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>I'm not overweight, so maybe I don't have the right perspective on this, but how terrible could "having a doctor tell you that you're overweight" be? Like, the only context I can understand this quote is that "Have someone tell you you're overweight" is some sort of grievous injury, and not just trivially inconvenient."

In my experience? It's a drain, and a good way to encourage me not to go see the doctor. Because it's every time I go to the doctor for literally my entire life. I have never not gotten a 10 minute lecture, including when I was on a varsity swim team.

Beyond that, it's a lecture that comes even when it's not the problem. In the not so recent past, we discussed my weight for 15 minutes...and the active pertussis infection I had for 5. If you have a chronic condition, you're almost certainly going to have your doctor tie it to your weight.

And here's the thing - fat people know we're fat.

When you put it like that, it does sound very unpleasant.

It is. The last post also ignored some larger problems - like fat people essentially having medical problems missed because doctors attribute it to their weight, or the exact opposite - skinny people not getting diabetic tests or cardiac stress tests because they're skinny.

The blood tests that are part of most medical insurance wellness plans now do check for diabetes symptoms. If your blood glucose or A1c is above the reference range then it will get flagged for your doctor as a possible diabetes case regardless of whether you're fat or skinny.

The solution doctors should provide starts with mental health (motivation, etc), not physical solution. This is the biggest problem in health care!!!

Note that the US government is doing nothing to change this. It's almost illegal for doctors to "prescribe" mental solutions over physical. Everyone wants a quick fix but the solution starts in the brain.

If you don't want the $50 savings then save the .125% of your salary and don't do it. Simple. Don't act like you don't have a choice.

In a just world, this would be at the top of the thread.

Is he paying $50 more for not participating, or getting a $50 discount for participating?

This is just semantics. In either case, it costs money to not participate.

Marketers like to frame things as the latter, as behavioral economics tells us you get better participation by using the latter words.

But we should draw a distinction between marketing and the bottom line. The bottom line is there's a $50 cost.

No its not according to numerous psychology studies

> If it's the latter (Anthem insurance doesn't change their premiums, but now rewards people for using preventative medicine), then how could anyone object? It really is a win-win, and people who don't want to participate are no worse off.

I would object. What would stop them actually rising the bonus or the costs for the rest in the future? You've justified it in so many ways. It's the grand health initiative! Let's make America healthy again!

Easy to sell and all that sweet data can be used for other good causes.

Meanwhile the discussion over overpriced medicines disappears. You can (must?) even push the prices for medicines, therapies, etc. leading to the fact that the insurances best customers, people who can't do anything about their sickness (anymore) will be burdened even more. Enforcing the "sick and out" narrative in this sick system.

> What this actually means: The trying-to-be-healthy population are no longer subsidizing the not-trying-to-be-healthy population. I don't know if this is a bad outcome

It is. It's like taxes but we lost that viewpoint (US maybe never even had it but we did in Germany) because of privatization.

There are other ways to educate people on how to be healthy and what the benefits are. Starting doing it at school SERIOUSLY would be a step. Marking obviously unhealthy food as such is another. Misleading advertisements is a big one. And so on. It can be done but I don't believe there is a really strong lobby for that out there. Or not strong enough.

I think it makes sense in the US because health insurance is a for-profit business here. It seems odd to criticize an insurance business for giving lower pricing to people who are less likely to use the insurance. I think it's a terrible way to run a healthcare system, but that's a different discussion.

Edit: (RTFA!) So, it's not the insurers, but the people paying for the insurance. One step removed from what I said, but I think the rest still applies.

> It seems odd to criticize an insurance business for giving lower pricing to people who are less likely to use the insurance.

It looks naive to assume that, together with the infrastructure costs and the running costs for this system this for-profit business wants to make less money.

What would the selling discussion have looked like? "Hey I have a system here that will make the most credit worthy clients pay less. Interested?"

This is basically completely backwards. Also, you seem to be criticizing this solution because its not perfect. Hint: there is no perfect solution.

I don't criticize it because it's not perfect. I criticize it because it opens an massive exploit onto people who are already giving more away of themselves then it's good for anyone. There is also a critique towards the greed that drives those companies and will therefore lead to this exploit being exploited.

"tends to take a lot of innocent people who are winners in the status quo (in this case, people who try to stay healthy, and enjoy lower premiums) and makes them into losers (since now they have to pay the same premiums as people who don't use preventative medicine)."

It's not obvious to me, in the US medical system, that "healthy" people use fewer healthcare dollars over their lifetimes.

Of course I'd like that to be the case and it would be satisfying to shift costs to people making relatively poorer health decisions.

The problem is, it appears that healthcare spending skyrockets asymptotically at the very end of life - as you are literally dying - and that explosion of costs and care-use occurs regardless of how healthy you were throughout your life. Healthy people (and their relatives) desperately attempt to eke out extra days and weeks of life just like unhealthy people (and their relatives) do.

I don't know how to solve this problem but until this is no longer the case I don't think it's appropriate for "healthy" people to act so wounded about the money they're paying in for the couch potatoes.

There are many parts of what you're saying I disagree with.

Here's some work from Harvard establishing that obesity does incurr a higher healthcare cost burden (https://www.hsph.harvard.edu/obesity-prevention-source/obesi...)

I can cite similar articles for excessive smoking/drinking as well, and as anecdata the physicians in my family firsthand support the statements in the above.

You're absolutely right re: asymptotic end of life costs, and I would be in full support of a rethink to the ROI on those costs (especially if they're being footed via e.g. medicare/other tax based resources)

But if anything I think this is _more_ reason for healthy people to be angry, as I'd argue that the upper bound on marginal benefit to keep a 90 year old alive another year as opposed to proactively treating smoking/obesity is probably far lower. (just by the empiricism that even in a best case the 90 year old probably doesn't have as much time left)

At the end of the day, the amount of money that my employer reports as paying for insurance is _astounding_ and I've yet to see any data to support that it's being used effectively, especially given trends of increasing rates without commensurate gains in QOL/life expectancy (there has absolutely been gains but most of the recent cost hikes have been political and divorced from a more needs based cost growth, assessing "need" as per net long term outcomes)

As I said in another post, I've had to surmount a few stress based/sedentary based injuries, and to be bluntly selfish, I'd rather that money to buy myself more stability/a faster retirement so that I may better take care of my own body and not incur a heavy cost on others later in life. (or worse, cut years off my own)

> Workers are being penalized because P(Not trying to be healthy | Doesn't participate in the wellness program) is greater than P(Not trying to be healthy).

This assumes the only reason for not participating is lack of motivation to be healthy. What about those of us who don't want to voluntarily surrender our entire genetic code to an insurance company? And once most people have, how do you know that your future premiums won't be based on genetic markers for certain diseases?

Then don't. If you make 40k a year its only .125% of your salary.

I don't.

But you avoided his entire second question.

It should be. A sustainable solution to increasing costs certainly isn't perfect. If a perfect solution exists its certainly not sustainable. This is econ 101. We need to be thinking not just of poor people now but the millions more poor people of the future - which systems makes them the least poor?

Please read up on adverse selection and moral hazard. The world isn't puppies and rainbows. Sustainability is the most important thing for any market when it comes to helping the poor in the very long term.

Who believes in puppies and rainbows? lol

A sustainable insurance market is also obtainable without genetic information. In fact, without any patient information at all. Information allows segmenting the population to allow for diverse premiums. Without any patient information the premium will just reflect the whole population risk.

We can argue if this system is fair or not (I don't like these discussion because they hinge on the definition of fair, which is silly); but your point is about economic feasibility, and it's quite feasible to have a health care system without digging up dirt on everyone.

And, as a libertarian, I have to admit that this country has one of the most inefficient health care systems in the world. The amount of money we spend for results that are worse than any other industrial country is obscene!

The Genetic Information Nondiscrimination Act (GINA) of 2008 makes it illegal to base medical insurance premiums on genetic markers.

Disclaimer: I am paid by my employer, a 3rd party provider of wellness programs, to write health incentives software.

It's always phrased as the former, but employees that don't get the discount often see it as the later.

Wait, it's phrased as a pay cut, but those who lose out see it as a bonus for those who benefit? That would be surprising. Did you mix up "former" and "latter"?

>Is he paying $50 more for not participating, or getting a $50 discount for participating?

On the other hand, think about it like this:

What if insurance costs $10,000 a month, with a $9900 discount for "healthy behavior", so your average person pays $100 a month.

It's a great deal.

Now what happens if someone gets sick and can't upkeep his healthy behavior?

He loses his insurance.

This defeats the purpose of health insurance, but most people tend not to think of long-term repercussions.

To me it looks like people who were born healthy get higher salary.

Isn't that true anyway due to bias? I believe taller men or women with bigger chests make bigger paychecks all else equal. I think in a geek world all paychecks would be determine by work ethic and brain power, but I don't think that's how the world works.

That might be true if a woman works as a waitress (and attracts customers to come more often) but I doubt that is important for a software developer.

No, it has a significant impact even on programmers, though less of one than it has on people in sales or customer service: http://timothy-judge.com/Height%20paper--JAP%20published.pdf

Look it up. People with nice faces and certain hair also make more. Humans have a hard time not showing bias in all parts of their life.

Maybe it's true due to human psychology but that doesn't mean we should institutionalize it.

Overweight or not (I am overweight) exercise is really important. As long as it doesn't result in hiring or advancement bias, it should be incentivized because it lowers corporate benefit costs in aggregate and improves the performance of the workforce. A large body of scientific studies exist showing that it:

Improves cognitive function (https://www.ncbi.nlm.nih.gov/pubmed/24696506)

Reduces sick leave (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2092583/)

Improves happiness/ more brain cells (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4789405/)

Smarter, happier people that miss less work are going to be more successful. Some people are born more gifted in this respect, but exercise can be very effective at narrowing that advantage for the rest of at surprisingly little cost in money and time.

Yes. This is true for literally (quite literally!!) every trait in humans that is positive and noticeable.

>Is he paying $50 more for not participating, or getting a $50 discount for participating?

What's the difference?

Less cognitive dissonance.

>>> but how terrible could "having a doctor tell you that you're overweight" be?

How terrible would it be to have a doctor tell you to stop smoking? Or to stop drinking? Or stop abusing drugs? Or to stop cutting yourself? It's all self destructive behavior just like overeating.

Has our culture really become so sensitive that it's now no longer acceptable for a doctor to tell you when you're being unhealthy and contributing to your own demise????

> How terrible would it be to have a doctor tell you to stop smoking? Or to stop drinking? Or stop abusing drugs? Or to stop cutting yourself? It's all self destructive behavior just like overeating.

It's not terrible, it's just pointless. Fat people know they're fat; people who self harm know they self harm and they know it's not ideal.

Merely saying "stop doing that" does nothing ot help them stop.

> Fat people know they're fat.

Many don't. Or they don't blame overeating. It's always "genetics" or "metabolism". Not just plain old overeating.

Sure, but even for those people merely telling them they're fat, and that they're fat because they eat the wrong food will do nothing to stop them from being fat.

> will do nothing to stop them from being fat.

I disagree with one point. It puts things into their control, rather than out of their control.

If the doctor says you're fat because your metabolism is low, or you're big boned, you can shrug it off and say "Well, there's nothing I can do about it, might as well not try."

If the doctor says you're fat because you eat too much food, you can do the same thing, but then at least the ball is in your court. You are fat because of your actions, and it's theoretically possible to change your actions, but it's definitely not possible to change your genetics or metabolism.

This is why a doctor won't tell his patient: "stop FOO". Instead, they might nudge him with information. Respecting the patients knowledge and struggle, a doctor is understanding, supporting and able to connect with others who have successfully "stopped FOO".

A good doctor understands that an eating disorder is part of a complex, intertwined and difficult to understand network of causes and effects. Helping the patient understand the complexity of the situation is often the first step towards a permanent solution.

Yes, I agree. Some people in this thread don't, and are saying that merely telling someone that smoking is harmful is enough to make that person stop smoking.

Or have a doctor tell you to stop engaging in risky sexual activity?

It's self-destructive behavior just like overeating.

TIL mental health problems go away if you tell sufferers to just get better.

This isn't House, M.D. The doctor's job is to assist to a great degree in fixing the problem, not just figuring out what the problem was.