Health insurance premiums are too high in general. But shouldn't health insurers offer discounts for non-smokers (some do I know), non-/light drinkers or even people who excercise regularly. In the same way should overweight people be penalized? And by how much? Which health risks should not require higher premiums, but be subsidized by others in a humane sense (such as those with Tay sachs disease or other genetic disorders). This might be a bit of an idealistic thread as some lifestyle habits would be difficult to verify.
Fairness in health premiums- What to add surcharges or give discounts for.
By American in Japan Follow Wed, 26 Jan 2011, 7:13pm 4,664 views 30 comments
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Overweight people shouldn't be penalized, if only because that sets a dangerous precedent. If someone is over their ideal body weight one pound or one hundred pounds, they're still above their IBW. There are disorders that lead to weight gain as well.
An example is Rheumatoid Arthritis. One of the lovely features of the disease is that the medications can make one sick, mirroring the symptoms of anorexia. This could place a person under their IBW, which isn't good. However - prednisone and other treatments can cause weight gain, which places a person over their IBW. Other diseases/conditions that lead to obesity can be low testosterone levels, thyroid problems, hormonal deficiencies, Diabetes, Cushings Disease... and cardiac problems that limit activity make it hard to exercise.
Many insurance companies offer gym discounts or memberships, and there should be rewards for keeping within a good weight range, etc. I think that the goal of healthcare reform is to spread the cost of premiums among many so that the premiums aren't so costly for those few with metabolic or chronic disorders.
Of course, the actual costs of premiums don't reflect the "spreading the wealth" theory. It's like credit card reform - before it took effect many cards raised their interest in anticipation of their inability to raise it later. That's because the ceo's needed new fur coats for their girlfriends, while their wives wanted new cars and the ceo's themselves needed another four or five apartments in the city for their new girlfriends...
but I'm not bitter. ;)
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Patrick has a link on the front page today that is about obesity NOT being the differentiating cause of worse health outcomes in the US. Rather, the study says, the reliance on an unregulated for-profit system is to blame.
http://www.bbc.co.uk/news/world-us-canada-11502938?source=patrick.net#page-bookmark-links-head
"We speculate that the nature of our health care system - specifically, its reliance on unregulated fee-for-service and specialty care - may explain both the increased spending and the relative deterioration in survival that we observed," the authors wrote.
I'm not going to go out and stuff myself because of one study, but it was good to get a repudiation of the pesky propaganda that our life expectancy is lower than in Europe only because of obese poor people (that do not have proper healthcare, by the way).
The reason for our worse outcomes relative to Europe IS because our healthcare system is plain wrong and wasteful.
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I have been a bit influenced by that article since reading it. I somewhat like BBC news but even more I like the UK Observer.
Here is another from Japantoday for what it's worth:
http://www.japantoday.com/category/lifestyle/view/smoking-obesity-are-why-u-s-lifespans-lag-a-bit#show_all_comments
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It is cheaper to pay out of pocket.
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Tenouncetrout says
Perhaps it is, for regular medical care if the doctor will work with you on payment. However, for those people who need a surgical procedure, most people can't come up with $20,000 on the spot.
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>most people can’t come up with $20,000 on the spot.
I wonder if even some sort of health "bail" bond lender business would be better than the corrupt system currently in place.
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That'd be great, until Dog the Bounty Hunter shows up to repossess your kidney.
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I think they made a movie about that, actually 2:
Repo Man: The rock opera (I think thats what its called)
and
Repo Men
Seems that the real problem at least to me is what is charged by the medical provider
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@elliemae
>Overweight people shouldn’t be penalized, if only because that sets a dangerous precedent. If someone is over their ideal body weight one pound or one hundred pounds, they’re still above their IBW. There are disorders that lead to weight gain as well.
I am going to disagree here for a change. I think that most (by most I mean 85% or so) of Americans are overweight because of life style choices –ie. (1) Eating too much and/or (2) excercising too little...In these cases I believe there should be some incentives to lose weight with lower ins. premiums. I do think there should be some exemptions to higher premiums (such as the side effects of medications as you have mentioned). Anyway, I appreciate the information of cases such as Rheumatoid Arthritis that you wrote above. You work in a related industry so you know more overall than I do.
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American in Japan says
You are absolutely correct - but it's damn hard to quantify this issue. If the weight gain is because of diet & a sedentary lifestyle, it's possible that the people could be penalized. But what if an underlying medical condition is causing the sedentary lifestyle? It's one of those issues that could go either way.
The vending machine where I work has candy, cookies, potato chips, etc. There is one with apples in it but those don't sell very well, possibly because the heat from the machine's lights tends to cook the apples and make them go back quickly. So a medical facility sells crap, and many of our nurses and other staff are overweight.
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Elliemae,
>The vending machine where I work has candy, cookies, potato chips, etc.
Amazing!
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American in Japan says
Working in a healthcare facility is interesting... vendors bring in food all the time. Hardly any salads, but plenty of junky type food. Today we had sandwich platters, and tons of cookies. We get so much chocolate it's crazy, and there's always someone selling stuff for their kid's fundraiser. And we're in the healthcare field.
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BTW, I eat my share - but I'm one of the healthier people there. We've got some fairly overweight nurses, nothing compared to some hospitals I've seen.
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Premium
Given the J-shaped mortality curve for wine drinking, maybe you should get a discount on your insurance if you have the optimal 1 to 1.5 glasses of red wine per day.
The J-shaped curve means that people who drink a glass or so of wine have a lower mortality rate than those who don't drink at all. But exceeding 2 drinks per day negates the benefits, and beyond that causes a rapid rise in mortality:
Heck, maybe insurers should just buy everyone red wine. :-)
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elliemae says
This phenomenon has been baffling me the last 10 years. An unusually large fraction of the employees at any healthcare facility I have seen are overweight and >50% are downright obese. More so than in any other profession I can think of having observed. The exception tends to be the doctors. They are generally in shape, with very few exceptions.
I understand why it happens, with all the food being given as thank-yous and gifts, but it is frightening to see.
Are the hospital nurses any better -- they should have more running around to do, or have they acquired so many assistants that they also sit still most of the time?
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justme says
This is not a major reason, offers of food as thank-yous by patients are rare.
The major reasons (at hospitals) are:
(1) irregular shift and night work disrupting normal eating times
(2) high stress levels
(3) round-the-clock availability of food from the hospital cafeteria,
including quick delivery to the unit. Few other workplaces have that.
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Ellie,
I am curious what diseases, conditions cause prolonged "overweightness" or obesity. I think there is a certain % of the people who are overweight who can do little about it.
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ellie,
I am always floored by how many OBESE healthcare staff I come in contact with, be it in a nursing home or a hospital, ok, nursing homes are far worse than hospitals. I have once visited a nursing home in Los Altos, the admission director is so obese that she can barely move herself out of her office. The nursing staff there are 80% obese, 100% overweight, which leads me to question how they can possibly serve their residents well should there be any emergency.
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Fisk says
But Fisk, I see it in medical personell that do not work shifts, such as front-desk employees of clinics and medical groups.
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IBW == Ideal Body Weight ??
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I am confused here. That means people have to be below their ideal body weight and have high blood sugar to be in this very unhealthy state?
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Is artery damage one of the main effects of high blood sugar? That is interesting. I wonder what the exact mechanism might be.
On the topic of skinny people, specifically those that also have high blood sugar: Seems to me that these could be type 1 (inborn) diabetics that just didn't know about their condition? I think this is a ppssibility. It would not be surprising if they have bad outcomes.
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thunderlips11 says
Actually you don't need huge quantities of this junk, just a high proportion of your calories. It's interesting that in America the increase in obesity almost exactly matches the increase in consumption of high fructose corn syrup. When I was a kid in the 50's sugar was pretty expensive. A soda was 12 oz and cost enough that it was only purchased as an actual treat. No one drank soda day in and day out.
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My impression is that the problem is not High Fructose Corn Syrup (HFCS) per se, but rather that the cheap availability of HFCS has led food manufacturers to add HFCS into foods that used to contain no sugar or other sweetener.
In other words, it is not that HFCS is worse than regular sugar, it is that sum total of sugar and HFCS has increased, mainly because producers have added more sweeteners to compete for the consumer tastebuds. HFCS is just an enabler because it is cheap(*).
Correct me if I'm wrong. There may be some disagreement on the science here.
(*) Except in stores. You may have noticed that HFCS syrup is more expensive than sugar at the retail level. Probably this is a marketing ploy to avoid being perceived as "cheap sweetener".
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After thinking about this for awhile, and consulting my wife (who is a physician), I have concluded that about 15-20% of the people who are overweight have a genuine reason that is mainly/entirely beyond their control. The other 80-85% can do a lot to prevent their overweight (or obese) situation. Most people are jumping on the excuse bandwagon.
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Charge fat and accident prone way more.
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Charge by the person not by the family. People with lots of kids aren't paying their fair share.
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American in Japan says
Private health insurers offer such discounts, but that's because it's less likely that they will be able to hand off people with lifestyle related illnesses to Medicare.
The most expensive medical treatment the majority of us will have will be end of life care and it will be expensive at 65 or 85. The lifetime health care costs for 65 year olds will almost certainly be less than those for 85 year olds.
Obesity doesn't increase lifetime medical costs:
"Although effective obesity prevention leads to a decrease in costs of obesity-related diseases, this decrease is offset by cost increases due to diseases unrelated to obesity in life-years gained. Obesity prevention may be an important and cost-effective way of improving public health, but it is not a cure for increasing health expenditures."
http://www.plosmedicine.org/article/info:doi/10.1371/journal.pmed.0050029
Smoking doesn't increase lifetime medical costs:
"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. "
http://www.nejm.org/doi/full/10.1056/NEJM199710093371506
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When you want to borrow in excess of $4 million dollars, Where do you go ? Insurance companies make larger profits than OIL companies. They charge too much . WHY ? WHY NOT ? Who could argue ? Anybody know a dog dental insurance company ?
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Further proof is in their stock prices over the last 10 years as compared to the S&P over that same time.
http://bit.ly/oLnz15
Humans up 700% +
Aetna up 436% +
S&P 500 up 17%