
Actually, I always ask for the receipt when I go to Goodwill. I always itemize what I'm donating before I drive to Goodwill. And I own a Honda (Civic), but why should that stop me from asking for the receipt every time I'm there? Why not get as much remaining value as possible out of those items you're donating?
I can't use the receipts because I don't itemize myself, but my parents and my brother do. This won't help me with making it more likely I'll exercise, that's true, so yes I'm digressing from the whole point of this article. But maybe others in my family who do itemize can use the receipts to reduce their own taxes. In this way, I'm helping other members of my family. So I always staple each itemized list and their receipt together and then give or mail all of them from Goodwill to my father, and he can either use them himself or, if he wishes, pass them on to my brother.
@Dov Todd
You realize that, although almost certain to go undetected, this would be tax evasion on your father's part, since he did not make the donation, and the goods weren't his to begin with. Same as if you said Ok, you take the deductions for my children, since you're in a higher bracket and will get more tax benefit than I would.
16
@margaret
Wow, I had no idea. Thank you for the explanation, much appreciated.
I just wanted to point out that very high deductible insurance plans are NOT HSA eligible. I am in good health and don't need to spend huge sums on monthly premiums, so I picked a plan with the highest deductible ($7,900) and the lowest premiium. I would love to be able to prudently put money tax-free into my HSA, but inexplicably, this is not allowed.
6
@Sharon hmm, might want to ask around, my high deductible plan in MN does allow HSA contributions, and my employer contributes to it too as they save even more with my riskier choice
6
@Sharon
all High ded plans allow for HSA - that is the selling point there. Pls ask around as advised by another poster.
3
I’d rather lose money and get to ponder the starry firmament above than slog through yet another document about how I can save money on some new health plan (aka scam) or other.
7
For the health of our population and the health of our environment, there is a “two-for-one” investment: more sidewalks and pleasant paths/trails that provide connectivity with other trails and other modes of transport.
When did we start building new residential communities without requiring sidewalks at the very least? I’m guessing about the same time that Republican talking points proliferated that accused government as being the enemy. Trails don’t build themselves.
I am on the board of a small trails advocacy group that attempts to plan and facilitate the building and maintenance of urban and rural trails. It’s an incredible amount of work to create even modest improvements in trail infrastructure. Local jurisdictions are loathe to participate, which is our biggest hurdle. Unbelievably, the local powers that be seem to associate the common good with “communism”.
Which leads me to believe that America’s finest days are behind us. We don’t build infrastructure for the common good anymore. We seem too busy fighting against each other, in an environment of increasing tribalism. Profit seems to be the most important feature of any project under consideration.
33
@Just Curious
It's not just a rurual issue. The path to the Metro North rail station in Spuyten Duyvil has no sidewalk. It's a narrow two-lane both-directions with side parking street. I guess they assumed that only motor vehicle users would want to take the train.
Requests to build a sidewalk were rebuffed with "no funds available" by DOT.
3
@Just Curious
One of the things I love about Britain is the ability to walk the old trails from village to village over the old right-of-ways. Nothing more developed than a gate or stile through the fences usually. We would make it impossibly expensive here.
2
Health savings accounts are a joke. I know lower income people and they are scraping to get by. You think they will sock away money for a future health expense and know how to invest it? I suppose republicans will again blame the individual even though said individual works hard but pay keeps getting cut anyway due to inflation.
Sadly many of these poor folks vote republican because all they are about is stuff that won’t affect them like abortion and gay marriage.
16
Not to mention that the GOP took away tax deductions for medical expenses from almost everyone.
So only the already very wealthy would benefit from the tax deduction for their gym memberships. And no doubt they can deduct their country club memberships as healthcare as well. That Mar-a-lago payment becomes a healthcare medical deduction.
Have they no shame? (Sorry, rhetorical question.)
26
How many people struggling to pay their bills will be able to pay for a gym membership in order to claim a tax deduction? The number is exactly zero. What a stupid, insulting proposal.
30
This is one of the most important research on which to base public policy- that is when there are competent people in government and public service.
in addition, individuals can also come up with passive strategies specific to their lives: build in activity within the day doing things you have to do anyway: don't buy and bring home food and drink you don't want to eat, you won't have to be tempted with them; get off at earlier bus stops/stations and walk a bit to destinations; take a walk or exercise during kids' sports/activities instead of sitting and watching. those are all things that work/ed for me. as the years go on, I have to find new/different ways of doing these things.
5
I’m not hugely wealthy but I do have rental income that helps pay the bills. Land rich not income rich and it’s not much land.
I depend on deductions as part of my income strategy for many years. My costs have risen and income that was once mine has been confiscated to the tune of about 60$ to 70$ a week. This April will be a reckoning for many trumpies in high tax states.
6
@John
People should be anti-Trump because he is a corrupt, incompetent deconstrctor, amoral, dishonest, and selling off all of the US’s assets (that means yours assets too) to loyalists for pennies on the dollar...not just because of your taxes. Sycophants who fail to see the whole picture because they only care about $$$$ deserve all the bad they are creating and then some for making the US a third world country.
10
Investment in efficient public transportation systems, as well as safer bike paths, would help both the environment and people’s health. Walking to/from bus stops or the subway, or feeling safe biking to work, could become part of more people’s daily routines.
But, of course, such investment does not help auto manufacturers or gas companies, so don’t hold your breath.
37
Simple facts: only the affluent itemize deductions. The affluent already tend to be aware of what they need to do for their health. The affluent live longer.
Who would these nudges help?
46
@Martin Lowy
They live longer because other people work their backsides off.
6
@SW you're right but only in part. I am affluent, I own my own business and employ people. I work harder than the people I employ. I work 7 days a week. I have to think about literally everything, all the time. I never get a day off.
5
This is a typical sop to the middle classes and the wealthy. In other words a tax break to those who can afford the luxuries of gym memberships and sports equipment. It looks good on the surface and while it's intent may be laudable, it is not a health care measure that will make any notable impact on the health of the nation other than to curb tax revenues. It will mostly impact those who are active and engaged in sports activities already. Better to take the foregone revenues and support school sports and health education accross the country. Be it in inner city schools, suburbs or rural communites, getting kids engaged in sports and outdoor activities at an early age is a more inclusive solution. There is no magic pill. Healthy outcomes come from healthy choices learned early in life.
32
"studies show" that poor people have less money than rich people. "studies show" that people with more money tend to be healthier that people with less money. "studies show" that researchers get more grant money by being insipid, than do researchers who rock the boat. and so on......
38
Medicare for all.
Every citizen required to vote or be fined (as in Australia)
Re-institute a draft and include in it a much broader range of public service.
Require solar panels in any new buildings where feasible.
Invest in more green research (for example, the re-use of what is now landfill)
Require in every public school curriculum face-to-face skills, arts and recreation and balance with science.
Offer emotional education so that feelings can be shared and fear/anxiety/sadness better tolerated.
Ensure to the degree possible that all persons have outdoor time at least 15 minutes a day.
Teach civics (what it means to participate in your society) and the value of both social norms and personal freedom. Include an examination of everyday service and everyday heroism.
135
@lrbarile
“The value of ...personal freedom?”
After I have been forced to participate in a political charade, made a slave of the state as a forced laborer, spend my money on solar panels that I don’t want, sit through brainwashing sessions with state paid social workers telling me how to think and feel, and get herded outdoors with the other proles for the required 15 minutes of group calisthenics, I would be in a homicidal rage if I valued personal freedom at all.
Why has the left become so danged authoritarian?
2
@lrbarile
Excellent, excellent, excellent list!
One more thing: Instruction in critical thinking beginning in first grade and continuing through high school.
7
Being retired, and thus having plenty of time to ponder what health care choices I make, I've pretty well concluded that less is more. As our health care "system" is currently so corporate and market-oriented, providers (if one has health insurance), seem to want to follow any condition closely, suggesting quarterly scans, check-ups, etc., when the literature might say once a year is enough. Same with prescription drugs - way too many seniors I know are on three or more, their interactions/side effects not made clear or simply unknown.
I've reached this conclusion after lots of reading, talking with friends, and trying to apply some common sense. This approach saves Medicare some money as well.
This said, I support some form of healthcare for all as a national policy, the sooner the better. Just worrying about how to get it when needed, or if payment will be denied, is a huge stress for way too many.
91
This article overlooks a major source of exercise--commuting to work by walking or bicycle. If daily commutes were to become more accessible and/or safer, Americans with low income levels would have a built-in form of exercise.
25
@Carolyn B.
Low income may mean backbreaking daily labor...
Commuting to work by walk or bicycle presumes that you are going no more than four miles (walking) or 10 miles (riding), that the weather is good more often than not, that there are no mountains or large hills and that there will be a place to get cleaned up at work and, if applicable, store your bike without it being stolen. Also, if you are a parent, it presumes that you can quickly get easy transportation in the event you have to deal with a sick child.
Every bus, every 10 minutes, might be a better solution by making it possible to get to work easily and quickly, leaving enough time for real exercise.
29
@Carolyn B.
If you ride a bike to work here You had better have your burial and life policies well paid up.
1
Tax tobacco and alcohol more, to cover the health costs caused by their use.
18
@turbot
also tax heavily the new addiction of maurawana being pushed on the public as safe. The reason people use this drug is because of its mind altering properties which will encourage the use of more toxic drugs. The states that have passed laws accepting the risk gave also shown rises in more driving accidents and more risky behavior. We have released the fox in the. Hen house and more corporate profits. Stop this nonsense now before itgets more of a stranglehold on our youth. Make it illegal again.
6
Don't forget sugary drinks, and simple carb sweets and snacks.
10
@Mk Seriously? The old "gateway drug" argument again? Don't smoke that joint. Before you know it, you'll be shooting up heroin in a back alley somewhere.
8
Our clinic serves low income adults of which the majority speak Spanish. We have a full time Registered Dietitian and Behavioral Specialist on staff (bilingual), in addition to our physicians and NPs. We proactively work to educate our patients to understand their labwork, how to prevent disease and improve their life style choices. We are seeing a large percentage that are making many small changes, losing weight, improving lab results, lowering blood pressure and A1C. We are not "financially" incenting them, but understandiing their motivation for better health is important. Our fully loaded total cost per patient is $500 PER YEAR.
70
@LMR - Good point - spend the money on staff who can personally interact with people whose lives are complicated by poverty and trauma, and keep them from falling through the cracks in our health care system.
9
Incentives for Healthy Choices ? Isn't good health incentive enough for someone who cares about their well being ?
The way around our uneven and unfair healthcare system is to adopt a financially balanced medicare for all system. Sorry Healthcare insurers and their lobbyists (and the Congress they bribe) but we need to remove the administrative bloat and the profit incentive for denying healthcare (ever feel that you need to fight for every $ your entitled to for reimbursement from your health insurer) vs. providing healthcare.
Provide Bronze (high deductible with co-payments) type medicare plans for everyone. Pay for it by increased medicare taxes on earned and unearned (investment) income over fair thresholds without phase-outs. Administrative costs should leave the system and increased utilization promote efficiency.
Employers can use the money they save on their present healthcare plans to provide supplemental insurance to their employees to cover deductibles and co-pays. Individuals can also purchase supplemental insurance that should be cheaper than their present Obamacare policies or pay out of pocket for uncovered treatments.
This plan pays for itself by first reducing the overall cost of healthcare by removing needless bureaucracy and increased efficiencies of scale; second diverting money now paid by employers and individuals for healthcare policies to increased medicare taxes; and third taxing investment income on those who will be enjoying better health.
3
No. Bronze type plans with high deductibles and copays result in people choosing not to get the medical care they need.
8
@Sneeral
Agreed. People who can't afford it would be subsidized by money presently allotted to medicaid. If they can afford it but don't pay it and their health suffers, then that is Darwinism in action.
1
There is no standard meaning to the word “health” (or its synonym “wellness”).
If you are going to talk about improving health, you need to start by defining what you mean.
Are you talking about health as a good life, measured by happiness, fitness and productivity measures or only in terms of disease burden?
If the former, then we need as a society to support good child rearing and education for all, and tear down barriers based on color, language and beliefs.
If the latter, then we promote the availability of treatments to reduce disease risk.
I prefer doing both things.
In any event, it is unreasonable (and hateful) to tell people without enough time or money to use both to fix themselves.
10
We can lament the whoflull health of poorly educated, poor Americans. We live in a country of free choice and individual responsibility. We need to formulate a system of financial incentives disincentives to discourage smoking, high salt, high fat overly caloric diets.
Some Americans are victims of their own lazy, undisciplined lifestyles. It’s not the job of government to bail everyone out of their own sorry ways.
2
Expecting people to opt-in to a health plan is a non-starter. I am retired and I still can't find time to take a walk some days, let alone go to a gym. I depend on housework and gardening for a lot of my exercise.
Meanwhile, the people who would benefit from the Republican plan, by and large, are those who can afford decent health insurance coverage anyway. Those who earn minimum wage may not be paying taxes, so they don't need tax deductions, and even if they do pay some taxes, they have little if anything to put aside for health benefits.
We need single payer in this country. Most of our allies have it and all of them like it. They think we are nuts for not having it and not treating good healthcare as a right rather than an option. Yes, they pay more taxes, but they still live well, probably better than many Americans, if health is taken into account.
56
Where are the true choices?
We have misleading choices, choices with incomplete information. Hospitals have finally produced lists of what a treatment will cost, but the lists are very difficult to understand -- and if you can correctly identify the item, you still don't know your cost because the costs of the list are not final.
Try figuring out which health insurance company policy will best deliver the treatment you and your family might need. Try comparing health insurance policies for cost effectiveness and clarity.
Add cost to obfuscation and yes, you've got stress!
15
No mention of reducing smoking??? Imagine the health and cost benefits with a smoke free America!!!
15
There should be a “formulary” of healthful foods that qualify for reimbursement. And credits for verified exercise and weight loss.
2
Austin Frakt and Gilbert Benavidez are two of the smartest experts writing in mainstream outlets about the health care business, and it's terribly disappointing when they put their names to an article like this.
Perhaps an Upshot article isn't the place to say that this Republican proposal is the health-care equivalent of trickle-down economics. Perhaps an Upshot article isn't the place to say the plan was designed by people with money for other people with money; that it gives yet another tax break to those who are already blessed with tax breaks, that it pretends any improvements in the public realm--water treatment, sewage treatment, school diets etc.--simply don't matter; that it leaves the current demented health-insurance system locked in place.
If an Upshot article isn't the place to say those things, what's the purpose of the story? Who benefits from it? So far as I can tell, the only winners are the GOP legislators who created the proposal, and their corporate donors. They get the imprimatur of NYT for what is, at bottom, a legislative Ponzi scheme.
40
Which basic national public health services ought to be provided a population with ,by definition an ambiguous -quarrel -question different administrations will imagine differently .
Which priorities should be set ,limited by alternatives available.
Or what public and individuell financial constraints acceptable at different levels of care and infrastructure,like water supply by communities,public hygiene by sanitation services,waste disposal ,” clean” air to breathe in and with ...especially important to prevent respiratory diseases ....
Or public finance and public health : it’s all about political acceptability nd desirability to run a country financially sound for the long run.
Unlike many of the other commenters on this NYT article or other NYT articles on health and exercise, I really don't know why so many Americans are obese and have poor numbers on standard tests for blood pressure, cholesterol, and triglycerides. But I suspect it has more to do with our culture than it does with government subsidies.
When I worked abroad, I was surprised at how many clients in those countries walked on a daily basis when they got home from work. On weekends, many of them went on longer walks in the countryside. I don't see this behavior in this country. If, on the weekend, you aren't one of the very few people who are hanging off a mountain side in climbing gear or doing a long run in preparation for a marathon, you are probably not doing anything else to get outside and move.
15
@Carl
On weekends, my husband and I usually take a hike (3-6 hours) on one of the days. During the week, I’m in a Thursday, women only, hiking group, and we do hikes of similar length, or snowshoeing in the winter. Here where there’s a lot of trail infrastructure (thank you WTA), we see people of all ages hiking. Our local transit system, King County Metro started a program called Trailhead direct, to give people a public transit option to get to trailheads close to Seattle. It operates on weekends and is very popular. There is plenty of demand for outdoor recreation here and local government is paying attention.
2
There aren’t any sidewalks in the suburbs so people can’t walk unless they walk in the street.
5
Promoting a healthier and less stressful life style for us all seems pretty laudable. Managing time and money (finances) is almost impossible for most folks living pay check to pay check. A living wage would be my first priority and then folks will have more free time to pursue healthier pleasures either passively or with incentives.
20
"...in the health realm, they are public efforts like water fluoridation and air quality improvement."
Absolutely to air quality improvement, but fluoride, an industry waste product? Please look at the Harvard study done in China showing children who received fluoride treatments and lost intelligence IQ points.
3
@lechrist - the Chinese studies that you cite involved water samples in areas where the fluoride levels were generally at least 3-4 times greater than the amount we use here in the U.S. to fluoridate drinking water. Anything (even calcium and Vitamin D) can pose health risks if it is consumed in extraordinary levels, but fluoridation doesn't expose Americans to levels that could be harmful. On the contrary, the CDC reports that fluoridation reduces the rate of tooth decay by 25%.
14
@lechrist, A waste product? A suggestion for you would be to find a reputable area find information of fluoride. First would be to check out the periodic table of elements- It's located to the right of oxygen, and is a mineral, like many of the required trace minerals located in the table around it. Next would be to look at the information coming out of Juneau, Alaska; they stopped fluoridating their water 11 years ago and are now in high stages of decay for it's residents. Can you imagine a generation of their children needing dentures by the time they are 18 or 20? Wonder about how they will be able to eat with infected or missing teeth when many of them can't afford dental care? Let's look at the public health angle here; it's cost effective and provides a dental benefit for communities that don't have it naturally in their water. All you need to receive this health benefit is drink the water. No going out of your way for something strenuous, no major changes- better than an "easy button".
12
@SKaye You use lots of fallacy arguments here. Do you work for the industry? Plenty of countries do not fluoridate and are doing fine. Diet is key to healthy teeth. See Weston Price research with photos of those with non-sugar based diets versus those who consume high levels in their food. Fluoride is a potent neurotoxin, period.
1
Oh, please. When Republicans brag they did something to help the common person, it is always a solution that helps out their business buddies. Making gym memberships tax-deductible? Nice for Gold's Gym and all the golf buddies.
32
$100 million to subsidize skiing, tennis?!! Even subsidies for gym memberships is appalling. Many low end workers put in a lot of hard physical labor, or at least the '10,000 steps' daily just doing their jobs. This proposal to improve health benefits only those who already have enough money to pay their own way.
If you have to throw money away, why not maintenance of public parks and play equipment? And that maintenance activity would support a few more low- and medium-skilled jobs and/or summer employment.
101
@Kim from Alaska Good idea on the parks maintenance. I would like to see more invested in sidewalks, too. A pedestrian-friendly community is a healthier community.
5
Why don't people just plug the new parameters into their trading algorithms? They'd be in the gym in milliseconds.
It is fitting that articles on preventative care should discuss the importance of exercise in staying healthy. My concern is that health-related articles in The Times, especially in the health section, lean heavily on exercise as a health booster, but place much less emphasis on healthy eating as a cornerstone of preventative care. No doubt the readership benefits from exercise-related reports, but the relative paucity of food-related reports leaves much to be desired. I think it is less controversial to offer positive messages about the benefits of exercise than to wade into the thorny issues tied to diet and nutrition. Nonetheless, I believe if The Times takes as its mission to help readers make better health choices, it could restore balance by addressing more often the role of food and beverage choices in staying healthy.
14
@William Sadly, when this column does attempt to address the nutritional side of the equation it's with out-dated and weak information.
I think the Times does a poor job in this area.
4
Sounds like this bill was put together by the sporting goods and health-club industries.
"It encourages exercise by treating gym memberships as tax-deductible medical expenses."
For people making enough to make itemizing worthwhile.
"It would help cover out-of-pocket costs for high-deductible health plans by allowing people to deposit more money in tax-shielded health savings accounts."
For people making enough to not depend day-to-day on paychecks.
"And it would permit the use of flexible spending accounts and health savings accounts to buy sports equipment."
For people making enough to afford choices like that.
The writers are correct, this bill isn't aimed at those in poorest health.
51
My wife spent a month living in a suburban town in France. The center of the little town had a park and a free gym for the locals that was really nice and clean, along with other public services people need: a creche for small kids, a few soccer fields and a bocce/pétanque area that had a crowd of retirees. Sports in the town weren't based in the schools, they were based in the town, which meant that people kept playing and being active outside of the school year or after graduation.
We don't just have privatized health care. Americans have also privatized sports, gyms and places for people to play and be active.
238
@Brian
This is that nasty socialism the GOP always warns us about. We like our freedom here -- the freedom to go bankrupt from illness while our tax dollars are shoveled to defense contractors and the already-wealthy.
122
@Brian I have friend living in a commuter suburb right outside of Paris. She is a single mother with 2 girls. The girls go to a public school that serves only organic food, they take FREE piano lessons (typically $50/hour here in NYC) and FREE horseback riding lessons ($80/hour in NYC) and go on a FREE 10 day ski trip to some ski area where they're town has cabins as a school trip every year since Kindergarden. Really. Organic food and all those free extra curriculars. I'm sure there are other things to be had either free or at very low cost if you are French living in France - those are just the things I know about. It's almost like we Americans don't like children and parents.
24
You are missing the easiest and most effective ways to nudge healthy living: require sidewalks and bike lanes so people can walk to schools and shopping, and change zoning laws to allow or require essential stores near residential areas. Then people won't have to drive so much (also helping the climate more than driving to the gym). And develop financial (lower fees, etc) incentives for those who lose weight and eat better diets. We have a plague of morbid obesity that is horrendous to observe in any public place where so many obese people are scooting around in motorized wheel chairs, can't even stand up in the grocery store. People eat way too much junk food (tax it!) and get way too little exercise.
23
@Martha
Those stores will not be coming, regardless of zoning. Small stores offering essential services -- groceries, drugstores, hardware stores, simply can no longer compete with the huge chains and Amazon. We lost our independent drug store about two decades ago, will lose our hardware store once the elderly owner retires, and are very likely to lose our 85+ year old grocery coop. All these stores made the town walkable for those who could not or chose not to drive for daily and frequent essentials. Once they are all gone, everything will have to be ordered on Amazon or driven to. And even with superb public transit -- trains and buses -- nothing that works for going grocery shopping. A small grocery outside the town but within walking (about a mile) closed, as did another small combo deli cafe when it burned down. And even the bigger stores -- still not huge, within a stiff walking distance (although very unpleasant) have closed, one about thirty years ago, and another about twelve years ago.
2
@Martha
I thought Trump's food box suggestion was a good idea that should have been explored instead of dismissed out of hand. A refrigerated box of lean meats and fish, fresh vegetables and fruit and shelf stable products (along with recipes) is a better idea than just giving people EBT cards to purchase frozen pizzas, cheez balls, cookies and other junk. No wonder so many people have digestive issues, damaged kidneys, and Type II diabetes.
2
How many hours a day does the average of us spend in front of a television?
@Dave Cushman: How many hours a day does the average person have to spend sitting in front of a computer monitor at work? I know many people whose jobs require them to sit for most of 8 hours a day, and they can't change the nature of their work!
18
It would be so insanely great if we have nationalized health care like France and Switzerland etc. I hate hate hate the ridiculous shakedown we're stuck with. I wish Congress would work on that instead of wasting its time with this proposal, which isn't going to help anyone.
Exercise is all very well, but diet is at the heart of many chronic illnesses. You can't run away from a bad diet. And diet, you can fix on your own time.
23
The nation needs medicare for all - pure and simple. These 'incentive" packages and "tax benefits" and FSAs / HSAs help to some degree. However, the "user" is the one financing, and when times are tough (which they are for many people), there is little "incentive" to spend money that's not there. These ideas are just more diversion and a charade.
30
"Other advanced nations tend to have universal health systems that are simpler..."
They don't "tend to" have those systems, they all have them and every serious study has concluded that they all deliver better outcomes at significantly less cost than our profit-based system of insurance company/pharma/big provider welfare. That is what our so-called elected representatives should be working on, not rearranging deck chairs on the Titanic with tax deductions and HSAs.
184
Ok posters, let's go over it again, we can rationalize, intellectualize, theorize, finger point, ax grind, scapegoat, bait and switch re this topic to the cows come home.
The answer is simple, a universal, affordable, quality health plan system that almost all of our peer countries have and many third world countries too.
It is not rocket science. We are one of the only peer countries in the world living in the Middle Ages re this issue.
329
@Paul
And before we hear the inevitable "we can't afford it," let's remember that nobody seems to say that when billions/trillions are wasted on wars of choice, expensive military hardware, and tax cuts for the wealthy. As the taxpayers, we have to decide if we want more of our money used to do something that directly benefits us such as universal healthcare, or more waste/fraud/abuse/military adventurism/etc.
154
@Pat-Thank you for your reply. Exactly true. This is one area where we can have the best but also at a greatly reduced cost.
Just ask the rest of our peer countries.
32
In other words. The same healthcare That congress people have
25
Once again, a suggestion that we re-invent a new program, rather than learn from the many countries who have single-payer health care that works for all citizens. Those of us who have lived and worked in countries where health care was considered a government paid right know that it works far better than our own system, and provides excellent care -----even for those who cannot afford the time or money for a gym membership. The billions of dollars US health "insurance" companies pay to our elected officials as an incentive to prevent such a proven and working system in our country is simply shameful. Single payer is a proven system that works for all citizens.
142
" .. Single payer is a proven system that works for all citizens."
No, it is not .. no, no, no.
https://www.bbc.com/news/health-46349989
https://www.nytimes.com/2018/01/03/world/europe/uk-national-health-service.html
@Bang Ding Ow
No, it doesn't work perfectly for all, you are correct. But it works far better for far larger shares of each countries population than our costly "system" works for the millions that it excludes.
5
These programs, while they sound very nice and might be considered the "right thing to do", utilization is not the problem with US health care. In fact, if you look at utilization difference between the US and other OECD countries with lower heath care costs, there is not a whole lot of difference.
The difference is simply we pay more on a unit cost basis than any other country in the world. If you look at commercial health plan reimbursement to hospital systems, it is over twice Medicare in most markets in the US and over three times in many markets.
Actuarially, it doesn't make a lot of difference either because, eventually, we will all get sick an incur costs to either get better or die. When I was in health plan management, no actuary would give anything for wellness programs and very little for utilization control programs because they knew the costs would pop up elsewhere. Now, sure, you can cut down the number of hospitalizations but, again, that is not what is driving health care costs.
It is simply we pay too much in a system where even the "non-profits" behave like for profits maximizing margins.
29
@Mike
Again, why focus only on providing health care and not keeping people well via exercise and diet? In Europe you see very old people walking, walking, arm in arm. Why can't we encourage walking by providing safe, lovely paths and convenient shopping?
16
@Martha
I'm in favor of encouraging exercise and healthy choices to improve quality of life as well as lower medical costs, but people get sick anyway, and as a society we need to support actual medical care for everyone, regardless of their lifestyle.
11
I contend that the majority of citizens would prefer a health care delivery system that is simple and fair. The idea of “choice” is disingenuous. We are spending more and getting less out of these “choices”. Not to mention the stress and amount of time involved in trying to understand all of the options. The only true beneficiaries are the insurance company executives.
259
@Concerned MD
That's exactly right. Because most people would "choose" to spend their limited spare time comparing policies that hide true costs to try to puzzle out the best policy for their family, not knowing their future needs because they are not seers. What fun!
12
@Concerned MD
thank you ! Simple and fair, with transparent billing.
4
@Concerned MD Which is why we do not have universal health care single payer to medicare for all.. the insurance industry is a huge blockage. Scare tactics abound.
4
While good at pointing out what doesn’t work in health incentives and other areas, this article doesn’t actually tell anything about what passive measures might work. Except for clean air and water fluoridation. Please expand and tell us something more useful relating to passive incentives for exercise, eating well, medical care, etc.
53
@Andy,
here is my comment:
This is one of the most important research on which to base public policy- that is when there are competent people in government and public service. in addition, individuals can also come up with passive strategies specific to their lives: build in activity within the day doing things you have to do anyway: don't buy and bring home food and drink you don't want to eat, you won't have to be tempted with them; get off at earlier bus stops/stations and walk a bit to destinations; take a walk or exercise during kids' sports/activities instead of sitting and watching. those are all things that work/ed for me. as the years go on, I have to find new/different ways of doing these things.
2
@An
The classic passive inventive was a garden spot, a shovel, and no other way to eat.
1
Deductions for gym and exercise equipment costs sounds laudable, but it's really just more welfare for the already well off. Poor people, whose income tax rate is already often zero, won't save much, and whatever they DO save still won't make a gym membership or a new 21 speed bike affordable for them. But meanwhile millions of young lawyers and doctors will be deducting the price of their new kayaks, and Jeff Bezos will be deducting his week of helicopter skiing in the Alps.
Can't we just start with single payer?
385
@Green Tea
"Deductions for gym and exercise equipment costs sounds laudable, but it's really just more welfare for the already well off. "
Exactly! And it benefits mainly people who live in urban areas. If the area is rural, how many times a week is someone going to drive 10 to 15 miles one way to go to the gym?
68
@Green Tea
The measures proposed in this article are nothing more than cosmetic tinkering on a system that has been proven over and over to deliver worse results at much higher cost than every other advanced nation.
80
@Green Tea
And who will be able to take those deductions? With the elimination of most SALT tax deductions, people have no choice but to take standard deductions, even those wealthy doctors and lawyers. Plus, many are paying far higher taxes now, having lost their SALT deductions + exemptions, so they will have fewer discretionary funds to devote to these purposes. Few people have medical expenses sufficient to get over the high hump for medical expense deductions, so they won't be able to take medical expenses in any event, and won't be able to throw on their sport's equipment. Of course Mitt Romney's dressage horse might put one over the top -- and if you add the expense of stabling and upkeep, that could be a whopping "medical deduction." Yet enough sop for the ultra wealthy.
18
Good article backed by believable research . With that said, not to harp on one subject, but having managed through the transition to successful so called globalization, for a fortune 500 US multinational, the two tier society we have matured to, is firmly in place. Only the well educated coming up and graduating, have a shot of working their way out of it, and devoting time and energy to taking care of their own health issues, exercise and diet. If one is in the 50 million number in poverty the article makes note of these folks simply try to get through each day at a time. Just feeding a family is job 1.
24
About six years ago, I got in with a bunch of guys who worked out in the gym every day. Our leader had over 1500 consecutive days.
Joining such a group takes away all the thinking - the question, shall I go to the gym today? never comes up. You just go. Like eating a healthy diet, or going to work every day, it's automatic, and the long-term effect is fantastic.
17
@Jonathan
Agree Jonathan. I traveled all the time in my job, and simply developed a habit /routine, of initially jogging every morning before the work day started, then as I got older walking . Wasn't fun, wasn't so called pleasant, it was simply a routine that had benefits. All types of climates some very cold in the winter. Jog in twenty below anyone Jog in 90 plus temperatures? Yes I could have used Hotel facilities, but that for me, was beyond boring. I knew if I used that venue I would just quit.
14
@Jonathan The best exercise regimen is one that you commit to on a daily basis. Therefore it must be individualized so it is convenient and realistic. You may need to adjust as you age or for physical limitations that arise but the time allotted should remain the same. There should be no ‘goal’ - a goal implies an endpoint. As you imply, it then becomes a habit like brushing your teeth. You don’t argue with yourself about it - you just do it.
6
It’s interesting that Cuba has the same life expectancy as the US, while spending a fraction of what we do on health care.
94
@Peter Silverman
Called cradle to grave . Same model was crafted in Venezuela, however people are dying of starvation and lack of medicines . My guess is, Cubans have so few options, they are not stressed. They do have reportedly good Physicians . Have zero idea where they go to Med School.I also would imagine their diet is universal and that may assist genetics. Doesn't appear junk food is routinely available for kids.
4
Nobody in Europe or Canada dies from lack of health care. Nobody in Europe or Canada goes without medicine because of cost. Nobody loses their home or goes bankrupt because of medical bills. Nobody starts a GoFundMe and begs for money for medical expenses in Europe or Canada where life expectancy is longer and where infant mortality is lower. Oh and in Europe you don’t have to acquire high interest debt to go to medical school.
23
@Peter Silverman, do you believe the life expectancy statistics promulgated by the Cuban government? We can't trust the US government. Why should we trust Cuba?
2
The argument is well made. But does anyone really think that public health policies like better air quality legislation will not be tinkered with by special interests to attain a softer impact on them? We also have the persistent belief within the culture of "freedom" solely experienced as individual choice. This inherently means the right to not choose and the right to do as I please regardless of the consequences certainly for myself, as well as for everyone else.
16
@Horsepower
Agree. We love fads . Ever notice how popular Wine is today? Many get passed the junk food stage. Smoking dope is becoming legal, so soon that will be common as a Smart phone, for kids. Governments are salivating over the tax revenues.
2