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Should junk food be taxed?
Replies
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Gallowmere1984 wrote: »Gallowmere1984 wrote: »zachbonner_ wrote: »janejellyroll wrote: »lemurcat12 wrote: »lemurcat12 wrote: »We went way off topic yesterday, which was as much my fault as anyone's, since I find the topic interesting (and understand that lots of people will have different opinions -- I used to post on usenet in the '90s, after all, and am not negative at all about internet libertarianism, even if I disagree).
Here, though, is I think Packerjohn's argument: whatever one thinks about what the gov't should do, it's likely that we will not get rid of Medicare, at least. Beyond that, it's probably generally a bad thing that the population is so obese, on average.
He submits that sugar/soda taxes could help and would at least raise money to help deal with the problem (similar to the argument for alcohol taxes, which exist).
I suspect that they will not, but think it makes sense for individual localities to experiment with them to see what the results are.
Others find all such taxes at any level bad, and are against "sin" taxes in general.
My question is if you think these taxes are not likely to work (like me), do you think there are other public policy things that should be tried (including non governmental community efforts?) or do you think obesity is not actually a problem or that it's not a public policy problem, but a purely individual one?
My feeling is that it is a public policy problem but one hard to solve. I think education is good (but doesn't seem to have worked so far), making available healthy food options (i.e., addressing food deserts, promoting gardening and community gardens) is great, but again likely has a small effect, promoting community cooking classes, same, medical intervention I think is important and could be done more/better than it is, calorie posting/labels seem already to be done. Anyway, I think it's an interesting topic.
The inherent problem with government is lack of transparency and accountability. As long as career politicians are allowed to exist corruption will flourish. Government is ill suited for this role, which is why all socialist systems ultimately fail. People love being charitable - they abhor being forced to support a failing system. Centralized systems only work in small populations. Attempts to centralize large populations require authoritarian structures. Smart agile businesses work around this through decentralized structures, giving local structures the freedom of deciding which policies produce the best results.
Negative reinforcement has never been an effective behavioral modifier.
Education has been completely ineffective because we have centralized conflicting policies. We also have "leaders" who talk the talk but do not walk the walk.
This would be far more effective and efficient to promote positive reinforcements - just as the business world has done. Maintain positive health metrics = tax credit/deduction.
So setting aside the broader debate over gov't philosophy, can you be more specific? Tax credit/deduction offered by whom (feds? state?) for what?
People seemed really down on insurance company/workplace wellness programs in some other thread, but isn't that basically similar to this idea, but not gov't-based?
You get success in achievement based systems. It is an amazingly effective tool that motivates users into desired activities.
For healthcare this could be tracked via an app - form a simple risk management structure (many business models already exist with these platforms in the business realm). Each participant actively engages in proactive measures and rewarded through specific credits/deductions. Specifically - maintaining a healthy BMI would equate to a $2000 deduction. This would be managed (ideally) privately; however as government has inserted itself by force this would be managed by state to minimize corruption and maximize competition. Unhappy with your state's policy - you can vote with your feet and relocate.
I have long been a proponent of a two tiered system. One for those who embrace the benefits and risks of liberty and another for those who do not. Those who want the safety net of government can certainly enjoy this, but they pay into this just as one would in an insurance pool. Those who do not can opt out.
How would you keep people from switching when they ran into issues later in life, like a child with a disability or a chronic disease developing? Would people decide which group they want to be in early in life and be prohibited from switching from the non-safety net group to the safety net group?
Without some mechanism to keep people from switching, wouldn't you have relatively few people in the safety net group unless they actually planned to draw benefits?
I assume they would be tracking the money you yourself have put into the pool. If you haven't contributed then you don't get health care.
Either that, or a literal opt out. That was always my problem with the individual mandate. I'd have been fine with it, if there were an option to opt out, which would prevent me from receiving any health care that I cannot either A: pay for up front, or B: have the credit to get a private loan to cover it.
yea, but if you opt out then the system can't afford to pay for everyone else's healthcare ...*sarcasm*
This is precisely why insurance as a whole needs to die in a fire, not be mandatory. The death of the private transaction, and insertion of a bunch of middlemen is a huge part of why medical costs are so stupid now, as you are well aware, I'm sure.
Unfortunately, I think this suggests why we are FAR from having a good way to stem the obesity epidemic. Our entire healthcare system is *kitten*-backwards bloated confusing crap. The average American doesn't think about their health until they lose it, and the reasons for that are tied up in our education system, all the problems with our insurance system, and all the problems with our healthcare system. And I'm not talking about Obamacare - I'm talking about stuff like the decision to tie insurance to employment way back when, the cultural focus on fixing the sick rather than supporting wellness, the pathetic malpractice arrangement, etc etc.
I honestly believe one of the reasons people are so quick to jump on one simple thing as "the reason" is because in the back of their minds they know that the problem is so complex it's hard to even imagine a solution.
Yeah, it's complicated. In internet discussions like this everyone claims not to want the insurance companies involved. (I also don't want the insurance companies involved, but then I'm a liberal.) But a plan that removed the benefits from employers for providing insurance and moved us away from the employer-insurance model (which is stupid, IMO) would be INCREDIBLY unpopular, since people mostly like their employer-based insurance when they have it and don't want to have to think about health insurance.
And of course old people and people with pre-existing conditions (a huge number of people who have employer-based care) would then be out of insurance and have incredibly expensive costs.
I suppose it comes down to whether you think that having enormous medical costs vs. low medical costs is mostly due to decisions made so it's fair that people with huge costs have to pay them or whether you think a huge amount of it is luck or something that most people end up dealing with as they age.
I've never really had any significant medical costs (I broke my leg once, that was about it), because I'm lucky. I'm also doctor-avoidant and have not gone to the doctor nearly as much as is recommended (yearly), despite having excellent employer-based insurance, which I admit isn't responsible of me, but also means that the amount that has been spent on me to date vs. what I've put in is a net win for the insurance company and for my employer-based group (vs. co-workers who have of course spent huge amounts on various things covered by insurance).
And yet I'd never choose to go without insurance (even if I had to buy it privately, which seems like a hassle), since I think that's irresponsible. (And I'm glad my mom had good employer-based insurance when she had breast cancer, back when I was a teen.)
Anyway, I do think one of the huge problems with the discussion of health care costs is that people don't understand the costs. I see it to some extent since I sit in year-end salary meetings that show everyone's benefits including amounts paid for their health care premiums by us. The employer thinks of those as part of overall compensation, but the employees generally do not, I don't think (I didn't years ago, anyway).0 -
lemurcat12 wrote: »lemurcat12 wrote: »lemurcat12 wrote: »We went way off topic yesterday, which was as much my fault as anyone's, since I find the topic interesting (and understand that lots of people will have different opinions -- I used to post on usenet in the '90s, after all, and am not negative at all about internet libertarianism, even if I disagree).
Here, though, is I think Packerjohn's argument: whatever one thinks about what the gov't should do, it's likely that we will not get rid of Medicare, at least. Beyond that, it's probably generally a bad thing that the population is so obese, on average.
He submits that sugar/soda taxes could help and would at least raise money to help deal with the problem (similar to the argument for alcohol taxes, which exist).
I suspect that they will not, but think it makes sense for individual localities to experiment with them to see what the results are.
Others find all such taxes at any level bad, and are against "sin" taxes in general.
My question is if you think these taxes are not likely to work (like me), do you think there are other public policy things that should be tried (including non governmental community efforts?) or do you think obesity is not actually a problem or that it's not a public policy problem, but a purely individual one?
My feeling is that it is a public policy problem but one hard to solve. I think education is good (but doesn't seem to have worked so far), making available healthy food options (i.e., addressing food deserts, promoting gardening and community gardens) is great, but again likely has a small effect, promoting community cooking classes, same, medical intervention I think is important and could be done more/better than it is, calorie posting/labels seem already to be done. Anyway, I think it's an interesting topic.
The inherent problem with government is lack of transparency and accountability. As long as career politicians are allowed to exist corruption will flourish. Government is ill suited for this role, which is why all socialist systems ultimately fail. People love being charitable - they abhor being forced to support a failing system. Centralized systems only work in small populations. Attempts to centralize large populations require authoritarian structures. Smart agile businesses work around this through decentralized structures, giving local structures the freedom of deciding which policies produce the best results.
Negative reinforcement has never been an effective behavioral modifier.
Education has been completely ineffective because we have centralized conflicting policies. We also have "leaders" who talk the talk but do not walk the walk.
This would be far more effective and efficient to promote positive reinforcements - just as the business world has done. Maintain positive health metrics = tax credit/deduction.
So setting aside the broader debate over gov't philosophy, can you be more specific? Tax credit/deduction offered by whom (feds? state?) for what?
People seemed really down on insurance company/workplace wellness programs in some other thread, but isn't that basically similar to this idea, but not gov't-based?
You get success in achievement based systems. It is an amazingly effective tool that motivates users into desired activities.
Well, I'm sure there are things we could look at to see how well it works with weight. Those insurance wellness programs, for example. I'm not sure how what you are suggesting is different, which is why I asked.For healthcare this could be tracked via an app - form a simple risk management structure (many business models already exist with these platforms in the business realm). Each participant actively engages in proactive measures and rewarded through specific credits/deductions. Specifically - maintaining a healthy BMI would equate to a $2000 deduction. This would be managed (ideally) privately; however as government has inserted itself by force this would be managed by state to minimize corruption and maximize competition. Unhappy with your state's policy - you can vote with your feet and relocate.
So to put this simply, I get a $2000 deduction from my state taxes for having a healthy BMI? (What if I'm Dwayne Johnson? I mean, I'm not, my BMI is 22 and I think I'd be better off around 20, so it's not a personal question.) It seems pretty open to abuse, as states are unlikely to be able to effectively check, but let's assume the technical issues get worked out--wondering what others would think of this idea.
It seems to me a more direct/effective approach, if people wanted to do this, was just let insurance companies charge extra if your BMI is 25+ (and you can't show your BF% is fine, I'd require that option), and still more if it's 30+ and so on. It really seems like the same thing, you still pay less for having a healthy weight.
Problem is that we probably WANT younger overweight/obese people to have insurance, as that's more likely to get them medical care and result in them losing weight when they haven't yet developed any medical issues. But young people without health issues are the most likely to say forget it if health care costs are high.
Just thinking this through, not arguing for anything.I have long been a proponent of a two tiered system. One for those who embrace the benefits and risks of liberty and another for those who do not. Those who want the safety net of government can certainly enjoy this, but they pay into this just as one would in an insurance pool. Those who do not can opt out.
One problem is that we don't have willingness as a society to see people suffer the effects of opting out, I don't think. Especially if the choice has to be made at age 18 or 21. (Edit: oh, janejellyroll is already raising the same points that I would have, yay.)
My husband's employer/insurance already implements something similar. We get penalized for high bmis, bad blood work panels, smoking etc. We also have a high deductible HSA plan that has several thousand dollars out of pocket before any benefits kick in.1 -
lemurcat12 wrote: »Gallowmere1984 wrote: »Gallowmere1984 wrote: »zachbonner_ wrote: »janejellyroll wrote: »lemurcat12 wrote: »lemurcat12 wrote: »We went way off topic yesterday, which was as much my fault as anyone's, since I find the topic interesting (and understand that lots of people will have different opinions -- I used to post on usenet in the '90s, after all, and am not negative at all about internet libertarianism, even if I disagree).
Here, though, is I think Packerjohn's argument: whatever one thinks about what the gov't should do, it's likely that we will not get rid of Medicare, at least. Beyond that, it's probably generally a bad thing that the population is so obese, on average.
He submits that sugar/soda taxes could help and would at least raise money to help deal with the problem (similar to the argument for alcohol taxes, which exist).
I suspect that they will not, but think it makes sense for individual localities to experiment with them to see what the results are.
Others find all such taxes at any level bad, and are against "sin" taxes in general.
My question is if you think these taxes are not likely to work (like me), do you think there are other public policy things that should be tried (including non governmental community efforts?) or do you think obesity is not actually a problem or that it's not a public policy problem, but a purely individual one?
My feeling is that it is a public policy problem but one hard to solve. I think education is good (but doesn't seem to have worked so far), making available healthy food options (i.e., addressing food deserts, promoting gardening and community gardens) is great, but again likely has a small effect, promoting community cooking classes, same, medical intervention I think is important and could be done more/better than it is, calorie posting/labels seem already to be done. Anyway, I think it's an interesting topic.
The inherent problem with government is lack of transparency and accountability. As long as career politicians are allowed to exist corruption will flourish. Government is ill suited for this role, which is why all socialist systems ultimately fail. People love being charitable - they abhor being forced to support a failing system. Centralized systems only work in small populations. Attempts to centralize large populations require authoritarian structures. Smart agile businesses work around this through decentralized structures, giving local structures the freedom of deciding which policies produce the best results.
Negative reinforcement has never been an effective behavioral modifier.
Education has been completely ineffective because we have centralized conflicting policies. We also have "leaders" who talk the talk but do not walk the walk.
This would be far more effective and efficient to promote positive reinforcements - just as the business world has done. Maintain positive health metrics = tax credit/deduction.
So setting aside the broader debate over gov't philosophy, can you be more specific? Tax credit/deduction offered by whom (feds? state?) for what?
People seemed really down on insurance company/workplace wellness programs in some other thread, but isn't that basically similar to this idea, but not gov't-based?
You get success in achievement based systems. It is an amazingly effective tool that motivates users into desired activities.
For healthcare this could be tracked via an app - form a simple risk management structure (many business models already exist with these platforms in the business realm). Each participant actively engages in proactive measures and rewarded through specific credits/deductions. Specifically - maintaining a healthy BMI would equate to a $2000 deduction. This would be managed (ideally) privately; however as government has inserted itself by force this would be managed by state to minimize corruption and maximize competition. Unhappy with your state's policy - you can vote with your feet and relocate.
I have long been a proponent of a two tiered system. One for those who embrace the benefits and risks of liberty and another for those who do not. Those who want the safety net of government can certainly enjoy this, but they pay into this just as one would in an insurance pool. Those who do not can opt out.
How would you keep people from switching when they ran into issues later in life, like a child with a disability or a chronic disease developing? Would people decide which group they want to be in early in life and be prohibited from switching from the non-safety net group to the safety net group?
Without some mechanism to keep people from switching, wouldn't you have relatively few people in the safety net group unless they actually planned to draw benefits?
I assume they would be tracking the money you yourself have put into the pool. If you haven't contributed then you don't get health care.
Either that, or a literal opt out. That was always my problem with the individual mandate. I'd have been fine with it, if there were an option to opt out, which would prevent me from receiving any health care that I cannot either A: pay for up front, or B: have the credit to get a private loan to cover it.
yea, but if you opt out then the system can't afford to pay for everyone else's healthcare ...*sarcasm*
This is precisely why insurance as a whole needs to die in a fire, not be mandatory. The death of the private transaction, and insertion of a bunch of middlemen is a huge part of why medical costs are so stupid now, as you are well aware, I'm sure.
Unfortunately, I think this suggests why we are FAR from having a good way to stem the obesity epidemic. Our entire healthcare system is *kitten*-backwards bloated confusing crap. The average American doesn't think about their health until they lose it, and the reasons for that are tied up in our education system, all the problems with our insurance system, and all the problems with our healthcare system. And I'm not talking about Obamacare - I'm talking about stuff like the decision to tie insurance to employment way back when, the cultural focus on fixing the sick rather than supporting wellness, the pathetic malpractice arrangement, etc etc.
I honestly believe one of the reasons people are so quick to jump on one simple thing as "the reason" is because in the back of their minds they know that the problem is so complex it's hard to even imagine a solution.
Yeah, it's complicated. In internet discussions like this everyone claims not to want the insurance companies involved. (I also don't want the insurance companies involved, but then I'm a liberal.) But a plan that removed the benefits from employers for providing insurance and moved us away from the employer-insurance model (which is stupid, IMO) would be INCREDIBLY unpopular, since people mostly like their employer-based insurance when they have it and don't want to have to think about health insurance.
And of course old people and people with pre-existing conditions (a huge number of people who have employer-based care) would then be out of insurance and have incredibly expensive costs.
I suppose it comes down to whether you think that having enormous medical costs vs. low medical costs is mostly due to decisions made so it's fair that people with huge costs have to pay them or whether you think a huge amount of it is luck or something that most people end up dealing with as they age.
I've never really had any significant medical costs (I broke my leg once, that was about it), because I'm lucky. I'm also doctor-avoidant and have not gone to the doctor nearly as much as is recommended (yearly), despite having excellent employer-based insurance, which I admit isn't responsible of me, but also means that the amount that has been spent on me to date vs. what I've put in is a net win for the insurance company and for my employer-based group (vs. co-workers who have of course spent huge amounts on various things covered by insurance).
And yet I'd never choose to go without insurance (even if I had to buy it privately, which seems like a hassle), since I think that's irresponsible. (And I'm glad my mom had good employer-based insurance when she had breast cancer, back when I was a teen.)
Anyway, I do think one of the huge problems with the discussion of health care costs is that people don't understand the costs. I see it to some extent since I sit in year-end salary meetings that show everyone's benefits including amounts paid for their health care premiums by us. The employer thinks of those as part of overall compensation, but the employees generally do not, I don't think (I didn't years ago, anyway).
vOv I am personally fine with the whole death thing. It's an unavoidable thing, but as a society, we seem hellbent on squeezing an extra year or two out of every person, regardless of the diminishing returns versus cost inflicted. Frankly, I find the whole thing ridiculous.0 -
crzycatlady1 wrote: »lemurcat12 wrote: »lemurcat12 wrote: »lemurcat12 wrote: »We went way off topic yesterday, which was as much my fault as anyone's, since I find the topic interesting (and understand that lots of people will have different opinions -- I used to post on usenet in the '90s, after all, and am not negative at all about internet libertarianism, even if I disagree).
Here, though, is I think Packerjohn's argument: whatever one thinks about what the gov't should do, it's likely that we will not get rid of Medicare, at least. Beyond that, it's probably generally a bad thing that the population is so obese, on average.
He submits that sugar/soda taxes could help and would at least raise money to help deal with the problem (similar to the argument for alcohol taxes, which exist).
I suspect that they will not, but think it makes sense for individual localities to experiment with them to see what the results are.
Others find all such taxes at any level bad, and are against "sin" taxes in general.
My question is if you think these taxes are not likely to work (like me), do you think there are other public policy things that should be tried (including non governmental community efforts?) or do you think obesity is not actually a problem or that it's not a public policy problem, but a purely individual one?
My feeling is that it is a public policy problem but one hard to solve. I think education is good (but doesn't seem to have worked so far), making available healthy food options (i.e., addressing food deserts, promoting gardening and community gardens) is great, but again likely has a small effect, promoting community cooking classes, same, medical intervention I think is important and could be done more/better than it is, calorie posting/labels seem already to be done. Anyway, I think it's an interesting topic.
The inherent problem with government is lack of transparency and accountability. As long as career politicians are allowed to exist corruption will flourish. Government is ill suited for this role, which is why all socialist systems ultimately fail. People love being charitable - they abhor being forced to support a failing system. Centralized systems only work in small populations. Attempts to centralize large populations require authoritarian structures. Smart agile businesses work around this through decentralized structures, giving local structures the freedom of deciding which policies produce the best results.
Negative reinforcement has never been an effective behavioral modifier.
Education has been completely ineffective because we have centralized conflicting policies. We also have "leaders" who talk the talk but do not walk the walk.
This would be far more effective and efficient to promote positive reinforcements - just as the business world has done. Maintain positive health metrics = tax credit/deduction.
So setting aside the broader debate over gov't philosophy, can you be more specific? Tax credit/deduction offered by whom (feds? state?) for what?
People seemed really down on insurance company/workplace wellness programs in some other thread, but isn't that basically similar to this idea, but not gov't-based?
You get success in achievement based systems. It is an amazingly effective tool that motivates users into desired activities.
Well, I'm sure there are things we could look at to see how well it works with weight. Those insurance wellness programs, for example. I'm not sure how what you are suggesting is different, which is why I asked.For healthcare this could be tracked via an app - form a simple risk management structure (many business models already exist with these platforms in the business realm). Each participant actively engages in proactive measures and rewarded through specific credits/deductions. Specifically - maintaining a healthy BMI would equate to a $2000 deduction. This would be managed (ideally) privately; however as government has inserted itself by force this would be managed by state to minimize corruption and maximize competition. Unhappy with your state's policy - you can vote with your feet and relocate.
So to put this simply, I get a $2000 deduction from my state taxes for having a healthy BMI? (What if I'm Dwayne Johnson? I mean, I'm not, my BMI is 22 and I think I'd be better off around 20, so it's not a personal question.) It seems pretty open to abuse, as states are unlikely to be able to effectively check, but let's assume the technical issues get worked out--wondering what others would think of this idea.
It seems to me a more direct/effective approach, if people wanted to do this, was just let insurance companies charge extra if your BMI is 25+ (and you can't show your BF% is fine, I'd require that option), and still more if it's 30+ and so on. It really seems like the same thing, you still pay less for having a healthy weight.
Problem is that we probably WANT younger overweight/obese people to have insurance, as that's more likely to get them medical care and result in them losing weight when they haven't yet developed any medical issues. But young people without health issues are the most likely to say forget it if health care costs are high.
Just thinking this through, not arguing for anything.I have long been a proponent of a two tiered system. One for those who embrace the benefits and risks of liberty and another for those who do not. Those who want the safety net of government can certainly enjoy this, but they pay into this just as one would in an insurance pool. Those who do not can opt out.
One problem is that we don't have willingness as a society to see people suffer the effects of opting out, I don't think. Especially if the choice has to be made at age 18 or 21. (Edit: oh, janejellyroll is already raising the same points that I would have, yay.)
My husband's employer/insurance already implements something similar. We get penalized for high bmis, bad blood work panels, smoking etc. We also have a high deductible HSA plan that has several thousand dollars out of pocket before any benefits kick in.
Ours is kind of like that. We have a very high deductible and smokers pay more each month. We do get extra money for our HSA for doing preventative care, which helps. But when my husband broke his wrist two years ago, I think we wound up paying $1,110 out of pocket and insurance only covered a little bit of the overall costs.0 -
The other thing is, libertarian dream world is all well and good in theory (even if I don't believe it would work well in practice), but we live in a real world. What is going to happen to ACA and Medicaid, beats me, but I would be shocked if (1) we get rid of Medicare, or (2) we truly attack employer-based insurance. We also require hospitals to provide certain kinds of treatment.
As a result, it's pretty certain that our health care costs/taxes/salaries are going to be affected, to some degree, by the choices/health care costs of others.
Now, it's entirely possible to say that this is fine, they are also affected by all kinds of other choices beyond weight, so we still don't care if other people are fat or not. (This is, in fact, my position when it comes to the junk food tax issue or whether it bothers me if someone else is fat -- I don't, it's not my business at all.)
But it's not really possible to say that we should make sure it can't possibly be a cost shared by society, because the fact is it will be.0 -
janejellyroll wrote: »janejellyroll wrote: »janejellyroll wrote: »lemurcat12 wrote: »lemurcat12 wrote: »We went way off topic yesterday, which was as much my fault as anyone's, since I find the topic interesting (and understand that lots of people will have different opinions -- I used to post on usenet in the '90s, after all, and am not negative at all about internet libertarianism, even if I disagree).
Here, though, is I think Packerjohn's argument: whatever one thinks about what the gov't should do, it's likely that we will not get rid of Medicare, at least. Beyond that, it's probably generally a bad thing that the population is so obese, on average.
He submits that sugar/soda taxes could help and would at least raise money to help deal with the problem (similar to the argument for alcohol taxes, which exist).
I suspect that they will not, but think it makes sense for individual localities to experiment with them to see what the results are.
Others find all such taxes at any level bad, and are against "sin" taxes in general.
My question is if you think these taxes are not likely to work (like me), do you think there are other public policy things that should be tried (including non governmental community efforts?) or do you think obesity is not actually a problem or that it's not a public policy problem, but a purely individual one?
My feeling is that it is a public policy problem but one hard to solve. I think education is good (but doesn't seem to have worked so far), making available healthy food options (i.e., addressing food deserts, promoting gardening and community gardens) is great, but again likely has a small effect, promoting community cooking classes, same, medical intervention I think is important and could be done more/better than it is, calorie posting/labels seem already to be done. Anyway, I think it's an interesting topic.
The inherent problem with government is lack of transparency and accountability. As long as career politicians are allowed to exist corruption will flourish. Government is ill suited for this role, which is why all socialist systems ultimately fail. People love being charitable - they abhor being forced to support a failing system. Centralized systems only work in small populations. Attempts to centralize large populations require authoritarian structures. Smart agile businesses work around this through decentralized structures, giving local structures the freedom of deciding which policies produce the best results.
Negative reinforcement has never been an effective behavioral modifier.
Education has been completely ineffective because we have centralized conflicting policies. We also have "leaders" who talk the talk but do not walk the walk.
This would be far more effective and efficient to promote positive reinforcements - just as the business world has done. Maintain positive health metrics = tax credit/deduction.
So setting aside the broader debate over gov't philosophy, can you be more specific? Tax credit/deduction offered by whom (feds? state?) for what?
People seemed really down on insurance company/workplace wellness programs in some other thread, but isn't that basically similar to this idea, but not gov't-based?
You get success in achievement based systems. It is an amazingly effective tool that motivates users into desired activities.
For healthcare this could be tracked via an app - form a simple risk management structure (many business models already exist with these platforms in the business realm). Each participant actively engages in proactive measures and rewarded through specific credits/deductions. Specifically - maintaining a healthy BMI would equate to a $2000 deduction. This would be managed (ideally) privately; however as government has inserted itself by force this would be managed by state to minimize corruption and maximize competition. Unhappy with your state's policy - you can vote with your feet and relocate.
I have long been a proponent of a two tiered system. One for those who embrace the benefits and risks of liberty and another for those who do not. Those who want the safety net of government can certainly enjoy this, but they pay into this just as one would in an insurance pool. Those who do not can opt out.
How would you keep people from switching when they ran into issues later in life, like a child with a disability or a chronic disease developing? Would people decide which group they want to be in early in life and be prohibited from switching from the non-safety net group to the safety net group?
Without some mechanism to keep people from switching, wouldn't you have relatively few people in the safety net group unless they actually planned to draw benefits?
These issues are outliers and can easily be absorbed in the system. You never make policy based on outliers.
You can switch groups, but would pay the prorated fee associated with opting out of the current plan.
That is precisely the point. Ponzi schemes are illegal for all parties with the curious exception of government. This also keeps politicians from pretending to play Robin Hood when they are, by default, the Sheriff of Nottingham.
Unfortunately, people with disabilities or chronic diseases aren't really an rare thing in our society, I wouldn't consider older people with chronic diseases or people drawing disability benefits to be outliars -- they'd have to be accounted for in any realistic program granting/denying benefits. There are probably lots of people who never think they'd draw certain government benefits until they find themselves in a situation where they need them.
That said, I understand what you're suggesting with the pro-rated fee. Thanks for clarifying.
These remain outliers - a very small portion of the overall populace.
This is precisely why government or any industry should be allowed permission in granting/denying benefits. This is a decision between the medical provider and the patient. By allowing additional parties into this extremely personal decision you have created a monster - one that can never be controlled and one that ensure corruption.
Probably? Policies should be based upon certainties or predictable expectations. If you set the bar low, the populace will aim low.
This is the realm of charity - not government.
8.7 million people got SS disability benefits in February 2017.
72.5 million people are on Medicaid, 55.3 million are on Medicare.
I don't consider that to be a small portion of the population -- they'd have to be considered in any overhaul (or removal) of the safety net. Some of those people may opt into the safety net lane at age 18 -- they obviously wouldn't cause the type of issue I was asking about. But it's likely that at least some of those people would begin their working lives thinking that they would be self-sufficient forever and then something happened.
I understand your position on the role of charity -- I was asking for specific clarification on how you would deal with people who began their working lives in the second group (opting out) and then decided, due to life events, that they wanted in.
Is the answer that these people are exceptions who don't have to be considered? I don't know that we can assume that. We know from the example of health insurance that people will often forgo insurance when they're young and healthy, only to want it later. Do we think people would act differently with the safety net, that young people feeling like they've got decades of health in front of them will decide to have *less money* in their pocket each month because they're making rational decisions about the future possibility that they will be 65 and unable to afford health care?
If a pro-rated fee is available to these people, then I understand your clarification. If charity is the only recourse for those who are unable to afford the pro-rated fee, I understand that as well.
I'm simply trying to understand your position, that's all.
330 million population in the US (likely closer to 360 M) so by conservative estimate 2.6% get SS disability benefits in February 2017. 100% pay into this Ponzi scheme
Medicaid and Medicare are failing systems and should be eliminated immediately. These serve no purpose other than to insert government into the free market. This is yet another primary driver of the increasing cost of medicine.
For actual implementation there would have to be a period of change. It is inexcusable for the younger generation to be expected to pay for the false promises and poor planning of politicians. One generation falling for this lie is enough. Implementing actual accountability is necessary as well. There will always be a safety net so to speak, but the care provided by the state would be minimal. Any additional care could always be provided through private enterprise.
Good policy is enacted based on the needs of the majority, with special exceptions crafted for exceptional circumstances. Basing policy on < 3% of the population will fail before it begins.
Just as in life people will choose poorly, but creating a safety net encourages poor behavior.
Using MFP as an example can you imagine if the CICO models were based upon the minority cases?
No problem at all. This is one of my favorite topics and I love to discuss and debate these issues.
1 -
janejellyroll wrote: »crzycatlady1 wrote: »lemurcat12 wrote: »lemurcat12 wrote: »lemurcat12 wrote: »We went way off topic yesterday, which was as much my fault as anyone's, since I find the topic interesting (and understand that lots of people will have different opinions -- I used to post on usenet in the '90s, after all, and am not negative at all about internet libertarianism, even if I disagree).
Here, though, is I think Packerjohn's argument: whatever one thinks about what the gov't should do, it's likely that we will not get rid of Medicare, at least. Beyond that, it's probably generally a bad thing that the population is so obese, on average.
He submits that sugar/soda taxes could help and would at least raise money to help deal with the problem (similar to the argument for alcohol taxes, which exist).
I suspect that they will not, but think it makes sense for individual localities to experiment with them to see what the results are.
Others find all such taxes at any level bad, and are against "sin" taxes in general.
My question is if you think these taxes are not likely to work (like me), do you think there are other public policy things that should be tried (including non governmental community efforts?) or do you think obesity is not actually a problem or that it's not a public policy problem, but a purely individual one?
My feeling is that it is a public policy problem but one hard to solve. I think education is good (but doesn't seem to have worked so far), making available healthy food options (i.e., addressing food deserts, promoting gardening and community gardens) is great, but again likely has a small effect, promoting community cooking classes, same, medical intervention I think is important and could be done more/better than it is, calorie posting/labels seem already to be done. Anyway, I think it's an interesting topic.
The inherent problem with government is lack of transparency and accountability. As long as career politicians are allowed to exist corruption will flourish. Government is ill suited for this role, which is why all socialist systems ultimately fail. People love being charitable - they abhor being forced to support a failing system. Centralized systems only work in small populations. Attempts to centralize large populations require authoritarian structures. Smart agile businesses work around this through decentralized structures, giving local structures the freedom of deciding which policies produce the best results.
Negative reinforcement has never been an effective behavioral modifier.
Education has been completely ineffective because we have centralized conflicting policies. We also have "leaders" who talk the talk but do not walk the walk.
This would be far more effective and efficient to promote positive reinforcements - just as the business world has done. Maintain positive health metrics = tax credit/deduction.
So setting aside the broader debate over gov't philosophy, can you be more specific? Tax credit/deduction offered by whom (feds? state?) for what?
People seemed really down on insurance company/workplace wellness programs in some other thread, but isn't that basically similar to this idea, but not gov't-based?
You get success in achievement based systems. It is an amazingly effective tool that motivates users into desired activities.
Well, I'm sure there are things we could look at to see how well it works with weight. Those insurance wellness programs, for example. I'm not sure how what you are suggesting is different, which is why I asked.For healthcare this could be tracked via an app - form a simple risk management structure (many business models already exist with these platforms in the business realm). Each participant actively engages in proactive measures and rewarded through specific credits/deductions. Specifically - maintaining a healthy BMI would equate to a $2000 deduction. This would be managed (ideally) privately; however as government has inserted itself by force this would be managed by state to minimize corruption and maximize competition. Unhappy with your state's policy - you can vote with your feet and relocate.
So to put this simply, I get a $2000 deduction from my state taxes for having a healthy BMI? (What if I'm Dwayne Johnson? I mean, I'm not, my BMI is 22 and I think I'd be better off around 20, so it's not a personal question.) It seems pretty open to abuse, as states are unlikely to be able to effectively check, but let's assume the technical issues get worked out--wondering what others would think of this idea.
It seems to me a more direct/effective approach, if people wanted to do this, was just let insurance companies charge extra if your BMI is 25+ (and you can't show your BF% is fine, I'd require that option), and still more if it's 30+ and so on. It really seems like the same thing, you still pay less for having a healthy weight.
Problem is that we probably WANT younger overweight/obese people to have insurance, as that's more likely to get them medical care and result in them losing weight when they haven't yet developed any medical issues. But young people without health issues are the most likely to say forget it if health care costs are high.
Just thinking this through, not arguing for anything.I have long been a proponent of a two tiered system. One for those who embrace the benefits and risks of liberty and another for those who do not. Those who want the safety net of government can certainly enjoy this, but they pay into this just as one would in an insurance pool. Those who do not can opt out.
One problem is that we don't have willingness as a society to see people suffer the effects of opting out, I don't think. Especially if the choice has to be made at age 18 or 21. (Edit: oh, janejellyroll is already raising the same points that I would have, yay.)
My husband's employer/insurance already implements something similar. We get penalized for high bmis, bad blood work panels, smoking etc. We also have a high deductible HSA plan that has several thousand dollars out of pocket before any benefits kick in.
Ours is kind of like that. We have a very high deductible and smokers pay more each month. We do get extra money for our HSA for doing preventative care, which helps. But when my husband broke his wrist two years ago, I think we wound up paying $1,110 out of pocket and insurance only covered a little bit of the overall costs.
I actually like high deductible plans. Mine isn't particularly (more since ACA than before), but I think that model makes sense, although with the exception for certain kinds of routine care if you want to encourage people to get preventative care. In my (obviously not something I would sell to the majority here, so I'm not trying!) ;-) personal government-based insurance plan, it would kick in after a certain amount, I think, which would preserve competition in the things you can actually compete in. I just think the notion of competing and driving down the cost for something like chemo makes no sense. If I am trying to buy a car or whatever, it's 100% true that I won't think it's worth it if the cost is too high and would walk away, which gives me competitive power. If it's take the treatment or die, well, I don't have that power (and same if something comes up in the middle of giving birth or some such).
For current insurance I tend to like the idea of cost reductions for various things/preventative care, etc., too, although I do not have such a plan.0 -
How about subsidizing fruits, vegetables, and so on instead? A lot of poorer families buy crappy food because it's cheaper than healthy food.1
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kenyonhaff wrote: »How about subsidizing fruits, vegetables, and so on instead? A lot of poorer families buy crappy food because it's cheaper than healthy food.
no, subsidies distort the market.4 -
kenyonhaff wrote: »How about subsidizing fruits, vegetables, and so on instead? A lot of poorer families buy crappy food because it's cheaper than healthy food.
no, subsidies distort the market.
Yes - subsidies all need to die. If the market cannot support it - it needs to die.3 -
kenyonhaff wrote: »How about subsidizing fruits, vegetables, and so on instead? A lot of poorer families buy crappy food because it's cheaper than healthy food.
no, subsidies distort the market.
Food in America is already subsidized... and by subsidized perhaps make food assistance more vigorous with healthy foods than at present. Poor families tend to have to rely on unhealthy food to make ends meet and pay for it with their health.0 -
janejellyroll wrote: »crzycatlady1 wrote: »lemurcat12 wrote: »lemurcat12 wrote: »lemurcat12 wrote: »We went way off topic yesterday, which was as much my fault as anyone's, since I find the topic interesting (and understand that lots of people will have different opinions -- I used to post on usenet in the '90s, after all, and am not negative at all about internet libertarianism, even if I disagree).
Here, though, is I think Packerjohn's argument: whatever one thinks about what the gov't should do, it's likely that we will not get rid of Medicare, at least. Beyond that, it's probably generally a bad thing that the population is so obese, on average.
He submits that sugar/soda taxes could help and would at least raise money to help deal with the problem (similar to the argument for alcohol taxes, which exist).
I suspect that they will not, but think it makes sense for individual localities to experiment with them to see what the results are.
Others find all such taxes at any level bad, and are against "sin" taxes in general.
My question is if you think these taxes are not likely to work (like me), do you think there are other public policy things that should be tried (including non governmental community efforts?) or do you think obesity is not actually a problem or that it's not a public policy problem, but a purely individual one?
My feeling is that it is a public policy problem but one hard to solve. I think education is good (but doesn't seem to have worked so far), making available healthy food options (i.e., addressing food deserts, promoting gardening and community gardens) is great, but again likely has a small effect, promoting community cooking classes, same, medical intervention I think is important and could be done more/better than it is, calorie posting/labels seem already to be done. Anyway, I think it's an interesting topic.
The inherent problem with government is lack of transparency and accountability. As long as career politicians are allowed to exist corruption will flourish. Government is ill suited for this role, which is why all socialist systems ultimately fail. People love being charitable - they abhor being forced to support a failing system. Centralized systems only work in small populations. Attempts to centralize large populations require authoritarian structures. Smart agile businesses work around this through decentralized structures, giving local structures the freedom of deciding which policies produce the best results.
Negative reinforcement has never been an effective behavioral modifier.
Education has been completely ineffective because we have centralized conflicting policies. We also have "leaders" who talk the talk but do not walk the walk.
This would be far more effective and efficient to promote positive reinforcements - just as the business world has done. Maintain positive health metrics = tax credit/deduction.
So setting aside the broader debate over gov't philosophy, can you be more specific? Tax credit/deduction offered by whom (feds? state?) for what?
People seemed really down on insurance company/workplace wellness programs in some other thread, but isn't that basically similar to this idea, but not gov't-based?
You get success in achievement based systems. It is an amazingly effective tool that motivates users into desired activities.
Well, I'm sure there are things we could look at to see how well it works with weight. Those insurance wellness programs, for example. I'm not sure how what you are suggesting is different, which is why I asked.For healthcare this could be tracked via an app - form a simple risk management structure (many business models already exist with these platforms in the business realm). Each participant actively engages in proactive measures and rewarded through specific credits/deductions. Specifically - maintaining a healthy BMI would equate to a $2000 deduction. This would be managed (ideally) privately; however as government has inserted itself by force this would be managed by state to minimize corruption and maximize competition. Unhappy with your state's policy - you can vote with your feet and relocate.
So to put this simply, I get a $2000 deduction from my state taxes for having a healthy BMI? (What if I'm Dwayne Johnson? I mean, I'm not, my BMI is 22 and I think I'd be better off around 20, so it's not a personal question.) It seems pretty open to abuse, as states are unlikely to be able to effectively check, but let's assume the technical issues get worked out--wondering what others would think of this idea.
It seems to me a more direct/effective approach, if people wanted to do this, was just let insurance companies charge extra if your BMI is 25+ (and you can't show your BF% is fine, I'd require that option), and still more if it's 30+ and so on. It really seems like the same thing, you still pay less for having a healthy weight.
Problem is that we probably WANT younger overweight/obese people to have insurance, as that's more likely to get them medical care and result in them losing weight when they haven't yet developed any medical issues. But young people without health issues are the most likely to say forget it if health care costs are high.
Just thinking this through, not arguing for anything.I have long been a proponent of a two tiered system. One for those who embrace the benefits and risks of liberty and another for those who do not. Those who want the safety net of government can certainly enjoy this, but they pay into this just as one would in an insurance pool. Those who do not can opt out.
One problem is that we don't have willingness as a society to see people suffer the effects of opting out, I don't think. Especially if the choice has to be made at age 18 or 21. (Edit: oh, janejellyroll is already raising the same points that I would have, yay.)
My husband's employer/insurance already implements something similar. We get penalized for high bmis, bad blood work panels, smoking etc. We also have a high deductible HSA plan that has several thousand dollars out of pocket before any benefits kick in.
Ours is kind of like that. We have a very high deductible and smokers pay more each month. We do get extra money for our HSA for doing preventative care, which helps. But when my husband broke his wrist two years ago, I think we wound up paying $1,110 out of pocket and insurance only covered a little bit of the overall costs.
The first year it was implemented we got a $1,000 HSA deposit from our employer to help offset the high deductible but it was only offered for a year, unfortunately.
Three years ago my daughter had out-patient surgery at a local hospital that required anesthesia. There was a follow up procedure at the hospital, as well as an unplanned ER visit due to complications. That year we ended up paying out over $10,000 out of pocket for medical expenses, on top of our insurance premiums (which are around $400 a month). The following year my husband ended up in the ER with stroke symptoms and we paid for that visit totally out of pocket, around $3,000. Last year was much nicer, with only a handful of med center visits for illness /small issues ($150-$175 a time), and then my daughter got her finger caught in a door and that cost us around $500 for 2 doctor appointments /xrays.
We're actually waiting for something big to hit again so we hit the high deductible -when that happens I'm getting cataract surgery done and my son needs allergy testing done for venom /bee stings. One of those things where you don't want something bad to happen but if/when it does, we'll tack on stuff to get our money's worth
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kenyonhaff wrote: »kenyonhaff wrote: »How about subsidizing fruits, vegetables, and so on instead? A lot of poorer families buy crappy food because it's cheaper than healthy food.
no, subsidies distort the market.
Food in America is already subsidized... and by subsidized perhaps make food assistance more vigorous with healthy foods than at present. Poor families tend to have to rely on unhealthy food to make ends meet and pay for it with their health.
I agree and the market is distorted because of it. They should be ended and we should also stop using the tax code for social engineering.1 -
janejellyroll wrote: »janejellyroll wrote: »janejellyroll wrote: »lemurcat12 wrote: »lemurcat12 wrote: »We went way off topic yesterday, which was as much my fault as anyone's, since I find the topic interesting (and understand that lots of people will have different opinions -- I used to post on usenet in the '90s, after all, and am not negative at all about internet libertarianism, even if I disagree).
Here, though, is I think Packerjohn's argument: whatever one thinks about what the gov't should do, it's likely that we will not get rid of Medicare, at least. Beyond that, it's probably generally a bad thing that the population is so obese, on average.
He submits that sugar/soda taxes could help and would at least raise money to help deal with the problem (similar to the argument for alcohol taxes, which exist).
I suspect that they will not, but think it makes sense for individual localities to experiment with them to see what the results are.
Others find all such taxes at any level bad, and are against "sin" taxes in general.
My question is if you think these taxes are not likely to work (like me), do you think there are other public policy things that should be tried (including non governmental community efforts?) or do you think obesity is not actually a problem or that it's not a public policy problem, but a purely individual one?
My feeling is that it is a public policy problem but one hard to solve. I think education is good (but doesn't seem to have worked so far), making available healthy food options (i.e., addressing food deserts, promoting gardening and community gardens) is great, but again likely has a small effect, promoting community cooking classes, same, medical intervention I think is important and could be done more/better than it is, calorie posting/labels seem already to be done. Anyway, I think it's an interesting topic.
The inherent problem with government is lack of transparency and accountability. As long as career politicians are allowed to exist corruption will flourish. Government is ill suited for this role, which is why all socialist systems ultimately fail. People love being charitable - they abhor being forced to support a failing system. Centralized systems only work in small populations. Attempts to centralize large populations require authoritarian structures. Smart agile businesses work around this through decentralized structures, giving local structures the freedom of deciding which policies produce the best results.
Negative reinforcement has never been an effective behavioral modifier.
Education has been completely ineffective because we have centralized conflicting policies. We also have "leaders" who talk the talk but do not walk the walk.
This would be far more effective and efficient to promote positive reinforcements - just as the business world has done. Maintain positive health metrics = tax credit/deduction.
So setting aside the broader debate over gov't philosophy, can you be more specific? Tax credit/deduction offered by whom (feds? state?) for what?
People seemed really down on insurance company/workplace wellness programs in some other thread, but isn't that basically similar to this idea, but not gov't-based?
You get success in achievement based systems. It is an amazingly effective tool that motivates users into desired activities.
For healthcare this could be tracked via an app - form a simple risk management structure (many business models already exist with these platforms in the business realm). Each participant actively engages in proactive measures and rewarded through specific credits/deductions. Specifically - maintaining a healthy BMI would equate to a $2000 deduction. This would be managed (ideally) privately; however as government has inserted itself by force this would be managed by state to minimize corruption and maximize competition. Unhappy with your state's policy - you can vote with your feet and relocate.
I have long been a proponent of a two tiered system. One for those who embrace the benefits and risks of liberty and another for those who do not. Those who want the safety net of government can certainly enjoy this, but they pay into this just as one would in an insurance pool. Those who do not can opt out.
How would you keep people from switching when they ran into issues later in life, like a child with a disability or a chronic disease developing? Would people decide which group they want to be in early in life and be prohibited from switching from the non-safety net group to the safety net group?
Without some mechanism to keep people from switching, wouldn't you have relatively few people in the safety net group unless they actually planned to draw benefits?
These issues are outliers and can easily be absorbed in the system. You never make policy based on outliers.
You can switch groups, but would pay the prorated fee associated with opting out of the current plan.
That is precisely the point. Ponzi schemes are illegal for all parties with the curious exception of government. This also keeps politicians from pretending to play Robin Hood when they are, by default, the Sheriff of Nottingham.
Unfortunately, people with disabilities or chronic diseases aren't really an rare thing in our society, I wouldn't consider older people with chronic diseases or people drawing disability benefits to be outliars -- they'd have to be accounted for in any realistic program granting/denying benefits. There are probably lots of people who never think they'd draw certain government benefits until they find themselves in a situation where they need them.
That said, I understand what you're suggesting with the pro-rated fee. Thanks for clarifying.
These remain outliers - a very small portion of the overall populace.
This is precisely why government or any industry should be allowed permission in granting/denying benefits. This is a decision between the medical provider and the patient. By allowing additional parties into this extremely personal decision you have created a monster - one that can never be controlled and one that ensure corruption.
Probably? Policies should be based upon certainties or predictable expectations. If you set the bar low, the populace will aim low.
This is the realm of charity - not government.
8.7 million people got SS disability benefits in February 2017.
72.5 million people are on Medicaid, 55.3 million are on Medicare.
I don't consider that to be a small portion of the population -- they'd have to be considered in any overhaul (or removal) of the safety net. Some of those people may opt into the safety net lane at age 18 -- they obviously wouldn't cause the type of issue I was asking about. But it's likely that at least some of those people would begin their working lives thinking that they would be self-sufficient forever and then something happened.
I understand your position on the role of charity -- I was asking for specific clarification on how you would deal with people who began their working lives in the second group (opting out) and then decided, due to life events, that they wanted in.
Is the answer that these people are exceptions who don't have to be considered? I don't know that we can assume that. We know from the example of health insurance that people will often forgo insurance when they're young and healthy, only to want it later. Do we think people would act differently with the safety net, that young people feeling like they've got decades of health in front of them will decide to have *less money* in their pocket each month because they're making rational decisions about the future possibility that they will be 65 and unable to afford health care?
If a pro-rated fee is available to these people, then I understand your clarification. If charity is the only recourse for those who are unable to afford the pro-rated fee, I understand that as well.
I'm simply trying to understand your position, that's all.
330 million population in the US (likely closer to 360 M) so by conservative estimate 2.6% get SS disability benefits in February 2017. 100% pay into this Ponzi scheme
Medicaid and Medicare are failing systems and should be eliminated immediately. These serve no purpose other than to insert government into the free market. This is yet another primary driver of the increasing cost of medicine.
For actual implementation there would have to be a period of change. It is inexcusable for the younger generation to be expected to pay for the false promises and poor planning of politicians. One generation falling for this lie is enough. Implementing actual accountability is necessary as well. There will always be a safety net so to speak, but the care provided by the state would be minimal. Any additional care could always be provided through private enterprise.
Good policy is enacted based on the needs of the majority, with special exceptions crafted for exceptional circumstances. Basing policy on < 3% of the population will fail before it begins.
Just as in life people will choose poorly, but creating a safety net encourages poor behavior.
Using MFP as an example can you imagine if the CICO models were based upon the minority cases?
No problem at all. This is one of my favorite topics and I love to discuss and debate these issues.
I appreciate the discussion -- it can be rare to find someone who is actually willing to discuss how their views would translate into actual policy changes.0 -
no, that's just stupid.1
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lemurcat12 wrote: »janejellyroll wrote: »crzycatlady1 wrote: »lemurcat12 wrote: »lemurcat12 wrote: »lemurcat12 wrote: »We went way off topic yesterday, which was as much my fault as anyone's, since I find the topic interesting (and understand that lots of people will have different opinions -- I used to post on usenet in the '90s, after all, and am not negative at all about internet libertarianism, even if I disagree).
Here, though, is I think Packerjohn's argument: whatever one thinks about what the gov't should do, it's likely that we will not get rid of Medicare, at least. Beyond that, it's probably generally a bad thing that the population is so obese, on average.
He submits that sugar/soda taxes could help and would at least raise money to help deal with the problem (similar to the argument for alcohol taxes, which exist).
I suspect that they will not, but think it makes sense for individual localities to experiment with them to see what the results are.
Others find all such taxes at any level bad, and are against "sin" taxes in general.
My question is if you think these taxes are not likely to work (like me), do you think there are other public policy things that should be tried (including non governmental community efforts?) or do you think obesity is not actually a problem or that it's not a public policy problem, but a purely individual one?
My feeling is that it is a public policy problem but one hard to solve. I think education is good (but doesn't seem to have worked so far), making available healthy food options (i.e., addressing food deserts, promoting gardening and community gardens) is great, but again likely has a small effect, promoting community cooking classes, same, medical intervention I think is important and could be done more/better than it is, calorie posting/labels seem already to be done. Anyway, I think it's an interesting topic.
The inherent problem with government is lack of transparency and accountability. As long as career politicians are allowed to exist corruption will flourish. Government is ill suited for this role, which is why all socialist systems ultimately fail. People love being charitable - they abhor being forced to support a failing system. Centralized systems only work in small populations. Attempts to centralize large populations require authoritarian structures. Smart agile businesses work around this through decentralized structures, giving local structures the freedom of deciding which policies produce the best results.
Negative reinforcement has never been an effective behavioral modifier.
Education has been completely ineffective because we have centralized conflicting policies. We also have "leaders" who talk the talk but do not walk the walk.
This would be far more effective and efficient to promote positive reinforcements - just as the business world has done. Maintain positive health metrics = tax credit/deduction.
So setting aside the broader debate over gov't philosophy, can you be more specific? Tax credit/deduction offered by whom (feds? state?) for what?
People seemed really down on insurance company/workplace wellness programs in some other thread, but isn't that basically similar to this idea, but not gov't-based?
You get success in achievement based systems. It is an amazingly effective tool that motivates users into desired activities.
Well, I'm sure there are things we could look at to see how well it works with weight. Those insurance wellness programs, for example. I'm not sure how what you are suggesting is different, which is why I asked.For healthcare this could be tracked via an app - form a simple risk management structure (many business models already exist with these platforms in the business realm). Each participant actively engages in proactive measures and rewarded through specific credits/deductions. Specifically - maintaining a healthy BMI would equate to a $2000 deduction. This would be managed (ideally) privately; however as government has inserted itself by force this would be managed by state to minimize corruption and maximize competition. Unhappy with your state's policy - you can vote with your feet and relocate.
So to put this simply, I get a $2000 deduction from my state taxes for having a healthy BMI? (What if I'm Dwayne Johnson? I mean, I'm not, my BMI is 22 and I think I'd be better off around 20, so it's not a personal question.) It seems pretty open to abuse, as states are unlikely to be able to effectively check, but let's assume the technical issues get worked out--wondering what others would think of this idea.
It seems to me a more direct/effective approach, if people wanted to do this, was just let insurance companies charge extra if your BMI is 25+ (and you can't show your BF% is fine, I'd require that option), and still more if it's 30+ and so on. It really seems like the same thing, you still pay less for having a healthy weight.
Problem is that we probably WANT younger overweight/obese people to have insurance, as that's more likely to get them medical care and result in them losing weight when they haven't yet developed any medical issues. But young people without health issues are the most likely to say forget it if health care costs are high.
Just thinking this through, not arguing for anything.I have long been a proponent of a two tiered system. One for those who embrace the benefits and risks of liberty and another for those who do not. Those who want the safety net of government can certainly enjoy this, but they pay into this just as one would in an insurance pool. Those who do not can opt out.
One problem is that we don't have willingness as a society to see people suffer the effects of opting out, I don't think. Especially if the choice has to be made at age 18 or 21. (Edit: oh, janejellyroll is already raising the same points that I would have, yay.)
My husband's employer/insurance already implements something similar. We get penalized for high bmis, bad blood work panels, smoking etc. We also have a high deductible HSA plan that has several thousand dollars out of pocket before any benefits kick in.
Ours is kind of like that. We have a very high deductible and smokers pay more each month. We do get extra money for our HSA for doing preventative care, which helps. But when my husband broke his wrist two years ago, I think we wound up paying $1,110 out of pocket and insurance only covered a little bit of the overall costs.
I actually like high deductible plans. Mine isn't particularly (more since ACA than before), but I think that model makes sense, although with the exception for certain kinds of routine care if you want to encourage people to get preventative care. In my (obviously not something I would sell to the majority here, so I'm not trying!) ;-) personal government-based insurance plan, it would kick in after a certain amount, I think, which would preserve competition in the things you can actually compete in. I just think the notion of competing and driving down the cost for something like chemo makes no sense. If I am trying to buy a car or whatever, it's 100% true that I won't think it's worth it if the cost is too high and would walk away, which gives me competitive power. If it's take the treatment or die, well, I don't have that power (and same if something comes up in the middle of giving birth or some such).
For current insurance I tend to like the idea of cost reductions for various things/preventative care, etc., too, although I do not have such a plan.
We don't mind having a high deductible/HSA plan, though it would be nice if our employer still helped with funding the HSA account. Right now we have designated $200 a month to be taken from our paychecks and deposited into the account. That doesn't go far, when you factor in the high deductible medical plan, prescriptions, eye care, dental care and then 3 kids in braces. Tomorrow I'm going on to have a crown done at the dentist. We pay for a dental insurance policy, separate from the high deductible medical insurance, but it's kind of a crappy policy and my portion tomorrow is $550. That will zero out our HSA account.1 -
lemurcat12 wrote: »janejellyroll wrote: »crzycatlady1 wrote: »lemurcat12 wrote: »lemurcat12 wrote: »lemurcat12 wrote: »We went way off topic yesterday, which was as much my fault as anyone's, since I find the topic interesting (and understand that lots of people will have different opinions -- I used to post on usenet in the '90s, after all, and am not negative at all about internet libertarianism, even if I disagree).
Here, though, is I think Packerjohn's argument: whatever one thinks about what the gov't should do, it's likely that we will not get rid of Medicare, at least. Beyond that, it's probably generally a bad thing that the population is so obese, on average.
He submits that sugar/soda taxes could help and would at least raise money to help deal with the problem (similar to the argument for alcohol taxes, which exist).
I suspect that they will not, but think it makes sense for individual localities to experiment with them to see what the results are.
Others find all such taxes at any level bad, and are against "sin" taxes in general.
My question is if you think these taxes are not likely to work (like me), do you think there are other public policy things that should be tried (including non governmental community efforts?) or do you think obesity is not actually a problem or that it's not a public policy problem, but a purely individual one?
My feeling is that it is a public policy problem but one hard to solve. I think education is good (but doesn't seem to have worked so far), making available healthy food options (i.e., addressing food deserts, promoting gardening and community gardens) is great, but again likely has a small effect, promoting community cooking classes, same, medical intervention I think is important and could be done more/better than it is, calorie posting/labels seem already to be done. Anyway, I think it's an interesting topic.
The inherent problem with government is lack of transparency and accountability. As long as career politicians are allowed to exist corruption will flourish. Government is ill suited for this role, which is why all socialist systems ultimately fail. People love being charitable - they abhor being forced to support a failing system. Centralized systems only work in small populations. Attempts to centralize large populations require authoritarian structures. Smart agile businesses work around this through decentralized structures, giving local structures the freedom of deciding which policies produce the best results.
Negative reinforcement has never been an effective behavioral modifier.
Education has been completely ineffective because we have centralized conflicting policies. We also have "leaders" who talk the talk but do not walk the walk.
This would be far more effective and efficient to promote positive reinforcements - just as the business world has done. Maintain positive health metrics = tax credit/deduction.
So setting aside the broader debate over gov't philosophy, can you be more specific? Tax credit/deduction offered by whom (feds? state?) for what?
People seemed really down on insurance company/workplace wellness programs in some other thread, but isn't that basically similar to this idea, but not gov't-based?
You get success in achievement based systems. It is an amazingly effective tool that motivates users into desired activities.
Well, I'm sure there are things we could look at to see how well it works with weight. Those insurance wellness programs, for example. I'm not sure how what you are suggesting is different, which is why I asked.For healthcare this could be tracked via an app - form a simple risk management structure (many business models already exist with these platforms in the business realm). Each participant actively engages in proactive measures and rewarded through specific credits/deductions. Specifically - maintaining a healthy BMI would equate to a $2000 deduction. This would be managed (ideally) privately; however as government has inserted itself by force this would be managed by state to minimize corruption and maximize competition. Unhappy with your state's policy - you can vote with your feet and relocate.
So to put this simply, I get a $2000 deduction from my state taxes for having a healthy BMI? (What if I'm Dwayne Johnson? I mean, I'm not, my BMI is 22 and I think I'd be better off around 20, so it's not a personal question.) It seems pretty open to abuse, as states are unlikely to be able to effectively check, but let's assume the technical issues get worked out--wondering what others would think of this idea.
It seems to me a more direct/effective approach, if people wanted to do this, was just let insurance companies charge extra if your BMI is 25+ (and you can't show your BF% is fine, I'd require that option), and still more if it's 30+ and so on. It really seems like the same thing, you still pay less for having a healthy weight.
Problem is that we probably WANT younger overweight/obese people to have insurance, as that's more likely to get them medical care and result in them losing weight when they haven't yet developed any medical issues. But young people without health issues are the most likely to say forget it if health care costs are high.
Just thinking this through, not arguing for anything.I have long been a proponent of a two tiered system. One for those who embrace the benefits and risks of liberty and another for those who do not. Those who want the safety net of government can certainly enjoy this, but they pay into this just as one would in an insurance pool. Those who do not can opt out.
One problem is that we don't have willingness as a society to see people suffer the effects of opting out, I don't think. Especially if the choice has to be made at age 18 or 21. (Edit: oh, janejellyroll is already raising the same points that I would have, yay.)
My husband's employer/insurance already implements something similar. We get penalized for high bmis, bad blood work panels, smoking etc. We also have a high deductible HSA plan that has several thousand dollars out of pocket before any benefits kick in.
Ours is kind of like that. We have a very high deductible and smokers pay more each month. We do get extra money for our HSA for doing preventative care, which helps. But when my husband broke his wrist two years ago, I think we wound up paying $1,110 out of pocket and insurance only covered a little bit of the overall costs.
I actually like high deductible plans. Mine isn't particularly (more since ACA than before), but I think that model makes sense, although with the exception for certain kinds of routine care if you want to encourage people to get preventative care. In my (obviously not something I would sell to the majority here, so I'm not trying!) ;-) personal government-based insurance plan, it would kick in after a certain amount, I think, which would preserve competition in the things you can actually compete in. I just think the notion of competing and driving down the cost for something like chemo makes no sense. If I am trying to buy a car or whatever, it's 100% true that I won't think it's worth it if the cost is too high and would walk away, which gives me competitive power. If it's take the treatment or die, well, I don't have that power (and same if something comes up in the middle of giving birth or some such).
For current insurance I tend to like the idea of cost reductions for various things/preventative care, etc., too, although I do not have such a plan.
I love the idea of the high deductible plan and I will say that it has made my husband and I much more . . . choosier about when we go to the doctor and when we wait it out. Our preventative care is also 100% free, so it works well in that regard. I think it would work better if there were really much cheaper options for medical care in our area. My husband had to have some diagnostic tests a couple of years ago and I called around to see if we could find the cheapest. One place wouldn't give me the cost at all (totally defeating the concept of shopping around), the others were all with $50 of the cost.
And this was for a relatively low stress set of tests. If I had to have chemo or it was a more urgent situation, I can't imagine putting myself through that at all. High deductibles assume we have a level of power, flexibility, and knowledge that most of us don't have.3 -
kenyonhaff wrote: »How about subsidizing fruits, vegetables, and so on instead? A lot of poorer families buy crappy food because it's cheaper than healthy food.
It is not actually expensive in most of the US to eat healthfully. I think it's far more likely that people (understandably) want convenience or don't really know how to cook. For some poor people it's also possible they lack kitchen equipment (even a real oven in some cases) or live in a food desert, but the obesity problem reaches well beyond people who suffer from these issues.
Where I live many farmers markets will not only accept SNAP but you get double benefits. Of course out of season that's less helpful, and things like frozen veg are probably still cheaper.2 -
crzycatlady1 wrote: »lemurcat12 wrote: »janejellyroll wrote: »crzycatlady1 wrote: »lemurcat12 wrote: »lemurcat12 wrote: »lemurcat12 wrote: »We went way off topic yesterday, which was as much my fault as anyone's, since I find the topic interesting (and understand that lots of people will have different opinions -- I used to post on usenet in the '90s, after all, and am not negative at all about internet libertarianism, even if I disagree).
Here, though, is I think Packerjohn's argument: whatever one thinks about what the gov't should do, it's likely that we will not get rid of Medicare, at least. Beyond that, it's probably generally a bad thing that the population is so obese, on average.
He submits that sugar/soda taxes could help and would at least raise money to help deal with the problem (similar to the argument for alcohol taxes, which exist).
I suspect that they will not, but think it makes sense for individual localities to experiment with them to see what the results are.
Others find all such taxes at any level bad, and are against "sin" taxes in general.
My question is if you think these taxes are not likely to work (like me), do you think there are other public policy things that should be tried (including non governmental community efforts?) or do you think obesity is not actually a problem or that it's not a public policy problem, but a purely individual one?
My feeling is that it is a public policy problem but one hard to solve. I think education is good (but doesn't seem to have worked so far), making available healthy food options (i.e., addressing food deserts, promoting gardening and community gardens) is great, but again likely has a small effect, promoting community cooking classes, same, medical intervention I think is important and could be done more/better than it is, calorie posting/labels seem already to be done. Anyway, I think it's an interesting topic.
The inherent problem with government is lack of transparency and accountability. As long as career politicians are allowed to exist corruption will flourish. Government is ill suited for this role, which is why all socialist systems ultimately fail. People love being charitable - they abhor being forced to support a failing system. Centralized systems only work in small populations. Attempts to centralize large populations require authoritarian structures. Smart agile businesses work around this through decentralized structures, giving local structures the freedom of deciding which policies produce the best results.
Negative reinforcement has never been an effective behavioral modifier.
Education has been completely ineffective because we have centralized conflicting policies. We also have "leaders" who talk the talk but do not walk the walk.
This would be far more effective and efficient to promote positive reinforcements - just as the business world has done. Maintain positive health metrics = tax credit/deduction.
So setting aside the broader debate over gov't philosophy, can you be more specific? Tax credit/deduction offered by whom (feds? state?) for what?
People seemed really down on insurance company/workplace wellness programs in some other thread, but isn't that basically similar to this idea, but not gov't-based?
You get success in achievement based systems. It is an amazingly effective tool that motivates users into desired activities.
Well, I'm sure there are things we could look at to see how well it works with weight. Those insurance wellness programs, for example. I'm not sure how what you are suggesting is different, which is why I asked.For healthcare this could be tracked via an app - form a simple risk management structure (many business models already exist with these platforms in the business realm). Each participant actively engages in proactive measures and rewarded through specific credits/deductions. Specifically - maintaining a healthy BMI would equate to a $2000 deduction. This would be managed (ideally) privately; however as government has inserted itself by force this would be managed by state to minimize corruption and maximize competition. Unhappy with your state's policy - you can vote with your feet and relocate.
So to put this simply, I get a $2000 deduction from my state taxes for having a healthy BMI? (What if I'm Dwayne Johnson? I mean, I'm not, my BMI is 22 and I think I'd be better off around 20, so it's not a personal question.) It seems pretty open to abuse, as states are unlikely to be able to effectively check, but let's assume the technical issues get worked out--wondering what others would think of this idea.
It seems to me a more direct/effective approach, if people wanted to do this, was just let insurance companies charge extra if your BMI is 25+ (and you can't show your BF% is fine, I'd require that option), and still more if it's 30+ and so on. It really seems like the same thing, you still pay less for having a healthy weight.
Problem is that we probably WANT younger overweight/obese people to have insurance, as that's more likely to get them medical care and result in them losing weight when they haven't yet developed any medical issues. But young people without health issues are the most likely to say forget it if health care costs are high.
Just thinking this through, not arguing for anything.I have long been a proponent of a two tiered system. One for those who embrace the benefits and risks of liberty and another for those who do not. Those who want the safety net of government can certainly enjoy this, but they pay into this just as one would in an insurance pool. Those who do not can opt out.
One problem is that we don't have willingness as a society to see people suffer the effects of opting out, I don't think. Especially if the choice has to be made at age 18 or 21. (Edit: oh, janejellyroll is already raising the same points that I would have, yay.)
My husband's employer/insurance already implements something similar. We get penalized for high bmis, bad blood work panels, smoking etc. We also have a high deductible HSA plan that has several thousand dollars out of pocket before any benefits kick in.
Ours is kind of like that. We have a very high deductible and smokers pay more each month. We do get extra money for our HSA for doing preventative care, which helps. But when my husband broke his wrist two years ago, I think we wound up paying $1,110 out of pocket and insurance only covered a little bit of the overall costs.
I actually like high deductible plans. Mine isn't particularly (more since ACA than before), but I think that model makes sense, although with the exception for certain kinds of routine care if you want to encourage people to get preventative care. In my (obviously not something I would sell to the majority here, so I'm not trying!) ;-) personal government-based insurance plan, it would kick in after a certain amount, I think, which would preserve competition in the things you can actually compete in. I just think the notion of competing and driving down the cost for something like chemo makes no sense. If I am trying to buy a car or whatever, it's 100% true that I won't think it's worth it if the cost is too high and would walk away, which gives me competitive power. If it's take the treatment or die, well, I don't have that power (and same if something comes up in the middle of giving birth or some such).
For current insurance I tend to like the idea of cost reductions for various things/preventative care, etc., too, although I do not have such a plan.
We don't mind having a high deductible/HSA plan, though it would be nice if our employer still helped with funding the HSA account. Right now we have designated $200 a month to be taken from our paychecks and deposited into the account. That doesn't go far, when you factor in the high deductible medical plan, prescriptions, eye care, dental care and then 3 kids in braces. Tomorrow I'm going on to have a crown done at the dentist. We pay for a dental insurance policy, separate from the high deductible medical insurance, but it's kind of a crappy policy and my portion tomorrow is $550. That will zero out our HSA account.
Yeah, I've never had a good dental policy.0 -
lemurcat12 wrote: »crzycatlady1 wrote: »lemurcat12 wrote: »janejellyroll wrote: »crzycatlady1 wrote: »lemurcat12 wrote: »lemurcat12 wrote: »lemurcat12 wrote: »We went way off topic yesterday, which was as much my fault as anyone's, since I find the topic interesting (and understand that lots of people will have different opinions -- I used to post on usenet in the '90s, after all, and am not negative at all about internet libertarianism, even if I disagree).
Here, though, is I think Packerjohn's argument: whatever one thinks about what the gov't should do, it's likely that we will not get rid of Medicare, at least. Beyond that, it's probably generally a bad thing that the population is so obese, on average.
He submits that sugar/soda taxes could help and would at least raise money to help deal with the problem (similar to the argument for alcohol taxes, which exist).
I suspect that they will not, but think it makes sense for individual localities to experiment with them to see what the results are.
Others find all such taxes at any level bad, and are against "sin" taxes in general.
My question is if you think these taxes are not likely to work (like me), do you think there are other public policy things that should be tried (including non governmental community efforts?) or do you think obesity is not actually a problem or that it's not a public policy problem, but a purely individual one?
My feeling is that it is a public policy problem but one hard to solve. I think education is good (but doesn't seem to have worked so far), making available healthy food options (i.e., addressing food deserts, promoting gardening and community gardens) is great, but again likely has a small effect, promoting community cooking classes, same, medical intervention I think is important and could be done more/better than it is, calorie posting/labels seem already to be done. Anyway, I think it's an interesting topic.
The inherent problem with government is lack of transparency and accountability. As long as career politicians are allowed to exist corruption will flourish. Government is ill suited for this role, which is why all socialist systems ultimately fail. People love being charitable - they abhor being forced to support a failing system. Centralized systems only work in small populations. Attempts to centralize large populations require authoritarian structures. Smart agile businesses work around this through decentralized structures, giving local structures the freedom of deciding which policies produce the best results.
Negative reinforcement has never been an effective behavioral modifier.
Education has been completely ineffective because we have centralized conflicting policies. We also have "leaders" who talk the talk but do not walk the walk.
This would be far more effective and efficient to promote positive reinforcements - just as the business world has done. Maintain positive health metrics = tax credit/deduction.
So setting aside the broader debate over gov't philosophy, can you be more specific? Tax credit/deduction offered by whom (feds? state?) for what?
People seemed really down on insurance company/workplace wellness programs in some other thread, but isn't that basically similar to this idea, but not gov't-based?
You get success in achievement based systems. It is an amazingly effective tool that motivates users into desired activities.
Well, I'm sure there are things we could look at to see how well it works with weight. Those insurance wellness programs, for example. I'm not sure how what you are suggesting is different, which is why I asked.For healthcare this could be tracked via an app - form a simple risk management structure (many business models already exist with these platforms in the business realm). Each participant actively engages in proactive measures and rewarded through specific credits/deductions. Specifically - maintaining a healthy BMI would equate to a $2000 deduction. This would be managed (ideally) privately; however as government has inserted itself by force this would be managed by state to minimize corruption and maximize competition. Unhappy with your state's policy - you can vote with your feet and relocate.
So to put this simply, I get a $2000 deduction from my state taxes for having a healthy BMI? (What if I'm Dwayne Johnson? I mean, I'm not, my BMI is 22 and I think I'd be better off around 20, so it's not a personal question.) It seems pretty open to abuse, as states are unlikely to be able to effectively check, but let's assume the technical issues get worked out--wondering what others would think of this idea.
It seems to me a more direct/effective approach, if people wanted to do this, was just let insurance companies charge extra if your BMI is 25+ (and you can't show your BF% is fine, I'd require that option), and still more if it's 30+ and so on. It really seems like the same thing, you still pay less for having a healthy weight.
Problem is that we probably WANT younger overweight/obese people to have insurance, as that's more likely to get them medical care and result in them losing weight when they haven't yet developed any medical issues. But young people without health issues are the most likely to say forget it if health care costs are high.
Just thinking this through, not arguing for anything.I have long been a proponent of a two tiered system. One for those who embrace the benefits and risks of liberty and another for those who do not. Those who want the safety net of government can certainly enjoy this, but they pay into this just as one would in an insurance pool. Those who do not can opt out.
One problem is that we don't have willingness as a society to see people suffer the effects of opting out, I don't think. Especially if the choice has to be made at age 18 or 21. (Edit: oh, janejellyroll is already raising the same points that I would have, yay.)
My husband's employer/insurance already implements something similar. We get penalized for high bmis, bad blood work panels, smoking etc. We also have a high deductible HSA plan that has several thousand dollars out of pocket before any benefits kick in.
Ours is kind of like that. We have a very high deductible and smokers pay more each month. We do get extra money for our HSA for doing preventative care, which helps. But when my husband broke his wrist two years ago, I think we wound up paying $1,110 out of pocket and insurance only covered a little bit of the overall costs.
I actually like high deductible plans. Mine isn't particularly (more since ACA than before), but I think that model makes sense, although with the exception for certain kinds of routine care if you want to encourage people to get preventative care. In my (obviously not something I would sell to the majority here, so I'm not trying!) ;-) personal government-based insurance plan, it would kick in after a certain amount, I think, which would preserve competition in the things you can actually compete in. I just think the notion of competing and driving down the cost for something like chemo makes no sense. If I am trying to buy a car or whatever, it's 100% true that I won't think it's worth it if the cost is too high and would walk away, which gives me competitive power. If it's take the treatment or die, well, I don't have that power (and same if something comes up in the middle of giving birth or some such).
For current insurance I tend to like the idea of cost reductions for various things/preventative care, etc., too, although I do not have such a plan.
We don't mind having a high deductible/HSA plan, though it would be nice if our employer still helped with funding the HSA account. Right now we have designated $200 a month to be taken from our paychecks and deposited into the account. That doesn't go far, when you factor in the high deductible medical plan, prescriptions, eye care, dental care and then 3 kids in braces. Tomorrow I'm going on to have a crown done at the dentist. We pay for a dental insurance policy, separate from the high deductible medical insurance, but it's kind of a crappy policy and my portion tomorrow is $550. That will zero out our HSA account.
Yeah, I've never had a good dental policy.
I don't think they exist lol.1 -
janejellyroll wrote: »lemurcat12 wrote: »janejellyroll wrote: »crzycatlady1 wrote: »lemurcat12 wrote: »lemurcat12 wrote: »lemurcat12 wrote: »We went way off topic yesterday, which was as much my fault as anyone's, since I find the topic interesting (and understand that lots of people will have different opinions -- I used to post on usenet in the '90s, after all, and am not negative at all about internet libertarianism, even if I disagree).
Here, though, is I think Packerjohn's argument: whatever one thinks about what the gov't should do, it's likely that we will not get rid of Medicare, at least. Beyond that, it's probably generally a bad thing that the population is so obese, on average.
He submits that sugar/soda taxes could help and would at least raise money to help deal with the problem (similar to the argument for alcohol taxes, which exist).
I suspect that they will not, but think it makes sense for individual localities to experiment with them to see what the results are.
Others find all such taxes at any level bad, and are against "sin" taxes in general.
My question is if you think these taxes are not likely to work (like me), do you think there are other public policy things that should be tried (including non governmental community efforts?) or do you think obesity is not actually a problem or that it's not a public policy problem, but a purely individual one?
My feeling is that it is a public policy problem but one hard to solve. I think education is good (but doesn't seem to have worked so far), making available healthy food options (i.e., addressing food deserts, promoting gardening and community gardens) is great, but again likely has a small effect, promoting community cooking classes, same, medical intervention I think is important and could be done more/better than it is, calorie posting/labels seem already to be done. Anyway, I think it's an interesting topic.
The inherent problem with government is lack of transparency and accountability. As long as career politicians are allowed to exist corruption will flourish. Government is ill suited for this role, which is why all socialist systems ultimately fail. People love being charitable - they abhor being forced to support a failing system. Centralized systems only work in small populations. Attempts to centralize large populations require authoritarian structures. Smart agile businesses work around this through decentralized structures, giving local structures the freedom of deciding which policies produce the best results.
Negative reinforcement has never been an effective behavioral modifier.
Education has been completely ineffective because we have centralized conflicting policies. We also have "leaders" who talk the talk but do not walk the walk.
This would be far more effective and efficient to promote positive reinforcements - just as the business world has done. Maintain positive health metrics = tax credit/deduction.
So setting aside the broader debate over gov't philosophy, can you be more specific? Tax credit/deduction offered by whom (feds? state?) for what?
People seemed really down on insurance company/workplace wellness programs in some other thread, but isn't that basically similar to this idea, but not gov't-based?
You get success in achievement based systems. It is an amazingly effective tool that motivates users into desired activities.
Well, I'm sure there are things we could look at to see how well it works with weight. Those insurance wellness programs, for example. I'm not sure how what you are suggesting is different, which is why I asked.For healthcare this could be tracked via an app - form a simple risk management structure (many business models already exist with these platforms in the business realm). Each participant actively engages in proactive measures and rewarded through specific credits/deductions. Specifically - maintaining a healthy BMI would equate to a $2000 deduction. This would be managed (ideally) privately; however as government has inserted itself by force this would be managed by state to minimize corruption and maximize competition. Unhappy with your state's policy - you can vote with your feet and relocate.
So to put this simply, I get a $2000 deduction from my state taxes for having a healthy BMI? (What if I'm Dwayne Johnson? I mean, I'm not, my BMI is 22 and I think I'd be better off around 20, so it's not a personal question.) It seems pretty open to abuse, as states are unlikely to be able to effectively check, but let's assume the technical issues get worked out--wondering what others would think of this idea.
It seems to me a more direct/effective approach, if people wanted to do this, was just let insurance companies charge extra if your BMI is 25+ (and you can't show your BF% is fine, I'd require that option), and still more if it's 30+ and so on. It really seems like the same thing, you still pay less for having a healthy weight.
Problem is that we probably WANT younger overweight/obese people to have insurance, as that's more likely to get them medical care and result in them losing weight when they haven't yet developed any medical issues. But young people without health issues are the most likely to say forget it if health care costs are high.
Just thinking this through, not arguing for anything.I have long been a proponent of a two tiered system. One for those who embrace the benefits and risks of liberty and another for those who do not. Those who want the safety net of government can certainly enjoy this, but they pay into this just as one would in an insurance pool. Those who do not can opt out.
One problem is that we don't have willingness as a society to see people suffer the effects of opting out, I don't think. Especially if the choice has to be made at age 18 or 21. (Edit: oh, janejellyroll is already raising the same points that I would have, yay.)
My husband's employer/insurance already implements something similar. We get penalized for high bmis, bad blood work panels, smoking etc. We also have a high deductible HSA plan that has several thousand dollars out of pocket before any benefits kick in.
Ours is kind of like that. We have a very high deductible and smokers pay more each month. We do get extra money for our HSA for doing preventative care, which helps. But when my husband broke his wrist two years ago, I think we wound up paying $1,110 out of pocket and insurance only covered a little bit of the overall costs.
I actually like high deductible plans. Mine isn't particularly (more since ACA than before), but I think that model makes sense, although with the exception for certain kinds of routine care if you want to encourage people to get preventative care. In my (obviously not something I would sell to the majority here, so I'm not trying!) ;-) personal government-based insurance plan, it would kick in after a certain amount, I think, which would preserve competition in the things you can actually compete in. I just think the notion of competing and driving down the cost for something like chemo makes no sense. If I am trying to buy a car or whatever, it's 100% true that I won't think it's worth it if the cost is too high and would walk away, which gives me competitive power. If it's take the treatment or die, well, I don't have that power (and same if something comes up in the middle of giving birth or some such).
For current insurance I tend to like the idea of cost reductions for various things/preventative care, etc., too, although I do not have such a plan.
I love the idea of the high deductible plan and I will say that it has made my husband and I much more . . . choosier about when we go to the doctor and when we wait it out. Our preventative care is also 100% free, so it works well in that regard. I think it would work better if there were really much cheaper options for medical care in our area. My husband had to have some diagnostic tests a couple of years ago and I called around to see if we could find the cheapest. One place wouldn't give me the cost at all (totally defeating the concept of shopping around), the others were all with $50 of the cost.
And this was for a relatively low stress set of tests. If I had to have chemo or it was a more urgent situation, I can't imagine putting myself through that at all. High deductibles assume we have a level of power, flexibility, and knowledge that most of us don't have.
Yeah, this is true. I forget that I am extremely fortunate with respect to the amount of medical care options I have in a big city with some excellent health care facilities. In some parts of the US there simply really just isn't much competition and it can even be hard to get an appointment, even apart from insurance.0 -
lemurcat12 wrote: »janejellyroll wrote: »lemurcat12 wrote: »janejellyroll wrote: »crzycatlady1 wrote: »lemurcat12 wrote: »lemurcat12 wrote: »lemurcat12 wrote: »We went way off topic yesterday, which was as much my fault as anyone's, since I find the topic interesting (and understand that lots of people will have different opinions -- I used to post on usenet in the '90s, after all, and am not negative at all about internet libertarianism, even if I disagree).
Here, though, is I think Packerjohn's argument: whatever one thinks about what the gov't should do, it's likely that we will not get rid of Medicare, at least. Beyond that, it's probably generally a bad thing that the population is so obese, on average.
He submits that sugar/soda taxes could help and would at least raise money to help deal with the problem (similar to the argument for alcohol taxes, which exist).
I suspect that they will not, but think it makes sense for individual localities to experiment with them to see what the results are.
Others find all such taxes at any level bad, and are against "sin" taxes in general.
My question is if you think these taxes are not likely to work (like me), do you think there are other public policy things that should be tried (including non governmental community efforts?) or do you think obesity is not actually a problem or that it's not a public policy problem, but a purely individual one?
My feeling is that it is a public policy problem but one hard to solve. I think education is good (but doesn't seem to have worked so far), making available healthy food options (i.e., addressing food deserts, promoting gardening and community gardens) is great, but again likely has a small effect, promoting community cooking classes, same, medical intervention I think is important and could be done more/better than it is, calorie posting/labels seem already to be done. Anyway, I think it's an interesting topic.
The inherent problem with government is lack of transparency and accountability. As long as career politicians are allowed to exist corruption will flourish. Government is ill suited for this role, which is why all socialist systems ultimately fail. People love being charitable - they abhor being forced to support a failing system. Centralized systems only work in small populations. Attempts to centralize large populations require authoritarian structures. Smart agile businesses work around this through decentralized structures, giving local structures the freedom of deciding which policies produce the best results.
Negative reinforcement has never been an effective behavioral modifier.
Education has been completely ineffective because we have centralized conflicting policies. We also have "leaders" who talk the talk but do not walk the walk.
This would be far more effective and efficient to promote positive reinforcements - just as the business world has done. Maintain positive health metrics = tax credit/deduction.
So setting aside the broader debate over gov't philosophy, can you be more specific? Tax credit/deduction offered by whom (feds? state?) for what?
People seemed really down on insurance company/workplace wellness programs in some other thread, but isn't that basically similar to this idea, but not gov't-based?
You get success in achievement based systems. It is an amazingly effective tool that motivates users into desired activities.
Well, I'm sure there are things we could look at to see how well it works with weight. Those insurance wellness programs, for example. I'm not sure how what you are suggesting is different, which is why I asked.For healthcare this could be tracked via an app - form a simple risk management structure (many business models already exist with these platforms in the business realm). Each participant actively engages in proactive measures and rewarded through specific credits/deductions. Specifically - maintaining a healthy BMI would equate to a $2000 deduction. This would be managed (ideally) privately; however as government has inserted itself by force this would be managed by state to minimize corruption and maximize competition. Unhappy with your state's policy - you can vote with your feet and relocate.
So to put this simply, I get a $2000 deduction from my state taxes for having a healthy BMI? (What if I'm Dwayne Johnson? I mean, I'm not, my BMI is 22 and I think I'd be better off around 20, so it's not a personal question.) It seems pretty open to abuse, as states are unlikely to be able to effectively check, but let's assume the technical issues get worked out--wondering what others would think of this idea.
It seems to me a more direct/effective approach, if people wanted to do this, was just let insurance companies charge extra if your BMI is 25+ (and you can't show your BF% is fine, I'd require that option), and still more if it's 30+ and so on. It really seems like the same thing, you still pay less for having a healthy weight.
Problem is that we probably WANT younger overweight/obese people to have insurance, as that's more likely to get them medical care and result in them losing weight when they haven't yet developed any medical issues. But young people without health issues are the most likely to say forget it if health care costs are high.
Just thinking this through, not arguing for anything.I have long been a proponent of a two tiered system. One for those who embrace the benefits and risks of liberty and another for those who do not. Those who want the safety net of government can certainly enjoy this, but they pay into this just as one would in an insurance pool. Those who do not can opt out.
One problem is that we don't have willingness as a society to see people suffer the effects of opting out, I don't think. Especially if the choice has to be made at age 18 or 21. (Edit: oh, janejellyroll is already raising the same points that I would have, yay.)
My husband's employer/insurance already implements something similar. We get penalized for high bmis, bad blood work panels, smoking etc. We also have a high deductible HSA plan that has several thousand dollars out of pocket before any benefits kick in.
Ours is kind of like that. We have a very high deductible and smokers pay more each month. We do get extra money for our HSA for doing preventative care, which helps. But when my husband broke his wrist two years ago, I think we wound up paying $1,110 out of pocket and insurance only covered a little bit of the overall costs.
I actually like high deductible plans. Mine isn't particularly (more since ACA than before), but I think that model makes sense, although with the exception for certain kinds of routine care if you want to encourage people to get preventative care. In my (obviously not something I would sell to the majority here, so I'm not trying!) ;-) personal government-based insurance plan, it would kick in after a certain amount, I think, which would preserve competition in the things you can actually compete in. I just think the notion of competing and driving down the cost for something like chemo makes no sense. If I am trying to buy a car or whatever, it's 100% true that I won't think it's worth it if the cost is too high and would walk away, which gives me competitive power. If it's take the treatment or die, well, I don't have that power (and same if something comes up in the middle of giving birth or some such).
For current insurance I tend to like the idea of cost reductions for various things/preventative care, etc., too, although I do not have such a plan.
I love the idea of the high deductible plan and I will say that it has made my husband and I much more . . . choosier about when we go to the doctor and when we wait it out. Our preventative care is also 100% free, so it works well in that regard. I think it would work better if there were really much cheaper options for medical care in our area. My husband had to have some diagnostic tests a couple of years ago and I called around to see if we could find the cheapest. One place wouldn't give me the cost at all (totally defeating the concept of shopping around), the others were all with $50 of the cost.
And this was for a relatively low stress set of tests. If I had to have chemo or it was a more urgent situation, I can't imagine putting myself through that at all. High deductibles assume we have a level of power, flexibility, and knowledge that most of us don't have.
Yeah, this is true. I forget that I am extremely fortunate with respect to the amount of medical care options I have in a big city with some excellent health care facilities. In some parts of the US there simply really just isn't much competition and it can even be hard to get an appointment, even apart from insurance.
I was probably over-general in saying most of us don't have that flexibility. Some of us do and some of us don't. My hope is that as high deductible plans become the standard (assuming they do), medical providers will be more upfront about costs and make it easier to compare our choices.0 -
janejellyroll wrote: »lemurcat12 wrote: »janejellyroll wrote: »crzycatlady1 wrote: »lemurcat12 wrote: »lemurcat12 wrote: »lemurcat12 wrote: »We went way off topic yesterday, which was as much my fault as anyone's, since I find the topic interesting (and understand that lots of people will have different opinions -- I used to post on usenet in the '90s, after all, and am not negative at all about internet libertarianism, even if I disagree).
Here, though, is I think Packerjohn's argument: whatever one thinks about what the gov't should do, it's likely that we will not get rid of Medicare, at least. Beyond that, it's probably generally a bad thing that the population is so obese, on average.
He submits that sugar/soda taxes could help and would at least raise money to help deal with the problem (similar to the argument for alcohol taxes, which exist).
I suspect that they will not, but think it makes sense for individual localities to experiment with them to see what the results are.
Others find all such taxes at any level bad, and are against "sin" taxes in general.
My question is if you think these taxes are not likely to work (like me), do you think there are other public policy things that should be tried (including non governmental community efforts?) or do you think obesity is not actually a problem or that it's not a public policy problem, but a purely individual one?
My feeling is that it is a public policy problem but one hard to solve. I think education is good (but doesn't seem to have worked so far), making available healthy food options (i.e., addressing food deserts, promoting gardening and community gardens) is great, but again likely has a small effect, promoting community cooking classes, same, medical intervention I think is important and could be done more/better than it is, calorie posting/labels seem already to be done. Anyway, I think it's an interesting topic.
The inherent problem with government is lack of transparency and accountability. As long as career politicians are allowed to exist corruption will flourish. Government is ill suited for this role, which is why all socialist systems ultimately fail. People love being charitable - they abhor being forced to support a failing system. Centralized systems only work in small populations. Attempts to centralize large populations require authoritarian structures. Smart agile businesses work around this through decentralized structures, giving local structures the freedom of deciding which policies produce the best results.
Negative reinforcement has never been an effective behavioral modifier.
Education has been completely ineffective because we have centralized conflicting policies. We also have "leaders" who talk the talk but do not walk the walk.
This would be far more effective and efficient to promote positive reinforcements - just as the business world has done. Maintain positive health metrics = tax credit/deduction.
So setting aside the broader debate over gov't philosophy, can you be more specific? Tax credit/deduction offered by whom (feds? state?) for what?
People seemed really down on insurance company/workplace wellness programs in some other thread, but isn't that basically similar to this idea, but not gov't-based?
You get success in achievement based systems. It is an amazingly effective tool that motivates users into desired activities.
Well, I'm sure there are things we could look at to see how well it works with weight. Those insurance wellness programs, for example. I'm not sure how what you are suggesting is different, which is why I asked.For healthcare this could be tracked via an app - form a simple risk management structure (many business models already exist with these platforms in the business realm). Each participant actively engages in proactive measures and rewarded through specific credits/deductions. Specifically - maintaining a healthy BMI would equate to a $2000 deduction. This would be managed (ideally) privately; however as government has inserted itself by force this would be managed by state to minimize corruption and maximize competition. Unhappy with your state's policy - you can vote with your feet and relocate.
So to put this simply, I get a $2000 deduction from my state taxes for having a healthy BMI? (What if I'm Dwayne Johnson? I mean, I'm not, my BMI is 22 and I think I'd be better off around 20, so it's not a personal question.) It seems pretty open to abuse, as states are unlikely to be able to effectively check, but let's assume the technical issues get worked out--wondering what others would think of this idea.
It seems to me a more direct/effective approach, if people wanted to do this, was just let insurance companies charge extra if your BMI is 25+ (and you can't show your BF% is fine, I'd require that option), and still more if it's 30+ and so on. It really seems like the same thing, you still pay less for having a healthy weight.
Problem is that we probably WANT younger overweight/obese people to have insurance, as that's more likely to get them medical care and result in them losing weight when they haven't yet developed any medical issues. But young people without health issues are the most likely to say forget it if health care costs are high.
Just thinking this through, not arguing for anything.I have long been a proponent of a two tiered system. One for those who embrace the benefits and risks of liberty and another for those who do not. Those who want the safety net of government can certainly enjoy this, but they pay into this just as one would in an insurance pool. Those who do not can opt out.
One problem is that we don't have willingness as a society to see people suffer the effects of opting out, I don't think. Especially if the choice has to be made at age 18 or 21. (Edit: oh, janejellyroll is already raising the same points that I would have, yay.)
My husband's employer/insurance already implements something similar. We get penalized for high bmis, bad blood work panels, smoking etc. We also have a high deductible HSA plan that has several thousand dollars out of pocket before any benefits kick in.
Ours is kind of like that. We have a very high deductible and smokers pay more each month. We do get extra money for our HSA for doing preventative care, which helps. But when my husband broke his wrist two years ago, I think we wound up paying $1,110 out of pocket and insurance only covered a little bit of the overall costs.
I actually like high deductible plans. Mine isn't particularly (more since ACA than before), but I think that model makes sense, although with the exception for certain kinds of routine care if you want to encourage people to get preventative care. In my (obviously not something I would sell to the majority here, so I'm not trying!) ;-) personal government-based insurance plan, it would kick in after a certain amount, I think, which would preserve competition in the things you can actually compete in. I just think the notion of competing and driving down the cost for something like chemo makes no sense. If I am trying to buy a car or whatever, it's 100% true that I won't think it's worth it if the cost is too high and would walk away, which gives me competitive power. If it's take the treatment or die, well, I don't have that power (and same if something comes up in the middle of giving birth or some such).
For current insurance I tend to like the idea of cost reductions for various things/preventative care, etc., too, although I do not have such a plan.
I love the idea of the high deductible plan and I will say that it has made my husband and I much more . . . choosier about when we go to the doctor and when we wait it out. Our preventative care is also 100% free, so it works well in that regard. I think it would work better if there were really much cheaper options for medical care in our area. My husband had to have some diagnostic tests a couple of years ago and I called around to see if we could find the cheapest. One place wouldn't give me the cost at all (totally defeating the concept of shopping around), the others were all with $50 of the cost.
And this was for a relatively low stress set of tests. If I had to have chemo or it was a more urgent situation, I can't imagine putting myself through that at all. High deductibles assume we have a level of power, flexibility, and knowledge that most of us don't have.
I had a high deductible plan until obamacare came along. Remember that whole "if you like your plan you can keep it" mantra? yea, no. Our plans were cancelled every year and then we always had to find a new one that cost more...
my deductible was like 2500 a year and now it is like 10k a year or something ridiculous...1 -
janejellyroll wrote: »lemurcat12 wrote: »janejellyroll wrote: »crzycatlady1 wrote: »lemurcat12 wrote: »lemurcat12 wrote: »lemurcat12 wrote: »We went way off topic yesterday, which was as much my fault as anyone's, since I find the topic interesting (and understand that lots of people will have different opinions -- I used to post on usenet in the '90s, after all, and am not negative at all about internet libertarianism, even if I disagree).
Here, though, is I think Packerjohn's argument: whatever one thinks about what the gov't should do, it's likely that we will not get rid of Medicare, at least. Beyond that, it's probably generally a bad thing that the population is so obese, on average.
He submits that sugar/soda taxes could help and would at least raise money to help deal with the problem (similar to the argument for alcohol taxes, which exist).
I suspect that they will not, but think it makes sense for individual localities to experiment with them to see what the results are.
Others find all such taxes at any level bad, and are against "sin" taxes in general.
My question is if you think these taxes are not likely to work (like me), do you think there are other public policy things that should be tried (including non governmental community efforts?) or do you think obesity is not actually a problem or that it's not a public policy problem, but a purely individual one?
My feeling is that it is a public policy problem but one hard to solve. I think education is good (but doesn't seem to have worked so far), making available healthy food options (i.e., addressing food deserts, promoting gardening and community gardens) is great, but again likely has a small effect, promoting community cooking classes, same, medical intervention I think is important and could be done more/better than it is, calorie posting/labels seem already to be done. Anyway, I think it's an interesting topic.
The inherent problem with government is lack of transparency and accountability. As long as career politicians are allowed to exist corruption will flourish. Government is ill suited for this role, which is why all socialist systems ultimately fail. People love being charitable - they abhor being forced to support a failing system. Centralized systems only work in small populations. Attempts to centralize large populations require authoritarian structures. Smart agile businesses work around this through decentralized structures, giving local structures the freedom of deciding which policies produce the best results.
Negative reinforcement has never been an effective behavioral modifier.
Education has been completely ineffective because we have centralized conflicting policies. We also have "leaders" who talk the talk but do not walk the walk.
This would be far more effective and efficient to promote positive reinforcements - just as the business world has done. Maintain positive health metrics = tax credit/deduction.
So setting aside the broader debate over gov't philosophy, can you be more specific? Tax credit/deduction offered by whom (feds? state?) for what?
People seemed really down on insurance company/workplace wellness programs in some other thread, but isn't that basically similar to this idea, but not gov't-based?
You get success in achievement based systems. It is an amazingly effective tool that motivates users into desired activities.
Well, I'm sure there are things we could look at to see how well it works with weight. Those insurance wellness programs, for example. I'm not sure how what you are suggesting is different, which is why I asked.For healthcare this could be tracked via an app - form a simple risk management structure (many business models already exist with these platforms in the business realm). Each participant actively engages in proactive measures and rewarded through specific credits/deductions. Specifically - maintaining a healthy BMI would equate to a $2000 deduction. This would be managed (ideally) privately; however as government has inserted itself by force this would be managed by state to minimize corruption and maximize competition. Unhappy with your state's policy - you can vote with your feet and relocate.
So to put this simply, I get a $2000 deduction from my state taxes for having a healthy BMI? (What if I'm Dwayne Johnson? I mean, I'm not, my BMI is 22 and I think I'd be better off around 20, so it's not a personal question.) It seems pretty open to abuse, as states are unlikely to be able to effectively check, but let's assume the technical issues get worked out--wondering what others would think of this idea.
It seems to me a more direct/effective approach, if people wanted to do this, was just let insurance companies charge extra if your BMI is 25+ (and you can't show your BF% is fine, I'd require that option), and still more if it's 30+ and so on. It really seems like the same thing, you still pay less for having a healthy weight.
Problem is that we probably WANT younger overweight/obese people to have insurance, as that's more likely to get them medical care and result in them losing weight when they haven't yet developed any medical issues. But young people without health issues are the most likely to say forget it if health care costs are high.
Just thinking this through, not arguing for anything.I have long been a proponent of a two tiered system. One for those who embrace the benefits and risks of liberty and another for those who do not. Those who want the safety net of government can certainly enjoy this, but they pay into this just as one would in an insurance pool. Those who do not can opt out.
One problem is that we don't have willingness as a society to see people suffer the effects of opting out, I don't think. Especially if the choice has to be made at age 18 or 21. (Edit: oh, janejellyroll is already raising the same points that I would have, yay.)
My husband's employer/insurance already implements something similar. We get penalized for high bmis, bad blood work panels, smoking etc. We also have a high deductible HSA plan that has several thousand dollars out of pocket before any benefits kick in.
Ours is kind of like that. We have a very high deductible and smokers pay more each month. We do get extra money for our HSA for doing preventative care, which helps. But when my husband broke his wrist two years ago, I think we wound up paying $1,110 out of pocket and insurance only covered a little bit of the overall costs.
I actually like high deductible plans. Mine isn't particularly (more since ACA than before), but I think that model makes sense, although with the exception for certain kinds of routine care if you want to encourage people to get preventative care. In my (obviously not something I would sell to the majority here, so I'm not trying!) ;-) personal government-based insurance plan, it would kick in after a certain amount, I think, which would preserve competition in the things you can actually compete in. I just think the notion of competing and driving down the cost for something like chemo makes no sense. If I am trying to buy a car or whatever, it's 100% true that I won't think it's worth it if the cost is too high and would walk away, which gives me competitive power. If it's take the treatment or die, well, I don't have that power (and same if something comes up in the middle of giving birth or some such).
For current insurance I tend to like the idea of cost reductions for various things/preventative care, etc., too, although I do not have such a plan.
I love the idea of the high deductible plan and I will say that it has made my husband and I much more . . . choosier about when we go to the doctor and when we wait it out. Our preventative care is also 100% free, so it works well in that regard. I think it would work better if there were really much cheaper options for medical care in our area. My husband had to have some diagnostic tests a couple of years ago and I called around to see if we could find the cheapest. One place wouldn't give me the cost at all (totally defeating the concept of shopping around), the others were all with $50 of the cost.
And this was for a relatively low stress set of tests. If I had to have chemo or it was a more urgent situation, I can't imagine putting myself through that at all. High deductibles assume we have a level of power, flexibility, and knowledge that most of us don't have.
I had a high deductible plan until obamacare came along. Remember that whole "if you like your plan you can keep it" mantra? yea, no. Our plans were cancelled every year and then we always had to find a new one that cost more...
my deductible was like 2500 a year and now it is like 10k a year or something ridiculous...
Yeah, mine is $9,500. I've never even approached it, but I know some of my co-workers hit it every year (usually due to chronic health issues, I think, not emergencies).0 -
janejellyroll wrote: »lemurcat12 wrote: »janejellyroll wrote: »lemurcat12 wrote: »janejellyroll wrote: »crzycatlady1 wrote: »lemurcat12 wrote: »lemurcat12 wrote: »lemurcat12 wrote: »We went way off topic yesterday, which was as much my fault as anyone's, since I find the topic interesting (and understand that lots of people will have different opinions -- I used to post on usenet in the '90s, after all, and am not negative at all about internet libertarianism, even if I disagree).
Here, though, is I think Packerjohn's argument: whatever one thinks about what the gov't should do, it's likely that we will not get rid of Medicare, at least. Beyond that, it's probably generally a bad thing that the population is so obese, on average.
He submits that sugar/soda taxes could help and would at least raise money to help deal with the problem (similar to the argument for alcohol taxes, which exist).
I suspect that they will not, but think it makes sense for individual localities to experiment with them to see what the results are.
Others find all such taxes at any level bad, and are against "sin" taxes in general.
My question is if you think these taxes are not likely to work (like me), do you think there are other public policy things that should be tried (including non governmental community efforts?) or do you think obesity is not actually a problem or that it's not a public policy problem, but a purely individual one?
My feeling is that it is a public policy problem but one hard to solve. I think education is good (but doesn't seem to have worked so far), making available healthy food options (i.e., addressing food deserts, promoting gardening and community gardens) is great, but again likely has a small effect, promoting community cooking classes, same, medical intervention I think is important and could be done more/better than it is, calorie posting/labels seem already to be done. Anyway, I think it's an interesting topic.
The inherent problem with government is lack of transparency and accountability. As long as career politicians are allowed to exist corruption will flourish. Government is ill suited for this role, which is why all socialist systems ultimately fail. People love being charitable - they abhor being forced to support a failing system. Centralized systems only work in small populations. Attempts to centralize large populations require authoritarian structures. Smart agile businesses work around this through decentralized structures, giving local structures the freedom of deciding which policies produce the best results.
Negative reinforcement has never been an effective behavioral modifier.
Education has been completely ineffective because we have centralized conflicting policies. We also have "leaders" who talk the talk but do not walk the walk.
This would be far more effective and efficient to promote positive reinforcements - just as the business world has done. Maintain positive health metrics = tax credit/deduction.
So setting aside the broader debate over gov't philosophy, can you be more specific? Tax credit/deduction offered by whom (feds? state?) for what?
People seemed really down on insurance company/workplace wellness programs in some other thread, but isn't that basically similar to this idea, but not gov't-based?
You get success in achievement based systems. It is an amazingly effective tool that motivates users into desired activities.
Well, I'm sure there are things we could look at to see how well it works with weight. Those insurance wellness programs, for example. I'm not sure how what you are suggesting is different, which is why I asked.For healthcare this could be tracked via an app - form a simple risk management structure (many business models already exist with these platforms in the business realm). Each participant actively engages in proactive measures and rewarded through specific credits/deductions. Specifically - maintaining a healthy BMI would equate to a $2000 deduction. This would be managed (ideally) privately; however as government has inserted itself by force this would be managed by state to minimize corruption and maximize competition. Unhappy with your state's policy - you can vote with your feet and relocate.
So to put this simply, I get a $2000 deduction from my state taxes for having a healthy BMI? (What if I'm Dwayne Johnson? I mean, I'm not, my BMI is 22 and I think I'd be better off around 20, so it's not a personal question.) It seems pretty open to abuse, as states are unlikely to be able to effectively check, but let's assume the technical issues get worked out--wondering what others would think of this idea.
It seems to me a more direct/effective approach, if people wanted to do this, was just let insurance companies charge extra if your BMI is 25+ (and you can't show your BF% is fine, I'd require that option), and still more if it's 30+ and so on. It really seems like the same thing, you still pay less for having a healthy weight.
Problem is that we probably WANT younger overweight/obese people to have insurance, as that's more likely to get them medical care and result in them losing weight when they haven't yet developed any medical issues. But young people without health issues are the most likely to say forget it if health care costs are high.
Just thinking this through, not arguing for anything.I have long been a proponent of a two tiered system. One for those who embrace the benefits and risks of liberty and another for those who do not. Those who want the safety net of government can certainly enjoy this, but they pay into this just as one would in an insurance pool. Those who do not can opt out.
One problem is that we don't have willingness as a society to see people suffer the effects of opting out, I don't think. Especially if the choice has to be made at age 18 or 21. (Edit: oh, janejellyroll is already raising the same points that I would have, yay.)
My husband's employer/insurance already implements something similar. We get penalized for high bmis, bad blood work panels, smoking etc. We also have a high deductible HSA plan that has several thousand dollars out of pocket before any benefits kick in.
Ours is kind of like that. We have a very high deductible and smokers pay more each month. We do get extra money for our HSA for doing preventative care, which helps. But when my husband broke his wrist two years ago, I think we wound up paying $1,110 out of pocket and insurance only covered a little bit of the overall costs.
I actually like high deductible plans. Mine isn't particularly (more since ACA than before), but I think that model makes sense, although with the exception for certain kinds of routine care if you want to encourage people to get preventative care. In my (obviously not something I would sell to the majority here, so I'm not trying!) ;-) personal government-based insurance plan, it would kick in after a certain amount, I think, which would preserve competition in the things you can actually compete in. I just think the notion of competing and driving down the cost for something like chemo makes no sense. If I am trying to buy a car or whatever, it's 100% true that I won't think it's worth it if the cost is too high and would walk away, which gives me competitive power. If it's take the treatment or die, well, I don't have that power (and same if something comes up in the middle of giving birth or some such).
For current insurance I tend to like the idea of cost reductions for various things/preventative care, etc., too, although I do not have such a plan.
I love the idea of the high deductible plan and I will say that it has made my husband and I much more . . . choosier about when we go to the doctor and when we wait it out. Our preventative care is also 100% free, so it works well in that regard. I think it would work better if there were really much cheaper options for medical care in our area. My husband had to have some diagnostic tests a couple of years ago and I called around to see if we could find the cheapest. One place wouldn't give me the cost at all (totally defeating the concept of shopping around), the others were all with $50 of the cost.
And this was for a relatively low stress set of tests. If I had to have chemo or it was a more urgent situation, I can't imagine putting myself through that at all. High deductibles assume we have a level of power, flexibility, and knowledge that most of us don't have.
Yeah, this is true. I forget that I am extremely fortunate with respect to the amount of medical care options I have in a big city with some excellent health care facilities. In some parts of the US there simply really just isn't much competition and it can even be hard to get an appointment, even apart from insurance.
I was probably over-general in saying most of us don't have that flexibility. Some of us do and some of us don't. My hope is that as high deductible plans become the standard (assuming they do), medical providers will be more upfront about costs and make it easier to compare our choices.
Agreed.0 -
zachbonner_ wrote: »Have to agree. Subsidies are horrible and are not representative of a free market
I'm no fan of subsidies, or social engineering taxation but free market?... We're not even close (UK, US, pretty much any modern industrial country) - it's a concept that is, in practice, completely unpalatable for (I'm guessing) 99.999% of people.0 -
lemurcat12 wrote: »We went way off topic yesterday, which was as much my fault as anyone's, since I find the topic interesting (and understand that lots of people will have different opinions -- I used to post on usenet in the '90s, after all, and am not negative at all about internet libertarianism, even if I disagree).
Here, though, is I think Packerjohn's argument: whatever one thinks about what the gov't should do, it's likely that we will not get rid of Medicare, at least. Beyond that, it's probably generally a bad thing that the population is so obese, on average.
He submits that sugar/soda taxes could help and would at least raise money to help deal with the problem (similar to the argument for alcohol taxes, which exist).
I suspect that they will not, but think it makes sense for individual localities to experiment with them to see what the results are.
Others find all such taxes at any level bad, and are against "sin" taxes in general.
My question is if you think these taxes are not likely to work (like me), do you think there are other public policy things that should be tried (including non governmental community efforts?) or do you think obesity is not actually a problem or that it's not a public policy problem, but a purely individual one?
My feeling is that it is a public policy problem but one hard to solve. I think education is good (but doesn't seem to have worked so far), making available healthy food options (i.e., addressing food deserts, promoting gardening and community gardens) is great, but again likely has a small effect, promoting community cooking classes, same, medical intervention I think is important and could be done more/better than it is, calorie posting/labels seem already to be done. Anyway, I think it's an interesting topic.
I think that the problem is one of misinformation and a centering voice, and I think that voice has to come from the medical community.
I've said this before that I think obesity/weight management should become a sub-specialty, with full service practices devoted to the treatment thereof. Patients could receive nutrition counseling, medical support, and behavioral therapy. These centers could also incorporate fitness centers that provide trainers for a holistic wellness experience that encourages all around health habit forming.
I know, I'm dreaming, but obesity has a lot of different moving parts that need to be addressed. Everyone keeps trying to focus on just one part, and they keep missing the big picture.3 -
janejellyroll wrote: »janejellyroll wrote: »janejellyroll wrote: »janejellyroll wrote: »lemurcat12 wrote: »lemurcat12 wrote: »We went way off topic yesterday, which was as much my fault as anyone's, since I find the topic interesting (and understand that lots of people will have different opinions -- I used to post on usenet in the '90s, after all, and am not negative at all about internet libertarianism, even if I disagree).
Here, though, is I think Packerjohn's argument: whatever one thinks about what the gov't should do, it's likely that we will not get rid of Medicare, at least. Beyond that, it's probably generally a bad thing that the population is so obese, on average.
He submits that sugar/soda taxes could help and would at least raise money to help deal with the problem (similar to the argument for alcohol taxes, which exist).
I suspect that they will not, but think it makes sense for individual localities to experiment with them to see what the results are.
Others find all such taxes at any level bad, and are against "sin" taxes in general.
My question is if you think these taxes are not likely to work (like me), do you think there are other public policy things that should be tried (including non governmental community efforts?) or do you think obesity is not actually a problem or that it's not a public policy problem, but a purely individual one?
My feeling is that it is a public policy problem but one hard to solve. I think education is good (but doesn't seem to have worked so far), making available healthy food options (i.e., addressing food deserts, promoting gardening and community gardens) is great, but again likely has a small effect, promoting community cooking classes, same, medical intervention I think is important and could be done more/better than it is, calorie posting/labels seem already to be done. Anyway, I think it's an interesting topic.
The inherent problem with government is lack of transparency and accountability. As long as career politicians are allowed to exist corruption will flourish. Government is ill suited for this role, which is why all socialist systems ultimately fail. People love being charitable - they abhor being forced to support a failing system. Centralized systems only work in small populations. Attempts to centralize large populations require authoritarian structures. Smart agile businesses work around this through decentralized structures, giving local structures the freedom of deciding which policies produce the best results.
Negative reinforcement has never been an effective behavioral modifier.
Education has been completely ineffective because we have centralized conflicting policies. We also have "leaders" who talk the talk but do not walk the walk.
This would be far more effective and efficient to promote positive reinforcements - just as the business world has done. Maintain positive health metrics = tax credit/deduction.
So setting aside the broader debate over gov't philosophy, can you be more specific? Tax credit/deduction offered by whom (feds? state?) for what?
People seemed really down on insurance company/workplace wellness programs in some other thread, but isn't that basically similar to this idea, but not gov't-based?
You get success in achievement based systems. It is an amazingly effective tool that motivates users into desired activities.
For healthcare this could be tracked via an app - form a simple risk management structure (many business models already exist with these platforms in the business realm). Each participant actively engages in proactive measures and rewarded through specific credits/deductions. Specifically - maintaining a healthy BMI would equate to a $2000 deduction. This would be managed (ideally) privately; however as government has inserted itself by force this would be managed by state to minimize corruption and maximize competition. Unhappy with your state's policy - you can vote with your feet and relocate.
I have long been a proponent of a two tiered system. One for those who embrace the benefits and risks of liberty and another for those who do not. Those who want the safety net of government can certainly enjoy this, but they pay into this just as one would in an insurance pool. Those who do not can opt out.
How would you keep people from switching when they ran into issues later in life, like a child with a disability or a chronic disease developing? Would people decide which group they want to be in early in life and be prohibited from switching from the non-safety net group to the safety net group?
Without some mechanism to keep people from switching, wouldn't you have relatively few people in the safety net group unless they actually planned to draw benefits?
These issues are outliers and can easily be absorbed in the system. You never make policy based on outliers.
You can switch groups, but would pay the prorated fee associated with opting out of the current plan.
That is precisely the point. Ponzi schemes are illegal for all parties with the curious exception of government. This also keeps politicians from pretending to play Robin Hood when they are, by default, the Sheriff of Nottingham.
Unfortunately, people with disabilities or chronic diseases aren't really an rare thing in our society, I wouldn't consider older people with chronic diseases or people drawing disability benefits to be outliars -- they'd have to be accounted for in any realistic program granting/denying benefits. There are probably lots of people who never think they'd draw certain government benefits until they find themselves in a situation where they need them.
That said, I understand what you're suggesting with the pro-rated fee. Thanks for clarifying.
These remain outliers - a very small portion of the overall populace.
This is precisely why government or any industry should be allowed permission in granting/denying benefits. This is a decision between the medical provider and the patient. By allowing additional parties into this extremely personal decision you have created a monster - one that can never be controlled and one that ensure corruption.
Probably? Policies should be based upon certainties or predictable expectations. If you set the bar low, the populace will aim low.
This is the realm of charity - not government.
8.7 million people got SS disability benefits in February 2017.
72.5 million people are on Medicaid, 55.3 million are on Medicare.
I don't consider that to be a small portion of the population -- they'd have to be considered in any overhaul (or removal) of the safety net. Some of those people may opt into the safety net lane at age 18 -- they obviously wouldn't cause the type of issue I was asking about. But it's likely that at least some of those people would begin their working lives thinking that they would be self-sufficient forever and then something happened.
I understand your position on the role of charity -- I was asking for specific clarification on how you would deal with people who began their working lives in the second group (opting out) and then decided, due to life events, that they wanted in.
Is the answer that these people are exceptions who don't have to be considered? I don't know that we can assume that. We know from the example of health insurance that people will often forgo insurance when they're young and healthy, only to want it later. Do we think people would act differently with the safety net, that young people feeling like they've got decades of health in front of them will decide to have *less money* in their pocket each month because they're making rational decisions about the future possibility that they will be 65 and unable to afford health care?
If a pro-rated fee is available to these people, then I understand your clarification. If charity is the only recourse for those who are unable to afford the pro-rated fee, I understand that as well.
I'm simply trying to understand your position, that's all.
330 million population in the US (likely closer to 360 M) so by conservative estimate 2.6% get SS disability benefits in February 2017. 100% pay into this Ponzi scheme
Medicaid and Medicare are failing systems and should be eliminated immediately. These serve no purpose other than to insert government into the free market. This is yet another primary driver of the increasing cost of medicine.
For actual implementation there would have to be a period of change. It is inexcusable for the younger generation to be expected to pay for the false promises and poor planning of politicians. One generation falling for this lie is enough. Implementing actual accountability is necessary as well. There will always be a safety net so to speak, but the care provided by the state would be minimal. Any additional care could always be provided through private enterprise.
Good policy is enacted based on the needs of the majority, with special exceptions crafted for exceptional circumstances. Basing policy on < 3% of the population will fail before it begins.
Just as in life people will choose poorly, but creating a safety net encourages poor behavior.
Using MFP as an example can you imagine if the CICO models were based upon the minority cases?
No problem at all. This is one of my favorite topics and I love to discuss and debate these issues.
I appreciate the discussion -- it can be rare to find someone who is actually willing to discuss how their views would translate into actual policy changes.
I owe this mentality to my remarkable history professor and debate coach - who would often find our strongest beliefs...and force us to debate the other side. I do not care what people believe - I want to know why they believe it. Thank you for sharing your insights into this.
2 -
StealthHealth wrote: »zachbonner_ wrote: »Have to agree. Subsidies are horrible and are not representative of a free market
I'm no fan of subsidies, or social engineering taxation but free market?... We're not even close (UK, US, pretty much any modern industrial country) - it's a concept that is, in practice, completely unpalatable for (I'm guessing) 99.999% of people.
I'm curious as to why you believe this. Is it the fear of risk associated with free market?0
This discussion has been closed.
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