Should we penalize smokers and the obese?

[dblack]

Why are the rw's ignoring the fact that high risk people are already charged more for their insurance?

Because prior to ACA we could refuse to do business with them. The individual mandate robs us of the most fundamental right a consumer has; the right to say no.

 

[The Professor]

Not so fast there, Private Brown.

While no one can deny that those who are obese face health problems not encountered by those of normal weight, that does not mean that their total lifetime health costs are going to be greater. In determining the comparative lifetime costs of the obese and non-obese, one must also take life expectancy into account. Since everyone knows that the obese and heavy smokers will not live as long as others, the lifetime cost of their care may be less, not more. This is especially true considering that the elderly consume more health care resources than younger people. I have read about a number of studies which have shown that those who are heavy smokers and obese use less health care resources because of their shortened life spans. Most of my information has come from books, but I will give you at least one link to consider:

Alcohol, Obesity and Smoking Do Not Cost Health Care Systems Money - Forbes

Personally, this is not a subject I have done a lot of research on and I do not know enough to give an opinion as to whether total health care costs of those with certain at-risk behavior are greater or less than those who do not engage in such behavior. I am merely suggesting that perhaps further inquiry is required. Perhaps some of you have seriously studied the matter and can enlighten the rest of us.

 

[Dragonlady]

If you'd like to look at what Fraser has put forth and argue the contents, by all means do. Just calling them "right wing liars" is not productive nor does it help in getting to the truth.

I have looked at the health care studies done by the Fraser Institute and have found them to be so skewed and biased as to be useless. I have a friend who works in statistical analysis and she says that if you torture the data long enough, it will tell you anything, which makes her skeptical of all studies, but especially those coming from organizations with an agenda which affects their point of view.

I am very aware of the per capita spending on health care in Canada and that a portion of that spending comes from taxes. We consider access to health care a right, not a privilege, but then our health care system is not spending $8000 per capita, and leaving 15% of the nation with no coverage at all.

 

[Skull Pilot]

Why are the rw's ignoring the fact that high risk people are already charged more for their insurance?

Because prior to ACA we could refuse to do business with them. The individual mandate robs us of the most fundamental right a consumer has; the right to say no.

This situation stems from equating health insurance with health care.

 

[editec]

Do penalties for smokers and the obese make sense?

... Annual health care costs are roughly $96 billion for smokers and $147 billion for the obese, the government says. These costs accompany sometimes heroic attempts to prolong lives, including surgery, chemotherapy and other measures.

But despite these rescue attempts, smokers tend to die 10 years earlier on average, and the obese die five to 12 years prematurely, according to various researchers' estimates...

Some have said they don't like the ACA because they can no longer get their health care for free. Should the rest of us have to pay for smoker's and the obese higher health care costs? If not, how do we make them responsible for their own higher health care costs? Or, does their right to smoke and be fat negate our right to not have to pay those extra costs.

And, yes, the extra costs do fall to the entire society to pay.

Instead of worrying about women's health insurance paying for birth control, maybe its time we forced smokers and the obese to pay higher premiums.

Smokers already pay high premiums in the form of taxes on cigarettes.

Sadly the money they pay isn't EARMARKED (as it ought to be) to help offset their medical expenses.

 

[BillyV]

If you'd like to look at what Fraser has put forth and argue the contents, by all means do. Just calling them "right wing liars" is not productive nor does it help in getting to the truth.

I have looked at the health care studies done by the Fraser Institute and have found them to be so skewed and biased as to be useless. I have a friend who works in statistical analysis and she says that if you torture the data long enough, it will tell you anything, which makes her skeptical of all studies, but especially those coming from organizations with an agenda which affects their point of view.

I am very aware of the per capita spending on health care in Canada and that a portion of that spending comes from taxes. We consider access to health care a right, not a privilege, but then our health care system is not spending $8000 per capita, and leaving 15% of the nation with no coverage at all.

But we're not discussing the relative merits of US vs Canadian health care; you said "The whole point of health insurance is that everyone, regardless of their health, gets put in the same pool, and everyone pays the same premium for health insurance." That isn't what happens in a socialized system; people are charged much different premiums based upon their ability to pay. And while you argue that the Fraser Institute study is biased, you have offered no evidence that their conclusions regarding the funding mechanism supporting the health system are incorrect; expressing the "skepticism" of your friend (who strangely enough "tortures" data for a living) is not a refutation.

As far as your jab at the US system, let's just say that both the US and Canadian models have their advantages and disadvantages that may not be apparent simply based upon spending; those in the US with access are generally happy with the fact that the system is profligate with resources and therefore is extremely responsive when needed, and apparently feel that makes the cost worth it.

 

[Dragonlady]

But we're not discussing the relative merits of US vs Canadian health care; you said "The whole point of health insurance is that everyone, regardless of their health, gets put in the same pool, and everyone pays the same premium for health insurance." That isn't what happens in a socialized system; people are charged much different premiums based upon their ability to pay. And while you argue that the Fraser Institute study is biased, you have offered no evidence that their conclusions regarding the funding mechanism supporting the health system are incorrect; expressing the "skepticism" of your friend (who strangely enough "tortures" data for a living) is not a refutation.

As far as your jab at the US system, let's just say that both the US and Canadian models have their advantages and disadvantages that may not be apparent simply based upon spending; those in the US with access are generally happy with the fact that the system is profligate with resources and therefore is extremely responsive when needed, and apparently feel that makes the cost worth it.

I pointed out that the Fraser Institute's assertion that a family making $55K a year is paying over $5K per year for insurance out of their own pockets and this is patently incorrect, and I used my family, with income closer to $100K as an example of what a middle income family pays to show how far out of line those figures are. Even if you add in another $1000 in Employer Health Tax, it still doesn't come close to the figure quoted. And I pointed out that in our situation, we pay more of the cost of supplemental insurance than most people in our situation do.

If our family pay half of what the Fraser tells you the average family making $55K per year would pay, how far out of line are their other figures, and where the hell did the $5,500 come from? I checked out what we would pay for supplemental health coverage if we didn't have a group plan and it would only be $2700 per year for Cadillac coverage. Add in $300 per person for OHIP, plus 1% employer health tax and it still comes out to $4,300 for a family making $100K per year. This premium figure is based on two adults, both over the age of 55 and my husband smokes, so our premiums are high. If that figure is so far wrong, it calls into question whether anything else they published in this study with respect to $$$.

One only has to click on the link for the Fraser Institute to see what their stated agenda is: "A free and prosperous world through choice, markets and responsibility". They oppose public education and publically funded health care and provide studies which help prove their basic premise which is that all government funded programs are bad. It is in their mission statement to promote the private options.

 

[BillyV]

But we're not discussing the relative merits of US vs Canadian health care; you said "The whole point of health insurance is that everyone, regardless of their health, gets put in the same pool, and everyone pays the same premium for health insurance." That isn't what happens in a socialized system; people are charged much different premiums based upon their ability to pay. And while you argue that the Fraser Institute study is biased, you have offered no evidence that their conclusions regarding the funding mechanism supporting the health system are incorrect; expressing the "skepticism" of your friend (who strangely enough "tortures" data for a living) is not a refutation.

As far as your jab at the US system, let's just say that both the US and Canadian models have their advantages and disadvantages that may not be apparent simply based upon spending; those in the US with access are generally happy with the fact that the system is profligate with resources and therefore is extremely responsive when needed, and apparently feel that makes the cost worth it.

I pointed out that the Fraser Institute's assertion that a family making $55K a year is paying over $5K per year for insurance out of their own pockets and this is patently incorrect, and I used my family, with income closer to $100K as an example of what a middle income family pays to show how far out of line those figures are. Even if you add in another $1000 in Employer Health Tax, it still doesn't come close to the figure quoted. And I pointed out that in our situation, we pay more of the cost of supplemental insurance than most people in our situation do.

If our family pay half of what the Fraser tells you the average family making $55K per year would pay, how far out of line are their other figures, and where the hell did the $5,500 come from? I checked out what we would pay for supplemental health coverage if we didn't have a group plan and it would only be $2700 per year for Cadillac coverage. Add in $300 per person for OHIP, plus 1% employer health tax and it still comes out to $4,300 for a family making $100K per year. This premium figure is based on two adults, both over the age of 55 and my husband smokes, so our premiums are high. If that figure is so far wrong, it calls into question whether anything else they published in this study with respect to $$$.

One only has to click on the link for the Fraser Institute to see what their stated agenda is: "A free and prosperous world through choice, markets and responsibility". They oppose public education and publically funded health care and provide studies which help prove their basic premise which is that all government funded programs are bad. It is in their mission statement to promote the private options.

So no portion of your income taxes in Canada goes to pay for the health care system? You don't consider income and other taxes as an "out of pocket" cost?

The point of the study may be as you say, to argue against publically funded health care, but that isn't proof that their math is incorrect. They indicate that the point of the study is that "some Canadians might assume that health care premiums cover the cost of health care in those provinces that assess them. However, the reality is that these premiums cover just a fraction of the cost of health care and are paid into general revenues from which health care is funded."

The $5,500 is simply the difference between the total per capita cost of government provided care in Canada for 2 less the amount you said you paid for insurance ($4,000 x 2 - $2,500 = $5,500). These costs have to be funded from somewhere; if you aren't paying them, then they are subsidized by someone else.

 

[Dragonlady]

The point of the study may be as you say, to argue against publically funded health care, but that isn't proof that their math is incorrect. They indicate that the point of the study is that "some Canadians might assume that health care premiums cover the cost of health care in those provinces that assess them. However, the reality is that these premiums cover just a fraction of the cost of health care and are paid into general revenues from which health care is funded."

The $5,500 is simply the difference between the total per capita cost of government provided care in Canada for 2 less the amount you said you paid for insurance ($4,000 x 2 - $2,500 = $5,500). These costs have to be funded from somewhere; if you aren't paying them, then they are subsidized by someone else.

The study says that:

The 10 percent of Canadian families who earn an average income of $55,271 will pay an average of $5,285 for public health care insurance, and the families among the top 10 percent of income earners in Canada will pay $32,628.

Please note in the parts that I have bolded that it says Canadians will pay for "public health care insurance", not health care, but health care insurance, and that figure is a lie, because Canadians as individuals pay very little of their health care insurance costs as a direct expense. So therefore these statements are flat out lies because health care insurance costs nowhere near what the Fraser Institute is claiming in this piece.

Even if you consider that wages may be reduced for those making over $400K per year because of the cost of Employer's Health Tax, a person in the top 10% income bracket would have to have earning of $1.7million per year for his/her employer to pay $32K per year in direct costs for health insurance. In my experience, anyone with this level of income would have it structured so as to reduce such taxes, with a substantial percentage of this income coming in the form of performance bonuses, car allowances, club memberships, stock options, and other forms of indirect income which would not be subject to the Employer's Health Tax.

It is you who is projecting the total costs of health care into this piece. The Fraser Institute is only talking about the costs for "health care insurance" and their figures are false. Period. End of Story.

 

[BillyV]

The point of the study may be as you say, to argue against publically funded health care, but that isn't proof that their math is incorrect. They indicate that the point of the study is that "some Canadians might assume that health care premiums cover the cost of health care in those provinces that assess them. However, the reality is that these premiums cover just a fraction of the cost of health care and are paid into general revenues from which health care is funded."

The $5,500 is simply the difference between the total per capita cost of government provided care in Canada for 2 less the amount you said you paid for insurance ($4,000 x 2 - $2,500 = $5,500). These costs have to be funded from somewhere; if you aren't paying them, then they are subsidized by someone else.

The study says that:

The 10 percent of Canadian families who earn an average income of $55,271 will pay an average of $5,285 for public health care insurance, and the families among the top 10 percent of income earners in Canada will pay $32,628.

Please note in the parts that I have bolded that it says Canadians will pay for "public health care insurance", not health care, but health care insurance, and that figure is a lie, because Canadians as individuals pay very little of their health care insurance costs as a direct expense. So therefore these statements are flat out lies because health care insurance costs nowhere near what the Fraser Institute is claiming in this piece.

Even if you consider that wages may be reduced for those making over $400K per year because of the cost of Employer's Health Tax, a person in the top 10% income bracket would have to have earning of $1.7million per year for his/her employer to pay $32K per year in direct costs for health insurance. In my experience, anyone with this level of income would have it structured so as to reduce such taxes, with a substantial percentage of this income coming in the form of performance bonuses, car allowances, club memberships, stock options, and other forms of indirect income which would not be subject to the Employer's Health Tax.

It is you who is projecting the total costs of health care into this piece. The Fraser Institute is only talking about the costs for "health care insurance" and their figures are false. Period. End of Story.

You seem to want to focus more on semantics than reality. OK, let's look at the semantics. Insurance involves a "transfer of risk" from one party to another. Investopedia defines transfer of risk as follows:

The underlying tenet behind insurance transactions. The purpose of this action is to take a specific risk, which is detailed in the insurance contract, and pass it from one party who does not wish to have this risk (the insured) to a party who is willing to take on the risk for a fee, or premium (the insurer).

Read more: Transfer Of Risk Definition | Investopedia

In this scenario, the taxpayer is the party who is being relieved of the risk, and the government is taking on the risk for a fee (tax). As the government is assuming the risk in exchange for taxes, it is essentially the insurer, and you could consider the taxes used to pay for this as "premiums". This is the position the study has taken, I did not interject it except to compare what you are paying to what it costs. You have agreed that the cost of providing the service is more than you or the average Canadian pays for care, therefore the government must be using general tax revenues to make up the difference. Those tax revenues are paid disproportionately by individuals, therefore the percentage of those revenues used to support the shortfall between costs of care and insurance premiums you pay are also disproportionately supported by those individuals who pay the most tax.

I'm not really interested in getting this far into the weeds so that you can make your "point." All I'm saying is that the burden of supporting the Canadian health care system is not shared equally among individuals, and that therefore they are not paying equal "premiums." I understand that those in the lower and middle classes find that beneficial because their costs are subsidized by others; that is a common theme of socialized medicine. Obviously, all advanced economies subsidize medical care for the truly poor, but is it fair to subsidize those who can afford it because some can pay more? I don't know; would it be fair to charge someone in the middle class $20,000 for a BMW when someone in the top 10% paid $60,000?

 

[Spoonman]

let's throw in pot smokers and drug users and drinkers and people who eat unhealthy diets and people with high risk occupations and people who live in high crime areas. that should narrow the list of people we need to ensure down to a few thousand and that is managable

 

[tjvh]

Do penalties for smokers and the obese make sense?

... Annual health care costs are roughly $96 billion for smokers and $147 billion for the obese, the government says. These costs accompany sometimes heroic attempts to prolong lives, including surgery, chemotherapy and other measures.

But despite these rescue attempts, smokers tend to die 10 years earlier on average, and the obese die five to 12 years prematurely, according to various researchers' estimates...

Some have said they don't like the ACA because they can no longer get their health care for free. Should the rest of us have to pay for smoker's and the obese higher health care costs? If not, how do we make them responsible for their own higher health care costs? Or, does their right to smoke and be fat negate our right to not have to pay those extra costs.

And, yes, the extra costs do fall to the entire society to pay.

Instead of worrying about women's health insurance paying for birth control, maybe its time we forced smokers and the obese to pay higher premiums.

The idiot has apparently not noticed the ridiculous Taxes imposed upon cigarettes in the last decade.

 

[boedicca]

We should neither penalize nor subsidize smokers and the obese (or anyone else, for that matter). Let them purchase their health care in a free market.

Period.

End of story.

 

[Spoonman]

Do penalties for smokers and the obese make sense?

... Annual health care costs are roughly $96 billion for smokers and $147 billion for the obese, the government says. These costs accompany sometimes heroic attempts to prolong lives, including surgery, chemotherapy and other measures.

But despite these rescue attempts, smokers tend to die 10 years earlier on average, and the obese die five to 12 years prematurely, according to various researchers' estimates...

Some have said they don't like the ACA because they can no longer get their health care for free. Should the rest of us have to pay for smoker's and the obese higher health care costs? If not, how do we make them responsible for their own higher health care costs? Or, does their right to smoke and be fat negate our right to not have to pay those extra costs.

And, yes, the extra costs do fall to the entire society to pay.

Instead of worrying about women's health insurance paying for birth control, maybe its time we forced smokers and the obese to pay higher premiums.

The idiot has apparently not noticed the ridiculous Taxes imposed upon cigarettes in the last decade.

you think taking it from 50 cents a pack to $10 a pack is ridiculous?

 

[thanatos144]

You know what I find humorous???? id the fucking progressives expect us to ignore the fact that a good portion of the taxes in cigarettes are going for this stupid healthcare debacle....So in essence you hypocritical asshats smokers are already paying more then you stupid fucks.

 

[dblack]

You know what I find humorous???? id the fucking progressives expect us to ignore the fact that a good portion of the taxes in cigarettes are going for this stupid healthcare debacle....So in essence you hypocritical asshats smokers are already paying more then you stupid fucks.

I wish I could find the humor in it. I do see irony, painful irony, in the fact that so many of those defending PPACA still think of themselves as standing in opposition to corporate dominance - while they defend a law that serves us up to the insurance industry on a platter as mandatory customers.:

 

[Dragonlady]

Well, I'm not an expert on Canadian health care nor on the political leanings of the Fraser Institute; however, the Canadian government reports spending $140 billion on its health care system, and the population is about 34.5 million, a per capita cost of just over $4,000. So if you are paying $2,500 for you and your husband, it would seem that your health care is being subsidized by at least $5,500 per year, or you are paying it through other not so obvious means (like taxes).

The point the Fraser study was making was that, since the system is largely funded by income taxes, higher income groups pay a greater amount in funding the health system (much as under the US Medicare system). The difference in the US is that a private insurance policy premium is based only on risk and return, not ability to pay, therefore the premium for a middle income person is the same as that for a poor or rich person with the same risk profile. [/QUOTE]

The Fraser Institute Study said very clearly that a family earning $55K per year pays $5500 for Canadian "health care insurance", not health care, but health care insurance and that amount cannot possibly be correct, based on payments that our family makes, and the amount of taxes charged by the Ontario Government which constitute our health care insurance premiums, together with payments for supplemental coverages.

I even ran the numbers for my daughter's family - 2 adults, 3 children under the age of 13, and their premiums for a family of 5 are only $3600 per year, and that's paying for their own private supplemental insurance.

As for the Employer Health Tax, I would argue that any payment made by your employer on your behalf is money that would have been available to you in salary had the government not mandated that payment (or said another way, that your salary is determined (reduced) partly based on the additional amounts that will have to be paid under the terms of your employment, including tax payments made on your behals.f).

If you'd like to look at what Fraser has put forth and argue the contents, by all means do. Just calling them "right wing liars" is not productive nor does it help in getting to the truth.

While it would be reasonable to assume that yes, funds which go to Employer Health Tax might be available as additional salary, it should be remembered that Employer Health Tax is less than 1% of payroll up to $400K. If you make $100K per year, EHT is on $980.00 which really doesn't make a whole lot of difference to an individual's salary at that level. Whereas having access to health care with no co-pays is worth significantly more than $1000 per year in most cases, and especially in the case of those who have underage dependents or pre-existing condition.

As for those making over $400K per year, usually the contract stipulates that a portion of the those earnings are in salary, another portion in performance bonuses, club memberships, automobiles, etc., and only those payments made as payroll would be subject to EHT. So even the guy/gal making $1.7 million would only pay the same $2500 out of pocket that we pay, or may less. His employer's EHT on a payroll of $1.7 million would be $34,000, but the Fraser said "Canadian families" were paying this amount for "health care insurance" and that is patently false.

Even if you argue that at $4000 per capita, the figures don't add up, well those monies don't just come from income tax, they come from corporate taxes, import and export duties, provincial sales taxes, and all of the other ways the government has of making money. Because our country believes that that the health of our people, all of our people, is important, not just individually, but as a nation.

A strong, healthy, well-educated work force with a strong work ethic is critical to the success of any nation. Health care is our right. People should not be bankrupted because of an illness. Your focus when seriously ill should be on getting better, not on how are we going to pay for all this, or fighting with your insurance company over what they will or will not pay.

The Fraser hates it that Canadians never see the bills for their health care. It bothers them no end. But do not be mistaken, that doesn't mean we don't know how much it costs or that we think it's free. We know what it costs and where the money comes from.

 

[BillyV]

Well, I'm not an expert on Canadian health care nor on the political leanings of the Fraser Institute; however, the Canadian government reports spending $140 billion on its health care system, and the population is about 34.5 million, a per capita cost of just over $4,000. So if you are paying $2,500 for you and your husband, it would seem that your health care is being subsidized by at least $5,500 per year, or you are paying it through other not so obvious means (like taxes).

The point the Fraser study was making was that, since the system is largely funded by income taxes, higher income groups pay a greater amount in funding the health system (much as under the US Medicare system). The difference in the US is that a private insurance policy premium is based only on risk and return, not ability to pay, therefore the premium for a middle income person is the same as that for a poor or rich person with the same risk profile.

The Fraser Institute Study said very clearly that a family earning $55K per year pays $5500 for Canadian "health care insurance", not health care, but health care insurance and that amount cannot possibly be correct, based on payments that our family makes, and the amount of taxes charged by the Ontario Government which constitute our health care insurance premiums, together with payments for supplemental coverages.

I even ran the numbers for my daughter's family - 2 adults, 3 children under the age of 13, and their premiums for a family of 5 are only $3600 per year, and that's paying for their own private supplemental insurance.

As for the Employer Health Tax, I would argue that any payment made by your employer on your behalf is money that would have been available to you in salary had the government not mandated that payment (or said another way, that your salary is determined (reduced) partly based on the additional amounts that will have to be paid under the terms of your employment, including tax payments made on your behals.f).

If you'd like to look at what Fraser has put forth and argue the contents, by all means do. Just calling them "right wing liars" is not productive nor does it help in getting to the truth.

While it would be reasonable to assume that yes, funds which go to Employer Health Tax might be available as additional salary, it should be remembered that Employer Health Tax is less than 1% of payroll up to $400K. If you make $100K per year, EHT is on $980.00 which really doesn't make a whole lot of difference to an individual's salary at that level. Whereas having access to health care with no co-pays is worth significantly more than $1000 per year in most cases, and especially in the case of those who have underage dependents or pre-existing condition.

As for those making over $400K per year, usually the contract stipulates that a portion of the those earnings are in salary, another portion in performance bonuses, club memberships, automobiles, etc., and only those payments made as payroll would be subject to EHT. So even the guy/gal making $1.7 million would only pay the same $2500 out of pocket that we pay, or may less. His employer's EHT on a payroll of $1.7 million would be $34,000, but the Fraser said "Canadian families" were paying this amount for "health care insurance" and that is patently false.

Even if you argue that at $4000 per capita, the figures don't add up, well those monies don't just come from income tax, they come from corporate taxes, import and export duties, provincial sales taxes, and all of the other ways the government has of making money. Because our country believes that that the health of our people, all of our people, is important, not just individually, but as a nation.

A strong, healthy, well-educated work force with a strong work ethic is critical to the success of any nation. Health care is our right. People should not be bankrupted because of an illness. Your focus when seriously ill should be on getting better, not on how are we going to pay for all this, or fighting with your insurance company over what they will or will not pay.

The Fraser hates it that Canadians never see the bills for their health care. It bothers them no end. But do not be mistaken, that doesn't mean we don't know how much it costs or that we think it's free. We know what it costs and where the money comes from.

OK, good, so you agree that coverage in Canada is not based upon "everyone paying the same premium for health insurance"; that's all I have said. No need to defend the system on moral grounds or bash the "right wing liars"; those are separate discussions.

 

[Dragonlady]

OK, good, so you agree that coverage in Canada is not based upon "everyone paying the same premium for health insurance"; that's all I have said. No need to defend the system on moral grounds or bash the "right wing liars"; those are separate discussions.

Everyone in Ontario pays the same premium for government health insurance. $25.00 per month as a payroll deductition. That is what families pay for government funded health insurance.

 

[BillyV]

OK, good, so you agree that coverage in Canada is not based upon "everyone paying the same premium for health insurance"; that's all I have said. No need to defend the system on moral grounds or bash the "right wing liars"; those are separate discussions.

Everyone in Ontario pays the same premium for government health insurance. $25.00 per month as a payroll deductition. That is what families pay for government funded health insurance.

OK, I give up. I can't continue to debate the same irrelevant answers over and over. I'm glad you're happy with your system and can remain blissfully ignorant of the source of funding.