Do you think the morbidly obese should pay more for medical insurance?

It's not that simple.

I suspect many of them are also poor, so it's not that simple.

Medical insurance works like this, right? If you're more likely to get sick or something, you pay more, right? I don't think it's about hating fat people. Don't smokers pay more? Not because everyone hates smokers, but because they get lung cancer and stuff?

Why not, cigarette smokers pay huge tax on tobacco product. I wonder why I pay so much for insurance when I rarely go to the doctor. I must be paying someone elses way!!!

No. They have a disorder, a health disorder.

Absolutely not, I cannot even comprehend such a concept. It would never deter anyone from keeping their weight down and it would just make those who are obese feel much worse about themselves (on top of the daily discrimination). This is not a way to motivate people into securing a healthier lifestyle, this is more like punishment and it isn't humane. Some obese issues are genetic or glandular, as well, but even without this consideration, this entire concept would produce nothing but low self esteem and even more destructive behavior.

We've somehow gotten to the point where we now expect health insurance to pay any and all medical bills. It's like expecting our auto insurance to pay for oil changes or our home owners insurance to pay for painting the house. I'd rather be closer to the other extreme where health insurance pays for nothing at all and people simply pay doctors for the treatment they get.

only if their obesity is not caused by a medical, or genetic condition

No.

So what happens to people who can't afford the medical treatment they need?

No. Most morbidly obese people have other physical factors that relate to being overweight and it's not just because they eat too much.

I think that if a Type 1 diabetic or someone with cancer can be denied affordable coverage, then to hell with all pre-existing conditions!

If there didn't exist medical insurance then I think pretty much the same thing would happen as happens now in the US. They would either get the money from somewhere else (charity or family for example), find donated medical care (free clinics), or do without. The difference would be that people would have more money available without the economic drag of insurance and medical care would be less expensive because patients would be involved with making decisions about which treatment to have. Also, medical care might well be cheaper because doctors wouldn't have to spend so much to collect from insurance companies. I've seen this one already over the last eight years that I haven't had medical insurance with the 10% to 30% discount for just paying my bill.

In other words, I think overall it would be an improvement.

> patients would be involved with making decisions about which treatment to have.

That's kind of a big leap. Why would they be any more or less involved than they are now, and how would it lower costs?

With insurance in the picture, people have no reason to pay any attention to the costs of medical treatments because they're not paying for it. With the normal market pressure to reduce costs gone, cost rise. Of course insurance companies try to control costs since they're the ones paying, which puts them in the position of making medical decisions for people which means the people are less involved in their own medical decisions. It's really a pretty crazy system.

No. I would think that better education and more compassion inthe health industry would be a better way to go ather than punishing someone for not being 'perfect'.

> I think that if a Type 1 diabetic or someone with cancer can be denied
> affordable coverage, then to hell with all pre-existing conditions!

Health Care Reform would cover this ridiculous exclusion. Those who are young and healthy,& have been healthy for years (never needing medical care) , always feel as those they are spending their hard earned money to care for other people's illnesses but this belief suddenly changes when they, themselves, are faced with a medical crisis costing hundreds of thousands of dollars for medical care. You cannot have it both ways. And I believe some of the insurance costs are currently outrageous. As far as cost reduction now, would removing a burst appendics for 18, 000 dollars instead of 30,000 dollars really make a difference to the average citizen? We are not talking about realistic costs here. Everyone should be entitled (yes entitled) to the same health care at the same expense. No one should have to 'do without' health care and be forced to suffer needlessly. Once again, it is not humane.

I think if you're going to have a healthcare system that revolves around private insurance companies, it's a bit unreasonable to expect those companies to ignore the fact that you weight 40 stone. If you make healthcare about business, then you have to accept that ultimately it's about making someone richer rather than about making people better.

Would I have the morbidly obese pay some sort of surplus to the National Health Service? No. Do I think insurance companies are within their rights to collect basic health information about you before they decide what your premiums are? Yes.

It's not that simple........ is my answer, should smokers? should people who work in dangerous jobs? ... a part of me wants to say "yes" if the obesity IS caused by overeating and not something with their pituitary (sp?) gland

Absolutely!!!!!

Did someone get this idea from me? I asked it in the question forum thread.

I have been informed this year that if I continue smoking, I will be required to pay $600 extra per year for medical insurance. I am a person that NEVER goes to the doctor. There are people at my job who sit on their asses ALL day long eating cheetos and ding dongs and only get up to use the restroom or walk to the vending machine. I smoke about every 2-3 hours and get the exercise of walking outside. You KNOW those morbidly obese people are being treated for diabetes, high blood pressure, ETC.

Grrrrrrr.

Tons of people go ahead and get treatments and procedures that aren't covered. Then they file for bankruptcy when they can't pay the bills themselves. I think people are likely to do whatever their doctors recommend they do, and whatever will save their lives. Personally, though, I think the problems of cost are why we should have a single-payer federal plan. Doing it the way you propose seems incredibly unfair to poorer people, or even middle-class people who can't afford major medical bills for things like cancer. There's no way that charities and donated care would pick up all that slack--if that were going to happen, we'd be seeing it happen already.

I'm sure that some people file for bankruptcy over medical bills but tons? Maybe. I don't know the numbers there. Anyway, single-payer isn't going to pick up all the slack either. There will always be people who do not get sufficient medical care so the question should be, what's going to work the best? That some proposal isn't perfect isn't an argument against it since nothing will be perfect.

There's no question that cost is one of the problems of our current system but I'm skeptical at how well single-payer would really help. I think other answers would be more effective at controlling costs. As a general principle, giving people choices works better than central control. I see no reason to think medicine would be any different than any other. Single-payer is central control and will most likely result in higher prices and worse service over time.

Single-payer also has some seriously bad side-effects like putting an incompetent government bureaucracy in charge of making medical decisions. I don't like medical insurance because I don't think people should be deciding individually what's best for them. Single-payer just makes that worse. It's the wrong direction to move if we want medical care to improve.

> Absolutely!!!!!
>
> Did someone get this idea from me? I asked it
> in the question forum thread.

Yes, I made bunch of surveys from the questions people were asking in the thread.

> I have been informed this year that if I continue
> smoking, I will be required to pay $600 extra
> per year for medical insurance. I am a person
> that NEVER goes to the doctor. There are people
> at my job who sit on their asses ALL day long
> eating cheetos and ding dongs and only get up
> to use the restroom or walk to the vending machine.
> I smoke about every 2-3 hours and get the exercise
> of walking outside. You KNOW those morbidly obese
> people are being treated for diabetes, high blood
> pressure, ETC.

I agree. I feel like smokers take way too much crap while other people get off scott free.

Ah The United States. A Country where the unemployed get fat while hard working middle class families can barely put food on the table.

I think the morbidly obese should spend less on food.

OK, maybe not tons! But unpayable medical bills are a substantial problem.
Giving people choices has already proven that it doesn't work.

And yet on the flip side, taking choice from people is evil. What I don't like about both insurance and the medical regulation we have is how it limits peoples' choices. I would prefer to move in the direction of more choices, not less. Single-payer adds the problems of a monopoly to even more limited choices. I think we're more likely to move in the direction you want rather than what I want, however. We'll get to see if medical care improves or not and if prices rise or fall, though of course we won't be able to compare it to what would have happened if we'd gone another path. I wish we'd remained more of a federation so different states could try different approaches and we could more easily compare and contrast.

As I've said in other contexts but it really applies here: I'd like to see laws come with performance specifications. The prop0nents of some health care reform bill would make the claim (for example) that this law would decrease medical costs by thus and so percent over the next two years. The opponents say it won't. If the bill passes then we measure the results. If health care costs go down that much, great. If not, the law is automatically repealed.

> Absolutely!!!!!
>
> Did someone get this idea from me? I asked it in the question forum
> thread.
>
> I have been informed this year that if I continue smoking, I will
> be required to pay $600 extra per year for medical insurance. I am
> a person that NEVER goes to the doctor. There are people at my job
> who sit on their asses ALL day long eating cheetos and ding dongs
> and only get up to use the restroom or walk to the vending machine.
> I smoke about every 2-3 hours and get the exercise of walking outside.
> You KNOW those morbidly obese people are being treated for diabetes,
> high blood pressure, ETC.
>
> Grrrrrrr.

Not all morbidly obese people have health issues. I gained 70 pounds after I stopped smoking... Does that mean that I should have to pay more for insurance? Sure I should work out more but other than being a little heavier... I am in perfect health. You shouldn't judge people by their looks...

That's not what I'm doing. My intention was not to offend. I am overweight and have been in the 'obese' range in the past. I'm simply singling out another group that is known for having health problems. The reason I'm diabetic/have kidney and cholesteral problems is because I got fat, so I know firsthand the toll it takes.

The reason they target smokers is that they are a group which is considered to have higher than average health problems. People who are obese are known for the same thing. I could quit smoking, someone who is overweight can eat better and get more exercise. It's the same thing, in my opinion.

And I am definitely not suggesting that overweight people be charged extra. I'm suggesting that smokers should not.

I can see how what I first said came off as nasty. It came from a really bitter place.... but it was only meant to be directed at the insurance companies, really. I'm in the middle of choosing my insurance coverage right now and the changes are staggering. I really hope we don't get sick.

ok, I agree. Besides the money factor I regret quitting smoking... It totally messed up my body! In fact I regret starting in the first place... I quit using Chantix within like 3 days and I haven't wanted a cigarette since... and I used to loveeee smoking! I don't think I would have done it again though... I don't know.

I *know* I will gain weight if I quit smoking again. It's really hard to quit. If I do quit, it will be my fourth time. Stress always brings me back to it..... even years later.

I tried starting smoking again but I couldn't do it... It just made me sick and I hated the way I smelled. I am sure if I would have just kept trying I could have done it. But man o man I hate the extra weight. Like super bad...

It would be interesting to see performance specifications, although it would be better to have a performance range, since I'm sure the numbers are difficult to predict well. The change in costs might end up being significant, even if they weren't as much as someone predicted. That would still make it worth it.

You should really root for the opt-out public option; then you'd get to see if your experiment would work. Although I doubt any states would actually opt out, since they all have poor people they'd like the federal government to cover. (Which I think is the best way to reinforce my own point on this issue!)

I think the morbidly obese should pay for their food. Other than that? Hell I don't care.

If the public option is mandatory or if I have to pay for it, then I don't want it. If I don't have to pay for the public option and it's optional, then how is it different from any private health insurance? Of course, I still don't like insurance that pays for regular medical care since it just increases costs. We don't need more of that.

The public option would still be managed differently, and because it would be a single-payer system, it would be able to keep costs down not only through the government's ability to bargain, but also by a decrease in the levels of administration involved. And ideally (in my opinion), everyone would eventually be on it. If there's a single, government-run system, then the costs would be considerably less, as evidenced by countries that do this. The advantage of the public option is that people who wouldn't be able to afford medical care, no matter how low the costs got (short of zero), gain access to the same medical care that people who can afford it have. I think it's a basic issue of human rights, personally.

If the public option is optional then it's not what I understand single payer to be. My understanding of those terms is that "single payer" means the government essentially takes over health care, or at least paying for health care. There is no other option. On the other hand, "public option" is essentially a government run health insurance program that "competes" with all the other options people have for health insurance (including not having insurance though I understand some of the proposals make that illegal too). I put "competes" in quotes because some of the proposals I've heard have the public option paid for out of tax revenues which would be nearly impossible to compete against while others say that it would be not take tax revenues which probably wouldn't work.

As for the public option or single payer giving people with no money access to the same medical care as people who can afford to pay for it themselves, you're dreaming. The only possible way that will ever happen is by limiting the medical care available to the rich. I'm not sure it's possible even then and I'm positive that it's not desirable. Dragging down the top so everyone is the same is not beneficial to anyone.

If people can't buy extra medical care, then everyone has roughly the same access to care, whether that's how it plays out in practice. However, I didn't say "the rich." I said "people who can afford to pay for it." I'm not necessarily opposed to people being able to pay for supplementary medical care if they want to--I'm not entirely sure I'm in favor of it either, but whatever. The point is to have *any* medical care for people who otherwise don't get care unless they go to an emergency room. Regular, preventive care for everyone would go a long way toward decreasing the amount of money we spend on medical care, since it would keep more people out of the emergency room, too.

Maybe I'm confused about the public option versus a single-payer program. The former is an acceptable stepping-stone on the way to the latter, though.

> If people can't buy extra medical care, then everyone has roughly
> the same access to care

Exactly. The only way to get equality is to bring the top down. If you do this, then the result is that those more expensive medical treatments never get developed. If they don't exist, then they can't get refined and brought down in price. In a few years, the available medical technology is substantially behind where it would have been without the intervention. People die because the medical care that could help them simply does not exist.

I don't think the medical technology that's available today is so good that we should stop advancing here. I want better -- much, much better.

The point is to have all treatments, expensive or otherwise,be covered by the public plan. It's not about bringing the top down but the bottom up.

Do you believe that's possible, that all possible medical treatments could be covered by any conceivable system? Do you believe any reform under consideration does anything like that?

I don't. Any possible medical insurance or payment plan will limit what it covers. Some procedures will be allowed, some medicines included, and some people covered. In other words, there will always be things that are not paid for.

And you've already talked about how you think single-payer will reduce costs. This is achieved by that single-payer using the force of government to shut down all competitors (otherwise it wouldn't be single-payer, it'd be multiple-payer) and then "negotiating" at the point of a gun. That negotiation includes prohibiting medical treatments that don't meet their price goals. That is, those treatments would not be available or only black-market. This is bringing the top down.

The other way to control costs is to limit who is allowed certain treatments. This was reflected in Obama's statement about how grandma might just take a pain pill instead of having some expensive treatment. She's old, probably won't live too much longer anyway, so why spend the money on her? It's ugly but if you're going to control costs with single-payer, it's an option.

> Do you believe that's possible, that all possible medical treatments
> could be covered by any conceivable system?

It's no more of a pipe-dream than your idea that a free-market system would end up providing care for low-income people.

> Do you believe any reform
> under consideration does anything like that?

Of course not. But they do a better job of extending more care to more people than the current system does, or than a completely private system would.

> I don't. Any possible medical insurance or payment plan will limit
> what it covers. Some procedures will be allowed, some medicines included,
> and some people covered. In other words, there will always be things
> that are not paid for.

Sure, but those decisions should be based on what medical treatments are most likely to be most effective and to extend people's lives the longest, not on what the person's socio-economic status is. And one major improvement in the current proposed reforms is that companies won't be able to deny coverage based on pre-existing conditions.

> And you've already talked about how you think single-payer will reduce
> costs. This is achieved by that single-payer using the force of government
> to shut down all competitors (otherwise it wouldn't be single-payer,
> it'd be multiple-payer) and then "negotiating" at the point of a gun.

Except that there's not actually a gun involved. And the insurance provider won't be concerned with making a profit. I have no problem with there being no competing insurance companies.

> That negotiation includes prohibiting medical treatments that don't
> meet their price goals. That is, those treatments would not be available
> or only black-market. This is bringing the top down.

Like I said, I'm not sure I'm opposed to people being able to buy supplemental care, which would certainly be preferable to a black market. If that covers things like multi-million-dollar treatments or very risky procedures that the government doesn't cover, fine. That's not my main concern, since such situations are a pretty small portion of the overall picture. I'm talking about people who can't afford a doctor not dying of pneumonia or women who can't afford a mammogram not dying of breast cancer. There are common problems that go untreated and kill people every day. These deaths are preventable by extending very basic care to everyone. It would make a huge difference across a large swath of the population. If people with the resources want to spend the extra money for whatever fancy treatment the government doesn't cover, be my guest. But don't deny everyone else the basic coverage they deserve--which is really what you're doing.

> The other way to control costs is to limit who is allowed certain
> treatments. This was reflected in Obama's statement about how grandma
> might just take a pain pill instead of having some expensive treatment.
> She's old, probably won't live too much longer anyway, so why spend
> the money on her? It's ugly but if you're going to control costs
> with single-payer, it's an option.

I don't actually have a problem with some degree of rationing. Like I said, I think it should be based on what's going the be the most effective medical treatment, not on what the patient's socio-economic status is.