Thursday, September 17, 2009
Political Mayhem Thursday: Is it fair to charge smokers more for health care?
Yesterday, Sen. Max Baucus released details of his health insurance reform proposal, which is now at the center of the health care debate.
One aspect of that plan is that it would allow insurers to charge smokers 50% more than they do similarly situated individuals, even when offering group insurance. On its face, this makes perfect sense, as smokers are far more unhealthy than the rest of us, and choose to have this condition. The choosing part distinguishes smoking from other health risks which are part of our genetic predisposition, such as a history of breast cancer in a family. Why not charge those who choose to be unhealthy more than the rest of us?
One reason not to charge smokers more has to do with income. Smokers tend to be poor and uneducated. The effect of this disparity would be to charge more to those who can least afford it. In other words, it would be regressive relative to income.
My view is that the problems of being poor and uneducated are compounded by smoking and the health issues that result. Choosing to smoke, for example, almost guarantees that you will not be around for as much of your child's life as you would be otherwise. If you cannot afford to smoke and have health insurance, you should quit smoking. Certain freedoms are expensive, and smoking enough cigarettes that you miss your child's graduation should be one of them. The fact is that the result will be that the wealthy will have one more benefit the poor do not enjoy-- that is, to both smoke and have health insurance. In my mind, that unfairness is a net benefit if the result is that more people quit smoking.
I'm sure there will be those who disagree. That's why I have a comments section!
Comments:
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As a smoker, I have to disagree with your choice part of the discussion. I started smoking without thinking it'd be a future thing. That doesn't make it right; however, I don't really consider it so much of a choice as whether to vote or not.
That is off point though, does that mean people that dip won't be charged more? I'm trying to get into dipping more and smoking less because I like being able to run up stairs. However, I've heard dipping is even worse.
If you want to say that we're giving the finger to cancer patients for the fact that they enjoy tobacco, it should apply to everyone.
-Brennan
That is off point though, does that mean people that dip won't be charged more? I'm trying to get into dipping more and smoking less because I like being able to run up stairs. However, I've heard dipping is even worse.
If you want to say that we're giving the finger to cancer patients for the fact that they enjoy tobacco, it should apply to everyone.
-Brennan
# posted by 
: 1:31 AM
: 1:31 AM
I'm all for it. I'd have more of a problem with the pseudo-social engineering aspects of the plan if:
1) choosing to smoke didn't endanger and inconvenience other people as much as if not more than the smoker,
2) charging smokers more didn't make perfect actuarial sense, and
3) going to smoke-free bars wasn't such a vastly more pleasant experience.
1) choosing to smoke didn't endanger and inconvenience other people as much as if not more than the smoker,
2) charging smokers more didn't make perfect actuarial sense, and
3) going to smoke-free bars wasn't such a vastly more pleasant experience.
This kind of passive aggressive social engineering doesn't work, though. Education and information have reduced the number of smokers, not sin taxes and higher prices. That just forces tobacco companies to make an inferior, more dangerous, more addictive product to keep those same margins (seriously; compare Latin American cigar production to American cigarette production).
It's still class warfare if it comes dressed in the guise of patronizing altruism.
It's still class warfare if it comes dressed in the guise of patronizing altruism.
It also unfairly singles out one unhealthy behavior that people choose -- what about people who drink too much? What about people who drive long commutes (who are also endangering us), or drive to work at all, as opposed to biking or taking public transport? What about people with unhealthy diets -- will they be charged extra too?
It's a part of the American cultural bias against smoking, and while I don't smoke, it's unfair.
As an aside, I saw a doctor in the spring who was filling in the computer record (they re-check it every time) and asked if I smoke. I said, "No...I mean, maybe like one per year, just to remind myself that I don't like it." Two days later I had another doctor's appointment, and while doing the initial check up she asked, "Do you still smoke 'occasionally'?" There was no box to check, and she felt she had to check a box, so she did that one; I protested, and now am listed as a "passive smoker" -- if it were to affect my insurance premiums, I'd be pretty upset...
It's a part of the American cultural bias against smoking, and while I don't smoke, it's unfair.
As an aside, I saw a doctor in the spring who was filling in the computer record (they re-check it every time) and asked if I smoke. I said, "No...I mean, maybe like one per year, just to remind myself that I don't like it." Two days later I had another doctor's appointment, and while doing the initial check up she asked, "Do you still smoke 'occasionally'?" There was no box to check, and she felt she had to check a box, so she did that one; I protested, and now am listed as a "passive smoker" -- if it were to affect my insurance premiums, I'd be pretty upset...
# posted by : 9:00 AM
: 9:00 AM
Septimus-
I'd love to see the kinds of "responsibility" premiums you're talking about on other things, like voluntary obesity. Because health insurance is largely employer based and organized around group coverage, there's not much room in the system for personal responsibility. We should perhaps look at that aspect of health coverage the way we look at life insurance rates. If you chose to be a risk, we well insure you like a risk. Especially since we'll be paying the bill on a new gov't subsidized system for the next 9 generations.
Lane-
Doesn't a term like "class warfare" implicate an element of intent? Are you saying Max Baucus is out to get poor people?
I'd love to see the kinds of "responsibility" premiums you're talking about on other things, like voluntary obesity. Because health insurance is largely employer based and organized around group coverage, there's not much room in the system for personal responsibility. We should perhaps look at that aspect of health coverage the way we look at life insurance rates. If you chose to be a risk, we well insure you like a risk. Especially since we'll be paying the bill on a new gov't subsidized system for the next 9 generations.
Lane-
Doesn't a term like "class warfare" implicate an element of intent? Are you saying Max Baucus is out to get poor people?
No, Jesse, I'm talking about societal structures, cultural mores, and the like. Max Baucus isn't a nefarious villain out to get poor people. The capitalist system that Baucus is a part of, the health care lobby within that system, etc. are out to "get" poor people, in the sense of not caring about disproportionate impact because the poor have little to no economic power.
I seem to remember signing up for group health insurance at work in the late 80's and a question on the form asked if I or anyone in my household was a smoker. For some reason, I think it impacted the premium the smoker paid versus the non-smoker.
Brennan - people who dip have higher incidents of oral cancer.
Now the question might be, should people pay a premium because they engage in behavioral health risks? Smoking, drinking, dipping, overeating, going to tanning salons or spending time outdoors with out taking proper precautions (sunscreen, hats, etc...).
Should people be penalized in our health insurance industry for developing cancers there is no or little proof we can control? Prostate, Breast, Ovarian, Pancreatic, etc.... These for the most part on non-behavioral illnesses yet if you are diagnosed with one of these cancers you will be priced out of individual insuance coverage.
Brennan - people who dip have higher incidents of oral cancer.
Now the question might be, should people pay a premium because they engage in behavioral health risks? Smoking, drinking, dipping, overeating, going to tanning salons or spending time outdoors with out taking proper precautions (sunscreen, hats, etc...).
Should people be penalized in our health insurance industry for developing cancers there is no or little proof we can control? Prostate, Breast, Ovarian, Pancreatic, etc.... These for the most part on non-behavioral illnesses yet if you are diagnosed with one of these cancers you will be priced out of individual insuance coverage.
Smoking is sweet. It makes you look cool. Chicks dig it. It makes the world look like it is full of rainbows and unicorns.
You guys are all missing out by not smoking. It is totally boss.
Cool Smokers:
Keith Richards, Johnny Depp, Michael Corleone in the Godfather, all of the Beatles, Barack Obama, Slash, really ever single cool rockstar/writer/or actor, the president on the West Wing, every character on Mad Men...I mean, the list could go on forever.
Cool People that don't smoke:
Nobody.
Don't tread on me. Smoke 'em if you got 'em.
You guys are all missing out by not smoking. It is totally boss.
Cool Smokers:
Keith Richards, Johnny Depp, Michael Corleone in the Godfather, all of the Beatles, Barack Obama, Slash, really ever single cool rockstar/writer/or actor, the president on the West Wing, every character on Mad Men...I mean, the list could go on forever.
Cool People that don't smoke:
Nobody.
Don't tread on me. Smoke 'em if you got 'em.
# posted by : 12:05 PM
: 12:05 PM
I'm concerned about taxes being regressive; I want insurance rates to reflect actual risks.
I care about the structural problems the poor and uneducated face, but we shouldn't implement social policy by controlling policy rates.
I care about the structural problems the poor and uneducated face, but we shouldn't implement social policy by controlling policy rates.
I agree with Lane, on the basis that sumptuary taxes like this generally don't have the desired effect. They are very popular, though, as a way of increasing revenue without raising taxes on most people. I'd say the lowered health care costs would be nice, but it's not goign to help a lot of people who either dont have health insurance or won't stop smoking because of it. I'd rather my health insurance cover my gym membership, or the government provide a tax benefit for belonging to a gym. Carrots generally work better than sticks when it comes to personal habits.
JT-
You're right that carrots work better than sticks, except in this situation the "carrot" is you own health and the "stick" is your own death. Both are obviosuly too remote for smokers to seriously consider.
And it's asinine to carry on this conversation under the pretense that anyone who is poor enough to raise legit concerns about disproportionate impact is not poor enough to qualify for Medicaid. Doubly so if ObamaCare passes. It's not really about what they're going to pay in premiums, it's what we're going to pay in premiums for them. So it's our call, and I say quit smoking so we don't get zinged with the actuarial reality of your high risk factors.
You're right that carrots work better than sticks, except in this situation the "carrot" is you own health and the "stick" is your own death. Both are obviosuly too remote for smokers to seriously consider.
And it's asinine to carry on this conversation under the pretense that anyone who is poor enough to raise legit concerns about disproportionate impact is not poor enough to qualify for Medicaid. Doubly so if ObamaCare passes. It's not really about what they're going to pay in premiums, it's what we're going to pay in premiums for them. So it's our call, and I say quit smoking so we don't get zinged with the actuarial reality of your high risk factors.
Charging more for smokers seems unfair since its still a legal activity.
Then again, so is auto racing, mountain climbing, operating chain saws and other risky actitivies.
The whole line-drawing thing starts to get a little creepy. Should people in Detroit pay more since the risk of being impacted by crime is higher there? Or people who live in one climate or another?
How about people in high stress jobs?
If there really was competition amongst health insurers (and I don't have a choice -- I guess my employer does), they could try offering different levels of protection for those doing dangerous things.
Factor in this: Some people are more susceptible to cancer than others. People with certain genetic make ups might smoke for 60 years and never get cancer, whilst others might get lung cancer from .... nothing at all.
Should we screen people genetically and charge more based upon their chromosones?
Then again, so is auto racing, mountain climbing, operating chain saws and other risky actitivies.
The whole line-drawing thing starts to get a little creepy. Should people in Detroit pay more since the risk of being impacted by crime is higher there? Or people who live in one climate or another?
How about people in high stress jobs?
If there really was competition amongst health insurers (and I don't have a choice -- I guess my employer does), they could try offering different levels of protection for those doing dangerous things.
Factor in this: Some people are more susceptible to cancer than others. People with certain genetic make ups might smoke for 60 years and never get cancer, whilst others might get lung cancer from .... nothing at all.
Should we screen people genetically and charge more based upon their chromosones?
IPLG--
Of course not. Genetic predisposition is not a chosen behavior like smoking, and you deter nothing (except people being insured).
Of course not. Genetic predisposition is not a chosen behavior like smoking, and you deter nothing (except people being insured).
I think we should charge higher premiums for lameness. Lameness factors would include the following:
-not smoking...lame.
-being a hippie.
-having attended Texas A&M.
-wearing a Che shirt.
-watching Bill O'Reilly.
-watching Keith Olbermann.
-ever referring to Beaudrillard, unless you're saying something like, "what are you, Beaudriallard?" in a mocking tone to make fun of some hippie.
-liking The Velvet Underground.
-discussing "American Beauty" in terms of existentialism or post-modernity.
-Living in a state other than Texas (IPLawguy is excluded from this, for no particular reason other than he is totally boss...like a smoker)
-not believing that the Rolling Stones' "Sticky Fingers" is one of the best albums ever recorded.
-ever uttering the words, "I'm just not that into Otis Redding."
-ever uttering the words, "I just don't get the whole Sam Cooke thing."
-not liking "All in the Family."
There are probably more. I will create a commission or a czar to come up with them.
Smoke 'em if you got 'em.
-not smoking...lame.
-being a hippie.
-having attended Texas A&M.
-wearing a Che shirt.
-watching Bill O'Reilly.
-watching Keith Olbermann.
-ever referring to Beaudrillard, unless you're saying something like, "what are you, Beaudriallard?" in a mocking tone to make fun of some hippie.
-liking The Velvet Underground.
-discussing "American Beauty" in terms of existentialism or post-modernity.
-Living in a state other than Texas (IPLawguy is excluded from this, for no particular reason other than he is totally boss...like a smoker)
-not believing that the Rolling Stones' "Sticky Fingers" is one of the best albums ever recorded.
-ever uttering the words, "I'm just not that into Otis Redding."
-ever uttering the words, "I just don't get the whole Sam Cooke thing."
-not liking "All in the Family."
There are probably more. I will create a commission or a czar to come up with them.
Smoke 'em if you got 'em.
# posted by : 5:05 PM
: 5:05 PM
Last week, I was talking to someone over at the Herald-Tribune, who mentioned that my commenters are pretty awesome. It's true.
I think saying "boss" in the context that RRL does is pretty lame and should require a higher premium.
Of course, If I'm poor and the difference in cost is gonna be a few hundred dollars, i'm just gonna check the box that says I don't smoke and the box that corresponds to me not saying "boss" as I light up another cig....now that would be boss
Of course, If I'm poor and the difference in cost is gonna be a few hundred dollars, i'm just gonna check the box that says I don't smoke and the box that corresponds to me not saying "boss" as I light up another cig....now that would be boss
# posted by : 7:24 PM
: 7:24 PM
I like Otis Redding and Sam Cooke.
IPLaw - there is no crime in Detroit - no one lives there anymore!
IPLaw - there is no crime in Detroit - no one lives there anymore!
Baudrillard.
Beaudrillard sounds like a French porn studio.
And Jesse, what about the working poor? Those with enough money to not get Medicaid and not be on an employer's health care plan? Point is - as long as there are policies like this in place, they'll reflect power imbalances. For RRL, that's Foucault, not Baudrillard. Hyperreal, huh?
Beaudrillard sounds like a French porn studio.
And Jesse, what about the working poor? Those with enough money to not get Medicaid and not be on an employer's health care plan? Point is - as long as there are policies like this in place, they'll reflect power imbalances. For RRL, that's Foucault, not Baudrillard. Hyperreal, huh?
Oh Lane...you beat me to it, with greater humour than I would have pulled off (though the affected European spelling of humor is for RRL's sake).
# posted by : 10:14 PM
: 10:14 PM
I'm European but in my country we don't spell "humor" that way, but we did learn that anything "commie grown" was bad. Hence why we wanted some missles in case the Russians came up with another great idea they wanted us to learn.
# posted by : 10:41 PM
: 10:41 PM
Without having read all the comments, I have to say I disagree. For one thing, it's not a given that you'll be missing your child's graduation because you smoke. I stand by my own guiding principle on this: people should be able to put whatever they want into their own bodies, as long as it's not hurting anyone else. By hurting anyone else, I mean physically injuring someone else, endangering someone else's life. If a smoker doesn't smoke around his kids, or around anyone else, that's fine with me.
Yes, perhaps smoking is irresponsible in that you might not live as long, but you could die early from drinking, or choosing to do dangerous sports. Are we going to charge heavy drinkers and people who bungee-jump or drive fast cars on dangerous mountain roads or climb ridiculously steep mountains with their bare hands?
I haven't read any news about Baucus's plan, so I can't say much, but if that's the main way the Dems plan to recoup the money spent on health-care reform, it seems awfully simplistic.
I suppose there are already "sin taxes", true, but those are not just on cigarettes.
Yes, perhaps smoking is irresponsible in that you might not live as long, but you could die early from drinking, or choosing to do dangerous sports. Are we going to charge heavy drinkers and people who bungee-jump or drive fast cars on dangerous mountain roads or climb ridiculously steep mountains with their bare hands?
I haven't read any news about Baucus's plan, so I can't say much, but if that's the main way the Dems plan to recoup the money spent on health-care reform, it seems awfully simplistic.
I suppose there are already "sin taxes", true, but those are not just on cigarettes.
# posted by : 10:44 PM
: 10:44 PM
SG--
Um, yeah, actually insurers charge people more when they engage in those behaviors, or won't insure them at all.
The question isn't whether or not people should be allowed to smoke, but whether it is fair for the rest of us to subsidize the resulting health care costs rather than charging them more.
Um, yeah, actually insurers charge people more when they engage in those behaviors, or won't insure them at all.
The question isn't whether or not people should be allowed to smoke, but whether it is fair for the rest of us to subsidize the resulting health care costs rather than charging them more.
And RRL, I'm glad that I would not be totally lame in your book, since I do not meet all your criteria. And hey, you actually said Barack Obama is cool. There may be hope for you yet.
# posted by : 11:06 PM
: 11:06 PM
The question isn't whether or not people should be allowed to _______, but whether it is fair for the rest of us to subsidize the resulting health care costs rather than charging them more.
smoke, eat fast food, ride a motorcycle, live under power lines, microwave styrofoam, swallow swords, etc. The idea itself is solid.. where to draw the line is where it gets tricky. At what point does something become risky enough to charge extra for? And who makes that decision?
smoke, eat fast food, ride a motorcycle, live under power lines, microwave styrofoam, swallow swords, etc. The idea itself is solid.. where to draw the line is where it gets tricky. At what point does something become risky enough to charge extra for? And who makes that decision?
Well, yes . . . what Justin said.
I suppose for me this bleeds into the issue of life, liberty and the pursuit of happiness: suddenly being charged a lot more to continue a habit you've already started, and probably enjoy, seems to cut into those principles.
I know, it's not fair that non-smokers subsidize smokers' health care. Part of me feels that unfairness, but on balance I'm not as bothered by that as I am by the fact that my tax dollars support war and the death penalty, which seem worse to me. There's always something we subsidize that we don't agree with.
I suppose for me this bleeds into the issue of life, liberty and the pursuit of happiness: suddenly being charged a lot more to continue a habit you've already started, and probably enjoy, seems to cut into those principles.
I know, it's not fair that non-smokers subsidize smokers' health care. Part of me feels that unfairness, but on balance I'm not as bothered by that as I am by the fact that my tax dollars support war and the death penalty, which seem worse to me. There's always something we subsidize that we don't agree with.
# posted by : 11:31 PM
: 11:31 PM
I actually feel proud I didn't spell
his name correctly. Though I'm
disappointed in myself for not
mentioning Foucault in my list of
things that make people lame.
I can see Lane in his smoking jacket
with his Cuban cigars (I smoke
Marlboro lights because I'm just a
poor dumb redneck that doesn't
appreciate the finer things...like
silly European philosophers) laughing
as he mocks my silliness for
getting Baudrillards name wrong.
Needless to say, that mental image is
now on the lame list.
And that is boss.
RRL
his name correctly. Though I'm
disappointed in myself for not
mentioning Foucault in my list of
things that make people lame.
I can see Lane in his smoking jacket
with his Cuban cigars (I smoke
Marlboro lights because I'm just a
poor dumb redneck that doesn't
appreciate the finer things...like
silly European philosophers) laughing
as he mocks my silliness for
getting Baudrillards name wrong.
Needless to say, that mental image is
now on the lame list.
And that is boss.
RRL
# posted by : 11:38 PM
: 11:38 PM
To everything there is a season... a time to smoke Cubans with Lane in his smoking jacket, and a time to smoke Marlboros with RRL in the vacant lot behind Scruffy's. Turn, turn, turn.
# posted by : 11:44 PM
: 11:44 PM
Don't forget Nietzsche, Camus, Sartre, De Beauvoir (she gets extra 'cus she's a woman), Hegel, Marty Heidegger (who, I am told, was a boozy beggar), and my personal favs, Karl Marx, Georg Lukacz, Edmund Husserl and Marcel Merleau-Ponty.
It's like the standard reading list for America-hating pseudo-intellectuality. I'm so glad Obama invents a time machine in 2015 and travels back in time to institute mandatory socio-fascist brainwashing.
It's like the standard reading list for America-hating pseudo-intellectuality. I'm so glad Obama invents a time machine in 2015 and travels back in time to institute mandatory socio-fascist brainwashing.
RRL:
About your list... yeah... I can't argue that the Beatles didn't smoke, but I thought that it was kind of implied that the people on your list were famous for smoking some form of tobacco? What the Beatles actually smoked was a matter of much debate (or little debate, depending on who you ask).
Also, mountain climbers have undergone hundreds of hours of training to make sure that they don't fall. You don't take a class about cigarette smoking.
About your list... yeah... I can't argue that the Beatles didn't smoke, but I thought that it was kind of implied that the people on your list were famous for smoking some form of tobacco? What the Beatles actually smoked was a matter of much debate (or little debate, depending on who you ask).
Also, mountain climbers have undergone hundreds of hours of training to make sure that they don't fall. You don't take a class about cigarette smoking.
Did we all forget that Baylor Law school would be in its current digs without all those people smoking!?
Had we kept people healthy and prevented the smoking by jacking up their rates, we would have had to go to school somewhere that didn't have bodies washing up next to such a nice building.
Maybe the dead guys in the river were guys who had passed because of their unhealthy choices.
Had we kept people healthy and prevented the smoking by jacking up their rates, we would have had to go to school somewhere that didn't have bodies washing up next to such a nice building.
Maybe the dead guys in the river were guys who had passed because of their unhealthy choices.
# posted by : 8:06 AM
: 8:06 AM
Insurance policy rates reflect actuarial risk. If an insured belongs to a higher risk category then they should pay a higher rate to be insured. Why should the underwriter of the policy assume that risk? A private underwriter can choose (or not) to accept the risk of the insured based on actuarial outcomes. A private underwriter always has that choice.
If the government is the underwriter then the government will have to come to terms with the disparity in risk. To some degree it could be construed as social engineering, but certainly not in way that Lane suggests. In fact, the exact opposite. Actuarial facts are not an attempt to moderate behavior, only to account for it in a monetizable sense. It introduces more social engineering when what should be higher rates based on risk are subsidized by the least at risk of us. Bad behaviors do not stop at socio-economic boundaries. They abound on both sides of the tracks. This is not a regressive tax like a sales tax. There is nothing wrong with paying a fair price for a fair product. You can make always choices that move you from one risk pool to another. If a "fair" product costs you more money than it costs me because I fall into a different risk pool, well then, life isn't fair. Get over it, or do something about it. No amount of money given to you or taken from you will make it any different.
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If the government is the underwriter then the government will have to come to terms with the disparity in risk. To some degree it could be construed as social engineering, but certainly not in way that Lane suggests. In fact, the exact opposite. Actuarial facts are not an attempt to moderate behavior, only to account for it in a monetizable sense. It introduces more social engineering when what should be higher rates based on risk are subsidized by the least at risk of us. Bad behaviors do not stop at socio-economic boundaries. They abound on both sides of the tracks. This is not a regressive tax like a sales tax. There is nothing wrong with paying a fair price for a fair product. You can make always choices that move you from one risk pool to another. If a "fair" product costs you more money than it costs me because I fall into a different risk pool, well then, life isn't fair. Get over it, or do something about it. No amount of money given to you or taken from you will make it any different.
# posted by : 4:30 PM
: 4:30 PM << Home
