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Do you think obese/overweight people should pay more for health insurance?
Replies
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Without the ability to underwrite individuals based on their risk (height, weight, age, overall health etc..) insurance companies will enter an Adverse Selection scenario. This is exactly why the ACA has failed. And this is the real debate; how much as a society are we willing to subsidize (ie tax dollars) the insurance companies so they will continue to write even when adverse selection exists. Group health plans are entirely different. The group's losses are evaluated and then the company decides how much of the premium they are going to pass on to the individual. Wellness plans are good for the company because it encourages people to be healthier and in turn, the company's premiums go down.4
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Obesity is not a lifestyle. It comes in many different forms and is an extreme struggle for most people. There are so many other issues that are lifestyle related that costs our health industry billions every year. Smoking, drinking, skydiving, mountain climbing etc etc etc.
Obesity is the #1 biggest cost for America's health care system today. It's more expensive to treat obesity related illnesses across the population than smoking related illnesses. Mountain climbing related illnesses don't even make the top 1,000.6 -
lemurcat12 wrote: »richardgavel wrote: »Frankly, the biggest issue in my mind is the idea that most people get their insurance thru a group plan via their job. This provides a disincentive to come up with these variable options. I'd rather insurance was always bought individually. Then it stays with you from job to job and likely there would be more flexibility.
This is true. Tying insurance to job is problematic in a number of ways.
... and the fact that quality health insurance for most in America has been invariably tied to people's employment is a side-effect of the disastrous government policy of making the cost of group health employment benefits tax-deductible for employers.
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lemurcat12 wrote: »richardgavel wrote: »Frankly, the biggest issue in my mind is the idea that most people get their insurance thru a group plan via their job. This provides a disincentive to come up with these variable options. I'd rather insurance was always bought individually. Then it stays with you from job to job and likely there would be more flexibility.
This is true. Tying insurance to job is problematic in a number of ways.
... and the fact that quality health insurance for most in America has been invariably tied to people's employment is a side-effect of the disastrous government policy of making the cost of group health employment benefits tax-deductible for employers.
No, the cost of group health benefits for employees is treated no differently than the wages and salaries from a corporate tax perspective.
The big thing from a tax perspective is the employee gets the company paid portion of the heath insurance premium and does not have to pay income taxes on it. Change to some government funded plan paid for by taxes, those employees lose that benefit. If the employer gives additional cash compensation, that compensation is taxed at the employee's marginal tax rate.2 -
Yes, they should pay more, as well as smokers. People are in charge of their lives and health options, and should pay that price for making those choices.
It's much harder to quit smocking then to change lifestyle and lose weight. If they choose to eat unhealthy and have unhealthy lifestyle, knowing well enough it's bad for their health and causes sicknesses, then they should pay extra.
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No. Mostly because I am in favour of a single payer health care system like the NHS we have here in the UK. I lived in the US for many years and paid more money for worse healthcare. I prefer to just pay a tax based on my income and know I am covered no matter what. This system also requires corporations to pay a tax for every employee as well so employers are not let off the hook racing to the bottom on who can offer the worst benefits..they all pay the same tax and it evens the playing field and allows the free labour market to operate without bringing employee health into the picture as a bargaining chip.
I have never smoked or been overweight my entire life. I have exercised religiously despite exercise induced asthma (inherited) and various allergies ( also inherited). I have never used recreational drugs. I do not drink much alcohol. I eat healthily. But breast cancer runs in my family, so I have a chance of developing that through no fault of my own just like the asthma. I think the US system fails to take into account that healthcare is a human right and should be offered to everyone on equal terms regardless of any pre-existing health conditions. I find it abhorrent to divide people up into less deserving vs. more deserving groups based on health issues.14 -
No. Mostly because I am in favour of a single payer health care system like the NHS we have here in the UK. I lived in the US for many years and paid more money for worse healthcare. I prefer to just pay a tax based on my income and know I am covered no matter what. This system also requires corporations to pay a tax for every employee as well so employers are not let off the hook racing to the bottom on who can offer the worst benefits..they all pay the same tax and it evens the playing field and allows the free labour market to operate without bringing employee health into the picture as a bargaining chip.
I have never smoked or been overweight my entire life. I have exercised religiously despite exercise induced asthma (inherited) and various allergies ( also inherited). I have never used recreational drugs. I do not drink much alcohol. I eat healthily. But breast cancer runs in my family, so I have a chance of developing that through no fault of my own just like the asthma. I think the US system fails to take into account that healthcare is a human right and should be offered to everyone on equal terms regardless of any pre-existing health conditions. I find it abhorrent to divide people up into less deserving vs. more deserving groups based on health issues.
I absolutely agree with you. When I lived in the States I had to travel back home to see doctors and buy medications. It's even cheaper and easier to go to the best private clinics in Switzerland (I think these are the best healthcare options), Israel or Germany then to get treated by American hospitals if you're not fully covered by insurance.
But I don't think that's ever possible for the US unfortunately. Insurance and Medical companies would never allow it.6 -
There was a time we didn't have an NHS. But then we didn't have insurance either. It was just tough luck if you couldn't afford medical care. Which is kind of the same really if adequate insurance is unaffordable to you and you just end up in mountains of medical related debt.
But it takes the will of a strong leader who is happy to be very unpopular and I'm not sure the American political system is set up to allow a president to just do it? And then there's the individual States situation too, not sure how that would work. But in an ideal world everyone would be happy to pay in regardless of whether they ever take out. It would be rare that in a whole family someone will make enough uses of services for higher taxes to be worthwhile as you're essentially paying for your family's care with no fear of the bills that come with it.
And then there are those with an every man for himself attitude who don't care if some people don't get they care they need. Current political attitudes are to divide and conquer as said above. The haves being disgusted by the have nots not just improving their lot by working harder.9 -
VintageFeline wrote: »There was a time we didn't have an NHS. But then we didn't have insurance either. It was just tough luck if you couldn't afford medical care. Which is kind of the same really if adequate insurance is unaffordable to you and you just end up in mountains of medical related debt.
But it takes the will of a strong leader who is happy to be very unpopular and I'm not sure the American political system is set up to allow a president to just do it?
Couple issues -- one is timing. The way the system has developed a lot of people (not just insurance companies) have a stake in it. They have good insurance and fear that a change will leave them with worse insurance. They don't understand (or believe, I guess) that the current system where many have excellent employer-based insurance and then graduate into Medicare (which is also currently excellent) is not sustainable.
The other is that no matter how much a president was willing to stake his or her popularity on single payer or some such (say we had President Bernie), that would be meaningless, as it would not be passed by Congress, period. Not yet. That's what all the lefties complaining that Obama just didn't try don't seem to understand.And then there's the individual States situation too, not sure how that would work.
Theoretically, that wouldn't be a problem, it would be like Medicare for all. The state's role traditionally has to do with Medicaid plus regulating the insurance companies.4 -
Lol, obviously don't know how insurance works then. More people pay in then they pay out. And trust me, insurance companies only do one main thing with the money......................they "grow" it by investing it.MoiAussi93 wrote: »cushman5279 wrote: »Not necessarily. I would rather be given a break on my insurance premiums or some money back for being healthy and active at a fitness center x times per week vs. making someone to pay more for being obese. There are too many variables.
They can't let you pay less without someone else without healthy stats paying more. Not if they actually want to stay in business. That's how it works. Money doesn't just grow on trees.
A.C.E. Certified Personal and Group Fitness Trainer
IDEA Fitness member
Kickboxing Certified Instructor
Been in fitness for 30 years and have studied kinesiology and nutrition
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lemurcat12 wrote: »VintageFeline wrote: »There was a time we didn't have an NHS. But then we didn't have insurance either. It was just tough luck if you couldn't afford medical care. Which is kind of the same really if adequate insurance is unaffordable to you and you just end up in mountains of medical related debt.
But it takes the will of a strong leader who is happy to be very unpopular and I'm not sure the American political system is set up to allow a president to just do it?
Couple issues -- one is timing. The way the system has developed a lot of people (not just insurance companies) have a stake in it. They have good insurance and fear that a change will leave them with worse insurance. They don't understand (or believe, I guess) that the current system where many have excellent employer-based insurance and then graduate into Medicare (which is also currently excellent) is not sustainable.
The other is that no matter how much a president was willing to stake his or her popularity on single payer or some such (say we had President Bernie), that would be meaningless, as it would not be passed by Congress, period. Not yet. That's what all the lefties complaining that Obama just didn't try don't seem to understand.And then there's the individual States situation too, not sure how that would work.
Theoretically, that wouldn't be a problem, it would be like Medicare for all. The state's role traditionally has to do with Medicaid plus regulating the insurance companies.
Thank you. I thought it would be a Congress problem I just didn't want to assert something I'm not fully versed in. We have a sort of version of this and I won't pretend to know how it got passed but it is certainly easier for our governments to pass things as a single party majority is naturally going to have a more favourable chance of getting more votes new legislation.2 -
Lol, obviously don't know how insurance works then. More people pay in then they pay out. And trust me, insurance companies only do one main thing with the money......................they "grow" it by investing it.MoiAussi93 wrote: »cushman5279 wrote: »Not necessarily. I would rather be given a break on my insurance premiums or some money back for being healthy and active at a fitness center x times per week vs. making someone to pay more for being obese. There are too many variables.
They can't let you pay less without someone else without healthy stats paying more. Not if they actually want to stay in business. That's how it works. Money doesn't just grow on trees.
A.C.E. Certified Personal and Group Fitness Trainer
IDEA Fitness member
Kickboxing Certified Instructor
Been in fitness for 30 years and have studied kinesiology and nutrition
Yep, the actual underwriting and insuring is just a way to collect money to invest. I live in a community where a large insurance company is the largest employer. The small group that runs their investments can often make $ close to what the CEO does with their bonuses if there is a good investing year.
If I was going to have an insurance company I would just do life insurance. Pretty simple. People pay their premiums, when an insured dies you get a government document stating so and write a check. So much easier than messing with medical claims, people trying to sue your auto policy owners for mysterious "whiplash" injuries, etc.1 -
Packerjohn wrote: »
Lol, obviously don't know how insurance works then. More people pay in then they pay out. And trust me, insurance companies only do one main thing with the money......................they "grow" it by investing it.MoiAussi93 wrote: »cushman5279 wrote: »Not necessarily. I would rather be given a break on my insurance premiums or some money back for being healthy and active at a fitness center x times per week vs. making someone to pay more for being obese. There are too many variables.
They can't let you pay less without someone else without healthy stats paying more. Not if they actually want to stay in business. That's how it works. Money doesn't just grow on trees.
A.C.E. Certified Personal and Group Fitness Trainer
IDEA Fitness member
Kickboxing Certified Instructor
Been in fitness for 30 years and have studied kinesiology and nutrition
Yep, the actual underwriting and insuring is just a way to collect money to invest. I live in a community where a large insurance company is the largest employer. The small group that runs their investments can often make $ close to what the CEO does with their bonuses if there is a good investing year.
If I was going to have an insurance company I would just do life insurance. Pretty simple. People pay their premiums, when an insured dies you get a government document stating so and write a check. So much easier than messing with medical claims, people trying to sue your auto policy owners for mysterious "whiplash" injuries, etc.
Doesn't it make sense for the insurance company to invest the premium money so that they will potentially have more for claims payouts?1 -
richardgavel wrote: »Packerjohn wrote: »
Lol, obviously don't know how insurance works then. More people pay in then they pay out. And trust me, insurance companies only do one main thing with the money......................they "grow" it by investing it.MoiAussi93 wrote: »cushman5279 wrote: »Not necessarily. I would rather be given a break on my insurance premiums or some money back for being healthy and active at a fitness center x times per week vs. making someone to pay more for being obese. There are too many variables.
They can't let you pay less without someone else without healthy stats paying more. Not if they actually want to stay in business. That's how it works. Money doesn't just grow on trees.
A.C.E. Certified Personal and Group Fitness Trainer
IDEA Fitness member
Kickboxing Certified Instructor
Been in fitness for 30 years and have studied kinesiology and nutrition
Yep, the actual underwriting and insuring is just a way to collect money to invest. I live in a community where a large insurance company is the largest employer. The small group that runs their investments can often make $ close to what the CEO does with their bonuses if there is a good investing year.
If I was going to have an insurance company I would just do life insurance. Pretty simple. People pay their premiums, when an insured dies you get a government document stating so and write a check. So much easier than messing with medical claims, people trying to sue your auto policy owners for mysterious "whiplash" injuries, etc.
Doesn't it make sense for the insurance company to invest the premium money so that they will potentially have more for claims payouts?
Without a doubt. My point is if you look at the income of an insurance company over the long term (to adjust for any widespread disasters like a major hurricane for a property insurer) the actual underwriting tends to be a breakeven. The are making money on their investments, not actually providing insurance. And yes, the investment income can help to offset the actual cost of insurance.1 -
Lol, obviously don't know how insurance works then. More people pay in then they pay out. And trust me, insurance companies only do one main thing with the money......................they "grow" it by investing it.MoiAussi93 wrote: »cushman5279 wrote: »Not necessarily. I would rather be given a break on my insurance premiums or some money back for being healthy and active at a fitness center x times per week vs. making someone to pay more for being obese. There are too many variables.
They can't let you pay less without someone else without healthy stats paying more. Not if they actually want to stay in business. That's how it works. Money doesn't just grow on trees.
A.C.E. Certified Personal and Group Fitness Trainer
IDEA Fitness member
Kickboxing Certified Instructor
Been in fitness for 30 years and have studied kinesiology and nutrition
Lol, obviously YOU don't understand how business and economics work. Insurance companies pull of of markets that aren't profitable...that's why Obamacare is failing. Some states have only one option available. Being forced to cover very high risk people at artificially low premiums has resulted in unbalanced risk pools. That is a failing business model...for any insurance provider.
If the healthy, low risk people are all given discounts without making the obese, high risk people pay more...then two things happen: 1) the insurance company has less money available to pay out claims when those obese people have heart attacks and develop other expensive health problems (regardless of their investment performance), and 2) profits fall. Since this is a capitalist society (after all, you admit that profit is a motive for you and you don't train people for free), insurance companies (and the regular people who buy the stock hoping to make some money to retire on) actually want to make a profit. You don't train people you don't make money on, so you should understand why somebody else would also think making money is a desirable thing.1 -
I think that the entire purpose of health insurance is to spread the risk. The moment we stop doing that we are making the entire concept of insurance pointless. The end conclusion of this thought train is that everyone should simply pay for their own medical costs since that is, in theory, the most optimal solution. There are so many categories of "high risk" that in the end I fear the insurance pool would literally be whittled down to "1".
In regards obesity in particular, when you have an epidemic you don't cut it out of your health care system. You look at the epidemic in question and fix it's causes. Sadly, in this case that's unlikely to happen since the cause is corporate profits and unbridled ideology. Which is another point entirely. Your same thought pattern could apply to the vendors of these products which are damaging to society. Why don't you want to charge McDonald's a health cost surcharge much like an environmental cleanup charge for a company which dumps toxic liquids?
Finally, as is always true in any insurance discussion, when you cut people out of access to health care you are agreeing that it's OK if they suffer and die. I don't agree with that.11 -
One question that should be answered, is an insurance based solution a good methodology for ALL medical costs? If you think about it, home owners insurance, auto insurance, flood insurance, are all based on dealing with unexpected catastrophic events. Maybe another model is needed for more predictable events, such as the savings model like HSAs.6
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richardgavel wrote: »One question that should be answered, is an insurance based solution a good methodology for ALL medical costs? If you think about it, home owners insurance, auto insurance, flood insurance, are all based on dealing with unexpected catastrophic events. Maybe another model is needed for more predictable events, such as the savings model like HSAs.
Sure that is were the high deductable plans and HSA's come in. The challenge is the average American family has less than $1,000 in a savings account:
https://www.fool.com/investing/2016/09/25/how-much-does-the-average-american-have-in-their-s.aspx
Have to get people's mindset to save instead Starbucks everyday, the newest iPhone, etc.2 -
Packerjohn wrote: »richardgavel wrote: »One question that should be answered, is an insurance based solution a good methodology for ALL medical costs? If you think about it, home owners insurance, auto insurance, flood insurance, are all based on dealing with unexpected catastrophic events. Maybe another model is needed for more predictable events, such as the savings model like HSAs.
Sure that is were the high deductable plans and HSA's come in. The challenge is the average American family has less than $1,000 in a savings account:
https://www.fool.com/investing/2016/09/25/how-much-does-the-average-american-have-in-their-s.aspx
Have to get people's mindset to save instead Starbucks everyday, the newest iPhone, etc.
I could skip Starbucks every day for a year (in fact, I guess I did because I never go) and it wouldn't have covered the co-pay we had when my husband accidentally cut his hand last year. We're relatively fortunate with our high deductable plan because we don't use a lot of health care, but it doesn't take much to wipe an account completely out.4 -
Never mind.0
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janejellyroll wrote: »Packerjohn wrote: »richardgavel wrote: »One question that should be answered, is an insurance based solution a good methodology for ALL medical costs? If you think about it, home owners insurance, auto insurance, flood insurance, are all based on dealing with unexpected catastrophic events. Maybe another model is needed for more predictable events, such as the savings model like HSAs.
Sure that is were the high deductable plans and HSA's come in. The challenge is the average American family has less than $1,000 in a savings account:
https://www.fool.com/investing/2016/09/25/how-much-does-the-average-american-have-in-their-s.aspx
Have to get people's mindset to save instead Starbucks everyday, the newest iPhone, etc.
I could skip Starbucks every day for a year (in fact, I guess I did because I never go) and it wouldn't have covered the co-pay we had when my husband accidentally cut his hand last year. We're relatively fortunate with our high deductable plan because we don't use a lot of health care, but it doesn't take much to wipe an account completely out.
Know all about it. Had about $10k out of pocket because the woman that was texting while driving hit my son and busted up his him. Had plenty of money for the damn phone, but not for proper insurance.
The Starbucks is just an example not to be taken literally. The problem with high deductable plans and HSAs it the savings rate in the US is already so low. Some people could increase their savings rate by reducing spending on luxury items like $5 a cup coffee. Some could not.3 -
Packerjohn wrote: »heiliskrimsli wrote: »lemurcat12 wrote: »If you don't have it and end up getting care from the emergency room, the rest of us have to pay.
Everything a provider has to write off for people who don't pay and use the ER as their personal doctor raises the prices for people who do pay.
A VP of our company was on the board of a hospital in a rust belt community. He told us the hospital actually collected 30% of the total amount billed.
Can confirm similar stats for the major health care system I work for in Texas.0 -
Packerjohn wrote: »janejellyroll wrote: »Packerjohn wrote: »richardgavel wrote: »One question that should be answered, is an insurance based solution a good methodology for ALL medical costs? If you think about it, home owners insurance, auto insurance, flood insurance, are all based on dealing with unexpected catastrophic events. Maybe another model is needed for more predictable events, such as the savings model like HSAs.
Sure that is were the high deductable plans and HSA's come in. The challenge is the average American family has less than $1,000 in a savings account:
https://www.fool.com/investing/2016/09/25/how-much-does-the-average-american-have-in-their-s.aspx
Have to get people's mindset to save instead Starbucks everyday, the newest iPhone, etc.
I could skip Starbucks every day for a year (in fact, I guess I did because I never go) and it wouldn't have covered the co-pay we had when my husband accidentally cut his hand last year. We're relatively fortunate with our high deductable plan because we don't use a lot of health care, but it doesn't take much to wipe an account completely out.
The Starbucks is just an example not to be taken literally. The problem with high deductable plans and HSAs it the savings rate in the US is already so low. Some people could increase their savings rate by reducing spending on luxury items like $5 a cup coffee. Some could not.
I'm sorry that I took your example too literally. My point is that skipping little luxuries like Starbucks isn't really the solution to health care costs. My husband and I already save much more than the average American family, including what is in our HSA and one (minor) medical event was still a pretty big expense for us. If it was something major like a significant illness or accident . . . Starbucks or skipping a new phone is going to be the answer.
I'm not saying people shouldn't save money. I think we should and live that value in my own life. But it seems like a savings account is much more useful when it comes to emergencies like car trouble than it is for medical needs. I make all my coffee at home, it isn't going to help me swing chemotherapy bills.10 -
Lol, obviously YOU don't understand how business and economics work. Insurance companies pull of of markets that aren't profitable...that's why Obamacare is failing. Some states have only one option available. Being forced to cover very high risk people at artificially low premiums has resulted in unbalanced risk pools. That is a failing business model...for any insurance provider.
Just to clarify the ACA has failed, not failing. Some states (technically individual markets within states) have zero options. The new proposed plan will have the same inherent risks of Adverse Selection which you describe in your post. It's truly a lose-lose position.2 -
Packerjohn wrote: »Know all about it. Had about $10k out of pocket because the woman that was texting while driving hit my son and busted up his him. Had plenty of money for the damn phone, but not for proper insurance.
My previous car was totaled when a texting driver rear ended me. I was stopped in traffic, the impact was so hard my car slammed into the one in front of me. Traffic was jammed for a mile ahead of me and it was blatantly obvious the driver wasn't paying attention. He admitted fault on the spot. This was expensive for everybody involved, but nobody was injured.
I was also hit by a car while doing hill repeats on my bike. I spent about 20 hours in the ER and ICU after that, with a $19,000 bill, plus the loss of an $8,000 bike. At least she had insurance.0 -
Packerjohn wrote: »heiliskrimsli wrote: »lemurcat12 wrote: »If you don't have it and end up getting care from the emergency room, the rest of us have to pay.
Everything a provider has to write off for people who don't pay and use the ER as their personal doctor raises the prices for people who do pay.
A VP of our company was on the board of a hospital in a rust belt community. He told us the hospital actually collected 30% of the total amount billed.
Can confirm similar stats for the major health care system I work for in Texas.
If you rely on actually collecting 30% of what you bill, and you are a very technology and skilled labor intensive field, you have to bill a lot to keep afloat.4 -
Increasing physical activity among children is a potentially important public health intervention. Quantifying the economic and health effects of the intervention would help decision makers understand its impact and priority. Using a computational simulation model that we developed to represent all US children ages 8–11 years, we estimated that maintaining the current physical activity levels (only 31.9 percent of children get twenty-five minutes of high-calorie-burning physical activity three times a week) would result each year in a net present value of $1.1 trillion in direct medical costs and $1.7 trillion in lost productivity over the course of their lifetimes. If 50 percent of children would exercise, the number of obese and overweight youth would decrease by 4.18 percent, averting $8.1 billion in direct medical costs and $13.8 billion in lost productivity. Increasing the proportion of children who exercised to 75 percent would avert $16.6 billion and $23.6 billion, respectively.
http://content.healthaffairs.org/content/36/5/9023 -
heiliskrimsli wrote: »Packerjohn wrote: »heiliskrimsli wrote: »lemurcat12 wrote: »If you don't have it and end up getting care from the emergency room, the rest of us have to pay.
Everything a provider has to write off for people who don't pay and use the ER as their personal doctor raises the prices for people who do pay.
A VP of our company was on the board of a hospital in a rust belt community. He told us the hospital actually collected 30% of the total amount billed.
Can confirm similar stats for the major health care system I work for in Texas.
If you rely on actually collecting 30% of what you bill, and you are a very technology and skilled labor intensive field, you have to bill a lot to keep afloat.
Yep, lots of fixed costs. You have to have all that fancy stuff in the hospital in case someone comes in and needs it. Might be anyone needing a particular item for several days or weeks. The person that rolls in and it saves their life will be pretty happy to have it.1 -
Packerjohn wrote: »richardgavel wrote: »One question that should be answered, is an insurance based solution a good methodology for ALL medical costs? If you think about it, home owners insurance, auto insurance, flood insurance, are all based on dealing with unexpected catastrophic events. Maybe another model is needed for more predictable events, such as the savings model like HSAs.
Sure that is were the high deductable plans and HSA's come in. The challenge is the average American family has less than $1,000 in a savings account:
https://www.fool.com/investing/2016/09/25/how-much-does-the-average-american-have-in-their-s.aspx
Have to get people's mindset to save instead Starbucks everyday, the newest iPhone, etc.
I'm not assuming it would be tied with a HIGH deductible plan. Also, hopefully this would reduce the overall cost of insurance because of fewer claims for stuff that is not catastrophic, and so the difference would go in the HSA. I would also expect Medicaid to be part insurance, part HSA. Companies already contribute into HSAs now.
Couple that with more price transparency since individuals are paying and seeing the costs.0 -
Somewhat related: My insurance company is offering a discount if you can run a 9-minute mile, or deadlift your weight.
More related: I think this is just inevitable, given all the tracking devices we have and whatnot.
And for those who say it ignores individual variation, well yes, that's how it works. When I was under 25, I paid a hell of a lot more for car insurance, despite being a really safe driver. Because *in general,* males of that age get in lots of accidents. Just as in general, someone carrying around lots of extra mass is at risk for all kinds of health i$$ues.2
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