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Do you think obese/overweight people should pay more for health insurance?
Replies
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richardgavel 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'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.
So are you saying people would self insure for smaller expenses? That is what a high deductible plan is. Maybe I'm not understanding you. Your premiums are lower, but you have to pay for minor things (and/or parts of major things) until you meet your deductible. A HSA may be offered so you could in theory put the premium difference in the HSA so you could pay the expenses up to your deductable. I have what qualifies as a high deductible plan that qualifies for a HSA (not all plans qualify under current rules). The company provided $500 "seed" money but that's their only contribution to the HSA. The company also pays part of the premium.0 -
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.
And pay a whole lot of money for a collections department to even get the small percentage you do. There's a lot in health care costs that has nothing to do with either health or care.4 -
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.
Health insurance is not a good model for medical costs but neither are HSAs because it links income to ability to pay for health care when the sick and disabled will almost never have the income to pay for health care as fast as they need to. Only the healthy and lucky with above average incomes will see their HSAs grow. I have used an HSA before and I ended up spending more than the limit I could save into it due to the fact that three of us in my family were born with asthma and the fourth was born with a chemical imbalance...so we all four were born with chronic health conditions requiring expensive prescription meds and the occasional ER visit. I remember entire pay checks that went into the HSA to fund our health costs.
Really, the single payer system is the fairest way. Yes, it means healthy people are subsidising my asthmatic wheezing self but shouldn't people who are unhealthy through an accident of birth not be cared for by society? Too, these same healthy people know they may be subsidised if they are unlucky enough to be the victims of an accident in life....actual accident, or cancer, or mental illness, or anything. Too people under these systems value their healthcare highly...yes we gripe and groan about the NHS but it's our way of keeping pressure on the Gov to fund it properly not a sign we don't want it. Just look at the Parliament petitions about not privatising the NHS, increasing funds by £350m per week, pleas that we're willing to pay more tax to keep it going, etc and you'll see the public likes and wants the NHS to be around for future generations. It is also a lot cheaper to cut out the middle man of the insurance company. Any comparison shows that the US healthcare costs are almost triple the UK fir the same drugs, procedures, care, etc.
I know it's probably an impossible feat to do in the US. After all, millions of people in the insurance industry would lose their jobs. As would anyone who does medical billing and coding. Yes this would be savings on healthcare costs making the system very affordable but it would be a huge impact much like when the rust belt lost all the steel mills.
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Here is an article relevant to this thread:
http://www.intellectualtakeout.org/blog/us-has-fattest-poor-people-world-why
What I find galling about the "study" is that it tries to make correlations about providing food benefits to the poor and BLAMES them for their poor food choices and their obesity. It's a classic blame the victim piece.
Specifically, many poor people exist in a food desert. If a person doesn't live near fresh food, how are they supposed to get to it, buy it, prepare it and eat it? Yes, eggs are cheap. But most of these corner stores that these people have access to in the inner city don't carry them.
Additionally, until recently, there were no restrictions on the EBT cards like there are with the WIC program (for women, infants and children) that stipulate that only cheese, eggs, and dairy can be purchased with the funds on the cards.
Case in point:
In my career I have worked at both the USDA and the US Navy Yard in SE DC. Until recently, (last 8 to 10 years) there was only 1 large grocery store (a Safeway) near South Capital Street and it was nearer the waterfront condos and wharf than it was near the low-income apartments and houses.
Things were so dire (in 2000) that the Navy brought in restaurants and a farmer's market for employees inside the base. If you didn't have a car, there was nothing close by. Not even food trucks would venture into SE. And, after dark - "forgetaboutit". While there were a few corner markets accepted EBT / SNAP food subsidy cards they only carried some frozen items like hot pockets and pizza as well as soda, candy, beer, chips, cigarettes, and lottery tickets. They didn't carry things like fresh meat, fruit, vegetables or eggs or cheese.
Also, there were TONS of fast food restaurants closer to these neighborhoods than grocery stores Domino's Pizza, Wendy's, KFC, Taco Bell are all generally more accessible than a grocery store. And, with $10.00 a mom can get a bucket of chicken and two sides (and nod, nod, wink, wink, sodas for the kids) or a loaf of bread, a half a dozen eggs, and a half a gallon of milk, which she still has to cook (if she has the time or the means) -- if she has the means to get to a store as well as the time and energy to cook if her stove works.
What the above article doesn't mention is that the food (the author deems that they should be buying) isn't where these people are, because the areas are considered high crime / high risk and companies don't want to put their stores in a high crime area.
(Industry leaders who met with the DC Council said that they couldn't attract employees that wouldn't steal from them and managers would rather quit than work a night shift in a DC store). Furthermore real estate per square foot is expensive and why lease to a grocery store when you can clear out the poor people and put up a high dollar / high rise apartment, with a grocery store in the lobby?
With the gentrification of the Navy Yard district, "The Yards" ball field (Go Nats!) and multi-million dollar apartments, things began to improve in order to attract higher income residents. (It's the law of supply and demand). There is also the Eastern Market area that is within walking distance, but, the shops in there are more boutiques and cater to people who can pay more for their food.
The low-income apartments and houses were bull dozed and the elderly and poor were moved out to PG County in Maryland (to make room for the gentrification), beginning 2003. So, those people who want to shop at a grocery store still have to get in their cars and drive somewhere else around the beltway in Maryland or Virginia (or get someone to take them if they don't have a car). There are now some strip malls with anchor stores like Giant or Safeway, but they are not where these folks can get to easily from the "projects".
Michelle Obama's "My Plate" initiative was not just about the food desert, it was also about portion control and "clean" eating; not eating a ton of grains and empty carbs and things from a box. It was about getting kids familiar with home grown foods and learning to grow them and eat them. Children who are used to fast food as their only food are not accustomed to eating "fresh" fruit and vegetables.
Additionally, many of these children are fed at school and the food is basically all from a box, a can or frozen (based on the contracts that the District has with its vendors). It's kind of like going to a foreign county as an American tourist and the first thing people generally look for is food that they are familiar with. These kids are being taught that other food exists and that they should try them and perhaps want to have them more often. There is a huge non-profit program sponsored by the Friends of the National Arboretum that goes to schools and helps them build urban gardens so that the kids can become familiar with good nourishing food.
In relation to the obesity epidemic, many of the fast foods are high in sugar and salt. If that is all a person is eating (e.g. the Super Size Me movie) then obviously something is going to happen metabolically to a person't body. Some time ago Dr Oz and Oprah also discussed that many African Americans (as well as poor white people) are predisposed to certain medical conditions because they have generationally survived dire conditions and that their bodies adapted to allow them to survive. They hold onto salt; their pancreases exude glucose. Additionally, add the stress of being poor, not feeling safe (these kids can't even play outside due to gun violence a lot of times) and not having access to minerals like iodine, they become hypothyroid / develop acute adrenal fatigue.
The SNAP program now limits what can be bought with the card. While box foods are still permitted and chips and soda are not, these box foods contain MSG -- and are fed to kids every school day if they get lunch at school regardless of their economic situation. MSG is also in most restaurant food unless they specifically tell you it isn't.
Ref: http://www.livestrong.com/article/408512-neurological-effect-of-monosodium-glutamate/
MSG actually cause people to eat more and is used in research circles used to fatten up rats for experimentation, because it dramatically increases insulin production. According to "Contemporary Nutrition," the food additive industry readily admits that MSG has addictive properties and can cause people to gain weight, but they justify its use by claiming that this can be beneficial to elderly persons who are sometimes malnourished. Glutamate, the main component of MSG, is the primary excitatory neurotransmitter in the brain, and it has been linked to neurological symptoms when taken in excess.
Finally, people who still think that Walmart food is good for you need to really examine their labels. Walmart came into many communities that had a family grocery store and forced them out of business. If you want to buy food, you now have to buy it at Walmart. Many people in rural areas have no choice in the matter. There is very little food at Walmart that is hormone, antibiotic, additive free. It's all factory farm food and the animals are fed expired box food!
So, I am not sure that blaming poor people for being fat is such a good idea -- because they are just the end point on the factory food supply chain.
It's all actually quite depressing... Anyway - that's all I have to offer the discussion.6 -
I think people saw my HSA comment and focused on that, but my real point was that catastrophic health care and "everyday" health care are two different animals and should be dealth with differently. When the comment is made that everyone will eventually need health care, I can concede that, but only for the latter. Plenty of people go thru life without actually using catastrophic/accidental care, which does fit the insurance model. But maybe a different type of coverage is needed for stuff like pregnancy, physicals, blood pressure, arthritis, your average non threatening visit, and other regular health care BECAUSE those expenses are going to occur.3
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CatchMom13 wrote: »heiliskrimsli wrote: »Think about the fact that a large percentage of overweight/obese are lower income. You can't compare this to buying cigarettes, because smoking is an additional purchase. Often folks only purchase cheap food. Cheap food is not filling, which lends itself to eating more of it, hence becoming overweight/obese. Adding that type of financial burden is not going to help overweight people. It's only going to further benefit those who are either naturally slim, or fit.
Less food costs less than more food.
Higher quality food costs more. Everyone knows that. I see it in my own grocery bill when I buy BETTER QUALITY food and stay away from processed food.
No it doesn't. I eat a mostly whole foods, plant based diet (with fish included 4-5 times a week), and I'm spending less money on what I eat now, than when I was eating a lot of processed food. I eat a ridiculous amount of veggies, a small amount of fruit, whole grains, beans/lentils, fish, eggs and then very small amounts of butter and cheese. These things are cheap.7 -
janejellyroll wrote: »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.
Don't most HSA accounts go hand in hand with high deductible insurance plans? (we've had several HSA/high deductible combos, including our current one). So after you get your HSA built up, that should cover the cost of the high deductible if someone runs into high medical costs. With your chemo example-the HSA account balance covers the cost of the deductible and then the insurance part kicks in and covers the big medical bills. The kicker is to get the HSA account built up asap and hope nothing big hits until you get that set aside.
We had our HSA built up pretty nicely until last year, when we had several thousand dollars of dental work happen. So at the time of our dd's accident a few weeks ago our HSA balance was around $400. That, along with new bi-weekly deposits (automatically deducted from dh's paycheck), will cover all the smaller dr. bills coming in but then we'll have to cover the bigger hospital bill oop. As a follow up to my previous posts-the $7,000ish bill has cleared claims and our oop expense will be $2,871. With that amount we've decided to just pay it right away from our regular savings, and not bother with their payment option. The bill breakdown didn't have any crazy surprises (no $50 gauze), and it did include the CT scan as well. My husband and I were actually surprised it wasn't more, considering everything it covered.0 -
richardgavel 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'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.
Some do, some don't. We've had employers give an HSA deposit at the beginning of the year, but our current employer does not.
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crazyycatladyy1 wrote: »janejellyroll wrote: »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.
Don't most HSA accounts go hand in hand with high deductible insurance plans? (we've had several HSA/high deductible combos, including our current one). So after you get your HSA built up, that should cover the cost of the high deductible if someone runs into high medical costs. With your chemo example-the HSA account balance covers the cost of the deductible and then the insurance part kicks in and covers the big medical bills. The kicker is to get the HSA account built up asap and hope nothing big hits until you get that set aside.
We had our HSA built up pretty nicely until last year, when we had several thousand dollars of dental work happen. So at the time of our dd's accident a few weeks ago our HSA balance was around $400. That, along with new bi-weekly deposits (automatically deducted from dh's paycheck), will cover all the smaller dr. bills coming in but then we'll have to cover the bigger hospital bill oop. As a follow up to my previous posts-the $7,000ish bill has cleared claims and our oop expense will be $2,871. With that amount we've decided to just pay it right away from our regular savings, and not bother with their payment option. The bill breakdown didn't have any crazy surprises (no $50 gauze), and it did include the CT scan as well. My husband and I were actually surprised it wasn't more, considering everything it covered.
Yes, by the way the regulation is written you cannot have an HSA if you do not have what is classified as a high deductible plan.0 -
Here is an article relevant to this thread:
http://www.intellectualtakeout.org/blog/us-has-fattest-poor-people-world-why
What the above article doesn't mention is that the food (the author deems that they should be buying) isn't where these people are, because the areas are considered high crime / high risk and companies don't want to put their stores in a high crime area.
(Industry leaders who met with the DC Council said that they couldn't attract employees that wouldn't steal from them and managers would rather quit than work a night shift in a DC store). Furthermore real estate per square foot is expensive and why lease to a grocery store when you can clear out the poor people and put up a high dollar / high rise apartment, with a grocery store in the lobby?
With the gentrification of the Navy Yard district, "The Yards" ball field (Go Nats!) and multi-million dollar apartments, things began to improve in order to attract higher income residents. (It's the law of supply and demand). There is also the Eastern Market area that is within walking distance, but, the shops in there are more boutiques and cater to people who can pay more for their food.
The low-income apartments and houses were bull dozed and the elderly and poor were moved out to PG County in Maryland (to make room for the gentrification), beginning 2003. So, those people who want to shop at a grocery store still have to get in their cars and drive somewhere else around the beltway in Maryland or Virginia (or get someone to take them if they don't have a car). There are now some strip malls with anchor stores like Giant or Safeway, but they are not where these folks can get to easily from the "projects".
I hope you don't think bulldozing low income apartments in the city and moving the residents to the suburbs is a solution to any issue. It's just kicking the can down the road.
I live in a mid-size city. About 10 years ago a major city about 100 miles away took down some low income housing and my community received some of the residents. Guess what, their problems followed them.
A large group was put in some nice apartments that were converted to public housing. The apartments were 2 blocks away from a 10 yr old 50000 sq ft 24 hour grocery store. After the new residents moved in, there were reports of robberies in the parking lot after dark. A neighbor kid that worked there said the store went from having one of the lowest shrinkage (theft) rates in the district to one of the highest in a year. Random gunshots were heard in the neighborhood. Because of the issues the store started closing at 9 PM and they hired armed security guards. The issues continued and the store ultimately closed. It was reconfigured so it is now part dollar store, a payday loan place, plasma "donation" center and part is empty.
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I can't comment on this with any first hand knowledge really, because I am incredibly lucky to have access to the National Health Service, but I'm wondering something.
If you drive a faster car, or play football, or ride a motorcycle etc - do these impact your health insurance costs?
Or, for example, if you live in an area where it's more likely you'll be involved in an altercation?2 -
BigDougie1211 wrote: »I can't comment on this with any first hand knowledge really, because I am incredibly lucky to have access to the National Health Service, but I'm wondering something.
If you drive a faster car, or play football, or ride a motorcycle etc - do these impact your health insurance costs?
Or, for example, if you live in an area where it's more likely you'll be involved in an altercation?
Yes, driving certain cars, living in certain areas, riding a motorcycle and some risky hobbies can impact your insurance costs.1 -
Both no/yes but with, no being; 1st because weight management, isn't common sense & thus until it's a requirement via schools for children/mandated to obtain insurance coverage for adults to, visit with a Registered Dietitian we'd be penalizing anyone for not knowing naturally what someone has; to obtain a college education to know! Once someone receives the knowledge necessary then yes 2nd if, they don't apply it by meeting reasonable weight expectations within; a year! When you know that you've the ability to, control your weight it's your; responsibility to do so! Businesses already charge, extra for; plus sizes because they, use more; fabric & thus it's unfair to expect a clothing manufacturer to, absorb those costs just as it's to; expect the taxpayer to for your health! Of course, the difference between; a business & government's that a business doesn't consider, why you're plus size to; charge you extra but the, government'd/does! However I, don't view it; as a penalty but as, a financial responsibility for; your choices! Obviously if you desire to reside within a larger house than you're able to, currently afford then you must figure how to; afford it upon your own accord! The same should apply to, the choices that lead to'ving a; larger body also!0
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richardgavel wrote: »I think people saw my HSA comment and focused on that, but my real point was that catastrophic health care and "everyday" health care are two different animals and should be dealth with differently. When the comment is made that everyone will eventually need health care, I can concede that, but only for the latter. Plenty of people go thru life without actually using catastrophic/accidental care, which does fit the insurance model. But maybe a different type of coverage is needed for stuff like pregnancy, physicals, blood pressure, arthritis, your average non threatening visit, and other regular health care BECAUSE those expenses are going to occur.
When I get wonky on the issue, I pretty much agree with this, but where it breaks down relates to the development of chronic type illnesses which become increasingly common as one ages (and why we need Medicare, as old people could not be covered with an insurance model).
One issue is that routine coverage probably could be dealt with through the market and would be responsive to price (although you would still need related catastrophic for things like pregnancy complications). The drawback to this--especially related to this discussion--is that that would tend to DISCOURAGE use of medical care, and we actually want to encourage routine care for preventative effects, including with obesity. If there are interventions that could help with obesity, I'd like them to be made.3 -
Packerjohn wrote: »BigDougie1211 wrote: »I can't comment on this with any first hand knowledge really, because I am incredibly lucky to have access to the National Health Service, but I'm wondering something.
If you drive a faster car, or play football, or ride a motorcycle etc - do these impact your health insurance costs?
Or, for example, if you live in an area where it's more likely you'll be involved in an altercation?
Yes, driving certain cars, living in certain areas, riding a motorcycle and some risky hobbies can impact your insurance costs.
He asked about health insurance. They don't affect health insurance costs, although of course they do affect car insurance costs.
If we had real underwriting for health insurance, they presumably would, although not for those under the employer model.1 -
lemurcat12 wrote: »richardgavel wrote: »I think people saw my HSA comment and focused on that, but my real point was that catastrophic health care and "everyday" health care are two different animals and should be dealth with differently. When the comment is made that everyone will eventually need health care, I can concede that, but only for the latter. Plenty of people go thru life without actually using catastrophic/accidental care, which does fit the insurance model. But maybe a different type of coverage is needed for stuff like pregnancy, physicals, blood pressure, arthritis, your average non threatening visit, and other regular health care BECAUSE those expenses are going to occur.
When I get wonky on the issue, I pretty much agree with this, but where it breaks down relates to the development of chronic type illnesses which become increasingly common as one ages (and why we need Medicare, as old people could not be covered with an insurance model).
One issue is that routine coverage probably could be dealt with through the market and would be responsive to price (although you would still need related catastrophic for things like pregnancy complications). The drawback to this--especially related to this discussion--is that that would tend to DISCOURAGE use of medical care, and we actually want to encourage routine care for preventative effects, including with obesity. If there are interventions that could help with obesity, I'd like them to be made.
I agree with the bolded, very much!1 -
Isn't this a pre-existing condition? I thought with the health care system in place, and even the one the legislature is considering, people with pre-existing conditions would not be penalized. Maybe the soda companies and candy companies and potato chip companies and fast food restaurants should be penalized, how's that for an idea? Maybe they should have to pay a health care tax or something like that (healthy tax?), and then they would pass the cost to the people who buy food there. Put the tax up so high just like the cigarette tax, and maybe some folks would automatically stop eating those foods. Of course, I am speaking "tongue-in-cheek", as this is a preposterous notion to me, but what a great topic for discussion!2
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It should be based on your actual health/how much you go to a doctor. I haven't been in 3 years- before that it was only once in 3 years. I've been to a doctor maybe 6 times in 15 years. I'm obese and have been so almost my whole life. I know plenty of "normal" weight people who go 2-6 times a year.0
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millcreekr wrote: »Isn't this a pre-existing condition? I thought with the health care system in place, and even the one the legislature is considering, people with pre-existing conditions would not be penalized.
The legislation that was just repealed was preX friendly. The new legislation replacing it is not.millcreekr wrote: »Maybe the soda companies and candy companies and potato chip companies and fast food restaurants should be penalized, how's that for an idea?
That's pretty bad as ideas go. Those companies weren't doing anything illegal. Nobody was forced to go out and buy potato chips and soda. People bought that stuff because they liked it; those companies made that stuff because people wanted it.1 -
To be politically correct, I will say it is based on circumstances but nothing really is set up to help us in the proper way, it should based on individual circumstances. It is all about the money all the time! Never about really helping the people that need to be helped. They got it all wrong!1
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It should be based on your actual health/how much you go to a doctor. I haven't been in 3 years- before that it was only once in 3 years. I've been to a doctor maybe 6 times in 15 years. I'm obese and have been so almost my whole life. I know plenty of "normal" weight people who go 2-6 times a year.
And you think this is a good idea? To not go in for annual physicals/well checkups, to make sure everything is ok? There's numerous medical conditions that don't have symptoms-for example I was a pre-diabetic and had no clue. My fil is another example-no symptoms at all, went in for a routine physical and found out his blood pressure was so high that he was at very high risk for stroke.
eta: clarity4 -
Leenizi129 wrote: »To be politically correct, I will say it is based on circumstances but nothing really is set up to help us in the proper way, it should based on individual circumstances. It is all about the money all the time! Never about really helping the people that need to be helped. They got it all wrong!
In what circumstance do you think an insurance company is going to look at someone who has a very high bmi, and not want to charge them more because of the risks that come along with their weight? What individual circumstances do you think would negate this? (genuinely curious).0 -
crazyycatladyy1 wrote: »janejellyroll wrote: »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.
Don't most HSA accounts go hand in hand with high deductible insurance plans? (we've had several HSA/high deductible combos, including our current one). So after you get your HSA built up, that should cover the cost of the high deductible if someone runs into high medical costs. With your chemo example-the HSA account balance covers the cost of the deductible and then the insurance part kicks in and covers the big medical bills. The kicker is to get the HSA account built up asap and hope nothing big hits until you get that set aside.
We had our HSA built up pretty nicely until last year, when we had several thousand dollars of dental work happen. So at the time of our dd's accident a few weeks ago our HSA balance was around $400. That, along with new bi-weekly deposits (automatically deducted from dh's paycheck), will cover all the smaller dr. bills coming in but then we'll have to cover the bigger hospital bill oop. As a follow up to my previous posts-the $7,000ish bill has cleared claims and our oop expense will be $2,871. With that amount we've decided to just pay it right away from our regular savings, and not bother with their payment option. The bill breakdown didn't have any crazy surprises (no $50 gauze), and it did include the CT scan as well. My husband and I were actually surprised it wasn't more, considering everything it covered.
I don't know if most HSA plans are paired with a high deductible, but mine is. We built ours up and it covered the cost of the care for my husband's hand. My point is that just skipping Starbucks or not buying a phone isn't going to allow us to save enough to meet the cost of our deductible.
This isn't really me bellyaching about my situation -- we're doing fine. That we're doing well is kind of my point. My husband and I are childless, don't have a car payment, live very reasonably, don't have any more student loan payments, and I have a good job. And it's still a consideration for us. For people who aren't in our situation, I'm not sure how practical it is to expect a HSA to bridge the gap.2 -
It should be based on your actual health/how much you go to a doctor. I haven't been in 3 years- before that it was only once in 3 years. I've been to a doctor maybe 6 times in 15 years. I'm obese and have been so almost my whole life. I know plenty of "normal" weight people who go 2-6 times a year.
I always go to the doctor once a year to get routine preventative care. Things like blood pressure readings, pap smears, blood tests, keeping up on vaccinations -- these aren't bad things. They're low cost to the health care system and they help prevent bigger expenses down the road.
There is a reason why so many plans make preventative care free to users. This is the kind of medical care they want you to use because it saves money for everyone.5 -
It should be based on your actual health/how much you go to a doctor. I haven't been in 3 years- before that it was only once in 3 years. I've been to a doctor maybe 6 times in 15 years. I'm obese and have been so almost my whole life. I know plenty of "normal" weight people who go 2-6 times a year.
Not going to the doctor frequent enough will be more costly than going too often, if a significant medical condition is not detected and treated early. I know people who are in poor health who have avoided getting physicals for years - all that does is change the nature of the treatment from preventative to reactive, and will end up costing a lot more than having regular periodic checkups.3 -
crazyycatladyy1 wrote: »It should be based on your actual health/how much you go to a doctor. I haven't been in 3 years- before that it was only once in 3 years. I've been to a doctor maybe 6 times in 15 years. I'm obese and have been so almost my whole life. I know plenty of "normal" weight people who go 2-6 times a year.
And you think this is a good idea? To not go in for annual physicals/well checkups, to make sure everything is ok? There's numerous medical conditions that don't have symptoms-for example I was a pre-diabetic and had no clue. My fil is another example-no symptoms at all, went in for a routine physical and found out his blood pressure was so high that he was at very high risk for stroke.
eta: clarity
Right -- from the point of view of an insurer, it would probably be better to cover someone who gets routine care (which is inexpensive) and thus is more likely to have preventative care that protects against some more expensive costs down the road. But who knows!
Main expense of medical care has 0 to do with how often you have check-ups, though, or even if you go in to get penicillin because you have strep.0 -
It should be based on your actual health/how much you go to a doctor. I haven't been in 3 years- before that it was only once in 3 years. I've been to a doctor maybe 6 times in 15 years. I'm obese and have been so almost my whole life. I know plenty of "normal" weight people who go 2-6 times a year.
So as obese person who has been lucky you think you should pay less than people who go to the doctor a couple times a year for maybe a check up or a sinus infection, maybe $300 a year. What do you think you should be paying when a big one hits and you rack up a $300k medical bill in a year and the normal weight people you speak of have their $300 for a couple sinus infections?1 -
It should be based on your actual health/how much you go to a doctor. I haven't been in 3 years- before that it was only once in 3 years. I've been to a doctor maybe 6 times in 15 years. I'm obese and have been so almost my whole life. I know plenty of "normal" weight people who go 2-6 times a year.
So you don't get pap smears or breast examinations either, what about testing your blood glucose and BP? There is a high risk for complications for being obese and just because you don't have any problems right now doesn't mean that you will not in the future (hopefully you never will)? Wow, that is too risky.
2 -
The whole point of health insurance is to spread the risk -- the way you do that is have large pools of people, all of who enroll (and are encouraged to do so) by paying reasonable premiums. Once you start dicing and slicing risk pools, then insurance becomes too expensive for vast numbers of premiums, and the whole point of spreading the risk (and reducing the cost) is lost.
Everybody has different risk factors (as has been pointed out here) -- to set everyone in different risk pools is counterproductive to the whole notion of health insurance. Also, the idea of health insurance (which is why high deductible policies don't make economic sense) is for people to seek health care early before the health condition gets out of control and is very expensive to treat (e.g. Type 2 diabetes) -- causing health insurance to be too expensive is a disincentive for people to get insurance -- then they can't afford preventative health care.
I studied these things when I got my graduate degree in public health. Most people don't really have an opportunity to learn about health insurance, or health care for that matter. For example, accessibility without affordability means nothing when it comes to getting the health care you need. It has to be both accessible and affordable.
Finally, there are quite a few studies that show exercise is more important to health than weight, etc., etc.3 -
It should be based on your actual health/how much you go to a doctor. I haven't been in 3 years- before that it was only once in 3 years. I've been to a doctor maybe 6 times in 15 years. I'm obese and have been so almost my whole life. I know plenty of "normal" weight people who go 2-6 times a year.
Honestly, how do you even know you're healthy? Other than you 'feel fine' I guess. Preventative care saves money AND lives.5
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