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Do you think obese/overweight people should pay more for health insurance?
Replies
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xmichaelyx wrote: »
Here's a lovely story highlighting the ultimate outcome of socialized medicine:
http://www.bbc.com/news/uk-40454177
In summary the bureaucrats decide who lives and who dies. When taken to higher authority the judges at the European Court of Human Rights concluded that further treatment would "continue to cause Charlie significant harm". Regardless of a US physician who has offered an alternative treatment the hospital will not release the child to the parent's custody.
If that kid had been a poor American, he'd have died a long time ago thanks to our idiotic, expensive system.
But by all means, keep parroting dumb talking points based on .000001% of cases while ignoring the other 99.999999% of outcomes.
I consider myself a conservative, and looking at the data from literally every Western country that's not the US, it's clear that single-payer is the fiscally conservative option.
And no, single-payer does nothing to keep wealthy people from using doctors outside of the system, or keep doctors from working outside of the system. It's the cheapest, most humane option available while retaining our beloved capitalist system for those who can afford it.
Our idiotic expensive system is idiotic and expensive based on two dominant factors: Insurance and Government.
Your solution is more insurance and government?
What data are you looking at?
Single payer is atrociously expensive, but the charges are largely hidden by the mazework of bureaucracy. For example the drug I manufacture cost less than 0.01 USD to manufacture and we sell this to wholesalers for 0.29 USD. Medicare pricing is 200 USD for this product. Explain how this happens and how single payer will "fix" this.
Are you aware of the negotiation process that occurs between buying groups, the Congressional committee, insurance groups, and pharmaceutical groups?
I'm fascinated by this disparity. I recently had an issue with my insurance where they would only cover up to 2 refills at a Rite Aid (the third was going to cost $150, when I normally pay around $3), but they would cover refills at CVS at the normal insurance rate. How do companies, or institutions like Medicare, get such leeway when pricing drugs? Where is all that profit going to? I wouldn't expect the end user to get the wholesale price, for sure - obviously there are costs associated with distribution, sale, etc. but that markup seems insane.
The idealist in me wonders why we can't have a system that fairly compensates drug manufacturers and distributors/sales points at a set rate, i.e. distributers get to mark up no more than 20% from the wholesale price, and retail gets to markup another 25% at most. In the example above, that drug would end up costing the end user ~.43. Assuming that the $200 that Medicare is charging is for a 30 day supply, the price difference per unit over $6. I'm going to go ahead and make another assumption that this particular drug is outside of the patent period, where the pharmaceutical company has recouped the R&D costs.
Generic drug prices vary wildly between different drugstores. The traditional drugstores use Rx medications as a main profit source and normally price much higher than supermarkets/department stores that use Rx's to get people in the door more often and make money selling you other stuff.0 -
rheddmobile wrote: »Angel49kitty wrote: »This is definitely a difficult topic, for sure.
There are a lot of factors: thyroid, medications, genetics, illness, diet, exercise, etc.
How do you draw the line between "this person is only overweight because of their thyroid which they have no choice about" and "this person is overweight because they decide to eat at McDonald's every day"? It's finicky, because how do you determine what is enough 'proof' of pre-existing medical illness? Especially if someone couldn't previously get treatment/diagnosis without health insurance.
I think it's kind of sad when people want to condemn others who may only be overweight because they don't have insurance to get medical help (example: thyroid medication is expensive). It makes me glad that I live in Canada, where everyone is treated as an equal in regards to medical care.
Thyroid impacts Resting Energy Expenditure (REE) by ~5%. That's 80 kcals/day out of a 1600 kcal/day budget. ...and that's the impact with no thyroid supplementation.
Synthroid or generics cost between .5-1.5 USD/day (variations on potency & brand).
You can say thyroid has little effect, but when I started getting thyroid meds I went from a little less than .2 lbs weight loss per day to half a pound a day, on the exact same meticulously tracked diet and exercise level. I had to start eating more in order to slow my weight loss. My non-exercise activity level was theoretically the same - sedentary - but probably accounts for most of the difference, since feeling better meant I did everything differently, from how often I went shopping to whether I stood while chopping vegetables or sat at the kitchen table to do it.
While it is possible for anyone to lose weight if calories are sufficiently restricted, the number of calories two different people need to eat can be very different. I don't think it's kind or fair to judge the willpower of a petite, menopausal, hypothyroid woman who has to limit her daily eating to three tiny meals in order to maintain her weight by the same standard as the willpower of a healthy, young, tall man who may be able to eat 3500 calories with the same effect. Sure, the second person might have willpower - but how would anyone know, since his willpower has never been tested?
I'm not saying it. I'm reporting results from clinical observation.
Your report is precisely why trained professionals rely on other trained professionals to study and eliminate variables. We all suffer from confirmation bias.
I don't understand why judgement needs to come into play. Studies on willpower are highly dubious. Limit the impact of willpower by focusing on routine and discipline.
You're reporting a single cherry picked and misleading fact, not the results of anything.
How exactly are you differentiating willpower and discipline? Is there some method for being disciplined which doesn't require willpower? If so, why haven't you patented this?0 -
ciscoperator wrote: »I'd say no. Once you start down the path of limiting healthcare on being overweight, it can follow on to DNA testing for genetic disorders and being charged more for e.g. a great-aunt that developed glaucoma or had sickle-cell anaemia.
We're better off keeping the simple system of universal healthcare where we pay the ~€100 per month with a deductible of €385 (though that keeps going up by around 15 euro each year), where the services of the healthcare provider are provided as part of the insurance (doctor, nurse, surgeon etc.) but the fees paid are for medicines and appliances. But I guess most answering your question aren't in The Netherlands.
Is that deducible a yearly one? That would come out to nearly $450 US which would be very tough for some people living near or below the poverty line - and tough for others if it's a per procedure kind of thing. In the Netherlands universal system, what happens if people cannot afford the monthly fee or deductible?
At least some of the Scandinavian countries have a much narrower income distribution than we have in the US. So possibly that is less of a problem (especially if other communal-use-type services are government subsidized - resulting in lower cost public transportation/child care/etc for the poor).
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rheddmobile wrote: »richardgavel wrote: »Angel49kitty wrote: »This is definitely a difficult topic, for sure.
There are a lot of factors: thyroid, medications, genetics, illness, diet, exercise, etc.
How do you draw the line between "this person is only overweight because of their thyroid which they have no choice about" and "this person is overweight because they decide to eat at McDonald's every day"? It's finicky, because how do you determine what is enough 'proof' of pre-existing medical illness? Especially if someone couldn't previously get treatment/diagnosis without health insurance.
I think it's kind of sad when people want to condemn others who may only be overweight because they don't have insurance to get medical help (example: thyroid medication is expensive). It makes me glad that I live in Canada, where everyone is treated as an equal in regards to medical care.
Does it matter why they're overweight? To my knowledge the correlation between weight and higher need of medical usage doesn't change based on why. Either costs the insurance company more to service.
The whole point of health insurance is to spread the costs of care across people, some of whom are well and some sick, since no one but the most wealthy can afford the cost of serious illness. If sick people could just pay for their own care, no one would need health insurance.
By that token, we shouldn't charge extra for auto insurance to people with frequent accidents or offer discounts to home owners who install home security systems, for example.4 -
rheddmobile wrote: »rheddmobile wrote: »Angel49kitty wrote: »This is definitely a difficult topic, for sure.
There are a lot of factors: thyroid, medications, genetics, illness, diet, exercise, etc.
How do you draw the line between "this person is only overweight because of their thyroid which they have no choice about" and "this person is overweight because they decide to eat at McDonald's every day"? It's finicky, because how do you determine what is enough 'proof' of pre-existing medical illness? Especially if someone couldn't previously get treatment/diagnosis without health insurance.
I think it's kind of sad when people want to condemn others who may only be overweight because they don't have insurance to get medical help (example: thyroid medication is expensive). It makes me glad that I live in Canada, where everyone is treated as an equal in regards to medical care.
Thyroid impacts Resting Energy Expenditure (REE) by ~5%. That's 80 kcals/day out of a 1600 kcal/day budget. ...and that's the impact with no thyroid supplementation.
Synthroid or generics cost between .5-1.5 USD/day (variations on potency & brand).
You can say thyroid has little effect, but when I started getting thyroid meds I went from a little less than .2 lbs weight loss per day to half a pound a day, on the exact same meticulously tracked diet and exercise level. I had to start eating more in order to slow my weight loss. My non-exercise activity level was theoretically the same - sedentary - but probably accounts for most of the difference, since feeling better meant I did everything differently, from how often I went shopping to whether I stood while chopping vegetables or sat at the kitchen table to do it.
While it is possible for anyone to lose weight if calories are sufficiently restricted, the number of calories two different people need to eat can be very different. I don't think it's kind or fair to judge the willpower of a petite, menopausal, hypothyroid woman who has to limit her daily eating to three tiny meals in order to maintain her weight by the same standard as the willpower of a healthy, young, tall man who may be able to eat 3500 calories with the same effect. Sure, the second person might have willpower - but how would anyone know, since his willpower has never been tested?
I'm not saying it. I'm reporting results from clinical observation.
Your report is precisely why trained professionals rely on other trained professionals to study and eliminate variables. We all suffer from confirmation bias.
I don't understand why judgement needs to come into play. Studies on willpower are highly dubious. Limit the impact of willpower by focusing on routine and discipline.
You're reporting a single cherry picked and misleading fact, not the results of anything.
How exactly are you differentiating willpower and discipline? Is there some method for being disciplined which doesn't require willpower? If so, why haven't you patented this?
Misleading? Do you have clinical evidence to the contrary? Please state if so. Multiple regulatory bodies would be very interested in this information and I'll have to amend the safety profiles of products.
Do you lack access to a dictionary?
Per OED:
Willpower: Control exerted to do something or restrain impulses.
Discipline: The practice of training people to obey rules or a code of behaviour, using punishment to correct disobedience.1 -
No. Everyone should be entitled to the same level of healthcare. I feel it's a basic human right. It's similar to charging people more who have a pre existing condition. What else, are we going to charge people more who have a genetic predisposition to certain Illnesses?
Basic human rights would be life, liberty and pursuit of happiness.
You have no right to demand services provided by another individual.
Are you saying there is no relationship between healthcare and life?
Life - as in you have the unalienable right to live your life as you see fit - enjoy the rewards as well as suffer the consequences for your behavior. You have no right to demand services provided by another individual. That would be a clear infringement upon their unalienable rights.
And yet csar is fine with everyone being entitled to the same level of fire or police services.....that's an exception to his 'you cannot demand services' mantra.
Depends on the nation. In the US there is a clear distinction - one of the responsibilities of government is to provide security to the citizens. So in this case this supports and ensures that life, liberty and pursuit of happiness is achievable.
Law enforcement is an inherent role of government. Healthcare is not.
It's true it depends on the nation as different nations have different opinions on human rights and governmental roles. I for one think healthcare is necessary for both life and the pursuit of happiness and by providing the same level to all citizens, it is not unduly impeding the rights of other citizens.
Euro/UK socialized health care (sick care) also provides tax payer funded medical services to non-citizens. Given the current situation in UK/Western Europe, how much longer do you think that will be sustainable?
I can't speak for other countries, but I know in the UK that healthcare is provided to all legal residents. Non British but EU citizens pay the same NI taxes as British citizens to fund the healthcare system. Non British and non EU citizens also pay the same NI taxes PLUS an NHS surcharge of £500/per visa. The usual visa lasts 30months. So every 30months the fee is paid again and it actually goes up a bit every few years. British expats/EU nationals are not legally allowed to just catch a flight to the UK and use the NHS, they have to formally relocate and re-establish their residency in the UK by staying there a year. So anyone who is not a legal resident, pays their own way. There is a problem with people defrauding the NHS which costs around 280M/yr but this is being cracked down on currently. In Europe we have the EHIC system where say you are Spanish and on holiday in the UK, you can use the NHS free to you and the NHS bills the costs to the Spanish government. And vice versa.
So, I think it is sustainable so long as Parliament continue to fund it. The biggest danger to the NHS right now is Parliament starving it of funds to boost pension payments. A sort of generational theft is going on here now.3 -
janejellyroll wrote: »GlassAngyl wrote: »Nope. I'm obese and I never go to the doctor. Why should I pay for a service I never use? Have you seen those heII holes? Nasty sick people spewing their diseases all over the place.. Vampires draining their victims of blood.. Mad scientist injecting unknown substances into bewitched volunteers.. No thank you. I'll take my chances.
I go to the doctor at least once a year and have never seen an office with "nasty sick people spewing their diseases all over the place." And I've never been drained of blood (at the most, it's a tube or two) or been injected with an unknown substance.
If you never go to the doctor, why are you so confident that you know what is happening there?
So you go to a doctor that only sees healthy people? I just went with my sister in law to take her son to get his 4 month shots. There were kids wheezing and coughing and boogering all over the waiting room. Some were there for well check ups and others were there because their moms feel the need to have them checked every time they get a runny nose. Guess who caught a cold two days later?
As for the vampire references and mad scientist, apparently you have never encountered sarcastic exaggerations before. I take a more literary approach when describing my surroundings. Curse of writers and avid readers I suppose, having a flair for the dramatic.
I don't go to the doctor for every tummy ache or discomfort. I'm not a hypochondriac that monitors every symptom through webMD. Sorry if my not following the lemmings offends you.
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https://fee.org/articles/health-insurance-is-illegal/
This whole thread is based on a faulty premise, anyways, at least as far as the USA is concerned.2 -
https://fee.org/articles/health-insurance-is-illegal/
This whole thread is based on a faulty premise, anyways, at least as far as the USA is concerned.
Excellent article. Much of what we term insurance today is actually nothing more than a pre-paid medical plan. With atrocious fiduciary abuses.3 -
GlassAngyl wrote: »janejellyroll wrote: »GlassAngyl wrote: »Nope. I'm obese and I never go to the doctor. Why should I pay for a service I never use? Have you seen those heII holes? Nasty sick people spewing their diseases all over the place.. Vampires draining their victims of blood.. Mad scientist injecting unknown substances into bewitched volunteers.. No thank you. I'll take my chances.
I go to the doctor at least once a year and have never seen an office with "nasty sick people spewing their diseases all over the place." And I've never been drained of blood (at the most, it's a tube or two) or been injected with an unknown substance.
If you never go to the doctor, why are you so confident that you know what is happening there?
So you go to a doctor that only sees healthy people? I just went with my sister in law to take her son to get his 4 month shots. There were kids wheezing and coughing and boogering all over the waiting room. Some were there for well check ups and others were there because their moms feel the need to have them checked every time they get a runny nose. Guess who caught a cold two days later?
As for the vampire references and mad scientist, apparently you have never encountered sarcastic exaggerations before. I take a more literary approach when describing my surroundings. Curse of writers and avid readers I suppose, having a flair for the dramatic.
I don't go to the doctor for every tummy ache or discomfort. I'm not a hypochondriac that monitors every symptom through webMD. Sorry if my not following the lemmings offends you.
When I visit the doctor, people with active symptoms are checked in right away. There is nobody "boogering" in the waiting room. I don't think I've ever become ill due to visiting the doctor.
I appreciate you clarifying that you were exaggerating. I am also an avid reader, although I prefer to read less fantastical approaches to reality (at least when the writer is attempting non-fiction).
I'm not at all offended by your preference to avoid medical treatment. I'm not even sure why you mind would go there. I can disagree with your position without being offended that you hold it.1 -
GlassAngyl wrote: »janejellyroll wrote: »GlassAngyl wrote: »Nope. I'm obese and I never go to the doctor. Why should I pay for a service I never use? Have you seen those heII holes? Nasty sick people spewing their diseases all over the place.. Vampires draining their victims of blood.. Mad scientist injecting unknown substances into bewitched volunteers.. No thank you. I'll take my chances.
I go to the doctor at least once a year and have never seen an office with "nasty sick people spewing their diseases all over the place." And I've never been drained of blood (at the most, it's a tube or two) or been injected with an unknown substance.
If you never go to the doctor, why are you so confident that you know what is happening there?
So you go to a doctor that only sees healthy people? I just went with my sister in law to take her son to get his 4 month shots. There were kids wheezing and coughing and boogering all over the waiting room. Some were there for well check ups and others were there because their moms feel the need to have them checked every time they get a runny nose. Guess who caught a cold two days later?
As for the vampire references and mad scientist, apparently you have never encountered sarcastic exaggerations before. I take a more literary approach when describing my surroundings. Curse of writers and avid readers I suppose, having a flair for the dramatic.
I don't go to the doctor for every tummy ache or discomfort. I'm not a hypochondriac that monitors every symptom through webMD. Sorry if my not following the lemmings offends you.
Medical care is for the lemmings...LOL.
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If one "higher risk" group is targeted, then all higher risk groups should be targeted.
Those who participate in extreme sports or endurance sports are at bigger risk of needing expensive surgeries.
Those who ride a bicycle to work are at higher risk of serious injury than people who drive.
Someone who drives a car instead of taking 2 to 4 times as long to get to work public transportation are at bigger risk.
Basically anyone who is not a couch potato, consuming food in perfect equilibrium, is at higher risk of incurring higher medical expenses.
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If one "higher risk" group is targeted, then all higher risk groups should be targeted.
Those who participate in extreme sports or endurance sports are at bigger risk of needing expensive surgeries.
Those who ride a bicycle to work are at higher risk of serious injury than people who drive.
Someone who drives a car instead of taking 2 to 4 times as long to get to work public transportation are at bigger risk.
Basically anyone who is not a couch potato, consuming food in perfect equilibrium, is at higher risk of incurring higher medical expenses.
Except that being a couch potato is one of the highest risk factors for serious, chronic health problems and early death. Those others you describe are at higher risk for accidents. Couch potatoes are at risk for chronic diseases. Just sayin'.
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My husband's employer offers a discount for participating is healthy lifestyle seminars and routine well-checks. I'd rather incentivise healthy lifestyles than punish unhealthy ones. I know, I know, potato pot-tah-to. But it seems like a more positive, easier to swallow spin.4
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How 'bout if instead of charging more for the obese they include coverage that would help them, like nutrition therapy? That's only covered once you've develpoed a condition like diabetes. Discounts for gym memberships, maybe?
...but then again I've never thought insurance companies were actually interested in getting people healthy. The more people in general are unhealthy, the more they can justify raising rates. Same thing with the modern medical/pharmaceutical induatry- they don't make money if they actually heal you, so they just treat the symptoms.1 -
Yes, they do it for life insurance. Also, why should I have to pay more than someone who can't be bothered to stop stuffing their face full of twinkies and get out and go for a walk?5
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Skinny doesn't mean healthy and fat doesn't mean unhealthy0
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Yes, they do it for life insurance. Also, why should I have to pay more than someone who can't be bothered to stop stuffing their face full of twinkies and get out and go for a walk?
Life insurance and health insurance are two very different products.
Also, are you kittening serious??2 -
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No. I don't think we should charge obese, chronically ill, female, or disabled patients more. End of story. But I do think that health insurance should better cover preventative care and/or lifestyle interventions. Like imagine if we could just fund nutritionists and therapists for people with all sorts of health problems, whether underweight or obese or chronically ill; we will likely see a reduction in dependence on expensive medical interventions.3
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Yes, they do it for life insurance. Also, why should I have to pay more than someone who can't be bothered to stop stuffing their face full of twinkies and get out and go for a walk?
I can't get life insurance or long term disability that requires medical clearance because I wad once diagnosed with sleep apnea. Doesn't matter that I don't have it anymore. It is in my medial record. Plus a polyp removed that had abnormal cells but not yet considered pre- cancerous.2 -
Yes, they do it for life insurance. Also, why should I have to pay more than someone who can't be bothered to stop stuffing their face full of twinkies and get out and go for a walk?
So should they charge more for women who keep getting pregnant because they can't seem to stop whatever it is they are doing to get pregnant?2 -
I haven't read all the responses, only skimmed a few. But, here's a little bit of personal experience in terms of weight, BMI and health insurance...
A number of years ago, before "Affordable" Health Care Act, I was self-employed with a family (wife with a pre-existing condition and a teenage son). I found it was very difficult to find private health insurance. Between her pre-existing condition, and my BMI (34%, and was very muscular due to powerlifting/strongman competitions), we were either declined or would have to pay an outrageous amount for really poor coverage. We wound up having to go with the poor coverage/high cost, otherwise, we would be without.
During the time I was searching for health insurance, I was being told my BMI was unacceptable. This was them not even looking at a medical chart, nor doing a physical on me. I offered to pay for a physical, at a doctor of their choice, to show I was healthy so long as they accepted it and covered me. They told me that they couldn't, due to how their programs read charts and compare numbers to determine. i asked if an underwriter would change it. Was again denied.
So, yes, at least back then they did charge more and/or deny coverage based on weight/BMI. Later, mine was rescinded because I neglected to write down that I went to a chiropractor for routine adjustments due to my strongman training. Which, is another story in and of itself...
As to the amount one pays for health insurance, I have zero issues if it is adjusted based upon health conditions. Charge more for pre-existing conditions, obesity, etc. While charging less for those whom can verifiably prove they are healthy. It is a reward program with incentives to be healthy. Heck, I know of insurance companies who will knock $1200/year off a family plan so long as certain conditions are met. Again, no issues there.
All that being said, here's where I have issues with health insurance and their plans:
1) Insurance should be charged by the person. Not by family. For example, why should a family of three pay the exact same premium as a family of eight?
2) The BMI chart is known to be faulty. Even the modified version for the military is. Therefore, if a person is on the heavier side due to heavy muscle mass, bone density, etc, give them a fitness test that is fair. If they can pass it, give them coverage at the standard rate. No issues if an annual physical shows this is no longer the case.
There are others. But, those are my big two. Now, on the flip side, it's been shown that our existing Gov't mandated health insurance is not "Affordable" and expenses keep skyrocketing. I see this as being caused by a few different reasons:
1) Rather than going to urgent care, or a regular doctor, many people will go sit in an ER waiting room for minor things that could be seen by a regular doctor. Most of them are lower income class, or immigrants, whom can't afford it. So, they go to ER and many times the bills are absorbed by those of us who do pay.
2) Most Americans with insurance rarely will bat an eye at the expenses of medical treatment, surgery, or otherwise. Why? Because they're "glad they aren't paying for it". But, they do complain about the percentage that isn't covered. If they were to pay closer attention to costs, and scrutinize charges, I'm sure it might help cut down on both number of visits which may not necessarily be needed as well as help control medical costs. Remove insurance, and they'd really think twice about some procedures...
3) Various other things such as costs to get FDA approval, malpractice insurance/laws, etc.
Regarding the first two, it will require a major change in thought process for when one should go be seen, and what kind of facility they need to go to.2 -
They already do, it's called the "self and family" rate of health insurance.Yes, they do it for life insurance. Also, why should I have to pay more than someone who can't be bothered to stop stuffing their face full of twinkies and get out and go for a walk?
So should they charge more for women who keep getting pregnant because they can't seem to stop whatever it is they are doing to get pregnant?
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Skinny doesn't mean healthy and fat doesn't mean unhealthy
Being fat is unhealthy. Just like smoking is unhealthy. A current smoker may not have lung cancer, but their risk is much greater than it would be if they didn't smoke. An obese person may not currently have diabetes, or high blood pressure, but they are greatly increasing their risk for a number of health issues. Anything that increases your risk like obesity does has to be considered unhealthy.3 -
How 'bout if instead of charging more for the obese they include coverage that would help them, like nutrition therapy? That's only covered once you've developed a condition like diabetes. Discounts for gym memberships, maybe?
They've gotten a lot better about stuff like that in recent years though. Some companies do give back an allotment of cash to be used at selected vendors which includes gyms, or things like nutrition classes. (ETA: as either a debit card accepted by certain vendors, or gyms will have pricing coordinated with some of the insurance companies).0 -
I have insurance from Aetna through my employer. Our plan includes big discounts for gym memberships, professional services like nutritionists and personal trainers, etc. We also have a reward program through Redbrick where we get discounts on our premiums, up to $300/yr, and can additionally earn up to $300/yr in cash rewards by completing certain activities.
I've only just recently started taking advantage of all that, and beating myself up over the $3000 I left on the table over the last 5 years with my employer that I didn't realize we had these options.2 -
No but instead they should get a discount if they start a diet program0
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I have insurance from Aetna through my employer. Our plan includes big discounts for gym memberships, professional services like nutritionists and personal trainers, etc. We also have a reward program through Redbrick where we get discounts on our premiums, up to $300/yr, and can additionally earn up to $300/yr in cash rewards by completing certain activities.
I've only just recently started taking advantage of all that, and beating myself up over the $3000 I left on the table over the last 5 years with my employer that I didn't realize we had these options.
@ritzvin @jdlobb
I'll have to look into that this open season. I used to have aetna and at the time the only gym type benefit was a discount for Curves. Not exactly helpful for me. Right now I have Kaiser Permanente. No gym/nutrition benefits that I know of.1
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