Should fitter people be offered discounted health insurance?

Discrimination against fat people or smokers is a complicated issue. Much more complicated than discrimination against groups defined by something they can’t help or that isn’t a bad thing.

I’m undecided as to whether it is justified or not.

I would be against such an scheme, not only does it seem to me like a load of guesswork, but it would open the door for people wanting to tell others what they can and cant do with their own body.

Personally, I would be more in favor of giving discounts to those who only seek medical treatment when it is absolutely necessary, aka cant stop the blood by your self. Or perhaps give discounts to those who have worked and paid in to the system for a greater number of years. And possibly have higher prices or penalty costs for those who waste doctors time on a regular basis with imaginary ailments.

However, I think the ideal system would simply be for everyone to pay a fixed amount that comes directly out of their wages on payday, with the option to opt out of health care completely.

@poisonedantidote
Do you think that determining what percentage of your client’s doctors visits is medically justified would not involve any guesswork, or even any less guesswork than a well regulated medical check-up?

@Fyrius
“Discrimination against fat people or smokers is a complicated issue. Much more complicated than discrimination against groups defined by something they can’t help or that isn’t a bad thing”
What about innate genetic diseases that affect how healthy you were deemed to be. Such as Prader-Willi syndrome? Just asking I have no stance.

Well, car insurance rates for teenagers are higher than for everyone else. Car insurance rates for young males are higher than those for young females. No one seems to be screaming bloody murder about those, direct discriminations. Why is this any different?

@Fyrius
Well, it is very hard to guess who is going to and who is not going to get sick. However I would say that it is quite easy to spot people who are wasting time.

My grandmother for example, she goes to the doctor for everything, even things that are pure imagination. She is a repeat offender at this, so much so that part of me thinks that she actually wants to be sick. These are the people I am talking about penalizing with higher prices. I think it is quite safe to say that no one needs to go to the doctor 1ce a week with a different complaint. After someone has gone to the hospital 50 or 100 times and there is no evidence that anything was ever wrong with them they should face higher prices or perhaps be sent to for psychiatric treatment to see what it is that is causing them to do this.

I already thought there were discounts for fitter people. My ex and his ex-wife had to go through a bunch of tests in order to establish their health insurance and I remember them working very hard for it, there had to be incentives. Should there be? Yes because so many people are unfit and drive the costs of insurance higher for everyone. I also think there should be discounts for women who will not be having children & using birthing services and check ups.

Should elderly citizens also pay more for being unhealthy?

Yes they should.

An insurance company is a business and the ultimate goal of a business is to make money. Based on statistics and common sense you are going to pay out less often on a person who keeps themselves fit and healthy.

Am I a fan of insurance companies? No. I think they are a BIG part of what is wrong with our current health care system, but you cannot say they are discriminating against fat people and smokers.

If they refused to cover an individual because of the color of their skin or their nationality, that would be discrimination. A black man has no more choice in being black than an individual being born in, say, Canada has in being a Canadian.

As much as you all don’t want to hear it, being fat and smoking are two things that folks choose to be. I KNOW THERE ARE EXCEPTIONS TO EVERY RULE, but the majority of overweight people are overweight because of the lifestyle choices they make and if you want to smoke you are going to pay the price for it when it comes to any type of health related issue.

So, as much as I despise insurance companies, I can’t argue with the fact that it is good business to offer discounts to clients that are not going to cost you as much in claims as others. To call that discriminatory is thinking with your heart instead of your head.

@Blondesjon
How will you be able to link the correlation between being overweight or being a smoker to being unhealthy when with some people it could be due to age. Should the elderly pay huge amounts on their insurance?

I agree with Blondesjon in that those who use more should pay more and if legislation prevents that, then a reward in the form of a reduced premium is quite fair. I also realise that people who have allowed themselves to become unhealthy cannot rectify that overnight and often not without aid. There has to be a safety-net.

I feel that possibly a condition of receiving un-penalised medical support could be a monitored and reported attempt to improve health and abandon negative health habits. It does appear inevitable that a user pays system will eventually predominate – the system is likely to collapse if it doesn’t.

Many people here are denied major surgery if they refuse to give up smoking or lose weight – even if their health is critical. They only receive palliative care until they comply.

@cooolbeans . . .If you look at insurance as the business that it is and not at what your emotions want it to be then my answer is yes.

The elderly would be a bigger drain on the bottom line so you would have to compensate with higher premiums.

There is no need for a link proving 100% that being overweight is unhealthy and that smoking is unhealthy. There is enough evidence to show, that in many cases, these things are unhealthy. In business you play the percentages.

@Blondesjon
What if it’s so high they can’t afford it?

Then they would go without insurance.

@Blondesjon
Do you think the American system is the best system in the world? Regarding health care?

@cooolbeans . . . Fuck no. Although most of my leanings are Libertarian my health care preferences are decidedly Socialist.

Fit people in America do get a discount for good health in private insurance; that is, people who have health problems (or smoke or drink a lot) can either not get insured or have to pay higher premiums. I had a problem with anemia for a time for a very specific reason and when I applied for a long term care policy, they wanted to charge me more until I proved that he problem had been resolved. In employer provided health care, they have open enrollment in which the insurance company plan has to take new employees despite pre-exisitng conditions.

Part of the change Congrress is looking to make is to mandate that health insurers have to “take all comers.”

I personally am in favor of a single payer universal health plan but I don’t see that happening any time soon in America.

@cooolbeans
Yes. A good point.
This is the sort of thing that makes this a complicated issue.

@gggritso
BLOODY MURDER
Because that actually is pretty disturbing.

@poisonedantidote
Hm. Yeah. If the doctors keep records for everyone of visits that resulted in a diagnosis and visits that resulted in telling the patient to get over herself, and the insurance agent gets to see these records, then yes. That is easy to determine.

But I don’t think it’s right to say predictions of who will or will not get sick are just “guesses”. At the very least they’re educated guesses. Such assessments are based on statistical probabilities, which are derived from factual data.
It’s technically true what you say, but I don’t like the connotations.

@gggritso
How will you be able to link the correlation between being overweight or being a smoker to being unhealthy when with some people it could be due to age. Should the elderly pay huge amounts on their insurance?

I know I asked this to Blondesjon but he answered with a reply I though was surprising and I don’t think a huge majority of people would feel the same way, so I’m seeing if you agree wit him or not.

@cooolbeans welcome to fluther. Lurve.

@cooolbeans So. Right off the bat, I’m not American. I don’t know how the health insurance system works there. At this point you can feel free to ignore everything else I say.

Next. The question was, and still is “Should fitter people be offered discounted health insurance?” Yes they should. People who work hard to take care of their body will lead healthier lives and should be rewarded. Since the insurance companies are less likely to pay, these people shouldn’t spend as much on health insurance.

There is a difference between hiking up prices for the sick and decreasing prices for the healthy. It does not make sense to increase prices for the elderly. It does make perfect sense for the elderly/sick to pay more for health insurance than the healthy/strong.

@gggritso
If now we pay extra to subsidise the unhealthier members of society, by us getting discounts the unhealthy will almost definitely have to pay more. The elderly, people with genetic disease, the disabled, etc.

But I see you point and thanks for replying.

With everyone covered by mandate, the law of large numbers takes care of the problem, distributing relative fitness along a normal curve so that people on the left subsidize people to the right of the mean if xy intersection represents perfect health.

No, even though that is how insurance works (which is one reason I think the insurance industry is one giant racket). It’s discrimination, even if on average less fit people do require more medical intervention in their lives. How do we define fit and unfit? Is it just weight? What about genetic factors and environmental factors?

How unfair it would be if someone was forced to pay so much more for insurance because they happen to be overweight and then never need to use it. When they die in their sleep at a ripe old age will their heirs get that money back?

Insurance is all about the pooling of risk. If those least healthy (or more accident-prone, or with bad genes…) paid for the entire cost of their medical treatment, we could just tell them to shoulder the bill themselves – and do away with insurance altogether.

@tinyfaery . . .I agree with you but any impassioned argument is not going to sway what is a money making business.

In capitalism there is no fair. From that standpoint for every one overweight healthy person you have there are ninety-nine others that have a myriad of health problems.

Again, when it comes to health care I am a dirty Socialist.

@Blondesjon I am a dirty Socialist about most things.

The thing is there is no “discount” for the fit. Really, it’s only “extra-charges” for the unhealthy.

I completely agree with @tinyfaery! As someone who medicine would describe as “overweight” (at least on the BMI scale), it seems ridiculous to say that I’m also “unhealthy”, as I very rarely get sick. knocks furiously on wood

I also only visit the doctor an average of twice a year (once for well-woman, once for the annual sinus infection) and the dentist, again, twice a year.

Enough about me, though.

I think that if insurance was “socialized” and to qualify for the lower rates you had to run a mile or something, and those who didn’t or couldn’t would pay a slightly higher rate, that might work. And perhaps the insurance company (government) could offer some sort of discount to gyms for those who want to get into shape. (But it would be hard to keep track of, no doubt.)

I don’t see this happening any time soon, though.

@evegrimm . . . if medicine was socialized we wouldn’t pay anything.

Medical care here (Australia) is free if you can’t afford medical insurance, as are most pharmaceuticals once you reach an annual Safety net level. Before that they are heavily subsidised. Things like insulin and other diabetic drugs are completely free. They ensure that those who can afford it take out private medical insurance by taxing them more heavily if they don’t have insurance. It isn’t a perfect system, you sometime have long waits for some types of surgery etc., but at least no matter who you are you will not be refused treatment or medication.

It is the middle and higher income earners who are likely to be affected by the suggested changes in private medical insurance. At the moment it is based on age, the older you are, the higher the premium. They are very likely to begin varying premiums based on fitness levels and previous history. They are taking away some of the privacy protection laws regarding medical records to allow insurance companies to better assess the risk that you present to them.

@Blondesjon – As much as you all don’t want to hear it, being fat and smoking are two things that folks choose to be. The truth is a little more complicated. The association of drug use – yes, that includes tobacco! – and overeating with depression is established, at least in young women. When an obese patient appears at the doctor’s what needs to be treated is the underlying condition. Of course I chose to be fat, in the sense you use the word. It was easier to eat than to deal with my personal problems and smoking was more socially acceptable than an alcohol addiction. It was not until the underlying mental problem (anxiety) was diagnosed, and treated, that I began to cope with overeating, and by extension, obesity. (I no longer smoke but that is another story). If my story is not unusual, it follows that the concept of choice in life styles has little meaning.

@bea2345 . . .I do believe I also stated (in ALL CAPS) that there are exceptions to every rule.

I am fat as well and I know that I allow this because of various emotional problems. I also know that if I did something about the emotional problems the weight issue would become a problem I could tackle.

Since we are quoting here, how about this one: If you choose not to decide you still have made a choice.

now off with you. . .or i shall be forced to quote rush again. . .

@Blondesjon – you sound startlingly like my youngest brother. He says, take your meds, cope with the depression and get on with your life. Choosing not to decide: that is not a choice, that is abdication. I did not know that what I had was a real illness. It was not until I retired, and a close relative was diagnosed with a severe form of depression that I learned what it was I had. All those years when using the telephone, when answering letters, even those from good friends, was too much effort; all those wasted years when I let friendships die out of sheer inertia caused by a deep sense of my own worthlessness. Need I go on? My condition is my no means as severe as that of my relative, it is controllable with drugs and a regimen of rest, exercise and diet. But don’t tell me that I had a choice. I never did.

@bea2345 . . .Again, I think I made it very clear that there are exceptions to the rule. I never once have applied my opinions specifically to you. If you’ve taken it that way, I apologize.

@Blondesjon – I never took your remarks personally and maybe I expressed myself badly.

People are complicated. The hugely obese women I used to see in the supermarkets in Macomb, Ill. – it was my sister that pointed out that many of them were that way because of poor life chances: ignorance of basic nutrition; insufficient income; poor education; so food choices were limited. Too often I would see these young women, some not yet 30, with four or five small children in tow and the market baskets would be full of breakfast cereals, starches, and sweet drinks. I doubt they chose their life in any real sense.

Your health services provision has to take into account the fact that people are variable. Most will pay their way given the opportunities provided by education, employment and a stable environment. But there are some who are weak, disabled or simply shiftless, who will always be a burden that the rest have to carry. You will not make that go away by visiting penalties on, for example, the obese and the addicted.

@bea2345 Great point. It occurred to me too that very often the most obese and unhealthy are also the poorest – not exclusively certainly, but often. So are you going to penalize them doubly by making their health care unaffordable or are you going to have government programs to try to educate them and enable them to improve their health?

@bea2345 . . .It’s not my health care provision.

I was only trying to illustrate that to insurance companies we nothing more than dollar signs . . .

. . . and that for every 1 @bea2345 there are 100 @Blondesjon ‘s who know that they just need to take care of the stress and self-esteem issues in their life but are just a little too lazy to try it for now. We get what we deserve.

If all the healthy people pay less into the pool, how will there be enough money for the unhealthy people to have insurance?

@benjaminlevi – not everybody gets sick; and not everybody who gets sick sees a doctor. Insurance works on the assumption that only some customers will make a claim. (That must be why it is so hard to get flood and earthquake insurance). BTW, healthy people will not pay all that less (and the unhealthy will not be paying anything close to an economic premium).

@bea2345 More like the unhealthy will either not be able to get insurance at all due to their preexisting conditions.

What I notice, admittedly from the sidelines, is the American practice of putting individual wants ahead of community need. As long as the economy was growing – and it grew steadily in the years after the second world war – what John Kenneth Galbraith called “public squalor” did not really matter. The streets of New York was the place, in the 1960s, to see fit, healthy people with clear skins and good dentition. I was able to visit the great museums only for the cost of the subway fare. My first experience of Fifth Avenue is a treasured memory. The place was booming.

During my last visit to the US, in the late 1990s, it was obvious that something was not working. I saw more poverty, more ill-health, more people with uncared for teeth – than at any time up to 1979. Now that more and more people are having difficulty with housing, food and transport, let alone health services: something’s gotta give. Forget insurance. It has had its day. What you need is a contributory scheme, whether private or state-run, somewhat like like a mutual fund or a credit union.

I would think really fat smokers and drinkers who drive without seatbelts should get a discount on health insurance. They certainly won’t require medical care through their golden years.

In other words, I think it’s a wash. Fit people live a lot longer, therefore, require medical care for a lot longer. They have many years in which to develop expensive medical conditions that a healthy lifestyle cannot prevent. Unhealthy people die sooner.

My grandmother recently died after many years of living in nursing/elder care homes. She wasn’t fat, didn’t smoke, and lived a very healthy lifestyle. She lived to be almost 90. In the last ten or fifteen years of her life, she was taking dozens of prescriptions to manage her various age-related illnesses. Her medical bills had to have been extraordinary.

My grandfather, on the other hand, drank, smoked and didn’t eat terribly well. He died of a heart attack more than thirty years ago. Who was more of a drain on the healthcare system?

Her medical bills had to have been extraordinary. That’s the problem. Why should her bills be “extraordinary”? These are expenses that can be provided, and controlled, by programmes designed to spread the burden of costs. Like the proposed public option (why is it called that?). If there is one thing that is absolutely guaranteed to bring down the costs of medical care, it is competition. What you have now, as far as health care is concerned, is not that.

Programmes designed to spread the burden of costs. That’s the problem. Why should anyone but her share the burden of the costs of her health care?

@Poser Because nobody knows when they will be hit by a truck or diagnosed with brain cancer.

Quite so. Life offers few guarantees and they don’t include a life free of care, illness and want. We all share in the good things when the economy is booming – I am sure anybody can make a list – and we help each other in bad times.

@Poser – for the same reason that they would share in the burden of paying police to catch a guy breaking into your house, or firefighters helping to put out your kitchen fire, or helping to educate you when you were a kid, or establishing a library where you can check out books, or putting down roads so you can get to work, or… you get the picture.