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Do you think obese/overweight people should pay more for health insurance?
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If you raise the rates for one high risk group, you need to do it for all high risk groups. Obesity can have complex causes that many of us never even think of, and yes, it can also be just a matter of having food as one's addiction rather than whiskey or nicotine. I think if you do charge higher rates for obesity, do it this way: For the first two years you are insured, you pay the same rate as everyone else but the ins company agrees to provide you with free customized nutrition counseling, behavior therapy, and personal training for the first year. If you have lost a sizable portion of your excess fat by renewal for 3rd year, your rates don't increase. If you stayed the same or gained weight then your rates go up.4
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ldscott716 wrote: »If you raise the rates for one high risk group, you need to do it for all high risk groups. Obesity can have complex causes that many of us never even think of, and yes, it can also be just a matter of having food as one's addiction rather than whiskey or nicotine. I think if you do charge higher rates for obesity, do it this way: For the first two years you are insured, you pay the same rate as everyone else but the ins company agrees to provide you with free customized nutrition counseling, behavior therapy, and personal training for the first year. If you have lost a sizable portion of your excess fat by renewal for 3rd year, your rates don't increase. If you stayed the same or gained weight then your rates go up.
How about some personal responsibility and the individual pays for the steps to lose the weight if they want lower rates?2 -
ldscott716 wrote: »If you raise the rates for one high risk group, you need to do it for all high risk groups. Obesity can have complex causes that many of us never even think of, and yes, it can also be just a matter of having food as one's addiction rather than whiskey or nicotine. I think if you do charge higher rates for obesity, do it this way: For the first two years you are insured, you pay the same rate as everyone else but the ins company agrees to provide you with free customized nutrition counseling, behavior therapy, and personal training for the first year. If you have lost a sizable portion of your excess fat by renewal for 3rd year, your rates don't increase. If you stayed the same or gained weight then your rates go up.
Obesity has one simple cause - one eats more calories than they burn.
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janejellyroll wrote: »JMcGee2018 wrote: »Assigning premiums based on lifestyle choices that can change at any time for any reason sounds like a pretty big overhead expense to me... and overhead costs are ultimately absorbed by consumers anyway. Sounds like a waste of time and money, but what do I know...
I think a mandatory yearly physical should be put in place, and at that time the doctor can calculate your BMI, which you would then submit as part of your taxes in return for a tax credit if you are in a healthy BMI range or no tax credit (or at least a reduced tax credit) if you are in an unhealthy range.
Wishful thinking. The government in the US is limiting tax credits and tax deductions and do you think that Congress will change the tax code again to accommodate for incentives for a healthy BMI? I think NOT!
Besides, we all know that BMI is a relative measure of fitness. A very fit person doing a lot of exercise and developing a nice muscular physic will weigh more and have a higher BMI that somebody leaner but probably not so healthy. So the ripped guy will pay more while the not so healthy one will be rewarded with a tax refund, credit or what ever? Not a good idea.
I am not advocating for a BMI-based tax credit system, but it's likely that the very fit person who has developed a muscular physique and the leaner person who is not so healthy will both fall into the healthy BMI range. BMI being thrown off my muscle is only an issue for more serious bodybuilders, not people who are just fit and developing muscle.
I understand the point that you are trying to make, but I don't believe the bolded is accurate. I am 6'2" 196lbs right now and I would fall into the overweight category(barely) and I am not a bodybuilder. When I bulk though I easily top 200lbs(still within 10-12% bodyfat) which puts me squarely into the overweight category. I understand I am an outlier, but I also don't believe that someone needs to be a bodybuilder or an elite athlete to fall outside of the normal range for BMI.2 -
Even if I thought wholly privatized health care was a generally good idea, the answer is still no. This practice undermines the idea of risk pooling, and really doesn't actually help anyone in the end except the insurance companies' bottom lines (you've got to be really naive or simply not be paying attention to think this would actually lower healthy people's rates by any significant amount).
The obese and overweight are just one high risk group -- there are several others as well. It follows that, in time, insurance companies would charge extra for those groups as well, regardless of if those groups have any control over their risk factors. Perhaps the "I got mine so whatever" crowd is cool with this, but personally I find it ethically wrong and also practically counterproductive if one truly cares about improving public health. People will sooner just be simply shut out of the services that they need than actually be driven to lose the weight. I don't know how long it's going to take for some people to notice that, for the most part, you can't beat people out of their bad habits like this. I suppose it's easier for them to bury their head in the sands and believe that the approach we've always used is working despite all our metrics indicating otherwise.4 -
janejellyroll wrote: »JMcGee2018 wrote: »Assigning premiums based on lifestyle choices that can change at any time for any reason sounds like a pretty big overhead expense to me... and overhead costs are ultimately absorbed by consumers anyway. Sounds like a waste of time and money, but what do I know...
I think a mandatory yearly physical should be put in place, and at that time the doctor can calculate your BMI, which you would then submit as part of your taxes in return for a tax credit if you are in a healthy BMI range or no tax credit (or at least a reduced tax credit) if you are in an unhealthy range.
Wishful thinking. The government in the US is limiting tax credits and tax deductions and do you think that Congress will change the tax code again to accommodate for incentives for a healthy BMI? I think NOT!
Besides, we all know that BMI is a relative measure of fitness. A very fit person doing a lot of exercise and developing a nice muscular physic will weigh more and have a higher BMI that somebody leaner but probably not so healthy. So the ripped guy will pay more while the not so healthy one will be rewarded with a tax refund, credit or what ever? Not a good idea.
I am not advocating for a BMI-based tax credit system, but it's likely that the very fit person who has developed a muscular physique and the leaner person who is not so healthy will both fall into the healthy BMI range. BMI being thrown off my muscle is only an issue for more serious bodybuilders, not people who are just fit and developing muscle.
I understand the point that you are trying to make, but I don't believe the bolded is accurate. I am 6'2" 196lbs right now and I would fall into the overweight category(barely) and I am not a bodybuilder. When I bulk though I easily top 200lbs(still within 10-12% bodyfat) which puts me squarely into the overweight category. I understand I am an outlier, but I also don't believe that someone needs to be a bodybuilder or an elite athlete to fall outside of the normal range for BMI.
Thanks for correcting me based on your personal experience. I had thought there was more of a threshold for muscle development built into BMI, but clearly I was wrong.2 -
Only if people are actually having to pull from insurance from obesity related issues should they have to pay more.
I myself am morbidly obese. But do I have high blood pressure? no. Do I have diabetes? no. Do I joint problems from excess weight that necessitate treatment? no. I have extra weight, which I am working very hard to get rid of, but I am an incredibly healthy person compared to many.
But, I do have schizophrenia and require medication for that. Did my "lifestyle choices" contribute to this health problem that effects every part of my life? Nope. Trust me. Nobody chooses to have schizophrenia.
In fact my medication used to treat it cause massive weight gain to the tune of 80 lbs in a year. That is WHY I am morbidy obese. How is that my fault? Simple. It's not.
I think that it's a good idea to have incentives for people to hit, like being able to pay less if you prove a certain amount of activity or go to wellness checkups or what not. Because that's what healthy people do. I mean, I work out 5 times a week for an hour and see my doctor regularly even though I'm obese. Those sorts of procedures don't discriminate because anyone can do them. If you choose not to and pay more, that's not "paying more to be fat". That's paying more to be unhealthy, pure and simple, and should happen.
Likewise as many people have said before, BMI is a poor marker of health among muscular people. Before I gained all this weight, I was incredibly athletic, and wore a size 8 while being 180 lbs of pure muscle at 5'9.5''. That would put me 10 lbs into the overweight category, even though I was probably fitter than most. And it's not like I spent hours at the gym to maintain this physique.
Asking overweight/obese people to pay more sounds like a good idea on the surface, but it's not that simple. Smoking gives a direct relationship to having unhealthy effects. Weight, not so much. Correlation does not imply causation. Also, what do you do with facts like the fact that for senior citizens, having an overweight BMI can actually provide more health protections than a healthy BMI in many diseases? Isn't that what insurance is trying to predict?
Frankly right now the relationship between weight and health is complex. I won't say it's a black box, but there's so much more to be understood. In the future there may be a way to tease apart what makes people healthy vs unhealthy. But right now, we don't know enough, and we'll just end up hurting people who are actually fine.2 -
It's a slippery slope.
We should employ resources, education, and smart policy to empower citizens to be better people capable of making better decisions.
Long Term vs. Short Term thinking.0 -
It's a slippery slope.
We should employ resources, education, and smart policy to empower citizens to be better people capable of making better decisions.
Long Term vs. Short Term thinking.
And it's not a simply moral argument.
Food doesn't just amount to individual choice. It's access to food, education about nutrition, financial security to invest in more expensive food (fresh food, vegetables, DO cost more). Studies find that as income increases, so do expenditures on "wellbeing": healthy food, physical activities, hobbies, etc.
We've only begun looking at how race affects issues of poverty, education, incarceration, employment opportunities, etc. Structural violence is not limited in this way. Understanding why trends exist, why people make the choices they do, having compassion instead of judgment, supporting instead of criticizing, rehabilitating instead of incarcerating, preventing instead of treating, investing in people's wellbeing --these are the basic benchmarks of a society that can grow to become good.0 -
ldscott716 wrote: »If you raise the rates for one high risk group, you need to do it for all high risk groups. Obesity can have complex causes that many of us never even think of, and yes, it can also be just a matter of having food as one's addiction rather than whiskey or nicotine. I think if you do charge higher rates for obesity, do it this way: For the first two years you are insured, you pay the same rate as everyone else but the ins company agrees to provide you with free customized nutrition counseling, behavior therapy, and personal training for the first year. If you have lost a sizable portion of your excess fat by renewal for 3rd year, your rates don't increase. If you stayed the same or gained weight then your rates go up.
Obesity has one simple cause - one eats more calories than they burn.
Usually, yes. But it can be far more complicated to reverse that. For example, how do you think *I* became obese to begin with? Eating more calories than I burned, obviously...but why? Why was my intake higher than my output? Anyone?
If you don't address the cause, then you aren't going to permanently resolve the problem. You'll have chronic re-gainers. The point of what I proposed is to help people who don't know jacksquat about health, their own health, and who very likely may not be able to afford the resources to learn about it in a way that's tailored to the cause of their imbalance between intake and output. The lack of knowledge out there is mind-boggling. Give the people tools if the goal is *truly* to have a healthier population, and not just to penalize fat people for being fat. Isn't that the goal? Good health?
The personal responsibility? Did you not see where that came into play? If the person does not *use* the educational tools the insurance provides and does not put in hard work to improve their health, then they start paying those high rates. You can dump all tools in the world on somebody, but the real work involved is using them.0 -
This is a tough question...
When I signed up for medical insurance, they wouldn't cover any pre-existing conditions.
So on that hand I can see how being obese could be seen as a pre-existing condition waiting to happen.
BUT, on the other hand, plenty of obese/overweight people don't have any of the illnesses one would associate with excess weight and plenty of 'normal' weight people DO have illnesses one associates with excess weight.
So, I guess... my final answer is no. I think it would open a huge can of worms. What's next? Charging those who are excessively underweight more? Charging those of certain heights more (some heights come with increased risk of back issues, for example)?
And this is slightly off topic but I think it would be awesome to see more companies invest in their employees health. My old job provided everyone with a free gym membership. I always thought that was an excellent way to encourage healthy habits in the staff (I didn't take them up because I had a gym membership elsewhere at the time but yeah, what a great idea). NOT SAYING companies SHOULD HAVE TO do that. Just saying it would be nice if those who could, did.1 -
I don't know about making them pay more, but it would be nice to see more incentives for those who put in the effort to stay healthy. The reality, however, is that tracking that information would likely create so much overhead that it would negate any advantages (or perhaps even end up costing more in the long run).
It's a mixed bag, really. Smokers (who admit to it) pay more, and it's shown that obesity is a drain on the healthcare system. But how to track and record that information? No idea if there's a good way to do it or not.0 -
This is a tough question...
So, I guess... my final answer is no. I think it would open a huge can of worms. What's next? Charging those who are excessively underweight more? Charging those of certain heights more (some heights come with increased risk of back issues, for example)?
lol I just imagined being charged a premium for big boobs - back problems waiting to happen!
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This is a tough question...
So, I guess... my final answer is no. I think it would open a huge can of worms. What's next? Charging those who are excessively underweight more? Charging those of certain heights more (some heights come with increased risk of back issues, for example)?
lol I just imagined being charged a premium for big boobs - back problems waiting to happen!
LOL! FML if that happens. I can lose weight, I can't do anything about the girls.0 -
HoneyBadger155 wrote: »I don't know about making them pay more, but it would be nice to see more incentives for those who put in the effort to stay healthy. The reality, however, is that tracking that information would likely create so much overhead that it would negate any advantages (or perhaps even end up costing more in the long run).
It's a mixed bag, really. Smokers (who admit to it) pay more, and it's shown that obesity is a drain on the healthcare system. But how to track and record that information? No idea if there's a good way to do it or not.
But smoker could say "I don't have lung cancer". We all know there's a "yet" that really should be attached to that. And yes, there are smokers who may never get related illnesses. It's not about the guarantee, it's about the higher risk. Someone who drives and expensive car may never have it stolen, it's not their fault even that it's the car it a higher target for theft. They still are paying more for insurance.2 -
No skinny fat people exist and so do people like my dad who refuse to do the things he was told to do by the doctor until too late. Now he's only got a few years to live with a heart thats shutting down. Then there are people like me who eat mostly healthy, exercise, don't drink in excess or smoke, and still get sick. I have never even been overweight. Top of average for my height, but not overweight. Should I pay?3
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MoiAussi93 wrote: »Yes, obesity greatly increases the risk of developing a wide range of expensive diseases. It's fair that overweight/obese people pay more. Smokers pay more for the same reason. This is no different.
This is not true smokers pay the same. I know my dad was a heavy smoker his plan is actually cheaper than mine. It really comes down to the carrier you are always paying for others.2 -
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.
Lol yeah they do its easy to lie about not smoking. Vapes make it impossible to control since smell no longer a factor. This is just a nonsense policy that makes people feel good and wastes resources. Nanny state indeed. I laugh at people who don't want the government in their business, but then are okay with companies and governments telling you what to do outside of nonworking hours. It's still a nanny state just with companies. Welcome to your government.0 -
should alcoholics pay more for alcohol, should drivers pay more for road tax, should daily commuters pay more for travel. List goes on and on and I see no difference between obese and many other issues so no they should not pay more.0
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Commuter train fare costs money, so even though taxes pay some portion of the cost, daily commuters pay more.
We have toll roads, but also roads benefit people who don't drive almost as much -- think of all the things transported by road.
Alcohol is taxed due to costs related to alcohol abuse, in part.
Thus, I don't understand what point is supposedly being made by those examples.
Re smoking, in a free market obviously insurance companies would charge more for smoking.
Obamacare permits smokers to be charged more.
Some states have additional laws prohibiting smokers from being charged more, but they are the minority.
Workplace group insurance very well may not have increased costs for smokers -- depends on what the workplace does (the same workplaces would likely not have increased costs for obesity or the like).
In the insurance context, risk affects insurance costs in everything but health care. It makes sense it doesn't for health care (it's dumb we handle it through insurance, IMO), but would it be good to place incentives for doing things that lead to lower health care costs in the future? Sure. The question is what are those things/what would be fair.
This suggests that current workplace wellness incentives aren't particularly useful: http://www.chicagotribune.com/business/ct-biz-workplace-wellness-programs-20180126-story.html
http://www.wbur.org/commonhealth/2018/01/26/gold-standard-workplace-wellness-zero
However, I'm not sure that's the end word, in that it's just a one year thing, and the benefits would be longer term. Work is for many people a place that does have an effect on their life more broadly -- at a prior employer of mine there being a culture that valued fitness and exercise and eating healthy largely did end up leading to a lot of people getting into it, I think, so that if it was a promoted thing (vs. "why are you thinking about health when you should be working only") and seemed like the fun cool thing people were doing then I think it could have a broader effect, but there's going to be major self-selection going on and the workplace being involved in life to that extent certainly has it's uncomfortable side.1
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