Risk rating for fatties?

Risk rating for fatties?

Summary: There is no difference, in fact, between government refusing care based on your lifestyle and a private insurer raising its rates through the roof on you for the same reason.


Yesterday's piece on obesity drew a lot of commenters who had an excellent point.

Denying coverage based on your lifestyle is a lot like the current industry mania about "pre-existing conditions" that began the reform debate.

So how about this.

Smokers already pay more for health insurance. This smoker's differential can amount to up to $50/month.

And this is on top of all the other trips society has for tobaccoholics, from smoking pens in airports to the nasty looks of people like me trying to get out of the way of your smoke trail.

When this first became popular, in 2006, the CDC was estimating smoking cost $92 billion per year in lost productivity and $75.5 billion in direct health care costs.

That's awfully close to the $147 billion cost for obesity, another CDC estimate.

Scientists can measure the cost of your lifestyle choices. Actuaries can build these risks into rates. This is where the health insurance industry is moving, toward the collection of more data on people who aren't sick, evaluation of lifestyle risks, help in minimizing those risks, and penalties for those who ignore the advice.

This is not a question of who pays. The concept is, in fact, moving ahead faster among private health insurers, who have to answer to employers paying your premiums, than it is in government programs.

But at the heart of the savings President Obama promises from health reform is the extension of this regime to everyone. Best practices are driven by data. Wellness programs are driven by data. And the whole idea of that data is to check your compliance with medical advice, to change your lifestyle.

Many of the comments yesterday were on point. But many others weren't. Commenters argued against public health programs generally, charging it was a "taking" from them they resented.

So when a private company charges you more for insurance because you're obese, or because its data indicates you don't comply with your doctor's orders regarding diet, exercise, and wellness, is that a taking? Sure feels like it to me, and it's those who don't get charged extra whom I feel are doing the taking.

In suggesting that certain lifestyles be excluded from coverage due to their cost, I obviously struck a nerve. But there is no difference, in fact, between government refusing care based on your lifestyle and a private insurer raising its rates through the roof on you for the same reason.

Big brother and little brother have the same agenda, which is making sure you do what they say.

Or else.  Be as much of a jerk as you want. Just not with my money.

Topics: Health, CXO, IT Employment

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  • But where are the exceptions?

    My wife went on heavy steroids when she was treated for acute leukemia.
    That changes your shape pretty fast - guess you could call it a bloating
    side effect.

    Actually, I prefer the tax on "fat food", including sugar based drinks, to
    build a fund to take care of the fat folks. If you have a Big Mac you're
    increasing your risk. But that's OK as you've paid for your care in

    That gives you the freedom to eat what you want, as much as you want
    and when ever you want without me having to pay for your care.
    • It didn't fly

      When it was proposed that "fat food" be taxed in the present health care negotiations, it was shot down faster than a Texas lawyer hunting with Dick Cheney.
      • Is that why Cheney shot him? (NT)

  • I still think..

    adding a premium hike for fatties as you put it is more of a workable solution. BTW, all you people who slam the idea of big government dictating lifestyle choice and say not with my money, this is exactly what happens with private insurers now. If you are living a healthly lifestyle, you are paying the price for those who are not. If you are leading an unhealthly lifestyle, then those of us who are are subsidizing your added cost of care by our larger premiums. That's the way insurance works. It spreads risk around. The natural solution is to charge more for those who choose to put themeselves at risk by choice. And obesity is mostly a choice.
    • But...

      ...if it's the same as with private insurers, then why change? Why have the federal government take on yet another huge bureaucracy, when the government is going broke as it is?

      Carl Rapson
      • Here is why...

        ...to save money. Cost-shifting of uninsured patients is driving more-and-more companies out of the private market. As costs rise, this increases. It's unsustainable.

        We will soon be left with a situation where only a lucky few get health care, with the rest going broke paying piece work prices, and no one worrying about cost controls. You want our life expectancies to fall behind Cuba's? I don't.

        If you put everyone into a system where market incentives favor best practices and wellness, as opposed to packing on the unnecessary tests and the over-priced drugs, our industry becomes more competitive. Good for business.

        Oh, and the citizens who pay the taxes are healthier.

        Without a public option, the current health insurance monopolies will continue to push prices to unsustainable levels. They have no market incentive not to. They're already unsustainable for nearly 20% of the market.

        The present situation is just not an option.
        • You are joking, right?

          In the same speech where the president said that a lot of the money we pay for medicare is just wasted he turned around and said that the same government that has been wasting our medicare dollars for years (his words) will magically do a good job of managing this new plan.

          If you were looking to hire someone and you saw that at their last job their screw ups had wasted their employer a lot of money would you hire him? Or would you conclude that this person's track record indicates he cant be trusted with your money?
        • Absolutely right!

          You are right on the money!

          The U.S. is the ONLY civilized Western nation that FAILS to provide health care for EVERY citizen! And those that do, have BETTER RESULTS! Not only are their costs lower, but their life expectancies are longer and their infant mortality rates are lower. Their citizens are healthier. The French eat lots of butter and cream sauces and pastry, but they don't have an epidemic of obesity because their government doesn't allow their food to be poisoned with hormones and pesticides. Their dairy products are clean - ours are dirty. Maybe since their government provides universal health care for every citizen, they take steps to ensure their citizens have safe food and drink. Denmark even provides free exercise groups and gyms to keep their people healthy. Here, we serve up drugs and cutting, not health.

          You just can't argue with RESULTS!!

    • And obesity is mostly a choice.

      I think that's about as stupid a statement as I have read in this whole debate.
      • I agree.

        Obesity is not a choice, it is a complex issue and also has been classified as a disease. To say that obesity is a "choice" is as stupid as saying that alcoholism or addictions are "choices".
      • Well said...

        Not only does our government allow big-agra to load our food with obesity-causing hormones and chemicals, but they are disproportionately directed at the poor who can't afford to buy organic food.

        There is also a hypothyroid epidemic here - also caused by the stress of these chemical on the organs - that is underdiagnosed and improperly treated with narrowly targeted synthetic chemicals instead of broad spectrum natural thyroid, which is the treatment of choice in other countries.

        Saying that obesity is a "choice" is blaming the disease on the sufferer - and it IS about as stupid (and callous) a statement as I have read.

        • Please Provide Documented Evidence

          of "obesity-causing hormones and chemicals."

          What is a "broad-spectrum natural thyroid?" I understand what a thyroid is - it's an organ of the body essential for appetite regulation. I don't understand how physicians prescribe a gland as treatment.
          • You Should Probably Figure Out How Google Works

            It'll answer many of your questions...seriously. My mom's thyroid was screwed up real bad, so they nuked it, via radiation pills, and now she gets from thyroid pills what she used to get from her thyroid. Said pills come from a variety of sources. Synthroid for example is a biochemical synthetic, whilst Armour is a "natural" source that comes from dessicated animals (usually pigs).
          • Cut The Sarcasm And Just Provide The References

            you are using if you have any.
    • Spoken As Someone Uninformed About Medicine

      Is someone overweight, for example, because he or she is an inactive glutton? Or is it because they have a thyroid disorder that is clearly NOT a matter of choice?


      Or is it because they have diabetes? Contrary to popular sentiment, diabetes is not largely a matter of diet, but is actually most commonly an autoimmune disorder (e.g. Type 1) or a genetic predisposition (e.g. Type 2):


      Or is it because they have pulmonary hypertension that is producing slowly degenerative heart failure? Why do they have pulmonary hypertension - from emphysema from chronic smoking? Or from repeated bouts of pulmonary emboli and pneumonia from a chronic leukemia?

      Just exactly how do you propose to arbite the complicated interdependency of body systems, not just for this one example, but for all 7,000 plus CPT codes and their related ICD9 codes to clearly identify which are by choice and which arise from life circumstances that simply can't be "avoided by living healthy?"

      What you are proposing is implementing a "fault" based system for healthcare similar to what we once had for automobile insurance. That system led to wasting time and money arguing over who was really "at fault." That wasted time and money is exactly why we now have "no-fault" insurance.

      The approach you support is a popular public sentiment right now - "Punish The Sickies!" The problem with the approach is that it is impossible to accurately define two things:

      What do "healthy living" and "unhealthy living" mean?

      What do "reward and punishment" mean?

      in ways that can be practically - much less fairly - administered.
      • Another Side Too

        What about poor people? That's most of us, really. We live paycheck to paycheck and making "healthy" eating choices is not always an option since foods that are "bad" for you are most often always cheaper than those that are "good" for you. Punishing poor people and wanting them to pay more money, money they *DON'T* have in the first place, because they can't afford all those uber high priced "healthy" alternatives is just ludicrous at best.
        • A Good Point

          if the middle class is strained by medical costs as it is, we must be leaving tens of millions of people in lower income brackets in the dust.

          This is like a witch hunt: Times are hard and people are turning to an irrational "blame game and punishment."

          Oh, we're so much more civilized now, aren't we? Don't burn people at the stake. Just kill them with neglect.
  • Price Signal Information Is Necessary

    Dana, you wrote:

    <i>But there is no difference, in fact, between
    government refusing care based on your lifestyle and a
    private insurer raising its rates through the roof on
    you for the same reason.</i>

    And yet you also wrote:

    <i>The concept is, in fact, moving ahead faster among
    private health insurers, who have to answer to
    employers paying your premiums, than it is in
    government programs.</i>

    And you do not see the fundamental disconnect between
    those two statements?

    In a true private health care situation, price signals
    drive down costs to the end consumer. Right now we
    have two mechanisms that keep this price signal from
    being transmitted.

    1) Fear of medical malpractice insurance.
    2) The person providing the care (the doctor) has no
    incentive to discuss with the patient, "Your choices
    are X, Y and Z, with prices of $100, $1,000 and
    $10,000, and odds of success of 95%, 96% and 97%". He
    gets paid more for pushing option Z because the
    insurance company is reimbursing him.

    I would phase OUT government mandated health insurance
    (other than the VA), I would create a government 'cash
    voucher' pool for preventive medicine, and I would
    regulate insurance companies as follows:

    1) They are held to the same standards for deposit
    versus actuarial payouts as deposit banks are.
    2) They may sell policies across state lines.
    3) They may price policies for 'pre-existing
    conditions' as the market will bear, but they may not
    flat out refuse to create them.

    Oddly enough, this is the policy about insurance of
    one of our neighboring countries. But it's not
    Canada. It's Mexico.

    The cash voucher pool for preventive medicine is this:
    If your income tax return falls below a certain
    threshold (let's call it triple the poverty line
    income), your tax return is automatically put into a
    fund with government matching dollars, and you're
    issued a smart card (rather than a printed check).
    That smart card is good for about 1,000 different
    'preventative' medical programs, and you may, as you
    choose, put pre-tax dollars onto it at any time during
    the year and get the same matching. At the end of the
    year, any unused funds (less the government matching)
    get mailed to you as a check, and the process starts
    over again.

    The drawback is that the list of what it can be used
    for is small; you won't be buying Botox treatments
    with it, or lipusuction or chemotherapy. You will be
    able to take your son to the pediatrician for an ear
    infection with it, buy aspirin, and get a flu shot
    with it - the same sorts of fairly inexpensive
    preventative care that often gets overlooked because
    it's under the cost of the deductible for a
    conventional medical insurance policy.

    I also want all drug company ads to list the MSRP of a
    30 day supply of the drug on the screen for five
    seconds in the same size font as the drug's logo.
    Ad Astra
    • You lost that argument

      This is the argument that was made by Republicans during the 2008 campaign. They lost it.

      I agree that the principle of price signal information is great, but unfortunately what you propose does not deliver that information. It just accelerates the present problem of people forced out of the system by lack of affordability and why -- for ideology.

      I'm tired of ideology.
      • Ah - rather than address the issue, dismiss it as ideology!

        <i>It just accelerates the present problem
        of people forced out of the system by lack
        of affordability and why -- for

        And you'd force people out for being
        obese, for smoking, or for owning guns.
        This is an improvement?

        I'm a responsible, legal firearms owner.
        If you drive a car, can I get you excluded
        from health insurance for being a direct
        contributor to more health costs and
        higher mortality than any other factor in
        the US? You are nearly 200x likelier to
        be killed by a legally operated automobile
        than you are by a legally owned handgun.
        I've seen how most people drive...which is
        why I decided that owning a car is a
        lifestyle choice. I don't drive - I
        restructured my life away from owning a
        car at all; I have more money to spend, I
        have much better health (more walking,
        using a bicycle for grocery shopping), and
        I'm much less likely to kill someone else
        in a car accident.

        I've directly experienced health care in
        the UK (with NHS), in Canada, in Mexico
        (and Portugal), and the US. All of them
        distort price signals and create
        absurdities. The one with the least
        distorted price signals is Mexico,
        followed by Portugal. (I took a flight to
        Lisbon because I needed a wisdom tooth
        extracted; NHS would get me to a dentist
        in 33 days; I could walk into an office,
        pay cash down and get it extracted the
        same day I arrived in Lisbon.)
        Ad Astra