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

lemurcat12

tbright1965 wrote: »

lemurcat12 wrote: »

mudknuckles wrote: »

I don't think anyone should have to pay for health insurance.

So you mean we should pay through taxes? We are still paying, if we pay taxes. I think that's a better approach too, at least for basic care/coverage, with the ability to buy additional to add on, but it doesn't mean people aren't paying for it.

Actually, paying through taxes is the MOST unfair means.

I disagree, but it's basically a separate topic.

Those who make more, but choose a healthy lifestyle are not allowed to benefit from their choices because they are paying based on income, not risk.

Health insurance isn't based on risk now. The proposal is that a risk element be included, such as a penalty or discount for meeting specific requirements (could be a whole bunch of things).

Right now, in the US, that's permitted through an employer-based health incentive plan (it's framed as a discount, but there's no real difference). Most people don't have those and haven't had those -- I've had employer based health care since I started working and was covered by my mother's before that, and none of it has ever been based on risk.

Pure risk-based for health care costs is a bad idea (and why a true insurance model would be bad), because a HUGE amount of risks and stuff that happens has nothing to do with anything you did, or it's impossible to tell. Someone gets cancer -- would they if they'd had a healthier lifestyle or never been overweight? Quite likely, yes, even if lifestyle factors are risk factors for that cancer. And in any case no one knows.

Expensive health problems are likely to happen to everyone, even if we live the most perfect healthy lives; it results from age.

So the question is, what's the best way to improve health care results, get people to reduce risk factors, reduce costs overall? IMO, there may be a role for incentives (however health care is funded), but also I think making sure people get routine health care, have prenatal health care and so on are important.

There needs to be a risk rating component so that people who make poor choices experience some fiscal consequences for choosing to eat at the drive through more than fresh fruits and vegetables.

How on earth would that be monitored, whether true insurance (i.e., similar to car insurance or fire insurance) or some other plan? You can give incentives/penalties for BMI and for test results (although it's very obvious that many other factors play into test results -- my dad had high cholesterol at one point despite never being overweight and being active, my cholesterol has always been good, even when I was fat). But you can't make it depend on people eating vegetables or not going to drive ins.

It's also funny since I thought one the horror story told about gov't interference is that the gov't could make you by broccoli! (See https://www.nytimes.com/2012/06/14/business/how-broccoli-became-a-symbol-in-the-health-care-debate.html)

tbright1965

lemurcat12 wrote: »

tbright1965 wrote: »

Actually, paying through taxes is the MOST unfair means.

I disagree, but it's basically a separate topic.

Those who make more, but choose a healthy lifestyle are not allowed to benefit from their choices because they are paying based on income, not risk.

Health insurance isn't based on risk now. The proposal is that a risk element be included, such as a penalty or discount for meeting specific requirements (could be a whole bunch of things).

Right now, in the US, that's permitted through an employer-based health incentive plan (it's framed as a discount, but there's no real difference). Most people don't have those and haven't had those -- I've had employer based health care since I started working and was covered by my mother's before that, and none of it has ever been based on risk.

Pure risk-based for health care costs is a bad idea (and why a true insurance model would be bad), because a HUGE amount of risks and stuff that happens has nothing to do with anything you did, or it's impossible to tell. Someone gets cancer -- would they if they'd had a healthier lifestyle or never been overweight? Quite likely, yes, even if lifestyle factors are risk factors for that cancer. And in any case no one knows.

Expensive health problems are likely to happen to everyone, even if we live the most perfect healthy lives; it results from age.

So the question is, what's the best way to improve health care results, get people to reduce risk factors, reduce costs overall? IMO, there may be a role for incentives (however health care is funded), but also I think making sure people get routine health care, have prenatal health care and so on are important.

There needs to be a risk rating component so that people who make poor choices experience some fiscal consequences for choosing to eat at the drive through more than fresh fruits and vegetables.

How on earth would that be monitored, whether true insurance (i.e., similar to car insurance or fire insurance) or some other plan? You can give incentives/penalties for BMI and for test results (although it's very obvious that many other factors play into test results -- my dad had high cholesterol at one point despite never being overweight and being active, my cholesterol has always been good, even when I was fat). But you can't make it depend on people eating vegetables or not going to drive ins.

It's also funny since I thought one the horror story told about gov't interference is that the gov't could make you by broccoli! (See https://www.nytimes.com/2012/06/14/business/how-broccoli-became-a-symbol-in-the-health-care-debate.html)

Part of the problem is we don't treat health insurance as insurance against catastrophic events. Most want it to pay for everything, and then you get all the friction of cost shifting, etc.

Now there are plans that offer that. HCSA where you can save and carry over health care dollars in a tax free account, and then a catastrophic plan that kicks in for that unexpected cancer diagnosis.

BMI monitoring, or even a basic panel of blood and urine tests every year to help set the relative risk wouldn't be a bad thing. We already have to be risk rated for life insurance, for car insurance, and even our homeowners to a certain extent. Why do people think it's ok to not apply risk rating to health insurance?

Sure, you can't have big brother watching to see if someone is eating broccoli or Big Macs, but I do believe in the majority of cases that will show up in the lab work. Blood Glucose, liver panel functions and other tests are going to give a general idea what's going in someone's mouth. I'm sure there are similar strength, aerobic and flexibility tests that would determine if people are active or sedentary. Probably a much better examination as well. If nothing else, it will get people thinking about it if in addition to their labwork, they were evaluated physically.

Heck, the Army tested us periodically and measured our height and weight. If we couldn't run 2 miles fast enough after having been tested for the number of pushups and situps we could do in a two minute period each, then what would be wrong with some sort of physical skills test as part of your physical?

Especially if you want the insurance company to protect you against catastrophic events, it seems only fair that they have an idea of the risk you present.

Voluntary links to MFP, Fitbit or a host of other tracking apps will see if people are biking or binge watching Netflix for the most part. Some sort of treadmill, stairclimber or similar test could measure aerobic conditioning. Tests for flexibility and strength could be done as well.

Could probably do much of that in the time I'm waiting for the DR to show up for my appt.

janejellyroll

tbright1965 wrote: »

Sure, you can't have big brother watching to see if someone is eating broccoli or Big Macs, but I do believe in the majority of cases that will show up in the lab work. Blood Glucose, liver panel functions and other tests are going to give a general idea what's going in someone's mouth.

These tests test for specific problems/potential problems -- they are not diagnostic tests to see if someone sometimes eats hamburgers.

Do the conditions they test for sometimes respond well to dietary changes? Absolutely. But to make this a people who eat broccoli versus people who eat Big Macs things is a vast over-simplification. Overweight people sometimes eat vegetables, fit people sometimes eat Big Macs. Health conditions strike people in both categories (although it does seem like many illnesses/conditions are associated with excess weight).

lemurcat12

tbright1965 wrote: »

lemurcat12 wrote: »

tbright1965 wrote: »

Actually, paying through taxes is the MOST unfair means.

I disagree, but it's basically a separate topic.

Those who make more, but choose a healthy lifestyle are not allowed to benefit from their choices because they are paying based on income, not risk.

Health insurance isn't based on risk now. The proposal is that a risk element be included, such as a penalty or discount for meeting specific requirements (could be a whole bunch of things).

Right now, in the US, that's permitted through an employer-based health incentive plan (it's framed as a discount, but there's no real difference). Most people don't have those and haven't had those -- I've had employer based health care since I started working and was covered by my mother's before that, and none of it has ever been based on risk.

Pure risk-based for health care costs is a bad idea (and why a true insurance model would be bad), because a HUGE amount of risks and stuff that happens has nothing to do with anything you did, or it's impossible to tell. Someone gets cancer -- would they if they'd had a healthier lifestyle or never been overweight? Quite likely, yes, even if lifestyle factors are risk factors for that cancer. And in any case no one knows.

Expensive health problems are likely to happen to everyone, even if we live the most perfect healthy lives; it results from age.

So the question is, what's the best way to improve health care results, get people to reduce risk factors, reduce costs overall? IMO, there may be a role for incentives (however health care is funded), but also I think making sure people get routine health care, have prenatal health care and so on are important.

There needs to be a risk rating component so that people who make poor choices experience some fiscal consequences for choosing to eat at the drive through more than fresh fruits and vegetables.

How on earth would that be monitored, whether true insurance (i.e., similar to car insurance or fire insurance) or some other plan? You can give incentives/penalties for BMI and for test results (although it's very obvious that many other factors play into test results -- my dad had high cholesterol at one point despite never being overweight and being active, my cholesterol has always been good, even when I was fat). But you can't make it depend on people eating vegetables or not going to drive ins.

It's also funny since I thought one the horror story told about gov't interference is that the gov't could make you by broccoli! (See https://www.nytimes.com/2012/06/14/business/how-broccoli-became-a-symbol-in-the-health-care-debate.html)

Part of the problem is we don't treat health insurance as insurance against catastrophic events. Most want it to pay for everything, and then you get all the friction of cost shifting, etc.

I'm not totally against a catastrophic model, but the problem is there are other major costs, specifically those associated with chronic conditions and aging. For aging we have Medicare already, but chronic conditions are a problem, especially given drug costs, and the issue with pre-existing conditions is of course one thing that almost everyone agrees makes the pure insurance model a problem.

Most people don't buy their own health insurance, also, but have employer based. Generally most going from employer based to a pure insurance model would perceive a loss.

The other issue is encouraging routine visits, preventative care, which is supposed to save costs over time (and should be a venue to work with people on improving lifestyle and losing weight, and prenatal care actually saves costs at/after the birth).

BMI monitoring, or even a basic panel of blood and urine tests every year to help set the relative risk wouldn't be a bad thing. We already have to be risk rated for life insurance, for car insurance, and even our homeowners to a certain extent. Why do people think it's ok to not apply risk rating to health insurance?

Why? Because the fact I may be born with T1 diabetes or a chronic autoimmune condition or had cancer may result in much higher costs going forward, but we don't think that bad luck is a reason that person should have to pay more (or be unable to get insurance).

I do believe in the majority of cases that will show up in the lab work. Blood Glucose, liver panel functions and other tests are going to give a general idea what's going in someone's mouth.

I think you are wrong here. For some it will, for some it won't. Some will have bad tests eating a good diet, some will eat bad diets and have good tests. It's all risk, not result. Insurance companies (under an insurance model) should care about risk, but this idea that bad health is only (and always) related to poor lifestyle choices is wrong.

But at any rate you are agreeing that the risk analysis would be based on BMI and test results, not what the person is actually eating, right?

Heck, the Army tested us periodically and measured our height and weight. If we couldn't run 2 miles fast enough after having been tested for the number of pushups and situps we could do in a two minute period each, then what would be wrong with some sort of physical skills test as part of your physical?

This would be an insurance company physical? Yearly, in connection with qualifying for health insurance?

Especially if you want the insurance company to protect you against catastrophic events, it seems only fair that they have an idea of the risk you present.

Voluntary links to MFP, Fitbit or a host of other tracking apps will see if people are biking or binge watching Netflix for the most part. Some sort of treadmill, stairclimber or similar test could measure aerobic conditioning. Tests for flexibility and strength could be done as well.

The insurance company is doing this and using it as a basis to determine premium? Do they get to deny coverage based on it? (For example, you said you would run 30 miles a week, but only logged 10 per week at MFP?)

urloved33

rsclause wrote: »

Why not, they charge smokers more. The older you get the higher your premiums get too.

they do charge smokers more.

tbright1965

I am not the one using the word always.

What is the normative result? Are the George Burns' of life a statistically common outcome or an outlier? Most don't drink and smoke and live to be 100+ years old.

Likewise, most who spend more time eating fast food than fresh food are not skinny/normal BMI.

I'm saying if people eat too much, even of healthy food, they'll get fat. Eat 50 bananas a day and unless you are an Olympic swimmer or similar, you'll probably gain weight. (Do we really have millions who are overeating bananas each day?)

Or is the more normative circumstance people who have a dozen take-out meals each week?

janejellyroll

tbright1965 wrote: »

I am not the one using the word always.

What is the normative result? Are the George Burns' of life a statistically common outcome or an outlier? Most don't drink and smoke and live to be 100+ years old.

Likewise, most who spend more time eating fast food than fresh food are not skinny/normal BMI.

I'm saying if people eat too much, even of healthy food, they'll get fat. Eat 50 bananas a day and unless you are an Olympic swimmer or similar, you'll probably gain weight. (Do we really have millions who are overeating bananas each day?)

Or is the more normative circumstance people who have a dozen take-out meals each week?

Most people don't live to be 100+, so I'm unsure exactly what you're getting at here.

Your initial comment was about tests designed for other conditions being used to tell who was eating broccoli and who was eating Big Macs. My point is that the world isn't neatly divided into those two categories. Most people eat a variety of things and using liver function tests to try to separate the vegetable eaters from the hamburger eaters isn't just using the test to do something it was never designed to do, it's trying to establish a distinction that doesn't exist for very many people.

If people eat too much of anything, they will get fat. The truth of that statement is another reason why trying to separate the world into those who eat broccoli and those who eat hamburgers won't achieve the results you seem to think it will.

I never ate take-out when I was overweight. So even if I had to take a liver function test to see if I tested positive for hamburger, it would be negative. What's the point?

tbright1965

janejellyroll wrote: »

What's the point?

I thought my point was obvious, we shouldn't ignore rating on risk.

Now we can debate how best to do that. But I believe risk should be a part of rating health insurance policies.

There are others who have no problem with passing along the costs of their choices to others. (And not just here, it's the human condition.

I see many cite these edge cases. So my question is how many of these cases are there vs the typical outcomes?

I've seen numbers that indicated that roughly 2/3rds of Americans are overweight. They don't all have some sort of disease "making" them this way. Right?

Shifting the costs to the taxpayer is exactly the WRONG way to see changed behavior in those who can address their condition by behavior modification. I.E. eat an apple instead of a cupcake.

That's my point.

If you want to pay for people to eat cupcakes instead of apples, I'd not prevent you from doing so.

I don't wish to be on the hook for those who make the choice of cupcakes over apples most of the time.

Does that mean I believe everyone does that? No.
Does that mean I don't believe there are people who don't have problems where even eating apples will be an issue for them? No. But I do believe that the population of those folks is very small. Most people are simply making bad choices or eating on autopilot.

My best anecdote is the box of Thin Mints or a pint of Ice Cream or a Bag of Chips. For many, those are single servings.

How can that be good? They don't have a disease, they simply don't pay attention to what is going in their mouth. I can be that person too, and have been, so I throw the stone with awareness that I might be a valid target as well.

Someone posted a video in one of the CICO threads where a woman was complaining that she had a slow metabolism. BBC news story IIRC. So they tested her. Normal metabolism. Had her do a video diary of what she ate, then a logbook diary.

Also some sort of bloodtest that could determine her CI based on some chemistry magic.

Bottom line, when she thought she was eating 1000 calories each day, it was closer to 3000.

How many believe they have some disease when in reality they are bad at math or remembering what they ate? Or they simply didn't read the label?

Sorry, ranted on too long about what's my point.

rsclause

I would like to see several things happen
1) Everybody pays something even if it is deducted out of a benefit check. All players need to have some skin in the game.
2) Break up the state line boundaries. A national pool is much bigger and would allow associations to form large groups.
3) Git rid of the first dollar covered with a $5 co-pay. We don't go and repaint the car after a scratch with a $5 co-pay.
4) Find a way to control the lawsuits and the belief that any adverse event should amount to a lottery win. The attorneys are the only big winners here. Today you go into a hospital room and the poorest patient families are there with their cell phones out recording everything for the event to happen.

I currently pay $2300.00 monthly to cover my spouse and me. I also have a $3000.00 deductible that I use a medical savings account to cover. I have had this policy for decades but have never used it. It is to protect me in the event something like cancer occurs. It really ticks me off when I see younger people with a $1000 I-Phone and they won't spend $150.00 a month on health insurance. When you are young insurance is still relatively cheap. It is when you age a bit and have assets that it get so un-affordable, it is literally a house payment now. Please don't tell me the government need to provide it, there is nothing the government does well or affordable.

lemurcat12

tbright1965 wrote: »

I am not the one using the word always.

What is the normative result? Are the George Burns' of life a statistically common outcome or an outlier? Most don't drink and smoke and live to be 100+ years old.

But you said something different. You suggested that we could know who eats a poor diet and who doesn't based on test results. Especially for a younger person, unlikely. I agree obesity and poor diet are risk factors, but not that we can know who is and who isn't from test results. Calling a system that charges more for doing poorly on a cholesterol test one that "charges more for eating McD and not vegetables" is not accurate.

Or is the more normative circumstance people who have a dozen take-out meals each week?

I got fat (I'm not now) without eating fast food, as I dislike it, and I always ate lots of vegetables. I was fat, though, so I would have been paying extra for being fat, which I don't really have a big problem with (a penalty or the absence of a discount). But let's not pretend it's about not eating vegetables or eating fast food and let's not pretend insurance companies COULD distinguish on that basis.

Oh, also, when I was fat I had great test results. I understood (and strongly believe) it is still a risk factor, but charging more based on poor test results would have included a thin friend of mine who has cholesterol issues, no one knows why (she eats fine, probably not too different from how I do), and my dad (at one point), even though he was normal weight and ran marathons and biked a lot.

But my cholesterol was good and for that matter my blood sugar was good (never been close to having an insulin issue), and I did fine on all other tests. So claiming you can tell stuff from tests is often not the case (especially for younger people, although I wasn't that young).

So let's stop pretending people are paying more for not eating vegetables and eating fast food a lot (who knows) and just say you want people to pay more for bad test results (so you'd pay more, as I understand it, right?) and BMI.

tbright1965

lemurcat12 wrote: »

So let's stop pretending people are paying more for not eating vegetables and eating fast food a lot (who knows) and just say you want people to pay more for bad test results (so you'd pay more, as I understand it, right?) and BMI.

But that isn't what I said.

I'm pretty sure I PROPOSED it.

I want people to face the fiscal consequences of their choices. I actually said that, full stop. I SUGGESTED testing.

If you know a better way, speak up.

But don't assume that just because I may not have suggested a fool proof way of demonstrating poor choices that I simply want people to pay for bad test results.

I was patently clear that I didn't want the risk of bad choices passed along to others. So please, don't put words in my mouth.

SimplyAdia

No. It depends on your actual health. My company has a health risk assessment every year in the fall. I get a discount on my insurance because my waist to hip ratio is 10+ inches, my glucose is low, my HDL is high, my bad cholesterol is low, the rest of what they check is always in the green ranges. I also don't smoke and that gets me some extra points.The only thing I fail is weight/BMI, but since my other blood work and blood pressure are fine, I get enough points to pass and every year I improve that score by lowering my weight and keeping everything else in the green. Why should I have to pay more? I pay $5000 a year in premiums and rarely even go to the doctor. Meanwhile, someone in the "healthy" weight range has high cholesterol, blood pressure, etc., but they pass with flying colors because they get a boost from having a low weight and BMI...but I'm not taking medication like they are. Shouldn't they pay more?

I think if your employer is going to impose that kind of thing, they should be testing everyone in the company before assigning rates.

lemurcat12

tbright1965 wrote: »

lemurcat12 wrote: »

So let's stop pretending people are paying more for not eating vegetables and eating fast food a lot (who knows) and just say you want people to pay more for bad test results (so you'd pay more, as I understand it, right?) and BMI.

But that isn't what I said.

I'm pretty sure I PROPOSED it.

You said that people should pay more for eating fast food and less for eating vegetables.

I asked how on earth the insurance company would be able to track that (and also if they would be able to use it as a basis to deny coverage, if you weren't fully upfront about your fast food habits or vegetable aversions).

You said that tests would show it.

So what you really mean is NOT that insurance companies will charge more based on diet (which doesn't seem possible to administer), but that they would charge more based on test results.

If I am not understanding this properly, what ARE you proposing when you say diet should be relevant to costs?

tbright1965

lemurcat12 wrote: »

tbright1965 wrote: »

lemurcat12 wrote: »

So let's stop pretending people are paying more for not eating vegetables and eating fast food a lot (who knows) and just say you want people to pay more for bad test results (so you'd pay more, as I understand it, right?) and BMI.

But that isn't what I said.

I'm pretty sure I PROPOSED it.

You said that people should pay more for eating fast food and less for eating vegetables.

I asked how on earth the insurance company would be able to track that (and also if they would be able to use it as a basis to deny coverage, if you weren't fully upfront about your fast food habits or vegetable aversions).

You said that tests would show it.

So what you really mean is NOT that insurance companies will charge more based on diet (which doesn't seem possible to administer), but that they would charge more based on test results.

If I am not understanding this properly, what ARE you proposing when you say diet should be relevant to costs?

Context is everything.

So if it wasn't clear before, is it clear now? Or are you still insisting on putting words in my mouth?

If someone makes poor food and fitness choices, why should others pay?

Now I may not know how to figure that out. What are your suggestions?

If blood work, urine tests, tests of cardiovascular response, flexibility and so on will not catch that, what will?

Why should the person who makes good choices be passed the fiscal responsibility of those who don't?

lemurcat12

tbright1965 wrote: »

lemurcat12 wrote: »

tbright1965 wrote: »

lemurcat12 wrote: »

So let's stop pretending people are paying more for not eating vegetables and eating fast food a lot (who knows) and just say you want people to pay more for bad test results (so you'd pay more, as I understand it, right?) and BMI.

But that isn't what I said.

I'm pretty sure I PROPOSED it.

You said that people should pay more for eating fast food and less for eating vegetables.

I asked how on earth the insurance company would be able to track that (and also if they would be able to use it as a basis to deny coverage, if you weren't fully upfront about your fast food habits or vegetable aversions).

You said that tests would show it.

So what you really mean is NOT that insurance companies will charge more based on diet (which doesn't seem possible to administer), but that they would charge more based on test results.

If I am not understanding this properly, what ARE you proposing when you say diet should be relevant to costs?

Context is everything.

So if it wasn't clear before, is it clear now? Or are you still insisting on putting words in my mouth?

If someone makes poor food and fitness choices, why should others pay?

Now I may not know how to figure that out. What are your suggestions?

If blood work, urine tests, tests of cardiovascular response, flexibility and so on will not catch that, what will?

Why should the person who makes good choices be passed the fiscal responsibility of those who don't?

Let me repeat:

If I am not understanding this properly, what ARE you proposing when you say diet should be relevant to costs?

It still looks to me like you are suggesting that people should pay more based on their various test results. If so, why not own it?

Edit: my own view is that insurance companies will not be able to determine how people are eating. Instead, the options would be something like a workplace fitness program where you get a discount for participating and doing certain things. (I have no problem with it, but some do, and I understand the research so far suggests they aren't actually making a difference, although I had some nits with it so am not 100% convinced they aren't helpful.) OR (or in addition to), the topic of the thread, charging more for having an obese BMI (or, if you challenge it, an obese BF%). I am not that bothered by that, but that's not the same thing as this charge people for eating fast food and not vegetables thing.

tbright1965

Because most people get fat because they make poor food choices.

I'm sure you can find an edge case.

Are you really telling me that the 2/3rd of Americans who are overweight are overweight because they eat too much broccoli?

Frankly, I really don't care what they eat.

However, I don't believe they are overweight because they eat too much broccoli.

Do you?

People don't get fat from sitting around and breathing. The biology doesn't work that way. Something has to go in their mouths. Given the high incidence of diabetes, heart disease and obesity, I'm not convinced they are getting fat because they are eating too many fruits and vegetables.

Now if you have data that indicates the vast majority of obese people are consuming the bulk of their calories in fruits, vegetables, fish, lean meats and low fat dairy, I'd like to see it.

What would ultimately be measured are the results of poor choices. No, I really don't care how they got there. But I'm willing to wager that the vast majority of those who are obese are obese because too many fast or processed foods and not enough more healthy choices.

Again, unless you have data that suggest that the 2/3rds who are obese are by and large consistently making good food and exercise choices and are merely victims of bad genetics.

But it's my contention that that figure is closer to 1% than it is a majority of the 2/3rds who are obese.

lemurcat12

tbright1965 wrote: »

Because most people get fat because they make poor food choices.

Obviously people get fat because they eat too much (too many calories), which is a result of making bad food choices (or not thinking about what they eat), whether they eat vegetables or fast food or both.

But you are changing the topic. Again, you said: "There needs to be a risk rating component so that people who make poor choices experience some fiscal consequences for choosing to eat at the drive through more than fresh fruits and vegetables."

I said (and janejellyroll also asked some questions): "How on earth would that be monitored, whether true insurance (i.e., similar to car insurance or fire insurance) or some other plan? You can give incentives/penalties for BMI and for test results (although it's very obvious that many other factors play into test results -- my dad had high cholesterol at one point despite never being overweight and being active, my cholesterol has always been good, even when I was fat). But you can't make it depend on people eating vegetables or not going to drive ins."

Again, this digression is not about the question "should people pay more if they have an obese BMI." I think that's probably a bad idea, but I am okay with various financial incentives for keeping in shape/not being obese, depending on how they are defined.

My point was that it's obviously not realistic to think you could be charged more based on how you eat as in whether in the past year you met the recommended amount of vegetables more often than not or never ate them or went to McD's every other day or not at all. (Similarly, you can be a poor or reckless driver and so long as you get away with it your car insurance won't reflect it.)

I'm sure you can find an edge case.

It's NOT an edge case to say plenty of fat people don't eat a lot of fast food (given the percentages who are fat you can't generalize about them, except that they all eat more than they should for their activity level, or did in the past). It's also not an edge case to say lots of fat people eat vegetables (I ate tons of vegetables, far more than most people, when I was fat, as I do now -- I also ate too much overall, and eating vegetables didn't mean I wasn't fat or that fat is not a risk factor).

Nor is it an edge case to say that plenty of people who aren't fat and eat well do poorly on health tests, even if fat people, on average, do worse. So if you want to base insurance costs on BMI or tests, that's fine, we can discuss that. You are the one who changed the topic to this idea of charging based on whether your diet is nutritionally sound or not, or fast food consumption.

Are you really telling me that the 2/3rd of Americans who are overweight are overweight because they eat too much broccoli?

I am saying they could easily be fat WHILE eating a good bit of broccoli and other vegetables (Americans in general eat far too few vegetables, obv, but there are lots of exceptions and they aren't all thin). They could also be overweight when not eating much fast food.

Frankly, I really don't care what they eat.

Great!

So can we stop pretending fat people must eat nutritionally poor, stereotypical diets (or that the only healthy diet has no foods that are easy to overeat in it)? Your proposal ISN'T that people should pay more for eating fast food and not vegetables. It's that they should pay more (if the insurance co wishes to charge them more) for being obese (or, I guess, just overweight, based on the latest). (And I of course agree that people get overweight because they eat too much, even if what they eat is different from your stereotype of them rushing through the drive in daily.)

Presumably the insurance co can also charge more for bad test results, if we are using a pure insurance model? That's what the underwriting would say.

janejellyroll

tbright1965 wrote: »

janejellyroll wrote: »

What's the point?

I thought my point was obvious, we shouldn't ignore rating on risk.

Now we can debate how best to do that. But I believe risk should be a part of rating health insurance policies.

There are others who have no problem with passing along the costs of their choices to others. (And not just here, it's the human condition.

I see many cite these edge cases. So my question is how many of these cases are there vs the typical outcomes?

I've seen numbers that indicated that roughly 2/3rds of Americans are overweight. They don't all have some sort of disease "making" them this way. Right?

Shifting the costs to the taxpayer is exactly the WRONG way to see changed behavior in those who can address their condition by behavior modification. I.E. eat an apple instead of a cupcake.

That's my point.

If you want to pay for people to eat cupcakes instead of apples, I'd not prevent you from doing so.

I don't wish to be on the hook for those who make the choice of cupcakes over apples most of the time.

Does that mean I believe everyone does that? No.
Does that mean I don't believe there are people who don't have problems where even eating apples will be an issue for them? No. But I do believe that the population of those folks is very small. Most people are simply making bad choices or eating on autopilot.

My best anecdote is the box of Thin Mints or a pint of Ice Cream or a Bag of Chips. For many, those are single servings.

How can that be good? They don't have a disease, they simply don't pay attention to what is going in their mouth. I can be that person too, and have been, so I throw the stone with awareness that I might be a valid target as well.

Someone posted a video in one of the CICO threads where a woman was complaining that she had a slow metabolism. BBC news story IIRC. So they tested her. Normal metabolism. Had her do a video diary of what she ate, then a logbook diary.

Also some sort of bloodtest that could determine her CI based on some chemistry magic.

Bottom line, when she thought she was eating 1000 calories each day, it was closer to 3000.

How many believe they have some disease when in reality they are bad at math or remembering what they ate? Or they simply didn't read the label?

Sorry, ranted on too long about what's my point.

A liver function test isn't going to disclose whether someone is sometimes eating cupcakes.

When I ask "What's the point?" I'm specifically talking about your proposal to use diagnostic tests designed for specific purposes (liver function, etc) and trying to somehow use that data to determine what people are eating.

If someone is overweight and losing weight will reduce their risk of chronic disease (which I believe to be shown by the evidence), it's irrelevant if they're eating apples or Big Macs. Whether their excess weight comes from whole grains or pizza (or, a combination of the two), losing weight is what is important. Can poor food choices be contributing to that? In some cases, probably.

But I'm not seeing the point of over-complicating things. If someone is overweight, getting to the root of that (consuming excess energy) is going to be more useful to assuming they eat too many hamburgers (I gained all my excess weight without ever eating a single burger).

janejellyroll

tbright1965 wrote: »

lemurcat12 wrote: »

tbright1965 wrote: »

lemurcat12 wrote: »

So let's stop pretending people are paying more for not eating vegetables and eating fast food a lot (who knows) and just say you want people to pay more for bad test results (so you'd pay more, as I understand it, right?) and BMI.

But that isn't what I said.

I'm pretty sure I PROPOSED it.

You said that people should pay more for eating fast food and less for eating vegetables.

I asked how on earth the insurance company would be able to track that (and also if they would be able to use it as a basis to deny coverage, if you weren't fully upfront about your fast food habits or vegetable aversions).

You said that tests would show it.

So what you really mean is NOT that insurance companies will charge more based on diet (which doesn't seem possible to administer), but that they would charge more based on test results.

If I am not understanding this properly, what ARE you proposing when you say diet should be relevant to costs?

Context is everything.

So if it wasn't clear before, is it clear now? Or are you still insisting on putting words in my mouth?

If someone makes poor food and fitness choices, why should others pay?

Now I may not know how to figure that out. What are your suggestions?

If blood work, urine tests, tests of cardiovascular response, flexibility and so on will not catch that, what will?

Why should the person who makes good choices be passed the fiscal responsibility of those who don't?

If we don't yet know how to determine if people are making "poor choices" (however you wish to define that), then it seems premature to insist that the people making them pay more.

mutantspicy

No. many body builders who have really low BF% are considered obese or overweight due to the lousy BMI metric.
The use of BMI by health insurance as metric of your overall health needs to be eliminated completely, its a complete farse that for many is terribly inaccurate.