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Do you think obese/overweight people should pay more for health insurance?
Replies
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This is already in place for our insurance. Smokers pay more as well, and staring next year those with bad blood work numbers will also pay more. We'll pay higher premiums for my husband with the new rule next year and I don't have a problem with that-he's a higher risk for needing costly medical care. Getting an insurance policy through the company is optional so if someone doesn't agree with these policies they don't need to participate.
edit: grammar4 -
lemurcat12 wrote: »Cost sharing is appropriate but there should also be consequences for things under your control. If your behavior affects your car insurance, why not health insurance.
Problem is that health insurance is nothing like car insurance because it is not freely underwritten because the truth is it's not really insurance. It covers fixed costs and, of course to the extent it covers pre-existing conditions (and can't charge more for them) that's another huge way it's not insurance.
I don't care about this, but I think we need to be honest that it's not really an insurance model and people don't really want the insurance model. (The number of people who would not be able to get insurance or would pay way, way, way more for it if it were actually based on individual underwriting is huge, and this would also probably lead to people not getting medical care -- just like minor accidents often are not reported or other possible claims on insurance forgone in other areas -- to avoid losing/cost increases with insurance. Most don't realize this, because most (or enough, anyway) are protected from this by group employer insurance. They don't connect their own actions to costs.)
Anyway, I'm not opposed to having some kind of surcharge for obesity, but it would be a pain and how does one do it, rely on self reporting? (I'm not sure how the smoking thing works.) Seems to me that it's essentially the same as those wellness programs in reverse (paying less for being normal weight=paying more for being overweight if the total is the same, obviously). But what we realistically cannot and will not have is actual underwriting based on risks.
(I think the political pressure is such that paying more for health insurance also will not happen, and it does open the door to other intrusions -- like in diet? -- that I think most would oppose.)I don't put much faith in 'wellness programs' since people mostly know they have problems with their lifestyle. We probably need more PSA type marketing on the benefits of healthy living. We have a marketing problem.
I think wellness programs are about exercising, reducing cholesterol, reducing weight. I don't think they work that well, but I do think having specific goals and action steps that have specific shorter term rewards has more potential for changing behavior than reliance on general "I know should lose weight and exercise more and eat better, but it's all overwhelming and I don't really know what to do and will do something someday." There is some evidence that people who change their behaviors often do it as a result of being told that it will have specific health consequences -- this helps with the long-term/short-term reward issue by making it more concrete and short-term. I think such a thing might have been helpful for me (maybe, maybe not), as I knew I should lose weight but put it off in part because I had no feeling of urgency -- my health and tests were always good and I knew it was a risk but kept thinking I could fix it later. (Ultimately it wasn't health but just being disgusted with myself and wanting to be more active and fit and look better that motivated me. I was sick of feeling depressed and miserable every time I bought clothes or someone pulled out a camera.)
It's already implemented for our insurance and every October (during open enrollment), employees and their spouses have to go in for mandatory health screenings (if you want insurance through the company). Basic blood work (cholesterol, glucose etc), weight, blood pressure and waist measurements are taken. They run a specific blood test to detect smokers as well. BMI is figured out during this visit.1 -
Carillon_Campanello wrote: »heiliskrimsli wrote: »
My employer doesn't hire smokers.
They also have a surcharge on insurance premiums to any "grandfathered" smokers that were employees prior to this policy being enacted.
With the % of Americans that are considered obese the backlash would be far and wide (is that a pun...no offense).
I see how this could be construed as a "surcharge" or penalty against employees that are obese. I think the litigation that followed directly after (and likely prior too) would vastly outweigh any cost savings benefits of an "obesity surcharge" on the premiums. When looking at the number of Americans that are obese...It's a pretty big hornets nest to kick and expect little repercussions.
So far I am aware of exactly one lawsuit in which an employer refused to hire someone due to his weight. He lost summarily because weight is not a protected class under either the ADA or EEOC. I don't think that would get very far.
Since smokers (something directly under their control) are already charged more and can be passed over for hiring or even fired if they fail to quit smoking in a mandated time frame I see no problem with extending this to overweight/obesity. It's a choice. If you don't like the consequences of it, make a different choice.9 -
BMI isn't a great measure though, as some people will have a high BMI but low body fat--if they work out a lot. My husband lifts weights for example.8
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crazyycatladyy1 wrote: »
It's already implemented for our insurance and every October (during open enrollment), employees and their spouses have to go in for mandatory health screenings (if you want insurance through the company). Basic blood work (cholesterol, glucose etc), weight, blood pressure and waist measurements are taken. They run a specific blood test to detect smokers as well. BMI is figured out during this visit.
Same at my previous employment through the state- we had state run health insurance for state employees that started rolling out these wellness visits as mandatory- or you get a $500 deductible increase. Next year, if you don't have a doctor's "excuse" then if you test poorly in these metrics, it is a deductible increase. It included all that CrazyCatLady mentioned. I no longer work there, however, and my new insurance doesn't have those requirements at the moment.
So it is already kind of starting in many places in the US.3 -
nevadavis1 wrote: »BMI isn't a great measure though, as some people will have a high BMI but low body fat--if they work out a lot. My husband lifts weights for example.
The vast majority of people who think they are outliers are wrong. Though he could always volunteer to go in the dunk tank, get a DEXA scan, or use waist-to-height ratio to prove that he is actually an outlier.14 -
nevadavis1 wrote: »BMI isn't a great measure though, as some people will have a high BMI but low body fat--if they work out a lot. My husband lifts weights for example.
Do you know what your husband's bmi is? For our insurance-the bmi number is quite high for the penalty (into the obese category).2 -
Penthesilea514 wrote: »crazyycatladyy1 wrote: »
It's already implemented for our insurance and every October (during open enrollment), employees and their spouses have to go in for mandatory health screenings (if you want insurance through the company). Basic blood work (cholesterol, glucose etc), weight, blood pressure and waist measurements are taken. They run a specific blood test to detect smokers as well. BMI is figured out during this visit.
Same at my previous employment through the state- we had state run health insurance for state employees that started rolling out these wellness visits as mandatory- or you get a $500 deductible increase. Next year, if you don't have a doctor's "excuse" then if you test poorly in these metrics, it is a deductible increase. It included all that CrazyCatLady mentioned. I no longer work there, however, and my new insurance doesn't have those requirements at the moment.
So it is already kind of starting in many places in the US.
Yep, that's exactly how they rolled out the changes-at first there was incentives, then penalties. They gave us plenty of notice though (several years), so none of it was a surprise. They also offer all sorts of resources for those who want help to change things.1 -
Every time people are checked out at an office, we pay for the visit. Every stay, test, etc, we pay. It doesn't matter the condition. Every insurance has a maximum they pay, right? No reason to give insurance companies more money to put into their pockets, that just gives people more reason to not go to the doctor.
No, I don't think so.18 -
Being from the UK I have nothing to offer but this discussion fascinates me. Your healthcare is so complex. Saying that our national health service is moving gradually towards privatisation and there are constantly think pieces about whether people who make avoidable decisions that lead to accidents/health problems e.g. drinking, smoking, overeating should have to pay to treat such health problems.
I disagree, I think the only people who should be charged are those who don't show up for their appointments (no excuse there) or who waste time by showing up to A&E with minor illnesses.18 -
Unequivocally yes.
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Every time people are checked out at an office, we pay for the visit. Every stay, test, etc, we pay. It doesn't matter the condition. Every insurance has a maximum they pay, right? No reason to give insurance companies more money to put into their pockets, that just gives people more reason to not go to the doctor.
No, I don't think so.
It just depends on the employer/policy. We have no annual cap on benefits paid through our insurance. We have an initial deductible/$3,000, then it goes to 20/80 up to $7,500 (we pay 20%, they pay 80%). After that $7,500 is reached though, insurance kicks in 100% with no cap (resets annually). We've had a year where the insurance paid out close to $100,000 due to a surgery one of my kids had. This year we've already hit our deductible, and most likely we'll hit the $7,500 as well (dd had a freak accident a few weeks ago-concussions/skull fracture/hospital stay, and the medical bills are processing right now), so from now till December 31st anything that happens the insurance will pay for 100% with no limitations.
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crazyycatladyy1 wrote: »
Do you know what your husband's bmi is? For our insurance-the bmi number is quite high for the penalty (into the obese category).
Oh, good to know. No, his just skews into the lowest area of "overweight" but he looks very thin as he builds lean not bulky muscle. He's been lifting since his early teens and also plays tennis and hikes. We haven't done the dunk tank though... Me on the other hand, my bmi is due to fat....2 -
heiliskrimsli wrote: »nevadavis1 wrote: »BMI isn't a great measure though, as some people will have a high BMI but low body fat--if they work out a lot. My husband lifts weights for example.
The vast majority of people who think they are outliers are wrong. Though he could always volunteer to go in the dunk tank, get a DEXA scan, or use waist-to-height ratio to prove that he is actually an outlier.
Yep charge extra and base it on the waist to height ratio. Takes away the "muscular" question.4 -
Yes I think that they should. There are many health issues that are related to obesity. And we pay for that in healthcare costs.
I don't think that it is fair when you see someone who's weight problem is because they eat too much or refuse to eat the right foods. There are of course extenuating circumstances to obesity. But by and large it is usually because of diet.
Therefore if someone like that refuses to take action and straighten out their lifestyle then they should pay more.4 -
nevadavis1 wrote: »crazyycatladyy1 wrote: »
Do you know what your husband's bmi is? For our insurance-the bmi number is quite high for the penalty (into the obese category).
Oh, good to know. No, his just skews into the lowest area of "overweight" but he looks very thin as he builds lean not bulky muscle. He's been lifting since his early teens and also plays tennis and hikes. We haven't done the dunk tank though... Me on the other hand, my bmi is due to fat....
I can't remember the number off the top of my head, but it was definitely into the obese range. My husband is in the overweight category by a few pounds and that hasn't been a problem.0 -
Packerjohn wrote: »heiliskrimsli wrote: »nevadavis1 wrote: »BMI isn't a great measure though, as some people will have a high BMI but low body fat--if they work out a lot. My husband lifts weights for example.
The vast majority of people who think they are outliers are wrong. Though he could always volunteer to go in the dunk tank, get a DEXA scan, or use waist-to-height ratio to prove that he is actually an outlier.
Yep charge extra and base it on the waist to height ratio. Takes away the "muscular" question.
As long as a DEXA scan or dunk tank is an option.
If it is, I'm in favor.... I'm also in favor of making the tank option a proposition bet... In other words, if the tank results don't show that you're an outlier, the fee for the tank gets rolled into your annual premium.
IF you are an outlier, the company eats it... which I know means it gets rolled into everyone's annual premium.8 -
stanmann571 wrote: »Packerjohn wrote: »heiliskrimsli wrote: »nevadavis1 wrote: »BMI isn't a great measure though, as some people will have a high BMI but low body fat--if they work out a lot. My husband lifts weights for example.
The vast majority of people who think they are outliers are wrong. Though he could always volunteer to go in the dunk tank, get a DEXA scan, or use waist-to-height ratio to prove that he is actually an outlier.
Yep charge extra and base it on the waist to height ratio. Takes away the "muscular" question.
As long as a DEXA scan or dunk tank is an option.
If it is, I'm in favor.... I'm also in favor of making the tank option a proposition bet... In other words, if the tank results don't show that you're an outlier, the fee for the tank gets rolled into your annual premium.
IF you are an outlier, the company eats it... which I know means it gets rolled into everyone's annual premium.
Loser pays. I like it.4 -
crazyycatladyy1 wrote: »Penthesilea514 wrote: »crazyycatladyy1 wrote: »
It's already implemented for our insurance and every October (during open enrollment), employees and their spouses have to go in for mandatory health screenings (if you want insurance through the company). Basic blood work (cholesterol, glucose etc), weight, blood pressure and waist measurements are taken. They run a specific blood test to detect smokers as well. BMI is figured out during this visit.
Same at my previous employment through the state- we had state run health insurance for state employees that started rolling out these wellness visits as mandatory- or you get a $500 deductible increase. Next year, if you don't have a doctor's "excuse" then if you test poorly in these metrics, it is a deductible increase. It included all that CrazyCatLady mentioned. I no longer work there, however, and my new insurance doesn't have those requirements at the moment.
So it is already kind of starting in many places in the US.
Yep, that's exactly how they rolled out the changes-at first there was incentives, then penalties. They gave us plenty of notice though (several years), so none of it was a surprise. They also offer all sorts of resources for those who want help to change things.
Yeah, they did give warnings it was happening to us too but I was a new employee so I didn't really get the benefit of too much advance warning. I will also say that the state I worked in was West Virginia, which has one of the highest overweight/obese populations in the country. And since the insurance was state-run, the taxpayers of the state were paying for these higher risk obese/overweight state employees, so saving money this way was, in many ways, a business decision for the state.3 -
Well they do. BMI is the guideline they use. And most people have to go through some sort of physical to assess the risk posed by their current health. If their are considered a higher risk, they pay higher premiums.
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4 -
In a way, they kind of do already; it's just an unfortunate consequence that the minority of people that aren't overweight are paying more as well... Going by the Google "fact" posted previously that nearly 70% of adults are overweight/obese, and knowing that insurance is determined by risk pools and the cost of insuring those pools--if the majority of the people in that pool are overweight and have increased healthcare costs (whether it's related to their weight or not), then everybody is paying more. What they should actually be doing is giving a discount to those who aren't overweight...
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IMO, until the US healthcare system isn't a FOR PROFIT venture, people will end up spending their retirement income and savings on it. See how much it costs to get hospitalized or how much medication costs for people who need it. It's pretty astounding and outrageous.
We could pay for ALL AMERICANS healthcare, it's just that our government chooses to spend more of taxes towards the military might instead.
A.C.E. Certified Personal and Group Fitness Trainer
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Been in fitness for 30 years and have studied kinesiology and nutrition 33 -
Gut answer, no. If the higher cost causes them to go without insurance, everyone else will be paying even more.7
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IMO, until the US healthcare system isn't a FOR PROFIT venture, people will end up spending their retirement income and savings on it. See how much it costs to get hospitalized or how much medication costs for people who need it. It's pretty astounding and outrageous.
We could pay for ALL AMERICANS healthcare, it's just that our government chooses to spend more of taxes towards the military might instead.
A.C.E. Certified Personal and Group Fitness Trainer
IDEA Fitness member
Kickboxing Certified Instructor
Been in fitness for 30 years and have studied kinesiology and nutrition
The issue with health care in the US is spending per person (from all sources) is doube what it is for the rest of the industrialized world.
Profit is a portion of this but nowhere near all. I believe one of our issues is the amont we spend on end of life care. Most other countries will make an 80 year with a serious illness comfortable and leto them die with no treatment. In the US we spend thousands of dollars for an extra couple of months of life with questionable quality.6 -
IMO, until the US healthcare system isn't a FOR PROFIT venture, people will end up spending their retirement income and savings on it. See how much it costs to get hospitalized or how much medication costs for people who need it. It's pretty astounding and outrageous.
We could pay for ALL AMERICANS healthcare, it's just that our government chooses to spend more of taxes towards the military might instead.
A.C.E. Certified Personal and Group Fitness Trainer
IDEA Fitness member
Kickboxing Certified Instructor
Been in fitness for 30 years and have studied kinesiology and nutrition
Dd was hospitalized a couple weeks ago and so far we have a $7,000 hospital bill pending. That will probably be for the ER (which in the past has run us around $1,000), and then most likely her one night stay, (since the claim is pending it doesn't have the breakdown available yet for what services it's for). All the doctors/specialists etc will be billed separately, as will the CT scan (from previous we know that will be around $1,500 for the scan). The neurologist who overlooked her while we were in the hospital was $468, the radiologist who took the scan was $173 etc. We get small discounts on those though because they were in-network, so we're looking at $411/$123 oop for those two things. There should be at least one other doctor bill incoming, from the ER dr. who examined her/put in her staples, but nothing has come through yet (unless that's rolled into the hospital bill). The hospital we used has a 0% payment plan, with a $20 a month minimum payment option. We've used it before and we'll most likely use that option again for the larger bill. The doctors/CT scan we'll pay oop right away/not need a payment plan.
I don't think any of the incoming bills are unreasonable for the amount of treatment/care my dd received? We had a potentially life threatening injury and we received prompt and appropriate care, and they had all of the tools, equipment and experienced staff on hand to help us. We had a follow up appointment with the neurologist yesterday, ($100), and as we were walking in the neurologist was running out because he had just been called into emergency surgery, for a child that had just been brought in with serious head trauma, (his office is attached to the hospital for that reason). To have someone like that available to help when needed, as well as the support staff/equipment, is priceless when you're in the midst of emergency situations.
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Packerjohn wrote: »IMO, until the US healthcare system isn't a FOR PROFIT venture, people will end up spending their retirement income and savings on it. See how much it costs to get hospitalized or how much medication costs for people who need it. It's pretty astounding and outrageous.
We could pay for ALL AMERICANS healthcare, it's just that our government chooses to spend more of taxes towards the military might instead.
A.C.E. Certified Personal and Group Fitness Trainer
IDEA Fitness member
Kickboxing Certified Instructor
Been in fitness for 30 years and have studied kinesiology and nutrition
The issue with health care in the US is spending per person (from all sources) is doube what it is for the rest of the industrialized world.
Profit is a portion of this but nowhere near all. I believe one of our issues is the amont we spend on end of life care. Most other countries will make an 80 year with a serious illness comfortable and leto them die with no treatment. In the US we spend thousands of dollars for an extra couple of months of life with questionable quality.
I think in other countries (my observations) that people are more physically active throughtout life and this helps with mobility as they age. I've seen 80 year olds on bikes or out for a walk with their walker in the park. I feel that in America the majority of older Americans aren't doing these types of activities and for many, their day consists of going to the senior center for a senior lunch that probably has enough calories to be their only meal that day...
I think many older people don't have enough saved for the cost of nursing facilities either. Honestly I don't know where all that money goes though, I've never heard of a facility that was properly staffed. At 10-15 dollars an hour for an extra CNA for as much as each resident pays a month it doesn't make sense to me but that's getting off track!4 -
I say that people who use health care should have to pay more for insurance. Put a 50% increase on your premium for each doctor visit. Another 50% increase for every prescription. 50% if you need lab tests or any scans. It's not fair healthy people pay for sick people.
What about people that get cancer or other medical issues that are out of their control already causing huge amount of medical debt? Marathon runners can have heart attacks and have to have monthly doctor follow ups and lots of follow up tests and procedures.10 -
I don't think so. It opens the door to a slippery slope where eventually everyone will have a reason they're charged more. Then we're all just paying more anyway.
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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?
Not unless you're going to allow pre-existing conditions to allow companies to charge a higher premium. In which case those who have Diabetes/PCOS/Leukemia/Cancer etc... will also pay a higher premium... which is lame. I feel like everyone should have a set premium.5 -
I say that people who use health care should have to pay more for insurance. Put a 50% increase on your premium for each doctor visit. Another 50% increase for every prescription. 50% if you need lab tests or any scans. It's not fair healthy people pay for sick people.
No. This makes absolutely no sense whatsoever. Ignoring health issues, delaying treatment, and avoiding care is a sure way to spend MORE in the long run. It's like not taking your car in for oil or filter changes until the engine seizes up.23
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