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Do you think obese/overweight people should pay more for health insurance?
Replies
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Because if your neighbor is NOT looking out after their own health and are constantly making poor diet choices instead then you have to cover that also.BigDougie1211 wrote: »
Hmm.. my point is that I -who work hard to remain physically fit and watch what I eat- do not want to pay for the health care costs associated with someone else being obese.stanmann571 wrote: »Yes, it's shocking, that the people who would suffer under your plan to tax us to supplement your care object.
But somehow you imply it means the overweight people would be supplementing *my* care?
You tried to turn the whole thing around. That isn't how a civilized debate or discussion works.
The whole point of Universal health care is that everyone supplements everyone's care. You look out for your neighbour and your neighbour looks out for you.
How can that be a bad thing?
How would you feel if every time I crashed my car YOUR car insurance went up?
Your car insurance costs continue to go up even though I have repeatedly been told I need to take a driving course - but I don't.
But again, I am advocating the Japanese system where they pay a additional tax for being too fat so I do not pay for those poor choices.
$147 billion worth of poor diet choices.
But I'm talking about Universal Healthcare as a whole topic here - not just the obesity question.
So what about the guy down the street who does look after himself, but for one reason or another can't afford health insurance?
Doesn't he deserve a hand? It's a hand we might all need ourselves one day.
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stanmann571 wrote: »CDC and NHS disagree with you. I'll go with them.
https://www.cdc.gov/obesity/adult/defining.html
http://www.nhs.uk/conditions/Obesity/Pages/Introduction.aspx
No they don't.
http://www.nhs.uk/conditions/Obesity/Pages/Introduction.aspx
"BMI isn't used to definitively diagnose obesity, because people who are very muscular sometimes have a high BMI without excess fat. But for most people, BMI is a useful indication of whether they're a healthy weight, overweight or obese."
https://www.cdc.gov/obesity/adult/defining.html
"Note: At an individual level, BMI can be used as a screening tool but is not diagnostic of the body fatness or the health of an individual. A trained healthcare provider should perform appropriate health assessments in order to evaluate an individual's health status and risks."
"BMI does not measure body fat directly, but research has shown that BMI is moderately correlated with more direct measures of body fat obtained from skinfold thickness measurements, bioelectrical impedance, underwater weighing, dual energy x-ray absorptiometry (DXA) and other methods"
You are either being deliberately obtuse or argumentative.
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stanmann571 wrote: »CDC and NHS disagree with you. I'll go with them.
https://www.cdc.gov/obesity/adult/defining.html
http://www.nhs.uk/conditions/Obesity/Pages/Introduction.aspx
No they don't.
http://www.nhs.uk/conditions/Obesity/Pages/Introduction.aspx
"BMI isn't used to definitively diagnose obesity, because people who are very muscular sometimes have a high BMI without excess fat. But for most people, BMI is a useful indication of whether they're a healthy weight, overweight or obese."
There are many ways in which a person's health in relation to their weight can be classified, but the most widely used method is body mass index (BMI).
BMI is a measure of whether you're a healthy weight for your height. You can use the BMI healthy weight calculator to work out your score.
For most adults, a BMI of:
•18.5 to 24.9 means you're a healthy weight
•25 to 29.9 means you're overweight
•30 to 39.9 means you're obese
•40 or above means you're severely obesehttps://www.cdc.gov/obesity/adult/defining.html
"Note: At an individual level, BMI can be used as a screening tool but is not diagnostic of the body fatness or the health of an individual. A trained healthcare provider should perform appropriate health assessments in order to evaluate an individual's health status and risks."
"BMI does not measure body fat directly, but research has shown that BMI is moderately correlated with more direct measures of body fat obtained from skinfold thickness measurements, bioelectrical impedance, underwater weighing, dual energy x-ray absorptiometry (DXA) and other methods"
You are either being deliberately obtuse or argumentative.
Weight that is higher than what is considered as a healthy weight for a given height is described as overweight or obese. Body Mass Index, or BMI, is used as a screening tool for overweight or obesity.
Adult Body Mass Index (BMI)
Body Mass Index (BMI) is a person's weight in kilograms divided by the square of height in meters. A high BMI can be an indicator of high body fatness.
To calculate BMI, see the Adult BMI Calculator or determine BMI by finding your height and weight in this BMI Index Chart.
•If your BMI is less than 18.5, it falls within the underweight range.
•If your BMI is 18.5 to <25, it falls within the normal.
•If your BMI is 25.0 to <30, it falls within the overweight range.
•If your BMI is 30.0 or higher, it falls within the obese range.
Obesity is frequently subdivided into categories:
•Class 1: BMI of 30 to < 35
•Class 2: BMI of 35 to < 40
•Class 3: BMI of 40 or higher. Class 3 obesity is sometimes categorized as “extreme” or “severe” obesity.
I'm becoming aggravated because you are being deliberately obtuse and argumentative and incorrectly using terms.0 -
BigDougie1211 wrote: »
Because if your neighbor is NOT looking out after their own health and are constantly making poor diet choices instead then you have to cover that also.BigDougie1211 wrote: »
Hmm.. my point is that I -who work hard to remain physically fit and watch what I eat- do not want to pay for the health care costs associated with someone else being obese.stanmann571 wrote: »Yes, it's shocking, that the people who would suffer under your plan to tax us to supplement your care object.
But somehow you imply it means the overweight people would be supplementing *my* care?
You tried to turn the whole thing around. That isn't how a civilized debate or discussion works.
The whole point of Universal health care is that everyone supplements everyone's care. You look out for your neighbour and your neighbour looks out for you.
How can that be a bad thing?
How would you feel if every time I crashed my car YOUR car insurance went up?
Your car insurance costs continue to go up even though I have repeatedly been told I need to take a driving course - but I don't.
But again, I am advocating the Japanese system where they pay a additional tax for being too fat so I do not pay for those poor choices.
$147 billion worth of poor diet choices.
But I'm talking about Universal Healthcare as a whole topic here - not just the obesity question.
So what about the guy down the street who does look after himself, but for one reason or another can't afford health insurance?
Doesn't he deserve a hand? It's a hand we might all need ourselves one day.
This is the realm of charitable institutions, not government. Implementing a system of governance around handouts will only end in failure. I hear Venezuela is nice this time of year...probably not now so much.
I deserve a hand - pay for my insurance.3 -
+1heiliskrimsli wrote: »do drug addicts, or alcoholics pay more? It's the same thing. Not all obese people are unhealthy and not all thin people are healthy...
With the power the insurance companies have, it could end up like car insurance, use it once and the price goes up...penalties for breaking a leg, or cutting your arm.
There is a precedent for smokers to be charged more.
The point of obesity's effect on health care is that it dramatically raises the risks of various diseases even if you don't have them yet.
Furthermore the negative effects may not be obvious at first.
You are going to have your work cut out for you if you think to convince me that "Not all obese people are unhealthy".
Diet, blood pressure, cholesterol, shortness of breath walking a flight of stairs, the toll on the joints.
I had none of these issues (but for toll on the joints, I am sure) when obese (I ate way more vegetables and probably less added sugar than the national average, also). However, I 100% agree that it was a health risk and I would have been okay with paying more, personally (although it probably would have caused me to be more observant and care more about other "risks" that people did not have to pay more for, which is what I think people are talking about. Insurance companies would like to charge more for people being obese for that factor. However, insurance companies would also like to charge more for the symptoms/bad tests, independent of obesity (i.e., for preexisting conditions). If you enter into new contracts each year, insurance companies would probably prefer to be able to charge more for things like high cholesterol, high blood pressure, blood sugar issues (none of which I had when obese, and which lots of non obese people have) than merely obesity.
All this aside, one thing I've found interesting about this discussion is that people seem bothered by charging more for obesity/overweight, but are NOT bothered by giving people discounts for being a healthy weight or making improvements on their weight, cholesterol, blood sugar, etc. There is actually not any difference between these two things. In the chance that the pluses for being fit approach encourages people to make improvements, I'd be in favor of it.4 -
stanmann571 wrote: »Isn't it interesting that most of the relatively fit people replying think paying more is a good idea while many of the responses from people who may be carrying more weight than necessary seem to disagree?
Yes, it's shocking, that the people who would suffer under your plan to tax us to supplement your care object.
Shocking indeed.
More services are great as long as someone else is paying for them.1 -
We have a differing stance on what "correctly" means.stanmann571 wrote: »I'm becoming aggravated because you are being deliberately obtuse and argumentative and incorrectly using terms.
You are working backwards from what you want the word to mean and then trying to cherry-pick stuff that seems to agree with you. I went to the links you provided and pointed out the parts that you seem to have missed.
I also pointed out how the word is at least 2000 years old and the etymology.
Just because BMI puts the word on a table does not mean it is somehow based on that.
There are probably a dozen words on the BMI table. Age, height, weight, male, female... are those "BMI terms" also?
You don't get much more clear than "BMI isn't used to definitively diagnose obesity", from your link.
I will concede that the way "BMI" has co-opted the word "Obese" has given nuance to the meaning and added to confusion.
However "obese" in the strict use of the word is a reference to too much body fat and that is still in formal use today.
"BMI" is a lazy way to estimate body fat and therefore put someone in a category quickly.
From the Harvard School of Public Health (related to School of Medicine), which is pretty darn authoritative:
https://www.hsph.harvard.edu/obesity-prevention-source/obesity-definition/
"Obesity definition
What Does It Actually Mean to Be Overweight or Obese?
At their most basic, the words “overweight” and “obesity” are ways to describe having too much body fat.
The most commonly used measure of weight status today is the body mass index, or BMI."
From the Medscape peer review panel:
http://emedicine.medscape.com/article/123702-overview
"Signs and symptoms
Although several classifications and definitions for degrees of obesity are accepted, the most widely accepted classifications are those from the World Health Organization (WHO), based on body mass index (BMI). The WHO designations are as follows:
Grade 1 overweight (commonly and simply called overweight) - BMI of 25-29.9 kg/m 2
Grade 2 overweight (commonly called obesity) - BMI of 30-39.9 kg/m 2
Grade 3 overweight (commonly called severe or morbid obesity) - BMI ≥40 kg/m 2
Some authorities advocate a definition of obesity based on percentage of body fat, as follows:
Men: Percentage of body fat greater than 25%, with 21-25% being borderline
Women: Percentage of body fat great than 33%, with 31-33% being borderline"
...
Evaluation of degree of body fat
BMI calculation, waist circumference, and waist/hip ratio are the common measures of the degree of body fat used in routine clinical practice. Other procedures that are used in few clinical centers include the following:
Caliper-derived measurements of skin-fold thickness
Dual-energy radiographic absorptiometry (DEXA)
Bioelectrical impedance analysis
Ultrasonography to determine fat thickness
Underwater weighing"
BMI arguably has a place when used compare large populations but the ease and speed of it led to widespread adoption and using it in place of more traditional and accurate measurements on individuals.4 -
Many work places in my area have entirely switched to high deductible health plans and with that the employer deposits money into their employee's HSA accounts. Now the trend I'm seeing is that this benefit is being denied if you are obese - but then the employer offers regular health screening and access to weight management resources. So I think this is a fair way to handle it. Everyone's insurance coverage and premiums are the same, but some employees receive an extra incentive for being healthy.0
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BusyBeeMeli wrote: »Many work places in my area have entirely switched to high deductible health plans and with that the employer deposits money into their employee's HSA accounts. Now the trend I'm seeing is that this benefit is being denied if you are obese - but then the employer offers regular health screening and access to weight management resources. So I think this is a fair way to handle it. Everyone's insurance coverage and premiums are the same, but some employees receive an extra incentive for being healthy.
Interesting. For those that aren't familiar an employer is not required to help fund someone's HSA. Just an optional benefit the employer can provide.1 -
This just in: http://www.cbsnews.com/news/fit-but-fat-may-be-a-myth-study-says/
Preliminary findings, but:
"They still have a higher risk of heart disease than normal-weight people, a new British study finds."
...
"At the population level, so-called metabolically healthy obesity is not a harmless condition and perhaps it is better not to use this term to describe an obese person, regardless of how many metabolic complications they have," Caleyachetty said in a meeting news release."0 -
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NorthCascades wrote: »
Oh, I didn't notice. Thanks for the heads-up.1 -
The other thread is delving into what is meant by health and fitness, and your comments and insight would be appreciated.0
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NorthCascades wrote: »The other thread is delving into what is meant by health and fitness, and your comments and insight would be appreciated.
I don't know if many of my responses are appreciated but I will give the thread a look.3 -
Sorry to interrupt, and no offense to anyone, but this definition just made me LOL.From French obésité, which is from Latin obesitas, which means "fatness," and from obesus, which means "something that's eaten itself fat."2
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Sorry to interrupt, and no offense to anyone, but this definition just made me LOL.From French obésité, which is from Latin obesitas, which means "fatness," and from obesus, which means "something that's eaten itself fat."
Although stated completely undiplomatically, it's not factually wrong as it can apply to any organism.3 -
You know me: All kinds of Politically Correct.heiliskrimsli wrote: »Although stated completely undiplomatically, it's not factually wrong as it can apply to any organism.
Nah, never mind. I'm thinking of someone else.
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Chef_Barbell wrote: »No. Sounds like a slippery slope and where does it stop?
I agree0 -
At the bottom?Chef_Barbell wrote: »No. Sounds like a slippery slope and where does it stop?
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Also, what about all the patient's that are on government assistance that don't pay for healthcare? I work in the medical field and there are many people that get state funded Medicaid that are obese and smoke. Many of them don't work, so they don't pay taxes to fund their healthcare. So on top of my own healthcare premiums, I am also paying for them.4
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Butts_Boys_and_Burgers_ohmy wrote: »Also, what about all the patient's that are on government assistance that don't pay for healthcare?
What about them? If they aren't paying, presumably they aren't going to pay more if obese.
Is the additional Medicare tax going to be more if you are fat?2 -
lemurcat12 wrote: »Butts_Boys_and_Burgers_ohmy wrote: »Also, what about all the patient's that are on government assistance that don't pay for healthcare?
What about them? If they aren't paying, presumably they aren't going to pay more if obese.
Is the additional Medicare tax going to be more if you are fat?
I think she's pointing out that we (taxpayers) already pay for others healthcare costs? And then those people don't file taxes so they're not paying into the system. Not sure though but that's how I read the post.
ETA: I'm wrong a lot so apologizes in advance.2 -
This content has been removed.
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BurlzGettingFit wrote: »lemurcat12 wrote: »Butts_Boys_and_Burgers_ohmy wrote: »Also, what about all the patient's that are on government assistance that don't pay for healthcare?
What about them? If they aren't paying, presumably they aren't going to pay more if obese.
Is the additional Medicare tax going to be more if you are fat?
I think she's pointing out that we (taxpayers) already pay for others healthcare costs? And then those people don't file taxes so they're not paying into the system. Not sure though but that's how I read the post.
ETA: I'm wrong a lot so apologizes in advance.
You are probably right, but I just wasn't sure how it was relevant, as of course we already pay for other's costs. I was bringing up another way (Medicare), and of course the group insurance/community rated insurance context that is at issue in this thread.0 -
MoiAussi93 wrote: »MoiAussi93 wrote: »AnninStPaul wrote: »If you aren't caring for your health, you should pay more. If you're diabetic and work with your physician to achieve control, you don't get a surcharge. If you're hypertensive and don't act to reduce your bp - lose weight, exercise, take anti-hypertensives - you get a surcharge.
This makes sense but it's a slippery slope. What if "caring for your health" extended to not engaging in extreme sports? Free climbing, wind suit jumping, paragliding, mountaineering, bmx trick riding, downhill mountain bike racing, white water rafting/kayaking, sky diving, etc. One could argue that taking risks of injury and death is not really caring for you health. We could all end up being limited to exercise machines indoors like hamsters.
I don't think it is a slippery slope at all. People who are fit and active enough to routinely engage in sports such as climbing and mountain biking are highly unlikely to be obese. The occasional broken arm which necessitates a couple of x-rays, a cast, or...worst case scenario...an outpatient surgery...will be an insignificant cost compared to the lifetime of expensive drugs, hospitalizations, intensive care units, etc. that obese people are likely to eventually need.
One sports injury will likely cost less to treat (and be a one time event) than a single year's supply of the expensive drugs needed to treat obesity related chronic illnesses.
I am sure any insurance company would GLADLY choose the super active sports participant over the fat person who sits inside their nice and safe home. And they would charge the sporty person much less...which is fair.
You missed my point. I'm sorry I wasn't clear. You stated that people who already have a health condition such as hypertension or diabetes should have the extra costs waived if they are working on improving their health. I think that's a slippery slope because people who have no condition such as extreme sports athletes who are arguably reckless about their health from an injury standpoint could then be charged extra costs under this mind set. This is what could happen if insurance were NOT based on whether you already have a condition but based on efforts to avoid health risks...which is what you were proposing.
It's got nothing to do with obesity or rates for obese people versus athletes. You were proposing rates based on efforts to avoid health risks INSTEAD of rates based on actual health conditions.
I didn't state that...it was somebody else. The lack of nesting in these threads make it hard to track who is responding to what! Maybe I missed some context to what you wrote because it was part of a previous reply.
My position is simply that obese people should pay more because they are a much higher risk and the payouts involved with them are likely to be MUCH higher than for the occasional minor accident with sporty fit people. Sporty people may have a slightly higher risk of minor injuries...but these injuries are relatively cheap to treat. They will not significantly impact the insurance company's profitability. Their overall risk is much lower because they are much less likely to develop heart disease, diabetes, various cancers, etc.
I think you have to charge based on actual health condition...and obesity is a MAJOR health condition. Maybe we are on the same page.
Sorry, the nesting does divorce responses from commentators. Yep, we are on same page. If there are to be different rates for people, then it should be based on actual health conditions. The poster I was responding to was saying it should be based not on actual conditions but on effort to avoid risks/conditions even if they had a condition.
However, I am in favour of a single payer system though so I do think that the ideal circumstance is where everyone pays the same % of their income towards healthcare which then makes it free at the point of service. This is simply because so many people with health insurance go bankrupt if they get cancer or in a bad car crash. It doesn't seem fair for people who work hard and pay in to lose everything because of misfortune.3 -
Is obesity a health condition in and of itself? I know it doubles your risk of heart failure, and increases risk for other conditions markedly like diabetes, joint issues, hypertension, stroke, etc. But is obesity really more an indication of high risk? As there are a proportion of people who are obese and lucky and manage to not develop health conditions.
Consider women with the BRAC1 gene. Their risk of breast cancer is 55-65% instead of the 11% of a "normal" woman. Their risk of ovarian cancer is 39% instead of the 1% of "normal" women.
If obese people were charged more, isn't it really because they are high risk? Could we then not apply the same logic to women with BRAC1...if you're high risk for developing certain health conditions, then you should pay higher rates? Especially since cancer trumps everything in terms of cost per capita to treat.
Or is this really about virtue/deserving versus undeserving? I've said before I had to pay a higher rate due to my asthma...inherited, not in my control. Is the sentiment here more about penalising people for high risk lifestyle choices ( letting themselves get obese) rather than a pure risk based calculation where all high risk people, regardless of why or how they are high risk should pay more?3 -
Is obesity a health condition in and of itself? I know it doubles your risk of heart failure, and increases risk for other conditions markedly like diabetes, joint issues, hypertension, stroke, etc. But is obesity really more an indication of high risk? As there are a proportion of people who are obese and lucky and manage to not develop health conditions.
I believe these people are pretty much like the 2 pack a day smokers that never develop any smoking related issues. Very few and far between3 -
Is obesity a health condition in and of itself? I know it doubles your risk of heart failure, and increases risk for other conditions markedly like diabetes, joint issues, hypertension, stroke, etc. But is obesity really more an indication of high risk? As there are a proportion of people who are obese and lucky and manage to not develop health conditions.
Consider women with the BRAC1 gene. Their risk of breast cancer is 55-65% instead of the 11% of a "normal" woman. Their risk of ovarian cancer is 39% instead of the 1% of "normal" women.
If obese people were charged more, isn't it really because they are high risk? Could we then not apply the same logic to women with BRAC1...if you're high risk for developing certain health conditions, then you should pay higher rates? Especially since cancer trumps everything in terms of cost per capita to treat.
Yes. From the insurance company's perspective, they'd like to charge according to risk. We (currently, who knows what the law will be) don't let them, but have some exceptions where it is believed to encourage positive behavior changes, specifically smoking. The argument for also allowing wellness programs (discounts for being in shape -- which is the same thing as charging more for not being in shape) or increased charges for obesity is the same as with making smoking an exception.Or is this really about virtue/deserving versus undeserving?
For some people I'm sure it is, but it need not be.2 -
I'm just going to leave this here....
TOFI
Thin outside fat inside0 -
Is obesity a health condition in and of itself? I know it doubles your risk of heart failure, and increases risk for other conditions markedly like diabetes, joint issues, hypertension, stroke, etc. But is obesity really more an indication of high risk? As there are a proportion of people who are obese and lucky and manage to not develop health conditions.
Consider women with the BRAC1 gene. Their risk of breast cancer is 55-65% instead of the 11% of a "normal" woman. Their risk of ovarian cancer is 39% instead of the 1% of "normal" women.
If obese people were charged more, isn't it really because they are high risk? Could we then not apply the same logic to women with BRAC1...if you're high risk for developing certain health conditions, then you should pay higher rates? Especially since cancer trumps everything in terms of cost per capita to treat.
Or is this really about virtue/deserving versus undeserving? I've said before I had to pay a higher rate due to my asthma...inherited, not in my control. Is the sentiment here more about penalising people for high risk lifestyle choices ( letting themselves get obese) rather than a pure risk based calculation where all high risk people, regardless of why or how they are high risk should pay more?
From a medical perspective - yes. From a regulatory perspective - yes. From an insurance/risk management perspective - yes.
Take hormonal disorders for example - as hormones are free cycling being overweight will impact hormonal balance. This may not manifest any symptoms, but causes the specific glands to work harder than normal. Depending on a combination of genetic and environmental factors this may manifest in a more serious condition or adverse experience. So did the hormonal deficiency cause obesity or did obesity cause the hormonal deficiency?
There are numerous discussions on this point, but these are devolve into a manner of chicken/egg disputes and meaningless when it comes to root cause analysis and application of therapy. Any effective correction would be holistic in nature, e.g. prescribed hormonal therapy and moderate caloric deficit.
Virtue/deserving will have to be included in any program as you are dealing with limited supply and unlimited demand. If cost is removed this will have to be replaced with some other metric - first come first served, rationing of care, etc.4
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