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

rheddmobile wrote: »

Cherimoose wrote: »

This is an ancient thread.

Onedaywriter wrote: »

I read earlier that runners have an usually high risk of injury. So would I pay more because I have higher injury risk or less because I’m no longer obese?

You would pay less because you're no longer obese. The costs of obesity far outweigh the cost of seeing a doctor once because of shin splints or Achilles tendinitis.

I dunno, my running injury was pretty expensive. I don’t have insurance so had to pay up front. It cost me almost as much to diagnose and treat a ruptured Baker’s cyst as my mom’s recent 6 day hospital stay with diabetes related kidney issues. Her whole hospital stay plus surgery and ER fees was 8k roughly. I had ER fees plus ultrasound and labs fo determine I didn’t have a blood clot, surgery guided by ultrasound to drain the cyst, X-rays and associated nonsense because the osteo was determined to do his usual collection of stuff whether I needed it or not, then an MRI “to be sure there’s not an underlying condition causing the Baker’s cyst.” Steroid shots, antibiotics, etc.

Given that some estimates put 80% of runners being injured every year, maybe they should consider running a pre-existing condition!

Your mom's 6 day hospital stay for kidney issues that included a surgery didn't cost $8k, that was her out of pocket. Total bill was probably closer to $200k+ and insurance picked up most of it.

Orthopedic injuries from exercise are generally lower cost if they happen and help prevent 6 figure hospitalizations from obesity related issues.

Wow. This thread is toxic. Obesity is NOT always a choice. I’ve been “overweight” according to BMI my whole life and I did NOT choose it. I was overweight DESPITE a healthy lifestyle of eating well and being relatively active. Bodies come in all shapes and sizes and lots of people are naturally bigger and it’s GENETIC and NOT a choice. BMI is a crappy system that doesn’t take muscle mass into account. Lots of “overweight” people with high muscle mass and an active lifestyle are perfectly healthy despite being labeled as “overweight” by BMI. Plus size women already face SO much discrimination in the workplace and we don’t get equal representation in the media and now you guys want to add on even more discrimination? What is wrong with you people? I’ve only been on this forum a few weeks but as someone who identifies as plus size I have felt so much negativity towards me here. Stuff like this is really triggering for me and I am feeling SO pissed right now!

CurvyEmmy wrote: »

Wow. This thread is toxic. Obesity is NOT always a choice. I’ve been “overweight” according to BMI my whole life and I did NOT choose it. I was overweight DESPITE a healthy lifestyle of eating well and being relatively active. Bodies come in all shapes and sizes and lots of people are naturally bigger and it’s GENETIC and NOT a choice. BMI is a crappy system that doesn’t take muscle mass into account. Lots of “overweight” people with high muscle mass and an active lifestyle are perfectly healthy despite being labeled as “overweight” by BMI. Plus size women already face SO much discrimination in the workplace and we don’t get equal representation in the media and now you guys want to add on even more discrimination? What is wrong with you people? I’ve only been on this forum a few weeks but as someone who identifies as plus size I have felt so much negativity towards me here. Stuff like this is really triggering for me and I am feeling SO pissed right now!

Sorry if you are feeling triggered. Does it trigger you that obesity is the second leading cause of preventable death in the US? If not it should: https://www.wvdhhr.org/bph/oehp/obesity/mortality.htm

It's nothing personal, just facts and data.

I would have no problem and would encourage basing any sort of obesity related insurance surcharge for obesity on bodyfat measurement via DEAX scan, etc as opposed to strictly BMI.

Fact is though in the vast majority of cases if someone is obese based on BMI they will be obese on measures of bodyfat such as a DEXA scan.

Theoldguy1 wrote: »

rheddmobile wrote: »

Cherimoose wrote: »

This is an ancient thread.

Onedaywriter wrote: »

I read earlier that runners have an usually high risk of injury. So would I pay more because I have higher injury risk or less because I’m no longer obese?

You would pay less because you're no longer obese. The costs of obesity far outweigh the cost of seeing a doctor once because of shin splints or Achilles tendinitis.

I dunno, my running injury was pretty expensive. I don’t have insurance so had to pay up front. It cost me almost as much to diagnose and treat a ruptured Baker’s cyst as my mom’s recent 6 day hospital stay with diabetes related kidney issues. Her whole hospital stay plus surgery and ER fees was 8k roughly. I had ER fees plus ultrasound and labs fo determine I didn’t have a blood clot, surgery guided by ultrasound to drain the cyst, X-rays and associated nonsense because the osteo was determined to do his usual collection of stuff whether I needed it or not, then an MRI “to be sure there’s not an underlying condition causing the Baker’s cyst.” Steroid shots, antibiotics, etc.

Given that some estimates put 80% of runners being injured every year, maybe they should consider running a pre-existing condition!

Your mom's 6 day hospital stay for kidney issues that included a surgery didn't cost $8k, that was her out of pocket. Total bill was probably closer to $200k+ and insurance picked up most of it.

Orthopedic injuries from exercise are generally lower cost if they happen and help prevent 6 figure hospitalizations from obesity related issues.

Her out of pocket was zero. It’s good to be an elderly widow of a military officer in the US. That is the stated total cost, Tricare said they would have covered up to 24k, but the bill was 8. I know, I was shocked too.

rheddmobile wrote: »

Theoldguy1 wrote: »

rheddmobile wrote: »

Cherimoose wrote: »

This is an ancient thread.

Onedaywriter wrote: »

I read earlier that runners have an usually high risk of injury. So would I pay more because I have higher injury risk or less because I’m no longer obese?

You would pay less because you're no longer obese. The costs of obesity far outweigh the cost of seeing a doctor once because of shin splints or Achilles tendinitis.

I dunno, my running injury was pretty expensive. I don’t have insurance so had to pay up front. It cost me almost as much to diagnose and treat a ruptured Baker’s cyst as my mom’s recent 6 day hospital stay with diabetes related kidney issues. Her whole hospital stay plus surgery and ER fees was 8k roughly. I had ER fees plus ultrasound and labs fo determine I didn’t have a blood clot, surgery guided by ultrasound to drain the cyst, X-rays and associated nonsense because the osteo was determined to do his usual collection of stuff whether I needed it or not, then an MRI “to be sure there’s not an underlying condition causing the Baker’s cyst.” Steroid shots, antibiotics, etc.

Given that some estimates put 80% of runners being injured every year, maybe they should consider running a pre-existing condition!

Your mom's 6 day hospital stay for kidney issues that included a surgery didn't cost $8k, that was her out of pocket. Total bill was probably closer to $200k+ and insurance picked up most of it.

Orthopedic injuries from exercise are generally lower cost if they happen and help prevent 6 figure hospitalizations from obesity related issues.

Her out of pocket was zero. It’s good to be an elderly widow of a military officer in the US. That is the stated total cost, Tricare said they would have covered up to 24k, but the bill was 8. I know, I was shocked too.

That is super strange. I had outpatient rotator cuff surgery a few years ago and the discounted price my insurance was charged was $12k, insurance paid $9k we had to pay $3k.

I don't think it would cause weight stigma inherently, but it would make getting insurance more difficult (do you have to be weighed first?) and seems like it could be logistically difficult if you have workplace insurance (for example, does someone in admin have information about who is classed as obese?). I also wouldn't want to do anything to discourage people from getting health coverage (like thinking that they should wait until they manage to lose weight).

What I would be okay with is a program where you get discounts for certain positive behaviors. For example, yearly checkups, getting points for losing weight or controlling blood sugar or lowering blood pressure (which would be between the doctor and the insurance company). It would be entirely opt in, so someone who didn't want that could just pay the base price.

Theoldguy1 wrote: »

rheddmobile wrote: »

Theoldguy1 wrote: »

rheddmobile wrote: »

Cherimoose wrote: »

This is an ancient thread.

Onedaywriter wrote: »

I read earlier that runners have an usually high risk of injury. So would I pay more because I have higher injury risk or less because I’m no longer obese?

You would pay less because you're no longer obese. The costs of obesity far outweigh the cost of seeing a doctor once because of shin splints or Achilles tendinitis.

I dunno, my running injury was pretty expensive. I don’t have insurance so had to pay up front. It cost me almost as much to diagnose and treat a ruptured Baker’s cyst as my mom’s recent 6 day hospital stay with diabetes related kidney issues. Her whole hospital stay plus surgery and ER fees was 8k roughly. I had ER fees plus ultrasound and labs fo determine I didn’t have a blood clot, surgery guided by ultrasound to drain the cyst, X-rays and associated nonsense because the osteo was determined to do his usual collection of stuff whether I needed it or not, then an MRI “to be sure there’s not an underlying condition causing the Baker’s cyst.” Steroid shots, antibiotics, etc.

Given that some estimates put 80% of runners being injured every year, maybe they should consider running a pre-existing condition!

Your mom's 6 day hospital stay for kidney issues that included a surgery didn't cost $8k, that was her out of pocket. Total bill was probably closer to $200k+ and insurance picked up most of it.

Orthopedic injuries from exercise are generally lower cost if they happen and help prevent 6 figure hospitalizations from obesity related issues.

Her out of pocket was zero. It’s good to be an elderly widow of a military officer in the US. That is the stated total cost, Tricare said they would have covered up to 24k, but the bill was 8. I know, I was shocked too.

That is super strange. I had outpatient rotator cuff surgery a few years ago and the discounted price my insurance was charged was $12k, insurance paid $9k we had to pay $3k.

Very typical of TriCare and CHAMPVA.
Of course, it costs taxpayers….

But we want officer’s spouses and the spouses of 100% service connected disabled vets to be taken care of, right?

Even if they’re obese?

Or maybe some here don’t want that? I am curious…

Onedaywriter wrote: »

I think that something everyone misses in the whole “obesity costs health care money” is that we will all die eventually. Toward the end of life, health care costs often skyrocket.
So, if obesity were “cured” (imaginary of course) then ten or twenty years from now health care costs would skyrocket for all the non obese people just being old.
My mom is nowhere near obese (never was) but 95 (in fact we need to help her gain weight). In the past 8 months she broke her right hip once and her left hip twice. The costs for surgery and rehab without insurance (she’s well insured) would have been astounding.
Should mom pay more because she’s more likely to need medical care?
I was obese for 30 years and with the exception of an inguinal hernia (hereditary) never saw a doctor. I know I was just lucky but would it have been fair to charge me more?
Health insurance is not like car Insurance. We will all need health care at some point but many of us will never have a serious car accident.

Anecdotally, what I've often seen in my immediate life is different outcomes, on average, for always slim/active friends vs. those who are not. Certainly, both groups can experience essentially random health events, such as auto accidents, some forms of cancer, etc.

Apart from that, though, I have to say that it seems like, *on average*, the obese/inactive are likely to be consuming more health care services at a younger age, and more often, than the slim/fit. Yes, it seems like they also die at a younger age, but it seems like they can be more likely to have a long, slow, costly decline, maybe starting in 30s/40s. (Costly in life quality, too, not just $$.) Absent the "sudden random catastrophe" scenario, it seems like the slim/fit group is more likely to have a sharp and rather shorter decline, leading to death. I haven't seen the bills, but it seems like the lifetime dollar cost of slow decline over decades would be higher.

I'm not saying every single case follows that pattern, I'm just saying that I think I see that kind of trend, among people I know. It's actually one of the things that contributed to my deciding to lose weight and (especially) stay at a healthy weight . . . not so much the dollars side of it, as the quality of life.

On average, among friends my age (I'm 65), the inactive/obese are taking more medications, experiencing more medication side effects and interactions, getting sick more often, recovering more slowly from illnesses or needed surgeries, less able to continue doing as many of their own home chores, etc. On average, they're more constrained in what they can do for fun: Art fairs and music festivals involve too much walking, stadium events too much walking and stairs, food/drink choices are limited by health conditions or drug contraindications, they have less discretionary spending because of health-related costs, etc.

In a broader sense, in this discussion, we're also circling around the question of statistical risk vs. individual instances.

Insurance, generally, is about managing risk by spreading uneven costs across a diverse group of individual cases, a mix of higher- and lower-cost cases. How that risk is spread is situational, and does often consider risk subgroups. The teen driver situation with auto insurance is an example.

Generally, though, insurance is not intended primarily as individual reward or punishment at a very granular level, because that would pretty much defeat the point for the buyer, and perhaps for society as well. (Example: Systematic denial of health insurance to people with pre-existing conditions, at certain times: If they're uninsurable, or insurable only at unaffordable cost, the cost of their health care is still spread societally via bankruptcy or charity, rather than via insurance . . . assuming that in a civilized society, it would be unacceptable to completely deny essential health care.)

IMO, it's a legitimate public policy discussion, concerning which risks should affect insurance rates, especially risks in which individual choice has some role, but not necessarily an absolute role. I wouldn't expect a clear answer that everyone will be happy with.

IMO, it's absolutely legitimate to take actions, as a society, that incentivize personal decisions that have positive societal outcomes in a statistical-probability sense. How to do that, and in which cases, is thorny, especially in cases at the margin of what's a true decision - fully discretionary - and what's not.

lemurcat2 wrote: »

I believe the strange part wasn't the 0 out of pocket, but the $8K total cost, which does seem so low as to be strange, but I would guess that Tricare negotiated a good deal for themselves, as they may have the power to.

That was my assumption. I was honestly expecting more like 50k!

AnnPT77 wrote: »

IMO, it's a legitimate public policy discussion, concerning which risks should affect insurance rates, especially risks in which individual choice has some role, but not necessarily an absolute role. I wouldn't expect a clear answer that everyone will be happy with.

In my opinion, an insurance company has an obligation to maximise its profit. In order to do this it must aim to provide the least acceptable coverage to the people who are at lowest risk of using that cover. It's simple: if a characteristic of a person is unfavourable for coverage it must cost them more: in fact it must cost them disproportionately more because by even offering them a policy the company is taking on risk and unbalancing the distribution of people who pay and don't use healthcare services and those who actually use healthcare services (and therefore cost the company money, from time to time, by paying out more in claims than taken in dues). Those at highest risk of using services should not be offered policies. The insurance companies, of course, don't think they should die, per se, just that it is not their business to provide the human right that is healthcare. If the government wants to pick up the slack for all the people who can't get or can't afford policies, well, that is at their discretion.

Just kidding.

I'm not American, and this whole conversation is baffling! Healthcare is a right. It's not life insurance, or travel insurance where you can decide to have cover or not. At some point all humans' bodies will fail in one way or another, and they'll suffer pain, impairment and death, and it is their right to receive the best care that a society can provide to support them, ameliorate their symptoms and try to ensure they live long and healthy lives.

AnnPT77 wrote: »

IMO, it's absolutely legitimate to take actions, as a society, that incentivize personal decisions that have positive societal outcomes in a statistical-probability sense. How to do that, and in which cases, is thorny, especially in cases at the margin of what's a true decision - fully discretionary - and what's not.

I think this is a fundamental point. The wide and cheap availability of calorie dense foods has made it such that it is unremarkable that the populations of many countries are becoming heavier and heavier. There is no question that each human, who is capable and is not a child, choses to eat the food they eat, but the options are dramatically different depending on social, economic, psychological and biological factors. The fact that any country which increases the availability of calorie dense foods ends up with an obesity crisis, and this is repeatable the world over, indicates that, on a population level, this is not a 'choice' but a function of how food is addressed by society.

My opinion is that solely looking to individuals to make choices to reduce the societal challenges of obesity is naive, or malicious. I think there are very powerful interests in creating and perpetuating the idea that a full 40% of people are in some way morally failing by being obese, while simultaneously manufacturing, distributing and selling foods which essential cannot be eaten healthily, or at least aren't eaten healthily.

For my whole childhood I watch ads for foods which should, by all rights not exist, never mind be fed to children. When I go to buy cereal my gut instinct is to go for those staples of Saturday morning cartoon ad breaks: and look at the amount of sugar in them! The suggested serving size in 1/10th of a bowl, and yet it is still 20% of an adults daily sugar. I have to actively resist the temptation, and I don't even like cereal particularly.

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Wiseandcurious wrote: »

I'm not American, and this whole conversation is baffling! Healthcare is a right. It's not life insurance, or travel insurance where you can decide to have cover or not. At some point all humans' bodies will fail in one way or another, and they'll suffer pain, impairment and death, and it is their right to receive the best care that a society can provide to support them, ameliorate their symptoms and try to ensure they live long and healthy lives.

I could have written this.

I think the much bigher question our American friends should be pondering is who tricked them to think of healthcare as necessarily insurance based at all.

And for the record - no obese people shouldn't pay more and neither should smokers. Because - ding ding ding - this should not be insurance at all to begin with...

I am all for paying based on our income (i.e..use taxes to fund it) and using based on our need. It has been like this in all 3 countries I have lived in longer-term. I have refused jobs specifically in order not to ever have to live in the US, not because I don't like the US but for 2 very specific reasons - this being one of them.

Even if that were the question on the top of us USA-ians minds, there is utterly no option for an individual to snap her fingers and instantly make it be different, however much we might wish it different.

It's a lot easier to disapprove, than it is to change it.

Nothing in this post should be taken to say anything about my opinion, one way or another, about our health care system as it stands now, or about what it should be.

janejellyroll wrote: »

I'd been thinking about some of the above points recently as I've resumed business travel. When I'm at home and I have the luxury of time to select and prepare my own food, it's now almost effortless to hit my calorie goals. I can bulk up meals with lower calorie vegetables to ensure satiety, I can limit my access to tempting high calorie foods, and I can adjust recipes to lower the calorie count. All of these are much harder to do when I'm on the road. When I'm at home I rarely feel like I'm "on a diet," but when I'm travelling I feel that way most of the time (even though I'm eating to maintain my weight).

In many ways, one has to eat "abnormally" to maintain a healthy weight because our default food culture is kind of messed up. To a big degree, I think people who lose weight and maintain that loss over time do it because we've found ways to adjust how we eat. I'm sympathetic to the people who say they're overweight even though they eat "normally," because it's the truth. There are people who are overweight because of eating disorders, but there are also plenty of people who aren't. It's just ridiculously easy to autopilot your way through the day and eat way more than you need. And in some contexts -- lack of time, lack of food prep skills/space, or lack of money -- it is very hard to alter your calorie intake in a way that is sustainable.

Try eating out as a diabetic! It’s even worse. I actually eat out pretty often but only because I time my eating to my runs so that I can consume amounts of carbs which would swamp me on a non-run day. There are a handful of local restaurants which provide low-calorie, reasonable food which fits into my diet, and all of them are run by people born in countries other than the US.

I’m a self-employed introvert. If I had a more active social life which regularly required me to eat out at restaurants picked by others, maintaining my weight and blood glucose would become an exercise in self-denial - I would have to learn to sit and watch others eat while not partaking.

rheddmobile wrote: »

janejellyroll wrote: »

I'd been thinking about some of the above points recently as I've resumed business travel. When I'm at home and I have the luxury of time to select and prepare my own food, it's now almost effortless to hit my calorie goals. I can bulk up meals with lower calorie vegetables to ensure satiety, I can limit my access to tempting high calorie foods, and I can adjust recipes to lower the calorie count. All of these are much harder to do when I'm on the road. When I'm at home I rarely feel like I'm "on a diet," but when I'm travelling I feel that way most of the time (even though I'm eating to maintain my weight).

In many ways, one has to eat "abnormally" to maintain a healthy weight because our default food culture is kind of messed up. To a big degree, I think people who lose weight and maintain that loss over time do it because we've found ways to adjust how we eat. I'm sympathetic to the people who say they're overweight even though they eat "normally," because it's the truth. There are people who are overweight because of eating disorders, but there are also plenty of people who aren't. It's just ridiculously easy to autopilot your way through the day and eat way more than you need. And in some contexts -- lack of time, lack of food prep skills/space, or lack of money -- it is very hard to alter your calorie intake in a way that is sustainable.

Try eating out as a diabetic! It’s even worse. I actually eat out pretty often but only because I time my eating to my runs so that I can consume amounts of carbs which would swamp me on a non-run day. There are a handful of local restaurants which provide low-calorie, reasonable food which fits into my diet, and all of them are run by people born in countries other than the US.

I’m a self-employed introvert. If I had a more active social life which regularly required me to eat out at restaurants picked by others, maintaining my weight and blood glucose would become an exercise in self-denial - I would have to learn to sit and watch others eat while not partaking.

Yep. 100% this.
I usually just have coffee when eating out with the family. Because gluten and allergies and now diabetes. My family is used to this. But anyone else is generally uncomfortable eating when I’m just nursing a cupola’

My husband adores restaurants. And when we head to one of his medical appointments, it usually means an entire day in The Big City (tm) so restaurants are part of the day.
We plan his carbs and sodium very tightly every other day. Restaurant days are always off the chart for any of his dietary requirements.

If he didn’t adore restaurants so much I’d just pack him a couple sandwiches. But everyone needs something to look forward to. So we keep the restaurants as part of his VA appointment routine.

His A1C is down considerably, and his retinopathy is actually reversing. So it works for us. As long as every other day is very tightly controlled diabetes wise.