WebMD Community Talk Show

This is a tough one. No, I don't think that they should pay more. For one I don't think that it is the obese people who are the ones that are costing the insurance companies the most. Sure there can be a lot of problems with obesity, but you can be overweight and still be healthy. I for one am obese and have no problems (I am here to lose weight so that continues to be the case). Thin people can still develop diabetes, heart disease, HTN, cancer and all the other disease associated with obesity, who is to say that many of those obese people with those problems wouldn't still have them if they were thin. I've read an article saying that healthy people actually cost the government more when it comes to health care because they live longer than unhealthy people.
http://www.npr.org/templates/story/story.php?storyId=18711498

One of the issues is how people are currently categorized as obese, or specifically the BMI index. I exercise 3-5 times per week, eat healthy, do not have high cholesterol or blood pressure. My BMI indicates that I am obese. I attribute gaining weight to taking meds (for pain) that commonly cause weight gain. That's a lot of factors not taken into account by "number crunching" done by huge corporations.

Not all people with a BMI that labels them as obese, are obese by choice, such as over-eating and under-exercising. Many have true endocine issues, problems with mobility, or are taking medications such as steroids that cause excess weight gain. To lump all obese people into one category and charge them more for insurance would be like charging men more than women, or straight people more than gays.

Yes, obesity is a healthy risk, but unless there are mechanisms in place to help those with weight issues (many insurances will not even pay for a nutritionist, etc.), then it is going to be a nightmare in sorting out those with metabolic obesity versus behavioral -- those who eat donuts all day.

If you want to start with risky behavior, start with SMOKING or tobacco use. You can charge them more, since there are not medical reasons (other than tobacco addiction - a "soft" diagnosis, for sure), to smoke.

What about the people who don't use seatbelts? Should they pay more? Or, those engaged in other risky behaviors?

Don't punish the obese.....find a strategy to help them. Everyone is different and treatments must be individualized.

I agree with you.

Very true!

It is my opinion that it would be very UNFAIR to charge people with weight problems more for insurance. I have a weight problem, and am considered obese. I do not want to be this way, and I know there are many factors in the way I got here. For one, I have been on a number of different medications for depression for years now. I never had a weight problem when I was growing up. I feel that the drugs I've had to take play a huge part in my weight gain. Not to mention when I was taking birth controls pills, too. Why punish people with weight problems when they are already dealing with more than enough problems in their everyday life.
Where will it all stop? Are we going to charge gay people more than straight people, based on the issue of AIDS? What about smokers? What about those who drink alcohol? What about those who drive very fast cars? These could go on and on. Seems it would be more beneficial to come up with something more positive and try to help those with weight problems instead.

To charge obese people more for health insurance, in my opinion, makes the "obesity epidemic" even worse. Making health insurance less affordable doesn't provide a (terrible metaphor ahead) carrot-stick approach to encourage weight loss; it simply creates more problems.

First, let's go with the "general population." If you can't afford health insurance - and many people can't, even if they're working - you don't get preventive health care. You don't get seen by a doctor regularly. You don't have that professional input into a healthy, safe, works-for-you plan to reach a healthy weight. If you develop high blood pressure or diabetes and you're not seeing a doctor regularly, your health conditions aren't properly controlled - if they're even diagnosed in the first place. If you feel ill enough to see a doctor, you're not going to a primary care doctor, you're probably going to urgent care or the emergency room or a free/low cost clinic that's likely inundated with too many patients to effectively handle in this economic climate. And chances are, you'll try to muddle through feeling ill until you really NEED the hospital... all because it was too expensive to get or stay healthy.

Second, I have a sort of special interest in the "dual diagnosed" group because I fall into it. As a person who is obese and has co-occurring severe mental health issues, I see the potential for a devastating emotional impact on people like me. Hearing that you must pay more for quality health care because of your size, to me, would come across as hearing that the people whose LIFE'S WORK it is to care for others... no longer care for you. You're too big and fat, you're hopeless, you're less of a person and we're giving up on you. And if I hear that message... I'm going to give up on myself. I'm not going to try to be healthy anymore, or I'm going to resort to unhealthy and unsafe diet practices (or eating disorder behaviors) to try to get THIN rather than healthy.

Funny enough on the Dr Oz show this afternoon they were talking about people who were skinny on the outside, fat on the inside. These are people who have a healthy BMI, but an unhealthy percentage of body fat. (One lady had a BMI of 23, but was 33% body fat!) Also, those who are body builders weigh more, but are considered healthy. So, how would one determine who should pay more? Is it by BMI or by fat %? I would think that it would be so difficult to come up with a flat standard for everyone.

Another issue is, what if an overweight person has a bariatric procedure? Would they get a cost reduction?

I do think that insurances have to start with something that is a personal choice, like smoking or drinking excessive amounts of alcohol. Yes you could make the argument that it's an addiction, but the person had to have made the choice to start, it's not something that just happens.

People who statistically incur more medical expenses specifically because of lifestyle choices should contribute more.

I am 6'0" tall and weigh 230 pounds. That may make me one of the "obese".

Some readers may not understand what health insurance is.
When a group of people contribute (premiums) to a pool of funds with the intent of using it to pay the medical bills of members as needed, that is insurance. However, in most cases employers are contributing more than their employees. That is intended to attract prospective employees and after hired to ensure they will contribute productivity to their full capacity.

The thing is, insurance companies dictate treatments that will be covered and are for-profit in most cases. Oh, and they take about THIRTY PERCENT off the top of premiums received for their service. Apparently, that is not enough because medical costs and insurance premiums have continued to increase while we are in a recession.
Part of that thirty percent is used to pay lobbyists who try to convince congressmen to vote for bills favorable to their industry.

In my opinion, the United States would be far better off if everyone was required to have some percentage (10%?) of their pay withheld and put into a bank account to be used only for medical expenses. If there is a balance left when someone passes on, the will would determine how it was disbursed - likely to health accounts of descendants.
Banks already manage IRA accounts, so it would not be a radical change.

And people would pay for medical service. Medical care would return to pricing based on supply and demand. Thousands of clerical staff presently doing medical coding in support of the insurance industry would no longer be required.

With that system no one would have to be concerned whether people smoke, drink, or eat more than their bodies require.

While I didn't state specifically, it was implied the mandatory deduction and health care account would REPLACE health insurance. And employers should pay employees MORE because they would no longer be subsidizing for-profit insurance companies.

I don't think anyone should have to pay for health care to begin with, so no I don't think premiums should go up for the obese/overweight. I think we should convert our health care system to be free public health care like they have in Canada & like Hillary Clinton wanted(or at least she wanted something similar). For example, my husband makes too much for us to qualify for medicaid through welfare but he doesn't make enough for us to be able to afford private insurance & he is an OTR trucker (over the road trucker) & can't get insurance through his company & with Obama's new policy I can't have my daughters on there own policy because he got a bill to pass stating that a parent must be on their child's policy now. It didn't use to be that way & I was able at one point to get a private policy just for my daughter, but now she is S.O.L too because of this. So tell me how fair that is or how that helped my kids? (I know it's a bit off topic, but goes towards my over all point). I'm all for community healthy care & don't think anyone should have to pay more for reason such as weight. Obesity is already a huge issue in America so make it worse by making it unaffordable to the overweight? Where does that make sense?

Anyone interested in moving more toward the direction of capitalism/free market/libertarian approaches and away from socialist/government run approaches?

I believe strong arguments can be made for each side.

I'm seriously concerned about the way our current system allows doctors and patients to basically ignore the costs of medical tests and treatments, since the insurance company is paying. In the long run we all pay more due to escalating premiums.

What about an approach that simply requires everybody to pay a certain percentage of all medical expenses? At least there is a clear link between what the patient pays and the actual cost.

Obviously this is an oversimplification and I did not suddenly solve the health care crisis, but the basic principle still stands: greater reliance on Free Market Forces has an important role to play and it is not obvious to me that we should abandon such approaches. There are obvious drawbacks and weaknesses of all potential approaches including this one, so let's hear more views from others on such matters.

In other words, I'm not saying you should "pay more if you weigh more" I'm saying you should "pay more if you spend more".

This is a fairly easy one. Since there is no negative health outcome that correlates directly to being "overweight" per BMI, then obviously there is no reason to charge "overweight" people higher premiums.

To unpack that a bit: having a heathy diet and lifestyle correlates to better health outcomes. But eating healthier and exercising won;t make everyone thin. A "fat" person who eats right and exercises is almost surely a lower health risk than a skinny person who doesn't.