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Should junk food be taxed?
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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.
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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 -
lemurcat12 wrote: »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.
The dirty little secret behind employer based insurance is it is not taxable income to the employee. Eliminate it and either the person's compensation total goes down or raise the person's salary to make up the difference and the way things are now, that amount is taxed at the taxpayer's marginal rate.
This would not go over big with the traditional Democratic Party supporters like union employees who cherish their benefits.
0 -
Yes. The tax money should be allocated to societal expenses related to obesity, like higher health care costs. Isn't that what the tax on cigarettes is for?2
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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?
A free market economy is one in which suppliers and their customers (only) dictate the value and therefore cost of goods and services, without interference of impediment by outside forces (governments).
If you live in a country where your government:- Applies tariffs to some trade deals (such as imposing a duty on imports or exports)
- Sets labour laws and regulations for those who provide goods and services (such as specifying that children can't work until a certain age)
- Set regulations as to what types of goods or products can be supplied (such as making certain drugs illegal and others illegal unless prescribed)
- Sets regulations as to how businesses can produce their goods or services (such as pollution regulations)
- Owns or part owns businesses (such as public transportation systems)
Then you don't live in a free market economy country (This is I think, pretty much every country - Free market economy is a concept rather than an achievable state and when talking about FMEs economists are usually really talking about the relative freeness of an economy).
Most people would be very uncomfortable about, for example, a country de-regulating the health industry, so that anyone could set up as a doctor. But, in a true FME, deregulation is one of the required conditions and crap doctors would be removed from the market by the customers taking their business elsewhere. The unpalatable part of this is that there would probably have to be a significant number of "issues" (deaths maybe) before the market realized that the cheapest doctor in town was a complete liability.
There was an interesting FME test recently in the UK (but I think the US treasury's financial support of the chapter 11 protection of GM is another example) where banks, about to fail were bought out and operated (in part) by the UK government. The FME supporter's argument was "let the banks fail - that is the FME in action" but there was understandably an outcry by those who had savings and investments in the failing banks since, if left to fail, they would lose a lot of money. So, the government (UK governments are generally, light touch, pro-FME) decided to step in: The argument was "The banks are too big to fail".
My point is - FME is an concept that some would strive towards, but not something that we actually have and so, arguing that we shouldn't do something because it contravenes the FME concept is a null argument.
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Note worthy:
http://www.independent.co.uk/news/uk/politics/budget-2017-sugar-tax-philip-hammond-fight-obesity-child-weight-gain-fizzy-drinks-a7618316.html
UK buget (announced 8th March 2017): "Tax on drinks with more than five grams of sugar per 100ml will be levied by 18p per litre, while those with eight grams or more of sugar per 100ml will have an extra tax of 24p per litre."
Pure fruit juices and diary based drinks are exempt from this tax.
The money raised is to go to Department of Eduction, specifically for sports education. Expected to raise £1bn (not clear over what time frame - 1bn per annum or longer??).
In the UK this would mean that the cost of a 330mls can of coke would go up by 8p and lower sugar (such as sprite) would increase by 6p. But, for the 2litre bottles typically sold in supermarkets, coke would increase by 48p on top of an existing cost of (un-discounted) about £1.95 - so quite a significant increase.0 -
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.
I will do a version of this sometimes -- when I find a position I find myself having a really negative or emotional reaction to, I will practice making a case for it from the POV of an advocate. My goal is to be able to explain the position to a third-party without them being able to tell that I'm against it. I have found it incredibly helpful to both understand other people, find potential common ground, and better understand the logic behind my own position.2 -
Packerjohn wrote: »lemurcat12 wrote: »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.
The dirty little secret behind employer based insurance is it is not taxable income to the employee.
I don't think that's a secret. I think a bigger issue is that people don't think of it as part of their compensation at all or understand that the system is the way it is because of tax-related benefits to the employer that encourage it. So many people (largely Republicans I'd say, but non political too) seem to think their generous employer-based insurance is the free market and would be the way it is without gov't intervention. And they don't seem to think there's anything wrong with insurance being tied to employment as it is. That's why I never believed wonkish plans like the one McCain had when running (but didn't actually talk about that much) that would largely separate employment and insurance would ever happen.
Funny thing is that the wonks who lean right and left both agree that employer-based insurance is dumb (as do I), but the general public tends to like it well enough.Eliminate it and either the person's compensation total goes down or raise the person's salary to make up the difference and the way things are now, that amount is taxed at the taxpayer's marginal rate.
As an employer (in that I'm a partner in a small business), we do see insurance as part of compensation and would have more freedom to tailor compensation to performance without that chunk that you can't touch/vary. We also understand that without it other compensation would substitute -- they wouldn't just go down if insurance went away, of course. I don't know how representative it is, but I think it's probably reasonably so. One problem is that employees don't see it as compensation -- explain to them that their compensation went up as a result of salary increase plus insurance increase, and they don't see the second as part of it, which is part of how the current system hides costs from a huge percentage of consumers.
This is private employers, which of course are mostly not unionized these days (and in a field that never was unionized anyway).
0 -
StealthHealth wrote: »UK buget (announced 8th March 2017): "Tax on drinks with more than five grams of sugar per 100ml will be levied by 18p per litre, while those with eight grams or more of sugar per 100ml will have an extra tax of 24p per litre."
Our new tax is a penny (US) an oz, or about 68 additional cents for a 2 liter bottle or 72 cents more for a 6-pack. It applies to sugar-sweetened and artificial sweetened beverages, no sliding scale (but not beverages without sugar added like milk or 100% fruit juice). (And I am convinced it's mostly just about money raising here, but was curious to compare the amounts.)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...
Ditto.
At least I work for a major healthcare system, so they saw the writing on the wall well in advance of the implementation and were trying to educate their employees about what was coming.
Most other people I know were caught completely off guard by the magnitude of the change, and these were largely people opposed to Obamacare from the get-go, so already thinking there was going to be an increase.1 -
lemurcat12 wrote: »Packerjohn wrote: »lemurcat12 wrote: »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.
The dirty little secret behind employer based insurance is it is not taxable income to the employee.
I don't think that's a secret. I think a bigger issue is that people don't think of it as part of their compensation at all or understand that the system is the way it is because of tax-related benefits to the employer that encourage it. So many people (largely Republicans I'd say, but non political too) seem to think their generous employer-based insurance is the free market and would be the way it is without gov't intervention. And they don't seem to think there's anything wrong with insurance being tied to employment as it is. That's why I never believed wonkish plans like the one McCain had when running (but didn't actually talk about that much) that would largely separate employment and insurance would ever happen.
Funny thing is that the wonks who lean right and left both agree that employer-based insurance is dumb (as do I), but the general public tends to like it well enough.Eliminate it and either the person's compensation total goes down or raise the person's salary to make up the difference and the way things are now, that amount is taxed at the taxpayer's marginal rate.
As an employer (in that I'm a partner in a small business), we do see insurance as part of compensation and would have more freedom to tailor compensation to performance without that chunk that you can't touch/vary. We also understand that without it other compensation would substitute -- they wouldn't just go down if insurance went away, of course. I don't know how representative it is, but I think it's probably reasonably so. One problem is that employees don't see it as compensation -- explain to them that their compensation went up as a result of salary increase plus insurance increase, and they don't see the second as part of it, which is part of how the current system hides costs from a huge percentage of consumers.
This is private employers, which of course are mostly not unionized these days (and in a field that never was unionized anyway).
@lemurcat12, Employer paid health insurance does not give an employer any special tax related benefits. A health insurance policy valued at $15,000 or $15,000 in cash compensation is treated the same way by the employer for tax purposes. In either case it is part of the expenses deducted from revenue to come up the profit the business will pay income taxes on.
I disagree that most of the public understands elimination of employer paid insurance and replacing it with the same value in another from of compensation would most likely result in additional taxable income.
Heck most people think it's a good thing when they get a tax refund at the end of the year after allowing over-withholding during the year.1
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