Should overweight people pay more for health care?

Wouldn’t that be discrimination?
I read the article

No. Then you would get into a whole other area of people that have a propensity for diabeties, cancer, heart illness, etc. Should we charge them more? Where would it stop?

No. I am overweight, but very healthy…

overgeneralizations suck.

Speaking as one, NOOOO!

This would be a great big huge fat new opportunity for corruption in the system.

No, it is discrimination and it is a slippery slope.

uhh…. no. if we (Americans) were afforded the same healthcare as say, canada, the uk, or paris… or if our foods weren’t genetically and chemically modified, maybe the united states wouldn’t be so overweight. I don’t think overweight people should be penalized for a problem the USDA, FDA, and corporate lobbyist designed to keep their pockets fat.

No, we shouldn’t pay more, this is the same shit that happened when ellis island and angel island were basically the hottest spots to find immigrants coming to America, we were like,“Oh come to America, make it one big melting pot, we have opportunity” but then,“weeelllll,..,.only a few of you can come at a time, or actually when we say you can”, I don’t care if overweight isn’t a race, but it’s discrimination, they said we would pay the same for healthcare as an average healthy person, now they’re just trying to cover their ass by saying we are more susceptible to injury, which maybe true, but it sure as he’ll shouldn’t change the amount we pay, just admit you were at fault instead of blaming us overweight people for being the way we are, I’m happy the way I am, and I’m like 5’11” and 255lbs, so stop blaming us and just say it like bill Clinton

You should look at obesity as a SYMPTOM, not a motivation problem. And done in that way, there’s no reason to charge one symptom differently then any other.

No. Once that can of worms is opened, then folks can start being discriminated against (be charged more) for all kinds of things.

Oh sure, I think overweight people should pay more for healthcare, as long as black people pay more as well (hey, they could have sickle cell), gay people (hey, they could have AIDS), people with a history of cancer (hey, they should pay through the nose when they get a broken leg, because they might get cancer), teenage girls (birth control ain’t cheap), smokers (for obvious reasons), drinkers (also for obvious reasons), people with allergies (a peanut is a dangerous thing), athletes (sports ain’t kind to the body) etc.

If we start down this road, pretty soon everyone except the perfectly healthy will be paying too much for health care.

Also, I think it’s ridiculous that doctor doesn’t hire smokers. When his liquor cabinet is empty, his vegetable drawer is full (of organics) and he has the blood pressure of Lance Armstrong, I’ll put his saddle on his high horse myself.

Here’s the answer, stop labeling things, don’t rush the world, and start looking at the world and find all it’s weak points and bad spots

Should smokers pay more?

Should people with genetic pre-disposition to disease pay more?

Should pregnant women pay more?

Should people who do extreme sports or sports at all pay more?

Where does it end?

We already do – more tirps to the doctor, more for the extra food we eat, more for the clothes we buy – what do you mean “should” we pay more?

Statistically speaking, if you are a high risk… you should pay more. Period.

Everybody else that “sins” has to pay more in taxes, then why shouldn’t obese people?

@mowens Not really. People can get sick or have accidents at any time statistically.

@Garebo How do people who “sin” pay more for health care?

@Marina The term “sin tax” refers to the extra charge for using hazardous substances or indulging in adverse activities.

@marina Right, but everyone has the same statistics to get in an accident. If someone boxes for a hobby, that is a high risk hobby then building model cars. You think both people should pay the same premiums? If you were the one holding the purse strings, would you charge them both the same amount? I sure as hell wouldn’t. It’s my money, I want to make a profit. It’s like betting on horses.

No, I became overweight when I quit smoking and now I’m trying to lose some of it. Charging me more would only discourage me!

@ShanEnri for many people the prospect of being charged more would be an incentive to encourage them to try harder.

@YARNLADY The only incentive it would give me is to not go to the hospital or doctor!

I would pay more if the surplus went to reversing car-based planning and sprawl, “food deserts” in urban areas, and “bliss point” engineering of unhealthy foods.

@YARNLADY, again a misconception. Obesity is rarely, if ever, a motivation problem (except, maybe, to people who never had the problem). In the article cited it even says: “We should declare obesity a disease and say we’re going to help you get over it”

Maybe people of healthier weight could pay less or is that the same thing

@ YARNLADY sin tax. that’s hilarious. it’s funny how one can be taxed by the government for using an adverse substance which was legalized by the government for public consumption. the vicious cycle is vicious indeed. and yet they won’t legalized marijuana. taxation and incentive in the same sentence is an oxymoron. taxation is enslavement.

@YARNLADY I know the term, but I do not know that people who smoke or drink pay more for health care.

@Quagmire The article is very narrow minded about the causes of obesity. I, for one, am suffering from an addiction to the computer, and need motivation to change that.

@Marina The only “more” they pay is when they must have more visits. The actual charge is not higher that I know of.

@mowens Yes I do think both should pay the same premium. The boxer might well be in better physical shape from working out while the car hobbyist might get a glue-sniffing addiction. We could go down this path all night. I think the premiums hsould be the same for everyone. I think everyone is entitled to health care.

@YARNLADY, with due respect, if motivation will change your behavior, then your problem is only that you use the computer too much.

If you truly were addicted, motivation alone wouldn’t do it.

@EVERYONE STOP MAKING EXCUSES FOR YOUR OWN PROBLEMS!

@Quagmire I welcome your quip that addiction is the wrong word to use. I have often wondered what is the operative difference between an addiction (such a physical dependancy) and a habitual use of the internet. I can hardly force myself to do the work I have around the house, because I would rather be here.

FYI, maybe it’s the housework that you DON’T want to do and it has little to do with the net. Remember how much time we’d watch television when we didn’t want to study?

@Quagmire I hate housework, but my dishes all get washed, the clothes always get washed, the rooms always get vacuumed, the meals always get cooked and various other household tasks get done (by me), but it is only in time “stolen” from my online participation.

@SuperMouse: I agree with the slippery slope in that I don’t want the unhealthy obese to pay more but I also don’t want my premiums raised because there are more and more unhealthy obese.

I think it would defeat the purpose of insurance, which is to spread risk. We all benefit when people stop smoking or lose weight, or start exercising. All of society benefits. We want to encourage people to acquire healthy habits, not punish them for unhealthy habits.

Perhaps people should pay more based upon utilization. The more you go to the doctor, the more the portion you pay should be.

As a smoker, it affects my auto insurance, and my rates are just a bit higher than if I were a non-smoker. I think it might apply to my homeowners insurance too, I am not exactly sure.

Donuts are as bad for you as cigarettes, so let’s add sin taxes to donuts. =)

Yes. And airline tickets, too. We already have to pay for extra checked luggage, don’t we? And in effect, fat people are carrying a lot more baggage (yes, pun intended), right?

And yes, I’m joking.

Kinda.

If smokers pay higher premiums on health insurance, then unless there is a medical condition causing the obesity, I see no reason why the obese too should not pay a premium. Without an underlying medical condition, overeating is a choice or an addiction, just like smoking, and it too costs society vast sums of money to provide blood pressure meds, heart meds, etc.

But in the end it would simply be one more aspect of our lives that would be legislated, regulated and controlled. What ever happened to land of the free, home of the brave?

Smoking is a lifestyle choice much more than “being fat”. It is fair to discriminate insurance-wise against people who make a willing choice to smoke versus people who are obese or overweight, words that have varying definitions from people to people (sex to sex, physical activity levels, etc) and which is not necessarily related to one’s choices in life (some people will just be larger, period, myself included, thanks genetics!).

That said, when your health insurance becomes health care, these companies can be motivated to encourage you to stop smoking and to live a healthier life. Here’s a wonderful example from my own life, remembering that I live in Canada and thus have a base level of health care provided by our government, so all of this relates to the additional plan offered by my work (which covers dental, prescriptions, glasses, and all the other stuff that OHIP doesn’t cover, like chiro and therapy). Every year we are given the option to earn an extra $100 into the health spending account by working out for 10 weeks in a row and tracking your progress online. I’ve earned it twice, and it’s helped me to adopt a healthier lifestyle! Win win! The same goes for smoking, they offer you discounts on cessation supplies as well as help/support. There are tons of resources on their website with health information, eating information, nutrition info, etc. They are motivated to give you information if you want to receive it.

Discriminating against something that is not almost 100% related to choice, unlike smoking, is not fair. Encouraging people to adopt a healthier lifestyle however is a wonderful way to contribute towards motivating people to do so themselves.

@rooeytoo Yes, there are medical reasons for obesity. Genetics also plays a large part, as does your knowledge and ability to get and use healthy foods. I am not saying that people can’t lose weight, I am saying however that the thought that every grossly obese person could become whatever the definition of “non-obese” is at that time is not something I would gamble on.

Furthermore, if you start discriminating based on food, you must discriminate on every other minute and non-minute risk element in your life (drive a truck? sorry, that’s more expensive because they are in more accidents, are you of childbirthing age? well that carries a risk too and that’s a thing of choice as well one could argue, don’t get me started on skydiving or traveling to Africa), and I’m sorry but that’s not a world I want to live in. Here in Canada we have it working pretty well indeed without such discrimination. And trust me, doctors here have no hesitations towards suggesting to lose a few pounds.

@Marina I would rather see smokers and heavy drinkers pay more for health care than overweight people.

Weight is so complex. Besides genetics, stress and sleep pay as big or more of a role in weight than diet and exercise. Getting enough quality sleep can take weight off of you without any dietary or exercise changes. So much of weight problems is caused by hormones, as well as eating habits. Likewise, eating a salad can add more calories than eating a sandwich.

Perhaps skinny ass people who eat nothing but burgers and tacos should pay more, too. Lots of thin people are at the same level of risk for heart disease and diabetes. My sister eats absolute junk and weighs as much as a mosquito. I, on the other hand, make almost all home-cooked meals and am overweight. I do eat heartily, but I rarely eat “junk.” II’m careful about eating too much sugar and artificial ingredients. I also take daily walks and do yoga, or did before my morning sickness became too uncomfortable. I can’t wait to get back into it. But, I have a thyroid disease (I know everyone uses this excuse) that I’m being treated for that contributes greatly to both my low metabolism and fatigue. So, I’d like to state that appearances can be deceiving and little can be categorized in such a way as the doctor in the article is suggesting.

Good point @ubersiren! I know many skinny people who have blood pressure, cholesterol, asthma, and other conditions that I do not have – it would not be fair to charge me more. My choices have led me to be larger than many, but I have not overloaded my body’s ability to regulate itself. However, there are those whose bodies are overwhelmed due to genetics.

@evelyns_pet_zebra: To smoke or not to smoke is more of a clear choice than to eat or not to eat, or to be fat vs. thin. I have always said that food is the hardest addiction to control, because there is no “cold turkey”, and the garbage actually costs less than the healthy stuff.

@ubersiren and @hearkat my ex husband weighs 98 pounds soaking wet but that guy is a walking ailment! He is on more different meds than any three other people I know. If we start charging people for health insurance by the pound we are going to miss a whole lot of unhealthy people who should be paying higher premiums while capturing many healthy folks who shouldn’t be.

Is weight really a choice? Anyone ever read Fast Food Nation: The Dark Side of the All-American Meal?

Another problem that we haven’t addressed unless my memory has failed me is that you have to define obesity before you can start charging more for it. My mother is a perfectly healthy weight for her but she is considered overweight. She has a stocky body type and is naturally very muscular. She also can’t get health insurance because she has a tendency to get expensive medical problems. She’s had cancer, nothing to do with her smoking had a large portion of her right kidney removed, broken various bones numerous times, went through expensive infertility treatments, etc. If the system changes so that she has to pay more because she is considered overweight, she probably wouldn’t ever be able to find insurance again.

@daloon: I’ve never read the book, but I believe that weight is not necessarily a choice. My aunt just recently lost about 120 pounds. This weight loss was prompted by her youngest son moving out. Before, when she had two children to look after, raising them was more important than eating healthy or exercising. She’s a nurse and even though she’s been at her clinic long enough to be paid relatively well, she was still getting a nurse’s salary and raising 2 children by herself on that money. Now, she can afford to go to the gym and eat higher quality food. Before, it was more about getting her kids fed, which often meant McDonald’s. Should she have been punished because she was overweight?

To expand on what I said above, I think it really depends on how you believe people are best motivated. Does punishment for not doing the right thing work as well as rewards for doing the right thing?

Personally, I don’t think people respond well to punishment. If they have their rates raised, they’re more likely to think ‘oh fuck it’ and continue the behavior, since they’re already paying for it, and they don’t like the way they are being treated, anyway.

I think that if people are given free memberships to gyms and exercise coaching and free healthy cooking lessons, and advice about how to fit these things into their busy lives, they will be much more likely to lose weight and to reduce incidence of high cholesterol, high blood pressure, heart and stroke problems. I think people want to be healthy, but they just don’t know how to do it. It just seems like too much. I think if they are punished for not being healthy, it will be counter-productive.

Not only that, but one person’s ill health hurts all of us. We lose the benefit of their productivity, of their labor, of their ideas and contributions to society. We also have to pay higher taxes or health insurance premiums to take care of their medical bills, especially if they drop insurance because they can no longer afford it.

For life insurance (death insurance?) and disability insurance—optional things, I can see using higher rates for less healthy people. But for health insurance when we all pay for the health care of those who can’t afford insurance, it just doesn’t make sense. We pay one way or the other. Doesn’t it make more sense to encourage healthy behavior, instead of shooting ourselves in the foot by punishing unhealthy behavior?

I don’t see why this couldn’t be enacted? When you apply for car insurance, your driving record, your car, your age, your gender, where you live, whether the car is garaged or not etc. are all plugged into an actuarial formula to give you a rate. Likewise, when you apply for life and disability insurance and have to undergo a medical evaluation, all sorts of family history and personal history along with biologic data is collected before you can get the insurance. I think slightly higher rates might serve as an incentive for people to lose weight. In fact, it could be included in the premium that if you lose X amount of weight, you will get a big fat deduction in your premium, perhaps even below the healthy rate (for some time period, before reverting to the average rate). That kind of disincentive-incentive might work.

@shilolo Pun intended? Big, fat deduction?

@Marina Um, no?

@shilolo: I think the difference is that you don’t need to drive a car but if you get hurt, you need medical care. Driving is a luxury, medical care is not.

@KatawaGrey Yes, but there is a fair amount of evidence pointing towards unhealthy eating habits and lack of exercise for our current obesity epidemic. Why should those who take good care of themselves have to subsidize those that don’t?

@shilolo : People who are appear thin, but really eat junk should be exempt from this tax? Shouldn’t it be a “lifestyle” tax rather than an “appearance” tax? What if the thin person does lots of drugs or drinks excessively or has unprotected sex?

@ubersiren Unfortunately, there is no obvious way to detect those things, and more importantly, being obese has been linked to various diseases, while being thin has not. Obesity is clearly tied to both genetics, diet, and exercise, but we cannot control our genetics while we can control the later two issues. With respect to the later issues (i.e. a lifestyle tax), there really is no way to identify such lifestyles, though when you apply for life/disability insurance, they do screen a variety of factors (like blood and urine for preexisting diseases or drug use). It could be done.

@shilolo: Why should only obese people be targeted then? Thin people could eat too little and exercise too much. These habits can be equally unhealthy and usually point to a mental disorder whereas eating a lot and not exercising don’t necessarily point to a mental disorder.

@KatawaGrey I beg to differ on the association of overeating with mental disease. More importantly, it seems you are reaching for straws. There is an obesity epidemic in this country (and other Western countries), with >20% of the US population having a BMI >30. I doubt very highly that the small numbers of unhealthy anorexics would, on balance, account for as much medical costs as the millions of obese and morbidly obese individuals in this country.

I understand that obesity is a pretty good indication of unhealthy habits. However, I just don’t see the point taxing them specifically when there are countless other non-weight related health problems that people thin and overweight share. Smoking, unprotected sex, drinking, drugs, as well as eating poorly and refusing to exercise.

I guess what I’m saying is, why tax only people who display their fault for all to see? How is this fair? Like @shilolo said, there is no easy way to tell who is using hard drugs or sleeping around without protection, so why tax anyone at all? Even smokers can lie, to some extent and cover their tracks.

A quick google search reveals that the percentage of people who smoke in the US is roughly the same as the obesity percentage. I’d have to call that an epidemic as well. Just because this may not seem like a high percent in other countries ( Like the crazy smokin’ Russians) doesn’t mean it’s not as bad of a problem.

Or what about this page which shows an astonishing number of people with an STD?

Why only pick on the ones who can’t hide it?

Consequently, I just found this article about life expectancy. Have no fear! Clicketty

@Marina: drastic late, but to reply, because they are addicted to carbohydrates, and can’t control themselves. Snacks, by the food industry are deadly, as you already know. People get overweight from their consumption and prone to diabetes, heart failure, clogged arteries and many other ailments. Starch abuse is not far removed from alcohol abuse, coincidentally both are sugars. Taxes are always a punishment, directly or indirectly.

@ubersiren: I was just thinking about how obesity is only being targeted because it is visible on the drive back to my apartment. Lurve for saying it here!

It’s just bad policy, and counter-productive. You could test this, I suppose. Here’s an article that says that no extrinsic motivator (neither reward nor punishment) will help people in the long run. They can have short term effects, but as soon as the extrinsic motivator is removed, they go back to old habits.

The article suggests that only programs that train people and support them to engage in healthy behaviors have any effectiveness (the example is about smoking, but it’s not a big stretch to believe it applies to weight loss as well):

By contrast, three better-designed experiments – in which various kinds of training and support were provided for quitting smoking – discovered that the effectiveness of these interventions was reduced if a reward was offered for kicking the habit. In some cases, people promised money actually fared worse than those who weren’t in a program at all!

There seem to be articles all over the place about weight loss motivation, some suggesting that both positive and negative reinforcement work. However, almost all do not seem to be backed by research, or the research is suspect. Many protocols do not follow people over the long term.

This article also says that negative reinforcement doesn’t work. It suggests ways to develop intrinsic motivation to lose weight.

There are many other articles out there that suggest that extrinsic motivators have only a short term effect, and that the best way to motivate a person to lose weight is to help them develop intrinsic motivation. There are many programs out there that claim to do this.

Anyway, it seems to me that taxing fat won’t work. I guess paying for weight loss won’t work either. This leaves us with at least one policy alternative—teaching folks how to maintain a desire to lose weight; how not to beat themselves up about it, and what techniques they can employ to help them.

unfortunately, if obese people are made to pay more for health insurance, this only affects part of the population. excluded people will be people who receive public funding, disabililty, Medicaid. so that part of the population will be able to continue to eat whatever they want (and we all know that high calorie, high fat foods, for example macaroni and cheese in a box, are cheaper than fresh fruits and vegetables – as quoted in the magazine article in the link). so working people will disproportionately be paying higher insurance premiums. where is the justice in that?

I would rather tax unhealthy food.

@mattbrowne: Fantastic idea! We have sin taxes for tobacco and alcohol, why not for Doritos and doughnuts?!?!?

I personally think we should considering also incentivizing manufacturers to make healthy changes to their foods. Eschew the use of high fructose corn syrup and cheap alternatives to butter and sugar, which are far worse than the originals.

Encourage packing in single servings that are truly single servings.

It is possible th create wonderful tasking snacks and desserts using whole grains, nuts, seeds and other things that are better than the processed crap in the marketplace now.

I believe people would buy it if it was out there.

@daloon Actually, there is strong data from a randomized, double blind clinical trial published in the New England Journal of Medicine (world’s most prestigious medical journal) that smoking cessation is significantly better when a cash reward is offered.

@hearkat – Some of the tax revenues should directly go into the health care budget

@shilolo I’m living proof of that. 31 years ago, a co-worker threw a hundred dollar bill on my desk and said it was mine if I quit smoking. Two weeks later, I quit cold turkey and have never smoked again. I was a pretty heavy smoker too, 1 to 2 packs a day.

@chyna You owe your friend way more than a $100…

@shilolo I know. I had read somewhere that after 7 years of non-smoking, your lungs were back to where they were if you had never smoked. I don’t know if that is true, but I sent him a big flower arrangement on my 7th anniversary of quitting, with a note thanking him for giving me my life back.

@chyna Your lungs are probably back to normal. That you sent him flowers was a really nice gesture. In addition to your health (for which a price is hard to arrive at), think of all the packs of cigarettes you never bought. Probably >$200,000 in today’s money