What do you think about health insurance companies charging more for overweight people?

Totally warranted. It’s like auto insurance companies charging more for teenage boys.

My BMI is in the 40s, but my blood pressure and blood sugars and all other measures of health are better than many skinny people I know. If a person has medical conditions that are caused by or significantly made worse by obesity, it makes sense for the insurance company to charge more if the patient does not follow their physician’s directive to lose weight as part of their treatment plan. It is discriminatory to charge a higher premium based on BMI.

@hearkat That is exactly the position one of my co-workers is in. Her BMI is above 30 but she has no health issues at all.

I agree with @Rarebear My husband and I pay an extra $100 a month because we smoke. I don’t like it, but I feel like it’s fair. I need to quit.

There are hidden risks. Not just diabetes and hypertension
http://www.cancer.gov/cancertopics/factsheet/Risk/obesity

In fact, my recent hospitalization was probably caused by smoking soo…..

Meh. It’s going to happen. It’s not the first factor preyed upon by the helpful, concerned insurance companies, and it won’t be the last. It’s just one more excuse to extract higher premiums.

I have mixed feelings about it. I can see the logic behind charging more for people with higher risk factors, but as you say, where does it stop? I have a serious problem with the two month time frame, though. How in the hell are people who have large amounts of weight to lose supposed to accomplish that in such a short time?

@augustlan I don’t think it can go beyond what is relevant NOW. I don’t think they’ll be allowed to adjust their rates because a woman’s family has a high rate of breast cancer, so she might get it too, things like that.

Smoking is a behavioral choice. Metabolism is not.

Exactly @hearkat. Being obese is a direct result of choices too.

@Dutchess_III: Not always. Besides, eating is necessary to survive, smoking is not.
My body processes food differently than my bean-pole brothers. I ate the same foods growing up. We have the same family history: some family members were plump, other family members were lean.

@hearkat Nevertheless, you’re still at higher overall medical risk. The insurance companies don’t care about individuals. All they look at is actuarial probabilities.

Let’s say you and your best friend both have medical insurance with XYZ company. Your friend is badly overweight, smokes constantly, and thinks he’s exercising by propping his feet up in front of th TV every night.

You, on the other hand, jog 5–6 days a week, have never smoked, can still wear your college jeans. Oh, and the only med you take is a daily multivitamin.

Each year your XYZ rates go up, which seems weird since your doctor says you have the body and health of a much younger man. Wonder if it’s because your friend had two hospital visits last year and is on five medications. Mmmmmmmm?

Everyone’s rates go up every year. Bet yours still aren’t as high as your friend.

I think I’m in big trouble.

Someone with a BMI in the 40s may have good health now but is at a higher risk of high blood pressure, diabetes, high cholesterol, heart problems, joint (knee, hip) replacements, cancer, hemorrhoids, stress incontinence, the list goes on and on.

I used to be over 300 lbs and had weight loss surgery. I had no problems listed above, YET, but understood that if I didn’t do something drastic, I’d be having all kinds of health issues. One of the many benefits of weight loss surgery is that instead of it taking years and years to lose weight, it comes off within months. Most people who are on medications for high cholesterol, high blood pressure and diabetes will stop taking the majority of those medications within days of surgery.

@Rarebear – and African Americans have higher risks for many illnesses – do they pay higher premiums?

I don’t think they can charge based on “risk,” just on what is real and present at the time.

@Dutchess_III: Insurance companies can and do charge more based on risk. They charge higher auto insurance premiums for people under 25, higher auto insurance for young boys, who, it seems, are more reckless drivers than young girls, higher auto insurance for people with a history of DWI, higher life insurance for people with risk factors such as smoking, and higher life insurance for people who do things like tower (cell phone tower) work, tree work, etc. They can charge whatever they like, and like anything, if the market will allow it, they can do it.

Well, yeah. That’s true @jca. All of the things you listed seem fair to me. People with a history of DUI should be charged higher premiums. People with high risk jobs should be charged more. As I said, I’m charged extra for smoking. But you can’t charge higher premiums for possible genetic risks.

@hearkat That’s a great question. I don’t know. I doubt it.

It was bound to happen and yes, there are risks to being overweight, smoking and plenty of pother things. However…there are also plenty of older fat smokers still toddling about too. I just saw this ancient man smoking outside a restaurant the other day. I get the logic behind the BMI but what’s next?

I’m a blonde blue eyed and fair skinned woman, I am at a higher risk for skin cancer, WTF…next thing you know blondes will have their premiums jacked up because of skin cancer risk. They will probably test you to see if you have been wearing sun screen on a regular basis. lol
Considering the majority of americans are on the overweight side the insurance companies have just latched their parasitic mouths onto a big fat cash crop of chubbies. They are having their cake and eating it too. haha

Fuck insurance companies, 2nd in command next to big bro.

It’s a great idea. Over-fat obese people are not healthy and more prone to developing several serious diseases.

Also I think that airlines should charge passengers by the pound of body weight (over 150 pounds). Because it cost more in jet fuel to get their big butts up off the ground.

They are going about it the wrong way. Where is their PR department? Use a carrot instead of a stick!

They need to raise everyone’s rates and then give a $700 discount to people with a BMI lower than 30 and an additional $300 to those individuals with a BMI between 17 and 25. The end result would be the same but there would be incentive to slim down.

Imagine an ad campaign with someone like (Progressive) Flo yelling “Discount!”.
“Do you exercise?”, “Yes.”, “Discount!”
“Is your BMI less than 30?”, “Yes.”, “Discount!”
“Is your BMI between 17 and 25?”, “Yes.”, “Discount!”
“Great! We will give you $80 per month to stay that way!”

The first company that offers insurance in that form will start to have healthy people gravitate toward them.

@Dutchess_III: They’re not charging more for possible genetic risks. They’re charging more based upon the fact that statistics show that people with high BMI have a higher chance of all these health issues, like people who smoke tend to have their health issues. Some people smoke for a lifetime but don’t get lung cancer, but the insurance companies charge more for them and we don’t complain. I’d be ok with that if I didn’t do something about my weight, my insurance company is going to want something from me because of it because even if I had great genes, at 300+ lbs I was bound to be needing something weight related down the road. At the very least, when a huge person goes to the hospital or rehab, they can’t fit into standard sized wheelchairs, hospital beds, etc. If they have trouble transferring off a toilet or out of bed, they need two people to assist, instead of one.

In the long run, we pay for this thru higher Medicare and Medicaid premiums. I used to work for Medicaid in my previous job and believe me, the heavy ones don’t qualify for help at home because they can’t do it with one person to assist, so they have no choice but go to nursing homes and it comes out of all of our pockets.

@LuckyGuy: That’s a great idea.

@jca That’s been my argument through this thread. They aren’t charging due to possible genetic risks. They charge based on personal choices that result in higher health risks, choices that people can control. Smoking and obesity are two of those. Being a race car driver is another.

I think it’s fair.

I would also add a discount for illegal drug use.

Right now, Flo (Progressive Insurance) offers a discount if you are willing to plug in Snapshot, a device that records your driving habits.

I would have Flo also offer a Pee in Cup (PIC) test. If you are willing to be randomly tested for crack, weed, coke, heroin, etc.you get a further 10% discount. If you are found positive, law enforcement would NOT be involved. But, you must reimburse Flo the discount at 3 times the value.

I read in the paper that there were something like 36 murders in the city of Rochester (a city of about 350,000 people) last year. People were outraged. That same paper said there were 55 deaths from Cocaine/heroin overdoses during that same period. It was met with a big, “Meh”. If there were that many deaths how many hospitalizations were there?
Our health care and insurance systems pay for these deaths.
Maybe it shouldn’t.

You need to change your name to Flo and start your own insurance company, @LuckyGuy. You have some really good ideas.

@Dutchess_III: Oh ok gotcha.

@hearkat: BMI in the 40’s is more than plump.

Agree with @LuckyGuy

Give incentives for losing weight and living a healthy lifestyle.
– discounts on gym memberships
– discounts if you demonstrate that you use your gym membership
– discount on locally harvested food
– discount on community supported agriculture

Otherwise, health insurance companies will be considering
– charging more for diabetes
– charging for for people of color
– charging based on genetic risks
– charging long distance runners or other athletes for orthopedic risk
– charging pregnant women more

The point is, health insurance should help us be healthier and control costs. Incentivize me to live healthy and cost less.

@LuckyGuy Rochester’s murder rate has gone down a ton. I didn’t hear any outrage. But I agree with your point.

@jca: Yes, with a BMI in the 40s, I am more than plump. I did not use that word to describe myself. I used the term for biological relatives whom I do not know their BMIs, but I know that side of the family tends toward overweight – from plump to obese – we have slow metabolisms. I used ‘plump’ as a generalization of a body type that tends toward highly efficient fat storage – like a beagle as opposed to a doberman.

I think it’s another ploy to upcharge a select few, again, just like the extra we smokers pay on our insurance. My company already has a way too interactive insurance policy, where we have to plug in our dates of physicals, results, and if we get a call from our insurance people, we are REQUIRED to talk to them (like if you’re too fat or whatever they deem wrong.)

If I pay my fee each month, then that should be it in my opinion.

@LuckyGuy You do have some good ideas, nice marketing plan, too…lol

It seems to me that a key question is whether companies are actually going to pay out more for those people—or go ahead and deny claims on some grounds (such as higher risk factors) even though they have charged more.

The issue isn’t so much whether the patients will have more and costlier ailments but whether the insurance companies will be paying more for treatment. We know that a huge amount of insurance company resources goes into denying claims.

The principle behind insurance is shared risk. If people decide to bear their own risks because they think they’ll pay less per year in actual medical costs than they would in premiums, insurance companies are out of business.

Well, they paid my $254, 843.87 hospital bill, handsomely. I only owed about $2,000 when the dust settled.

I received a statement for $33,000 in charges paid for a less-than-24-hour hospital stay last December. I remarked on that to my doctor. He said, “Yes, that’s about ten times the actual charges. That’s what you would have to pay if you didn’t have insurance.” I said that was crazy, and he agreed.

Besides, @Dutchess_III, my point was not whether they would pay out but whether they would pay out more where they had charged more.

And should they? My father died of lung cancer, having never smoked in his life nor been around smokers. If you paid a higher premium than he did, would that entitle you to more extensive treatment for the same illness?

I don’t think so. You choose which plan…. 70/30, 80/20 or 90/10, and you pay the premiums accordingly. I believe you get treated the way the doctor wants to treat you. I don’t know if they even go track down your insurance information.

The point is…in a discussion about whether high-risk patients ought to pay more for coverage, one should ask whether more insurance-company funds will actually be spent on those who paid more. If not, what are they paying for?

I believe that yes, they will. Smokers and obese people are surely going to get hit with medical issues they wouldn’t otherwise because of the lifestyle they chose.

@Dutchess_III Like drinkers and dopers and all these people on prescription pills that kill their kidneys?

Yes.

@Dutchess_III It just kind of irritates me that someone being overweight is perceived to be as bad as someone pre-kidney failure. You can SEE fat, but you can’t see an enlarged kidney or damaged liver without tests, not really fair to compare them.

Many of the prescription medications that have detrimental side effects (for example on liver and kidneys) are to treat ailments such as high blood pressure, diabetes, high cholesterol – all ailments that statistically are increased by a higher BMI.

One day in the future, I believe insurance companies will have us all take DNA tests and our insurance rates will be calculated by our genetic dispositions toward certain diseases and ailments.

@jca Another reason not to reproduce, sounds awful.

One day in the future, I hope to hell we have universal healthcare with a single payer. Get rid of the insurance companies altogether! The US really needs to get with the program and do what every other industrialized nation on earth does.

I can see that I’m failing to communicate, so I won’t keep trying. I am amazed at the apparent assumption that if an insurance company is billed, it will pay.

@KNOWITALL Well, I guess that’s comparable to the fact that you can’t SEE a smokers lungs, but it’s a pretty good guess that they probably aren’t doing so good.

@Jeruba You asked if more insurance funds will actually be spent on them. IMO, in the long run, the answer is “probably.” So, what exactly were you asking? Insurance is insurance. What if you pay these premium for years and years and never do get sick? Never do need to tap into it?
I have never experienced an insurance billing that wasn’t paid. Do you have an example for us?

It’s gamble, and usually the insured wins.

@Jeruba You are saying exactly what I’m wanting to know…if rates are higher for issues like obesity, will claims still be denied. I’ve worked in the insurance field for 30 years and now for a doctors office. I think claims will be denied. I’ve seen it myself.
Also, the doctors in my hospital don’t want to treat homeless, drug addicts or alcoholics. They do treat them, but get them out of the hospital as quick as they can.

I see. I see what she’s saying.
What reason would there be for claims being denied?
All I have is my own recent experience with “walking pneumonia.” I got sick probably because I smoke. Nothing was denied. Some things were fubarred…like one bill said the charges (on that bill) are not covered by insurance. It was $900. Took me 2 months, but I tracked it down. There was some coding problem or something. In the end I only owed about $60.

It opens a can of worms.

Insurance companies would have to charge extra to people who do not exercise enough, who smoke, who drink alcohol above their daily limit, who don’t eat fruit and vegetables, who stare at a computer screen without frequent breaks, who live in a city near heavy traffic frequented by vehicles without diesel particulate filters, who are frequent flyers, who go to work when they have a serious cold, who ski, who play handball, who don’t have enough sex, who work more than 12 hours a day, who don’t relax, who sleep less than their daily minimum, who get upset about everything all the time…

Besides, losing some weight in two months is a completely stupid irrelevant approach. What about gaining it afterwards? What matters is keeping a lower weight for the next decades.

@mattbrowne Our insurance DOES charge more because we smoke. $100 a month more.
I think we could narrow this down to the two biggest habits that are a clear and present danger today….obesity and smoking.

There are huge differences between smoking and weight.

Smoking has been proven to cause a variety of health issues. It is clear who smokes and who does not. It is a choice, albeit an addiction, to smoke cigarettes.

Weight is far more complicated. Obesity is correlated with disease… but has not been proven causal. Not all obese people overeat. How do you define obesity? BMI? Bodybuilders have obese-level BMIs. What about obese people with perfectly sound cholesterol, blood pressure, no family history of diabetes or heart disease?

I know a woman with a variety of health issues. She has to take medication that has ballooned up her weight. It is beyond her control. It is not about calories for her.

Obesity is not as clearly a modifiable risk factor as smoking.

Also, smoking effects the health of people around you. Obesity does not.

Every obese person I know overeats.
And yes, smoking affects the health of those around you (although I grew up in a smoking household, and I’ve never suffered any ill effects. Neither have my sisters.) That’s why I, and everyone I know, goes outside to smoke.

@Cupcake – I mostly disagree. Of course it has been proven that obesity causes disease. Almost all obese people overeat and lack exercise. Obesity can be defined. The extra weight is fat, not additional muscle mass. Medication alone doesn’t make people obese.

@mattbrowne Show me a causal peer-reviewed study.

@Cupcake: I would argue that obese people may not presently have cholesterol issues, blood pressure issues, etc. (when they’re young) but will very likely end up with some or all of those issues eventually. Someone said to me once that you don’t see elderly morbidly obese people in nursing homes…....that was a good point.

My point, again, is that is has not been proven to be causal. That is the clear difference between obesity and smoking.

Try this cupcake.

You get fat build up around your heart and other organs. You’re less able to move around. That is not good.

@Cupcake: Are there not a large number of studies and stats available on obesity and health risks (i.e. diseases, death stats, etc.)?

We all have to die of something, I am not advocating reckless negligence of ones health but…OTOH…I plan on sliding out sideways wine in one hand and chocolate in the other. lol
Also there are always variables and genetics at play as well. I have a “Type A” personality friend and she is very petite, works out an hour every morning, walking etc. and has high blood pressure because she is a stressed out type of personality. I on the other hand tend to go with the flow and could stand to drop some weight and rope in a few vices but my blood pressure is just fine. Ya just never know…live and let live I say.

Is being overweight or smoking any better or worse than being an uptight, angry and fussy personality? I think not. Better a happy smoker than an angry health nut. lol

@jca Not causal studies. You’re referring to correlation.

I’m not trying to be a pain in the ass here. I was just pointing out why I think it’s OK to charge more for smoking (although I would also be fine with incentives to not smoke) but not charge for obesity. And I am very clear that there are many correlations with obesity and health problems/increased costs.

I liken it to charging more for diabetes or cancer. Certainly people with diabetes or cancer cost insurance a lot more money, but I don’t see good reason to charge them more. I see shitty greedy reasons… but not sound, in my opinion.

I think all insurance companies should be offering incentives to be healthy. A couple of free or low cost individual or family therapy sessions, a reduced cost gym membership, discounts on local produce, free information sessions, etc.

I like the idea of incentives and things like reduced gym memberships. We agree on that.

Well..I am going to my county fair this afternoon and fully plan on having a corn dog, fried zuchinni and whatever fair fare strikes my fancy. I hope the insurance police are not tailing me. Piss off I say! lol

FUNNEL CAKE!!!!

@Cupcake – There are hundreds of studies showing the causality. Let’s take this one as an example (conducted in Sweden):

http://www.ncbi.nlm.nih.gov/pubmed/23163728

“Obesity is a risk factor for diabetes, cardiovascular disease events, cancer and overall mortality. Weight loss may protect against these conditions, but robust evidence for this has been lacking. The Swedish Obese Subjects (SOS) study is the first long-term, prospective, controlled trial to provide information on the effects of bariatric surgery on the incidence of these objective endpoints.
...
Compared with usual care, bariatric surgery was associated with a long-term reduction in overall mortality, decreased incidences of diabetes, myocardial infarction, stroke and cancer.”

@Cupcake: I personally don’t have time to google for your request, but I’m sure if you google something like “effects of obesity” or “health risks of obesity” you’ll find plenty of information.

I laugh when people write (or say) things like “I know someone who is 300 lbs and she has no other health problems.” It’s possible the person has no other health problems but that does not mean they’re not going to develop. Also, many people won’t tell others about their health problems. They don’t feel a need to share their health issues, even when asked. Therefore it gives an impression that they’re totally fine. Third, some people just don’t like to go to the doctor. Ignorance is bliss. Also, there will always be thin people who “do everything right” who will have health problems, but statistically, overweight people will have more health issues (and more of the same health issues) as thin people. Many health issues (like GERD) can be alleviated just by losing weight.

The former German chancellor Helmut Schmidt is a smoker. He’s almost 95 years old. Ergo: smoking doesn’t cause disease? Btw, @Cupcake, can you give me one example of an obese human being on our planet who is 95 years old? Or 90 years old? Or 85 years old?

Maybe I’m just cynical, but I thought insurance companies preferred higher-risk individuals to go ahead and die and stop requiring costly treatments.

@Jeruba: True and that makes sense, but nowadays, thanks to modern technology and pharmaceuticals, people are kept alive for decades with ailments that just thirty years ago would have killed them. Cardiac problems, diabetes, amputations, brain injuries, cancers, you name it, people are living with these things, just costing insurance companies more in terms of care, medications, hospitalizations, equipment.

Bringing this answer back to the question of overweight, a few years ago I was in the hospital on a physical rehabilitation floor (I had Gulilain Barre Syndrome) and there were people on the floor that just had bariatric surgery. These were the occasional ones that were older and very big, bigger than most, and so they needed a few days of rehab to get them up and better before they went home. The hospital had extra wide wheelchairs (wheelchairs the size of loveseats), special larger, sturdier beds, hydraulic lifts to get the people out of bed or off a toilet (or off the floor if they fell). All that stuff is extra money out of someone’s pocket.

I have no plans on life extension if I am diagnosed with a serious disease. Better a few months of comfort and peace than years of invasive and debilitating treatments that just extend the inevitable. I do not agree with keeping terminally ill people alive and think we should all accept our mortality with grace and dignity. I wholeheartedly support the right to die and euthanasia.

I’m only going to say this one more time.

I am clear that there are risk factors associated with obesity, just like the link @mattbrowne provided.

Obesity has not been proven to cause health problems.

And no one addressed my issue that bodybuilders have high BMI, so you cannot charge based on BMI. What criteria will you use to charge people more?

Are you OK with charging people who have or have had cancer more money? To me, this is a much more appropriate comparison than smoking.

@Cupcake:

“Risk factors or determinants are correlational and not necessarily causal, because correlation does not prove causation.”

“Not necessarily causal” means that there are certain risk factors where this is so and other risk factors for which it’s been proven that they are causes as well, i.e. we have correlation and causation.

Perhaps we can agree on this:

Obesity shortens people’s lifespan.

http://www.sciencedaily.com/releases/2009/03/090319224823.htm

“The Oxford University research found that moderate obesity, which is now common, reduces life expectancy by about 3 years, and that severe obesity, which is still uncommon, can shorten a person’s life by 10 years. This 10 year loss is equal to the effects of lifelong smoking. The analysis brought together data from 57 long-term research studies mostly based in Europe or North America.”

@Cupcake: Insurance companies can charge based on BMI. Apparently they are at present. Again, if the consumer does not like it, they can vote with their wallets.

In googling (just now I googled it) body builder BMI, there’s a separate criteria and separate BMI for body builders. :P

@mattbrowne: Obese people usually have a shorter life span, that is why LIFE insurance companies can charge more or even decline to cover obese people. This question is in reference to medical insurance.

@hearkat: I think @mattbrowne was referring to the ensuing discussion about the health effects of obesity, which @Cupcake seems to refute.

@Cupcake One other criteria on the questionnaire is waist size, so I think that might take care of your body builder question. The body builder’s I have seen usually have small waists.

@chyna: If you google it, you’ll see there’s different BMI criteria for body builders.

@jca – Yes, I am aware that he was addressing the health risks associated with obesity. My point is that death isn’t a ‘health’ risk in the eyes of a medical insurance company… as Jeruba pointed out, you cost them nothing when you’re dead. Therefore, the point is moot relative to the original question about health insurers charging higher premiums for overweight customers.

I agree with Cupcake that correlation does not prove causality, and don’t feel I should pay more because I might develop diabetes or high blood pressure, when I know many people who are thinner and more active than I who have these conditions.

What about tanning? Should health insurers charge higher premiums for people who go tanning – whether in the sun or in a salon?

What about health insurers charging more for people who drink soda or alcohol?

@hearkat: I know many people can be thin and have other diseases such as diabetes. However, I’m sure you’ve heard that statistically, a far larger percentage of overweight people will have diabetes, heart disease, high cholesterol, high blood pressure, GERD, bad knees, bad hips, sleep apnea, etc. I’m sure this is not news to you.

If health insurance companies had an effective, accurate way to prove and enforce people not drinking soda, tanning and drinking alcohol, they would.

@jca – Yes, I did. Claiming obesity doesn’t cause disease is like claiming that nicotine isn’t addictive.

@mattbrowne: It’s not clear why you’re addressing that to me. Yes you did?

@jca I think he was agreeing with your response here

What @Dutchess_III said! Thanks.

http://well.blogs.nytimes.com/2013/07/01/a-label-calls-attention-to-obesity/

Article pretty well sums it all up.