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

[davester]

Ted King wrote:
I'm not in tune with the "pay more for your health care because you do 'X' in your life." If somebody needs medical care then, sh*t, I say let's give it to them. Everybody pays the same and gets the health care that they need when they need it. I don't feel that way about everything, but I do feel that way about health care.

In a way, I'm with you and would support an NHS-type single payer system. However, in the completely ridiculous insurance-company-based system that has been foisted upon us, we are still going to have to go out and shop for insurance and will be purchasing different products with different benefits for different amounts of money. In that market-based scenario then I don't have a big problem with giving discounts to people who are willing to reduce their need for benefits.

[hal]

Ted King wrote:
I'm not in tune with the "pay more for your health care because you do 'X' in your life." If somebody needs medical care then, sh*t, I say let's give it to them. Everybody pays the same and gets the health care that they need when they need it. I don't feel that way about everything, but I do feel that way about health care.

Now wait a minute here... I'm already paying more because I'm old. If I then elect to put myself further at risk by smoking, I should pay even more.

I CHOOSE to smoke... This isn't about addiction. At some point, you choose to have that first cigarette. You should have stopped there, but you CHOSE to continue.

If you make the case that people are becoming addicted through no fault of their own, then hand the blame to the makers AND REGULATORS of cigarettes.

[Ted King]

hal wrote:
[quote=Ted King]
I'm not in tune with the "pay more for your health care because you do 'X' in your life." If somebody needs medical care then, sh*t, I say let's give it to them. Everybody pays the same and gets the health care that they need when they need it. I don't feel that way about everything, but I do feel that way about health care.

Now wait a minute here... I'm already paying more because I'm old. If I then elect to put myself further at risk by smoking, I should pay even more.

I CHOOSE to smoke... This isn't about addiction. At some point, you choose to have that first cigarette. You should have stopped there, but you CHOSE to continue.

If you make the case that people are becoming addicted through no fault of their own, then hand the blame to the makers AND REGULATORS of cigarettes.
I understand the sense of fairness and justice that underlies your view. I just think that when you really begin to get fine-grained in looking at how much people should be accountable for their health-cost-increasing choices, what you find is a mess. We went through it in our teacher's union. When I first started teaching, the school district covered the whole cost of our health insurance and there was no differentiating amongst teachers about who bore more responsibility for health care costs. Over time we started sharing the cost of the health care premiums with the district. As those costs to us individually began to go up, at a certain point some teachers began to gripe about having to pay just as much as other teachers who had higher health care costs because of ___________ . Various things that went in the blank: number of kids they had covered, being older, being smokers, being a heavy drinker of alcohol, being severely overweight, etc. The notions of fairness spread out in all kinds of directions and left a lot of hard feelings in its wake. I just kept saying that I thought we should look at it as though we are all in it together and just pay the same. I think that to the degree that you fragment a risk pool, the less effective it is going to be collectively, though many individuals may temporarily benefit from the fragmentation. That's just my view, though; I understand others may not feel that way.

[Grateful11]

Long time friend of mine's 35yo daughter was released from the hospital a few ago. Clogged artery in the
neck. Most people would probably automatically think obese, eats bad, etc. She a long time distance and
marathon runner. They thought she had a stroke but luckily it was just a clogged artery. At one point they
didn't think she was going to make, she spent several days in the ICU. Artery was too weak to open it up,
luckily clot buster dissolved the clot. Her running days may be over from what I understand but don't have
all the details.

Never judge a book by its cover.

[davester]

Grateful11, Single instances are not really relevant to the discussion. Of course there are some people whose personal experiences will not be in keeping with where they are in a statistical population, but that is the exception, not the rule. Before the incident your friend's daughter's risk of having a condition like that may have been low, but it was not zero.

Ted is advocating that we don't fragment the risk pool as a general philosophy, apparently based on a sense of fairness or avoidance of enmity between groups. I would agree with that if everybody was paying in the same amount and getting the same benefits, but in our current system and the system that will be in place when Obamacare is implemented the risk pool is already fragmented and different people pay different amounts for different levels of care. If we're going to play that game then I say we should throw all the factors that affect costs into the pot to come up with an equation regarding who pays what.

[kj]

davester wrote:
Grateful11, Single instances are not really relevant to the discussion. Of course there are some people whose personal experiences will not be in keeping with where they are in a statistical population, but that is the exception, not the rule. Before the incident your friend's daughter's risk of having a condition like that may have been low, but it was not zero.

Ted is advocating that we don't fragment the risk pool as a general philosophy, apparently based on a sense of fairness or avoidance of enmity between groups. I would agree with that if everybody was paying in the same amount and getting the same benefits, but in our current system and the system that will be in place when Obamacare is implemented the risk pool is already fragmented and different people pay different amounts for different levels of care. If we're going to play that game then I say we should throw all the factors that affect costs into the pot to come up with an equation regarding who pays what.

My thought is that almost everyone does something risky. Also, it seems to me if the actuaries did a super good job, we'd all pay about what we cost into the system, which kind of defeats the purpose. Maybe the reward for being healthy should be "being healthy". kj.

[Lemon Drop]

I'd like a discount for both life and health insurance because studies have shown that slightly overweight people are less likely to get sick and die than normal weight or obese people.


Conclusions and Relevance Relative to normal weight, both obesity (all grades) and grades 2 and 3 obesity were associated with significantly higher all-cause mortality. Grade 1 obesity overall was not associated with higher mortality, and overweight was associated with significantly lower all-cause mortality. The use of predefined standard BMI groupings can facilitate between-study comparisons.
http://jama.jamanetwork.com/article.aspx...qundefined

[davester]

kj wrote:
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.

[RgrF]

hal wrote:
[quote=Pam]
It's extremely wrong. People voluntarily ignore diet and exercise warnings resulting in diabetes, high blood pressure, high cholesterol, etc yet they'll single out smoking? Look at the obesity rate. But that's ok. Pop some pills, don't change your habits. There are far more people in that category than in the smoking category.

I disagree. I call it a good start. If one chooses to take on greater risk, they should pay for it. Obesity should be addressed too: sell insurance by the pound...
Agreed, These are (with some exceptions) lifestyle choices and if you choose them you lose the right to complain about your health coverage. My evil twin says let them go on as they are, die early and thus cost us less.

[Ted King]

davester wrote:
[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.