Friday, August 21, 2009

The Health Care Plan and Obesity

Listening to an NPR discussion of the health care plan the other day, I heard a libertarian caller come out strongly against the plan. One of his arguments was that it was unfair that he, who takes care of himself, should end up paying for the high health care costs of the obese, who don't take care of themselves for the most part. After thinking about this for awhile, I find it hard to disagree with his contention.

Insurance, which is what the health care plan is, has always taken risk into account. High risk means high insurance cost. If you were the insurer, you wouldn't argue with this. As an insured, you know that if you have tickets or collisions, your auto insurance goes up. If you live where hurricanes are prevalent, your homeowners goes up. If you own a pit bull or a chow, maybe you don't qualify for liablility insurance. If you smoke, your life insurance premium is higher. But nobody's talking about obesity and the cost of health care insurance. Why not?

As I've ranted about in other posts, obesity is a major cause of many chronic diseases that are expensive to treat. And, contrary to what some would say, most obesity is voluntary...put in more calories than you burn off, you get fat. In most cases, obesity is as voluntary as speeding, living in a hurricane zone, owning a pit bull, or smoking. In short, obese people are very high risk for requiring extensive long term health care. Why should the general population pay for the excessive costs of their inappropriate voluntary behavior?

An often-mentioned component of the health care plan would provide coverage for the "uninsurable" or those with "preexisting conditions". Based on my ambulance experience, I'd be willing to bet that a high percentage of people who fit this criteria are obese. Giving these folks insurance at normal rates represents a reward for unhealthy behavior and a financial penalty for those who try to take care of themselves.

I'd be the first to admit that diseases are caused by a multitude of factors, including the genetics that make one tend to be obese. But, even a genetic tendency toward obesity does not cause it; the calories still need to be eaten. It's known that 32% of adult Americans are obese, the highest rate of any developed country, by far. This is a major problem, and not just a financial problem.

If we are to have government get involved in paying for health care, then government needs to manage the spending. Putting a mandatory high premium on the cost of health care for obese citizens is not only the fair thing to do but also the most positive. Insurance is insurance.

"Pre-existing conditions" can be voluntary or involuntary. I'm not asking for high rates on those who have involuntary pre-existing conditions. But obese folks should pay more, and not a little more. Tough love.


Dave said...

I'm quickly thinking you are mixing and matching separate things.

Insurance presupposes a large pool of insureds whether the insurer is the government, private companies or a mix.

When you start excluding insureds, someone picks up the slack - right now that is us by way of government programs that pay for the uninsured.

Smoking, obesity, drugs, lack of exercise - the things that lead to the need for "excess" health care aren't an insurance problem, they are life choice problems. Exclude treatment for them from whatever insurance program you advocate, they exist; and, unless you go totally libertarian, nothing but private self paid care, you are still going to pay for them via government support.

1138 said...

"obesity is as voluntary as speeding, living in a hurricane zone, owning a pit bull, or smoking. "

Some - not all

Your statement verges on bigotry
And no, I'm not an obese person

Life Hiker said...

Hey, 1138, do you have a reading problem? In virtually every reference I've made to obesity I've qualified the term. In the instance you quoted, I prefaced it with "In most cases". Would you dispute this?

Of course some obesity is caused by factors not related directly to overeating or underutilizing calories consumed. But, in most cases (prove me wrong, pal), obesity is voluntary.

I'm an ex-smoker, driven out of the habit by a combination of social pressure, the government-mandated high cost of tobacco, and my own health concerns. Where are the corresponding challenges to obesity which just as bad, or worse, than smoking?

Life Hiker said...

Dave, you've got it right. We will pay these costs whether we insure these people or not. Maybe our country will just collapse under its own weight before global warming gets us.

ThomasLB said...

I'd like to see more spending on the preventive side- more programs to help lose weight and stop smoking, more subsidized vaccinations and immunizations.

I think treating mental illness would pay for itself with fewer people ending up in prison.

This has nothing to do with anything, really, but: Tyler, Texas has the fattest cops I've ever seen, I mean seriously obese. You don't have to run from them- a fast walk will leave them panting and heaving in your dust. I don't know what they're doing wrong, but the need to make fitness more of a priority.

1138 said...

"But, in most cases (prove me wrong, pal), obesity is voluntary."

Prove yourself right "Pal".

It's not a choice for the poorly educated and the poor and you can't produce digit one showing your majority.

Mostly what I have trouble with is your stinky self righteous tone.
I've seen the absolute devastation it wreaks on the unfortunate that cannot "just quit eating" and solve their problem.

No one wants to be fat, and most work harder carrying weight than they would without it.

Your exception toss away didn't excuse the rest of your typical "conservative" crap.