No Pre-existing Conditions in Health-Care Reform - Except Obesity!
By Susie Madrak Friday Oct 16, 2009 1:00pm
One of the bloggers on a conference call with Sen. Arlen Specter this week was pressing him on increasing health insurance premiums for overweight Americans. Specter gently corrected her. He said his son, a resident psychiatrist, has explained to him weight is a matter of many complex factors and it wouldn't be fair to financially penalize an entire group based on things they couldn't control.
I was appalled at the question. I've put on 50 pounds in two years of inactivity as a result of my (until recently undiagnosed) ankle injury and the last thing I need is someone charging me more money for it.
As policy, this is an especially uninformed and insensitive position because every study shows that rural and inner-city residents (who have the highest obesity rates) actually have little access to affordable, healthy food. (And that's not even touching the research showing that the chemicals in foods have all kinds of harmful effects on your body that encourage weight retention.)
So if people could educate themselves about these issues, we won't have to waste time on discussing what amount to punitive measures:
Get in shape or pay a price.
That's a message more Americans could hear if health-care reform provisions passed by the Senate finance and health committees become law. By more than doubling the maximum penalties that companies can apply to employees who flunk medical evaluations, the legislation could put workers under intense financial pressure to lose weight, stop smoking or even lower their cholesterol.
The bipartisan initiative, largely eclipsed in the health-care debate, builds on a trend that is in play among some corporations and that more workers will see in the benefits packages they bring home during this fall's open enrollment. Some employers offer lower premiums to workers who complete personal health assessments; others limit coverage for smokers.
The current legislative effort would take the trend a step further. It is backed by major employer groups, including the U.S. Chamber of Commerce and the National Association of Manufacturers. It is opposed by labor unions and organizations devoted to combating serious illnesses, such as the American Heart Association, the American Cancer Society and the American Diabetes Association.
Critics say employers could use the rewards and penalties to drive some workers out of their health plans.
President Obama and members of Congress have said they are trying to create a system in which no one can be denied coverage or charged higher premiums based on their health status. The insurance lobby has said it shares that goal. However, so-called wellness incentives could introduce a colossal loophole. In effect, they would permit insurers and employers to make coverage less affordable for people exhibiting risk factors for problems such as diabetes, heart disease and stroke.
"Everybody said that we're going to be ending discrimination based on preexisting conditions. But this is, in effect, discrimination again based on preexisting conditions," said Ann Kempski of the Service Employees International Union.
The legislation would make exceptions for people who have medical reasons for not meeting targets.
Supporters say economic incentives can prompt workers to make healthier choices, thereby reducing medical expenses. The aim is to "focus on wellness and prevention rather than just disease and treatment," said John J. Castellani, president of the Business Roundtable.
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My guess is that the insurance assholes want to keep that Pre-existing condition door open.
own a lot of "Weight Watchers" and "Jenny Craig" stock options. Weight loss is a big business.
No, they probably own a lot of corn futures.
but it's for our own good.
It is a form of exclusions for pre-existing conditions. But corporate Amerika is getting in on the act, too.
The corporation into whose service I am held as one of their chattels (a very low single digit number on the forbes 500 list that alleges to "bring good things..") is implementing this exact plan in the upcoming enrollment period, for everyone except hourly employees. But, it's worse than it appears on the surface. First, they are tripling (or more) the costs of insurance, and significantly increasing the deductibles; this amounts to a significant pay cut....this on top of already in effect long term pay freezes. Inherent in this new and improved healthcare plan is the appropriation for themselves of the right to intrude even further than they already do into all employee's personal lives, imposing more control over our already pathologically micromanaged lives. Then, they compound the insult by telling us what a great thing they're doing for us. Yeah, right.
They claim to have no choice but to implement such a plan, which is bullshit, because they are implacably against universal healthcare or the public option....things that could completely remove the burden of providing healthcare access benefits to their employees. They, like most other corporations, are against universal healthcare or public option healthcare, because they prefer control above competitiveness in the global marketplace. If they, as sole bestowers of employee benefits, can maintain their role as the exclusive gatekeepers of meaningful access to healthcare, they can maintain the de facto rationing of medical care that exists in his country. An enviable position for them. With a 50(+) million population of unfortunates who have no access to healthcare, and another 25+) million whose access is only imaginary, corporate-benefits-dispensing Amerika can serve up to its chattels/employees the most effective imaginable fear-inducing example of what can happen to them if they step out of line and lose their jobs. A perfect tool of control. They have chosen control over greater competiveness and greater profits. The lawmakers seem to be of the same mind: a fearful citizenry is a compliant citizenry. A pre-existing conditions clause is just the tool for the job, because it can effectively negate civerage and access.
I think they've chosen both. Many a corporation benefits from our costly inefficient health care system - even those bringing good things.
for people to be obese/over weight, then lets extend it to smoking for lung cancer and drinking and driving. If you get lung cancer and insist on continuing to smoke while waiting for a lung transplant you should be moved to the head of the line before you die. Let others who quit smoking wait a little longer. Don't charge drunk drivers, clear the road for them.
While last two are obviously ridiculous, so is being obese, all three are decisions made by the people consuming the products.
is a matter of choice. Some people are just born with a tendency to gain weight. Sometimes gaining weight (as in Susie's case) is a side effect of a different medical condition.
It's not like smoking. You can quit smoking, but you can't quit eating.
I have more than a couple of extra pounds. I take medication for high blood pressure and high cholesterol. But oddly enough, it's the exact same medication as my aunt takes for the same two problems - and she's dead on target for the goal weight for her height. In fact, my dosage is smaller. Our risk for heart disease basically has little to do with weight, and everything to do with genetics. In fact, when all the lifestyle factors are taken into consideration, my fat little self is actually at LOWER risk.
And I said nothing.
..
Since obesity and smoking, the two things being singled out for increased premiums, as largely afflictions of the poor, what would be the point of actually allowing increased premiums? It would not punish the users (as I assume is the supposed reason for this in the first place) but instead the taxpayer, as those most likely to be singled out are also those most likely to be receiving subsidies to purchase insurance.
where the little money the poor have can procure the highest number of calories.
When you're broke, it's a pretty simple calculus.
The american retail food industry--MickeyD's foremost, of course, but all of them--gets enormously rich providing cheap sources of fat, which is nature's most satisfying food because in nature it is one of the rarest...
'Are there no prisons? [asked Scrooge.]
'Plenty of prisons,' said the gentleman, laying down the pen again.
'And the Union workhouses.' demanded Scrooge. 'Are they still in operation?'
'Both very busy, sir.'
'Oh. I was afraid, from what you said at first, that something had occurred to stop them in their useful course,' said Scrooge. 'I'm very glad to hear it.'
'Under the impression that they scarcely furnish Christian cheer of mind or body to the multitude,' returned the gentleman, 'a few of us are endeavouring to raise a fund to buy the Poor some meat and drink, and means of warmth. We choose this time, because it is a time, of all others, when Want is keenly felt, and Abundance rejoices. What shall I put you down for?'
'Nothing!' Scrooge replied.
'You wish to be anonymous?'
'I wish to be left alone,' said Scrooge. 'Since you ask me what I wish, gentlemen, that is my answer. I don't make merry myself at Christmas and I can't afford to make idle people merry. I help to support the establishments I have mentioned-they cost enough; and those who are badly off must go there.'
'Many can't go there; and many would rather die.'
'If they would rather die,' said Scrooge, 'they had better do it, and decrease the surplus population."
-- Charles Dickens, A Christmas Carol
The U.S. Chamber of Commerce is a right wing corporate propaganda tool. You name any particular thing they lobby for, and that thing is a disaster for America.
If those same organizations would be in favor of ending all agricultural subsidies that favor the cheap production of corn syrup, refined sugar, saturated fats, etc. Or how about fair-trade versus free-trade that allows cheaper and less healthy food to come into the country from half the world away?
Crickets.
n/t
When it comes to decide between fasting or eating cheap crappy food, guess which one most people would take.
but we could sure as hell stop making it easier for people to eat poorly.
Foods, and that there may be other barriers keeping them from accessing better food, that sin tax would hit the ones who could least afford it. It's asking to put all food, crappy or otherwise, out of the reach of the poor. And that's unacceptable.
So much as end corporate subsidies that make it easier to dump crap into our food supply. Access to free health care including preventative medicine and nutritional education could offset the increase in food prices. Not that I'm holding my breath for that, mind you . .
No, good numbers of people cannot afford to go to Whole Foods, but they don't need to go there to eat a healthy diet. You can and should learn how to buy and prepare better meals and that can be done by shopping pretty much anywhere.
That said, we also should not paint with a broad brush that everyone that is "over weight" is hit with higher premiums.
Yes, GENERALLY being fatter is unhealthy, but there are plenty of people who are well within their target weight that are also very unhealthy due to poor choices, poor eating habits, etc..
Also, fuck Whole Foods. They are dickheads. I'd rather spend my money in a union store or in places like Trader Joe's and Costco where my money goes further and the people get better wages.
Are you not aware that there are a LOT of neighborhoods, especially poor, inner city neighborhoods, where grocery stores are almost non-existent? Or at least, grocery stores of the variety that you seem to be thinking of. If the only store available to you is roughly the equivalent of grocery shopping at a 7-11, your options are a tad bit limited.
... but subsidizing virtue.
*
note how they're not suggesting the tobacco companies pony up. is there a way to set the elephant of big tobacco against the hippopotomus of "ahip" and let them fight it out? like some sort of celebrity death match?
If nothing else, the health reform follies have exposed the anger and hatred people feel for fat people and cig smokers. Strange, considering most Americans are fat. Be careful, or the next bad habit to get people dropped from health care coverage may be yours.
... this whole debacle has exposed to utter lack of anything resembling a social conscience in this country.
Whilst 10 points for the the social conscience thing, the fact is that smokers and obese people do have more health issues. It isn't fair to frame them as harmless habits.
Almost everything is potentially bad for your health. Lay off the fatties.
Of dumping 75% of the people off the eligibility list.
Until America gets serious about removing chemicals and chemical companies, like Monsanto and ADM from processing all our food, there will be health problems and obesity.
I don't think this could hold up in a court of law since the food needed to stay trim is no longer supplied in America....
unless you're rich and can import your meals.
Caveat: Young people don't see this until they hit their mid 30's or so.
than the working class or the poor on any given day.
from that pile of fruit so it won't spoil the good food.
Fish is poisonous now. All of it.
It might taint the chemicals sprayed all over those fruits and veggies.
All this health care reform is just about putting more burden on lower income americans. All it is.
Capitalism works fine if you can get the workers to pay for it...
But yeah, that's what's gonna happen...
That many of those people are at town hall meetings screaming until they're red in the face to maintain the status quo instead of doing something that would actually improve their lives.
society in human history where the poor revolt with the sole purpose of fighting for the interests of the rich.
LEAVE RICH PEOPLE ALONE!!!!
;)
is now a pre-existing condition.
Unless it's immaculate of course.
We will be seeing an increase in the number of babies born in mangers, barns, crack houses, etc.
As they keep bringing in the gold, frankincense, but not so much the myrrh.
BTW, HIS name is Brian!!
;)
...
as a physician i have an understanding for how complex this issue can be per person. this is an economic, cultural/social and/or psychological issue(s). this is why i feel there needs to be more preventive health care. it's understood there will a certain demograhic/individuals that are obese for physiological/psychological reasons, but having said that there are many/others in my opinion that need self-education and exercise to maintain optimum body weight/fat. obesity is on the rise and adds additional cost to the system. for many other health care conditions obesity can be a COMPLICATING factor/condition that can prolong/complicate a condition(s) essentially requiring more health care.
By BETSY MCKAY
The medical costs of treating obesity-related diseases may have soared as high as $147 billion in 2008, the Centers for Disease Control and Prevention said Monday, as its new director set a fresh tone in favor of more aggressively attacking obesity.
The cost of treating obesity doubled over a decade, signaling the rising prevalence of excess weight and the toll it is taking on the health-care system. The medical costs of obesity were estimated to be $74 billion in 1998, according to a study by federal government researchers and RTI International, a nonprofit research institute in Research Triangle Park, N.C.
The findings were released at a conference on obesity held by the CDC in Washington, D.C. The prevalence of obesity rose 37% between 1998 and 2006, and medical costs climbed to about 9.1% of all U.S. medical costs, the researchers said.
http://online.wsj.com/article/SB1000142405297...
Obese people spent 42% more than people of normal weight on medical costs in 2006, a difference of $1,429, the study found. Prescription drugs accounted for much of the increase.
one of the things I dearly missed from living in Europe, it is the whole concept of ambulatory clinics freely available to citizens. That removes a lot of pressure from specialists and hospitals (especially ERs) and significantly reduces costs, after all it is cheaper (and easier) to prevent than to cure after the fact.
I am tired of seeing proposals geared to add further penalties on a society already burdened enough, while at the same time making no effort whatsoever to educate and tackle the root of the problem. I think it is another way of blaming the victim, and I am tired of it.
I think it is the prevalent "f*ck you buddy" attitude in this country that allowed our society to devolve down to this point.
although, i respect personal responsibility health care and health care conditions are also a collective issue. i agree that the "me" idealism is out of control. much of that has to do with the type of capitalism we currently have in this country. keeping up with the "jones" and being preoccupied with trumping people has been a social engineering phenomenon perfected by psychological based marketing. i've actually had people tell me it's their business whether they are obese or not. ideally that's true and i respect that but again because health conditions are a collective issue. obesity now effects everyone. the cost is shifted to the PAYing pool/TAX payers. to me this has some similarities regarding second hand smoke. BUT overall i feel we need to get back to the basics of not judging people by what they have and don't have. this may sound alittle syrupy i just believe people would be happier but of course capitalists don't want happiness. they want profit.
although, i respect personal responsibility health care and health care conditions are also a collective issue. i agree that the "me" idealism is out of control. much of that has to do with the type of capitalism we currently have in this country. keeping up with the "jones" and being preoccupied with trumping people has been a social engineering phenomenon perfected by psychological based marketing. i've actually had people tell me it's their business whether they are obese or not. ideally that's true and i respect that but again because health conditions are a collective issue. obesity now effects everyone. the cost is shifted to the PAYing pool/TAX payers. to me this has some similarities regarding second hand smoke. BUT overall i feel we need to get back to the basics of not judging people by what they have and don't have. this may sound alittle syrupy i just believe people would be happier but of course capitalists don't want happiness. they want profit.
I see your point doctor. I as an obese person hate to pay for drunks, druggies, and smokers too. You don't hear me bitching. Obese people already pay more for everything we buy. I am sick and tired of hearing people whine about what they have to pay. Life isn't fair we don't choice what families we are born into. You people who have no idea what a person who has a weight problem goes through. It easy so easy to say go on a diet. I worked very hard. I am married and have a child and I never asked for nothing that I don't pay for on my own. I am not lazy. I have worked 2 jobs and then come home help a child with homework, have to cook dinner while my husband goes to his second job. We work together. Yes we aren't rich and we live in a rural area when my husband retired from the military. I have always had to pay more for things. I am not asking for any hand outs. I expect to be treated equal to everyone else. You want me to pay more because of my weight. Then people who drink, and are drug addicts should to. Then I will think raising my insurance is fair.
I think that the obese are the scapegoats of the day, as someone who takes care of VERY sick people, who cannot move themselves in some cases, I have seen people who were obese and actually quite healthy and people with appropriate BMIs who were trainwrecks. Just because you're overweight it does not automatically make you unhealthy and just because you are thin it does not mean you are healthy.
It's really all relative. I sit on the borderline with my weight (BMI about 29), I'm 50 years old and I'm really quite healthy. I drink wine occasionally, but not regularly. The thought that I might pack on a few more pounds, it raises my BMI and I'm now considered obese and would thus be charged more would be a travesty.
Frankly, I think it's just about deflection from the real issues and distraction from a productive discussion. This doesn't just boil down to whose weight is "appropriate" and whose isn't if you have people that aren't even covered at all.
The anecdotes are fine, I'm sure there are plenty of buff people with health issues, but the fundamentals are that obesity increases the likeliness of health issues.
your links are where? Stress is just as bad on a body as any of the other things mentioned here. What do you do about those people that have a familial predisposition to hypercholesterolemia? I've seen some that are wicked thin, but you draw their blood and you can see it congeal the minute it hits room air. They actually eat well, but their own bodies manufacture excessive cholesterol. They are awesome risks for everything from PVD, to heart attack, to stroke, etc. Penalize them cuz they were unlucky in the gene pool?
way for a variety of reasons, including psychological ones we won't go into, socioeconomic reasons (only now do I have the money to grocery shop where there are better foods), bad habits formed when my father was terminally ill (long story short, we didn't want to torture him with the smell of home-cooked meals...he couldn't eat them), I am on several medications - some of which lead to weight gain, I come from a family of plus-size women, I live in the San Joaquin Valley, so no, I don't think it's fair to penalize people for their weight. I'm working on my own health now...my town has its own government-run fitness center, and that is a huge help, but I would still need insurance!
I can relate to you. I am lucky I have government health insurance I wish you and people like my son could get. I pray every day for people to get insurance they can afford.
issues, but it angers me that other people get denied insurance because of their weight.
And I definitely feel lucky that I've got the Medicare/Medicaid...
How overweight is overweight? At 5'8" and 160 pounds, I could definitely do with taking a few pounds off. I've been as heavy as 185 pounds, which was well within the realm of 'fat', and with strenuous diet and exercise dropped to 145lbs for a while, but slowly gained it back over winter, with less exercise and more fatty seasonal foods.
Years ago, however, I became deathly ill, and lost so much weight I was 109lbs, I looked like an Auschwitz survivor. My 'health' club raved at the super-skinny me, and gave me 'points' off on my membership. I dropped my membership after that - nothing rammed home how 'unhealthy' being super skinny was like being 'rewarded' for almost dying!
So where would you draw the line between 'too' this or the other? Would I trust an insurance company to make that decision?
Absolutely not.
Weight gain and loss has too many factors to be decided as a 'pre-existing condition' and is too obviously open for abuse by companies already having proven themselves ruthless enough to deny a baby coverage for being 'too fat' or allowing children to die by delaying medical treatment.
Smoking on the other hand... No, that shouldn't be the prerogative of insurance companies either. But cigarettes should have a whopping big sales tax slapped on them, and all the profits used to fund anti-smoking treatment (which tobacco companies wouldn't be too out of pocket with, as they also manufacture nicotine patches, nicotine gum, etc.). As someone who watched my beloved father smoke himself to death, I wouldn't want insurance companies (as they did, actually) making medical decisions on what my dad could and couldn't have in the way of treatment. But I would like to see a more aggressive anti-smoking campaign.
Either way, insurance companies have no business, literally, in deciding the fate of people who smoke or have weight problems of any kind. They have become the cancer on the American medical body that is killing us all.
What is fat? What is fit?
What constitutes a "medical reason" for not meeting a target?
Insurance companies are the last people I want answering those questions.
What about people who are fat but fit? Humans come in all shapes and sizes (biodiversity)naturally, so is weight the bottom line? I say no, it isn't.
From the NYT in 2000:
None of us comfortably fit with a 'one size fits all' anything, weight, health care, education, insurance...
...difference between reality and fantasy is greater than the US. We work overtime to "imagine" what a perfect society we are and spend almost no time trying to make it better. That's why there are so many clowns who can utter such nonsense with a straight face: Need "health care?" Just go to your local ER. Anyone who says something that stupid has obviously never stopped to consider what "health is." There is a huge difference between health care and emergency care. EMTALA does not require hospitals to provide health care. Health care is a continuous process that involves regular checkups, lab tests, and non-emergency procedures.
We need to insure everyone and simultaneously begin massive programs to educate Americans to deal responsibly with their own health. We don't need to single out groups and make the targets.
Slavery, pure and simple. Hmm, who else may use insurance more than others? Well, women have babies, so we should definitely charge them more. Gay people don't, but there is that whole HIV thing, so we may not want to hire them or offer them insurance. Can we take a peak at your family history? Dad had a heart attack. Well, we can hire you, but you'll have to pay double. If you don't live like I say you must, NO INSURANCE FOR YOU.
Insurance is supposed to be POOLED RISK, we all share the burden. So, yes, we pay for the fat people and the gay people pay for you to pump out kids and you pay for the cancer victim. That is how it works. We don't each pay for ourselves, that is not insurance.
... universal coverage is more akin to pooled risk.
I think there is a big difference, and we need to act accordingly. It is not a question of if you are going to get sick, but when you are going to get sick. I think we need to stop worrying so much about fictitious economic organizations like capitalism, and spend more time dealing and coping with real human physiology.
I'm hypothyroid - according to my doctor this is epidemic in the US with our water supply being one of the possible factors.
The medications for hypothyroidism do NOT address with the weight gain. Exercise needs to be beyond the normal effort to try to stay normal. Many people can hardly find time to exercise at all - much less beyond what is normal.
Does this necessarily result in obesity? Not normally, but obesity IS often a result of many different concerns. So while I am not obese - I am not so ignorant to thoughtlessly blame those that are.
Good for Arlen Specter.
*
Plus size people have always been a target for most people. They get discriminated against because of their physical appearance. I know big people that are healthier and happier than most skinny or "healthy" people. I swear, everything is a pre-existing condition. No need for reform here, no siree...
was a size 8 or 10... It's disingenous for people to act like that being overweight or obese is the only thing making people ill. If thin people don't eat right or exercise, they can be in *worse* condition than a plus-size person who isn't endeavoring to do those things.
Let's face facts...obesity in the American population is a real factor in increasing health care costs. It leads to multitudes of serious, complex, and expensive medical treatments. Americans are the FATEST people in the world. There is no discrimination in that fact. Not to mention smoking and excessive alcohol consumption. Sure, there are poor people in the country that have a lack of access to healthy food for multiple reasons and also lack information about living a healthy life. The vast minority of those that are obese have legitimate medical reasons for that state of affairs. Take responsibility for yourself and don't expect the system to bail you out of bad, unhealthful choices.
couldn't necesarily control, and you gained a lot of weight, you would be among the first people telling the insurance racket that it's peachy keen to deny you even a chance to buy insurance, right?
Even fat people deserve health care!
personally taken care of people (I'm an ICU nurse) that exercised every day, didn't smoke, didn't drink, ordered in special grains, in other words lead lives that should have rendered them really healthy, and, guess what, they still got sick. Really sick, ICU sick. Please don't be so naive as to assume that just because you do everything you're told should keep you healthy will keep you healthy, or assume that just because someone's overweight they are unhealthy. Get someone with a little binging and purging going and they will be awesomely thin, but look at their electrolytes, look at their dental health, etc. and you'll find a very unhealthy person.
The reality is, that when you are a subscriber to a health insurer's plan you generally get a limited benefit amount, usually $1 million, sometimes more. One good car wreck (which wasn't your fault); need an organ transplanted (again, maybe not your fault, could be genetic); a stroke (hell, even kids have them - not even fat ones) and your money is all gone and you're screwed. It costs $6,000/day to lie in one of our ICU beds, that's no tests, no scans, no bloodwork, no physician charges, etc. This is really not about fat people, no matter how anyone dices it, this is just to divert from the real discussion.
Let me start out by saying that I'm not actually on any insurance company's side. However, good or bad, they are profit making systems. They don't have to insure anyone. They do not have to insure those who are in an increased risk category. To deny that fundamental fact, you may as well say smoking doesn't relate to cancer and the sun doesn't shine on the other side of the world at night.
Some commenters are claiming they don't have access to good food. Thats rubbish. In every Supermarket there is fresh fruit, vegetables, fish, grains, cereals and meat. Sure, there is a lot of crap too but good food is there to be chosen.
Some claim fast food is a good value deal, and that is why poor people eat it. Yes it is high bulk. McDonalds will provide. It doesn't mean you have to do it, nor often.
America leads the way in obesity. When we say obesity, we are not talking a few pounds over, a love handle, a bit of a muffin top, a layer of luxury. We are talking obesity.
Not all obesity is a medical issue you can do nothing about. Get it in perspective. At no point in history has a population been able to get to a point where a significant percentage is obese like the US is now. Why has most of history managed to work it out but not here and now?
In the words of Oscar Wilde 'I can resist everything but temptation'. In today's world where access to sugary, fatty foods at at time really cheaply and more workers are sendentary. That makes things harder. It takes monitoring and effort. That monitoring and effort is the responsibility of individuals, and the absence of it does not shift the responsibility to an insurance company or a government program. Nor does it mean that despite the reality of the level of obesity, it's health impacts on people and the system, the issue can be diluted into nothing more than harmless 'bad habit'.
So, after a number of years having C&L as one of my daily must reads, for one of the first times, I'm disappointed with C&L commenters.
Annaleigh, I'm sorry that you have found yourself in an unfortunate situation. However, you are the "minority" that I referred to. As BC states, obesity is a different issue. That comes from an extended period of mismanagement of eating and exercise.
You need to differentiate between those realities. You even stated, I believe, that your current situation is not the norm for you. Should the insurance industry deny coverage to the unfortunate? No. Should coverage be denied or premiums increased for those that have brought their health problems on themselves by personal choice? Absolutely.
coverage for us fatties, think about what would happen if it were YOU that the insurance company could and would target.
You'd know that many people live in areas without access to healthy, affordable food. Stop telling people what they "should" do until you understand what they're working against.
Oh, and by the way: Skinny people who live longer actually cost insurance companies more money, because end-of-life care is more expensive.
people are insulated they don't realize the ways in which people live, even here in the U.S. I know that in some of the inner city areas of Las Vegas there is no grocery store. How are you supposed to get fresh food when all you have is your corner convenience store and the bus routes are crappy/ineffective and you don't have enough money for a cab? Not everyone, everywhere in the U.S. lives near a grocery store and with limited transportation comes limited access.
in the San Joaquin Valley) required our family to go to the grocery store about once a month. The nearest grocery stores were several miles away.
People need to really think before they assume that because things are so darn easy for them it is for everyone else.
supermarkets in its city limits. That's a few hundred thousand people, mostly poor and African-American, who have to rely on overpriced, over-processed foods from their neighborhood bodegas.
Susie,
The average American has access to better and more food than just about anyone on the planet. I reject that there is no reasonable access to it. If it is so, then that almost single handedly refutes the enterprising nature of the American people - All this market being unattended to. Not likely in anything by deepest rural areas, which means few are affected by it.
The argument presented that skinny people are in fact worse for insurance companies raises some unattractive things. I'm not fussed about the wellbeing of an insurance company. It is would be irresponsible to justify obesity by the second arguement. Perhaps we should encourage smokers to light up, as they'll die earlier relieving insurance companies of their pain too?
Susie, there are several hundred million Americans and a significant percentage are obese. This is not because people, in the richest nation on earth, have no access to good food. In most cases it is not a lack of education that says McDonalds is not a good meal to have each evening. The issue is the access of cheap food, good and crap - we eat a lot of it!
... better though? No f*cking way.
The crappiest meat/fish section of any supermarket in my mum's town back in Europe would be considered an upper scale gourmet shoppe in my yuppie Northern California town.
Although there are elements of personal responsibility in some cases. Some people simply don't have access to good quality foods due to the fact that they have to stretch their grocery dollars as much as possible. And in that regard a lot of families chose the cheap crap route, because they can get plenty of it.
If people could afford gourmet food, I am willing to wager that they would buy it en masse. Who does not like good food?
The problem is that there is simply not a culture of good proper culinary and eating practices in this country, period. The local dish in some parts of this country is the deep fried twinkie for crying out loud.
Three studies found a reduced risk of obesity among people with more supermarkets in their neighborhood; two of these studies found a link between better access to convenience stores and increased obesity risk.
Research also clearly shows "stark racial and ethnic disparities" in the type of food stores available in neighborhoods, according to the researchers. One study showed that mostly-black neighborhoods had half as many chain supermarkets as predominantly white neighborhoods, while Hispanic neighborhoods had a third as many such stores as white areas.
Six studies in which investigators actually visited stores and checked out the merchandise found healthy foods like fresh produce, low fat dairy foods, high fiber breads and lean meats were more available and of higher quality in white neighborhoods than non-white neighborhoods. Rural communities also tend to have worse access to supermarkets, the researchers add.
Possible ways to encourage supermarkets to set up shop in lower income neighborhoods could include "financial incentives, helping to conduct market feasibility studies, assistance with parking/transportation plans, and assistance with site cleanup/assembly," Larson said. However, she added, there has been very little research on evaluating strategies or policies for reducing inequalities to access to healthy foods."
You really don't know about which you speak. Let me guess, you live in the burbs, chain grocery store every mile, am I right? There are many places where the chains (and these are generally the ones with the money and the mojo to go in)have fled the inner city. I know here in Las Vegas in our inner city they have been trying, without luck I might add, to attract a grocery store. So, what they have are 7-11s, Circle Ks, etc. Combine that with a less than stellar public transit system and it makes it very hard, logistically and monetarily, for some to get to the places that have all that healthy food.
Also, store brand mac and cheese can run .25 cents on sale. A pound of asparagus, well, that will set you back $4.99 pound, unless you're lucky enough to get it on sale and then it's a mere $2.99 a pound. If you are poor, what is it exactly that you are going to serve?
did a video diary about this issue, and how she had to ride on the city transits for hours to get to a Whole Foods, and also about how activists were fighting to try and prevent more fast food places being built in their neighborhoods, but they weren't doing very well with it. Me thinks this may be a bit of class privilege on BC's part, that he thinks it's so easy for people to access good food that easily!
From Australia s/he only sees the US as a whole, without any detail to be able to differentiate the wealthy areas from the poverty-stricken areas.
Very Frist-ian of you, BC.
*
And yes, I live in Australia, which culturally not that different from the U.S. We also have an obesity problem. The reasons are exactly the same: We eat more than we need, and of the wrong foods. Thats the elephant in the room. You can fight that as much as you believe possible, but the fact remains.
Secondly, to suggest that you've got the tyranny of distance to an Australian is audacious in the extreme. Remember, we're 22 million in a place the size of North America.
I'm sorry if you believe that living in Aus means I cannot read your articles and disagree. I'm sorry that having an outsiders perspective may have upset you. Perhaps this is why the health system can't be fixed by looking at other systems elsewhere?
In the end, America has access to food, not all of it good, and a helleva lot of it as do we, in Australia. Until the elephant in the room is acknowledged, then people will spend a great deal of time and effort tinkering around the edges.
Maybe you can advise my nephew's paternal aunt on the proper walkabout to one of those stores in the suburbs that carries healthy food while avoiding the Cass Corridor or any of the myriad of dangerous neighborhoods in that city...Better yet, why don't you try it yourself, in February, when there are three feet of unshoveled snow blanketing the sidewalks and it's -5 degrees Farenheit?
Or maybe you'd like to be the guide for the family stuck out in rural Mecosta County, MI, who used to be able to stop in at the Greenville Meijers for some fresh produce and meats every few days on the way home from work, but who don't have the luxury of a job any longer since Electroluxe closed up and moved to Mexico. They stretch the money on their Bridge card as far as they can on that single, monthly, 30-mile-round-trip into town, which means they forego fresh foodstuffs for cheap, processed shit crammed full of sugar and fats....
Because, you see, you're in a large country, but the vast majority of you are concentrated on the edges of your continent. You obviously have no idea what it's like living outside of the areas of this country not frequented by tourists.
may have a problem with, as much as you not having any remote idea of what you were speaking of.
It would be very bold for an American to make any sort of authoritative appreciation of any domestic issue affecting Australia based on a couple of articles and maybe a touristic trip sometime in the past.
The fact that you live half a world away should have been disclosed a tad earlier in this thread, me thinks.
You'll find that the American experience is basically the same as the rest of the western world. I'm sorry, in this one you can't claim American exceptionalism.
I've put some links about Greece in another response, which almost perfectly captures the issue of change from a good diet to a poor diet.
I've posted links to Australian government sites as well as non-govt.
The common theme you will find for any articles, studies and profiles of nations with rising obesity is that they all come to the same conclusion: Too much food, too much bad food and a more sedentary lifestyle.
There are plenty of points you could argue about not living in the U.S being relevant, but choosing a global phenomenon probably isn't the best pick.
Some commenters are claiming they don't have access to good food. Thats rubbish. In every Supermarket there is fresh fruit, vegetables, fish, grains, cereals and meat. Sure, there is a lot of crap too but good food is there to be chosen.
I'd like to know how you know all 307 million people in the US have access to a supermarket given that your profile lists you as in Australia. Also, as one of those 307 million, your argument is rubbish because *I* do not have access to a supermarket, just a quick mart type place. If I need groceries it's a 25 minute drive, minimum. Ergo, you're ridiculous pronouncement of truth is false.
Also "good food is there to be chosen" - yes, but only if you can pay for it. As boocilla pointed out, when you're poor, you have to get the most calories out of your dollar, which means the fresh vegetables, while appealing, won't provide you as much as the canned (and also will spoil a lot faster).
You're saying because there are supermarkets in a lot of places nobody has the excuse not to buy "healthy" food, willfully ignoring that your assumption is wrong to begin with and also that you're completely leaving out the issue of costs.
America leads the way in obesity. When we say obesity, we are not talking a few pounds over, a love handle, a bit of a muffin top, a layer of luxury. We are talking obesity.
Actually, the rate of obesity (over 30 on the BMI) is about 30%. The "over 60% of Americans" statistic includes both obese and overweight individuals, which includes both the "morbidly obese" people with a BMI over 40 who you always see in scare stories on the news falling out of chairs (and also without heads, which seems to be a side effect of American Obesity) and people who are 5 pounds over weight or 1 BMI point above "normal" - the cut off for which is 25, by the way.
FYI also, the cut off to define overweight used to be 29. In 1998, after a relentless campaign by the drug and diet companies, they lowered the cut off to 25, so normal became 18-24, overweight 25-29 and obese anything over 30. I went from being overweight to obese overnight, and didn't gain a pound.
Oh and guess what? People in that 25-29 category live the longest. Yep, the "overweight" category folks have the longest life expectancy. And if you read thoroughly (not that you seem to be doing so) you'll find that the "normal" BMI category has the same life expectancy as... the obeses!
At no point in history has a population been able to get to a point where a significant percentage is obese like the US is now. Why has most of history managed to work it out but not here and now?
We're living in the first age when the majority of the country has not (yet) had to worry about where our next meal was coming from. Also we do not have to cook everything from scratch, all the time, among the first of 3 generations or so to have that privilege thanks to prepared foods, better methods of preserving and cooking, and indoor refrigeration units. And let's not forget how backbreaking both manual labor and housework were up until very recently. Laundry was a multiday task when you had to pump the water by hand.
Also, again, 30% of the country is obese. Significant, yes, but not dire. Especially when you consider that, according to the Mathematical Association of America, the BMI is utterly useless as a health indicator.
That makes things harder. It takes monitoring and effort. That monitoring and effort is the responsibility of individuals, and the absence of it does not shift the responsibility to an insurance company or a government program.
You realize the whole "fat people are just lazy" meme has been so thoroughly discredited even Stephen Colbert was making fun of it the other night? Diets don't work. No, really. That UCLA study in that link suggested that not only do diets not keep the weight off, over 80% of people gain back more weight than they initially lost so they end up fatter. Here, have another link you won't read.
You seem to be enjoying pontificating with absolutely no facts or backup. I think if you come to America, you have a future with FOX news.
DRST
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Now, for some other links.
Greece, wonderful case study. Traditionally, has the best diet around. Suddenly, western diet and obesity.
Australia, same deal.
Child obesity
Federal government guidance
State level perhaps?
Guys, the point is we are all in the same boat. The large part of the answer is also the same. We have access to more food than we need and we are more sedentary. Not all of that food is good.
Perhaps some of the resistance to the perception of access is in DRST's response. I don't know many people who think 25 mins driving is considered to far for groceries. Maybe it is expectations, eh?
So, DRST, the direction change to dieting isn't the point. The core of it is, too much food too sedentary. That is a pattern all over the western world. Diets are not total lifestyle changes of what we eat.
At no point have I tried the 'fat people are lazy' meme as you so eloquently put into my mouth. People do need to take responsibility and a large percentage of that is monitoring what & how much goes in. Who else is going to do it?
I've read the articles posted. Do a quick google yourself about what other people from other places think about the topic. You'll find lots and lots.
We all have the same challenge, most of countries do recognise where the bulk of the challenge is.
We had a book chat on it a couple of months ago.
The author very deftly points out several fallacies in your post
http://crooksandliars.com/nicole-belle/book-c...
Los Angeles
http://articles.latimes.com/2007/sep/10/local...
On this one I can't support you. Being over weight is a health issue the same as smoking and drinking (except for alcoholism) it's your choice. The extra 50 lbs. is holding up the recovery of your ankle because it's having to carry more weight when it should be carrying less.
The laws of physics apply to everyone, not just those who are slim or fit. If you take in 1800 calories and burn only 1750, you're going to get fat, so you have to modify your diet to suit or find alternative ways to burn them.
Lift weights while sitting, no strain on the ankle at all and it'll thank you when the weight starts to drop off.
I gained 30 lbs from having to take prednizone to control my asthma.
I work out 5 days a week, 30 - 60 minutes a day. I vary between yoga, cardio and weights.
I watch what I eat. I'm mostly vegetarian, eat salads daily, don't eat desserts, don't eat fast food and generally do the things I'm supposed to do.
I can't lose this weight. Nothing I do gets this weight off. This is my body's response to taking these steroids. And if I don't take them, I end up in the ER six times a year unable to get oxygen in my lungs.
circumstances beyond anyones control, but in most cases, it's the person not pushing away from the table soon enough.
I agree with O on this, it's time for people to start taking responsibility for their own good health.
Drive past the wendy's and mcdonald's, stop buying junk in the grocery store. I saw an interesting observation by someone who said, "90% of the items at the checkout shouldn't have a bar code, if it does, it's probably been processed to the point it's not good for you"
I would have a hard time getting coverage as I am now under this stipulation, because those extra 30 lbs put me at a BMI considered overweight.
I need insurance more than many, because I have a chronic and life-threatening disease. And it's not obesity. I have almost died once from my asthma, when my oxygen levels dropped below 50% (30% is fatal).
I DO drive past Wendy's and McDonald's and you'll find me at a health food store more than you will find me buying junk food.
But yet, because of these stereotypes, I will have a harder time getting coverage because of my weight.
What you describe is impossible.
Really?
Spend a lot of time with over-40 asthmatics, do you?
You can quit smoking and quit drinking cold turkey. Pretty damn hard to give up eating completely, dontcha think?
But here's a thought. Why do you put alcoholism in a separate category? Why do you think drunks should get a pass in the "it's your choice" category, but overweight people shouldn't? Or smokers, for that matter.
Obesity ? Well there goes half the population in this country ... no health-care even with the new and improved "reformed" version ! Ain't gonna happen folks .Ah Mikeeeee come on man , being over weight is often but not always " by choice " as you say and simply a matter of eating too much and too little exercise , just one of many examples ... Nichole's post here . Think my man !
I'm a holistic health practitioner and while I respect the cultural, psychological and physical issues that contribute to obesity I do fall on the side of the fence that says obesity is a conglomeration of choices. I understand there isn't enough information available to people so they can make better choices. The bottom line is that I'd have to put the blame at the western medical establishment's feet as well as our educational system. When it comes to preventative care, truthful and real healthful information is out there but you MUST MUST MUST take responsibility and begin seeking it out on your own. There is no other way today. Speaking from experience, use your doctor for health information but by no means rely on that information as gospel. Many doctors have alot of knowledge about a certain way of analyzing the human body and it is far from comprehensive. What they offer may be helpful and healing but possibly not. There are a great many alternatives and the future is in preventative care. If you are sick enough to be in a hospital or see a doctor it is already too late. Your health and your awareness of your health has to be a part of your life rather than as a consideration only when you don't feel well. *I'm not intending to tear down doctors or to discredit them in any way. I respect their schooling and experience. Still, with that respect, western medicine has yet to embrace more perspectives of health and the body when considering a treatment protocol.
... and their silly request for proof.
You know drug addiction, alchol addiction, gambling, restless leg syndrome, and even hoarding (yes, HOARDING) are considered diseases. A boil on your ass can keep you out of the military as can flat feet. Hair loss merits such serious attention that you would think it was erectile dysfunction. Rosacea and eczema will get you lots of sympathy but if you're fat... YOU are a lazy, stinking, cry baby who just cant keep the ham sandwiches out of your gaping pie hole. Weight gain is NOT in ANY WAY a medical condition, it is a sign of personal weakness. If you would just waddle to McDonalds instead of drive there then the problem would be solved!
Even smokers can get solace from the fact that nicotine is an addictive substance, but how addictive is Twinkie cream? Fast food grease? Cheetos dust? And JUST because the VAST MAJORITY of Americans are overweight or obese don't even THINK that there could be some causal environmental factor at play - it is ALWAYS the fault of the fat for their slovenly habits and gluttonous ways.
Oh what joy to be in a hated "minority" group. Fat is this years black I guess but not in the fashion sense of the word - in the lynching sense of it.
I understand you feel discriminated and hated. I'm not a hater. Food is addicting and all that greasy crap and sugar is definitely like being addicted to crack. So you have to find a way to break the chain. I've been there myself. Not obese but overweight for sure and fighting my food cravings. It took years of practice and a change of attitude but my diet finally changed on a permanent basis. Being healthy is not being on a diet. Being healthy is a fundamental change of attitude. As much as you don't want to hear it, your choices have made you fat. I have a friend who eats ok but she's obese and when I've broached the subject she denies she has any role to play in her bodily state. Yet when we go out she orders a moderate sized healthy meal but with a chocolate milk shake and eats a big cheesecake desert. In her mind, because she eats a nice chicken and vegetable dinner the chocolate shake and desert are discounted. How much fuel does your body truly need vs. what your cravings are for food?
i've read some personal and interesting entries on this thread. i want to say again this is a difficult issue. although, health care and health care conditions are collective they are best treated on an individual basis.
i'm very familiar with conditions that bring on weight gain genetics,adverse effects from medication,psychological disorders/challenges,disability,income challenged to name a few, but i also know some people need self-education and exercise(calories in and calories out). i feel it's very important that a progressive health model be incorporated inorder to instill self- responsibility/prevention. yes, there are challenges in maintaining optimum body weight for many demographics/people but we must meet those challenges. there are global financial elites that want to get people in/near poverty(stagnant wages) this may be the biggest challenge regarding this problem. where the health status of this country compares to the rest of the world has a lot to do with collateral damage of capitalism.
Just lose some weight fatso?
Makes you feel good saying shit like that. I work out virtually everyday(not for vain reasons mind you, it helps me deal with my stressful job.) I'm forty years old and am extremely fortunate to not have any lingering or debilitating injuries that would prevent me from being able to keep myself fit. I run into many people who have the same determination that I have but injuries like a bad back, ankles, knees, etc. prevent them from pursuing their health goals.
Instead of being a fake superior asshole, you might want to offer more understanding and some helpful advice.
Why should we pay for your stupidity?
And why should we pay for fertility teatments for women who can't get pregnant on their own, or for medication for men who can't manage an erection, or for depression treatment? Stay infertile, limp, and mopey why should society pay for things that aren't crippling?
Lose a leg, then you can hop. Lose an arm, well that's why you had two. Got skin cancer, then quit wearing bikinis. With the wisdom of Solomon maybe Solo25 should be Surgeon General?
Anything the Chamber of
CommerceFascism is for, I'm against! If there is a more vile, dispicable organization than the CoC, I don't know what it is?BMI may be a good statistical estimation tool for obesity across an entire statistical population, but there are way too many healthy people that are considered exceptions to this calculation. Since BMI only looks at height and weight and not true body fat percentage, it frequently misclassifies muscular individuals. Most of these individual can probably care less if a BMI metric is off -- but try to now charge them more for insurance because of an inadequate metric and they are likely going file a lawsuit.
Look at it this way: applying a standard BMI calculation to the current Chicago Bears player roster listed in the Chicago Tribune, only the team's punter is considered of just barely normal weight with a BMI of 24.8 (6'1", 188lbs). Everyone else --> 59 of 60 players including Kickers, QBs, Defensive Backs & Receivers, are at least classified as overweight with BMI's over 25 and more than half of the roster (32 of 60 players including linebackers, Defensive Ends, Fullbacks, Guards, Centers and Tackles) are classified as at least obese with BMI's over 30. Twelve players are at least Type2 Obese with BMI over 35 and one player, thier run-stuffing mountain of a nose-tackle Anthony Adams at 6', 310lbs and a BMI of 42.0 is well into the Type3 (Morbidly) Obese category. We're not talking "The Fridge" here. If you haven't seen this guy, see his picture here --> http://www3.timeoutny.com/chicago/blog/out-an.... Scary big, yes. Morbidly Obese, no.
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