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Comment by anonymouse008 | Hacker News Reader

Maybe slightly off topic, but it’s always been odd to me how life insurance tests with vigor for tobacco use but lack that enthusiasm for metabolic health / diet.

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It depends on the amount of life insurance you get. Mine is of an amount that blood work was required and it definitely affects the rate. One of the things I learned is I have a "fatty liver" - which is indicative of poor metabolic health. I started taking care of that, brought the levels down to normal, and my rate was lowered.

With this kind of testing, they might find so few acceptable customers that it wouldn't be worth being in the insurance business anymore.

In the US, you are not going to be able to get any decently priced term life insurance without a blood test, height, and weight. The A1C and cholesterol levels, combined with height, weight, medical history, and family medical history probably give them enough information for metabolic health/diet.

They certainly test for basic health, or did with me. I had to give blood and urine, and a nurse came to check other vitals. They also get your basic measurements which gives them BMI. They can then categorize you into "preferred" or other groups.

To get my life insurance 5ish years ago, I had to have a blood test that included tobacco, drug use and cholesterol. My understanding is that is pretty common.

One you qualify though, I don't think they can re-test you.

You often do get tested and rated based on health factors. Maybe not exact diet, but they can surely infer some of that from blood/urine/size/weight/etc. It depends on the insurance company but more likely the size of the policy. I think a lot of $20-$100k policies don't require any tests - they may also be more expensive. I got a decent term 15 years ago, and I had to have an in-home exam from a nurse.

correct many small polices don't require testing, same for group life policies upto a certain amount of benefit. When you get into the 10 million range that's when a carrier really starts digging into family history etc.

Few carriers are currently willing to write anyone over 60 which is affecting key person policies more than anything, in my experience.

>> it’s always been odd to me how life insurance tests with vigor for tobacco use but lack that enthusiasm for metabolic health / diet.

This commenter has never had a major individual life insurance policy. While Tobacco effects underwriting, it's not as major of a factor anymore.

You can control your tobacco use. That is why Pigovian taxation is effective.

I’ll go where you’re alluding

A “food desert” doesn’t account for the person who consistently orders two flavors in their tall iced coffee (usually equates to 6+ oz of simple syrup); that’s a choice — and a severe negative externality.

Indeed. Tax that at point of sale, like cigarettes and other tobacco.

Risk pooling in insurance is simply an added benefit, but a less clear moral approach when the disease is not necessarily controllable by the person. Metabolic disorders exist. Tobacco disorders, not as much except conditioning and addiction.

But, it should be a focus for wellness programs so that metabolic disorders are destigmatized.

Nearly 3/4 of out adults are overweight, thats mostly shitty choices. You say "disorder" like it is something these people got through no fault of their own but that is not often the case. Shitty choices probably we should stigmatize becuase accepting this many fat people have gotten us a public health crisis.

I hear this shtick repeated every time someone doesn't want to fund universal healthcare because they don't want to pay for fat people. Fun fact, obese people actually have lower lifetime healthcare costs than healthy people.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2225433/

Now, if you wish to reduce obesity because you're more interested in a person's quality adjusted life years, you absolutely do want to treat obesity (and addiction) like a disorder, because compassion and empathy is the only way you're ever going to get someone to make the long term life choices they need to get better.

I referenced overweight which is many more people. They are the ones who live long enough to spend big dollars on healthcare but still cost much more. They arent food addicts or something they just cant be bothered to make gym trips.

I'm assuming you have studies to back these assertions up?

>Is it because they die sooner and more suddenly?

Fun fact, obese people actually have lower lifetime healthcare costs than healthy people.

I believe Obamacare banned testing for everything except tobacco.

Edit: oh life insurance, thanks.

That's for health insurance.

I'm doubtful Obamacare would regulate life insurance.

As far as I know, life insurance policies of significant amounts still do medical exams. And care about drug use, tobacco use, high blood pressure, disclosure about things like past cancer diagnosis, lifestyle stuff (skydiving, climbing, and so on) etc.

We still don't really understand how diet affects health long term.

The effects of smoking OTOH are extremely clear.

> We still don't really understand how diet affects health long term.

I thought it was pretty clear that we do. Go talk to any physician and they will tell you the 3 things you control to increase your chances of a long & healthy life are:

1. Limit alcohol/tobacco 2. exercise frequently 3. eat a healthy diet

Are you suggesting for #3 they have no data to back that recommendation up?

Eh, yes there is data but the association is not clear and straightforward that diet is the necessary or sufficient condition for metabolic or cardiovascular diseases. What you're quoting is, in healthcare, called the "standard of care" and is the workflow that is recommended for doctors (i.e. less likely to be sued for malpractice if they follow the route). Most doctors are technicians, not researchers establishing causal claims with strong data.

Please don't misread, I agree with you in principle. I am simply pointing out there are nuances.

"Most doctors are technicians, not researchers"

Thanks. Very succinct, and helps me frame my medical interactions a bit more clearly now.

You are wrong. There are great volumes of evidence that keeping a low weight and keeping macronutrients roughly in some gap makes you live longer. I'm not sure what is left to be talking about. Specific fad diets?

I'm happy to be corrected. Can you provide some sources? And what about edge cases where people follow low caloric diets and persist their weight?

Are you seriously arguing edge cases here? It's on level with anti vaxxer claiming his smoking overweight uncle had no problems with corona hence we both don't get vaccinated.

I'm not arguing edge cases. I'm requesting sources and population considerations.

Were I to argue, I would have included source references.

This stuff is presented in middleschool and highschool health classes and pretty much everywhere on the internet if you look for life improvement advice. Weight is perhaps the single most strongly linked indicator of life expectancy.

What is your level of education? I need to know so I can give you sources I am sure you can use.

Sufficient to understand metasurveys of relevant literature and models of dynamical systems, insufficient to grok or critique individual studies outside clear statistical issues.

https://sci-hub.st/10.1371/journal.pmed.1001673 from 2014, but this has been known for decades if not centuries.

A lay explanation at https://www.nih.gov/news-events/news-releases/nih-study-find.... This is simply the first I found.

If you are able to understand this literature I am quite confused as to how you can't find it yourself -- the associations go far deeper, with increased fat intake causing plaque buildup that eventually leads to heart problems. Obesity under class III also shortens life expectancy.

Realize also that per what is laid out in that review someone who is 6" ~180lbs is obese, even if it mostly muscle. Even if it is obesity caused by muscle instead of fat, you don't live as long.

Thank you. Will review.

I don’t believe that there are any studies which show that macronutrient percentages make you live longer.

They have a lot of recommendations. The problem is that they change radically about once per decade.

~10 years ago they still thought eating fat made you fat, and recommended high carb diets.

Perhaps the 2021 recommendations are finally the correct ones. But how do I know that?

Yeh, that's science. As we learn more the guidance is refined. Generally speaking for decades the guidance has been to eat a well balanced diet—that hasn't changed.

There is also a second issue, government agencies have been co-opted by industry to make recommendations not supported by the science. I'm specifically thinking about recommendations around fat&sugar, the same thing you called out that indicates the problem is not the science but rather regulatory capture.

#America

What makes you think it is different in other countries?

I didn't, nor did I imply.

OSHA is America-based, yes?

Your comment was literally "#America", certainly this implies you think it's different in other countries, otherwise, why would you highlight the Americanness?

> OSHA is America-based, yes?

You were responding to a tangent about life insurance, that had nothing to do with OSHA nor anything else US-specific.

Most EU countries reached high vaccination rate without extreme measures because people here are not poisoned with right wing propaganda.

Not true. Germany has the "three g" mandate (and it has faced significant pushback). France has no vaccination mandate but does have policies to encourage it, which have also faced massive protests. Both and the US have first-dose vaccination rates within ten percentage points of each other.

In all three countries, the pushback is primarily from populist/right-wing political movements. This is not a strictly American phenomenon.

>In all three countries, the pushback is primarily from populist/right-wing political movements.

This article says, at least in the US, the poor and young are the least likely to get a vaccine. You have any data for your political assertion that it's primarily right wingers? Keep in mind, politicizing COVID is what got us where we are today.

https://www.vox.com/22587443/covid-19-vaccine-refusal-hesita...

note that I wrote "MOST EU countries". So, you suggestion that it's not true makes zero sense.

Besides the (insane and infuriating) politicization of the vaccine, I wonder how much of the problem comes down to a fear of the US healthcare system for those who are uninsured or have catastrophic-only coverage. I worry that people fear they'll go in for a “free” shot and end up getting a $300 bill in the mail, because hidden costs abound in the US healthcare system. (Even though we know that they won't)

"They" might. I blacked out after my second Pfizer shot, and was ambulanced to an ER. This was $4k, not really my choice. Yes, I have health insurance. Everything was repriced to the 'negotiated' insurance rate, and it was still ~$2k. On top of the $1k/month I already pay (me and spouse). I would get the shot again, without a doubt, but it still hits people.

This is extremely insightful. I wonder how many uninsured/underinsured people are afraid of getting hit with an unexpected medical bill? I'll be honest, having insurance I often times don't think of these things.

There was a period of my life in which I was underinsured (catastrophic only). I ended up burning my foot badly enough that the nurse line insisted I do to urgent care. Three people walked in, looked at my foot, told me not to pop the blister. I walked away with two pain pills and a bill for $4,000 that I negotiated down to about $3200.

You’re sure as hell right that it was going to take something catastrophic for me to walk through those doors again.

Edit: I have a job that offers decent insurance now, but my immediate emotional reaction to healthcare in the United States is very negative (even though I quite like my doctor, dentist, etc). I believe our system is corrupted and abusive towards the poor.

I think more it’s an indirect side effect. Healthcare is so expensive that people no longer go to a family doctor but avoid the doctor and get their information/advice from their social circle and the Internet or alternative medicine.

I think people are truly terrified of the long-term effects due to over-litigation here in America.

You can't turn on the TV, Facebook, YouTube, etc. without a class action lawsuit message in the form of: "Have you used baby powder in the past 2 years? If so, you may be eligible for compensation under the Talcum Powder Class Action Lawsuit, call us at..."

The seemingly "safe" things in America that we take for granted, like baby powder, or Round-Up weed killer, or even tap water in Michigan has turned out to be not so safe.

so these people are OKAY with getting COVID and die but afraid of hidden costs? how does that make any sense?

The young and minorities have some of the highest rates of not being vaccinated. Are those demographics heavily right wing?

do you have any evidence of what you said?

Just to clarify something. When I said minorities I was only talking about Hispanic and black. Not Asian. I should have been more precise in my wording.

Breakdown by age

https://www.mayoclinic.org/coronavirus-covid-19/vaccine-trac...

Here is a breakdown by race in each state

https://www.bloomberg.com/graphics/covid-vaccine-tracker-glo...

Did you have breakdown by political party?

Younger people along with Hispanics and blacks are more likely members of the Democratic Party than other parties. I haven't seen the vaccine rate and party breakdown though.

Like it or not, but it's the GOP that fights covid measures tooth and nails and poisons society with insane propaganda while their own supporters die every day. Hopefully any prospect of GOP taking back the house and the Senate will die as well

Canada achieved a high vaccination rate without resorting to lotteries (in most provinces, anyway), or mandates (until this month).

The rate might be higher, but we have our share of anti-vax people - including some violent protests at the Prime Minister lately, causing him to cancel rally events.

In our office, we have a number of people I know aren't vaccinated.

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