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Should medically judged fat people pay higher medical costs? [W:87]

Should medically judged fat people pay higher medical costs?

  • Yes

    Votes: 31 42.5%
  • No

    Votes: 42 57.5%

  • Total voters
    73
I fail to see how this is a political question unless the thread starter is leaving unstated an assumption that the government should mandate such a proposition?

Left to its own devices, the market answers the question "absolutely" as greater risks carry greater associated cost. Should the government (presumably the federal government) mandate those kinds of considerations? Absolutely not. There is no constitutional authority for the federal government to legislate what a company charges for its goods or services.
 
So then you must think that if you get speeding tickets you should not be charged more for auto insurance?

You must also think that if you have a wood shake roof on your home in an area prone to wildfires you should not be charged more for home owners insurance?

You must also think then that if you get a dui, you should not have to carry an SR-22 policy?

You seem to have a very flawed understanding of how insurance works.
Why I must I think those things?

Auto insurance isnt at all comparable to health insurance. Its apples and oranges the only thing tying them together is the name insurance. Other than that insuring a car is nothing like health insurance. Auto insurance laws have to do with damage or injury to other drivers; liabilities. Speeding, drunk driving are a liability because it endangers other people not just the driver to drive like a idiot. To further your analogy what about cell phone users? Should cell phone users be charged more for insurance? What about women since they often use make up and some put it on on the way to work? Not all women and not all cell phone users pose a risk on our highways. Not all fat people are going to cost more money in their life time of medical care. Blaming fat people is a witch hunt that ignores the inherent problem with insurance driven medical care.

Oh I left out home insurance. Which leads to the concept of building codes. Often in high risk areas there are building codes that address such things as fire risk, flood, land slides and what have you. Cars and houses/buildings are inanimate non thinking objects. It is our responsibility as thinking beings to take care of our possessions. It is also our personal responsibility to take care of ourselves. Charging more for a assumed risk to our personal body deserves actual evidence that the customer is actually unhealthy and will beyond all doubt cost more in the long run to take care of. Pointing fingers at fat people and screaming that they are costing you money on your own premium is a logical fallacy. Individual health is much more complex than lumping entire sections of society into a group that some people presume to be unhealthy based solely on their weight and appearance.

If the goal is risk assessment then why single out the overweight and smokers why not just give a damn physical and go from there?
 
Why I must I think those things?

Auto insurance isnt at all comparable to health insurance. Its apples and oranges the only thing tying them together is the name insurance. Other than that insuring a car is nothing like health insurance. Auto insurance laws have to do with damage or injury to other drivers; liabilities. Speeding, drunk driving are a liability because it endangers other people not just the driver to drive like a idiot. To further your analogy what about cell phone users? Should cell phone users be charged more for insurance?

Sure if the actuaries determine them to be a higher risk.

What about women since they often use make up and some put it on on the way to work? Not all women and not all cell phone users pose a risk on our highways.

Women typically pay lower auto insurance rates because they are statistically safer drivers.

Not all fat people are going to cost more money in their life time of medical care. Blaming fat people is a witch hunt that ignores the inherent problem with insurance driven medical care.

So if an actuary determines that a personal life choice, in this case obesity, statistically leads to higher health care costs, and thus determines that someone that is obese should pay higher insurance rate to reflect those higher health costs, its a "witch hunt".

Would charging smokers more for health insurance be a witch hunt as well?


Oh I left out home insurance. Which leads to the concept of building codes. Often in high risk areas there are building codes that address such things as fire risk, flood, land slides and what have you. Cars and houses/buildings are inanimate non thinking objects. It is our responsibility as thinking beings to take care of our possessions. It is also our personal responsibility to take care of ourselves. Charging more for a assumed risk to our personal body deserves actual evidence that the customer is actually unhealthy and will beyond all doubt cost more in the long run to take care of. Pointing fingers at fat people and screaming that they are costing you money on your own premium is a logical fallacy. Individual health is much more complex than lumping entire sections of society into a group that some people presume to be unhealthy based solely on their weight and appearance.

If the goal is risk assessment then why single out the overweight and smokers why not just give a damn physical and go from there?

Actually many group plans are already doing just that. In order to get the preferred rate at my employer, you must get a yearly health assessment (physical).
 
In the vast majority of policies they are not taken into consideration. Few group plans take them into consideration, and Medicare doesn't either.

When it comes to medicare/medicaid, they have to pretty much take care of anyone, no matter what and that's all tax supported.
 
Actually many group plans are already doing just that. In order to get the preferred rate at my employer, you must get a yearly health assessment (physical).

While it may be forced, this isnt such a bad idea because it can be hell trying to get people in to get any preventative care. You cant get lots of people into the doc's unless they are dying or it's too late. Preventative care can save $ in the longer term.
 
When it comes to medicare/medicaid, they have to pretty much take care of anyone, no matter what and that's all tax supported.

Right, but in my opinion, instead of taxing the crap out of junk food and sugary soft drinks, it makes a lot more sense to give you a preferred rate on Medicare if you are a healthy weight and a non-smoker, and pay a higher rate if you are a smoker or clinically obese. It seems to me that would go a long way towards providing recipients with the incentives to make better personal health choices and thus get costs under control.
 
While it may be forced, this isnt such a bad idea because it can be hell trying to get people in to get any preventative care. You cant get lots of people into the doc's unless they are dying or it's too late. Preventative care can save $ in the longer term.

Its not totally forced though, just an incentive. You don't have to get a yearly health assessment to get coverage, you just pay a higher rate. To get the preferred rate, you have to get a health assessment. Some companies carry it further by requiring you to go to smoking cessation classes if you are a smoker and want the preferred rate, or participating in a wellness plan if you are obese to get the preferred rate.
 
Right, but in my opinion, instead of taxing the crap out of junk food and sugary soft drinks, it makes a lot more sense to give you a preferred rate on Medicare if you are a healthy weight and a non-smoker, and pay a higher rate if you are a smoker or clinically obese. It seems to me that would go a long way towards providing recipients with the incentives to make better personal health choices and thus get costs under control.

What do we do when the medicare reciepient can't afford to pay a higher rate? Do we then just let them die?

And the weight that they have gained is often accumulated over decades, it didn't just happen the day they turned old enough to qualify for medicare. If we more heavily taxed sugar and foods with excess fat in them we are killing two birds with one stone. the first is that we are disincentizing the types of products that heavily contribute to us becoming fat. the second is that we are raising revenue to pay for the results of their food (or smoking) sins.

We could charge everyone the same (low) rate for insurance, and then just subsidize the cost of insuring fatties and smokers out of the sin taxes that they paid in. Seems pretty straightforward to me, especially when we are talking about government paid for heathcare (Medicare/Medicade/etc).
 
When it comes to medicare/medicaid, they have to pretty much take care of anyone, no matter what and that's all tax supported.

Yes, but Medicare is not free. There is a charge to be on Medicare. So, the question remains: Should obese people pay more for their Medicare than those of normal weight? Currently, they don't, but do use more health services.
 
What do we do when the medicare reciepient can't afford to pay a higher rate? Do we then just let them die?

And the weight that they have gained is often accumulated over decades, it didn't just happen the day they turned old enough to qualify for medicare. If we more heavily taxed sugar and foods with excess fat in them we are killing two birds with one stone. the first is that we are disincentizing the types of products that heavily contribute to us becoming fat. the second is that we are raising revenue to pay for the results of their food (or smoking) sins.

We could charge everyone the same (low) rate for insurance, and then just subsidize the cost of insuring fatties and smokers out of the sin taxes that they paid in. Seems pretty straightforward to me, especially when we are talking about government paid for heathcare (Medicare/Medicade/etc).

My point is that it's mostly the poor who have these vices and who are overweight/obese. So, if we are going to charge them a surcharge, then we are actually charging ourselves a surcharge too, since we pay for their health insurance through taxes. Therefore, the proposal doesn't really make much sense and would only make health insurance more expensive for ALL of us in the long run.
 
No. Under Smeagolcare hospital or doctor group membership is standard. One flat rate for single memberships, another flat rate for family memberships. Preexisting conditions have no bearing. However the voluntary individual healthy lifestyle incentive rebate applies. Being outside of the rage of one's recommended body mass index, along with a list of other items, would reduce the amount of the annual rebate check issued every December 1.
 
My point is that it's mostly the poor who have these vices and who are overweight/obese. So, if we are going to charge them a surcharge, then we are actually charging ourselves a surcharge too, since we pay for their health insurance through taxes. Therefore, the proposal doesn't really make much sense and would only make health insurance more expensive for ALL of us in the long run.

Assumably the more pricy we make a product, the fewer people will purchase it. Italian sportscars are very expensive, so not many of us drive them. The more poor someone is, the more sensitive to prices they are, and thus the better the disincentive effect of higher prices.

If we had a higher tax on sugar and fat filled foods, then the fewer of those foods the poor would purchase, and thus there would naturally be fewer overweight people, or at least they wouldn't be as overweight. this would result in a lower national healthcare bill, and would thus result in lower insurance prices for all of us.

The side effect of increasing this sin tax would be to collect additional revenue from those who tend to be the worst abusers, this revenue could be used to subsidize the insurance risk of insuring fat people.

Basically the way I see it, we have few options. We can allow insurance to become so unaffordable for faties that they just don't purchase it, and then we can just let them die untreated.

Or we can jack up everyones insurance rate just a tad, essentially charging healthy people for the bill of avoidably unhealthy.

Or we can keep their insurance rates modist by subsidizing it with revenue from bad food choices that they make. This seems to be the most human and sensible option. This way most everyone can acquire insurance, but those who tend to create their own health care costs will pay for those costs at the cash register (a little at a time, in a manner that is perceived as being affordable, and in direct proportion to the amount of bad choices that they make), instead of externalizing them onto other people.

You have to step back and look at the big picture. I don't like to use the word "fair" in an economic discussion, but this is certainly practical.
 
No. Under Smeagolcare hospital or doctor group membership is standard. One flat rate for single memberships, another flat rate for family memberships. Preexisting conditions have no bearing. However the voluntary individual healthy lifestyle incentive rebate applies. Being outside of the rage of one's recommended body mass index, along with a list of other items, would reduce the amount of the annual rebate check issued every December 1.

I'm a fan of some aspects of Smeagolcare, but isn't that just like jacking up the price of a product so that you can offer "desirable" customers a discount?

And people like me, who exercise five or six days a week, live an active lifestyle even when I am not exercising, and eat a very healthy diet, have a low bodyfat percent, would still miss out on the discounts because I am above the BMI standards. I find that ironic because the only way that I could reduce my weight enough to meet the standard would be to have an amputation, or to stop exercising so that I loose muscle mass. Neither of those options are acceptible to me.
 
I'm a fan of some aspects of Smeagolcare, but isn't that just like jacking up the price of a product so that you can offer "desirable" customers a discount?

And people like me, who exercise five or six days a week, live an active lifestyle even when I am not exercising, and eat a very healthy diet, have a low bodyfat percent, would still miss out on the discounts because I am above the BMI standards. I find that ironic because the only way that I could reduce my weight enough to meet the standard would be to have an amputation, or to stop exercising so that I loose muscle mass. Neither of those options are acceptible to me.

Yes but more. The voluntary healthy lifestyle incentives create a greater sense of there being and even playing field to some. Then anybody and everybody , or at least most people are eligible for a big fat Christmas bonus if they simply choose make healthy lifestyle choices like you:

- Recommended BMI range
- Low cholesterol
- Low triglycerides
- Verified regular work out regimen
- Pass random recreational drug tests
- Safe driver
- Request a special state issued no alcohol or tobacco divers license

Not all or nothing. Each item increases the rebate. There's also as group rebate so there's a peer pressure dynamic to making healthy choices. More importantly, it places carrots in the faces of Americans to want the REWARD of living healthily; money to spend at Christmas. Heck, all of the retail sector will be encouraging all of us to live healthily, our kids who want gifts, family who want the money to take that family vacation. The whole country would be incentivized. Meanwhile costs come down because health "insurance" is eliminated as an unneeded middleman on top of less expensive treatment since more of us will be living healthy.
 
Yes but more. The voluntary healthy lifestyle incentives create a greater sense of there being and even playing field to some. Then anybody and everybody , or at least most people are eligible for a big fat Christmas bonus if they simply choose make healthy lifestyle choices like you:

- Recommended BMI range
- Low cholesterol
- Low triglycerides
- Verified regular work out regimen
- Pass random recreational drug tests
- Safe driver
- Request a special state issued no alcohol or tobacco divers license

Not all or nothing. Each item increases the rebate. There's also as group rebate so there's a peer pressure dynamic to making healthy choices. More importantly, it places carrots in the faces of Americans to want the REWARD of living healthily; money to spend at Christmas. Heck, all of the retail sector will be encouraging all of us to live healthily, our kids who want gifts, family who want the money to take that family vacation. The whole country would be incentivized. Meanwhile costs come down because health "insurance" is eliminated as an unneeded middleman on top of less expensive treatment since more of us will be living healthy.

You dont think that it would be considered invasive to have to take drug tests for your insurance company? And doesn't that add to the cost of healthcare? And how would someone who exercises in their home verify that they exercised?
 
Yes, but Medicare is not free. There is a charge to be on Medicare. So, the question remains: Should obese people pay more for their Medicare than those of normal weight? Currently, they don't, but do use more health services.
I think thats a bad assumption.

Do Obese people use more health services? I'm not sure about that.

I see lots of emaciated people with pretty severe health problems. In fact, if you look at long term health figures, being overweight generally leads to greater health and less medical expenditure than being underweight. So do we charge the underweight too? Should models be surcharged for insurance?

The question is...how do you know someone is obese thru bad lifestyle or thru bad genes or thru disease? Some patients have thyroid issues that lead to obesity. Some people have need for medications that can cause obesity (antipsychotics, for example). Some patients probably have gut flora that is wrong and leads to obesity - this is a pretty promising angle in modern obesity science.

Obesity tends to skew toward the more healthy people, to be honest, except for T2 Diabetes - and frankly, most of the type 2 diabetes patients cannot reduce their weight - they would not be "medically judged" to be able to lose weight. Its really hard to do that when you have a massive amount of insulin in your system from diabetes, which is an anabolic hormone, and the treatment for it is.. give more of this hormone that makes you gain weight.

Heart failure paitents are often obese.. but I've diuresed 40 lbs of water off some of those.. so I'm not sure we can classify them as "medically judged" obese.
 
What do we do when the medicare reciepient can't afford to pay a higher rate? Do we then just let them die?

And the weight that they have gained is often accumulated over decades, it didn't just happen the day they turned old enough to qualify for medicare. If we more heavily taxed sugar and foods with excess fat in them we are killing two birds with one stone. the first is that we are disincentizing the types of products that heavily contribute to us becoming fat. the second is that we are raising revenue to pay for the results of their food (or smoking) sins.

We could charge everyone the same (low) rate for insurance, and then just subsidize the cost of insuring fatties and smokers out of the sin taxes that they paid in. Seems pretty straightforward to me, especially when we are talking about government paid for heathcare (Medicare/Medicade/etc).
Alternatively and more easily, we could Tax Wholesale Sugar and Corn/Corn-sweeteners.

Instead, and not coincidentally, we Subsidize Both!
 
I think thats a bad assumption.
Do Obese people use more health services? I'm not sure about that.

I see lots of emaciated people with pretty severe health problems. In fact, if you look at long term health figures, being overweight generally leads to greater health and less medical expenditure than being underweight. So do we charge the underweight too? Should models be surcharged for insurance?

The question is...how do you know someone is obese thru bad lifestyle or thru bad genes or thru disease? Some patients have thyroid issues that lead to obesity. Some people have need for medications that can cause obesity (antipsychotics, for example). Some patients probably have gut flora that is wrong and leads to obesity - this is a pretty promising angle in modern obesity science.

Obesity tends to skew toward the more healthy people, to be honest, except for T2 Diabetes - and frankly, most of the type 2 diabetes patients cannot reduce their weight - they would not be "medically judged" to be able to lose weight. Its really hard to do that when you have a massive amount of insulin in your system from diabetes, which is an anabolic hormone, and the treatment for it is.. give more of this hormone that makes you gain weight.
Heart failure paitents are often obese.. but I've diuresed 40 lbs of water off some of those.. so I'm not sure we can classify them as "medically judged" obese.
Along that same line...

Everyone dies of something.
Is it better, Strictly from a financial/mercenary point of view, to have then die at 55 or 95?

Who costs the system more?
A smoker who dies at 55 from Lung Cancer after having paid into the (Medcare/SS) system for 30 years and withdrawing nothing..
Or the 95 Year old whose been Nailing the system from Many chronic conditions of old age for 30 years.. and finally dies of.. Lung Cancer.. too.
 
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Along that same line...

Everyone dies of something.
Is it better, Strictly from a financial/mercenary point of view, to have then die at 55 or 95?

Who costs the system more?
A smoker who dies at 55 from Lung Cancer after having paid into the (Medcare/SS) system for 30 years and withdrawing nothing..
Or the 95 Year old whose been Nailing the system from Many chronic conditions of old age for 30 years.. and finally dies of.. Lung Cancer.. too.

That's true. We keep people alive much longer than they probably should be with procedures and medications. I don't know how some patients can keep all their medications straight because they are on so many!! :shock:
 
Along that same line...

Everyone dies of something.
Is it better, Strictly from a financial/mercenary point of view, to have then die at 55 or 95?

Who costs the system more?
A smoker who dies at 55 from Lung Cancer after having paid into the (Medcare/SS) system for 30 years and withdrawing nothing..
Or the 95 Year old whose been Nailing the system from Many chronic conditions of old age for 30 years.. and finally dies of.. Lung Cancer.. too.

That reminds me of a landmark cost effectiveness analysis done in the New England Journal of Medicine in about 1993, It clearly showed that stopping tobacco use would lead to much higher health care costs in the US, because with all the money you save in cardiovascular and respiratory diseases, you saved because smokers tended to die before Medicare age of functionally uncurable non-small cell lung cancer, which wasnt treatable back then - meaning a very quick, very cheap death with a tremendous amount of savings to the Medicare system.

I bring that paper out every time someone gives me a lecture on how this intervention or that intervention will save money.
 
I think thats a bad assumption.

Do Obese people use more health services? I'm not sure about that.

I see lots of emaciated people with pretty severe health problems. In fact, if you look at long term health figures, being overweight generally leads to greater health and less medical expenditure than being underweight. So do we charge the underweight too? Should models be surcharged for insurance?

The question is...how do you know someone is obese thru bad lifestyle or thru bad genes or thru disease? Some patients have thyroid issues that lead to obesity. Some people have need for medications that can cause obesity (antipsychotics, for example). Some patients probably have gut flora that is wrong and leads to obesity - this is a pretty promising angle in modern obesity science.

Obesity tends to skew toward the more healthy people, to be honest, except for T2 Diabetes - and frankly, most of the type 2 diabetes patients cannot reduce their weight - they would not be "medically judged" to be able to lose weight. Its really hard to do that when you have a massive amount of insulin in your system from diabetes, which is an anabolic hormone, and the treatment for it is.. give more of this hormone that makes you gain weight.

Heart failure paitents are often obese.. but I've diuresed 40 lbs of water off some of those.. so I'm not sure we can classify them as "medically judged" obese.

It is intuitive that obese and overweight people will cost more for health care, but perhaps that isn't true at all, so I typed the question into my search engine and came up with this from Time Online:

Between 2001 and 2006, average health care expenditure for normal weight people increased from $2,607 to $3,315—a 27% gain.
For overweight people, the average cost rose from $2,792 to $3,636—an increase of 30%.
And for obese people, the average amount paid increased from $3,458 to $5,148—a gain of 49%.
 
You dont think that it would be considered invasive to have to take drug tests for your insurance company? And doesn't that add to the cost of healthcare? And how would someone who exercises in their home verify that they exercised?

No because its voluntary. Everyone is free to pass on any or all of the rebates if they want. Plus, your hospital/doctor knows pretty much everything medical about you anyway.

I understand its hard sometimes to think differently when something has been done one way for so long but Smeagolcare does not involve health insurance and by extention, health insurance companies. Under Smeagolcare its a direct membership with the hospital similar to joining a gym for a flat monthly fee. Your insurance company will not know your drug test results because you won't have nor will you need health insurance. That's aspect alone will emilinate a middle man and reduce costs. Not needing to provide drug rehab services to patients is less expensive than drug tests.

I'm not sure about verifying working out at home. With going to a gym there's a check in/check out procedure and even some equipment has docking stations where you can plug in your smart phone to monitor your own work out stats. I know with some smart phone apps you can send your heart rate, etc. to the phone. Technology can work it out I'm sure.
 
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It is intuitive that obese and overweight people will cost more for health care, but perhaps that isn't true at all, so I typed the question into my search engine and came up with this from Time Online:

Yes- but you have to control for the fact that some medical conditions actually CAUSE obesity, which confounds that calculation.

Overall, obesity seems to be less of a driver of medical costs than one might think.

http://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.0050029
 
I think thats a bad assumption.

Do Obese people use more health services? I'm not sure about that.

I see lots of emaciated people with pretty severe health problems. In fact, if you look at long term health figures, being overweight generally leads to greater health and less medical expenditure than being underweight. So do we charge the underweight too? Should models be surcharged for insurance?

The question is...how do you know someone is obese thru bad lifestyle or thru bad genes or thru disease? Some patients have thyroid issues that lead to obesity. Some people have need for medications that can cause obesity (antipsychotics, for example). Some patients probably have gut flora that is wrong and leads to obesity - this is a pretty promising angle in modern obesity science.

Obesity tends to skew toward the more healthy people, to be honest, except for T2 Diabetes - and frankly, most of the type 2 diabetes patients cannot reduce their weight - they would not be "medically judged" to be able to lose weight. Its really hard to do that when you have a massive amount of insulin in your system from diabetes, which is an anabolic hormone, and the treatment for it is.. give more of this hormone that makes you gain weight.

Heart failure paitents are often obese.. but I've diuresed 40 lbs of water off some of those.. so I'm not sure we can classify them as "medically judged" obese.

I started Lantus last month for my T2 diabetes. One of the side affects is that it brings on weight gain. In my case that isn't a big deal as my thyroid problems have kept me defined as "underweight" for almost my entire life, but most people aren't like me.
 
I started Lantus last month for my T2 diabetes. One of the side affects is that it brings on weight gain. In my case that isn't a big deal as my thyroid problems have kept me defined as "underweight" for almost my entire life, but most people aren't like me.

I was simultaniously diagnosed with a thyroid problem and T2 diabetes. Once I got my diabetes under control, my thyroid problem went away also.
 
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