bbchangeup
Shy Member
Posts: 38 
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Post by bbchangeup on May 4, 2017 1:22:49 GMT
As faculty at a major university who teaches public health, I am intrigued by the threads about insurance coverage. Certainly, many diseases affect people who have no risk factors for that disease, and who have played no part in the development of the disease, just “dumb luck” or genetics. We've seen multiple examples posted by the peas. Unfortunately, however, a great deal of the most common chronic diseases we see in the United States are definitely lifestyle related. I’m interested in opinions about what level of responsibility we, as individuals, have for living a lifestyle that prevents the development of these diseases. As we wrestle with health care costs, does the individual have any responsibility for maintaining a healthy diet, exercising and avoiding known substances that cause things such as heart disease, lung disease and cancer? “Among U.S. adults, more than 90 percent of type 2 diabetes, 80 percent of CAD, 70 percent of stroke, and 70 percent of colon cancer are potentially preventable by a combination of nonsmoking, avoidance of overweight, moderate physical activity, healthy diet, and moderate alcohol consumption” (Willett 2002). Walter Willett is a professor of nutrition and epidemiology at the Harvard School of Public Health and has published more than 1500 articles. He is currently one of the primary researchers of the Harvard Nurses’ Health Study 2, which is a longitudinal study of the health of nurses over many years beginning in 1989 and continuing to this day. Ninety percent of nurses originally in the study (including me!) still participate. Prevention of Chronic DiseaseWhen the Affordable Care Act was being debated, it was all about access to care. Are we living in a society where people demand health care access but feel no sense of responsibility for their own health? Would it not bring down health care costs dramatically if we could significantly reduce the incidence of heart disease, diabetes, lung disease, and cancer? Is that not a logical place to start trying to control costs? It is interesting that we charge more for automobile insurance for those who have multiple traffic tickets or multiple accidents. Is it so far-fetched to consider a person paying more if they choose an unhealthy lifestyle? I DO understand that we don't choose many things that happen to us health-wise, but our biggest cost items, as stated by Dr. Willett, ARE lifestyle choice related. So what is the responsibility of the individual? And if you don't believe he/she has any, what are your ideas about how we control costs from these relatively preventable diseases? What say the peas? |
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Post by myshelly on May 4, 2017 1:37:59 GMT
The problem is that a lot of things rich people (i.e. law makers, insurance executives, and doctors) view as "lifestyle choices" are simply facts of life for people who live in poverty.
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Deleted
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May 18, 2024 1:34:33 GMT
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Post by Deleted on May 4, 2017 1:45:03 GMT
I would not go down this rabbit hole.
Some diseases can be prevented by a healthy lifestyle. Some can't. There was a famous runner back in the 70s/80s drop dead of a massive heart attack. And recent bob ( the guy from the biggest loser ) had heart problems. I don't think you could get a healthier lifestyle than his.
Maybe it would be better to get rid of all for profit insurance?
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keithurbanlovinpea
Pearl Clutcher
Flowing with the go...
Posts: 4,271
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Post by keithurbanlovinpea on May 4, 2017 1:48:21 GMT
I would rather see the rates be the same for all and then be reduced if you improve your health. Lower your A1C, stop smoking, etc. Although I get your point. Life insurance is cheaper if you are healthier. I get a discount on my corporate sponsored health plan if I meet certain health screening markers.
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Post by lovinlife on May 4, 2017 1:49:42 GMT
That really is a difficult situation since I agree people are responsible for their health but let's face it there are many factors in play here. It is expensive to eat healthy so is the government going to help subsidize the difference between say mac and cheese and fresh fruit? If you are living pay check to pay check and do not have insurance most people are not able to afford well care/ preventative visits. Which in the long run cost more since the problems become more serious before they see a doctor. Some of the factors such as smoking and drinking you could argue are a choice and they should be responsible for those problems. If that is the case in if you do not exercise should you also be held accountable? I am not trying to be difficult like I said I do agree with you to a point but it's complicated.
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Post by lucyg on May 4, 2017 1:51:12 GMT
Michelle Obama tried to encourage children to eat a healthier diet and move around more, and people went batsh*t crazy. I don't see this kind of thing flying any better than that did.
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Post by epeanymous on May 4, 2017 1:56:01 GMT
You know what would be great? If instead of our health care system trying to improve health, it tried to assign blame.
Yes, that is sarcasm. I have had ulcerative colitis for decades, my whole colon is involved, and my risk of cancer is therefore sky high. I exercise every day, eat a healthy diet, and I have never smoked. I have a cousin with the same disease who had to have her colon removed. Was that because she had an even worse case and was younger at diagnosis? Because her disease responded differently to treatment? Because she was less in control of her eating, maybe in part because she had a worse case and had a lot of trouble with coping? Ugh. I kind of think having your colon out is its own "punishment." But more importantly, she and I both need treatment, and gosh, I wonder what incentives insurance companies would have to determine both of us are in positions of our own making?
Or maybe us sickies can just have chips installed so that our habits can be properly monitored.
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kate
Drama Llama
Posts: 5,517
Location: The city that doesn't sleep
Site Supporter
Jun 26, 2014 3:30:05 GMT
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Post by kate on May 4, 2017 1:56:38 GMT
I was having this discussion with some colleagues today. At this point, I think responsibility (some would say blame) for preventable diseases is much too subjective and complex to quantify.
Hypothetically: is my knee replacement going to cost more because I'm overweight? Well, guess what - it was bad enough to be replaced before I became overweight. Does my current weight mean I have to pay more, even though I have documented damage from ten years ago, when I was an athlete?
Or, say I'm obese and have perfect arteries. Sibling #1 is obese and has CAD. Sibling #2 is slim with CAD. Does sibling #1`pay more for care than either me or sibling #2?
The above are not true scenarios, BTW.
I also think it would usher in a whole level of shenanigans like we currently have with service animals. Some people really do need them, but the people who get "service animal" vests for their household pets are watering down the respect and rights that the working animals deserve. I imagine that smokers might look to have their smoking declared "therapeutic" (e.g. for their mental health) so that they could dodge any surcharges...
But the bottom line is that I believe in compassion. We can't possibly know whether your colon cancer was caused by poor genes or a poor diet, so let's just get you treated.
I have to think there's a better way to do health care than the way we're doing it now - and i guess I'm a little touchy about it because I just found out that the health care package offered by my employer is changing on July 1, and not for the better.
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Post by ntsf on May 4, 2017 2:34:18 GMT
if there was universal health care.. and people could develop consistent, lifelong access to healthcare.. there would be more prevention and control of disease. not perfect.. countries with this still have people with issues.. we are human.. but it would save money.. just by keeping people out of the emergency room..
and some more social support for poor and disabled.. my adult child will a disability is expected to live on $875 a month.. what kind of food will that provide.. even with supportive housing...
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Post by ntsf on May 4, 2017 2:34:54 GMT
if there was universal health care.. and people could develop consistent, lifelong access to healthcare.. there would be more prevention and control of disease. not perfect.. countries with this still have people with issues.. we are human.. but it would save money.. just by keeping people out of the emergency room..
and some more social support for poor and disabled.. my adult child will a disability is expected to live on $875 a month.. what kind of food will that provide.. even with supportive housing...
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Post by misadventurous on May 4, 2017 2:36:58 GMT
I could not agree with you more. The problem is that a lot of things rich people (i.e. law makers, insurance executives, and doctors) view as "lifestyle choices" are simply facts of life for people who live in poverty. The poverty level has hovered in the 11-15% range for the past 35 years or so, but the % of Americans with Type 2 diabetes and heart disease has skyrocketed (tripled, I believe?) in that same period. I don't think this is the answer. |
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Post by Merge on May 4, 2017 2:43:30 GMT
Let's add in the fact that there is a lot of evidence for a psychological component to obesity - how are people supposed to begin to deal with that if they don't have access to health care in the first place?
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Post by pondrunner on May 4, 2017 2:44:16 GMT
Then let's make people healthier
Let's make good tasting healthy school lunches affordable for kids
Let's make sure inner cities and rural areas have access to quality food
Let's teach people how to shop and cook on a budget
Let's feed people who are hungry with something healthier than a dollar menu cheeseburger at McDonald's
Let's make transit more efficient and shorten the workday a bit and the school day too, so people can get home with their kids before daylight is over and they can go outside and be active together
Let's subsidize the farmers who grow actual food for actual people
Let's make preventive care easier to access
Let's help people stop smoking
Let's get the additives out of our food that contribute to health problems
Let's do it, let's make people healthier
I'm in
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Post by misadventurous on May 4, 2017 2:44:40 GMT
I was having this discussion with some colleagues today. At this point, I think responsibility (some would say blame) for preventable diseases is much too subjective and complex to quantify. Hypothetically: is my knee replacement going to cost more because I'm overweight? Well, guess what - it was bad enough to be replaced before I became overweight. Does my current weight mean I have to pay more, even though I have documented damage from ten years ago, when I was an athlete? Or, say I'm obese and have perfect arteries. Sibling #1 is obese and has CAD. Sibling #2 is slim with CAD. Does sibling #1`pay more for care than either me or sibling #2? The above are not true scenarios, BTW. I also think it would usher in a whole level of shenanigans like we currently have with service animals. Some people really do need them, but the people who get "service animal" vests for their household pets are watering down the respect and rights that the working animals deserve. I imagine that smokers might look to have their smoking declared "therapeutic" (e.g. for their mental health) so that they could dodge any surcharges... But the bottom line is that I believe in compassion. We can't possibly know whether your colon cancer was caused by poor genes or a poor diet, so let's just get you treated.I have to think there's a better way to do health care than the way we're doing it now - and i guess I'm a little touchy about it because I just found out that the health care package offered by my employer is changing on July 1, and not for the better. Sure, but wouldn't it be way better to do everything we can prevent that colon cancer in the first place? Obviously in some cases there is nothing anyone could do, but in some cases there probably is, so shouldn't we be doing those things? |
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Post by freecharlie on May 4, 2017 2:48:41 GMT
I believe our insurance cost more for tobacco users. I would have no problem with a discounted price for those who are in the average weight range (I wouldn't qualify BTW) as that is a risk factor that could be controlled. BUT that opens the door to a slippery slope. I saw a health care article that mentioned a whole bunch of occupations that would have difficulty getting insurance if the proponent had their way and if they got insurance that it would be significantly higher. At where do we draw that line?
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Post by smokeynspike on May 4, 2017 2:54:43 GMT
I want LESS government regulation in just about all aspects of my life, including health care.
Melissa
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Post by freecharlie on May 4, 2017 2:59:45 GMT
I want LESS government regulation in just about all aspects of my life, including health care. Melissa Is that government regulation though or insurance market regulation? |
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Post by crazy4scraps on May 4, 2017 3:11:09 GMT
It's a very slippery slope. I know so many people who have dealt with chronic or serious illnesses that were totally not lifestyle choices, with many of them being children or teens when the issues popped up. Things like childhood cancer, celiac, MHE, ADHD, bipolar, depression, schizophrenia, etc. How is anyone supposed to determine when something is a case of lifestyle vs something that is hereditary or genetic? What about people who were exposed to their parent's smoking for decades as children like I was, or people who were subjected to alcohol or drugs before they were born? I certainly don't expect to be held accountable as an adult for something that I as a child had absolutely ZERO control over. My parents, almost all of my aunts and uncles, even most of my siblings all smoked like chimneys. I *HATED* it as a child, and I'm sure I smelled like an ashtray every day of my life until I moved out when I was 19 and I finally could live in a smoke free environment. Who knows what kind of permanent damage was done during those formative years that won't pop up until later in life? Then to complicate things even more, how about people who have been negatively impacted by pollution? This is particularly concerning with the current attempts by this administration to gut the EPA and roll back all kinds of regulations that protect the general public from the dumping or emitting of toxic substances by businesses. In short, there are far too many ailments and circumstances that are NOT caused by lifestyle to just flippantly state, "Well if you took better care of yourself, this stuff wouldn't happen."  Yeah, right. |
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Post by mellyw on May 4, 2017 3:11:45 GMT
I'll attempt to not be defensive, but I do despise the blame game America likes to play. Maybe I need to keep a cut and paste of my health conditions if I'm going to participate in these threads. I'll apologize in advance to anyone having to read my boo-hooping again. But here we go. Brain tumor at 5, survived it, just to get an ugly case of Orbital Cellulitus I wasn't supposed to survive. Giant Dermoid Cyst at 22 that wrecked my insides, including the ability to have anymore children. Bouts of kidney stones, gallbladder removed, a lovely case of Trigeminal Neuralgia ( trust me, it gets its nickname of suicide disease for a reason), Rheumatoid Arthritis, Sjogrens Syndrome, Raynauds Disease, Ulcerative Colitis. Those are truly just the highlights, every single thing has left behind complications, like Adhesive disease from the surgeries. Yes, I am overweight. I could give you a pile of excuses, but if you can read my medical records and judge, well, hell, go for it. I absolutely do my best, and will be going along O.K, and get hit with something like heart problems that put me on bed rest last year. Man, I suck. Sorry to the healthy people who have to share a world and healthcare costs with.  |
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quiltedbrain
Full Member
Posts: 429
Jun 26, 2014 3:34:53 GMT
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Post by quiltedbrain on May 4, 2017 3:13:36 GMT
As faculty at a major university who teaches public health, I am intrigued by the threads about insurance coverage. Certainly, many diseases affect people who have no risk factors for that disease, and who have played no part in the development of the disease, just “dumb luck” or genetics. We've seen multiple examples posted by the peas. Unfortunately, however, a great deal of the most common chronic diseases we see in the United States are definitely lifestyle related. I’m interested in opinions about what level of responsibility we, as individuals, have for living a lifestyle that prevents the development of these diseases. As we wrestle with health care costs, does the individual have any responsibility for maintaining a healthy diet, exercising and avoiding known substances that cause things such as heart disease, lung disease and cancer? “Among U.S. adults, more than 90 percent of type 2 diabetes, 80 percent of CAD, 70 percent of stroke, and 70 percent of colon cancer are potentially preventable by a combination of nonsmoking, avoidance of overweight, moderate physical activity, healthy diet, and moderate alcohol consumption” (Willett 2002). Walter Willett is a professor of nutrition and epidemiology at the Harvard School of Public Health and has published more than 1500 articles. He is currently one of the primary researchers of the Harvard Nurses’ Health Study 2, which is a longitudinal study of the health of nurses over many years beginning in 1989 and continuing to this day. Ninety percent of nurses originally in the study (including me!) still participate. Prevention of Chronic DiseaseWhen the Affordable Care Act was being debated, it was all about access to care. Are we living in a society where people demand health care access but feel no sense of responsibility for their own health? Would it not bring down health care costs dramatically if we could significantly reduce the incidence of heart disease, diabetes, lung disease, and cancer? Is that not a logical place to start trying to control costs? It is interesting that we charge more for automobile insurance for those who have multiple traffic tickets or multiple accidents. Is it so far-fetched to consider a person paying more if they choose an unhealthy lifestyle? I DO understand that we don't choose many things that happen to us health-wise, but our biggest cost items, as stated by Dr. Willett, ARE lifestyle choice related. So what is the responsibility of the individual? And if you don't believe he/she has any, what are your ideas about how we control costs from these relatively preventable diseases? What say the peas? You teach public health at a major university and you're coming here for answers to these questions??? I call BS. |
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Post by scrapmaven on May 4, 2017 3:17:28 GMT
My chronic issues have nothing to do w/lifestyle and everything to do w/my sympathetic nervous system. I'm a bit annoyed at the thought of that. I cannot stand that people blame lifestyle on most chronic diseases. Yes. In certain situations lifestyle does play a role, but in many many chronic diseases it's just rotten luck and we are dealt a nasty blow. You can lose weight and control diabetes or high blood pressure, but not in all cases. People shouldn't assume that I did something wrong and this is the result. I was born this way and nothing could have prevented any of this.
ETA: I didn't click on your link, because I don't click on links when I'm suspicious.
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Post by elaine on May 4, 2017 3:22:10 GMT
Well, if we seriously - not just theoretically - go down that rabbit hole, then we most certainly should do away with guns, which contribute quite a bit to our mortality rate. Because people should gladly want to acknowledge and accept responsibility for the fact that there is a substantial number of injuries and death caused by handguns each year, and be willing to pass strict gun control legislation to control healthcare costs.
I have Graves Disease, caused by nothing. I have had tens of thousands of dollars of surgeries and medical treatment because of it. My docs actually speculate that it was my training for half-marathons that stressed my body and triggered an attack on my eyes.
My son has Osteogenesis Imperfecta - aka Brittle Bone Disease - caused by a spontaneous genetic mutation.
These are two clear instances, in my family alone, where healthy lifestyle had absolutely nothing - or may actually have CONTRIBUTED- to serious health conditions. What is the answer for that?
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Post by elaine on May 4, 2017 3:23:16 GMT
As faculty at a major university who teaches public health, I am intrigued by the threads about insurance coverage. Certainly, many diseases affect people who have no risk factors for that disease, and who have played no part in the development of the disease, just “dumb luck” or genetics. We've seen multiple examples posted by the peas. Unfortunately, however, a great deal of the most common chronic diseases we see in the United States are definitely lifestyle related. I’m interested in opinions about what level of responsibility we, as individuals, have for living a lifestyle that prevents the development of these diseases. As we wrestle with health care costs, does the individual have any responsibility for maintaining a healthy diet, exercising and avoiding known substances that cause things such as heart disease, lung disease and cancer? “Among U.S. adults, more than 90 percent of type 2 diabetes, 80 percent of CAD, 70 percent of stroke, and 70 percent of colon cancer are potentially preventable by a combination of nonsmoking, avoidance of overweight, moderate physical activity, healthy diet, and moderate alcohol consumption” (Willett 2002). Walter Willett is a professor of nutrition and epidemiology at the Harvard School of Public Health and has published more than 1500 articles. He is currently one of the primary researchers of the Harvard Nurses’ Health Study 2, which is a longitudinal study of the health of nurses over many years beginning in 1989 and continuing to this day. Ninety percent of nurses originally in the study (including me!) still participate. Prevention of Chronic DiseaseWhen the Affordable Care Act was being debated, it was all about access to care. Are we living in a society where people demand health care access but feel no sense of responsibility for their own health? Would it not bring down health care costs dramatically if we could significantly reduce the incidence of heart disease, diabetes, lung disease, and cancer? Is that not a logical place to start trying to control costs? It is interesting that we charge more for automobile insurance for those who have multiple traffic tickets or multiple accidents. Is it so far-fetched to consider a person paying more if they choose an unhealthy lifestyle? I DO understand that we don't choose many things that happen to us health-wise, but our biggest cost items, as stated by Dr. Willett, ARE lifestyle choice related. So what is the responsibility of the individual? And if you don't believe he/she has any, what are your ideas about how we control costs from these relatively preventable diseases? What say the peas? Well, yeah. You have a very rational point.  |
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Post by hollymolly on May 4, 2017 3:23:25 GMT
Slippery slope.
There are tons of life choices that could make a person higher risk for health care. Someone who skis regularly is at more risk of broken bones. The more you are in your car the greater your chance of being in a car accident. If you choose to drive to your vacation instead of fly, again car accidents are much more prevalent than air accidents.
If you choose to live where you have a long commute, you could have poor health from spending so much time cramped in the seat of your car unable to move around much.
If you engage in unsafe sex with multiple partners, you have an increased risk of STDs which can have long ranging effects on your health.
If you choose not to vaccinate your children, you risk them contracting the disease. If you are immunocompromised and you choose to leave your home and expose yourself to people, you are putting yourself at risk for any number of diseases.
Let's just forgive people their "bad" choices and take care of each other.
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Post by iamkristinl16 on May 4, 2017 3:24:05 GMT
I agree that people should take more responsive for their health, for both prevention and improvement of diseases. But it is a complex issue. I would also like for the government to stop helping big businesses ruin ok food system and environment, which do a lot to affect our health negatively.
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Post by chaosisapony on May 4, 2017 3:47:02 GMT
How is an insurance company to determine that person A's diabetes and high blood pressure are caused by a poor diet but person B's diabetes and high blood pressure are just a result of bad genes and bad luck? They can't and they shouldn't even try. The issue is by far more complex than simply telling people "Sorry, you have made poor lifestyle choices therefore you'll be penalized with higher premiums" can solve.
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katybee
Drama Llama
Posts: 5,378
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Post by katybee on May 4, 2017 4:10:26 GMT
As long as insurance companies are FOR PROFIT, they will find any way they can to charge people more and provide fewer benefits. I am all for giving people discounts for maintaining a healthy weight or not smoking… but for the benefit of other people, not huge insurance companies. I am completely against charging higher premiums for people with "pre-existing conditions". Is having the BRCA gene a pre-existing condition? My brother has kidney cancer, which puts me at a higher risk. Is that a pre-existing condition? My dad had heart disease and diabetes, which puts me at a higher risk. Is that a pre-existing condition? Like I said in another thread, I had hernia surgery when I was nine. Does that put me in a high risk pool? It did 15 years ago… I occasionally have a margarita. Or a glass of wine. Should I pay more? But wait--red wine has health benefits, so maybe I should pay less.
Don't kid yourself. Insurance companies will ALWAYS choose the bottom line over the well being of their patients. I've seen it every day since my brother was diagnosed 6 years ago. Congress is passing a law for the insurance companies and their stockholders. Not for me, not for you.
You take the profit out of the healthcare industry, and then I might be more willing to see your point of view (but since I believe health care is a basic human right, I probably won't).
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Post by crimsoncat05 on May 4, 2017 4:12:28 GMT
Then let's make people healthier Let's make good tasting healthy school lunches affordable for kids Let's make sure inner cities and rural areas have access to quality food Let's teach people how to shop and cook on a budget Let's feed people who are hungry with something healthier than a dollar menu cheeseburger at McDonald's Let's make transit more efficient and shorten the workday a bit and the school day too, so people can get home with their kids before daylight is over and they can go outside and be active together Let's subsidize the farmers who grow actual food for actual people Let's make preventive care easier to access Let's help people stop smoking Let's get the additives out of our food that contribute to health problems Let's do it, let's make people healthier I'm in  |
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PLurker
Prolific Pea
Posts: 9,744
Location: Behind the Cheddar Curtain
Jun 28, 2014 3:48:49 GMT
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Post by PLurker on May 4, 2017 5:19:19 GMT
and what about reckless behavior (thrill seekers, adrenalin junkies) that doesn't show on health "tests" how do we go about accounting for that? Like some people who exercise, eat healthy etc but take crazy risks frequently can have catastrophic medical bills, too. Just like us with chronic illness gotten through no other way than the (bad) luck of birth and heredity.
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zella
Pearl Clutcher
Posts: 3,884
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Post by zella on May 4, 2017 5:36:10 GMT
There is no way to gauge responsibility for illness and disability, nor should there be. It is just a form of judgment that will lead to healthy people having power while the sicker ones (who will be disproportionately poor, less educated and minorities) suffer.
There is no such thing as a healthy diet, meaning one way of eating that would provide all people with good health if they just ate that way. This is a fallacy. First of all, what the USDA says is healthy has changed many times through the years, and is at least partially influenced by dairy and meat lobbyists. There are people like me who CAN'T eat many "healthy" foods because they make us ill. I can't exercise either, because any stress or excess heat or sweating triggers my body to have an allergic reaction. When you look at a person who is obese, you don't know their story. You have no idea if they are obese because they eat a lot of junk food, or because they are on prednisone, or because they have an endocrine disorder, or because they have Prader-Willi syndrome (which causes people to be hungry all the time and never feel full). Yes, it's frustrating that people still smoke cigarettes, which puts them at increased risk for strokes, heart attacks and multiple kinds of cancer. But maybe smoking is the only thing that eases their anxiety and really helps them stay alive. We don't know.
One thing that I learned when I was on prednisone and gained about 45 pounds: DON'T JUDGE.
And who should get the right to decide if a person's "behavior" led to illness? You? Me? A panel of medical experts? The only acceptable answer is no one. We treat illness. We encourage healthy living and good decisions. But we also accept that we don't know all the answers and we treat people who need the care, no matter who they are, what the illness is, or how it came to be.
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Yeah, right.
