'Bama proposing obese state emps. pay more for insurance

[scaeagles]

What do you think? (http://www.foxnews.com/story/0,2933,414861,00.html)

This seems to make sense....as much as paying more for insurance if you are a smoker, but I find myself on the fence about it. Obese people typically have higher helath care costs.

[Tom]

The obvious difference seems to be that one chooses to smoke. Even if addictive, at some point one chose to smoke. But obesity, though it can be ameliorated by choice cannot always be eliminated. There's a strong genetic component to obesity, and I don't think it's right to make people pay higher insurance premiums for bad genes.

[JWBear]

I read the tread title to say "Obama....", and thought "WTF???" Oops...

[Alex]

If it is health insurance, it makes sense.

If it is health assurance, then it doesn't make sense.

[BarTopDancer]

I think a better way to go about it is offer a healthy living incentive. Instead of offering a discounted rate to a gym, offer a membership and then obtain information of how often the member goes to the gym. If you go to the gym 4-5 times a week (20-25 times a week you get x amount off your insurance) Of course something like this would be an administrative nightmare and a slippery slope to other intrusions.

[LSPoorEeyorick]

And what of, say, state employees' spouses, possibly also covered by this plan, who might, for instance, have some sort of degenerative disease with medicine that causes weight gain and side effects that prevent motion?

I'm all for encouraging good choices. But I'm NOT for governmental regulation of what is and is not "healthy" in terms of weight. I know some fat triathalon runners... that 300-pound Olympic weight lifter... some pretty fit chubby people. I know some lazy-ass, junk-food-eating, heart-attack-in-the-making thin people. And vice versa. If they're going to charge more for health risks, then they should be basing that on people's cholesterol numbers, their blood pressure, their general health. Because not being within the average BMI is not a guarantee that you're dying young. And being inside it is not a guarantee that you won't die young.

And what if they're losing weight at a slow, healthy, behavioral-changing and eating-disorder-free rate, but it's too slow for Alabama? Do we then encourage band-aid solutions like medical liquid diets (for which dieters have a large chance of rubber-banding back to their old weight as soon as they stop?) Or gastric surgery, for which mortality rates are high and chance of re-gain after stomachs re-stretch are even higher?

And what is the right rate for the right body, to stop losing weight? If, say, I got to 180 pounds and say "hey, I feel as great as I've ever felt, I am happy with the way I look, I am active and eating healthy and don't wish to lose any more." If I can run faster than the 120-pound anorexic, do I need to pay more for my health insurance?

And obesity - though, indeed, a problem more common today than before, and often the result of behavioral training as much as genes - is only one of a zillion genetically-imposed health problems. What about the children of breast cancer who become breast cancer patients? Do we charge them more up front, knowing that their boob may cost more in the long run?

Then what defines my insurance carrier as an insurance carrier, and not a savings plan for the human body's guaranteed eventual decline?

[Alex]

If the actuarial tables say that a fat person will cost the insurance company more then it makes complete sense for the insurance company to charge the fat person more.

If the children of breast cancer mortalities show a significantly increased chance of breast cancer, then an insurance model should of course cost them more. Just as a $100,000 life insurance policy should cost $100,000/month if I have a cancer diagnosis saying I'll die this month while it will probably only be $40/month for the 20-year-old track star.

That's insurance.

I'm an obese man in his mid-30s with a pronounced history of early male death in his family. I should pay more for insurance.

That's why I get frustrated when people talking about wanting everybody to have insurance. They don't, because then they get upset when the insurance companies act like insurance companies and charge those most in need (or most likely to need) of their insurance the most money.

[scaeagles]

I read the tread title to say "Obama....", and thought "WTF???" Oops...

HA! Funny. Not my intention, but funny. Just trying to shorten the thread title.

[innerSpaceman]

I'm glad you cleared that up, because I seriously thought that was indeed your intention.

[BarTopDancer]

The only time I've heard Alabama referred to as 'Bama is by someone who is from Alabama.

[scaeagles]

College football is my exposure. They are 'Bama, never Alabama, unless joined together with Crimson Tide, in which case you say Alabama, not 'Bama.

Geez, people! :)

[BarTopDancer]

Football is not hockey.

[scaeagles]

However, more on the subject, women typically are more expensive to insure during child bearing years because that's when they incur the most cost. The older you get, the more expensive you are to insure, because you incur more medical expenses.

While many find this offensive, insurance is a business to make money.

[scaeagles]

Football is not hockey.

And we all thank the good lord above for that.

[Ghoulish Delight]

While many find this offensive, insurance is a business to make money.Which is exactly why I support socialized medical care. My health should not be someone else's business decision.

[LSPoorEeyorick]

Which is exactly why I support socialized medical care. My health should not be someone else's business decision.

Words right out of my mouth.

Insurance shouldn't be at the behest of shareholders. I've seen, from the inside, what it does to the quality of health care. And it isn't pretty.

[scaeagles]

I still don't get why it should be the responsibility of others to pay for my medical expenses, nor do I understand why health care is considered a right to a large portion of society. I understand there is that portion, and while I don't belittle that viewpoint, I don't understand it. I suppose paying into a government system is not that much different, but i'd rather ahve a business that is competing against other businesses for my money having a say rather than the government. I don't think the giovernment manages well the responsibilities it already has. I don't want government mandated exercise programs (though I exercise daily) or any other government requirements determining what I must or must not do to receive benefit X.

I've been mulling over going deeper (it keeps getting longer the more I re-edit), but I won't. We've been down the road of medical care and insurance before.

[innerSpaceman]

I'll tell you why it's considered a right. Because IT IS SO CONSIDERED.

All we have to do as Americans for something to become our right, is to declare it so. We have that freedom. And we have a government that, by design, exists to support the general welfare. That's one of the guiding philosophies of America, enshrined in the preamble to the Constitution as a duty of the government We the People form on our behalf.

What is necessary to support the general welfare is something that evolves, and I think it's finally evolving to a right we Americans declare for and demand.

[scaeagles]

If it is a right, then it should be constitutionally guaranteed as one. If the rights we have can be determined by what society considers to be one, then rights we have can be removed by the same whims. The general welfare clause, as noted in the federalist papers (which one escapes me at present, and while I realize they are not a binding document, they certainly note the intentions of the writers) was never intended as a blank check for the federal government.

[Ghoulish Delight]

I still don't get why it should be the responsibility of others to pay for my medical expenses, nor do I understand why health care is considered a right to a large portion of society.
I can't possibly state it more simply than I have hundreds of times already.

Because those of us who believe it is a right believe that the value of someone's life should not and cannot be equated to their material worth.

[Morrigoon]

I believe, then, it falls under the right to LIFE, liberty and the pursuit of happiness.

That being said, I share the same reservations about our government, the government of Katrina, Fema, Waco, etc., being in charge of my health care. However, if I had some assurance that our gov't would behave better than the current HMOs in terms of speed, approval, and flexibility of care, then I admit it does appeal. I think I'd want to see a government INSURANCE program, rather than handing the whole system over to them lock, stock and barrel. Sort of like providing the required minimum (like they do for Medicare), only they're simply going to HAVE to cut back on the paperwork, because it's driving doctors out of business.

As far as the obesity thing goes, I'm torn on that. On one hand I'm outraged, but then I acknowledge that they do charge smokers more. But like LSPE points out, it's not entirely behavioral, and the ability to control the behavior is also affected by genetics, so it's sort of like charging the cancer-prone more. Also, smokers do have a choice of whether to smoke or not. Alcoholics have a choice of whether to drink or not. But say you told an alcoholic that they had to drink exactly half a shot every single day of their life in order to live - would you REALLY be surprised if they couldn't stick to that?

I'm frankly sick of the "moral outrage" that people not afflicted with obesity-relate problems feel they have a right to.

[Alex]

As I've said, socialized healthcare doesn't make money a non-issue, it just changes who gets to make the decision as to when money becomes an issue.

I personally don't think healthcare is a fundamental human right (but then, I don't think there is any such thing) but it is certainly something we as a society can decide to do.

[Morrigoon]

Therein lies the problem. One of my biggest fears of nationalized healthcare is allowing the government to decide for me.

On the other hand, if the government also insured the doctors, they could probably lower costs of providing the care! (Liability insurance, I mean).

How about a "voucher" system? You can take the basic (free) gov't plan, OR the gov't can pledge a certain amount to private carriers that insure you, and let the carriers compete for who gets the business. Which is basically what I said relating it to medicare (medicare supplemental insurance being a model)

[tracilicious]

College football is my exposure. They are 'Bama, never Alabama, unless joined together with Crimson Tide, in which case you say Alabama, not 'Bama.




And here I thought he was shortening Obama.

[Tenigma]

This seems to make sense....as much as paying more for insurance if you are a smoker, but I find myself on the fence about it. Obese people typically have higher helath care costs.

I hope the state has a lot of money to pay out lawsuits.

Obesity, as others have mentioned, is very strongly linked to genetics. In addition, there are some scientists who believe obesity is NOT as unhealthy as we are all led to believe... it is LACK OF EXERCISE that's bad, not necessarily obesity.

What they could do is require X amount of exercise every week, X number of check-ups per year. Those are quantifiable. I don't think they could mandate people be skinny. What about thin people who are unhealthy, to start?

[Moonliner]

Why stop at weight?

As Alex pointed out certain diseases can be hereditary, tall people don't live as long,overly fit people actually have a higher mortality rate as do lefties and anyone that does not drink moderate amounts of alcohol.

Now with the advent of genetic testing there are all sorts of new windows opening for determining who is higher risk for the insurance industry.

[Ghoulish Delight]

As I've said, socialized healthcare doesn't make money a non-issue, it just changes who gets to make the decision as to when money becomes an issue.This is true, but at least that monetary decision is made and enforced equally for all citizens.

[Cadaverous Pallor]

After all the word of people being denied health care coverage due to "preexisting conditions", such as being old or being pregnant, the more it seems that the gov't may actually be able to do this better than the greedy bastards who run the HMOs.

[scaeagles]

I don't know. If you don't run a business at a profit, you run a business at a deficit. The government would not try to turn a profit, per se (and very, very quick research showed profit margins of HMOs from 2.1% to 4.2% - not high by any stretch of the imagination....sometimes their profits are reported as a "profit increase of 50%", but if you are making a 2.1% profit margin and increase it by 50%, it's still only a 3.1% profit margin), and based on the profit margins I've found for HMOs (again, very quick research), that doesn't allow for a whole lot of cost reduction to the consumer to run at 0%. Consider the propensity of government to be bloated and wasteful, I would guess they would run at a HUGE deficit, constantly increasing the cost through taxation to the consumer. As I believe we are ridiculously overtaxed as it is, that to me doesn't sound appealing. To avoid running at a deficit or increasing taxes, this means care would have to be rationed, and my guess is that it would very shortly be worse than anything the private sector is doing now.

[Moonliner]

I don't know. If you don't run a business at a profit, you run a business at a deficit. The government would not try to turn a profit, per se (and very, very quick research showed profit margins of HMOs from 2.1% to 4.2% - not high by any stretch of the imagination....sometimes their profits are reported as a "profit increase of 50%", but if you are making a 2.1% profit margin and increase it by 50%, it's still only a 3.1% profit margin), and based on the profit margins I've found for HMOs (again, very quick research), that doesn't allow for a whole lot of cost reduction to the consumer to run at 0%. Consider the propensity of government to be bloated and wasteful, I would guess they would run at a HUGE deficit, constantly increasing the cost through taxation to the consumer. As I believe we are ridiculously overtaxed as it is, that to me doesn't sound appealing. To avoid running at a deficit or increasing taxes, this means care would have to be rationed, and my guess is that it would very shortly be worse than anything the private sector is doing now.

Are either of the candidates proposing socialized health care? I think both plans still involve the use of HMO's. It's just a question of how you can reduce the cost of them to the point where everyone (or almost everyone) can afford them.

[Betty]

Why stop at weight?

As Alex pointed out certain diseases can be hereditary, tall people don't live as long,overly fit people actually have a higher mortality rate as do lefties and anyone that does not drink moderate amounts of alcohol.

Now with the advent of genetic testing there are all sorts of new windows opening for determining who is higher risk for the insurance industry.

And then they could just start monitoring you right? Who says if you had one drink today you wouldn't have one tomorrow, or that you would have 10 tomorrow.

It works now because we all pay into it. Yeah - I may be fat... but you've got a family history of breast cancer and that guy over there is going to get lung cancer. We've ALL got something wrong with us now or will have something wrong someday. They would have to either exclude everyone or charge everyone more... hmmm...

Should I pay more my whole life because I'm overweight? If so, then you should go bankrupt when you (not YOU but - you in a general sense) get cancer and have to have surgery and chemo and all that. Right? It's only fair that if I have to pay more all along that when something really bad happens to you that you have to pay a hefty price then.

But that's the whole point of having health coverage isn't it? To avoid having to pay an enormous fee sometime in the future.

And what about the person who develops a disease after paying decades into it, and then gets told that they are no longer covered. Oh wait - that happens now already doesn't it. :(

[scaeagles]

A fine goal. I just have seen no evidence ever of the government containing cost or limiting buraeucracy when it gets involved in anything.

Interestingly, it is a state agency that is proposing additional costs for the obese.

[scaeagles]

And then they could just start monitoring you right? Who says if you had one drink today you wouldn't have one tomorrow, or that you would have 10 tomorrow.

And to reiterate what I just posted, it is a state agency proposing additional costs for the obese.

[Moonliner]

And I wonder if obese people really do have higher heath care rates overall. If on average they die younger they have less years to need health care. Over the long run they are less likely to need the cost of long term health care for issues like cancer or alzheimers because they would already be dead.

[scaeagles]

Very interesting point, Moonliner.

My mother in law recently had a major heart attack. She is approaching 70, but eats well, exercises, and is not in the least overweight. The costs associated with it were immense (4 days ICU, 4 days non ICU in the hospital).

[Ghoulish Delight]

Very interesting point, Moonliner.

My mother in law recently had a major heart attack. She is approaching 70, but eats well, exercises, and is not in the least overweight. The costs associated with it were immense (4 days ICU, 4 days non ICU in the hospital).
Individual cases are not what matters. You will always be able to find variation from actuarial tables when you look at individuals. Just because one person beats the odds doesn't change the reality of the average.

Insurance is the only game where you hope to lose your bet.

[scaeagles]

Except that she her mom and grandmother both died of heart attacks. Family history and all.

[Not Afraid]

I'm completely uninsurable.

[Morrigoon]

And I wonder if obese people really do have higher heath care rates overall. If on average they die younger they have less years to need health care. Over the long run they are less likely to need the cost of long term health care for issues like cancer or alzheimers because they would already be dead.
I've heard this before.

[Alex]

Yeah, that's why I oppose seatbelt laws. The money the state saves in medical bills is more than wasted paying to educate kids that should be dead or in vegetative states.



Yes, that's a non sequiter. I have no point.

[Morrigoon]

And an amusing one, thank you, Alex.