Should be obese people pay higher premiums for healthcare?

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davidlee

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The rest of the nation is shouldering the burden for issues such as heart disease and diabetes which are directly related to weight. Some insurance companies charge more for people who smoke. Because weight is an absolutely controllable issue, should ben't overweight people pay more for healthcare so that it is affordable to the rest of the nation who takes care of themselves?

Is it fair that people can be stuff their faces until they die, and we have to pay for it?

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Yup, two problems with that argument.

1. Weight is not "absolutely controllable" the jury is still out on to what extent genetics plays a part in weight loss/control, though most agree that it plays some part.

2. If you begin "taxing" one unhealthy/dangerous behavior, to be fair, you must tax them all. So, we should raise premiums of people who drive cars (more dangerous than walking, and "absolutely controllable") especially raise premiums of those who drive motorcycles (even more dangerous, and still "absolutely controllable,") people who sunbathe/suntan (increased risk of skin cancer, and another "absolutely controllable" behavior,) etc, etc.

Though I'm not a smoker, nor am I a big fan of smoking, I'm afraid that all of the "health taxes" placed on smokers have set a precident for taxing the "unhealthy absolutely controllable" behavior du joir.

The reality is that this nation has become so fat that the general populace wouldn't stand for such a "fat tax." The smoking taxes were accepted because smokers had become a minority, but overweight people are fast becoming a majority (if they are not already.)
 
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Other types of insurance such as disability and life already rate you worse if you're fat. I don't see health insurance being too far behind. Health insurers aleady punish those with pre-existing conditions such as hypertension and high cholesterol when they try to buy insurance on the open market.
 
1. Weight is not "absolutely controllable" the jury is still out on to what extent genetics plays a part in weight loss/control, though most agree that it plays some part.
I actually agree with what you're saying. Just for the sake of argument if we say that we can exclude behavoiral choices like smoking but not genetic predispositions like obesity won't the addiction crowd claim that thier alcoholism and drug abuse are due to heredity. By your logic if we can't set different insurance costs for people with diseases that might not be totally their own fault then insurers should allow someone who is actively addicted to sign up.
2. If you begin "taxing" one unhealthy/dangerous behavior, to be fair, you must tax them all. So, we should raise premiums of people who drive cars (more dangerous than walking, and "absolutely controllable") especially raise premiums of those who drive motorcycles (even more dangerous, and still "absolutely controllable,") people who sunbathe/suntan (increased risk of skin cancer, and another "absolutely controllable" behavior,) etc, etc.
Most insurers do ask questions about risky activities such as skydiving and motorcycle riding. I was asked about plans to go overseas. The insurers already do take into account those risk factors that their actuarial data show are likely to be more costly. Other risk factors must not reach the level that they wish to address.
 
I actually agree with what you're saying. Just for the sake of argument if we say that we can exclude behavoiral choices like smoking but not genetic predispositions like obesity won't the addiction crowd claim that thier alcoholism and drug abuse are due to heredity. By your logic if we can't set different insurance costs for people with diseases that might not be totally their own fault then insurers should allow someone who is actively addicted to sign up.

Most insurers do ask questions about risky activities such as skydiving and motorcycle riding. I was asked about plans to go overseas. The insurers already do take into account those risk factors that their actuarial data show are likely to be more costly. Other risk factors must not reach the level that they wish to address.

I'm only temporarily ignoring the valid points that you make in your message, but are you sure about what you are saying in your second paragraph? I have had group health coverage through my employer for almost 12 years now, and I have changed insurance companies several times (I forget how many exactly, but more than 5) as either I changed jobs, or my employers pursued the cheapest health insurance plans out there. Never have I had to answer any questions about any "risky" activities in which I engaged for the insurance company. Not smoking, not alcohol, and certainly not skydiving or motorcycle riding. Perhaps individual coverage is different. I guess I was assuming the following (perhaps erroneously):

1. Everybody's group coverage is the same as mine WRT disclosure of "risky" behavior.
2. The majority of people covered by insurance are covered by group coverage (in this respect, Medicare and Medicaid are simlar to group coverage since no premium is paid; therefore, premiums can't be adjusted based upon "risky" activites in which the insurer engages.)

Fundamentally, I have no problem with insurers setting prices as they see fit (so long as they don't discriminate against any "protected" classes) but further increasing the price of insurance to an emerging majority of customers will only lead to more people "rolling the dice" and not buying insurance.
 
Perhaps individual coverage is different. I guess I was assuming the following (perhaps erroneously):

1. Everybody's group coverage is the same as mine WRT disclosure of "risky" behavior.
2. The majority of people covered by insurance are covered by group coverage (in this respect, Medicare and Medicaid are simlar to group coverage since no premium is paid; therefore, premiums can't be adjusted based upon "risky" activites in which the insurer engages.)
Individual health coverage is different than group coverage. With individual coverage you can be excluded for pre-existing conditions, activities and so on. Group coverage is attractive because the insurer agrees to cover the group and won't exclude individuals. The idea for the insurer is that if the group is basically healthy the few "bad apples" won't make it a losing deal. They do demand that you prove to them that they will make money on the deal.

My physician group just went through the process of getting group insurance. They had us fill out health surveys and they demand that a certain percentage of the eligible partners subscribe to the plan. After they got our info they decided what rate they'd insure the group for.
 

Well I suppose there may be other components, but it would be hard to argue the opposite--that excess weight is entirely dismissive of fault on the individual who accrues it.

As a health care worker I can attest to the huge impact a large immobile person has on the system; the amount of man hours it takes to care for them is higher than you might think and that's just incidental in house costs.

So, while implementation of such a tax would be problematic for all sorts of reasons, my back tells me every time I lift one one of these folks that it would not be such an unfair idea.
 
not specifically weight though but bmi.
I wouldn't be opposed to higher rates for the morbidly obese(says the 5'9" 150 lb ultramarathon runner)
there is a difference between being 6'4" 220 and 5'2" 220 after all
 
Well I suppose there may be other components, but it would be hard to argue the opposite--that excess weight is entirely dismissive of fault on the individual who accrues it.

As a health care worker I can attest to the huge impact a large immobile person has on the system; the amount of man hours it takes to care for them is higher than you might think and that's just incidental in house costs.

So, while implementation of such a tax would be problematic for all sorts of reasons, my back tells me every time I lift one one of these folks that it would not be such an unfair idea.
I couldn't agree more with this. It reminds me of the "Fatties" thread.

http://forums.studentdoctor.net/showthread.php?t=270024
 
I couldn't agree more with this. It reminds me of the "Fatties" thread.

http://forums.studentdoctor.net/showthread.php?t=270024


Indeed. I liked your ideas in that thread--which after perusing the first 2 pages was particularly short on ideas. Especially the possible center for morbidly obese people where the staff could be highly trained in the necessary equipment to move them and perform exams.

I worked on the lift teams among other things. Working in a hospital is more dangerous than people think. I had 2 back surgeries for herniated discs last year and it looks like my career for that type of work is over.

Whenever a 4-5 hundred pounder came into our hospital every service seemed to groan under the weight with the extra labor that needed to be managed around them. We didn't have the equipment we needed and so on.
With this segment of the population growing we're going to see a lot of unsafe care for both the patient and staff, it seems to me.
 
No. They should not, and I am not overweight. It's like saying they are fat because they eat to much,not all do, there are medical reasons and genetic reasons why people put on weight as well as the obvious they eat to much but even that can be laid at the door of an eating disorder or depression.

People who are taller are more likely to bang their heads than the rest of us average height people do we refuse or increase their tax burden to compensate.
 
People who are taller are more likely to bang their heads than the rest of us average height people do we refuse or increase their tax burden to compensate.

That made me giggle.


I definitely think, in the vast majority of cases, too much in and too little out overshadows genetic factors. But there ARE genetic factors involved for the Average Joe, not to mention extreme cases like Prader-Willi (or would people with that condition be exceptions to the higher premiums?). And as you said, a lot of eating disorders result from depression. I personally know a few overweight women who tend to eat when they get sad. What they need to do is go to therapy and hopefully turn their mental and physical health back in a positive direction. And it's not like a smoking addiction - you can't stop eating cold turkey.

Also, it is my understanding that a higher percentage of the poor are overweight when compared to the upper societal circles. Probably because a lot of the cheap foods are processed, preserved, are unhealthy. If they already have problems paying for insurance, and their premiums go up, will the uninsured population just increase a bunch?


But I totally understand where you other people in favor of higher premiums for the overweight are coming from, which is why I tried to stay out of this thread.
 
That made me giggle.


I definitely think, in the vast majority of cases, too much in and too little out overshadows genetic factors. But there ARE genetic factors involved for the Average Joe, not to mention extreme cases like Prader-Willi (or would people with that condition be exceptions to the higher premiums?). And as you said, a lot of eating disorders result from depression. I personally know a few overweight women who tend to eat when they get sad. What they need to do is go to therapy and hopefully turn their mental and physical health back in a positive direction. And it's not like a smoking addiction - you can't stop eating cold turkey.

Also, it is my understanding that a higher percentage of the poor are overweight when compared to the upper societal circles. Probably because a lot of the cheap foods are processed, preserved, are unhealthy. If they already have problems paying for insurance, and their premiums go up, will the uninsured population just increase a bunch?


But I totally understand where you other people in favor of higher premiums for the overweight are coming from, which is why I tried to stay out of this thread.


Do not underestimate the connection between poverty and a lack of self control. Some of it is the food that one can afford while poor, but I know firsthand that one can survive on very little money and support a family without getting fat.
 
That made me giggle.


I definitely think, in the vast majority of cases, too much in and too little out overshadows genetic factors. But there ARE genetic factors involved for the Average Joe, not to mention extreme cases like Prader-Willi (or would people with that condition be exceptions to the higher premiums?). And as you said, a lot of eating disorders result from depression. I personally know a few overweight women who tend to eat when they get sad. What they need to do is go to therapy and hopefully turn their mental and physical health back in a positive direction. And it's not like a smoking addiction - you can't stop eating cold turkey.

Also, it is my understanding that a higher percentage of the poor are overweight when compared to the upper societal circles. Probably because a lot of the cheap foods are processed, preserved, are unhealthy. If they already have problems paying for insurance, and their premiums go up, will the uninsured population just increase a bunch?


But I totally understand where you other people in favor of higher premiums for the overweight are coming from, which is why I tried to stay out of this thread.
I think you are missing the point of privately purchased health insurance. We're not talking about covering everyone or being fair to the poor or saving the world on this one. There are a few other threads on that around. In this instance I'm talking about what happens if you pick up the phone and call Blue Cross and say "I want to buy health insurance." You would not be eligible if you have Prader-Willi. They wouldn't touch something like that wih a ten foot pole. You will have higher premiums or exclusions if you have health problems. They don't care if you're poor or not. This isn't Medicaid, it's McDonalds. You want a burger then pay or get out. Bill Gates or the bum on the corner.

Another economic fact that makes everyone squeemish is that if I am insured by a company and you apply with some health problems I want them to deny you. I get the most for my dollar if I am the unhealthiest person on the plan. If they put a Prader-Willi patient on my plan he's going to use up lots of resources so I either get less coverage or higher rates.
 
There are a lot of people that would love to be able to have healthcare coverage but can't afford it.

There are others that have had healthcare coverage for so long that they think that it is a right. These people tend to not follow directions of their medical providers, which makes them sick again, and then their back wondering why they are sick again.

If your not going to follow the advise of medical providers than either find a new physician that understands your needs or withdraw from the healthcare plan.
It is people like you that are unhealthy that require a lot more personal attention that are keeping costs high for those of us that would like to pay less for healthcare.

A word to the healthcare providers.
If your patients don't listen and follow your advice or instructions then you should drop them as your patient and make them go to another physician. If they don't want to listen to the 2nd person, then they need to be dropped from the plan all together.
 
Thanks for your all replies.
 
I think it is totally reasonable to charge more for health insurance for the obese whether you are one of the many overeaters or one of the few obese due to hormonal abmormalities. They can charge more for auto insurance if you are male (100% genetic) or young (100% beyong your control) just because you are in a group with statistically higher insurance claims, so why not charge more for obese people based on their risk group?
 
So for those of you who think it's reasonable for the fat to be charged more for health insurance (which includes me) what about race. African Americans have high rates of hypertension and diabetes. Should they be singled out and charged more? I expect that few would advocate such a position and no insurer would ever attempt such a thing. It shows that there are limits to the actuarial data is king concept.
 
Excellent point. I think it would be hypocritical to surcharge one high-risk group and not another, but I agree that there is no way in hades that the insurance companies would touch that one with a 10 foot pole. That's why I think it is OK for them to just share the risk. Chances are that everybody engages in SOME risky behavior (though obviously some more than others.) I'm OK with paying a little more for my insurance because I am subsidizing the high-BMI crowd (of which I am not a member) than have the insurance companies digging more and more into my personal business/habits/hobbies.

Those who do not participate in ANY risky behavior ARE getting screwed, but they will presumably be rewarded through their longer, healthier lives. Let's not forget that we are talking about a stochastic process here. Just because you lead a healthy lifestyle, does not mean you will absolutely be less of a burden on the insurer, it's just that it's more likely to turn out that way.

Also, genetics plays a big part in risk, as well. Perhaps an example not as extreme as yours, but more extreme than surcharging obese people would be surcharging people whose family has a predisposition to cancer (of any sort.) Clearly, those people have a higher risk of cancer, and will be a bigger drain on the insurer than those who don't. Should people whose families have a predisposition to cancer or heart disease pay higher premiums?
 
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