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Lightlyseared's avatar

Well they are more likely to use the service so yes. Boy racers with fast cars and a history of causing accidents pay more for car insurance. You pay more for house insurance if you live in a bad neighborhood. I’d be very surprised if smokers aren’t penalised by health insurance companies.

augustlan's avatar

So far, smokers (at least in my area) are not penalized by health insurance companies, but are heavily penalized by life insurers.

Snoopy's avatar

Yes. And so should smokers.

wundayatta's avatar

It’s such a tricky question. In theory, people who use more health services, should take on a fair share of the burden.

Unfortunately, we live in a very perverse world. In this world, charging overweight people more for health insurance would end up costing all of us more.

Here’s why: if the cost of insurance is too high, people are less likely to purchase it. It is typical for the uninsured to wait until they are very very sick to get health care. Treatment is very much more expensive at this point than it would have been earlier. They have no insurance; they can’t pay for their care, but the providers are required by law, to provide the care anyway. Who picks up the tab if they can’t pay out of pocket? You guessed it. The rest of us.

So, it’s a nice idea, but until we have a universal coverage, single-payer system in this country, it will only make healthy people pay more.

I believe I read once that while penalties for unhealthy behavior don’t work; rewards for taking steps towards health do work. It would be better if insurers provided weight-loss programs for free, or near-fee, than to charge overweight folk more in premiums.

See, economic analysis turns up some very strange, unexpected behavior patterns.

augustlan's avatar

Good point, daloon.

Snoopy's avatar

Scots (the turf people) already does this….they provide extensive weight loss, smoking cessation programs. They also have a system to help people get their diabetes under better control, for example.

If people choose not to participate, they simply pay higher premiums.

wildflower's avatar

I actually think the idea discussed in the linked article is good: obese people who aren’t doing anything about it should pay more. And the insurance companies and public healthcare should offer easy access to programs/activities to help obese people lose weight.
However, extending that to everyone who’s overweight might be pushing it…..If you’re going to target everyone who has 1 pound more on their body than some medical theoretical table suggests one should have, they may as well just up the premiums across the board!

Snoopy's avatar

@wildflower. I suspect that it is directed at people who are “morbidly” obese. This is typically defined as 20% > ideal body weight.

wildflower's avatar

I know and I think that’s fine – but the question here was if overweight people (i.e. anyone above their ideal weight – and I suspect one would have to trust some chart for what that ideal weight is) should pay more.

wundayatta's avatar

It will be counterproductive, Wildflower. We want people healthier, not less healthy. Increasing the cost of insurance means more uninsured or underinsured, and that is directly related to poorer health, poorer health outcomes, and greater health care spending. It seems backwards, I know, but that’s human behavior for you.

wildflower's avatar

That makes a lot of sense, daloon!
The idea is still good, that if you’re a high-risk of any kind, you pay more in to the pool because you’re more likely to take out of the pool, but I get what you’re saying that it may cause further imbalances.
Perhaps the alternative is taxing fatty food more and subsidizing health-food, exercise (gym, pool, sports-club memberships) – or is that too socialistic for good ol’ USA?

wundayatta's avatar

@wildflower: I think a “fat” tax on fatty food is a great idea, but it faces huge obstacles. That having been said, a number of cities have actually banned the use of transfats in restaurants in the city. So, we are making progress towards healthier living.

Again, I prefer education to force, because I think force doesn’t really work.

BarbieM's avatar

I think the problem comes in sometimes on who sets the cut off. One of the news programs that had a piece on this topic had members of their staff evaluated using the insurance company’s BMI guide. One man who had a lot of muscle mass but was pretty short actually landed in the obese range since muscle weighs more than fat though he clearly was not obese. It could very easily be abused by insurance companies to make sure lots of people paid more for coverage.

cak's avatar

Here’s my thinking. No. It really won’t work.

I was perfectly healthy, a few years ago. Now, I have cancer. It hasn’t been solved by chemo, then radiation and boom, I’m done. It’s been chemo, hospitalization, radiation, chemo, surgeries, chemo, more surgeries, radiation, hospitalization and 2 bone marrow transplants.

My husband, overweight…much healthier than I am. No high blood pressure, cholesterol is great, physicals every year. His only ongoing issue. He’s allergic to pollen.

Why penalize him?

One of my best friends, 113lbs, appears to be the picture of health. Her doctor just told her that she has really awful cholesterol, high blood pressure. She’s not overweight, but is costing more to cover…what do you want to do about that?

Snoopy's avatar

I think that is a very fair point, cak. I would still say that anyone who is overweight and/or who smokes is still stacking the odds against themselves.

wildflower's avatar

I think the trickiest is establishing who is considered ‘overweight’ and I don’t think everyone who’s overweight is necessarily a higher risk – obese is a different matter though.
I suppose it comes down to: Which of these should pay the higher premium?

susanc's avatar

How about “sports medicine”?
People go out and beat themselves up running etc., break their bones and tear their ligaments and no one complains about THEM getting insurance. They have a choice too, just like the smokers and the eaters. Why should the law-abiding couch potatoes among us pay for these nutcases’ repair work?

Lightlyseared's avatar

the cost of fixing a few broken bones is nothing in comparison to the treatment of someone with possibly multiple chronic conditions complicated by the fact hospitals will need specialist equipment to diagnose and treat them.

wundayatta's avatar

If the game is to carry this idea to its absurd extremes, then let’s do a dna test on everyone, and all those folks with genes that predispose them to any cance, any heart condition, diabetes, any mental health condition, sickle cell anemia, cystic fibrosis, etc, etc, should all pay higher premiums.

In fact, why not just put the sick people on reservations, and not let them have insurance at all? Soon enough they’ll die, and then those bad genes will be eliminated from the gene pool. Never mind that the so-called mutations that sometimes give rise to these illnesses, also confer an advantage under some environmental conditions.

Oh, wait! It already is this way! If you have a pre-existing condition, and you’re buying on the private market, you can’t get affordable insurance. And in any case, most insurance won’t pay for ameliorating the impact of certain forms of CF. And forget mental health. Even really good insurance pays for only about fifteen percent of the actual cost of care. Well, on an outpatient basis. Go to a hospital, which, of course, costs about twenty times more than outpatient care, and the insurers will pay for all of that!

If you’re looking to try to make some kind of logic out of health insurance in this country, you might as well also go looking for a farting unicorn.

The health insurance system is so broken, if it were a patient in a hospital, it would be on life support. Bandages aren’t going to fix this system. Only a radical new treatment will. The problem is, for some reason, the people who are minding the patient got the records mixed up, and they think the patient is in another ward entirely.

Lightlyseared's avatar

Hey I quite agree that medical system in US is screwed. You guys spend twice as much on health care (GDPwise) than most other developed nations and still manage to have some of the biggest health inequalities.

A particular story that makes me sad is kids who are transplanted require life long immunosuppressants. However when they turn 18 and apply for insurance as an adult it is treated as pre existing complaint and not covered.

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