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Do you think obese/overweight people should pay more for health insurance?
Replies
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rheddmobile wrote: »
I dunno, my running injury was pretty expensive. I don’t have insurance so had to pay up front. It cost me almost as much to diagnose and treat a ruptured Baker’s cyst as my mom’s recent 6 day hospital stay with diabetes related kidney issues. Her whole hospital stay plus surgery and ER fees was 8k roughly. I had ER fees plus ultrasound and labs fo determine I didn’t have a blood clot, surgery guided by ultrasound to drain the cyst, X-rays and associated nonsense because the osteo was determined to do his usual collection of stuff whether I needed it or not, then an MRI “to be sure there’s not an underlying condition causing the Baker’s cyst.” Steroid shots, antibiotics, etc.Cherimoose wrote: »This is an ancient thread.Onedaywriter wrote: »I read earlier that runners have an usually high risk of injury. So would I pay more because I have higher injury risk or less because I’m no longer obese?
You would pay less because you're no longer obese. The costs of obesity far outweigh the cost of seeing a doctor once because of shin splints or Achilles tendinitis.
Given that some estimates put 80% of runners being injured every year, maybe they should consider running a pre-existing condition!
Your mom's 6 day hospital stay for kidney issues that included a surgery didn't cost $8k, that was her out of pocket. Total bill was probably closer to $200k+ and insurance picked up most of it.
Orthopedic injuries from exercise are generally lower cost if they happen and help prevent 6 figure hospitalizations from obesity related issues.0 -
MargaretYakoda wrote: »Cherimoose wrote: »This is an ancient thread.Onedaywriter wrote: »I read earlier that runners have an usually high risk of injury. So would I pay more because I have higher injury risk or less because I’m no longer obese?
You would pay less because you're no longer obese. The costs of obesity far outweigh the cost of seeing a doctor once because of shin splints or Achilles tendinitis.
In the US, being obese is classified as a disability if it is caused by an underlying disorder.
Should every disabled person have to pay more for insurance? Or just the obese people?
And if so, are you talking about morbidly obese people? Or all overweight people?
Obesity is a lifestyle choice in most cases as opposed to something the individual has no choice over. Big difference IMO.2 -
Wow. This thread is toxic. Obesity is NOT always a choice. I’ve been “overweight” according to BMI my whole life and I did NOT choose it. I was overweight DESPITE a healthy lifestyle of eating well and being relatively active. Bodies come in all shapes and sizes and lots of people are naturally bigger and it’s GENETIC and NOT a choice. BMI is a crappy system that doesn’t take muscle mass into account. Lots of “overweight” people with high muscle mass and an active lifestyle are perfectly healthy despite being labeled as “overweight” by BMI. Plus size women already face SO much discrimination in the workplace and we don’t get equal representation in the media and now you guys want to add on even more discrimination? What is wrong with you people? I’ve only been on this forum a few weeks but as someone who identifies as plus size I have felt so much negativity towards me here. Stuff like this is really triggering for me and I am feeling SO pissed right now!4
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Wow. This thread is toxic. Obesity is NOT always a choice. I’ve been “overweight” according to BMI my whole life and I did NOT choose it. I was overweight DESPITE a healthy lifestyle of eating well and being relatively active. Bodies come in all shapes and sizes and lots of people are naturally bigger and it’s GENETIC and NOT a choice. BMI is a crappy system that doesn’t take muscle mass into account. Lots of “overweight” people with high muscle mass and an active lifestyle are perfectly healthy despite being labeled as “overweight” by BMI. Plus size women already face SO much discrimination in the workplace and we don’t get equal representation in the media and now you guys want to add on even more discrimination? What is wrong with you people? I’ve only been on this forum a few weeks but as someone who identifies as plus size I have felt so much negativity towards me here. Stuff like this is really triggering for me and I am feeling SO pissed right now!
Welcome - I'm sorry this thread is upsetting to you, but the "debate" area tends to be more freewheeling when it comes to discussing topics like this. You may find areas like "Support" to be more useful for you.
When people say obesity is a choice, what they are usually saying is that obesity is the result of daily, regular choices. It's not that there is a belief that people wake up and say "I'd like to be fat." The particular situation of a lot of people here is that we were overweight and we've realized the role that our choices played in that. It's not that we weren't eating well and being active (many of us were eating well and being active), it's that our choices resulted in us consuming more calories than our body needed. Our current environment makes it incredibly easy for people to do that . . . but we still have choices over how we interact with our environment.
I personally found this realization to be empowering. I understand that's not the way it feels for everyone.10 -
Wow. This thread is toxic. Obesity is NOT always a choice. I’ve been “overweight” according to BMI my whole life and I did NOT choose it. I was overweight DESPITE a healthy lifestyle of eating well and being relatively active. Bodies come in all shapes and sizes and lots of people are naturally bigger and it’s GENETIC and NOT a choice. BMI is a crappy system that doesn’t take muscle mass into account. Lots of “overweight” people with high muscle mass and an active lifestyle are perfectly healthy despite being labeled as “overweight” by BMI. Plus size women already face SO much discrimination in the workplace and we don’t get equal representation in the media and now you guys want to add on even more discrimination? What is wrong with you people? I’ve only been on this forum a few weeks but as someone who identifies as plus size I have felt so much negativity towards me here. Stuff like this is really triggering for me and I am feeling SO pissed right now!
Sorry if you are feeling triggered. Does it trigger you that obesity is the second leading cause of preventable death in the US? If not it should: https://www.wvdhhr.org/bph/oehp/obesity/mortality.htm
It's nothing personal, just facts and data.
I would have no problem and would encourage basing any sort of obesity related insurance surcharge for obesity on bodyfat measurement via DEAX scan, etc as opposed to strictly BMI.
Fact is though in the vast majority of cases if someone is obese based on BMI they will be obese on measures of bodyfat such as a DEXA scan.
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I think that something everyone misses in the whole “obesity costs health care money” is that we will all die eventually. Toward the end of life, health care costs often skyrocket.
So, if obesity were “cured” (imaginary of course) then ten or twenty years from now health care costs would skyrocket for all the non obese people just being old.
My mom is nowhere near obese (never was) but 95 (in fact we need to help her gain weight). In the past 8 months she broke her right hip once and her left hip twice. The costs for surgery and rehab without insurance (she’s well insured) would have been astounding.
Should mom pay more because she’s more likely to need medical care?
I was obese for 30 years and with the exception of an inguinal hernia (hereditary) never saw a doctor. I know I was just lucky but would it have been fair to charge me more?
Health insurance is not like car Insurance. We will all need health care at some point but many of us will never have a serious car accident.5 -
Her out of pocket was zero. It’s good to be an elderly widow of a military officer in the US. That is the stated total cost, Tricare said they would have covered up to 24k, but the bill was 8. I know, I was shocked too.Theoldguy1 wrote: »rheddmobile wrote: »
I dunno, my running injury was pretty expensive. I don’t have insurance so had to pay up front. It cost me almost as much to diagnose and treat a ruptured Baker’s cyst as my mom’s recent 6 day hospital stay with diabetes related kidney issues. Her whole hospital stay plus surgery and ER fees was 8k roughly. I had ER fees plus ultrasound and labs fo determine I didn’t have a blood clot, surgery guided by ultrasound to drain the cyst, X-rays and associated nonsense because the osteo was determined to do his usual collection of stuff whether I needed it or not, then an MRI “to be sure there’s not an underlying condition causing the Baker’s cyst.” Steroid shots, antibiotics, etc.Cherimoose wrote: »This is an ancient thread.Onedaywriter wrote: »I read earlier that runners have an usually high risk of injury. So would I pay more because I have higher injury risk or less because I’m no longer obese?
You would pay less because you're no longer obese. The costs of obesity far outweigh the cost of seeing a doctor once because of shin splints or Achilles tendinitis.
Given that some estimates put 80% of runners being injured every year, maybe they should consider running a pre-existing condition!
Your mom's 6 day hospital stay for kidney issues that included a surgery didn't cost $8k, that was her out of pocket. Total bill was probably closer to $200k+ and insurance picked up most of it.
Orthopedic injuries from exercise are generally lower cost if they happen and help prevent 6 figure hospitalizations from obesity related issues.
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Wow. This thread is toxic. Obesity is NOT always a choice. I’ve been “overweight” according to BMI my whole life and I did NOT choose it. I was overweight DESPITE a healthy lifestyle of eating well and being relatively active. Bodies come in all shapes and sizes and lots of people are naturally bigger and it’s GENETIC and NOT a choice. BMI is a crappy system that doesn’t take muscle mass into account. Lots of “overweight” people with high muscle mass and an active lifestyle are perfectly healthy despite being labeled as “overweight” by BMI. Plus size women already face SO much discrimination in the workplace and we don’t get equal representation in the media and now you guys want to add on even more discrimination? What is wrong with you people? I’ve only been on this forum a few weeks but as someone who identifies as plus size I have felt so much negativity towards me here. Stuff like this is really triggering for me and I am feeling SO pissed right now!
Eating well apparently means something unique to you. To me it means eating the correct number of calories to maintain a normal BMI. Doing that, or not, is indeed a choice. There are no people who can maintain an overweight BMI despite not eating. If there were, NASA would be contacting them to solve to the problem of how to ship enough food to Mars to sustain astronauts on a manned flight.
Approximately 10% of people fall into the “overweight” category despite not being over fat. Most of them are athletes.
In other posts you have claimed that because most people in America are overweight or obese, the BMI defined as “normal” should be changed. I recently read a good example of why that is a false use of statistics. What is the average number of arms a human being has? Some people have fewer than two, while almost no one has three or more, so the average is less than two. Does that mean that I, with my two arms, have an abnormally large number of arms?4 -
rheddmobile wrote: »
Her out of pocket was zero. It’s good to be an elderly widow of a military officer in the US. That is the stated total cost, Tricare said they would have covered up to 24k, but the bill was 8. I know, I was shocked too.Theoldguy1 wrote: »rheddmobile wrote: »
I dunno, my running injury was pretty expensive. I don’t have insurance so had to pay up front. It cost me almost as much to diagnose and treat a ruptured Baker’s cyst as my mom’s recent 6 day hospital stay with diabetes related kidney issues. Her whole hospital stay plus surgery and ER fees was 8k roughly. I had ER fees plus ultrasound and labs fo determine I didn’t have a blood clot, surgery guided by ultrasound to drain the cyst, X-rays and associated nonsense because the osteo was determined to do his usual collection of stuff whether I needed it or not, then an MRI “to be sure there’s not an underlying condition causing the Baker’s cyst.” Steroid shots, antibiotics, etc.Cherimoose wrote: »This is an ancient thread.Onedaywriter wrote: »I read earlier that runners have an usually high risk of injury. So would I pay more because I have higher injury risk or less because I’m no longer obese?
You would pay less because you're no longer obese. The costs of obesity far outweigh the cost of seeing a doctor once because of shin splints or Achilles tendinitis.
Given that some estimates put 80% of runners being injured every year, maybe they should consider running a pre-existing condition!
Your mom's 6 day hospital stay for kidney issues that included a surgery didn't cost $8k, that was her out of pocket. Total bill was probably closer to $200k+ and insurance picked up most of it.
Orthopedic injuries from exercise are generally lower cost if they happen and help prevent 6 figure hospitalizations from obesity related issues.
That is super strange. I had outpatient rotator cuff surgery a few years ago and the discounted price my insurance was charged was $12k, insurance paid $9k we had to pay $3k.0 -
No, because it would promote weight stigma, and to solve obesity problems we should first solve the parallel problems of weight stigma.My mom and I were discussing this today and I thought it would be a great topic for this forum, especially with all the politics surrounding health care these days.
So do you think people who are overweight and/or obese should have to pay more?
Do you think this would be a deterrent to gaining weight for people that are not in this category?
Should people with medications/medical conditions that cause weight gain be exempt?
I know that with obamacare/ACA there are wellness programs available, do you think these are all that helpful if you've been to one?
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I don't think it would cause weight stigma inherently, but it would make getting insurance more difficult (do you have to be weighed first?) and seems like it could be logistically difficult if you have workplace insurance (for example, does someone in admin have information about who is classed as obese?). I also wouldn't want to do anything to discourage people from getting health coverage (like thinking that they should wait until they manage to lose weight).
What I would be okay with is a program where you get discounts for certain positive behaviors. For example, yearly checkups, getting points for losing weight or controlling blood sugar or lowering blood pressure (which would be between the doctor and the insurance company). It would be entirely opt in, so someone who didn't want that could just pay the base price.3 -
I don't think it would cause weight stigma inherently, but it would make getting insurance more difficult (do you have to be weighed first?) and seems like it could be logistically difficult if you have workplace insurance (for example, does someone in admin have information about who is classed as obese?). I also wouldn't want to do anything to discourage people from getting health coverage (like thinking that they should wait until they manage to lose weight).
What I would be okay with is a program where you get discounts for certain positive behaviors. For example, yearly checkups, getting points for losing weight or controlling blood sugar or lowering blood pressure (which would be between the doctor and the insurance company). It would be entirely opt in, so someone who didn't want that could just pay the base price.
This. Many insurance plans are already providing discounted gym memberships and free nutritional counseling, since healthier people use less insurance dollars.3 -
Theoldguy1 wrote: »rheddmobile wrote: »
Her out of pocket was zero. It’s good to be an elderly widow of a military officer in the US. That is the stated total cost, Tricare said they would have covered up to 24k, but the bill was 8. I know, I was shocked too.Theoldguy1 wrote: »rheddmobile wrote: »
I dunno, my running injury was pretty expensive. I don’t have insurance so had to pay up front. It cost me almost as much to diagnose and treat a ruptured Baker’s cyst as my mom’s recent 6 day hospital stay with diabetes related kidney issues. Her whole hospital stay plus surgery and ER fees was 8k roughly. I had ER fees plus ultrasound and labs fo determine I didn’t have a blood clot, surgery guided by ultrasound to drain the cyst, X-rays and associated nonsense because the osteo was determined to do his usual collection of stuff whether I needed it or not, then an MRI “to be sure there’s not an underlying condition causing the Baker’s cyst.” Steroid shots, antibiotics, etc.Cherimoose wrote: »This is an ancient thread.Onedaywriter wrote: »I read earlier that runners have an usually high risk of injury. So would I pay more because I have higher injury risk or less because I’m no longer obese?
You would pay less because you're no longer obese. The costs of obesity far outweigh the cost of seeing a doctor once because of shin splints or Achilles tendinitis.
Given that some estimates put 80% of runners being injured every year, maybe they should consider running a pre-existing condition!
Your mom's 6 day hospital stay for kidney issues that included a surgery didn't cost $8k, that was her out of pocket. Total bill was probably closer to $200k+ and insurance picked up most of it.
Orthopedic injuries from exercise are generally lower cost if they happen and help prevent 6 figure hospitalizations from obesity related issues.
That is super strange. I had outpatient rotator cuff surgery a few years ago and the discounted price my insurance was charged was $12k, insurance paid $9k we had to pay $3k.
Very typical of TriCare and CHAMPVA.
Of course, it costs taxpayers….
But we want officer’s spouses and the spouses of 100% service connected disabled vets to be taken care of, right?
Even if they’re obese?
Or maybe some here don’t want that? I am curious…3 -
I believe the strange part wasn't the 0 out of pocket, but the $8K total cost, which does seem so low as to be strange, but I would guess that Tricare negotiated a good deal for themselves, as they may have the power to.0
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Onedaywriter wrote: »I think that something everyone misses in the whole “obesity costs health care money” is that we will all die eventually. Toward the end of life, health care costs often skyrocket.
So, if obesity were “cured” (imaginary of course) then ten or twenty years from now health care costs would skyrocket for all the non obese people just being old.
My mom is nowhere near obese (never was) but 95 (in fact we need to help her gain weight). In the past 8 months she broke her right hip once and her left hip twice. The costs for surgery and rehab without insurance (she’s well insured) would have been astounding.
Should mom pay more because she’s more likely to need medical care?
I was obese for 30 years and with the exception of an inguinal hernia (hereditary) never saw a doctor. I know I was just lucky but would it have been fair to charge me more?
Health insurance is not like car Insurance. We will all need health care at some point but many of us will never have a serious car accident.
Anecdotally, what I've often seen in my immediate life is different outcomes, on average, for always slim/active friends vs. those who are not. Certainly, both groups can experience essentially random health events, such as auto accidents, some forms of cancer, etc.
Apart from that, though, I have to say that it seems like, *on average*, the obese/inactive are likely to be consuming more health care services at a younger age, and more often, than the slim/fit. Yes, it seems like they also die at a younger age, but it seems like they can be more likely to have a long, slow, costly decline, maybe starting in 30s/40s. (Costly in life quality, too, not just $$.) Absent the "sudden random catastrophe" scenario, it seems like the slim/fit group is more likely to have a sharp and rather shorter decline, leading to death. I haven't seen the bills, but it seems like the lifetime dollar cost of slow decline over decades would be higher.
I'm not saying every single case follows that pattern, I'm just saying that I think I see that kind of trend, among people I know. It's actually one of the things that contributed to my deciding to lose weight and (especially) stay at a healthy weight . . . not so much the dollars side of it, as the quality of life.
On average, among friends my age (I'm 65), the inactive/obese are taking more medications, experiencing more medication side effects and interactions, getting sick more often, recovering more slowly from illnesses or needed surgeries, less able to continue doing as many of their own home chores, etc. On average, they're more constrained in what they can do for fun: Art fairs and music festivals involve too much walking, stadium events too much walking and stairs, food/drink choices are limited by health conditions or drug contraindications, they have less discretionary spending because of health-related costs, etc.
In a broader sense, in this discussion, we're also circling around the question of statistical risk vs. individual instances.
Insurance, generally, is about managing risk by spreading uneven costs across a diverse group of individual cases, a mix of higher- and lower-cost cases. How that risk is spread is situational, and does often consider risk subgroups. The teen driver situation with auto insurance is an example.
Generally, though, insurance is not intended primarily as individual reward or punishment at a very granular level, because that would pretty much defeat the point for the buyer, and perhaps for society as well. (Example: Systematic denial of health insurance to people with pre-existing conditions, at certain times: If they're uninsurable, or insurable only at unaffordable cost, the cost of their health care is still spread societally via bankruptcy or charity, rather than via insurance . . . assuming that in a civilized society, it would be unacceptable to completely deny essential health care.)
IMO, it's a legitimate public policy discussion, concerning which risks should affect insurance rates, especially risks in which individual choice has some role, but not necessarily an absolute role. I wouldn't expect a clear answer that everyone will be happy with.
IMO, it's absolutely legitimate to take actions, as a society, that incentivize personal decisions that have positive societal outcomes in a statistical-probability sense. How to do that, and in which cases, is thorny, especially in cases at the margin of what's a true decision - fully discretionary - and what's not.
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MargaretYakoda wrote: »Theoldguy1 wrote: »rheddmobile wrote: »
Her out of pocket was zero. It’s good to be an elderly widow of a military officer in the US. That is the stated total cost, Tricare said they would have covered up to 24k, but the bill was 8. I know, I was shocked too.Theoldguy1 wrote: »rheddmobile wrote: »
I dunno, my running injury was pretty expensive. I don’t have insurance so had to pay up front. It cost me almost as much to diagnose and treat a ruptured Baker’s cyst as my mom’s recent 6 day hospital stay with diabetes related kidney issues. Her whole hospital stay plus surgery and ER fees was 8k roughly. I had ER fees plus ultrasound and labs fo determine I didn’t have a blood clot, surgery guided by ultrasound to drain the cyst, X-rays and associated nonsense because the osteo was determined to do his usual collection of stuff whether I needed it or not, then an MRI “to be sure there’s not an underlying condition causing the Baker’s cyst.” Steroid shots, antibiotics, etc.Cherimoose wrote: »This is an ancient thread.Onedaywriter wrote: »I read earlier that runners have an usually high risk of injury. So would I pay more because I have higher injury risk or less because I’m no longer obese?
You would pay less because you're no longer obese. The costs of obesity far outweigh the cost of seeing a doctor once because of shin splints or Achilles tendinitis.
Given that some estimates put 80% of runners being injured every year, maybe they should consider running a pre-existing condition!
Your mom's 6 day hospital stay for kidney issues that included a surgery didn't cost $8k, that was her out of pocket. Total bill was probably closer to $200k+ and insurance picked up most of it.
Orthopedic injuries from exercise are generally lower cost if they happen and help prevent 6 figure hospitalizations from obesity related issues.
That is super strange. I had outpatient rotator cuff surgery a few years ago and the discounted price my insurance was charged was $12k, insurance paid $9k we had to pay $3k.
Very typical of TriCare and CHAMPVA.
Of course, it costs taxpayers….
But we want officer’s spouses and the spouses of 100% service connected disabled vets to be taken care of, right?
Even if they’re obese?
Or maybe some here don’t want that? I am curious…
I totally respect our military. My point was the actual cost (regardless of who pays it) of 6 days in a hospital in the US plus a surgery is not $8k.3 -
I believe the strange part wasn't the 0 out of pocket, but the $8K total cost, which does seem so low as to be strange, but I would guess that Tricare negotiated a good deal for themselves, as they may have the power to.
That was my assumption. I was honestly expecting more like 50k!1 -
rheddmobile wrote: »I believe the strange part wasn't the 0 out of pocket, but the $8K total cost, which does seem so low as to be strange, but I would guess that Tricare negotiated a good deal for themselves, as they may have the power to.
That was my assumption. I was honestly expecting more like 50k!
The US is used to seeing very inflated hospital bills because we have the whole insurance company middle man and for profit health care. Basically they charge a lot because they can.
Actual costs worldwide don't even BEGIN to approach what our bills reflect.
Full average cost of vaginal childbirth in the US (ie: Not out of pocket but with employer provided insurance) is $13,811. Canada it's about 3,000. Actual cost, again, not out of pocket expenses. Similar/same length of stay and level of care.4 -
IMO, it's a legitimate public policy discussion, concerning which risks should affect insurance rates, especially risks in which individual choice has some role, but not necessarily an absolute role. I wouldn't expect a clear answer that everyone will be happy with.
In my opinion, an insurance company has an obligation to maximise its profit. In order to do this it must aim to provide the least acceptable coverage to the people who are at lowest risk of using that cover. It's simple: if a characteristic of a person is unfavourable for coverage it must cost them more: in fact it must cost them disproportionately more because by even offering them a policy the company is taking on risk and unbalancing the distribution of people who pay and don't use healthcare services and those who actually use healthcare services (and therefore cost the company money, from time to time, by paying out more in claims than taken in dues). Those at highest risk of using services should not be offered policies. The insurance companies, of course, don't think they should die, per se, just that it is not their business to provide the human right that is healthcare. If the government wants to pick up the slack for all the people who can't get or can't afford policies, well, that is at their discretion.
Just kidding.
I'm not American, and this whole conversation is baffling! Healthcare is a right. It's not life insurance, or travel insurance where you can decide to have cover or not. At some point all humans' bodies will fail in one way or another, and they'll suffer pain, impairment and death, and it is their right to receive the best care that a society can provide to support them, ameliorate their symptoms and try to ensure they live long and healthy lives.IMO, it's absolutely legitimate to take actions, as a society, that incentivize personal decisions that have positive societal outcomes in a statistical-probability sense. How to do that, and in which cases, is thorny, especially in cases at the margin of what's a true decision - fully discretionary - and what's not.
I think this is a fundamental point. The wide and cheap availability of calorie dense foods has made it such that it is unremarkable that the populations of many countries are becoming heavier and heavier. There is no question that each human, who is capable and is not a child, choses to eat the food they eat, but the options are dramatically different depending on social, economic, psychological and biological factors. The fact that any country which increases the availability of calorie dense foods ends up with an obesity crisis, and this is repeatable the world over, indicates that, on a population level, this is not a 'choice' but a function of how food is addressed by society.
My opinion is that solely looking to individuals to make choices to reduce the societal challenges of obesity is naive, or malicious. I think there are very powerful interests in creating and perpetuating the idea that a full 40% of people are in some way morally failing by being obese, while simultaneously manufacturing, distributing and selling foods which essential cannot be eaten healthily, or at least aren't eaten healthily.
For my whole childhood I watch ads for foods which should, by all rights not exist, never mind be fed to children. When I go to buy cereal my gut instinct is to go for those staples of Saturday morning cartoon ad breaks: and look at the amount of sugar in them! The suggested serving size in 1/10th of a bowl, and yet it is still 20% of an adults daily sugar. I have to actively resist the temptation, and I don't even like cereal particularly.4 -
autobahn66 wrote: »IMO, it's a legitimate public policy discussion, concerning which risks should affect insurance rates, especially risks in which individual choice has some role, but not necessarily an absolute role. I wouldn't expect a clear answer that everyone will be happy with.
In my opinion, an insurance company has an obligation to maximise its profit. In order to do this it must aim to provide the least acceptable coverage to the people who are at lowest risk of using that cover. It's simple: if a characteristic of a person is unfavourable for coverage it must cost them more: in fact it must cost them disproportionately more because by even offering them a policy the company is taking on risk and unbalancing the distribution of people who pay and don't use healthcare services and those who actually use healthcare services (and therefore cost the company money, from time to time, by paying out more in claims than taken in dues). Those at highest risk of using services should not be offered policies. The insurance companies, of course, don't think they should die, per se, just that it is not their business to provide the human right that is healthcare. If the government wants to pick up the slack for all the people who can't get or can't afford policies, well, that is at their discretion.
Just kidding.
I'm not American, and this whole conversation is baffling! Healthcare is a right. It's not life insurance, or travel insurance where you can decide to have cover or not. At some point all humans' bodies will fail in one way or another, and they'll suffer pain, impairment and death, and it is their right to receive the best care that a society can provide to support them, ameliorate their symptoms and try to ensure they live long and healthy lives.IMO, it's absolutely legitimate to take actions, as a society, that incentivize personal decisions that have positive societal outcomes in a statistical-probability sense. How to do that, and in which cases, is thorny, especially in cases at the margin of what's a true decision - fully discretionary - and what's not.
I think this is a fundamental point. The wide and cheap availability of calorie dense foods has made it such that it is unremarkable that the populations of many countries are becoming heavier and heavier. There is no question that each human, who is capable and is not a child, choses to eat the food they eat, but the options are dramatically different depending on social, economic, psychological and biological factors. The fact that any country which increases the availability of calorie dense foods ends up with an obesity crisis, and this is repeatable the world over, indicates that, on a population level, this is not a 'choice' but a function of how food is addressed by society.
My opinion is that solely looking to individuals to make choices to reduce the societal challenges of obesity is naive, or malicious. I think there are very powerful interests in creating and perpetuating the idea that a full 40% of people are in some way morally failing by being obese, while simultaneously manufacturing, distributing and selling foods which essential cannot be eaten healthily, or at least aren't eaten healthily.
For my whole childhood I watch ads for foods which should, by all rights not exist, never mind be fed to children. When I go to buy cereal my gut instinct is to go for those staples of Saturday morning cartoon ad breaks: and look at the amount of sugar in them! The suggested serving size in 1/10th of a bowl, and yet it is still 20% of an adults daily sugar. I have to actively resist the temptation, and I don't even like cereal particularly.
Good post, and much that I agree with.
Of course individual choice is not "the solution", but IMO it's a puzzle piece.
I'm old enough to have been adult before the usually-attributed start period of the "obesity crisis" in the mid-1980s. (I reached the US age of legal adulthood in 1973, was a full-time worker bee by 1978.)
Product demand is the collectivization of individual choices, and product demand is what most affects what is sold. Food producers also have an obligation to make a profit. Yes, marketers know how to push our buttons; that's not new, either - though they refine their practices over time, regulation (in the US at least) also limits them . . . and on net advertising is not so very different now than in the 1970s, IMO.
It's hard to isolate "the difference" vs. the 1970s, IMO, because it's complicated. For me, some of the things picked out as "THE reason" for more-recent common obesity don't pass the sniff test as big let alone exclusive reasons. I think it's complicated. I think the solution - if there is one - will be complicated, too. Influencing individual choices, as I said, is a potential piece of that. (Influencing personal choices played a role in reducing rates of smoking in the population, I believe.)
I agree that many insurance companies seek profit, in the US - though some are in fact non-profit entities, so seeking enough profit to stay in business and support the services they provide (including, arguably, silly-high salaries for execs, equivalent to the silly-high salaries in other lines of business in the US). Since you're evidently not USA-ian, you may not realize that the insurance companies' ability to profit-maximize is not completely unchecked. Though there are problems with this, and I'm certainly not defending the US system as a whole, it's a fact that US insurance companies are regulated, and there are certain factors they're not allowed to consider in setting rates or offering policies.
Your statement that "Those at highest risk of using services should not be offered policies." may be theoretically accurate, but there are regulatory limitations placed on companies' abilities to do that. Do they try to game that, use proxy factors, etc.? Sure.
The debate here is about whether body weight should be permitted to be considered, or not. If not, that implies regulation, not just expecting insurance companies to do it out of benevolence.
At the level of interaction with individual humans, such as here on MFP, I do encourage people to make choices that support their long-term health. They have some (constrained) ability to do that, IMO. I support societal-level initiatives that encourage better choices. I support some degree of regulation/legislation that influences producers/marketers to make more positive contributions.
Can each and every individual, in our current collective context, and in that individual's current state (economic, physical, psychological, social, etc.), as a practical matter make choices that will lead them to be at a healthy weight, and fit? Probably not.
But I think many people may have more power than they themselves believe: Realizing that certain negative outcomes involve choice is very uncomfortable. That, in itself, is a psychological choice-limiter, for at least a few.1 -
I'd been thinking about some of the above points recently as I've resumed business travel. When I'm at home and I have the luxury of time to select and prepare my own food, it's now almost effortless to hit my calorie goals. I can bulk up meals with lower calorie vegetables to ensure satiety, I can limit my access to tempting high calorie foods, and I can adjust recipes to lower the calorie count. All of these are much harder to do when I'm on the road. When I'm at home I rarely feel like I'm "on a diet," but when I'm travelling I feel that way most of the time (even though I'm eating to maintain my weight).
In many ways, one has to eat "abnormally" to maintain a healthy weight because our default food culture is kind of messed up. To a big degree, I think people who lose weight and maintain that loss over time do it because we've found ways to adjust how we eat. I'm sympathetic to the people who say they're overweight even though they eat "normally," because it's the truth. There are people who are overweight because of eating disorders, but there are also plenty of people who aren't. It's just ridiculously easy to autopilot your way through the day and eat way more than you need. And in some contexts -- lack of time, lack of food prep skills/space, or lack of money -- it is very hard to alter your calorie intake in a way that is sustainable.8 -
autobahn66 wrote: »I think this is a fundamental point. The wide and cheap availability of calorie dense foods has made it such that it is unremarkable that the populations of many countries are becoming heavier and heavier. There is no question that each human, who is capable and is not a child, choses to eat the food they eat, but the options are dramatically different depending on social, economic, psychological and biological factors. The fact that any country which increases the availability of calorie dense foods ends up with an obesity crisis, and this is repeatable the world over, indicates that, on a population level, this is not a 'choice' but a function of how food is addressed by society.
My opinion is that solely looking to individuals to make choices to reduce the societal challenges of obesity is naive, or malicious. I think there are very powerful interests in creating and perpetuating the idea that a full 40% of people are in some way morally failing by being obese, while simultaneously manufacturing, distributing and selling foods which essential cannot be eaten healthily, or at least aren't eaten healthily.
For my whole childhood I watch ads for foods which should, by all rights not exist, never mind be fed to children. When I go to buy cereal my gut instinct is to go for those staples of Saturday morning cartoon ad breaks: and look at the amount of sugar in them! The suggested serving size in 1/10th of a bowl, and yet it is still 20% of an adults daily sugar. I have to actively resist the temptation, and I don't even like cereal particularly.
I think this fits better in the obesity epidemic thread, but I do think that healthcare providers and insurance can maybe be a piece of the puzzle such as through the incentives I mentioned. I would also say (as that thread's OP was discussing) that having coverage that would aid with nutrition and weight issues would be good.
However, while I think the issue is NOT just individual choice (individuals haven't changed much since, say, 1960), what you or I can do about our weight issues (if we have them) IS a matter of individual choice.
What we can do as a society to help with a broad societal problem is something different, but -- as we have been discussing in that thread -- not easy to figure out. If you think there are some good, effective policies or plans that would be effective, I'd love to hear ideas. (I don't actually think banning food advertising on TV would work, for example, but if you want to make a pitch...)1 -
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I'm not American, and this whole conversation is baffling! Healthcare is a right. It's not life insurance, or travel insurance where you can decide to have cover or not. At some point all humans' bodies will fail in one way or another, and they'll suffer pain, impairment and death, and it is their right to receive the best care that a society can provide to support them, ameliorate their symptoms and try to ensure they live long and healthy lives.
I could have written this.
I think the much bigher question our American friends should be pondering is who tricked them to think of healthcare as necessarily insurance based at all.
And for the record - no obese people shouldn't pay more and neither should smokers. Because - ding ding ding - this should not be insurance at all to begin with...
I am all for paying based on our income (i.e..use taxes to fund it) and using based on our need. It has been like this in all 3 countries I have lived in longer-term. I have refused jobs specifically in order not to ever have to live in the US, not because I don't like the US but for 2 very specific reasons - this being one of them.3 -
Wiseandcurious wrote: »I'm not American, and this whole conversation is baffling! Healthcare is a right. It's not life insurance, or travel insurance where you can decide to have cover or not. At some point all humans' bodies will fail in one way or another, and they'll suffer pain, impairment and death, and it is their right to receive the best care that a society can provide to support them, ameliorate their symptoms and try to ensure they live long and healthy lives.
I could have written this.
I think the much bigher question our American friends should be pondering is who tricked them to think of healthcare as necessarily insurance based at all.
And for the record - no obese people shouldn't pay more and neither should smokers. Because - ding ding ding - this should not be insurance at all to begin with...
I am all for paying based on our income (i.e..use taxes to fund it) and using based on our need. It has been like this in all 3 countries I have lived in longer-term. I have refused jobs specifically in order not to ever have to live in the US, not because I don't like the US but for 2 very specific reasons - this being one of them.
Even if that were the question on the top of us USA-ians minds, there is utterly no option for an individual to snap her fingers and instantly make it be different, however much we might wish it different.
It's a lot easier to disapprove, than it is to change it.
Nothing in this post should be taken to say anything about my opinion, one way or another, about our health care system as it stands now, or about what it should be.2 -
Why we have the insurance model (although it's not really much like most other kinds of insurance): during WW2 the gov't was controlling wages to limit inflation and companies wanted to compete for workers (scarce due to the war) and so started offering health insurance benefits. It didn't count as wages to the worker so the worker didn't have to pay taxes on it, so it was popular. After the war, and during the '50s when labor unions were quite strong here, many unions bargained for excellent health care packages. Eventually, Medicare was created for retired people too (1965).
That something is insurance-based doesn't say anything about whether it is universal or not. Germany has an insurance based program, although of course it works differently than that in the US: https://www.ncbi.nlm.nih.gov/books/NBK298834/
In the US, people still commonly get health insurance through their workplaces, which means that absent an employee wellness program (that allows for discounts/incentives and arguably encourages positive health behaviors), what affects costs will be if you have a selection among plans and whether you have single or family coverage, typically.
For insurance on the marketplace, the things that affect cost are age (premiums can be up to 3 times higher for older people than for younger ones), location, smoking, individual vs. family enrollment, and type of plan (how you and the plan will share costs, with higher premiums for lower out-of-pocket, typically. So it's already quite regulated. And of course the other point of the marketplace is that purchase of the insurance plan is subsidized for those who are below various income levels.
Even where healthcare doesn't require insurance and is free at point of purchase, there may be insurance available to pay for things the healthcare would not cover -- that's how it is with Medicare here, based on my parents' experience, even though Medicare otherwise operates as single payer.
Anyway, I don't see anything wrong with a workplace wellness program -- I think they possibly can pay a positive role in helping encourage things that ultimately reduce burdens on the healthcare system, which is an issue any country with an obesity problem may have concerns about.3 -
janejellyroll wrote: »I'd been thinking about some of the above points recently as I've resumed business travel. When I'm at home and I have the luxury of time to select and prepare my own food, it's now almost effortless to hit my calorie goals. I can bulk up meals with lower calorie vegetables to ensure satiety, I can limit my access to tempting high calorie foods, and I can adjust recipes to lower the calorie count. All of these are much harder to do when I'm on the road. When I'm at home I rarely feel like I'm "on a diet," but when I'm travelling I feel that way most of the time (even though I'm eating to maintain my weight).
In many ways, one has to eat "abnormally" to maintain a healthy weight because our default food culture is kind of messed up. To a big degree, I think people who lose weight and maintain that loss over time do it because we've found ways to adjust how we eat. I'm sympathetic to the people who say they're overweight even though they eat "normally," because it's the truth. There are people who are overweight because of eating disorders, but there are also plenty of people who aren't. It's just ridiculously easy to autopilot your way through the day and eat way more than you need. And in some contexts -- lack of time, lack of food prep skills/space, or lack of money -- it is very hard to alter your calorie intake in a way that is sustainable.
Try eating out as a diabetic! It’s even worse. I actually eat out pretty often but only because I time my eating to my runs so that I can consume amounts of carbs which would swamp me on a non-run day. There are a handful of local restaurants which provide low-calorie, reasonable food which fits into my diet, and all of them are run by people born in countries other than the US.
I’m a self-employed introvert. If I had a more active social life which regularly required me to eat out at restaurants picked by others, maintaining my weight and blood glucose would become an exercise in self-denial - I would have to learn to sit and watch others eat while not partaking.4 -
autobahn66 wrote: »For my whole childhood I watch ads for foods which should, by all rights not exist, never mind be fed to children.
I don’t know if this was the case where you live, but I remember when Nutella was advertised here in the US as a healthy breakfast choice for children.
I mean, sure. Nutella is delicious. But it’s not exactly a healthy breakfast option. It’s a treat. And should never have been allowed to be advertised as anything otherwise.2 -
rheddmobile wrote: »janejellyroll wrote: »I'd been thinking about some of the above points recently as I've resumed business travel. When I'm at home and I have the luxury of time to select and prepare my own food, it's now almost effortless to hit my calorie goals. I can bulk up meals with lower calorie vegetables to ensure satiety, I can limit my access to tempting high calorie foods, and I can adjust recipes to lower the calorie count. All of these are much harder to do when I'm on the road. When I'm at home I rarely feel like I'm "on a diet," but when I'm travelling I feel that way most of the time (even though I'm eating to maintain my weight).
In many ways, one has to eat "abnormally" to maintain a healthy weight because our default food culture is kind of messed up. To a big degree, I think people who lose weight and maintain that loss over time do it because we've found ways to adjust how we eat. I'm sympathetic to the people who say they're overweight even though they eat "normally," because it's the truth. There are people who are overweight because of eating disorders, but there are also plenty of people who aren't. It's just ridiculously easy to autopilot your way through the day and eat way more than you need. And in some contexts -- lack of time, lack of food prep skills/space, or lack of money -- it is very hard to alter your calorie intake in a way that is sustainable.
Try eating out as a diabetic! It’s even worse. I actually eat out pretty often but only because I time my eating to my runs so that I can consume amounts of carbs which would swamp me on a non-run day. There are a handful of local restaurants which provide low-calorie, reasonable food which fits into my diet, and all of them are run by people born in countries other than the US.
I’m a self-employed introvert. If I had a more active social life which regularly required me to eat out at restaurants picked by others, maintaining my weight and blood glucose would become an exercise in self-denial - I would have to learn to sit and watch others eat while not partaking.
Yep. 100% this.
I usually just have coffee when eating out with the family. Because gluten and allergies and now diabetes. My family is used to this. But anyone else is generally uncomfortable eating when I’m just nursing a cupola’
My husband adores restaurants. And when we head to one of his medical appointments, it usually means an entire day in The Big City (tm) so restaurants are part of the day.
We plan his carbs and sodium very tightly every other day. Restaurant days are always off the chart for any of his dietary requirements.
If he didn’t adore restaurants so much I’d just pack him a couple sandwiches. But everyone needs something to look forward to. So we keep the restaurants as part of his VA appointment routine.
His A1C is down considerably, and his retinopathy is actually reversing. So it works for us. As long as every other day is very tightly controlled diabetes wise.3 -
Why we have the insurance model (although it's not really much like most other kinds of insurance): during WW2 the gov't was controlling wages to limit inflation and companies wanted to compete for workers (scarce due to the war) and so started offering health insurance benefits. It didn't count as wages to the worker so the worker didn't have to pay taxes on it, so it was popular. After the war, and during the '50s when labor unions were quite strong here, many unions bargained for excellent health care packages. Eventually, Medicare was created for retired people too (1965).
That something is insurance-based doesn't say anything about whether it is universal or not. Germany has an insurance based program, although of course it works differently than that in the US: https://www.ncbi.nlm.nih.gov/books/NBK298834/
In the US, people still commonly get health insurance through their workplaces, which means that absent an employee wellness program (that allows for discounts/incentives and arguably encourages positive health behaviors), what affects costs will be if you have a selection among plans and whether you have single or family coverage, typically.
For insurance on the marketplace, the things that affect cost are age (premiums can be up to 3 times higher for older people than for younger ones), location, smoking, individual vs. family enrollment, and type of plan (how you and the plan will share costs, with higher premiums for lower out-of-pocket, typically. So it's already quite regulated. And of course the other point of the marketplace is that purchase of the insurance plan is subsidized for those who are below various income levels.
Even where healthcare doesn't require insurance and is free at point of purchase, there may be insurance available to pay for things the healthcare would not cover -- that's how it is with Medicare here, based on my parents' experience, even though Medicare otherwise operates as single payer.
Anyway, I don't see anything wrong with a workplace wellness program -- I think they possibly can pay a positive role in helping encourage things that ultimately reduce burdens on the healthcare system, which is an issue any country with an obesity problem may have concerns about.
My large company dropped it's wellness plan after about 15 years. Determined minimal if any payback.0
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