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November 14, 2007


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Great advice! I wish more people took it. I see my exercise & healthy eating habits as an "investment" in myself and my health and eventually my finances. I do wish I was rewarded more for being healthy, or at least I didn't have to cover the additional cost to insure people who made bad health choices.

Good word FMF! Getting in shape is the number one thing you can do for yourself and as you've pointed out before, it's good for the pocketbook, from increased earning potential to lower insurance. My company has changed our insurance for this year. Non-smokers get a discount. I think this is a non-smoker, I feel that I should be rewarded for taking exquisite care of my body.

Scott Kustes

Completely agree! Just like people that get in too many car accidents, they pay higher insurance!

I think it's a slippery slope when people buy into the idea of not having to pay, because it's services they don't use.

I mean -- I don't have children, so why should I have to pay the cost to support someone's prenatal visits or dependent care? That's a choice to start a family. Or even for the additional preventative health care: women have the annual gyn visit and tests that men don't have. Should my employer make women pay more? Or for older workers -- it is more cost effective not to employ workers 50+, and replace them with younger workers who charge less and take less resources. But is it ethical to make that call?

Honestly, a person with kids probably consumes more of the health care expenses than any smoker/fat person does. If you're a fat smoker at 25 and have a heart attack at 65, then you've had 40 years with no additional costs. Why are you paying more during that time, especially as the employer you have at 25 won't be the same at 65 anyway. Or you have the attack at 70, when you're not employed at all.

But tally up the cost of prenatal, parental leave, immunizations, annual checkups, lost days from childcare snafus, kids bringing home ebola from school -- that's a huge cost.

I don't know if you've ever had to deal with the insurance agencies when there's a health crisis. I have, and it's a -constant- fight to get them to cover the costs of things you've already paid into. With the cost of care going through the roof, I think this is an instance where looking at reforming the system is going to have a greater impact than having the clients shuffle the costs.

btw: Im not fat, I don't smoke, and although I don't have kids yet, I probably will one day.

A heart attack at 65 will cost as much or more as all of the prenatal, immunizations, checkups etc that kids need.

And would you really rather have kids not getting immunizations and getting measles, mumps, etc instead. The cost to treat those would be astronomically higher than a $50 shot.

The point is, if people were healthier, their costs should go down. Preventative care is always cheaper.

What I'm saying is that the employer isn't paying for that, so why are they asking for the consumer to pay the additional costs?

"If you're a fat smoker at 25 and have a heart attack at 65, then you've had 40 years with no additional costs."

Not exactly - "fat smokers at 25" will probably develop other complications during their lifetime (eg, diabetes and/or emphysema) that will place a burden on the healthcare system that will exceed the costs of regular healthcare for children.

Since I've lost a bunch of weight, I'm already seeing the cost-savings in that I don't have to take a blood pressure medication and I see my doctor less.

And the question wasn't: "is preventative care cheaper", but "should cost be distrubuted against expectation of use?" In that case, the people with kids should -still- be charged more, because either they 1) incur extra costs to prevent them from getting ill or 2) incur catastrophic costs if they actually do get sick. Because it is, as argued against the smokers, a choice.

Annab -

They would ask the consumer to pay for extra costs because the consumer is the one smoking, getting fat, etc.

I realize the question wasn't cost of repair vs. prevention, I was rebutting your argument that a fat, smoker would cost more than a family with kids.

Personally, I am fine with paying out of pocket for immunizations and checkups to catch potential problems early, but I am lucky and my insurance covers those things. But how is "incurring a catastrophic cost" a choice? That is what insurance is for - to protect against huge events that are unforeseeable and would otherwise ruin you financially.

I just have a real issue with a bias against the overweight, specifically. And I doubt the validity of the popular claims that fat = disease. Here's some readings that illustrate what I mean here:

Here's an easier and very well studied way to help protect your health-take 1000IU of vitamin D per day. Here are excerpts from some of the many studies:

An article in our local paper today refers to five different studies on Vitamin D. The first showed a significant association between low levels of Vitamin D in Alzheimer’s patients and poor performance on cognitive tests. The study was done after families of Alzheimer’s patients reported how well the patients did after starting Vitamin D supplementation.

The second study concluded that 1,000 to 2,000 IU of Vitamin D per day could reduce the incidence of colon cancer by 50%. The third study, by the same researchers also concluded that 2,000 IU of Vitamin D could reduce the incidence of breast cancer by 50%. The authors of that study also concluded that

…Vitamin D has the potential to reduce at least half of serious invasive cancers and make the remaining ones milder and far more treatable.

The fourth study found that, out of seven million white males in the US military, those with the highest levels of Vitamin D in their blood were 62% less likely to develop multiple sclerosis than those with low levels.

The fifth study related low levels of Vitamin D to flu susceptibility. The author of that study was quoted as saying that

Maybe the shot people need to get in the fall is not a flu shot, but a Vitamin D shot.

Then there was an article in the Life Extension Foundation update e-mail I receive:

A report published in the February, 2007 issue of the Journal of the American Geriatrics Society concluded that supplementing with vitamin D can help prevent nursing home falls in older men and women. Falls occur in approximately half of the residents of nursing homes each year, and render the patients more susceptible to further injury.

Kerry Broe and Douglas Kiel of the Institute for Aging Research at Hebrew Senior Life in Boston and colleagues at Boston Medical Center and Harvard analyzed data from a randomized, controlled clinical trial of 124 nursing home residents with an average age of 89. Participants received 200, 400, 600, or 800 international units (IU) vitamin D per day or placebo for five months.

At the study’s conclusion, 44 percent of the patients in the placebo group had fallen, compared with 20 percent of the group that received 800 IU vitamin D. The adjusted-incidence rate ratio of falls of the subjects in this group was 72 percent lower than that of the placebo group. Lower doses of vitamin D than 800 IU were not associated with any significant effects compared to placebo.

Over half of the subjects who were using a multivitamin supplement at the beginning of the study had suboptimal serum vitamin D levels of less than 20 nanograms per milliliter. When total vitamin D supplement intake was calculated to include multinutrient supplements, the group whose intake was in the lowest one-fifth of the participants had the greatest number of fallers, while the top fifth had the least.

And now two additional reasons to take Vitamin D supplements from the May 2007 issue of Life Extension Magazine. First, it shows promise in reducing the incidence of Type II diabetes:

Exciting research also indicates a possible therapeutic role for vitamin D in preventing diabetes.

Vitamin D supplementation may reduce susceptibility to type II diabetes by slowing the loss of insulin sensitivity in people who show early signs of the disease. Researchers studied 314 adults without diabetes and gave them either 700 IU of vitamin D and 500 mg of calcium daily or a placebo for three years. Among subjects who had impaired (slightly elevated) fasting glucose levels at the study’s onset, those taking the active supplement had a smaller rise in glucose levels over three years than did the controls, as well as a smaller increase in insulin resistance. The researchers concluded that for older adults with impaired glucose levels, supplementing with vitamin D and calcium may help avert metabolic syndrome and type II diabetes.

And it shows promise in the treatment and prevention of prostate cancer:

Aware that low vitamin D levels are a major risk factor for prostate cancer, researchers examined the vitamin’s preventive effect in a cancer-prone mutant strain of mice. Mutant and control mice were given vitamin D for four months either before or after developing the first signs of cancer. Vitamin D substantially reduced the occurrence of early cancerous changes in tissue, yet appeared to have no effect on the androgen (male hormone) system. This is crucial, because many conventional prostate cancer drugs impair androgen function. Human prostate cancer cells in culture show similar reductions in cancerous changes and proliferation when treated with vitamin D3 and a synthetic retinoid (a vitamin A-like compound)

A 1998 study demonstrated that vitamin D can reduce prostate cancer growth in human subjects. Seven men with recurrent prostate cancer following surgery or radiation (as measured by increasing levels of prostate-specific antigen, or PSA) were given a prescription form of vitamin D called calcitriol (Rocaltrol®) at increasing doses from 0.5 to 2.5 mcg (20-100 IU) per day. The rate of PSA increase (an indicator of disease progression) during treatment fell significantly compared to the rate before treatment in six of the subjects, suggesting a slowing of prostate cancer progression. In a related study, weekly dosing with calcitriol (at 20 IU per kilogram of body weight) increased median PSA doubling time in men who had been treated for prostate cancer. An increased PSA doubling time means that it takes longer for the PSA cancer marker to elevate (double), which is a favorable sign.

annab - there is much in the medical science community that both supports and refutes the correlation of overweight and disease.

First off, please don't take what BLOGGERS say as the de facto interpretation of the medical literature! Do you go to a blogger for your health checkups?

Regarding the latest article about overweight not leading to death: sure you won't DIE from being overweight, but the article still doesn't refute that you're still more likely to develop type 2 diabetes, coronary heart disease, gout, and other undesirable conditions. One HUGE caveat from that article: these are associated risks! Did you know that higher incidences of rape are associated with greater ice cream consumption?

Anywhoo, I guess after all of that rant, I applaud you for making your own, EDUCATED healthcare decisions. Being educated, more than being thin or healthly or whatever, will probably lead to the most economical healthcare choices.

@Kevin, I agree that preventative care is important, but my insurance (like yours) covers all of these costs, so even if you don't use any of the benefits, the cost to the employer is still the same as if you had something super expensive.

My reason for bringing up the kids-vs-fatsmokers is that it's easy to look at a group (like the smokers) and say: we could cut costs if it weren't for you.

But the problem with that argument is that it doesn't look at exactly who is using what services, and where these total costs are coming from. Not where they might come from, where they DO come from.

If being a smoker actually costs the employer more than any other factor, then that would be one issue. But does it? I say: not as much as what you're guessing, and do we as workers, want to encourage a scheme where we "tax" for risk factors, rather than for actual expense?

It's easy to say "well, you chose this, so you pay", but the underlying question is: do we reduce costs by eliminating access to those who might cost us more?

In that case, do you have the person with a pre-existing condition pay more? Or not be insured by the employer at all? Or going back to choice, if a worker had a risky lifestyle before, and doesn't now, do they still pay more than the person who had never had that behavoir? I mean, does the 45 year old who smoked from 25-40, but is healthy, pay more than the 45 year-old who never smoked at all?

For the record:

If I had kids, I'd want them covered. And I don't mind the fact that the cost of my coverage goes for someone else's child. But when people start saying, "why should I have to pay for X condition, it's going to cost big time one day", my statement is that anyone can use this logic, and if so, apply it equally, to the costs we know are here right now.

Basically -- there's a huge need for healthcare reform.


Ok, the ice cream comment made me laugh!


annab - insurance companies hire people to figure out who the greater risks are, and thus who pays more. Those statistics are what premiums for different people are based on. It's not willy-nilly or at the whim of whoever processes your application. That's why when you apply for health or life insurance there is a box to check if you are a smoker. Can a smoker live to be 95? Sure, but statistically they probably won't.

Your idea of "taxing" for actual expenses rather than risk is flawed. How do you "tax" someone who dies of lung cancer because they smoked their entire life? You can't go back and say: Crap, you were a smoker, died of lung cancer and caused all these extra expenses, so we need to retroactively raise your insurance premiums. It's too late.

I meant for employer-based insurance. Where I work, everyone's in a big pool, and we have group coverage. So payments for/by all workers cover each other.

(wishing there were an edit function here)

Specifically, an employer asking Smoker to pay an extra coverage that he doesn't ask Nonsmoker to pay, because of the anticipation that Smoker is going to cost more than Nonsmoker doesn't seem fair to me.

First -- because the presumption of expense doesn't anticipate how long Smoker will be at the job. So if you pay extra, you do so even if you'll only be there for a few years (most people I know don't stay at an agency for their entire careers.)

Second, because they're not asking for that additional expense for the people who are actually costing extras: preexisting conditions, extra dependents. You may pay for dependent care, but is the amount you pay compensated by the extra expense?

Finally, the choice of what is subsidized vs. what isn't speaks (in my opinion) as much to public opinion as solid health issues. The examples about obesity are an example. What we visually understand as obese goes beyond the strict definition of obesity. So that extra 20 can be an risk factor as much as the 50.

Because even increasing the cost for the easy targets like the obese or the smokers doesn't compensate for rising health care costs. So who's next? The parents? The people with preexisting conditions? The people genetically disposed to expensive conditions? I'm talking employer-based group care here.

What I'm saying is this: allowing insurers to push the cost back to potentially costly (or even definitely costly) consumers doesn't mean that overall heath care costs go down.

Insurance is a for-profit industry. By throwing more cost on the consumer, the profit is increased. That's why I think there needs to be heathcare reform.

I can't really speak to individual coverage. In this instance, it could make more sense, as you're likely to stay with your individual insurer for a lot longer than you might stay at a job. I mean, I've had 3 jobs in as many years.


"allowing insurers to push the cost back to potentially costly (or even definitely costly) consumers doesn't mean that overall heath care costs go down"

should have said: employers, not insurers.

If everyone were created physically equal this argument might have some weight to it. There are plenty of people that don't exercise, eat like a horse and have a hard time gaining weight. There are also plenty of people that eat a normal diet, exercise and are still classified as overweight.

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