The cost of smoking

when i was a smoker i had an employer institute a smoker premium.  we were a smoke-free workplace, and therefore the only people that KNEW i smoked were people i hung out with outside of work.  so i just said i wasn't.  eventually during that year i quit, but i don't know HOW you enforce a policy like this??

i also sort of disagree with the policy because of the slippery slope issue.  as a woman it absolutely scares me - i am in the prime demographic to bring on nice high healthcare costs should i get pregnant!  should i be charged more cause i definitely cost the insurance company more than my healthy zero-risk husband?  the smoker premium says so...

If they lie about smoking and then it is uncovered in a medical test when they are receiving treatment, don;t you think the insurance company can flat out deny coverage due to them lying about smoking?

I swore there was this exact thread about a year ago...

I know where this is going.  Probably not worth going in circles.  BUT probably repeating myself...

Insurance charges you if you have/do things that are considered "risky".

Sports car?  Higher rates than a minivan.  Motorcycle?  Higher rates if it's a Ninja 6r than a cruiser.  Have a trampoline?  Higher rates.  Rates go up of you drive further to work or more miles in a week.  Rates are higher for men, young people, and people with traffic violations.

Seems to me, if you do something that statistically increased their chance to pay out, they will bump up the rates.  Sure, they discriminate.  But not just smokers, anyone that costs them money.  BTW, the last questionnaire I got about health insurance DID ask about drinking and BMI.  I figured if they ask, it makes a difference...  (oh, and I lied about the number of drinks and gave them my race weight - so it's a game everyone plays)  So I don't think smokers are getting unfairly called out.

I don't care if people smoke.  That's up to them.  Just not around me if it's a place where it's not allowed.  But I also don't care if cigarettes are taxed at a ridiculous and/or unfair amount or if insurance rates are higher to cover lung cancer costs for those who get it.  Cost of doing what you love, I suppose.  I also don't care if they did had higher rates for high BMI (BF % may be better measurement though).  I pay higher rates to ride my motorcycle and don't cry about it and all it does is get me from home to work  - probably MORE efficiently than my car.  Cost of what I enjoy.

Now we will get into how all my examples don't apply and get into the "if this then what's next" conversation and talk about a lot of imaginary scenarios about what they may (or may not) jack rates up for in the future.

Completely side topic.  I am curious how insurance will cover marijuana usage in the legal recreational states like Colorado... 

They can raise the rate for whatever they want.  I wouldn't put it past them.  HOWEVER, choosing to smoke seems different TO ME than the undecided choice to be a woman...

We should also remember.  Unless if the entire insurance industry adopts these kind of rate increases, I would think there would be the competition factor.  If a company won't charge you for being a woman, then I might go with them instead of a company that does.  Maybe there are companies that feel for smokers and will give them a break?  Maybe worth shopping around.

Cell phone companies charge for things that other cell phone companies don't.  Why would insurance be different?  They are all trying to get customers.  If people complain or stop using them, they will change their policy.  Free market.

Genetic profiling?  That seems like it would be less palatable for people to accept to be charged based on genetic markers that could be an indicator, rather than an ACTUAL increase in risk such as smoking or riding a motorcycle...  People have expected those to be risks, and there is probably not enough outcry amongst consumers to make the insurance companies change.

agree that it sounds verrrrry familiar.

I will hesitantly wade in...

1. Who cares. No one is forcing anyone to smoke. If they can't afford it they should quit. You are penalizing people who make a risky decision, a choice, they can choose to not smoke and no more penalty. 

2. Yep, definitely an issue. I suppose they could threaten to not cover things if you lie on an app, but who knows if that is enforceable.

3. And this is the exact problem with insurance, and made far, far worse by the ACA or O-care.

Health insurance was previously based on putting similar people into similar pools so they could benefit from lower costs if they were in the healthy low risk pool or they would pay their fair share if in the unhealthy high risk pool. People in the triathlete pool shouldn't have to pay for a 400lb smoker and their health care costs. Just the same as joe average, healthy person may not want to pay for the risky behavior of triathletes and their bike accidents. The pools were able to discriminate based on these things and thus give the insured choice. Want to pay less, don't engage in risky or unhealthy behavior. 

The ACA did away with all of that. It is socialized medicine at it's almost best. The entire design was to spread the cost of unhealthy, risk takers to everyone and you have no choice but to pay for their bad decisions. Insurance companies are no longer able to create pools of healthy people and give them a break on rate. Now they can not charge the 400lb smoker more than 3 times what they can charge the 25 year old 10% body fat, fit guy. There is a reason they are calling it a "shared responsibility tax". The design is unsustainable and I believe it was designed to be so. Why should a healthy person sign up to pay much more than their fair share so that others can continue to make poor decisions? Insurance companies have to find a way to keep the rates low enough to attract the healthy people but they also have to cover expenses, that is why you are seeing smoking fees, and may see fat fees, or motorcycle rider fees, or triathlete fees. 

I believe the system was designed to fail but to break the insurance industry down so far that it can't be repaired. At that point the government can step in as the savior and give us the single payer system they have wanted all along. Once they do that, they can have all sorts of control over your decision making. Once the government sets rates and removes all choice from the market place they will be able to make decisions for you based on rate. Wanna ride your bike on the road? Stats say you die when a car hits you, no one else wants to pay for that, so now you pay %50 more. Wanna ride a motorcycle or sky dive? Pay more. Where as before you could shop and find a company that was willing to accept the risk of a bicycle rider but not a 400lb smoker. In a single payer system there is no choice. 

Sorry - 11 months ago.

http://beginnertriathlete.com/discussion/forums/thread-view.asp?tid=492778&page=1#

I doubt sentiments have changed...  I can probably cut and paste the responses.

ha, it was even started by the same person.

Originally posted by wannabefaster As physician I no longer give the "stop smoking" lecture to patients. They have all heard it a thousand times and just tune it out. Instead, I give the "you should smoke more speech." I explain how I have kids to put through college and that I want to buy a sports car some day and as a physician I make asignificant amount of my salary off smokers. One day you will likely need cardiac surgery, vascular surgery, lung surgery. Your skin will look old and you will need plastic surgery. Head and neck cancers are not uncommon in smokers...... Some chuckle. Some get defensive. Most probably think I'm a jerk. But, I'm telling the truth and it at least gets their attention. If people could stop smoking, control their weight, drink in moderation and not drive like maniacs it could put half of the physicians in America out of business. I'm not nervous about that happening. Did I post this same thing in the last thread?

nope, you had a better response, you proposed a "smoking license"

The BMI chart has it's issues as well so would be very hard to administer any policy that tied rates to BMI.

Most athletes are going to be outside the norm on a BMI chart. Weight lifters with low body fat percentage are usually obese on the BMI chart. My brother in law works full time for a crossfit gym and is in very good shape with little body fat. Due to his height and muscle mass he pushes severely obese on the BMI chart. 

Actual body fat percentage tests would be an interesting thing to try to administer.

Then of course you have the argument of long distance running and or triathlon is bad for you, which body fat % and BMI would not account for. 

Definitely some interesting things to consider. Unfortunately I think health care is only going to get more intrusive and more difficult to administer. 

. Unfortunately I think health care is only going to get more intrusive and more difficult to administer. 

An issue that stands out to me is personal responsibility and with that malpractice insurance.

Malpractice insurance is a large expense for physicians, limits on lawsuits would help to reduce some of that cost and risk.

The biggest issue to me is people don't take responsibility for themselves and their decisions. An ideal hospital or doctors office to me would have a menu board out front with given costs for each thing. If I have a cold and think a doc can help I can look at the board and decide based on cost what is worth having done. 

Currently all of the responsibility for one's own person is placed squarely on the doctors shoulders. So they have to run every test and try every treatment there is because the patient does not want to make any decisions and they are not concerned about the cost. People are programmed to just go to the doc for any little thing, then the doc is pressured to fix it by any test or means possible.

My wife was born with a brain tumor that went undiagnosed until she was 12 when a dermatologist finally figured it out and the tumor was removed. She spent her entire childhood in the doc office getting every test there was. She is programmed to go to the doc for every little thing. It wasn't until she was on her own and had a not so Cadillac health plan that I was able to convince her to not go for a cold. She got a cold, went to the doc, he said she "had the crud, go home and sleep" then charged her $300 out of pocket. 

Since that incident (5 years ago) she has been twice, and she went in knowing what she needed and negotiating to get that at the lowest price possible. She did not go in as a fiscally unaware sheep like so many tend to do.

I recently had a medical issue that she wanted me to see a doc for. I chose not to because I don't have any insurance and the cost is almost impossible to determine upfront. If there was a menu board and I could choose which tests or advice I was willing to pay for I would have considered it. But I am not going to just walk in with a blank check and say do whatever you want doc. Instead I decided to wait and see, and things worked out on their own. Perhaps I am lucky but I have only been to the doc for broken bones. Now of course serious terminal illness would be different, but the health care industry is heavily abused by many IMO.

Small example of that, I was having severe chest pains (later determined to be a muscle spasm) and my then GF got freaked out and begged me to go to the ER. I sat in the waiting room for 3 hours and saw every little scratch and tummy ache in the city come through the door. I saw three different people who had sunburns and brought their whole families in with them to have the sunburn treated. It was ridiculous!  

Anyway, I think personal responsibility for decisions about one's person would go a long way to making a person realize the cost, limits on lawsuits of malpractice because a doc didn't do every test in the book would help. 

I agree Aaron.  And I can tell you that I'm part of the problem. (along with many others)  I have always been well insured and couldn't care less what something costs.  All I care about is my out of pocket, which is also very small.  I don't go to the doctor very often because my work provides a yearly comnprehensive physical, to include complete blood work, stress test, etc.  The times I have needed a doctor for sugery, etc. it has nevber occured to me to even look at the bill........I just don't care because that's between the docs, the hospital, and th einsurance company and doesn't concern me at all.  Looking at your post I can see where that is part of the problem in health care costs.....I don't have to be responsible at all for them.

. Unfortunately I think health care is only going to get more intrusive and more difficult to administer. 

looking at the bill is useless because you can't interpret the thing anyway!

 I bet that's right.