Tough question

[Isis33]

What do you guys think of the proposal that smokers should have to pay significantly higher insurance premiums? I am all for it if it will discourage unhealthy behavior and reduce costs for everyone down the line.
Conversely what do you think of the issue of deciding who gets a lung transplant if there is only one resource available a smoker for 30 years who has advanced lung cancer, or a nonsmoker with a family?

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[Captain Fantastic]

Insurers should be able to require a higher premium for unhealthy behavior. That's the business of insurance. They're making the gamble that you'll pay more in premiums that you'll require in payments (and you're making the opposite gamble). If you choose to engage in a behavior that raises your health risk, the insurers should charge you a higher premium to cover that higher risk. I don't see how this is different than having higher premiums on new drivers. If you're more likely to file a claim, you should expect to pay a higher premium.

I'd go with the non-smoker unless the smoker has a substatiated history of smoking cessation. Then its a toss up. Otherwise my concern in giving the smoker the lung would be having him destroying the transplanted lung as well. If he wants to smoke himself to death that's his business, but if that's his choice I'd rather give the lung to someone who will take better care of it.

 

[Pretty POHA]

What do you guys think of the proposal that smokers should have to pay significantly higher insurance premiums? I am all for it if it will discourage unhealthy behavior and reduce costs for everyone down the line.
Conversely what do you think of the issue of deciding who gets a lung transplant if there is only one resource available a smoker for 30 years who has advanced lung cancer, or a nonsmoker with a family?

These don't seem to be tough questions at all...
Of course, I'm not familiar with the laws what the lawmakers have said regarding these questions-- but if I was a lawmaker voting:
A) health insurance should be higher for smokers. Should be lower for non-smokers. Smoking increases you risk of medical issues in many areas: smokers are more frequently sick, have a high risk of cancer, have a higher risk of stroke, heart disease, and bronchitis... to name just a few things that come to my head right this minute. Smoking is a choice that a person makes. Choosing to smoke is a priviledge, but they make premiums higher for people with other illnesses-- and many people are uninsurable simply based upon a medical issue that is beyond their control.
B) Lung cancer can happen in anyone, not just smokers. But if you're getting a transplant of an organ, I think it should be a written legal promise that you will do everything to protect and value that new organ. On the same line of thinking a drinker should legally bind themselves in a promise to not drink if they got a liver transplant... Failing to uphold that promise should be a crime because abusing a transplanted organ is a neglect that prevents another person more interested in healthy living from receiving that organ.

 

[DrBowtie]

Both seem like no brainers to me. Everyone else have already given all the good answers.

 

[GujjuNo1]

Correct me if I am wrong...but insurance companied already charge higher premiums to people that smoke (or have high BP or diabetes etc...).

The question comes in when the insurance is bought through the employer. In that case, it should be the same as someone buying their own insurance - It should be higher.

Wouldn't this be tough to regulate?

 

[Captain Fantastic]

The question comes in when the insurance is bought through the employer. In that case, it should be the same as someone buying their own insurance - It should be higher.

Wouldn't this be tough to regulate?

Well, I think the employer should decide how they want to handle it. What they choose to take out of each employee's pay-check is something they can negotiate between each employee (or the union if the employees are represented).

Some employers self-insure and use the insurance company for "Administrative Services Only." In self-insured cases the employer is paying the medical bill directly -- they are effectively the insurance company, too. If they don't mind sitting on the increased risk of a smoker, then who am I to say they should do so.

The employer offers health insurance as a way to mitigate lost productivity, attract and retain valuable employees, and there-by increase profits. At some point I'm guessing insurance will cost the employer so much that they will no longer see a reason to offer it as a benefit. We've all grown used to the idea of receiving this benefit from employers, but I think its days are numbered.

 

[Shredder]

yeah they dont really seem like tough questions. it brings to mind something called a death spiral in insurance...does anyone know what im talking about?

 

[pagemmapants]

Not only should they pay higher tax premiums, but it's my own personal opinion that tobacco (and all other drugs) should not be made illegal but that they should just have the hell taxed out of them and the proceeds put toward education and/or medical research.

 

[IAMS]

I read about an employer who was refusing to hire (and thereby insure) smokers at his business last year. This will soon be the norm. Tobacco is fast being considered an unacceptable liability.

 

[OSUdoc08]

Not only should they pay higher tax premiums, but it's my own personal opinion that tobacco (and all other drugs) should not be made illegal but that they should just have the hell taxed out of them and the proceeds put toward education and/or medical research.

This is becoming a reality:

There was a $0.65/pack tax added to all Oklahoma tobacco purchases last year.

ALL of this money was sent directly to healthcare in the state, with a significant portion going to the state's medical schools.

 

[chandelantern]

I agree with what everyone has said...not really a debate if you ask me. I'm also all for anti-smoking laws in public, as many more cities and states are moving towards (thank goodness!)

Here might be a little trickier question though. Should it be legal for health insurance companies to have higher (sometimes completely unaffordable) premiums for patients that have a genetic history of a genetically inheritable illness, or have otherwise been identified as higher risk for an illness dispite good health behaviors of the patient. One example is a woman that has had numerous abnormal pap smears (statisitcally, she is more likely to develop cervical cancer) so are insurance companies justified in making her insurance substaintially higher than a "normal" customer? (oh, and this woman doesn't work at a job with health insurance benefits and does not qualify for governmental insurance.)

 

[futuredo32]

What would you think about higher insurance premiums for obese individuals who are more prone to DM type two, htn, etc?

 

[OSUdoc08]

What would you think about higher taxes for obese individuals who are more prone to DM type two, htn, etc?

You can't do this, since obesity is often genetic.

Smoking is not.

 

[futuredo32]

You can't do this, since obesity is often genetic.

Smoking is not.

Obesity does have a genetic component, but one can exercise and eat healthy. People can and do lose weight, even those with a genetic predisposition to being overweight. Food, like cigarettes, is an addiction for many.
I think that it may be a slight incentive for some people to lose weight. Obviously, there are other incentives as well and for many, these incentives aren't "enough." I also think that obesity related health problems add to the care of health care in America and that by having higher insurance premiums, it would do a little bit to off set these costs. (I am not suggesting that this alone will solve the problems we have with the high cost of health care, but every little bit helps.)

 

[Shredder]

You can't do this, since obesity is often genetic.

Smoking is not.

inclination to smoke or drink, and especially to get addicted, is also affected by genetics. driving is even affected by temperament/genes. genetics and insurance is a real conundrum

 

[OSUdoc08]

inclination to smoke or drink, and especially to get addicted, is also affected by genetics. driving is even affected by temperament/genes. genetics and insurance is a real conundrum

Although true, smoking isn't a major morbidity of the pediatric population, while obesity is.

The fact of the matter is these children have no control over this. Since they have no control, you cannot regulate it.

 

[DropkickMurphy]

Genetic redisposition and actually carrying out an act are two seperate things. People, like it or not, are responsible for their own actions. Just as I should (and do) pay higher premiums on my life insurance because I actively skydive and scuba dive, smokers, heavy drinkers, obese people and other persons who act without regard for their own health should be required to pay more than the rest of us.

 

[NonTradMed]

Well, I always thought nonsmokers paid more in insurance premiums....?

Personally, I think insurance should charge higher premiums for any and all personal bad habits which can lead to poor health---including eating junk food! How this would be regulated I have no idea, but if there is a way, I think it'll be great method to ensure better eating habits. Just as putting a cigerette into one's mouth is unhealthy, eating a bag of cheetos has little redeeming nutritional value and should be treated as a burden on one's health just like smoking....so who's with me?

 

[chef_NU]

In my opinion:

As far as insurance companies go, the government should not regulate them at all. However, the government does need to uphold the right to privacy for individuals. I.e., an individual would be able to prosecute "fact-finders" for snooping around and intruding upon private lifestyle. Thus, insurance companies do not have the right to personal or medical information unless the individual chooses to disclose it. Obviously, someone with nothing to hide could probably get a better premium than someone who refused to disclose their information. Government forcing insurance companies not to discriminate (even when information they collect is legal) seems like it is forcing public charity. To me, this is horse doo-doo. The business of a business is to make money, not to provide handouts.

Would this force people to adopt a healthy lifestyle? No. But it would be pretty stupid not to. If you want to eat twinkies and smoke all day, you'll just be paying the REAL price involved in those behaviors.

 

[chef_NU]

You can't do this, since obesity is often genetic.

Smoking is not.

This is lame.

Granted, a select few people will be obese pretty much regardless of what they do. That number is extremely low, though (think about natural selection, people. you wouldn't be here today if you and all your ancestors were inevitably to become obese. the lion or tiger or wolf pack would have had prime rib fatass for dinner when they caught up with you.) This has been brought up before, and I'll say it again. Obesity is a disease of lifestyle. Look at the history of obesity rates in this country. Stop claiming vindication from your supposed "genetic" obesity.

 

[OSUdoc08]

This is lame.

Granted, a select few people will be obese pretty much regardless of what they do. That number is extremely low, though (think about natural selection, people. you wouldn't be here today if you and all your ancestors were inevitably to become obese. the lion or tiger or wolf pack would have had prime rib fatass for dinner when they caught up with you.) This has been brought up before, and I'll say it again. Obesity is a disease of lifestyle. Look at the history of obesity rates in this country. Stop claiming vindication from your supposed "genetic" obesity.

I weigh 160.

Read my thread about children.

 

[OSUdoc08]

Genetic redisposition and actually carrying out an act are two seperate things. People, like it or not, are responsible for their own actions. Just as I should (and do) pay higher premiums on my life insurance because I actively skydive and scuba dive, smokers, heavy drinkers, obese people and other persons who act without regard for their own health should be required to pay more than the rest of us.

Once again, I will refer you to obese children.

The parents may or may not be responsible, but is it right to make healthcare too expensive for children to be covered, when the obesity is out of their control?

 

[calcium boy]

If health insurance companies charge higher premiums because of personal lifestyle (McDonalds every day or the women I saw on the TRAIN THAT ATE SIX DONUTS IN 30 MINUTES), fewer people would be able to afford health insurance.

In the United State we already have so many uninsured people, we don’t need anymore.
If people can not afford insurance because of their unhealthy lifestyle, how will they pay you future docs? You say some people are to fat so insurance companies should charge more, but no insurance means a smaller paycheck for you.

I thought it was our job as healthcare professionals to educate patients and help improve their lifestyle.

Insurance companies already suck, with their drug formularies, referrals, tons of paper work and all other bullsh*th. Insurance companies want to make money and they do.

 

[bananaface]

Although true, smoking isn't a major morbidity of the pediatric population, while obesity is.

The fact of the matter is these children have no control over this. Since they have no control, you cannot regulate it.

You could theoretically charge higher premiums to smokers to get their kids coverage, since those kids have a higher rate of illness than kids whose parents do not smoke.

 

[Gut Shot]

Insurers should be able to require a higher premium for unhealthy behavior.

How about the notion that certain unhealthy behaviors actually save money in the long run? Smokers have a strong tendency to die earlier than non-smokers, and thus avoid the rather extensive costs associated with old age.

There have been a number of analyses published in the scientific literature which support this view. This article from those hippies at The Cato Institute sums up things nicely.

"When those savings are computed (at a 3 percent discount rate), they more than offset the costs that smokers create. Smokers actually save society about $.32 per pack smoked. Not only do smokers save taxpayers money, smokers also pay an average of $.53 per pack in federal and state taxes. And given the approximately 30 billion packs of cigarettes smoked a year in the United States, smokers pay $15.9 billion more than would be necessary if we were to follow the principle that people should pay for the costs they impose on others. In effect, smokers pay taxpayers for the right to smoke in addition to the savings that they create for taxpayers by dying early."

Thank you, Big Tobacco!

 

[Gut Shot]

What do you guys think of the proposal that smokers should have to pay significantly higher insurance premiums? I am all for it if it will discourage unhealthy behavior and reduce costs for everyone down the line.

If this came to pass, however, my concern is that patients would resort to hiding their unhealthy behavior from their physicians, which doesn't really benefit anyone.

As I alluded to in the above post, this is built on a faulty premise. Fat, lazy smokers save us money in the long run by having the courtesy to die early. If anyone should be charged higher premiums, it should be the jerks who insist on living to 97 (with dementia) and require dialysis, nursing care and 73 medications.

Help out our healthcare system: eat six donuts in 30 minutes.

Conversely what do you think of the issue of deciding who gets a lung transplant if there is only one resource available a smoker for 30 years who has advanced lung cancer, or a nonsmoker with a family?

There will be a lot of factors which dictate who gets the lungs, and I can guarantee that the smoker will have to have quit smoking for a certain period before becoming eligible. Prognosis will also be factored in, and "advanced lung cancer" doesn't make one very optimistic. Unless there is something extraordinary about this scenario, Captain Cancer here would probably be getting palliative treatment, not transplant.

 

[bananaface]

How about the notion that certain unhealthy behaviors actually save money in the long run? Smokers have a strong tendency to die earlier than non-smokers, and thus avoid the rather extensive costs associated with old age.

There have been a number of analyses published in the scientific literature which support this view. This article from those hippies at The Cato Institute sums up things nicely.

"When those savings are computed (at a 3 percent discount rate), they more than offset the costs that smokers create. Smokers actually save society about $.32 per pack smoked. Not only do smokers save taxpayers money, smokers also pay an average of $.53 per pack in federal and state taxes. And given the approximately 30 billion packs of cigarettes smoked a year in the United States, smokers pay $15.9 billion more than would be necessary if we were to follow the principle that people should pay for the costs they impose on others. In effect, smokers pay taxpayers for the right to smoke in addition to the savings that they create for taxpayers by dying early."

Thank you, Big Tobacco!

So, smokers pay society 10 cents a pack, hm? I heard on some radio show that the healthcare costs to the public per pack of cigarettes smoked is like $6-7. I have no idea where they got that figure from. But it's a helluvalot greater than 10 cents.

 

[chef_NU]

How about the notion that certain unhealthy behaviors actually save money in the long run? Smokers have a strong tendency to die earlier than non-smokers, and thus avoid the rather extensive costs associated with old age.

There have been a number of analyses published in the scientific literature which support this view. This article from those hippies at The Cato Institute sums up things nicely.

"When those savings are computed (at a 3 percent discount rate), they more than offset the costs that smokers create. Smokers actually save society about $.32 per pack smoked. Not only do smokers save taxpayers money, smokers also pay an average of $.53 per pack in federal and state taxes. And given the approximately 30 billion packs of cigarettes smoked a year in the United States, smokers pay $15.9 billion more than would be necessary if we were to follow the principle that people should pay for the costs they impose on others. In effect, smokers pay taxpayers for the right to smoke in addition to the savings that they create for taxpayers by dying early."

Thank you, Big Tobacco!

Very interesting article. = )

I suppose that the incentive for insurance companies to demand greater premiums from smokers stems from the fact that they assume the health care risks, and the federal government (and not the insurance company) makes the savings in pensions and retirement benefits. Were we to completely remove government funded entitlements, though, we wouldn't be saving any federal money by encouraging people to smoke.

Smokers save money in the long run in the system we have in place TODAY, which is rightly somewhat bizarre when you think about it. This is because of the pooled expenditures of the federal government. In a society where these things don't exist, though, it is better for the individual not to smoke, because they will save money on healthcare premiums. Of course, they could live shorter, unhealthy lives and pay less total money for their lifetime health care. But is that really what the individual desires?

 

[Gut Shot]

So, smokers pay society 10 cents a pack, hm? I heard on some radio show that the healthcare costs to the public per pack of cigarettes smoked is like $6-7. I have no idea where they got that figure from. But it's a helluvalot greater than 10 cents.

Wow! I'm not sure I can compete with "some radio show," but here is the abstract:

BACKGROUND: Although smoking cessation is desirable from a public health perspective, its consequences with respect to health care costs are still debated. Smokers have more disease than nonsmokers, but nonsmokers live longer and can incur more health costs at advanced ages. We analyzed health care costs for smokers and nonsmokers and estimated the economic consequences of smoking cessation. METHODS: We used three life tables to examine the effect of smoking on health care costs - one for a mixed population of smokers and nonsmokers, one for a population of smokers, and one for a population of nonsmokers. We also used a dynamic method to estimate the effects of smoking cessation on health care costs over time. RESULTS: Health care costs for smokers at a given age are as much as 40 percent higher than those for nonsmokers, but in a population in which no one smoked the costs would be 7 percent higher among men and 4 percent higher among women than the costs in the current mixed population of smokers and nonsmokers. If all smokers quit, health care costs would be lower at first, but after 15 years they would become higher than at present. In the long term, complete smoking cessation would produce a net increase in health care costs, but it could still be seen as economically favorable under reasonable assumptions of discount rate and evaluation period. CONCLUSIONS: If people stopped smoking, there would be a savings in health care costs, but only in the short term. Eventually, smoking cessation would lead to increased health care costs.

N Engl J Med. 1997 Oct 9;337(15):1052-7.

This is, as one might imagine, a rather hotly debated topic.