Should Fat People Pay More For Health Insurance?

nytimes.com:

Two years ago, the Cleveland Clinic stopped hiring smokers. It was one part of a "wellness initiative" that has won the renowned hospital -- which President Obama recently visited -- some very nice publicity. The clinic has a farmers market on its main campus and has offered smoking-cessation classes for the surrounding community. Refusing to hire smokers may be more hard-nosed than the other parts of the program. But given the social marginalization of smoking, the policy is hardly shocking. All in all, the wellness initiative seems to be a feel-good story.

Read the whole story: nytimes.com

Comments

[Mark4Boston]

This post brings in prejudice in many forms, and raises ethical and moral quesions. However...

Should we allow fat people or junkies to have medical care? Yes, and more importantly we need them to have mental health care. What is the nature of health care?

In this modern world, I believe mental health is a major cause of health problems. We need to treat people as whole beings, not as a bunch of symptoms in one body.

We should have a national single payer plan, whether socialized medicine (MD's are gov't employees) or health insurance for all, where cost is paid by employers, or funded on a pro rata basis.

As the great philosopher George Clinton said, "Free your ass and your mind will follow!"

[So-many-opinions]

Of course fat people should pay more for health insurance. So should people who smoke, or have a family history of disease, or who have a pre-existing condition. The whole point of insurance is to deal with risk, and the higher probability (risk) that a claim will need to be paid, the higher the premium needed to cover the risk. When dealing with homeowner's insurance, people with brick houses pay less than people with wooden houses, because brick is less likely to burn down. A fat, unhealthy person is the equivalent of a house made out of gasoline-soaked straw. High risk means, high premium. Bringing "fairness" into the debate is misleading. Any insurance underwriter in the world looks at pre-existing conditions -- do you think someone would sell you homeowner's insurance if they knew your house was already on fire? If when you sign up for health insurance you are already fat, that is a valid consideration.

[LewDan]

For anyone who wants to be sure that they don't pay more than their fair share there's a simpler, more traditional plan, its called "cash on demand." Just pay your own bills.

Otherwise, what entitles you to receive more than you paid if necesary is that you take the chance of paying more than you'll get back.

Charging more based on risk-factors isn't about being "fair", fair is everyone pays the same and takes their chances. Charging the obese more is about trying to stack the deck. To pay less to provide coverage for others than they have to pay to provide coverage for you.

Charging the obese more is statisticly fair for the group, but for the individual. Statistics aren't precise enough to predict individual outcomes and its not "fair" to penalize an individual who may or may not turn out to be representative of the group. Sure insurers have been doing it for decades, but certainly not because it was "fair," but because it was profitable and marketable.

Its also a stupid argument. I doubt a 40 year-old 360 lb man would be upset about having paid more and gotten less in healthcare than the 29 year-old vegetarian marathon runner with cancer.

You want "fair" just pay your own bills.

[Burkelbile]

Your concept is valid, and your heart may be in the right place, but consider this:

My friend's wife collapsed, went code blue, and was "revived" in the emergency ward, then in a coma in the ICU for 6 weeks,
then 3 weeks regular hospital room recovery, then 10 days rehab before returning home.

Total bill - $225,000.00. (no bs) - Try "just paying" that.

The root concept of insurance is that many healthy pay in to cover the few catastrophic illness events (heart attack, / cancer, auto accidents etc) that occur to the unfortunate / sick and could happen to anyone, anytime. Kind of cold to base who pays on "luck," don't you think?

Our healthcare is good to average, insurance companies corrupt, and the system is broken.
That's why we're having this little discussion.

[Burkelbile]

Your concept is valid, and your heart may be in the right place, but consider this:

My friend's wife collapsed, went code blue, and was "revived" in the emergency ward, then in a coma in the ICU for 6 weeks,
then 3 weeks regular hospital room recovery, then 10 days rehab before returning home.

Total bill - $225,000.00. (no bs) - Try "just paying" that.

The root concept of insurance is that many healthy pay in to cover the few catastrophic illness events (heart attack, / cancer, auto accidents etc) that occur to the unfortunate / sick and could happen to anyone, anytime. Kind of cold to base who pays on "luck," don't you think?

Our healthcare is good to average, insurance companies corrupt, and the system is broken.
That's why we're having this little discussion.

[Pippen]

Good points all of them Lew -

I agree and believe if you lined up every "fat" person in the U.S. and asked them "...are you fat because of over eating and narcissitic indulgent behavior...?" They would all say emphatically "NO"!

They would give every excuse in the book except that one. Some would be telling the truth others would pay Doctors to lie for them so they could appear to be telling the truth. Vertiglio ? I think not.

1 Medical
2 bad RNA DNA (genetically heredical)
3 Disease
4 Symptoms of treatments for something else
5 Disabled motor functions, broken legs, etc...
6 Mental disorders
7 Trying but can't take it off for unknown reasons
8 Fat Thetans taking over their internal organs
9 Possessed by the devil
10 Their twin lives inside them like a goider
11 Pregnant 24/7 and has 100 children

You get the picture

The other side of that would be we shouldn't tax fat people for fast food or grocery shopping or gas. Why ? Because they add more to the economy then some Vegan growing their dinner in their backyard. Should off set itself a little.

[Sebbybear]

While you are at it charge more for African-Americans and Latinos since they have a higher rate of heart disease, high blood pressure and diabetes. Now don't forget to add additional charges for women because they have an annoying tendency to get pregnant and we all know how much pre-natal care can cost. Then of course if they have made the selfish decision to continue an at risk pregnancy, well they've got to pay extra for that too. Oh wait, athletes have a much much higher incidence of sports injury than the general population, gotta make sue they pay up accordingly. Why not be like the auto insurers and raise the rate even more for folks who have had a claim in the last five years. What absolute and total bunk!

[outnow]

Can it be concluded that you are overweight?

[Pippen]

I appreciate your argument and I tend to agree but lets consider a few things here.

1.) Football players ALREADY pay a higher insurance premium, not sure ? Go ask one. He'll tell you absolutely.

2.) Pregnancy doesn't typically threaten someones life nor is it a precursor to a terminal illness unless you count parenthood. Obesity does.

3.) I don't have a problem paying for my life style why should anyone else not act more responsibly ?

In my youth I doubt any insurance company in their right mind would have insured me but they did and never had an automobile incident involving my insurance save one speeding ticket. But I can assure you there countess incidents. I'm willing to accept that. I paid then and I'm willing to pay now.

It's time America started growing up and facing it's actions.

[the964kid]

Yes, except in cases where excessive weight gain is caused by a specific health problem. Also foods that are especially unhealthy should be taxed more, just as cigarettes are, which may help deter consumption as well as raise additional revenue that can be used to help fund health care costs.

[Burkelbile]

Yup.
Regularly stuffing quarter pounders w/cheese, large fries, and mega-coke down my throat is just as dumb as lighting up a Kool every 45 minutes.

Base the "weight" requirement on a professional "Body Mass Index" (BMI) measurement during insurance physical
(it takes a scale, a tape measure, and about 1 minute)
- screen via questionaire, medical history and current meds for a specific health problem that can cause weight gain that is not the applicant's fault,
and then, if you "flunk" with no legit excuse, Yes.

If you smoke, you rightfully pay significantly more in premiums;
and if you binge food, don't exercise, and get obese, your premium should be rated according to BMI
with an option to lower premiums when / if BMI goes down.

We all pay for it - everyone should have coverage without exception for pre-existing conditions,
but the healthy should be rewarded fairly with a lower premium. They're payin' for any of us fatties' diabetes, heart attacks, etc down the road.
Good for your personal health and motivation to lose weight when you get a kick in the wallet.

[Pippen]

It's doable.

The military decided to stop enlistment, recruiting etc..of any Obese member Officer or Enlisted, tenured on active duty or candidate enrolled. How ? They weighed them, calculated a body fat index for height, ethnicity, gerth, muscle fiber and diet monitoring. Takes about a month.

After a person is assessed a fat %, the Captain decides along with the Medical Officer is that person is Obese.

Then they decide if that person can be rehabillitated through a regime, program, medical or physical.

If the answer is Yes they are issued a "time frame" in which to drop weight or lose their uniform and be kicked out of the service for Behavior Unbecoming.

If the answer is no. They assemble a different team to determine if that person has extended problems preventing successful weight loss. If they are genetic, medical, complicated symptoms of disease etc...they assess if that person is a hazard to the environment (military). If they work in a land based safe zone behind a desk more than likely they are fine but if they are active duty in a hostile area they must relocate their enlistment or be kicked out on a Medical Discharge.

I don't trust large corporations or the government to implement a law or policy that would LOWER the costs to citizens so unless they could convince me that would be part of the program I would fight against it.

[LewDan]

Yeah, doable, as long as we want to cede complete control of our lives to the government, just like military personnel.

[mrwallin]

NO. For two reasons: 1) because obesity is a constantly fluctuating term. How do we establish obesity? body mass index? weight to hight? too problematic and contentious. 2) More importantly, obesity is the symtom, not the disease.

Do what other, "socialized" systems like European countries and Canada have done, and heavily taxed substances that contribute to health care risk: tobacco, alcohol, fatty, and sugared foods and drinks. This allows people the choice and occasional indulgence, but offsets the corresponding risk by paying into the system.

[ashabot]

YES!

[dididangerlove]

Yes. Obesity has been cited as the single biggest health care problem. Watching a lot of very overweight people in Atlanta holding signs saying "Keep your slimy hands off my health care" was more than annoying. If I'm not smoking or doing drugs or drinking to excess or over eating and I'm eating well and exercising, then why should I have to pay the same rate as someone who is smoking, doing drugs, drinking to excess and stuffing their pie hole?

Behavior modification should be encouraged and paying more for health insurance is certainly an incentive. By it's very nature, insurance is socialized. I pay into a group along with other people who make different lifestyle choices than I do. It isn't fair.

[outnow]

Try Dean Ornish's Spectrum Program, a series of healthy choices.

I became a vegan three weeks ago and lost weight. If you believe 217 to 198lbs at 6 feet tall. Not bad for being in my sixties!

I go to the gym but have had a cold during this period so it wasn't the exercise.

There is no such thing as a meat-deficiency syndrome. Eliminate meat and eat complex carbs and raw foods. Cut cancer, heart disease, diabetes, arthritis. Cognitive Behavioral Therapy is very good.

Insurance spreads risk but privatizes profit. But you are letting the bean-counters and the insurance companies call the tune - that isn't "socialized." I would rather have the government mandate good habits for a tax credit or a deduction. There would be some savings there, but healthy people live longer and use more benefits because of their extended life span. Final illnesses, whether sooner or later, still cost the same.

Forget the entire debate - just keep up your healthy choices and habits. The only one yoy can save is you. I like single payer. I'm hoping to survive until I am 65 and can get coverage because of my pre-existing conditions which have excluded me, and my age.

[raechel]

Think of it as a health (sick) care savings plan. Anyone who smokes, drinks excessively, over-eats (please don't insult us with the glandular problem bs), uses a tanning bed, or anything else that is a strong predictor of future illness should be required to pay accordingly into a health care savings plan. Anything you choose to do, and could choose not to do, such as over-eat, should be factored in to the amount you are required to pre-pay.

[LewDan]

Wow! Now, THAT'S fascist.

And you appear completely cluless to just HOW antithetical to American ideals that is.

[nihila]

Yeah! Free loading is the real American way. There is scarcely any insurance in the U.S. that is not "experience rated" -- i.e. large beneficiaries pay higher premiums. That's why drunks and DUI collectors get to pay super-high premiums if they are not canceled. Getting life insurance at standard rates if you admit that you like to race motorcycles, climb mountains, wrestle tiger sharks is tough. If you lie and your body is found partially digested in the guts of a TS your heirs will not collect. No unsubsidized insurance that is not experience-rated can survive unless it is badly overpriced (like airline trip life insurance). Of course, you don't see that around much anymore do you? Private bombers took care of that -- a sweet racket while it lasted but "moral risk" took care of that. Don't try to burn down your retail store that you have just filled with the season's fashions even if you have the "paid" bills.
BTW Don call people you disagree with "fascists" -- it's so 1930's.
that been out of style since 1945.

[CarbonCreditSeller]

Gay men should pay more due to the higher incidence of AIDS in their community.

[Steven Anderson]

One of the best one-liner posts I have seen in months...you got that right!!!

[dididangerlove]

Not all gay men participate in unsafe sex. You would have to include heterosexual people as well since there are other sexually transmitted diseases that increase the chances of developing a serious disease. Genital warts, which has been proven to increase the chance of developing cancer in women, is an example.

[mrwallin]

way to think like an insurance company! let's keep going with your logic, shall we? Since Blacks are disproportionally afflicted by AIDS, they should pay more than other ethnic groups. Since teenagers and young adults are more likely to engage in risky behavior, they should pay the most....

no. The corporations make profits dividing us, but we will be guaranteed care if we are united: we all pay the same, we all get the same quality care.

[kevin3]

since any form of sex carries the risk of disease, then all who have sex should pay more.

[nihila]

Not having some form of sex causes mental disease according to Dr. Freud. Check into that for me will you?

[nihila]

Say, CS, is that your photo? Looks queer to me. How about higher rates for people who look gay?

[textynn]

Why don't we consider fining corporations that are running Superfund sites? Why don't we make employers whose work sites are Superfund sites pay huge fines. Oh I know the reason, it''s because polluters are in the medical insurance industry. yep it's true.

[textynn]

This is mindless crap. Many people have weight issues because they have other medical problems, For example my friend has advanced arthritis and can't really walk much. Is she obese, yes. Why, cause she is unable to move around much barely able to walk. This is infantile thinking and I am ashamed of anyone that thinks all obesity is caused by character flaw. Its like blaming all crimes on mothers. Give me a break, it's just simple.

[raechel]

It is simple. Eat less. If you are less active, adjust your caloric intake accordingly.

[seattle music]

Anyone who uses the phrase "it is simple" when discussing solving the obesity problem in the United States is inhabiting an alternate universe.

It's a red flag of ignorance.

[outnow]

Being fat produces a witches' brew of chemicals and hormones that destroy the matrix of the carilage is joints - plus the weight. But for some, genetics is their destiny.

I just lost 20 lbs on a vegan diet in three weeks with relatively little exercise and I am over sixty. I never skipped a meal. I was never hungry. get rid of all meat and dairy products.

Read Dr. Dean Ornish's book, The Spectrum - it can reverse heart disease and arthritis. He provides the scientific proof, as he has done for thirty years.

Finally, like my alcoholic friend who doesn't drink anymore (or any less) you cannot take her reports of how much he/she eats at face value. I will be back to 185 lbs soon and my knees will thank me.

[nihila]

Instead of reading Ornish's books, try eating them instead.

[nihila]

Sorry your friend with weight issues has arthritis. It is well established that the greater
the weight on the joints the greater the incidence and severity of arthritis. Exercise is hard to do but essential to keep the joints working well. If ahe cannot restrict her food input try a gastrectomy. A heart attack sometimes works. Obesity is not caused by a character flaw, it is caused by excessive food consumption. Make a friend for life and tell her about it. If you don't, you are an enabler. She will eventually forgive you and maybe even thank you.

[Steven Anderson]

Certainly they should. Every study out there suggests that overweight people die earlier due to a wide variety of conditions. The insurance industry is a business just like anything else. HIgher risk, higher premium. I smoke almost 2 packs of cigarettes a day...don't you think I should pay higher insurance. Naturally. I like the idea some have blogged that fatty and/or unhealthy food should be hit with a big tax like they do for my cigs as long as it goes directly to subsidize the treatment of conditions related to the reason that it is being collected.

[berensma]

Until we all have equal access to the food, facilities, and information that will help us to prevent obesity on an individual level, no right exists to tax any of us.

It's always such an easy and distracting solution in this country, to develop a new group of "others" and demonize them. Helps you to feel smug and in control. But we're not in control of much, are we?

[yemaya]

divide and conquer, bread and circuses.

[raechel]

Oh, for crying out loud. I've been watching the town halls, so I am certainly aware that ignorance is epidemic, but is there ANYONE out there who doesn't know that if you over-eat, or eat the wrong foods, you will be overweight? Is there anyone out there who doesn't know a salad and vegetables and fruits are better for you than a candy bar? Ignorance isn't the issue.

[seattle music]

Do you actually know ANYTHING about obesity, eating disorders, food cravings, hunger-stimulating hormones, PCOS, thyroid disorders, adrenal disorders? Anything?

Ghrelin?

Neuropeptide Y?

Leptin?

Glucocorticosteriods?

Anything? Am I ringing any bells?

Here's a nice quote to get you thinking: "Higher levels of NPY may be associated with resilience against and recovery from posttraumatic stress disorder and with dampening the fear response, allowing individuals to perform better under extreme stress." What's that? The same neuropeptide that provides people with resilience against EXTREME stress also makes people ravenously hungry -- all the time?

Solving that little problem may sound "simple" to you. To me it sounds a bit more thorny, especially in cases of...oh, let me just throw out:

-- rape
-- child sexual abuse
-- death of a loved one (e.g. the spouse of a serviceman killed in action)
-- loss of not just a job but of the entire industry in which your job existed
-- foreclosure and loss of your home
-- an international economic melt-down
-- etc.

Again, if obesity were an easy problem to solve, NO ONE would be obese. In this society? Where being obese marks a person for constant verbal and social attack, abuse and abandonment? Who would choose that?!?