I don't believe in smoking but......

[kj]

Ted King wrote:
[quote=davester]
[quote=kj]
My thought is that almost everyone does something risky.

The insurance companies and their mathematicians beg to differ(at least to the degree of risk). The science of predetermining which populations will cost the most to take care of is well established. It is simply a fact that an obese sedentary alcoholic smoker is going to cost a fortune in healthcare costs compared to a nonsmoker who watches their weight and rides their bike to work.
This is where the granularity thing I was talking about earlier comes into my thinking. Like kj says, we all choose to do some things that will lead to additional health care costs some time during our lives. If the science of actuariness about health costs were completely mature, we would all wear monitors that would calculate to what degree each of our choices were going to lead to increased health care costs in the future and then your premium payments would be adjusted accordingly. But again like kj said, that would make the whole idea of insurance superfluous. And the whole approach ignores the extremely thorny problem of figuring out what kinds of things - and to what degree - do we do things that we have enough power of choice over to have some to-be-determined degree of responsibility.

Since we don't have a completely mature science of actuariness, we tend to just "look for the biggies" and single them out. I suppose you can make the case that there's a kind of fairness in going after "the biggies" and ignoring so many other things people do that also lead to increased health care costs since "the biggie" types of behavior do indeed lead to increased costs. It's just that at the fine grained level of people's behavior, it sure doesn't seem to me like picking on "the biggies" is the fairest thing to do. It's like a whole lot of people are getting together saying "let's make a risk pool" and even though we know a whole lot of people in the risk pool are going to be making choices that will lead to increased costs for the risk pool that are as much as the choices you will be making, because we have identified your area of choice and not theirs as too risky, you have to pay more. I don't see the pragmatic necessity to do this - the costs will be borne by the whole of the premium payers, what we are talking about is just who pays how much of that cost.
To my thinking, it just makes sense they would go from predicting the costs of larger groups to smaller and smaller groups, until they are predicting what you as an individual will cost (granularity?). An illustration of the above is that some smokers don't get cancer, likely because of their genetics. Of course, if you don't have the genetic predisposition toward cancer, you might cost less even if you smoke. And on it goes in the same fashion until everyone pays what they cost.

I wonder if the variables they use for prediction have more to do with the ease of measurement than they do the cost (the biggies). Or maybe the biggies are the easiest to measure/predict. I'm also not sure there is a lot of incentive for them to make sure individuals pay their "fair share", just so the whole group of insured pays enough to cover costs and profit. kj.

[$tevie]

I know that everyone hates the "slippery slope" argument, but exactly where would this end? Do we charge more for people with high cholesterol? With family histories of cancer or heart disease?

So if the point is that one can stop smoking or over eating, I would VASTLY prefer that insurance would pay for cessation programs and weight loss programs to encourage and assist people in changing their unhealthy lifestyles. People who never smoked or gained weight find it very easy to justify charging more for these people's insurance but I think it's wrong to have a company in charge of our punitive revenge fantasies. How about helping these people and that will ultimately save more money than giving them scarlet letters. This hating on people with addictions is very 1950s.

In the spirit of compromise I will cede the ability to raise rates if the person refuses all help. I think that might be fair.

[Lemon Drop]

The other piece on the "slippery slope" is genetic predisposition to disease.
Should those folks pay more? I mean, they are certainly the most likely to use big medical bucks, right?

[$tevie]

Lemon Drop wrote:
The other piece on the "slippery slope" is genetic predisposition to disease.
Should those folks pay more? I mean, they are certainly the most likely to use big medical bucks, right?

Absolutely. That's why this feels more like punishment than like actuarial-driven realism.

[Lemon Drop]

$tevie wrote:
[quote=Lemon Drop]
The other piece on the "slippery slope" is genetic predisposition to disease.
Should those folks pay more? I mean, they are certainly the most likely to use big medical bucks, right?

Absolutely. That's why this feels more like punishment than like actuarial-driven realism.
Yes, our human bodies and human lives are so full of frailties, instead of judging and finger pointing, why not just embrace the common sense that is universal health care, single-payer?

[$tevie]

Amen to that.

[Manlove]

Health care should be free for every citizen, paid for out of taxes. The govt. would soon start to put serious money into preventative care and cessation/weight-loss type programs, because not doing so would soon prove very expensive. I mean, shit, you might have to wage a few less wars to pay for it!
How to tax? From each of you as you are able-to each of you as you have need.
A 63 year old obese smoker would not be disallowed treatment, but the treatment would involve admission to and supervision in those preventative programs.

Most people want to be healthy, to be productive and not burden others, but when need arises, even when the need is exacerbated by genetic propensity or boring old human weakness, the need should be met by society.
Anything else is pretty low in my opinion.
If you can't look after the weakest in your society, then, truly you don't have a society worth maintaining.

[Manlove]

Should be added that I don't think my idea will ever be taken seriously. I put it out there so that it can be shown as an extreme, something that delineates the edges so that it can be pulled back from when one side wants to show how much compromise they are willing to make.
You know, exactly what Romney didn't do when running for Pres! Returning to somewhere near the center after dallying with the lunatic fringe!

Unfortunately, with the current ability of geneticists to determine likely future health, I think we are inevitably moving in the opposite direction. You've all seen Gattaca I take it?

[August West]

Lemon Drop wrote:
The other piece on the "slippery slope" is genetic predisposition to disease.
Should those folks pay more? I mean, they are certainly the most likely to use big medical bucks, right?

Some might say they should be eliminated from society as an endpoint to the argument.

[Mac1337]

A lot of interesting things to read here. Smoking is not my kind of thing. I believe in smoking but I believe what harm could it cause to health. It's one of the The Biggest Threats to Your Memory and Brain Power. Be ware of it!