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

rheddmobile wrote: »

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!

The US is used to seeing very inflated hospital bills because we have the whole insurance company middle man and for profit health care. Basically they charge a lot because they can.

Actual costs worldwide don't even BEGIN to approach what our bills reflect.

Full average cost of vaginal childbirth in the US (ie: Not out of pocket but with employer provided insurance) is $13,811. Canada it's about 3,000. Actual cost, again, not out of pocket expenses. Similar/same length of stay and level of care.

autobahn66 wrote: »

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.

Good post, and much that I agree with.

Of course individual choice is not "the solution", but IMO it's a puzzle piece.

I'm old enough to have been adult before the usually-attributed start period of the "obesity crisis" in the mid-1980s. (I reached the US age of legal adulthood in 1973, was a full-time worker bee by 1978.)

Product demand is the collectivization of individual choices, and product demand is what most affects what is sold. Food producers also have an obligation to make a profit. Yes, marketers know how to push our buttons; that's not new, either - though they refine their practices over time, regulation (in the US at least) also limits them . . . and on net advertising is not so very different now than in the 1970s, IMO.

It's hard to isolate "the difference" vs. the 1970s, IMO, because it's complicated. For me, some of the things picked out as "THE reason" for more-recent common obesity don't pass the sniff test as big let alone exclusive reasons. I think it's complicated. I think the solution - if there is one - will be complicated, too. Influencing individual choices, as I said, is a potential piece of that. (Influencing personal choices played a role in reducing rates of smoking in the population, I believe.)

I agree that many insurance companies seek profit, in the US - though some are in fact non-profit entities, so seeking enough profit to stay in business and support the services they provide (including, arguably, silly-high salaries for execs, equivalent to the silly-high salaries in other lines of business in the US). Since you're evidently not USA-ian, you may not realize that the insurance companies' ability to profit-maximize is not completely unchecked. Though there are problems with this, and I'm certainly not defending the US system as a whole, it's a fact that US insurance companies are regulated, and there are certain factors they're not allowed to consider in setting rates or offering policies.

Your statement that "Those at highest risk of using services should not be offered policies." may be theoretically accurate, but there are regulatory limitations placed on companies' abilities to do that. Do they try to game that, use proxy factors, etc.? Sure.

The debate here is about whether body weight should be permitted to be considered, or not. If not, that implies regulation, not just expecting insurance companies to do it out of benevolence.

At the level of interaction with individual humans, such as here on MFP, I do encourage people to make choices that support their long-term health. They have some (constrained) ability to do that, IMO. I support societal-level initiatives that encourage better choices. I support some degree of regulation/legislation that influences producers/marketers to make more positive contributions.

Can each and every individual, in our current collective context, and in that individual's current state (economic, physical, psychological, social, etc.), as a practical matter make choices that will lead them to be at a healthy weight, and fit? Probably not.

But I think many people may have more power than they themselves believe: Realizing that certain negative outcomes involve choice is very uncomfortable. That, in itself, is a psychological choice-limiter, for at least a few.

autobahn66 wrote: »

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.

I think this fits better in the obesity epidemic thread, but I do think that healthcare providers and insurance can maybe be a piece of the puzzle such as through the incentives I mentioned. I would also say (as that thread's OP was discussing) that having coverage that would aid with nutrition and weight issues would be good.

However, while I think the issue is NOT just individual choice (individuals haven't changed much since, say, 1960), what you or I can do about our weight issues (if we have them) IS a matter of individual choice.

What we can do as a society to help with a broad societal problem is something different, but -- as we have been discussing in that thread -- not easy to figure out. If you think there are some good, effective policies or plans that would be effective, I'd love to hear ideas. (I don't actually think banning food advertising on TV would work, for example, but if you want to make a pitch...)

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.

lemurcat2 wrote: »

MargaretYakoda wrote: »

autobahn66 wrote: »

For my whole childhood I watch ads for foods which should, by all rights not exist, never mind be fed to children.

I don’t know if this was the case where you live, but I remember when Nutella was advertised here in the US as a healthy breakfast choice for children.

I mean, sure. Nutella is delicious. But it’s not exactly a healthy breakfast option. It’s a treat. And should never have been allowed to be advertised as anything otherwise.

Interesting--I find many people I know in the US have never tried nutella (I haven't), and I've never seen an ad for it. I mostly know of it from Europeans, although it's not a surprising thing to find on the menu as part of some dish in a brunch restaurant (there's a Nutella Cafe here, although I've never been). Never heard it advertised as a "healthy breakfast," so googled and found this: https://www.cbsnews.com/news/nutella-health-claims-net-305-million-settlement-in-class-action-lawsuit/

Have to admit I agree with this: https://slate.com/human-interest/2011/08/nutella-lawsuit-why-it-s-bunk.html

It was definitely advertised as “part of a healthy breakfast”
And ya. People often don’t put much critical thinking into food choices that are advertised at us as “healthy”

I had an elderly German friend back then who advised me Nutella is a treat, not a fruit. So I didn’t get in the habit of slathering it on anything too thickly.

In fact, when I worked at a daycare very occasionally we would give it to the school aged kids as their afternoon snack. My boss had purchased it originally thinking it was a healthy choice.

So, I showed her my trick.
On butter flavored rice cakes. Spread the Nutella as thinly as you can possibly manage. Sweet, salty, buttery, crunchy. And chocolate.
It’s absolutely divine that way. And you can make the jar last a very long time.

Wiseandcurious wrote: »

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.

I think it would be a huge mistake to assume that the average American likes our health care system, thinks it is the best way to allocate health resources, or that we aren't aware that other countries arrange things differently.