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Do you think obese/overweight people should pay more for health insurance?

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Replies

  • Packerjohn
    Packerjohn Posts: 4,855 Member
    edited May 2017
    Packerjohn 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.
  • stealthq
    stealthq Posts: 4,298 Member
    Packerjohn 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.
  • ras2g2
    ras2g2 Posts: 2 Member


    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.
  • NorthCascades
    NorthCascades Posts: 10,970 Member
    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.
  • heiliskrimsli
    heiliskrimsli Posts: 735 Member
    stealthq wrote: »
    Packerjohn 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.
  • NorthCascades
    NorthCascades Posts: 10,970 Member
    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/36/5/902
  • Packerjohn
    Packerjohn Posts: 4,855 Member
    stealthq wrote: »
    Packerjohn 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.
  • richardgavel
    richardgavel Posts: 1,001 Member
    Packerjohn 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.
  • zamphir66
    zamphir66 Posts: 582 Member
    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.
  • Packerjohn
    Packerjohn Posts: 4,855 Member
    Packerjohn 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.
  • stealthq
    stealthq Posts: 4,298 Member
    stealthq wrote: »
    Packerjohn 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.
  • Macy9336
    Macy9336 Posts: 694 Member
    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.



  • richardgavel
    richardgavel Posts: 1,001 Member
    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.
  • crazyycatladyy1
    crazyycatladyy1 Posts: 156 Member
    edited May 2017
    Packerjohn wrote: »
    Packerjohn 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.
  • crazyycatladyy1
    crazyycatladyy1 Posts: 156 Member
    Packerjohn 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.
  • Packerjohn
    Packerjohn Posts: 4,855 Member
    Packerjohn wrote: »
    Packerjohn 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.
  • Packerjohn
    Packerjohn Posts: 4,855 Member

    Sunna_W wrote: »
    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.