Journal of Insurance Medicine Volume 51: Issue 3

Universal Health Insurance does not exist in the United States for two reasons: (1) there is a general unwillingness to dismantle the historically grown framework of the world’s most complex mix of public and private sector health coverage and (2) mere cost considerations. The first concern can be abated by establishing a Universal Health Insurance system which retains many or most of the historically grown infrastructure. Cost containment of such a reform is addressed herein in that the two proposed pathways comprise either (1) a leveled solution through Medicare-expansion for the uninsured only or (2) a more complex solution through a national, 2-tier healthcare system for all Americans. Both pathways are based on solid financing without major tax increases by using existing and/or yet untapped funding sources. The insurance consequences for both options are assessable. They are minor for the Medicare-expansion and more wide-ranging, yet also achievable, for a national, 2-tier healthcare system. Universal Health Insurance must no longer be an illusion that continues to haunt our society in the 21^st century.

Objective.—

To demonstrate a method which is being used to apportion between risk factors for occupationally related disease and compensate individuals with multiple risk factors. The application to individuals will be demonstrated for varicose veins.

Background.—

The National Insurance Institute (NII) is tasked with compensating work related injuries and illness in Israel. Population attributable fraction (PAF) has been utilized in order to estimate the amount of disease that can potentially be eliminated in a population through the elimination of individual risk factors. PAF is based on relative risks and the prevalence of these risks.

Methods.—

A review of the medical literature consisting of epidemiological studies of varicose veins and its multiple risk factors was conducted, with special attention to prolonged occupational standing. Summary, weighted, relative risks were calculated for eight different risk factors. The proposed formula then allowed for apportioning among those risk factors in the individual.

Results.—

The findings of the current study indicate that prolonged standing may be associated with the presence of varicose veins, however in light of the multiple other risk factors associated, its overall contribution is generally minor.

Conclusion.—

Apportionment among multiple risk factors for varicose veins can be accomplished mathematically in individuals. This application is being applied successfully for other diseases as well.

Little evidence based information exists in the medical literature on the mortality of abusers of anabolic androgenic steroids. These individuals range from competitive athletes and body builders to those whose who use physician prescribed mega-doses. Life insurance medical directors have little guidance on how to underwrite these individuals when presented with their applications. A recent article presented a Kaplan-Meir mortality curve accompanied with a control population demonstrating the mortality of these individuals over a 13-year period. Users of non-physiologic doses of anabolic androgenic steroids experience a mortality about two times the expected mortality of the control population. They should be underwritten with ratings commensurate with their anabolic androgenic steroid abuse and demonstrated mortality.

Many COVID-19 survivors report protracted symptoms, sometimes lasting 3 years or more. These are collectively called post-acute sequelae of SARS-CoV-2 infection (PASC), or long Covid.^1–4 In addition, several common diseases appear to be diagnosed more frequently following COVID-19 infection. Amongst these, cardiopulmonary disorders predominate, but diseases of many organ systems have been reported. Case reports of de novo autoimmune disorders appeared early during the pandemic. In 2023, 5 large international cohort studies provided further evidence that autoimmune disorders may be more common.

Incidence Of Autoimmune Diseases

Dysregulated immune responses have been a consistent feature of SARS-CoV-2 infection. One

Mortality Risk of High BMI in Life Insurance Applicants and the US Population

Steven J. RigattiMD, DBIM, FAAIM,

Stephanie Tanasia SaputraMSc, ALMI, and

Jean-Marc FixFSA

Innovative Strategies and Insurance Consequences for Implementing Universal Health Insurance in the United States

The Future of the Journal of Insurance Medicine and AAIM

Varicose Veins as Model for Apportionment among Risk Factors for Compensation Purposes

Objective.—

Background.—

Methods.—

Results.—

Conclusion.—

Non-Physiologic Doses of Androgenic Anabolic Steroids: Mortality and Underwriting Assessment

An Outline of a Simple, Interpretable Epigenetic Composite Score for Mortality Prediction for Accelerated Underwriting

Background.—

Objective.—

Method.—

Results.—

Conclusion.—

Autoimmune Diseases following COVID-19 Infection: How Solid is the Evidence?

Incidence Of Autoimmune Diseases

Assessing the Pathophysiology, Morbidity, and Mortality of Obstructive Sleep Apnea

The Survival Benefit of Pancreas Transplantation: Considerations for Insurance Coverage

Chronic Fatigue Syndrome: Challenges for Evaluation

Beware the Black Widow at Claim Time: A Report of Three Cases

Mortality Risk of High BMI in Life Insurance Applicants and the US Population

Prostate Cancer Insurability: Population Identification Within the Insurability Corridor and the Right to be Forgotten

Chronic Myeloid Leukemia – A Review of Current Status

Shortened Survival and Life Expectancy with a Diagnosis of Attention-Deficit and Hyperactivity Disorder (ADHD)

Ovarian Cancer: Many Diseases Under One Name

LETTER TO THE EDITOR

Déjà Vu – A New Coronavirus Challenge

Alpha-1 Antitrypsin Deficiency

Hydatid Cysts of the Lung and Liver

Suitability of HIV-Infected Subjects for Insurance